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Tuesday, May 20th, 2014
The Centers for Disease Control and Prevention (CDC) have provided new data suggesting that it is becoming common to not only diagnosis attention deficit hyperactivity disorder (ADHD) in 2- and 3-year-olds – but also to prescribe medication to these toddlers. As reported in the New York Times, data collected by the CDC suggested an estimate that 10,000 young toddlers are being given stimulant medication. And, of course, it could be more and the number could be growing.
There are many problems with diagnosing and medicating young toddlers for ADHD. Here are three primary issues:
ADHD is difficult to diagnosis – even in older children. While comprehensive, multidisciplinary clinical teams can offer productive diagnostic assessments of school aged children, ADHD is still difficult to diagnosis with certainty. It’s clear from prior analyses and studies that many school aged children are being given diagnoses of ADHD without such careful clinical evaluation and put on medications that they may not need. Given this, the idea that ADHD can be reliably diagnosed in 2- and 3-year-olds is shaky, to say the least – or simply not advisable.
The effects of stimulant medications in young toddlers have not been studied. Stimulant medications require careful clinical monitoring in school-aged children. It is controversial to administer them to 4- and 5-year olds. Prescribing them to 2- and 3-year-olds is not within the clinical boundaries. There is a reason that drugs are studied and approved for specific conditions and age groups. We don’t know the side effects of stimulants on young toddlers or how they influence the developing brain.
Behavioral management of toddlers is important but can be achieved without medication. Young toddlers need to be socialized. They need to have some structure and learn boundaries. They need to know how to modify their behavior in different settings. These are developmental goals, not the stuff of psychiatric diagnosis. If parents are having difficulties with young toddlers – and as we know, they can be rambunctious, as they should be – it’s certainly worth thinking about getting some advice or even learning behavioral management techniques that can be especially effective with some youngsters. The idea that this process may be circumvented by inappropriate clinical diagnosis and drug treatment is very troubling – especially since there is good evidence that behavioral techniques work and no evidence supporting the use of stimulant medication in young toddlers.
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ADHD, CDC, diagnosing ADHD in toddlers, Health, Kids Health, medication for ADHD, stimulants, toddlers | Categories:
Behavior, Health, Intervention, Must Read, Parenting, Red-Hot Parenting, Stories
Sunday, March 30th, 2014
While there is a growing consensus that kids need to take risks, the conversation often focuses on “danger” versus “safety.” Not all risk taking ventures for kids involves potential danger. Rather it’s more about the idea of exploration and getting outside of a comfort zone.
NOODLE FOREST: NOT YOUR EVERYDAY NOODLES via childrensmuseumofphoenix.org
Consider a terrific exhibit/experience at the Children’s Museum of Phoenix – the Noodle Forest, comprised of lots of pool noodles. Check out the description from the museum’s website:
Oodles of noodles suspended from above offer sensory immersion in a unique and engaging environment. A thick forest of textural delight awaits visitors as they navigate this unfamiliar yet stimulating terrain. The Noodle Forest is guaranteed to activate the senses and inspire the giggles.
Here’s the thing. For a toddler, it can be a little disorienting making your way through the Noodle Forest. You do indeed get immersed in the noodles – you can’t see or hear much of anything else. You have to push your way through it and the noodles swing back at you. I’ve tried it myself and it is surprising how quickly you feel like you are, well, working your way through a Noodle Forest.
So it’s somewhat “risky” for some kids because it’s different and perhaps even a little challenging psychologically. But it’s physically safe and kids know that a parent is waiting for them once they get through it. This is an excellent balance of sensory stimulation combined with experiencing something a little different that pushes a toddler a little and makes them feel like they did something cool.
The Children’s Museum of Phoenix has many other exciting exhibits and exhibitions. Some especially promote creativity and fine motor development. Some push kids a bit more to get out of their comfort zone. This is the kind of risk taking play that toddlers need.
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Children's Museum of Phoenix, children's museums, Health, Kids Health, Noodle Forest, pool noodles, Risk Taking in Childhood, toddler play, toddlers | Categories:
Behavior, Health, Parenting, Red-Hot Parenting
Tuesday, February 25th, 2014
In principle, no. But if a preschool environment is not designed with developmental principles in mind, and ADHD criteria are tossed around without regard to developmental level, then we could see artificial diagnoses made – maybe a lot of them.
