ParentTime Live! Transcript Diagnosing ADHD The Use of Ritalin Is Ritalin Right for My Child? Attention Span Development Constricted Veins of the Face Attachment Disorders Homework and Teens Bedwetting Excess Saliva Weaning Discouraging Drug Use Nightmares		Dr. Bill and Martha Sears on ParentTime Live! The challenges of raising a special needs child. ParentTime This moderated chat took place on February 7, 1996. Be sure to check the schedule of upcoming ParentTime Live! events. Moderator: Welcome to a moderated chat with Dr. Bill and Martha Sears. Today we are discussing the topic of Raising a Child With Special Needs. Bill and Martha Sears: Hi parents! Today we will answer questions and chat about parenting children with special needs. Even though all children have special needs, some have more needs than others. Parenting a child with special needs is like taking a trip to a foreign land. Your baby is born and the journey begins. Suddenly, your trip isn’t going as planned. You’re traveling to a place you hadn’t planned on. Your child is not following the guidebooks. He takes you on a different journey, one that you might not have chosen and certainly not the one you had anticipated. You probably resent this change in travel plans. The road is bumpy. It is lonely. And it’s costing you much more energy than you had budgeted. But you’ve purchased a non-refundable ticket, so you must go on. Now, your journey is not like that of your friends whose children are more convenient, more predictable. more “normal.” Yet, you begin to notice that your journey is getting more challenging, more interesting. Your child takes you down side roads, off the usual paths and into places where you are forced to carve new trails on your own. Before long you begin to see the journey through your child’s eyes and begin to realize how much richer your life is, and how much wiser you are for having experienced this special journey. What helped us a lot in parenting our child with special needs Stephen, who is now seven years old and has Down Syndrome, is that he is not “disabled.” He is differently abled. Once we learned not to compare Stephen with “normal” children, and focus not on his “disability” but on his specialness, life became much easier for us. Living with a special needs child is not easy. In fact, it’s very hard. because it’s not a path we would have chosen, nor were we prepared for it. Yet, these children have a way of bringing out special qualities in their parents that you would never have had to develop if you hadn ’t had such a special child. It also helps to remember that being different does not mean being less. In some cases, these children have qualities that are more than other children. They are just not the ones that society places high value on. For example, children with Down Syndrome are more affectionate fun loving, bubbly, huggable, and sometimes more intense. Another trap that we almost fell into is to treat Stephen like a project instead of a person. When he was first born, we were going to write the definitive book on Down Syndrome, do some research to discover its cause, find some magical treatment, and after giving up these unrealistic goals, during which we regarded Stephen as a project, life became much easier once we accepted him and loved him as his own unique person.
		Diagnosing ADHD Question: What signs and symptoms could indicate ADHD in a six-year-old boy? Bill and Martha Sears: ADHD, which we regard as a difference and not a disorder, nor a disability, is a much over-used label which is tagged onto children who are neither convenient for parents or teachers, nor do they learn or behave the way that most other children do. ADHD becomes a disability if it is not recognized and treated appropriately. Some signs you may watch for are inappropriate attention, meaning your child focuses on only the things that interest him and are inappropriate at the time. such as focusing on the bug on the wall rather than what the teacher is saying or the directive the parent is giving. They are also impulsive. They fly off the handle at the least provocation. Their anger is easily triggered. Their hyperactivity is more than just “an energetic boy.” It is consistently disruptive. The main difference between ADHD children and these behaviors that occur sometimes in regular children is that these behaviors in ADHD children are a consistent pattern. a predominant pattern, the rule rather than the exception. While most children show inattention, impulsivity, and hyperactivity sometimes, ADHD children show it most of the time. A helpful question to ask yourself if you’re worried whether or not your child has ADHD is does my child’s inattention and hyperactivity interfere with his learning, his social development, and his self-image? If the answer to all of these is “no,” then you don’t have to worry.
		The Use of Ritalin Question: We have a nine-year-old ADHD son who has been on Ritalin for a year, but also suffers with undetermined allergies. I can’t find a medicine to help the allergies without hindering the Ritalin. Can you help? Bill and Martha Sears: Ritalin is very helpful for children who truly have ADHD, yet it should never be the ONLY treatment. Even the manufacturer of Ritalin, in addition to the American Academy of Pediatrics, cautions against using only Ritalin in treating ADHD. Your child needs a whole package: behavior modification, learning strategies, diet modification, family counseling, nutritional counseling, discipline strategies, all of which work better with Ritalin. Antihistamines and decongestants should not be used along with Ritalin. Better to try nasal sprays, such as nasal cortisone (Vancenase or Beconase), environmental control using a HEPA air filter in his bedroom. If he absolutely needs decongestants or antihistamines, use them at night when the Ritalin wears off. Or use the allergy medicines on weekends or school holidays instead of the Ritalin, so-called “drug holidays.” Allergies can make behavior worse, especially a child with ADHD. Ask your doctor about using these nasal sprays or inhalation medications instead of oral allergy medications. These would be safe with Ritalin.
