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the WISC-V

Understanding the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V)

In the world of psychological assessment, the Wechsler Intelligence Scales are considered to be the gold standard measures of intellectual functioning.  The assessments represent over 70 years of research and subsequent revisions that reflect advancements in neurodevelopmental and neurocognitive research, psychology, technology, and changes in population. (Wechsler, 2014).

The Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V):

One of the most commonly used assessments for school-aged children is the Wechslerchilds-brain-Portrait Intelligence Scale for Children, Fifth Edition (WISC-V). The assessment generates five composite score indices:

  • Verbal Comprehension (VCI)
  • Visual Spatial Index (VSI)
  • Fluid Reasoning Index (FRI)
  • Working Memory Index (WMI)
  • Processing Speed Index (PSI)

Together, a Full Scale Intelligent Quotient (FSIQ) is developed.  When large discrepancies are identified between the indices which comprise a child’s FSIQ, alternative scores can be calculated to best capture a child’s cognitive profile.  Alternative scores may be considered when deficits in language, attention, or motivation appear to have negatively impacted a child’s overall performance. Through the analysis of the general and specific domains of cognitive functioning, clinicians are better able to make informed decisions regarding diagnostic conceptualization and treatment recommendations.

WISC-V Composite Score Indices:

  • VCI: The VCI measures verbal reasoning, understanding, concept formation, in addition to a child’s fund of knowledge and crystallized intelligence.  Crystallized intelligence is the knowledge a child has acquired over his or her lifespan through experiences and learning.  The core subtests which comprise the VCI require youth to define pictures or vocabulary words, and describe how words are conceptually related.  Children with expressive and/or receptive language deficits often exhibit poorer performance on the VCI.  Studies have also indicated that a child’s vocabulary knowledge is related to the development of reading abilities, and as such, weaker performance on tasks involving vocabulary may signal an academic area of difficulty.
  • VSI:  The VSI measures a child’s nonverbal reasoning and concept formation, visual perception and organization, visual-motor coordination, ability to analyze and synthesize abstract information, and distinguish figure-ground in visual stimuli.  Specifically, the core subtests of the VSI require that a child use mental rotation and visualization in order to build a geometric design to match a model with and without the presence of blocks.  Children with visual-spatial deficits may exhibit difficulty on tasks involving mathematics, building a model from an instruction sheet, or differentiating visual stimuli and figure ground on a computer screen.
  • FRI: The FRI assesses a child’s quantitative reasoning, classification and spatial ability, knowledge of part to whole relationships.  It also evaluates a child’s fluid reasoning abilities, which is the ability to solve novel problems independent of previous knowledge.    The core tasks which make up the FRI require that a child choose an option to complete an incomplete matrix or series, and view a scale with missing weight(s) in order to select an option that would keep the scale balanced.  A child with fluid reasoning deficits may have difficulty understanding relationships between concepts, and as such, may generalize concepts learned.  They may also struggle when asked to solve a problem after the content has changed, or when question is expressed differently from how a child was taught (e.g., setting up a math problem by using information in a word problem).  Difficulties with inductive reasoning can also manifest as challenges identifying an underlying rule or procedure.
  • WMI: The WMI evaluates a child’s ability to sustain auditory attention, concentrate, and exert mental control.  Children are asked to repeat numbers read aloud by the evaluator in a particular order, and have memory for pictures previously presented.  Deficits in working memory often suggest that children will require repetition when learning new information, as they exhibit difficulties taking information in short-term memory, manipulating it, and producing a response at a level comparable to their same age peers.  It is also not uncommon for youth with self-regulatory challenges, as observed in Attention-Deficit/Hyperactivity Disorder (ADHD) to present with difficulties in working memory and processing speed (noted below).
  • PSI: The PSI estimates how quickly and accurately a child is able to process information. Youth are asked to engage in tasks involving motor coordination, visual processing, and search skills under time constraints.  Assuming processing speed difficulties are not related to delays in visual-motor functioning, weaker performance on the tasks which comprise the core subtests of the PSI indicate that a child will require additional time to process information and complete their work.  In the academic context, school-based accommodations may include allowing a child to take unfinished assignments home, focusing on the quality of work over quantity, shortening tasks, and allowing extended time.

