View Full Version : Suspect LD, please advise if you can


JmeB78
10-04-06, 05:23 PM
Hi, My son Connor was dx'd with ADHD a few years ago. We are almost out of med opptions, and so now I am wondering if there is a learning disability, or something else that is co existing. He is not hyper, or angry, or anything, he just seems to get lost in his own little world, and has trouble writing independant sentences, and with reading comprhension. He is also having trouble with spelling, and math. He was tested in math, and language when he was dx'd with AD/HD, and he had average scores in all. That was in first grade. Now he is in 3rd. I am having trouble getting him tested again since it was only two years ago that they tested.
The meds we have tried are Adderall, riddlin, straterra, and now dylanta. They seem to help a little, but we have done the max dose for his weight with all, and are not really seeing good improvement. He really struggles with language quite a bit. He has a couple of friends, so I was told there is no way it is aspergers. I am at a total blank of what to do, and how to help. Any suggestions would be welcome. Thanks, Jamie

scuro
10-04-06, 06:05 PM
If he is more quiet, day dreamy...he might well be inattentive ADHD. This has been recently referred to as Sluggish Cognitive Tempo. Do a search on it, there is a recent thread on it. They are spacy...slow to process, often in their old little world, make simple and careless errors....and meds don't work as well for them. There could be an LD there too but all that you described could be explained by SCT.

Does that sound about right?

JmeB78
10-04-06, 08:53 PM
Thanks for the info! I think it might be SCT. I have a meeting with the teacher, resource dept, principal, and school phsych that I have called. I think I am still going to ask for further testing to be done, as sometimes you ask him to tell you about something green, and he tells you about his new shoes that are black, and have nothing to do with green. I also printed some of the articles I found on SCT, and plan on taking them to his GP. Thanks for pointing me in the right direction.
Jamie

scuro
10-04-06, 10:27 PM
Dr. Russell Barkley does the best job I have seen in explaining SCT to the layman. I don't think he is right about it being a seperate disorder. There is still debate on that issue.

Is Inattentive AD/HD Really Another Type of Disorder?

So let’s talk about this Inattentive type: the kids who come to see us who don’t show problems with hyperactivity, who aren’t impulsive. What do we know about that subtype? We know enough that several of us in the research community have taken to arguing that this is a different disorder. This does not belong in AD/HD. This is not AD/HD. This is a real attention disorder with real information processing deficits, and it has little in common with the other two kinds of AD/HD. The Hyperactive type of AD/HD and the Combined type of AD/HD are the same disorder. You’re just catching it at different developmental stages. Kids start out with Hyperactivity; the attention deficits come within a few years after that, and then they move into being the Combined type. But these children, on the other hand, are a different story all together.

Why do I think this is a different disorder? Why do some of my colleagues agree with it? Why do the rest of my scientific colleagues certainly agree that this is a qualitatively different group of children? Whether you view them as a different subtype or as an entirely different disorder is less of concern to me than that you understand these are not the same kids. They do not have the same risk, the same co-morbidities, the same causes and the same outcome, and it is likely that they do not respond to the same treatments the same way. But we will not know any more about treatment if we don’t view them differently, because everyone will assume as you may do, quite naively, that the treatments for one apply to all the subtypes, and they don’t. We have discovered a new disorder and it does not belong here. It needs its own name and its own criteria and it needs to get out of this category known as the disruptive behavior disorders, because it has no affinity for them. So let me show you why many of my colleagues are now slowly coming around to an idea that 10 years ago I argued for. This is a different disorder.

Why do I think it’s a different disorder? Because these children come in with the opposite symptoms. Instead of being hyperactive, intrusive, distractable, they’re lethargic, slow-moving, hypoactive, spacey, daydreamy, quiet, passive, withdrawn, confused, in a fog. They are the polar opposite of the AD/HD child in their clinical presentation. This is not an impulsive, disruptive, intrusive, aggressive, emotional, naive child. This is a kid who is staring, daydreaming, confused, and not processing information accurately. This is a real attention deficit, if attention means information processing. These kids have a processing deficit. AD/HD children do not. Do not confuse these two groups. They do not have the same problems with paying attention.

Other things we see in these children: when we bring them into the clinic, and we run them through a battery of neuropsychological tests, they have deficits in an area we call selective attention. Selective attention is how quickly you can deduce what’s important from unimportant in a spatial array of information, how fast you accurately process information coming at you. AD/HD children have no trouble with selective attention. And by the way, let’s put an end then, to this metaphor forAD/HD that it’s a filtering problem. Because it isn’t. Real AD/HD has no trouble with filtering, selecting information. AD/HD children perceive the world exactly as everybody else does. These children don’t.