		Is Ritalin Right for My Child? Question: My five-year-old son has been suspended from Kindergarten three times for disrupting the class. The school want him on Ritalin. I am against it. What is your opinion? Bill and Martha Sears: You probably have a child who is too bright for the class he is in. Teachers often push Ritalin as the first treatment because it is a quick-fix, it makes the child more convenient (we call them “convenient clones”) where they become less disruptive and more like “regular” children. Take a tip from Maria Montessori, one of the all-time experts on kindergarten children, who said: ”If a child is not doing well in class, first look at the class, second look at the teacher, and third look at the child. Follow her advice. Is your child in the right class? Some boys are not ready for the structure of kindergarten at five years of age and should never be labeled ADD or drugged for it just because they can’t sit still in circle time. Next, is there a mismatch between child and teacher? Also, perhaps your child is not yet ready for kindergarten. Certainly, before even considering Ritalin, change classes or change teachers, or change schools, and see if your child doesn’t fit in better. Some bright, creative, inenergetic five-year-olds are unfairly labeled “misfits” or “a learning disability” simply because they have a unique style of learning and behaving, which requires a unique style of teaching and discipline. The disability oftentimes is more in the educational system than in the child. It may be reassuring to you to look into the school histories of many famous people. A common complaint was they didn’t fit well into the early grades. Your intuition sounds right in this matter.
		Attention Span Development Question: My 18-month-old son is in a combined occupational, physical, speech, and educational therapy program. He was a preemie and was delayed in his development, which concerned me and frustrated him, but our pediatrician assured me he would catch up. I was so worried, I had him evaluated anyway, and he qualified. By the time he made it to the top of the waiting list and was admitted, he caught up on his own to the point at which I was happy. However, they tell me that, after 7 months in the program, there are still concerns, most having to do with his ability to “attend.” My husband, my family, and I all see this as a typical toddler trait as well as a similarity to my personality. For instance, neither my son or I can read in a room full of people. It seems to me that the therapists are trained to find problems, and find some in everyone. What they call “tactile defenseness” I call “not liking smooshy stuff.” My husband wants him out of the program. I keep him in because I’m hoping that, if my son does indeed have a problem with paying attention and sticking to tasks, we should nip it in the bud now. What’s your opinion? Bill and Martha Sears: It is too early to label an 18-month-old with “inability to attend.” A normal toddler’s attention span is measured in seconds, not minutes. Toddlers normally flit from task to task seldom sitting still or “paying attention” for more than a few seconds to a few minutes. This could be more your child’s creative, energetic personality than a disability due to his prematurity. Suggest that you get the best out of the class by having the therapists teach you how you can teach your child at home. Play therapy geared to the child’s own level is the best way to prolong attention. Your husband has a point here. Your child is getting an unfair label at too early an age. Yet, professional therapists have a lot to offer in teaching you specific play therapies that can hold your child’s attention. Here’s a trick that we began with our toddlers: Whenever speaking to your child, demand eye contact, such as “I need your eyes, I need your ears.” In this way, your child learns that paying attention is the normal, social behavior expected in your home.
		Constricted Veins of the Face Question: My friend’s newborn son has constricted veins in his face which cause a reddish birth mark. This problem is now spreading into his nostrils and left eye and may be the cause of a cyst inside his head. The baby is being seen by a number of doctors, but they are not very encouraging in their diagnosis. Is there a definitive treatment for this problem and where can they take their son for specialized treatment? I should add that they live in Canada. Bill and Martha Sears: Fortunately, they live in Canada, which not only has an excellent system of medical care, but they are privileged to have one of the best, in fact the largest, children’s hospital in the world, THE HOSPITAL FOR SICK CHILDREN, Toronto. (Incidentally, that’s where Dr. Bill had some of his training.) For this specialized problem, they will find the best specialists in the world at this hospital.
		Attachment Disorders Question: Can you comment on attachment disorder and current therapies available to treat it? Bill and Martha Sears: Attachment disorders are due to a person not having learned to give and receive touch and A person with this disorder has difficulty handling intimacy with friends or with a mate. This is one of the reasons we emphasize so much the importance of “attachment parenting” during the first couple of years. This includes frequent holding, massage, wearing baby in a baby sling, breastfeeding, and giving a nurturing response to baby’s cries. In this way, baby learns that attachment is the normal behavior among humans. The child grows up being comfortable giving and receiving attachment. They like being held and like holding. The great thing about human nature is that it is resilient. If a child has an attachment disorder, they can be reparented with gradual, small doses of touching and holding, and eye contact, with gradually increasing levels of intimacy. Yet, it will often take years before a child will become comfortable with attachment, if that has not been the norm in the early months or years. In fact, many adult emotional and social problems fall into the category of attachment disorders, which truly is a “preventable disease.” by the style of parenting the child receives in the early, formative years.
