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School struggles + ADHD = Learning disorders. (Test for Processing Problems).

HONOLULU -- Albert Einstein's third cousin was flunking fourth grade with an IQ of 148 when he was brought to Dr. Deborah R. Simkin for an evaluation.

"This kid could go upstairs on the computer and come down with 60 pages on gene transfer therapy and teach the kids about it, but ask him to color something in, and he couldn't do it. Ask him to repeat back to me what I was saying to him, and he couldn't," recalled Dr. Simkin, a former teacher who is now a child psychiatrist in Destin, Fla.

Testing revealed a visual-motor processing deficit, an auditory processing deficit, and attention-deficit hyperactivity disorder (ADHD). With treatment and educational accommodations, the young genius now is in seventh grade and is making straight As on his report cards.

Intrigued by the occurrence of processing deficits with ADHD, Dr. Simkin studied 77 other children and adolescents whose ADHD or attention-deficit disorder (ADD) was well controlled on medication but who began having difficulty with their grades as cognitive demands in school became greater over time. "They got to middle school and they started bombing out," she said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Sixty-seven (87%) of the children had an auditory processing problem that probably caused them difficulty as teaching shifted toward lectures in middle school. Testing also found processing speed problems in 54 children (70%), short-term memory problems in 39 (51%), long-term memory problems in 38 (49%), and visual-motor problems in 16 (21%), Dr. Simkin reported in a poster presentation at the meeting.

More than half of the children had a reading learning disorder (40), a math learning disorder (47), or a disorder of written expression (63)--52%, 61%, and 82%, respectively.

Learning disorders were determined by subtracting 15 points from the full-scale IQ; any scores at or below this score on the administered tests were considered a learning disorder. Although a 15-point deviation is a nationally recommended cutoff for detecting learning disorders in children from 11 to 17 years of age, some school districts opt to use a higher point deviation, she noted.

If the 22-point deviation used by Dr. Simkin's local school district was applied to the study cohort, more than half of the children with learning disorders would not qualify as having learning disorders.

All of the children in the study were bright, with IQs above 100 and an average IQ of 124. A majority of the children had a comorbid internalizing disorder such as depression or anxiety that was well controlled with medication. The study excluded an additional 34 children with a comorbid diagnosis of conduct disorder, bipolar disorder, autism or pervasive developmental disorder, schizoaffective disorder, or any psychotic disorder.

When children with ADHD begin struggling in school, parents often bring them to physicians asking for a higher dose of stimulant medication, thinking the ADHD is causing the learning difficulties. When dosage adjustments do not improve grades as expected, consider testing for learning disorders and processing problems.

Health insurance companies usually will not cover educational testing, but parents have a federally mandated right to ask the schools to do it. Some school administrators may balk, believing that these children with relatively high IQs need no additional testing or citing a scarcity of funds for testing.

Physicians should act as a medical liaison with the schools to explain the need to test these children and to provide educational accommodations when appropriate, Dr. Simkin said.
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Title Annotation:attention-deficit hyperactivity disorder
Author:Boschert, Sherry
Publication:Pediatric News
Geographic Code:1USA
Date:Mar 1, 2002
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