Parenting: 'Your Struggling Child'

Millions of children across the United States are falling behind in school, acting out at home, having problems making friends, suffering dramatic mood swings, and more. Their parents are frustrated and afraid, aware that something's wrong, but not sure where to turn for help or how to cope with their child's behavior.

Author and neuropsychologist Richard F. Newby was online Friday, Feb. 17, at 10 a.m. to answer questions for parents who know their child has a problem but don't know how to get help.

Newby is coauthor with Lynn Sonberg of "Your Struggling Child: A Guide to Diagnosing, Understanding, and Advocating for Your Child with Learning, Behavior, or Emotional Problem" (Collins). The book explains the different and overlapping symptoms of learning, mood, and behavior disorders and guides parents in getting the right diagnosis and treatment.

Newby has conducted more than three thousand neuropsychological evaluations of children. His original research focuses on ADD, dyslexia, and reading disabilities, and he speaks frequently to lay and professional groups.

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Robert F. Newby: Thanks for joining us. Our topic today is helping kids grow up when they are struggling with tasks like learning, handling their emotions and directing their behavior productively. In particular, we want to help parents understand what the core difficulties are in these situations, so you can have a clear picture of where to really put your efforts.

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Hooper, Utah: There are several people in my family with dyslexia. Is this a hereditary disorder? Are there warning signs to watch for in my preschool age children? If signs are noticed, what is the best early intervention?

Robert F. Newby: Dyslexia, which essentially means the same thing as reading disability, is often but not always hereditary. As with most problems that children have, if there are genetic predispositions, the kind of teaching and experiences the child has can make a big difference in whether the dyslexia actually emerges or may be prevented.

Early warning signs would include difficulties learning the alphabet, learning how the letters are associated with sound and learning how sounds are segmented and relate to each other in oral speech, for instance through rhyming. There's been a lot of good research in the last 20 years to show that extra doses of what is called "phonemic awareness training" can really help with these early signs. This would include activities like taking the sounds in words apart, for instance having the child tell you how many sounds there are in the word "cat." Or identifying words that are spoken that sound the same at the beginning or sound the same at the end.

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Columbia, Md.: Our teenaged son has Asperger's. We have elected to put him in private school--academically challeging, no special support other than small classes. This seems to have worked well but I am concerned about giving him real work experiences. Could you discuss issues of ASD adolescents and work? Thank you.

Robert F. Newby: This is a very good and very hopeful situation of what can be called niche-finding. For starters, many children in this situation gradually build their everyday life, social and employment skills in carefully chosen extra-curricular activites, volunteer work, or part-time jobs that fit with their interests and that have limited demands for social flexibility and social interaction. One of my favorite stories is the teenaged boy who was fascinated with John Deere tractors, who basically sewed up the whole neighborhood lawn- care and snow-removal business, carefully saved his money and ended up with the top-end equipment, much to the gratification of his Asperger's-related interests. Often computer or other technology activities are just the thing.

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Upper Marlboro, Md.: My daughter has a (reading) learning disabilty. She is currently enrolled at Douglas High School 10th grade. I dont know what to do...I wrote the school and we had a meeting only for them to tell me it was learned behavior...Help!

Robert F. Newby: As pointed out by the major researchers, reading is in fact learned, and it needs to be taught, rather than coming naturally. If your daughter shows a big enough gap in her reading skills that is not due to issues such as poor attendance at school or low effort in reading-learning activities, there are federal and state laws requiring special education help. Your note says that you had a meeting at school, which may have been an informal discussion, or may have involved the next thing I'm going to suggest: You can, in writing, at the school office sign a form requesting formally (and is legally required) an Individualized Specialized Education program, and then it becomes more than just a discussion. Relevant testing of areas such as intelligence, reading and written language skills needs to be done by the school for free within a specified time period according to state law if there is good reason to suspect learing disability in this area. If you run into brick walls or confusion in requesting an IEP evaluation, contact the state department of public instruction or state school board, whatever it's called in your state, to ask how to proceed.

At the same time that you ask for the evaluation at school, you can get a referral for an outside or independent evaluation, for instance with a good child psychologist who can conduct testing in these areas. Keep in mind whether you go the school route first, or the independent route first, or both at the same time, you don't want your child to be taking exactly the same tests in more than one place. If there's more than one place involved, make sure they talk to each other so the same tests don't get given twice in a short period of time.

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Pittsburgh Pa.: Is there any relationship between dyslexia and ADHD?