		Homework and Teens Question: I have a 15-year-old boy who will not do his homework. We have tried grounding, the reward system you name it. He does not seem to care. Do you have any other suggestions for this very frustrated parent? Bill and Martha Sears: A 15-year-old will not do his homework unless he is motivated to. First, discuss the homework with the teacher. Is it possible that the child can do his homework at school? Secondly, develop a reward system where the child gets rewards with a job well done. Break up the homework in small portions. Some children are overwhelmed by the fact that they have 2-3 hours of work at the end of a long school day. Change the way the homework is presented. Some children are unfairly labeled as ADD or a learning disability because of not being able to complete their homework, which they find boring or irrelevant. Many creative, bright children need to be shown the relevancy of what they are studying. Instead of just filling in a workbook, let him create a play, write a story, build a project, go on a field trip and report on it. Many children are visual and tactile learners rather than workbook learners. A child who won’t do homework is often a clue to a mismatch between the way the child is being taught and the individual learning style of the child, rather than a reflection on the child or the parents.
		Bedwetting Question: My five year old daughter is still wetting the bed at night. She was potty trained at the age of three. She stopped wetting the bed at about the age of three and a half for about six months, and now she has gone back to bed wetting. I was praising her and rewarding her when she would wake up dry, but this did not seem to help. So, my pediatrician told me to stop and just put pull-ups back on her. He said I was better off just ignoring it and it would probably stop soon. But, it has not. Do you have any suggestions for me? Bill and Martha Sears: The most effective way to keep your daughter dry during the night is by using a pad-and-buzzer, which is a bladder-conditioning device that helps her bladder be trained during the night. First, draw a picture on how her bladder gets filled up like a balloon the size of a baseball. During the day, this balloon tells the brain that it’s full and the brain says, “Go to the bathroom.” At night, the brain is sleeping and says to the bladder: “Don’t bother me,” so the bladder just ignores the brain and empties itself on the bed. A bladder-conditioning device consists of a moisture-sensitive pad that fits in your child’s underwear and connects to a tiny beeper attached to your child’s pajama top. When the first drop of urine hits the bad, the beeper goes off, awakening the child to get up and go to the toilet to fully empty her bladder. These can be purchased out of infant supply catalogs, or at most infant product stores. But they only work well if you do a conditioning drill with your child at night as follows: Make the beeper go off, and tell her as soon as she hears the beeper she goes to the bathroom, puts water on her face, wakes herself up and goes potty. Go through this drill with her three times each night before going to bed and before applying the device. Studies show that this method is effective in 90 percent of children over 6 years of age, yet it often works as early as 5 years. Dr. Bill has been using this technique in his office with lots of success over the past 10 years. In the small percentage of children in which this does not work, a nasal spray called DDAVP is also helpful. Above all, do this in consultation with your child’s doctor, who should first exclude there being any problem in your child’s urinary tract.
		Excess Saliva Question: Occasionally, our baby aspirates or seems to choke on her saliva. Is this normal? Bill and Martha Sears: Yes, this is normal. Many children, especially during teething spurts, make more saliva than they can comfortably swallow. The excess saliva puddles in the back of her throat and causes a child to gag. This should subside between two and three years of age. Yet, it is worth reporting this to your doctor during your baby’s regular check-ups. If your child does not have a problem swallowing milk or food, then you do not have to worry.
		Weaning Question: My child is ten months old and is still not interested in solids. She is breastfed. The doctor seems concerned. What should I do? I offer solids several times a day. Also, she is not sleeping through the night. We sleep with her, but I am finding that I am very tired during the day. Bill and Martha Sears: Some infants, especially if they are allergic to solids, will refuse them. Best solids to start with are: mashed, ripe bananas, pears, rice cereal, and avocados. Sit her on your lap and put her baby food on your plate, which is a marketing technique that has worked in the Sears’ family kitchen. Be sure your doctor checks your baby’s hemoglobin for iron. If your infant’s growth is normal and hemoglobin is normal, then you are supplying all her needs with your milk alone.
		Discouraging Drug Use Question: What types of restrictions, counseling and/or consequences should be put on a 15yr. old that has been caught with marijuana? Bill and Martha Sears: First, discuss the hazards of marijuana with your child. Secondly, substitute a healthier habit. Get your child in a sport or extracurricular activity that he excels in, so he does not need marijuana to get his kicks. Monitor his friends and the places he hangs out. Impress upon your child that because you love him and because you want him to have a healthy body and healthy brain, you care about what he puts into his body and you want him to respect the law. Above all, monitor his friends. Do what you can to steer him into healthier peer relationships.
		Nightmares Question: My two-year-old son experienced nightmares for the first time last night. He has not experienced/viewed anything that one might think brought on his nightmare about a “bird-monster”. He clung to me tightly all night and awoke every half-hour. What can we do to help him through this if it happens again and what do you think causes nightmares? Bill and Martha Sears: Nighttime is scary time for little people. Obviously, something spooked your toddler, such as something he saw on TV, heard someone say, or some event that occurred during the day that became distorted in a dream. Put his mattress at the foot of your bed and give him a few nights of security close to you. The nightmares should subside. Be sure he has a day full of pleasant events and not scary ones, so he won’t have to reflect on scary themes at night. Parenting a child with special needs can bring out the best and the worst in all of us as parents. We hope our suggestions today will help you and your child enjoy living together more.