In summary, IQ is more than one aspect of functioning and encapsulates several factors described above.  As a result, it is often more helpful to assess the indices which comprise a child’s FSIQ separately in order to best inform treatment and intervention.

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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!


adhd and summer organization

How to Set-Up an Organized Summer for Children with ADHD

Children with Attention Deficit Hyperactivity Disorder (ADHD) frequently exhibit concerns with regard to their executive functioning including organization, initiation, time management, and ability to transition between tasks.  The school year often provides a natural structure and organization for children as the daily expectations are often clearly stated.  Summertime can often provide a source of frustration for these children (and parents) as the days may not be as structured and routine.  It is important to try to keep daily events organized and structured so that the child has clear expectations as to what to expect.  Some strategies that might prove beneficial are listed below.

Strategies to Organize the Summer for a Child With ADHD:

  1.  Try to keep daily routines the same.  Have the time the child wakes up, meal time, bed time the same asHelp Your Child With ADHD Stay Organized This Summer much as possible.
  2. Have an organized plan for the week.  Try to set up a calendar and list of weekly events in a clearly stated place.  Make sure the child is well aware of the schedule.
  3. If there are any changes in routine, plan on informing the child as soon as possible about the change.

Summer does not have to be a free for all in which there are no expectations or routines.  Try to keep daily routines as set as possible with clear expectations for any changes.  

ADHD Resource Center

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

What Can Happen When ADHD Goes Untreated

The Long Term Effects of Not Treating ADHD

A recent article published in Healthline indicated that there are numerous long-term negative effects of not treating children who have Attention Deficit Hyperactivity Disorder.

One of the concerns is that children who do not receive either behavioral and/or pharmacologicalThe Long-Term Effects of Untreated ADHD intervention to address their inattention and impulse control never learn strategies to deal with impulsivity when they become adolescents and adults.  It has been documented that there is an increase in unemployment or underemployment for adults with ADHD who never received any form of intervention.  These individuals were also found to make between $8,000 to $15,000 less then non-ADHD workers in similar jobs.

There have been studies that indicate that adults with untreated ADHD are nearly twice as likely as non-ADHD adults to get divorced.

Many times in my clinic I hear parents indicate that they do not want to medicate their children, as they are afraid that it may lead to later substance use.  The research actually indicates the direct opposite in that adolescents and adults with untreated ADHD are at an increased risk for substance use in the form of self-medication to help alleviate symptoms of distress associated with their inattention or impulsivity.

There is ample evidence to indicate that children who never receive treatment for their ADHD are at increased risk for negative social and behavioral concerns as they reach adolescents and adulthood.  If a parent or teacher believes a child may have symptomology of ADHD it is important that the child receives intervention to help deal with the concerns they exhibit.

ADHD Resource Center

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

What is Auditory Processing?

What is Auditory Processing?

The term “auditory processing” has experienced an increase in attention over the past several years, as awareness has been raised for the diagnosis of auditory processing disorder (APD). With the rise in awareness for this disorder, it is important to fully understand the components of auditory processing to avoid confusion and misdiagnosis.

Auditory Processing refers to how the central nervous system uses auditory information. WhenWhat is Auditory Processing? processing auditory information there are several steps that take place. First, the listener needs to remember and organize the information that was presented to them. Once that information has been retained, the listener must discriminate between the received signals – listening for the differences in the speech. This step will help the listener determine what speech-sounds were produced and with what intonation/prosody (i.e., discriminating a question from a statement). The auditory information is then sequenced and conceptualized (i.e., meaning is applied to what was heard). Lastly, the auditory signal that has been processed is synthesized to receive the “main idea” of what was said.

The Components of Auditory Processing:

The components of auditory processing are intricate and complex. It is clear that if one skill set is weak, that will ultimately affect that person’s ability to correctly understand spoken information. It is important to recognize that an auditory processing disorder (APD) is not a result of a higher cognitive or language disorder, but is an auditory deficit. There are other disorders that can also affect a person’s ability to accurately understand auditory information. For example, a child with ADHD will have difficulty accurately following and understanding verbal information – however this is due to an attentional deficit, rather than his or her ability to process information. Likewise, a child with autism spectrum disorder will also have difficulty comprehending spoken language, however, again this is due to a high-order language deficit. It is possible for APD to co-exist with another disorder, however, careful diagnosis by a certified audiologist is necessary for an accurate diagnosis.

