Tuesday, January 8, 2013

ADHD & Dropping Out

This is an article that was published in our local newspaper The Herald Dispatch on July 12, 2012.

A few years ago I had a 16 year old teenager come to my office for help with school problems. He had been retained in Kindergarten for “immaturity”, struggled through elementary school and repeated 6th grade because of poor test scores and missing assignments. Although he was now only half-way through his freshman year in high school, his parents had been notified that he was in danger of failing again. All his grades were low and he was refusing to do his work and more than once slept at his desk. Recently, he had become argumentative with the teachers and other students and was often tardy or absent from class.
            His parents remarked that even as a young child he had always been “on the go” – “full force” they said. He often forgot the rules about staying in his seat, not talking and forgetting to raise his hand. He was a slow reader and did poorly on timed tests. In middle school his lack of organization resulted in zeros for lost papers and unexpected exams. Homework was a nightmare for everyone that could last for hours and might end in tears and threats. He was becoming very moody and was staying out later with unfamiliar and unwelcome friends. In the morning it was hard to wake him up and he would complain of being tired all day. He was thinking about dropping out of school and his parents were at the end of their rope.
            I was reminded of this patient and many others like him when I read an article in the Herald Dispatch describing a new initiative to reduce dropouts in Cabell County. A multi-disciplinary team of parents and professionals lead by Laura Gilliam and Sara Blevins of The United Way of River Cities was meeting regularly to address three basic concerns: attendance, behavior, and course performance. Although it is still unclear to me if I volunteered or was drafted, I was glad to join the Education Matters team.
            As a physician I have learned that children and adolescents with school problems usually have more than one diagnosis. They may have any combination of learning differences, emotional problems, family conflicts and Attention Deficit Hyperactivity Disorder (ADHD). Effective treatment requires finding all the diagnoses present and creating a team of education, behavior, social, and medical specialists that the family can use to help them get back on track. My expertise in ADHD is based on board certification in Neurodevelopment Disabilities and on-the-job training as a parent of two children with ADHD.  
            ADHD is a neurologic medical condition that may be present in up to 10 % of all children. The American Academy of Pediatrics has recently published evidence based guidelines for accurate diagnosis and treatment of the condition. More than 50% of children with ADHD continue through adolescence to have symptoms of hyperactivity, short attention span as well as physical, verbal, and emotional impulsivity. Children with ADHD also have an increased rate of learning disabilities causing them to struggle with reading, getting their thoughts on papers, and staying organized.    Deficits in social comprehension and problem-solving lead to difficulties making and keeping friends or maintaining good relationships with parents, teachers, and school personnel.
            Research has shown that high school students with ADHD when compared to their classmates generally have significantly lower GPAs, turn in a lower percentage of assignments and are more likely to be absent or tardy. A higher likelihood of grade retention and failure to graduate has also been documented in this group.  It is not surprising to discover that a study completed in 2011 found that the dropout rate of adolescents with ADHD was eight times greater than their age and sex matched peers.  Investigators noted that other factors independently contributing to dropping out included lower IQ, marijuana use, and decreased paternal interaction.
            What can be done to solve this complicated problem and help these teenagers? Studies across the country are showing that multi-disciplinary programs based at the local school and community level can be effective. Teachers and school administrators, agency and governmental representatives, counselors, mental health professionals, and physicians can work together to provide their special expertise. Parent leadership, however, is the key to success. North Carolina has developed a model protocol which provides the combination of education, behavioral, and medical treatment that allows these students to reach their full potential both academically and socially.
            There are happy endings. My patient’s parents obtained IQ testing for him through his school eventually resulting in an Individual Education Plan that maximized his educational strengths while providing needed modifications. Family counseling and a behavior modification system to reward correct decisions was implemented.  Medical therapy was added resulting in improved attention span and better grades. He graduated, went on to technical school, found a good job and a stable, loving relationship. 
            Education Matters, with the help and support of our community, is building a comprehensive program for these Cabell County students that can spread this kind of success to everyone.  This is an opportunity for all of us to lend a hand and get the dropout rate under control.

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