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Friday, May 24th, 2013
The new diagnostic criteria for ADHD in DSM-5 flag issues that deserve attention if you are a parent. These include:
1) Age doesn’t matter as much. In prior versions of the DSM, ADHD was represented as a disorder which starts in childhood – an onset prior to age 7 had to be established to make a diagnosis. This has changed – the age of onset has been extended to before 12 years of age. So parents should be aware that ADHD symptoms may now be detected later in childhood. And parents too may be more likely to be diagnosed themselves, as the new criteria make it easier to recognize ADHD in adults.
2) Age does matter though. While it is legitimate to say that children, teens, and adults all can show symptoms of ADHD, applying the criteria to the different age groups requires much clinical skill. Keep in mind that the proper use of DSM-5 requires this. For example, a clinician must apply the same criteria to a 5-year-old, a 10-year-old, and a 15-year old. The symptoms of ADHD reflect behaviors that can be shown by any child – it’s typically the frequency of these behaviors (they occur much more often as compared to what’s expected developmentally), the pervasiveness of the behaviors (you see them at home and in school), and the consequences of the behaviors (e.g., a kid is having difficulties keeping up with school work, is getting in trouble in school). A clinician needs to have a reference point for each age in their head in order to properly apply the DSM-5 criteria. This means that they should have very solid training in developmental science as part of their overall expertise. This is particularly true given the controversies about diagnosing and treating ADHD in preschoolers.
3) Be careful who applies the criteria. The DSM series (we are now on the 5th edition) is a guidebook for clinicians. It represents current thinking on the most telling signs of a disorder. It does not say anything about how the information should be collected to come to a clinical decision. So, you need to beware of anyone who doesn’t do a full, comprehensive evaluation that includes observations of the child, interviews with the child, much discussion with parents, acquiring lots of information from parents via questionnaires, collecting information from teachers and school personnel, and ideally a range of tests (including neuropsychological exams) that can consider alternative issues (like underlying learning disorders). This kind of evaluation is required to prevent overdiagnosis of ADHD, which may be rampant these days.
4) DSM-5 does not dictate what treatment will work best. DSM-5 is designed to facilitate the diagnostic process. It does not dictate the treatment strategy. A diagnosis of ADHD does not mean that a child necessarily needs Ritalin or other similar medications to control the symptoms. That’s a whole different discussion with a clinician who is trained to consider a range of treatment strategies. It is always wise to consider first behavioral treatments for ADHD and determine, after a sufficient amount of time, how much improvement can be gained by them before thinking about medication. Do not believe a practitioner who only endorses medication after a diagnosis is made.
The bottom line is the the DSM-5 is not intended to be used in a simplistic way to quickly diagnose ADHD and immediately promote medication. It is a tool that helps clinicians come to a determination of where a child is at developmentally with respect to ADHD. This is a complex process that requires lots of clinical insight. Having DSM-5 in hand doesn’t change that.
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ADHD, behavioral treatment, DSM 5, Health, Kids Health, Overdiagnosis, Preschoolers, Ritalin | Categories:
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Tuesday, April 30th, 2013
The recent debate on whether sharing in preschool should be mandated or left in part to kids to work out for themselves brings up a related issue: the difference between hot and cold cognition in kids.
Cold cognition can be thought of as processing information in a “factual” way without regard to emotional or social cues. We can try to teach kids “rules” about sharing – when you should share, when you don’t have to share, why sharing is a good thing. While this type of knowledge is important to acquire, bear in mind that it can be rather abstract.
Which brings us to hot cognition. Hot cognition is the type of processing that directly integrates social and emotional factors with that “knowledge” that comes about via cold cognition. So while you can tell a preschooler that it is important to share – or that they don’t have to share – it’s different when they are in the moment interacting with another child, and they have to deal with their own emotions, the other kid’s emotions, and the social situation.
Let’s take two concrete examples. First, you have two kids in a preschool in a morning meeting with a teacher. They are told about the “rules” of sharing. Second, they then go off and one kid starts playing with a toy. The other kid comes over and wants to play with it too. In that situation, it’s not just about the “rules” – and it’s hard to know what will happen next. Maybe the kid doesn’t want to share it. The other one gets frustrated. They have a little exchange about it. Or … maybe the kid with the toy wants to share it. Maybe the other kid asks if they can both play with it. Maybe they are friends and that happens. Maybe they don’t get along well and it doesn’t happen.
