ADHD Symptoms: ADHD or Sleep Deprivation?

ADHD symptoms can sometimes be a sign of simple sleep deprivation. That’s the upshot of the discussion at a recent conference in Paris. Psychiatric researchers presented a roundup of the data that suggests that sleep and attention deficit hyperactivity disorder (ADHD) are linked. Some of the experts, however, remain unconvinced that such a connection exists. Instead, they say the ADHD symptoms we see in sleep-deprived children only mimic the symptoms of ADHD. What we’re really seeing, say these dissenting experts, may be a sleep disorder.

That’s important, because the upward increase in the number of children diagnosed with ADHD is striking. We need to know if it’s possible we’re not seeing ADHD after all, but something altogether different. If it’s not ADHD and we treat the symptoms with drugs, we may not be addressing the root cause, and may even be making things worse. Especially since some medications for ADHD, for instance, Ritalin, can make it difficult for children to sleep.

“If adults don’t get enough sleep, they’ll appear sleepy,” says Dr. Syed Naqvi, a pediatric sleep expert at UT Southwestern’s Peter O’Donnell Jr. Brain Institute and Children’s Health. “Children don’t do that. They show ADHD-like behavior instead—hyperactive or inattentive.”

Dr. Naqvi says he sees lots of children in his practice who have been diagnosed with ADHD whose behavior doesn’t respond to medication. What they really need is sleep. Once the issue of quality and duration of sleep is treated, the symptoms improve.

ADHD Symptoms from Ritalin

Naqvi has seen the occasional case where ADHD medication was the actual source of the sleep problem. In other words: these kids with ADHD symptoms didn’t actually have ADHD. They were exhibiting the symptoms of ADHD because they needed better and more sleep. And the drugs they were given for their ADHD symptoms exacerbated their sleep issues and caused them to be even more symptomatic. They needed sleep, not Ritalin.

Dr. Preston Wiles, an ADHD expert with the O’Donnell Brain Institute, agrees that the rise in the number of children taking medications for ADHD symptoms is “concerning.” Wiles says the increase in pediatric prescriptions for ADHD medications is due, in large measure, to the fact that there are so few clinicians who are qualified to render an accurate diagnosis of ADHD. Many of the “experts” prescribing these medications have little understanding of child behavior.

“Pills can be a poor substitute for taking the time to truly understand what is going on with behavior,” Dr. Wiles says.

Little Girl wearily rubbing her eyes
ADHD symptoms or just plum tuckered out?

Kars4Kids spoke with Dr. Naqvi to find out more about why children aren’t getting enough quality sleep and what parents can do to help:

Kars4Kids: What is the impact of technology, for instance, kids texting friends at night and the exposure to bright screens, on our children’s quality and quantity of sleep?

Dr. Syed Naqvi: Using technology in the bed with blue light-emitting screens or socializing at that time results in increased arousal and stimulation of the brain that should actually be winding down time in preparation for sleep. Such technology use frequently results in an artificial delay in sleep, causing inadequate sleep which in turn, impacts on daytime alertness.

Kars4Kids: What can parents do to improve a child’s quantity and quality of sleep?

Dr. Syed Naqvi: Parents should make sure there is a consistent routine for bedtime for the whole family with dimmer lights and a quiet environment, and allowing for age-appropriate sleep time and duration. Control the use of technology an hour before bedtime, and limit caffeine or sugary drinks intake from late in the afternoon. Younger children should go to sleep earlier, teenagers a little later.

Kars4Kids: Is it safe and/or effective to give children melatonin to help improve quantity and quality of sleep?

Dr. Syed Naqvi: Normal children do not need any sleep aid. Melatonin in small amounts may be used in select cases and is generally safe. Discuss the issue with a sleep specialist for a persistent sleep difficulty or any other need for using melatonin.

Mother showing tired boy with ADHD symptoms that it's time to go to bed
Is he exhibiting ADHD symptoms? He may just need more sleep.

Dr. Naqvi also offers a few tips to help parents figure out whether sleep disturbances may be affecting their children’s behavior:

  • Watch for signs of breathing problems, for instance snoring or short intervals where breathing is halted. If you see possible signs of breathing problems, have your child evaluated by a sleep expert.
  • Measure the duration of nighttime sleep the child is getting and monitor any daytime sleepiness.
  • Monitor your children’s school performance and seek help if things don’t improve after starting on ADHD medications.

How Does the Brain Learn?