Drs. Stephen P. Hinshaw and Richard M. Scheffler predict (in an Op-Ed in the New York Times) that such a scenario can lead to an epidemic of incorrect diagnoses of ADHD in preschoolers. What are the key factors parents should thing about? Here’s a few tips:
MAKE SURE A PRESCHOOL IS JUST THAT: PRE-SCHOOL
There are tremendous developmental benefits to attending preschool. These are achieved when they are designed with developmental principles in mind. That means, simply, that kids should be playing a lot of the time.
Play includes all kinds of activities, including: arts & crafts, music, using blocks to build things, pretend play, running around, and engaging in playground types of activities. Wait, what about learning letters and numbers and developing advanced reading skills and mathematical proficiency? That will come … when they get older (the idea is to promote academic readiness, not academics). For decades, we’ve known that early learning – the academic readiness that we are shooting for in preschool – operates very much through the body. Both gross motor and fine motor skills are primary for brain development and provide the sensory mechanisms underlying cognitive exploration and innovation. All that exploration sets the stage for fundamental cognitive skills that will be used later to master reading and math and writing. Consider this: the simple act of learning to copy figures in toddlerhood is a significant predictor of later academic performance in kindergarten (even after controlling for “cognitive” skills). So while some “academics” can be introduced in the preschool years, the savvy educators know how to do this in measure, and focus on the ways that preschoolers should be spending their time.
Keep in mind that interaction with adults and other kids is also critical for both social and cognitive development. It’s more important that they are being read to, than “reading” on their own. Their vocabularies are expanding tremendously but so much of this happens naturally in conversation and via planned reading group activities (rather than drills to master letters and words). Kids need to express themselves socially, and begin to learn some age-appropriate rudiments of self-control and emotion regulation. They also need to mix it up a little with other kids and learn how to get along with each other (with a little guidance here and there).
ONLY SEEK OUT ASSESSMENT FOR ADHD IF IT’S REALLY A SUBSTANTIAL CONCERN TO EVERYONE
We are now diagnosing toddlers with ADHD. Some toddlers are getting prescribed medication for ADHD. The rationale for this is to help kids as early as possible before the consequences of ADHD take hold on their development.
While this strategy has been controversial, the fact is that some toddlers show very extreme levels of behavior that are different than what you see at that age. But keep in mind that this is a very low percentage of toddlers, and that it’s very challenging to determine this clinically. Hinshaw and Scheffler point out that inappropriate diagnoses of ADHD often come about because the diagnostic process is not comprehensive, and in fact way too short. The result is then a sloppy (and typically wrong) diagnosis of ADHD, and a potentially inappropriate prescription.
Parents need to be appropriately cautious (but not dismissive) of concerns that their toddlers are showing signs of ADHD, particularly if they are in a preschool that is expecting them to behave like “school kids.” One of the hallmarks of ADHD is that it is pervasive – it should be a big problem at home, at school, almost everywhere. Maybe not all the time, but you shouldn’t see “symptoms” in just one context, like a preschool classroom. And you should see the “symptoms” occurring much more frequently than you see them in other toddlers. Often times (not always) a hallmark is very impulsive behavior that can put a youngster at risk for injury. Being distracted now and then and not wanting to sit still is what we call … being a toddler.
BE A SAVVY PARENT
The reality is that parents need to be savvy, both about the type of preschool environment that’s right for toddlers, and how ADHD gets wrongly diagnosed, especially in very young children. A preschool should look and feel like a preschool when you go in there. Kids should be acting like kids, having fun, but have some structure and purpose in mind. They should be playing a lot more than they should be doing “schoolwork.” Educators know how to nurture their developing brains and bodies to promote the very real and necessary social, emotional and cognitive development that takes place in those critical years that provide a foundation for academic readiness (a term which, by the way, shouldn’t go away in the early school years either). And if your preschool is concerned about ADHD, take the concern seriously, but be discriminate. Here’s an interview with an ADHD expert that provides a good feel for knowing when to be concerned about ADHD, and what to do about it.
Kids Playing via Shutterstock.com
Help your child organize her homework assignments with our helpful worksheet.