See below for a list of behaviors that are common for children to exhibit who experience difficulties with auditory processing.

Red Flags for Children with APD:

  • Difficulty understanding speech in noisy environments.
  • Inability to consistently and accurately follow directions.
  • Difficulty discriminating similar-sounding speech sounds (i.e., /b/ versus /p/).
  • Frequently asking for repetition or clarification.
  • Poor performance with spelling or understanding information verbally presented.
  • Child typically performs better on tasks that don’t rely on listening.


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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!
Resource: Bellis, Teri James. Understanding Auditory Processing Disorders in Children. American Speech-Language-Hearing Association. Retrieved from http://www.asha.org.

 

keep your child organized this summer

Strategies to Keep Your Child Organized This Summer

Spring is in the air and with the warm temperature creeping in, this is a sure sign of one thing to come…school’s out for summer! For many, this is a time of year we look forward to, but it can also be a difficult time for our kiddos with ADHD that benefit from the structure and routine that school provides Monday through Friday. Check out these useful tips to help ward off the “I’m bored” summer bug.

Tips to Keep Your Child Organized This Summer:Keep Your Child Organized This Summer

  1. Keep them happy campers: There are many summer camps out there that range from 1 week to several months long. Figure out what would work best for your family. This allows your child time to burn off some energy and engage in social interactions in a structured, monitored environment. Contact your local YMCA or park district for local camps or classes offered near you.
  2. Keep morning routines the same: When kids know what to expect in the morning, it can help to limit meltdowns.
  3. Post a weekly schedule of activities: These can range from very simple tasks like chores and reading to more involved activities like an outing to the park or museum. Make your child part of this so they feel empowered too! This can also be helpful for your child’s sitter if both parents are working.
  4. Plan for at least one success a day: Let your child pick activities they enjoy doing (or do well J) and give praise for their work. Give them an opportunity to tell you about what they did, too!
  5. Join a sport: Many times a child with ADHD may do better in an individual sport. If you child has a low frustration tolerance, difficulty following directions, or acts before thinking, think about enrolling your kiddo in martial arts, golf or bowling!
  6. Dust off the old board games: Games like checkers, chess and UNO help with executive functioning skills. Uno helps kids practice switching between matching colors versus numbers helps to practice cognitive flexibility. Chess also can provide a platform for teaching impulsive children to slow down and think carefully before making their next move
  7. Cook together:Waiting for instructions (inhibition), trying to remember the directions (working memory) and measuring and counting steps (sustained-attention) all help to develop executive functioning skills.

Have a fun and organized summer!

executive functioning

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

ADHD and medication

Medication and ADHD

As a pediatric psychologist, I am often asked the question: “Do you think medications are over-prescribed in children with ADHD?”  The question is a valid one and the numbers are pretty clear: the rates of stimulant medication prescriptions in children rose dramatically in the 1990s (from under 1% to 2.7%) and have been rising at a more modest rate ever since (Zuvekas & Vitiello, 2012).  The most recent rate of prescription in children and adolescents was 3.5% in 2008 (nimh.org).  This sounds like a lot but the truth is, this number is still lower than the 5% prevalence rate of ADHD (American Psychiatric Association, 2014).  What this suggests is that, while the majority of children with ADHD are on medication, there remains a large number who are not.

Medication and ADHD-What We Know:

What we know about stimulant medications is that they can be very effective in treating the coreADHD and medication symptoms of ADHD (inattention, distractibility, and hyperactivity).  What we also know about these medications, which is equally as important, is that they do not do much to impact the long-term course of ADHD (Molina, Hinshaw, Swanson, Arnold, Vitiello, Jensen, Epstein, Hoza, Hechtman, Abikoff, Elliott, Greenhill, Newcorn, Wells, Wigal, Severe, Gibbons, Hur, Houck, and the MTA Cooperate Group, 2009.)  Furthermore, for reasons that remain unclear, the maintenance of medication treatment over time is not well sustained despite the fact that we know ADHD tends to be a chronic condition (Molina et al., 2009 and American Psychiatric Association, 2014).