How does the brain learn and truly absorb the information it receives? The brain learns through a process of Sequencing: putting information into the right order; Abstraction: making sense of that information; and Organization: using the information to form thoughts. When the brain completes these three steps of processing information, this is called Integration.

The term “integration” is a way of saying the brain has learned something. This may be input from the classroom, or input from life. A child can learn how to add and subtract in the classroom. The child can also learn through life experience that touching a hot stove can burn the skin and cause pain. No matter the source of the information, once it is input and integrated, the brain understands the information it has been fed.

How does the brain, this remarkable organ, take in the information it receives, make sense of it, and use it to create and do incredible things? And what happens when something goes wrong along the way? Is there a way to assist the brain in understanding and absorbing information?

Answering these questions begins with knowing how the brain learns, or the steps we take in processing information. The three steps of the brain’s unique learning formula (sequencing, abstraction, and organization), also provide clues where there are learning difficulties. These clues can ensure we offer children with learning problems the right kind of help.

How Does the Brain Learn: Sequencing

What kind of problems might be spotted as the child learns information? A child might, for example, have a problem with sequencing. If the child has a consistent weakness in this area, a learning difficulty or disability might be suspected. A child may have trouble learning to count, for instance. This might suggest the child has trouble sequencing numbers: putting them in order.

Confirmation that the difficulty has to do with sequencing might come when the child then has trouble learning the correct order of the letters of the alphabet, or the months of the year. When one looks at all the difficulties the child has, and sees they are about placing information into the correct order, two things become clear:

  • The child’s brain has a problem with processing information
  • The specific neurological (brain) problem is sequencing: putting information in order.

How Does the Brain Learn: Abstraction

Once the brain has the information sorted into the right sequence, it’s time to understand the meaning of the information (abstraction). Most children with learning difficulties have no serious problem with this part of learning. Abstraction is about things like understanding symbols (for example, a stop sign), or the meaning of a word (sit, eat, sleep). These are basic brain tasks. A child with a serious problem in the area of abstraction wouldn’t have a learning disability or difficulty, but an intellectual disability.

How Does the Brain Work: the brain does abstract thinking in the chemistry lab

There can, however, be minor problems with abstraction. A person who doesn’t “get” jokes, and doesn’t seem to have a sense of humor, may have a problem with abstraction. A person who doesn’t understand puns or idioms may be having problems with abstraction. Call this person a “pig” and he won’t understand that the word “pig” is not just an animal, but an insult. These types of abstraction issues are exceptions to the rule.

How Does the Brain Learn: Organization

When we think of organization difficulties, it’s easy to imagine a child with a messy room. The child can never find anything. Nothing has a specific place. The child loses things, forgets to bring important items to school, mislays homework, text books, notebooks. These issues may extend to time management. The child is always late and can never turn in assignments on time.

Each of these scenarios: messy room; losing things; forgetfulness; time management issues, have to do with different pathways in the brain. Learning creates new brain pathways. When we call on these brain pathways, electrical impulses light up and activate those parts of the brain.

In some children, the wiring gets crossed or tangled. In other children, the brain pathways may be damaged. Since the circuit in the brain is interrupted, the information never gets to where it is sent, at least not in the form it was intended. Sometimes only part of the information is sent. This leads to incomplete or flawed information processing.

tangled wires

When such processing problems repeat on a regular basis and interfere with the child’s learning, it is time to think whether the child might have a learning difficulty or disability. This is where an evaluation is both necessary and helpful. A thorough evaluation can help pinpoint subtle issues in brain functioning. This can tell parents and educators where the failure is occurring within the three-step procedure of information processing.

That doesn’t mean an exact diagnosis is easy to obtain. A child who calls a fork, a “korf,” may have a problem, but it is difficult to say what the problem might be. It could be the child has a problem with sequencing, verbal output, or auditory processing. The mispronunciation may be about integrating any or all of the these processing areas into one solid whole. For this reason, the child must be assessed in all of these areas.

How Does the Brain Learn: Basic Skills

Whether the problem is sequencing, abstraction, organization, or something else, If a child’s brain has a problem processing information, the child may find it difficult to learn even basic skills such as reading, writing, and arithmetic. When neurological (brain) processing interferes with reading, for instance, the child will be said to have dyslexia. When a processing problem interferes with learning to write, we call it dysgraphia. A problem with processing numbers is called dyscalculia. These are just three examples of learning difficulties that are labeled according to the specific skill sets affected by neurological processing problems.

Learning difficulties are not limited to basic skills. Sometimes processing problems interfere with a child’s higher level skills. Higher level skills include managing time, organization, and abstract thinking. Here too, a learning difficulty is recognized according to the specific processing issue.