Robert F. Newby: If you have either dyslexia or ADHD, you have an increased chance of also having the other one, compared to the general population. Many research studies suggest about 25 percent overlap. This does not mean that they are caused by the same thing going on in the brain. That's still being researched. However the brain is very complicated and the different systems are closely related to each other, so researchers may in the long run find some core or essential relationship between these two common disorders.

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Union, N.J.: My 17-year-old son, a junior in high school, has ADD (inattentive). This year due to a heavy courseload, a suddenly active social life, a girlfriend, marching band, he just shut down and fell behind in schoolwork. Became anxious and depressed and has stopped doing any schoolwork. Goes to school but does not do work. Has anxiety attacks. He's on Wellbutrin & Xanax. Psychiatrist thinks he may have obsessive thoughts so possibly OCD and wants to change meds to an SSRI. School gave him some accommodations but thinks he needs more intensive therapy, possibly an outpatient day program at a hospital. I'd prefer he continue at school due to the social aspect which is new and good for him. How do we get him to try work? How do you think we should proceed?

Robert F. Newby: This kind of mixture between attention problems and emotional complications, the anxiety and mood difficulties, is not uncommon. IF your son is in counseling now, you and the counselor want to consult together to do the best job you can of mapping out the "chicken and egg" of this complex present situation. The explaination that you imply is that the attention problems have been there all along, and some changes in your son's life have added stress, so now there are the emotional symptoms. Generally speaking, you need to treat both, if both are present.So the idea of introducing counselign, or making the counseling more frequent, or changing the shift of the counseling has a decent chance of helping with the emotional side of this. Sometimes a relatively drastic change in the situation is needed, but as you point out, it would be good to avoid this if progress can be made with the anxiety and mood complications while staying in the current situation, i.e. sticking with the school program. Keep in mind that the ultimate goal of school is both learning and productivity or practice, so the fact that work has ground to a halt is important and needs to be turned around, but it doesn't neccessarily mean that learning has stopped. Especially when you have rattling or dramatic symptoms such as panic attacks, you as the parent helping your struggling child need to keep the perspective when "all is not lost," even if it feels that way.

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Fort Washington Md.: New information has stated that some children that have been diagnosed with ADD and other disorders are really sleep deprived. One of my child's teachers stated to me that she wished parents would continue the same bedtime that were enforced during the week of standardized testing week. The difference in the children was amazing.

What are your thoughts?

Robert F. Newby: This kind of question comes up about ADHD all the time, and is very important. When a careful diagnosis of ADHD is made, the evaluator should be considering other possible causes, and either ruling out those causes or pointing out there's more than one thing going on, for instance, real ADHD and sleep disruption. In most cases, if a careful review of the child's behavior patterns -- including sleep -- suggests that in this case sleep is the real culprit, then the careful, cautious conclusion would be to hold off on the ADHD diagnosis until the sleep problems can be improved, then look at the picture again. Because most careful evaluators already think in this way, it's pretty unlikely that very many of children who have received an ADHD diagnosis are instead sleep-disrupted.

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Columbus, Ohio: I know that many children struggle with learning, their emotions and behavior, but how often are these problems caused by poor parenting? How do you approach parents in those cases to let them know how much harm they're doing to their child? My experience is that most parents blame everyone else (teachers, society, other kids, etc.) for their child's problems, but it's obvious to everyone else around them, that the parents themselves are the source of the problem.

Robert F. Newby: I love this question. This shows the insight that all behaviors that children give us to work with result from both nature and nurture. It's a matter of what degree of which seems to be really operating in this case at this time. In addition, there are many behavior patterns or learning struggles, includin ghte common ones of ADHD and reading disability, where changes in the parenting and teaching can make a big difference even if it is fair to infer a strong "nature" or biological or neurological basis. So all parents should examine themselves and their parenting approaches when their children are struggling, not mostly for blame, but to start the process of figuring out waht you can do different for the sake of your particular child's strength and weakness.

It's interesting as a psychologist to reflect that, by the time most parents get into my office with their children, they've been willing to and interested in starting some of this self-reflection, and they're looking for help and doing the best self-reflection. That may not be true, or not as true, for many parents out there who haven't taken the step of seeking professional help yet. Remember, it's not either/or.

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Parker, Colorado: My son is 10 and in the 5th grade. He has trouble keeping his anger in check and gets upset very easily. He took a 6-week class last year on anger management but when he's angry he won't use the principles they taught him (stop, deep breath, think about the alternatives). I know he's suffering with this and doesn't know how to help himself, but it also gets very frustrating for the rest of the family. Your comments would be appreciated.