Other Treatment for ADHD:

This is where additional intervention approaches are vital to supporting children with ADHD and thus far the consensus is a prolonged multi-modal treatment approach that adapts as the child progresses through differing developmental stages.  Such approaches include behavior therapy with the child that focuses on specific skill building and self-awareness, parent training and psycho-education, teacher consultation, and classroom accommodations.  As children enter middle school, it can also be beneficial to spend time with an executive function tutor to begin to lay the foundation for keeping oneself organized, compensate for weaknesses, and feel a sense of control in their lives.

Medication is often an essential part of the treatment plan but to just treat the core symptoms of ADHD, without attention to the functional impairments it creates or the additional psychiatric conditions that often accompany it (learning disabilities, anxiety, depression, and conduct problem), would be remiss.

Click here to listen to Dr. Amy Wolok discuss ADHD and medication in an interview on Bloomberg radio.


ADHD

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

ADHD and Social Skills

Social Skills And ADHD

Many children with Attention Deficit Hyperactivity Disorder (ADHD) exhibit significant concerns with regard to their social and emotional functioning.  Research has indicated that there is a high correlation between children who have ADHD and their social skills.  What is important to understand is that many of these children do not have specific social deficits (such as those often associated with Autism Spectrum Disorder); however, the issues with impulsivity and attention to detail impact the social success of the child.

Social Concerns for Kids with ADHDADHD and social skills

Children with impulse control issues and inattention are often at risk for social concerns because of the impact that these issues have on the child’s socialization.  Oftentimes the children have difficulty ‘putting the brakes on’ when playing with peers and struggle with regulating behavior.  The other children might become upset and shy away in future social events.  These children are also at risk for missing social cues when engaging peers which might lead to rejection or neglect in future interactions.

Strategies to Build Social Skills in Kids with ADHD

It is important to provide strategies and support to improve the socialization of children who have ADHD.  These children often need extra support in non-structured situations such as the playground, recess, gym time.  Parents and teachers should work closely with the children to ensure that they are able to provide extra guidance during these activities.  Provide the child with immediate feedback about how his or her behavior is impacting the social environment as well as how to better handle the situation in the future.

Oftentimes with ADHD we are worried about a child’s academic performance; however, we must also be concerned and intervene for his or her socialization and emotional functioning.

Click here to read more about how ADHD affects your child’s social skills and friendships.


ADHD Resource Center
NSPT offers Behavior Therapy in Bucktown, Evanston, Highland Park, Lincolnwood (coming soon), Glenview and the Neuropsychology Diagnostic and Testing Center in Des Plaines. If you have questions, or concerns, about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

memory and adhd

Wait… What Did You Say? Memory in the ADHD Student

Making memories is an important part of being human, and our beloved camera phones seem to make the process that much easier! However… our cameras aren’t the only ones doing the work. What about when you have to remember that long 10 digit phone… oh wait… we don’t have to do that anymore either! I suppose a modern day challenge would be to remember all those tedious passwords we have to keep!

But that’s neither here nor there!

Our awesome brains deserve a little credit, too, actually a lot of credit for that (grey) matter (just a little brain joke for ya!)

While memory is a challenge for all of us, it can be an exceptional challenge for a student with ADHD. In order to understand this, we will look at the 3 basic stages of memory.

Three basic stages of memory:

Encoding: Information enters into our memory systemmemory and adhd

Storage:

  • Short-term memory (STM) : 20-30 Seconds: Information that is transferred from the STM enters into the HIPPOCAMPUS! When we repeat information over and over again it’s like sending it through the hippocampus several times!
  • Long-term memory (LTM): Can last a lifetime

Retrieval:

  • How you store depends on how you get those memories back OUT
  • Organization is key here (i.e. using the alphabet to categorize things or remembering numbers in chunks)

Something happens around you that you can see, hear and/or touch. This sensation lingers in our short-term (working) memory for about 20-30 seconds. For example, when you are having a conversation with someone and they are talking, you may be thinking of what to say next (thanks to your working memory).