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ADHD, ADHD overdiagnosis, Health, Kids Health, NY Times Op-Ed, preschool, stimulants for ADHD, toddlers, toddlers with ADHD | Categories:
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Thursday, November 21st, 2013
Toddlers, kids, tweens, and teens may pose unique parenting challenges – but there are some principles that apply across all those developmental periods that help promote good, compliant, social behavior. There are 2 constructs that have been shown in research to be key parenting strategies. They are:
1) Limit Setting. Every toddler, tween, and teen needs limit setting. They need to know their boundaries and how to respect them. Some things are off-limits. Some behaviors are not acceptable. Think of providing clear, consistent rules that make sense. A toddler can’t run around and touch every thing they want in a store. A tween can’t talk back to a parent disrespectfully. A teen can’t stay out all night. You can come up with a whole bunch across the ages – but the limits should be clear, to the point, developmentally appropriate, and enforced with consistency. And of course as kids age the limits change – but the principle remains the same. There are limits, they are set, they are adhered to, and there are (appropriate) consequences to not abiding.
2) Monitoring. As toddlers begin to assert their independence, monitoring becomes really important – and remains important through the teen years. Parents of toddlers need to keep an eye on them. Using the example from above, it’s one thing to say a toddler can’t run around a store and touch everything that looks appealing. It’s another thing to actually monitor them to follow through on that. Same principle down the developmental line. It gets hard – we can’t know what our kids are doing every second of the day. But it’s our obligation to be as informed as possible and to be proactive about the need to monitor. As kids get older, an open line of communication is essential as kids spend more and more time outside the home. Mobile technology – which is becoming commonplace – is certainly a tool that can be used in a good way to stay in touch with our kids and keep the lines of communication open to permit remote monitoring and aid limit setting.
Parenting can be tough. Consistency can be hard to achieve. But keeping in mind basic principles to guide our parenting strategies can help us keep the big picture in mind – and give us a framework that is applicable to nearly every developmental stage.
Find out what your parenting style is with our handy quiz. Then, browse through these no-fail tantrum tamers.
Ask Your Mother via Shutterstock.com
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Good Behavior, Health, kids, Kids Health, limit setting, Mobile Technology, monitoring, Parent-Child Communication, teens, toddlers, Tweens | Categories:
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Monday, October 14th, 2013
Reading to young kids isn’t always easy – especially when they don’t want to sit still. This guest post by Dr. Claire Elizabeth Cameron provides a unique perspective on what to do – and why it works!
While some children sit still when you read to them, others are wiggly and want to act up or speak out while reading. Aren’t they supposed to just be quiet and pay attention?
Actually, no! Acting out the parts of a story may help children remember what happened.
If children are given toys that represent characters in a story, and they act out the characters’ actions as they read, later those children answer more story questions correctly than those who simply reread the key sentences a few times. In small groups, even children who watch other children acting out the story remember what happened better. There are a few reasons this could be:
- Children may not know all the words in a story, but acting out the story may help them figure out the unknown words.
- Doing a movement along with saying the words that go with the movement creates multiple locations or “codes” in children’s brains for the information – whereas saying the words creates only one.
- When children read or hear a story, they create a mental model of what is happening, and acting the story out may help them create the model.
- Watching a sibling, or a peer, act out the story may work just as well.
A theory known as “embodied cognition” means that our brain works together with our body to help us learn. For example, children may learn new words or phrases by mapping the word they haven’t heard before to the action or object that they see when they hear the new word. They also gather information about the world by deciding how they might interact with a given object, like a sofa. Seeing the “sofa” as something fun to jump up and down on helps them understand and learn the meaning of that word.
So while it’s nice to try snuggling together to read books on the sofa, it’s okay to encourage the wiggle-worms to act out – or even imagine acting out – the story. And this approach may also be good for the book worms too!
Claire Elizabeth Cameron is a Research Scientist with expertise in early childhood development at the University of Virginia’s Center for Advanced Study of Teaching and Learning (CASTL). She received BAs in Honors Psychology and Italian, a MS in Developmental Psychology, and a PhD in Education and Psychology from the University of Michigan before completing a Postdoctoral Fellowship from the Institute for Education Sciences at CASTL.
Girls Having Fun via Shutterstock.com
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