The thing is, the outcome isn’t the point. The process is the point. The process of processing all of this stuff – the rules, the emotions, the relationship – is the stuff of real social, emotional, and cognitive development. Kids need a chance to try out their social “rules” as they arise in real-time interaction and get integrated with emotion. Adults should be at the ready to help them sort through the issues and offer informed support. But without the chance to experience ‘hot’ cognition all that ‘cold’ cognitive processing becomes somewhat meaningless. That’s why it’s really important to let kids experience social interactions and help teach themselves the rules of play and sharing – because that’s how they learn how to interact with each other.
Kids Playing via Shutterstock.com
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Cognitive, Cold Cognition, Emotional, Health, Hot Cognition, Kids Health, Mandated Sharing, No Sharing, Preschoolers, Sharing, Social | Categories:
Behavior, Must Read, Parenting, Red-Hot Parenting
Wednesday, April 24th, 2013
Should young kids be told that they must always share? Should they be told that they never have to share? Or should they be encouraged to learn how to try to work things out themselves?
The answer from decades of research on preschoolers is … they should get experience in trying to try to work things out themselves, with good guidance from adults.
To get an expert perspective on this, I contacted Dr. Melanie Killen, who is Professor of Human Development, Professor of Psychology (Affiliate), and the Associate Director for the Center for Children, Relationships, and Culture at the University of Maryland. She is the author of Children and Social Exclusion: Morality, Prejudice and Group Identity (2011), co-editor of Social Development in Childhood and Adolescence: A Contemporary Reader (2011), and serves as the Editor of the Handbook on Moral Development (2006, 2013). Dr. Killen has a distinguished record of conducting seminal research on the social, moral, and cognitive development of preschoolers (as well as older children), and as such is well positioned to offer a perspective on sharing in the preschool years. Below is her take on a few key issues.
ARE EXPERIENCES THAT ARISE FROM CONFLICTS ABOUT SHARING IMPORTANT IN EARLY CHILDHOOD?
Yes. Sharing toys and resources is a fundamental aspect of early childhood social interactions that promotes the development of social competence. In fact, children who learn how to resolve conflicts about sharing in constructive ways (e.g., through negotiation and bargaining) are more liked by their peers and better adjusted in school contexts than are children who resort to aggressive strategies (such as insistence on one’s own way). What children learn from conflicts about sharing toys under optimal conditions is how to bargain, negotiate, and apply principles of fairness to their peers.
WHAT’S WRONG WITH TELLING KIDS THAT THEY HAVE TO – OR DON’T HAVE TO – SHARE?
A policy that mandates either sharing or “no sharing” is a problem from the start because it removes the opportunity for children to understand the principles that underlie sharing behavior. These principles include the fair distribution of resources – how do we share resources (or toys) in such a way as to treat others with mutual respect? This involves explaining to children the conditions in which not sharing toys is being unfair to another child (“If you play with all of the toys then he won’t have any to play with”). However, it’s also important to recognize that there are also conditions in which not sharing toys is viewed as legitimate, such as claims to ownership (“This is her special birthday present and she doesn’t want it to get broken”), or previously agreed upon rules about the use of resources (“She had the toy yesterday so today it’s your turn to use the toy”).
WHAT ROLE SHOULD ADULTS PLAY IN SHARING?
The bottom line is that a unilateral policy takes away from the learning opportunities for young children through which they teach each other what makes it wrong to refrain from sharing (“You had it all morning and I didn’t get to play with it so can I play with it now?”). Adults need to facilitate the opportunities for children to discuss, negotiate, and interact about how to play with toys, especially in early childhood when the stakes are still low. Learning how to share toys, which includes the recognition of ownership claims is a fundamental social skill that is related to constructing notions of equality, fair treatment, and mutual respect.
Children Playing via Shutterstock.com
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Conflicts, Health, Kids Health, No Sharing, preschool, Preschoolers, Sharing | Categories:
Behavior, Health, Must Read, Parenting, Questions, Red-Hot Parenting, Relationships