Robert F. Newby: It sounds like the anger management class may have used some of the well researched counseling methods called cognitive behavior therapy. In this method, people (children or adults!) are taught how to think and act differently in the face of a problem than their intuition or usual behavior habits dictate. In many situations, where children successfully learn these methods in the therapy themselves, and can in fact demonstrate some or good skill in using the methods in the practice therapy situations, it doesn't necessarily transfer over to everyday life very well. All this means is that other things that you as a parent and teachers or other adults who may be working with your child need ot do is to remind and especially reinforce them using these well developed techniques in every day life. In almost all situations, this process, which we professionals call "generalization," starts off gradual and piecemeal, then in the well followed cases, builds to a point where some use of the methods is occuring in at least some situations in everyday life. You can't expect 100 percent, and it does take work (sometimes lots) on the part of the adult in everyday life. It can be particularly tricky with high intensity emotions, such as anger or strong anxiety. Talk to the therapist about tips for promoting generalization.

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Fairfax, Va.: My daughter, who just turned 16, has had an ADHD diagnosis since third grade. School has always been a huge struggle for her (she has an IEP) and recently she has started having discipline problems at school. At the recommendation of an educational consultant, we have arranged for her to have a full-day neuro-psych evaluation in the hope that it may uncover some other underlying issues that are causing her academic problems. How can we use the results from that evaluation to improve her IEP?

Robert F. Newby: If the neuropsychological evaluation shows particular weaknesses in key academic skills, such as reading comprehension, that haven't been addressed thoroughly enough inthe IEP, then the evaluation has added valuable information on another kind of help that your daughter needs at this time. Sometimes the neuropsychological evaluation reveals weaknesses in broader areas of functioning than a certain academic skill, for instance, oral language comprehension skills, or abstract reasoning. These also can be added to the IEP as goals for improvement. Sometimes the neuropsychological evaluation, after all the different details of thinking and behavior have been carefully examined, tells you nothing new. In these instances, you can throw up your hands and cry that you've wasted time and energy in the testing, or you can pat yourselves on the back and say we've been on the right track, we need to keep working on the things we already know about, and perhaps we need to add some ways of working on the things we already knew about that haven't been tried before, or tried enough or tried recently. Most pediatric neuropsychologists are well trained and strongly motivated to give you additional intervention recommendations, whether those are based on something new that the testing hsa revealed, or whether it's based on that professional's careful review with you of what has already been tried.

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Southern Maryland: I love Columbus, Ohio's comment that the problem is the parent's fault! It doesn't take a brain surgeon to figure out that dysfunctional parents produce dysfunctional children. My brother retired from working in a corrections facility. He'd tell us about the teens, and younger, who went through the system. When the parents came in to bail the kids out ... BINGO! ... the parents were just as squirelly as the kids.

Robert F. Newby: Sometimes, more often than we'd like actually, the frustrating or sad similarities do show up. But remember it's not either-or. In your own professional work, when you see the similarity in behavior or attitude or emotion between the child and the parent, that still doesn't tell us how much is due to parenting, how much is inherited, and (very importantly) how much is related to that child's social, school and peer experiences. Again, all parents have to take responsibility for the productive and not-so-productive things that they give their kids, but there isn't a kid in the world whose struggles are completely due to parenting.

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Arlington, Va.: I though the Columbus questioner was implying there there's no such thing as these disorders, that it's all a made-up science. Your thoughts?

Robert F. Newby: Social science can be even more complicated than examples like nuclear physics, but when regular, recurring patterns of behavior, learning, or emotion struggles keep showing up, it becomes meaningful to group the symptoms together and summarize them in some fashion as "disorders." A famous anthropologist whose name I can't recall right now, once wisely said, "All men are in some ways the same, in some ways different fromevery other man, and in some ways the same as some other men," although I must admit my paraphrase is probably quite inexact. All we are doing in researching disorders and applying those concepts to indiviuatl children is trying to make use of that third thing in that anthropologist's statement.

To put it concretely, every child with a reading disability is different in some way with a reading disability, but the similarities help us to more efficiently design instruction methods and group them together in classrooms or tutoring approaches to improve those problems, than we would be able to if we just stayed with the thought of each one being unique. In my book I propose (and I emphasize that it is not a new proposal) labels can be tools, not chains. That's what we're talking about here.

It's important to keep in mind that some labels tend to accurately go on year after year for a particular child, but in the well treated and lucky situations, the labels can go away.

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Robert F. Newby: Thank you all for sending in your questions, and please keep up your efforts on your children's behalf.

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