A Pediatrician on Helping your Kid with ADD/ ADHD

Copyright (c) 2007 SharpBrains

Today we interview Dr. Arthur Lavin, Associate Clinical Professor of Pediatrics at Case Western School of Medicine, pediatrician in private practice, and one of the first providers of a Working Memory Training program for kids with attention deficits. Dr. Lavin trained with esteemed Mel Levine.

AF (Alvaro Fernandez): Dr. Lavin, thanks for being with us. Can you explain the source of your interest in brain research and applications?

AL (Arthur Lavin): I am fascinated by how the mind works. How can neuroscientists' increasing knowledge improve kids' lives?

AF: Some readers may think that a major part of the problem we face today is that kids are simply "lazy". What do you say to that?

AL: I have never met a lazy kid. All people want to succeed, in life if not in school. The ones that are labeled as "lazy" are typically ashamed of their lack of capacity to deal with demands, and resort to evasive strategies.

AF: You mention a "lack of capacity to deal with demands". Is that gap growing?

AL: Yes. I can see how complex homework assignments are these days even in 3-4rd grade. Kids need to plan and prepare a whole matrix of tasks that require good organizational work to complete. They need to sequence what they do today, tomorrow, the day after. The major difficulty, for which such young brains may not be fully ready, is to deal with an overwhelming amount of information and demands.

AF: that seems to imply a higher need for good executive functions than years ago. A kid needs to have good working memory to retain, prioritize and sequence much information into actionable plans, and then execute them. We know that a common problem with many kids with diagnosed attention deficits is, indeed, working memory (the ability to hold in mind and manipulate several units of information). Can you explain what you see in your work with schools?

AL: I am afraid that many schools are too quick to diagnose ADD/ ADHD and consider drugs as the only potential intervention. The label itself can be misleading and counterproductive. School psychologists have wonderful expertise in evaluating subject-related problems and describing attentional deficit symptomatology, but are not trained or asked to complete neuropsychological profiles of a child's cognitive functions. Up to a point, many kids with attention problems would benefit from educational, not medical, interventions to improve cognitive functions such as working memory. I am seeing it first hand, having used a Working Memory Training program with 15 pre-screened kids: 80% of them presented a substantive improvement. With 50%, the results we have seen have been dramatic.

AF: Please give us some examples.

AL: Let me give you 3 vignettes, all 3 with diagnosed attention deficits.

Patient 1: 11-year-old boy, very impulsive, even on medication. Doesn't do homework, constantly forgets chores. After the 5-week program, he is able to sit down and listen instructions, engaging in fewer arguments with his parents. He can do better mental math- for the first time in his life able to do so without using his fingers. He finds that following school and doing homework is easier, grades have improved dramatically.

Patient 2: 16-year-old girl with ADD. She has trouble executing homework, often telling parents she had done it when she really hadn't. Her parents thought she liked to lie. Yet, when I talk to her, she is clearly more ashamed than dishonest. The working memory training program helps her develop a much improved perception of time. For example, she starts to manage her shower time better, being aware of when 5 minutes have passed-instead of spending 30 minutes in the shower, as before. Much improved school work, lying at home has dropped dramatically.

Patient 3: 19-year-old boy in college, who often became paralyzed when he was faced with complex challenges. He had a tough time with the cognitive training program, but after a while he started learning new strategies and developing self-confidence, and showing marked improvement. Now, he can break complex tasks into manageable pieces . His attentional deficits appeared to threaten his opportunities in his family business. Unable to keep track of change at the cash register, lines at the business would grow and customers get angry, leaving him out of consideration for key start-up employment in the business. Now he can manage day-to-day challenges such as these, and the door to being part of the family business is now open. He can sequence tasks and execute then with a clear plan in mind, without being distracted and losing sight of that plan.

AF: Dr. Lavin, this is all very exciting news. Thank you very much for your time.

AL: Thank you.