These kids have a selective attention problem, which by the way explains something that we have found in about six different studies. These kids make more mistakes in academic work than AD/HD children do, many more mistakes. The problem that AD/HD children have is with productivity; number of problems attempted. The problem with these kids is accuracy: the number of errors made. These kids have a real problem with input coming into the brain, how quickly they can handle it, how accurately they can select it out, and deal with it. These children have memory problems. AD/HD children do not. These children have trouble with getting information out of short-term and long-term memory and doing it correctly. It’s especially so for long-term memory, so that they show a very erratic recall of information. AD/HD children, if they have a memory problem, it’s going to be in a very unusual form of memory we’re going to talk about later today. But this is traditional long-term storage, and these children have some trouble with that, probably for the same reason. They’re not getting information out of memory any more accurately than they’re processing information coming into the brain. There are problems with selection, with filtering, with focusing their attention. These children have a very different social profile.

The traditional AD/HD child is often a rejected child, because they’re immature and emotional and hotheaded and demanding and controlling and impulsive and often aggressive, so that when we compute a social profile of the AD/HD children they often wind up as being the least liked, the least popular and most likely to fight. That is their peer group profile. That is what Ken Dodge and his profile of peer acceptance views as the rejected child. And 50 percent or more of AD/HD children are utterly rejected by their peer group; these [inattentive] children, very different picture. These children are overlooked. In Ken Dodge’s taxonomy of social problems, they’re neglected. Why? Because they’re passive, uninvolved. They’re staring, daydreaming, hypoactive, absent-minded, passive. Unengaged is a better term for them. They’re not disliked by the other kids. They’re not rejected by them. The other kids just don’t know them. They’re not engaging. They’re not out there participating. They’re just kind of passive kids. They have more friends than AD/HD children have, actually. These kids tend to be neglected, not rejected. It’s a very different social profile.

Other differences: there is no affinity of this disorder for Oppositional (Defiant) or Conduct Disorder that we can tell. They basically have the same base rates as the normal population. But many AD/HD children are likely to go on to develop Oppositional Disorder and Conduct Disorder. Forty-five to 55 percent of AD/HD children develop Oppositional Disorder by age 7, and another 25-45 percent move up to Conduct Disorder by ages 8 to 12. AD/HD goes with Oppositional and Conduct Disorder. The inattentive group does not. You see another reason why they don’t belong in this group? Those three disorders—AD/HD, ODD, and CD—are all part of a larger category we call the disruptive disorders. The inattentive group isn’t and it shouldn’t be there.

Other differences that we see: by definition, of course, these kids are not impulsive. They don’t have any difficulties with inhibition. These children do not respond to stimulants anywhere near as well as AD/HD hyperactive, impulsive children do. Only about one in five of these children will show a sufficiently therapeutic response to maintain them on medication after an initial period of titration. Oh, you’ll find that about two-thirds of them show mild improvement, but those improvements are not enough to justify calling them clinical responders, therapeutic responders. Ninety-two percent of AD/HD children respond to stimulants. Twenty percent of these children respond to stimulants. And the dosing is different. AD/HD children tend to be better on moderate to high doses. Inattentive children, if they’re going to respond at all, it’s at very light doses, small doses.

So the drug response is different. And that’s all we know. [At this time] there are no other studies of treatment of this group—none. The only studies are five involving medication and mine was the only one that tested multiple doses with a placebo control.

There are only two pages in my parents’ book, Taking Charge of ADHD, on this group, and it tells you what I just told you. This is what we know. These are different kids. This is a different disorder. Stay tuned. We don’t know what to do with them. It’s up to you. You’re just going to have to cobble together some help any way you can and hope that it works, because there is no science beyond what I just told you.

They may have different causes. They certainly have different family histories. Those children tend to come from families where there are more anxiety disorders and learning disabilities. AD/HD children come from families where there’s more AD/HD, Conduct Disorder, antisocial behavior, and substance abuse. The family histories of these two groups are not the same.