Kids use their working memory all day in the classroom to follow instructions, remember where they need to be, and to keep track of their belongings and assignments (just to name a few). Kiddos with ADHD tend to struggle more with these tasks, which can make learning difficult, specifically reading comprehension.

Let’s say a teacher says, “Go to your desk, grab your book and a pencil, go the center, and finish the worksheet.” That can be a lot to remember for a child who has a deficit in this area and can be misinterpreted as purely inattention.

“How can you plan ahead if you don’t use working memory to keep your goal in mind, resist distractions and inhibit impulsive choices?” says Matthew Cruger, PhD, neuropsychologist with the Learning and Diagnostics Center at the Child Mind Institute in New York.

Here are 4 ways to help teach ways to integrate learning for kids with ADHD:

  • Teaching mnemonic devices: “Never Eat Soggy Waffles” : North, East, South,West
  • Creating visuals
  • Use songs or a melody to learn concepts
  • Ask follow-up questions

Sometimes it can be hard to tell whether a child has a memory deficit or if it is a by-product of ADHD or a Learning Disorder. Receiving formal testing can be beneficial to tease them apart or better identify how they influence one another.

oppositional defiant disorder

Top Warning Signs for Oppositional Defiant Disorder (ODD)

How can a child’s irritable mood, lack of awareness into how their behavior impacts others, and resistance towards engagement in unfavorable tasks be differentiated from age-appropriate/typical behavior to something more serious, like a clinical diagnosis of Oppositional Defiant Disorder (ODD).

What is ODD?

According to the DSM-V, a diagnosis of Oppositional Defiant Disorder (ODD) is characterized as “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from these categories.” The DSM-V also outlines that to qualify for a diagnosis of ODD, the individual must demonstrate these symptoms during an interaction with at least one other person other than a sibling.

Warning signs for ODD include:

  • Often loses temper
  • Negative outlook/mood
  • Defiance
  • Disobedience
  • Hostility towards authority figures
  • Regular temper tantrums
  • Blames others for his mistakes or misbehavior
  • Does not comply with rules of tasks assigned by adult
  • Spiteful or vindictive nature
  • Enjoys annoying others and is easily annoyed themselves

Treatment for ODD includes clinical intervention and potential medication management to address related symptoms such as mood dysregulation or impulse control as resonate of an ADHD diagnosis. Parent training for education on how to effectively discipline and avoid power struggles, individual/family therapy, and cognitive behavioral therapy are all treatment modalities to holistically treat ODD.





 

mastering morning routines

Mastering Morning Routines

 

 

 

Many parents report the most anxiety prone time of the day is the weekday mornings. There is much going on in a very limited time. Parents often need to ensure that they are ready for work and have their children ready for school. This time of day is difficult for most children; however, children with attention problems or executive functioning weaknesses are much more prone to exhibit significant weakness with regard to their ability to follow routines and get out the door on time. Although it is difficult, it is not impossible for these children to be ready to go on time! Mastering the morning routine is the best way to get the family out the door, happily, each day.

Steps to Master the Morning Routine:

The main recommendation is to keep the mornings as structured and consistent as possible. Have the schedule planned and written out. Think about all daily routines from waking up, brushing teeth, getting dressed, to leaving the house. Think about not only the tasks that are expected of the child but also a reasonable amount of time to complete each task. It may come down to it that the list of expectations placed on the child’s morning is not realistic (today) and there might have to be some modifications.

Once it has been established that the tasks in the morning are reasonable, create a chart with picture cues for each task. Also, have the time expected for each task written down next to that item.

The first few days or weeks will require a significant amount of adult assistance to help ensure the child is finishing the tasks in the appropriate order within the required time allotments. Use strategies such as reinforcing completed tasks, timers, and praise.

Morning routines can be hectic but do not have to be impossible. With structure, organization support, and use of reinforcement, many children with attention concerns and executive functioning weaknesses are able to stay to the routine and get out the door in time.