Striving at School, Thriving at Play

Striving at School, Thriving at Play – February 2015 ADHD Talk Recap

On a cold and snowy evening in early February, parents, Kennebec staff, teachers, and clinicians gathered at the University of Toronto for a talk about medical and non medical approaches to ADHD that Camp sponsored.

The theme of the discussion was Striving at School, Thriving at Play, led by Dr. Doron Almagor, a child and adolescent psychiatrist who recently opened The Possibilities Clinic in Toronto, and Dr. Brenda Miles, a pediatric neuropsychologist and children’s book author. Dr. Miles began by discussing non-medical strategies for boosting children’s striving at school and thriving at play. Dr. Almagor, an expert in ADHD, continued by dispelling common myths about inattention and hyperactivity, and explored medical options for children whose striving and thriving is challenged by inattention and difficulties regulating behaviour. I sat down with Dr. Miles and Dr. Almagor for a brief Q&A to explore these issues further.

Rob Deman: Dr. Miles, you mentioned that Ontario report cards have changed recently. Why is this change so important?

Dr. Brenda Miles, Speaker at "Striving at School, Thriving at Play"

Dr. Brenda Miles, Author, Speaker at “Striving at School, Thriving at Play”

Dr. Miles: That’s a good question, Rob. In 2010, learning skills and work habits moved to the front page of report cards while grades moved to the back. This change reflects a fundamental shift in our thinking about how children succeed—and it’s a shift supported by research. Learning skills and work habits on the new report cards cover six areas: responsibility, initiative, independent work, organization, collaboration and self-regulation. Psychologists refer to these abilities as executive functioning skills. Research shows that these skills are critically important for taking healthy risks, persevering on tasks, and being flexible in problem solving when the going gets tough. Good executive functioning skills help all of us strive and thrive—when we are learning, playing, and working!

Rob Deman: What is the brain’s role in these skills?

Dr. Miles: Executive functioning skills are controlled largely by the brain’s frontal lobes—just behind your forehead. Every time you ensure that your child’s bike helmet is covering the forehead and not sitting too far back, you are protecting your child’s frontal lobes. And that’s a good thing because frontal lobes do so much. They help us step back and think before we act; they help keep our tempers and frustrations in check; and they help us stay focused and resist distractions as we work towards our goals. The frontal lobes take a long time to develop—in fact they are still developing in early adulthood—so children and teens need support with many of these skills at home and school.

Rob Deman: Tell us about your new picture book! Does it offer suggestions for supporting these skills in young children?

Dr. Miles: Yes! Stickley Sticks to It!: A Frog’s Guide to Getting Things Done, is published by the American Psychological Association’s Magination Press. The book is illustrated by Canadian Steve Mack whose drawings are fun and colorful! Stickley teaches children a 6-step plan for starting tasks and sticking to them until they are done. A Note to Parents, Caregivers and Teachers at the back of the book explains how adults can support children’s frontal lobes and boost perseverance. I encourage parents to review their child’s report cards closely, too—especially those learning skills and work habits on the front page. If these skills are rated as only satisfactory or needing improvement, a discussion with the teacher about strategies for supporting these skills at home and school will be important. If initiating tasks, resisting distractions, and getting work done are still challenging for your child—even after strategies are put into place—a referral to a medical doctor with expertise in attention and other executive functioning skills will be important, too.

Rob Deman: Speaking of medical doctors, I’ll turn now to you, Dr. Almagor. Your talk focused on myths surrounding ADHD. You also spoke about treatments available today. When should parents start medication treatment for ADHD?

Dr. Doron Almagor of The Possibilities Clinic & Speaker at "Striving at School, Thriving at Play"

Dr. Doron Almagor of The Possibilities Clinic & Speaker at “Striving at School, Thriving at Play”

Dr. Almagor: Firstly Rob, I want to thank Camp Kennebec for providing the forum for Striving at School,Thriving at Play. As I discussed in the talk, ADHD remains unrecognized and untreated for many children and adolescents, preventing them from achieving their full potential. The first step is always a thorough evaluation. Before any treatment, it’s essential to know what we are dealing with. Attention issues happen not only with ADHD but also with other medical, psychiatric, and psychological issues like anxiety, depression and learning disabilities. All of these possibilities must be considered in a careful evaluation by a specialist in Child and Adolescent Psychiatry or a pediatrician who is comfortable with child development issues and ADHD.

Rob Deman: So you are saying a proper evaluation and diagnosis are the first steps? And then you would recommend medication?

Dr. Almagor: Not necessarily, Rob. Just as every person is unique, every treatment plan must be unique as well. In my practice I might see identical twins, with identical diagnoses, that require completely different approaches. When and whether to use medication as part of the treatment plan is a complex decision that has to be made for each individual—and ongoing discussion with the family, the child or adolescent, teachers, and all treatment professionals involved is critical. Remember that our main goal in treatment is helping the child or adolescent function more effectively. Better functioning could include improving academic performance but, as Dr. Miles pointed out, we hope to see improvements in a broad area of executive functioning—not just at school, but at home and play too! Working to improve motivation and perseverance using the approaches described by Dr. Miles in her talk is essential. Sometimes these approaches prove to be enough, and we can work on executive functioning without any medication. But often these strategies are most effective when they used along with medications that normalize and boost functioning in the brain’s frontal lobes. The medications, then, act as a kind of scaffolding, helping school interventions and tools like Stickley’s 6-step plan for stick-to-it-ness to work better.

Rob Deman: And if children do take medication, I understand from your talk that there are several strategies that can help with finding and continuing with the most effective one?

Dr. Almagor: Yes, as I discussed in our talk, we have a number of up-to-date treatments and strategies that need to be tailored for each child. Too often I’ve seen families give up on medication after a short trial that may not have been conducted properly. Families may be discouraged by side effects or a lack of results if they are expecting improvements right away. Questions families should ask include: Was the right medication tried? At the right dose? For the proper amount of time? If side effects occur, are there strategies that can help counter them? It’s important that families have detailed discussions with their physician before discounting medical options. My main message is this: finding the most appropriate treatment for ADHD requires patience and persistence. Managing ADHD is not a one-time prescription. It requires an ongoing, integrated approach to ensure long-term gains at home, school and play.

Rob Deman: Thank you, Dr. Almagor and Dr. Miles, for answering these questions, and for your “Striving at School,Thriving at Play” lecture. We look forward to having you back soon!

Drs. Almagor and Miles: Thank you!