Now, we have to be careful here, because the Inattentive group, it turns out, is rather a wastebasket group of kids. First of all, in that group are the true Inattentive kids. But also in that group are AD/HD children who came in one symptom short of being in the Combined group, right? They’ve got six inattention and five hyperactive symptoms, and according to the DSM, if they don’t have six, they’re not in the Combined type. Well, yes they are, and you should think of them as being Combined type children, even if they come up one symptom short. Don’t put those kids into the Inattentive group. The Inattentive group in our clinic is for kids with three symptoms or fewer off of that Hyperactive-Impulsive list. Any more than three and you’re better off thinking of them as what we call sub-threshold Combined type children.

There’s another group, the group that starts out being in the Combined type and by adolescence or adulthood are no longer so hyperactive, but they meet the criteria on the Hyperactive list. Now you would flip them over into the Inattentive type. Don’t do it. You always think of them as Combined type. So, bottom line is this: If any point in your history there was a whiff of problems with inhibition and impulse control, you’re a traditional AD/HD Combined type kid, and it shouldn’t matter what the DSM is telling you about cut-off scores. Clinically that’s how you would approach that child. That’s a Combined type kid. And you reserve this Inattentive group for kids who have never in their lives had trouble with inhibition. Those are the spacey, daydreamy, confused, in a fog, sluggish, hypoactive, slow-moving group. And as long as you conceptualize them that way, you won’t make any clinical mistakes. But if you follow the DSM as it’s written—perhaps you have OCD and you just have to follow all those criteria, just as they’re written—then you’re going to get yourself into some trouble. Because remember, the DSM was not chiseled in stone in Israel. It’s a set of guidelines developed to help make clinical decisions, but it’s to be used with clinical judgment and understanding of the criteria.

Okay, that’s just to resolve some confusion. And by the way, I said the Inattentive group was a wastebasket. Why did I say that? Inattention is nonspecific. Inattention is unhelpful in defining what disorder you have, because most mental disorders produce inattention. So if somebody walks into your clinic and says, you know, I’m having a lot of trouble concentrating, can’t pay attention, can’t finish work, you have no idea what they have. You don’t automatically say, oh, that’s AD/HD, I’ve heard about that. This could be a psychotic. This person could be a substance abuser. This person could have a generalized anxiety disorder or panic attacks or major depression or bipolar illness. How the hell do you know what they have?

For now, just know that the Inattentive type of AD/HD is a real wastebasket category of really inattentive children, along with children who have other disorders that are producing their inattention. There really is an Inattentive group out there, but they have a different disorder, and it’s not AD/HD.

JmeB78
10-05-06, 01:23 AM
Scuro, Thank you so much! You are a true blessing! I can't truely express how happy I am to have some answers even if it is I don't know.

Yep, that is him to a T! I guess there is not much I can do except be paitent, and try to find alteritive ways to help him learn. I will still take him to the doc, and see if maybe a lower dose would be better, and see if we can get a little better results with that. Maybe I can get his teacher to work with me, and hopefuly this time if I can get him tested he will qualify for resorce.

QueensU_girl
10-05-06, 09:40 PM
I've never heard of SCT.

Is that a processing disorder?

JmeB78
10-06-06, 03:04 AM
I did a search on prosessing disorder, as I wasn't sure. I still am not sure. CAPD came back with the most hits. There was also Sensory, and Visual. How many types of prossessing disorders are there? And where can I learn about them? Thanks, Jamie

speedo
10-06-06, 06:44 PM
Sensory Integration disorder is another one. I think it is more of a global label for people having a variety of sensory problems. There are some specific diagnoses for various sensory problems.. About 20% of those who have adhd will have some kind of sensory issues.

http://www.bigsplace.com/SID.html
http://www.sensoryint.com
http://www.sinetwork.org
http://www.associatedcontent.com/article/2496/understanding_sensory_integration_disorder.html

You might find this book useful: http://www.out-of-sync-child.com/

Me :D

JmeB78
10-07-06, 12:38 AM
Thanks a ton, Speedo! Great information!

sciencer
06-22-11, 03:07 PM
He might have Dyslexia(language based disorder) HIGHTLY and attention problems as well in this case meds won't be effective. try a lower dose of medication it might target the right path way.

The meds will help with his motivation to learn. he will need ur support for a while in school. He will turn out fine don't worry. to even be diagnosis with a learning disablity someone has to have average to above average in intelligences. It just means he will have to face lot more challenges than many other people in school do...

He is probably on the sensitive. and was a late talker... :) I was the same way when small and I am an excellent talker. when I was tested for an LD they even recommend me to see a speech specialist, its just that sometimes it takes me a while to learn the pronunciation with certain words.

you might want him to be exclude from taking another language in school/college later on.

feel free to PM me