How Does the Brain Learn: Four Areas of Processing

A child’s processing problem may have to do with taking in information (input); or it may be about making sense of information (integration). For another child, the difficulty may be storing information and retrieving it for later use (memory). In some cases, a child may have no trouble taking in information, making sense of it, and remembering it, but can’t use this information to form words, write, draw, or gesture (output). It is in one or more of these four basic areas that children diagnosed with learning difficulties will be found to have a processing problem.

Input Output sockets

When the brain receives information, this is called input. Sometimes input is visual, or information we understand with our eyes. Sometimes input is auditory, or information we understand with our ears.

How Does the Brain Learn: Visual Input

A difficulty with visual input doesn’t mean, for instance someone who has a vision problem, such as near or far-sightedness. A visual input problem has to do with the way the brain understands what is seen. If the brain sees letters in reverse, for example, this might be a visual input processing problem.

Let’s say a child has trouble with the mechanics of catching a ball. In order to catch the ball, the eyes have to focus on the ball. This is called figure-ground. At the same time, the brain must be able to pinpoint the position of the ball and its path (depth perception). This helps the body understand where and when to move. Finally, the body must obey the brain’s commands, to stretch out the hands and actually catch the ball as it arrives. If the child misjudges the speed of the ball, or how far it must travel, or if the brain doesn’t issue the right commands to the arms and hands, the child may very well fail to catch the ball.

These are just two examples of visual processing problems. In one example, the visual processing problem leads to letter reversals. In the other example, visual processing problems quite literally lead to dropping the ball. There are many other ways we might see the effects of visual processing problems.

How Does the Brain Learn: Auditory Input

Just as a visual processing problem isn’t about being near or far-sighted, a difficulty with auditory input doesn’t mean that someone is, for example, hearing challenged. An auditory processing problem has to do with the way the brain understands what is heard. A child who has an auditory processing problem, may, for instance, be unable to understand how the words too, two, and to are not the same word. This can lead to confusion when the child hears these words in spoken sentences.

In another example of an auditory input processing problem, the child might need more time to understand what is heard. Because of this, the child misses some of what you say because the speed of your speech is too quick for his understanding. This is called an “auditory lag.”

Children can have both visual and auditory processing problems. This might make it difficult for a child to make sense of what is happening when the child receives visual and auditory information at the same time. An example of this could be the student who sees writing on a blackboard while listening to an explanation of those words.

How Does the Brain Learn:  Integration

Once input is complete, through visual and/or auditory means, it’s time for the three-step integration process. The brain must put all the information into the right order (sequencing). The brain must be able to understand how to use the information (abstraction). Last of all, the brain must take each piece of information and add it to the whole to make a complete thought. This type of organization of information is the final step in integration. It is what makes integration complete.

How Does the Brain Learn:  Memory

At this point, learning is still not complete. Will the brain hold onto the memory for tomorrow’s French test (short-term memory or working memory), or will the child remember that French phrase ten years later (long-term memory) when she visits France as an exchange student? Like abstraction, it is unlikely that your child would have a serious long-term memory disability. Such a problem would not be a learning difficulty, but rather an intellectual disability.

A short-term memory disability, on the other hand, is a real phenomenon. You see it with the child who spends hours memorizing the names of countries on a map for geography class and then forgets everything during the test the next morning. By the same token, the teacher may be very patient in the classroom, explaining how to divide fractions. But when the child pulls out her math homework that night, she cannot remember how to do the work.

How Does the Brain Learn:  Output

The final step in learning is actual using the information. This is called output. Output may be verbal, by way of spoken words or language, or motor, which is by way of muscle activity. Motor output includes drawing, writing, and pointing, for example. A child with issues in these areas might have a language disability or a motor disability.

There are two types of language we use to communicate: spontaneous language and demand language. Spontaneous language is where you begin a conversation. You’ve chosen the topic, and had time to think about what you’re going to say. Most children have no problem here.

In demand language, however, someone might ask you a question. You haven’t chosen the subject, thought about your response, or organized your thoughts. You’ve got this split-second to answer the question. For the child with a language disability, this is a tongue-tying situation. The child may ask you to repeat the question, or simply answer, “What?” or “I don’t know.” Some children will respond but the response won’t make any sense—won’t seem to relate to the question.

Child draws outline with colored pen

In motor disabilities, the child may have a problem using the large muscle groups. This is known as a gross motor disability. For other children, it’s hard to perform tasks that requires using many muscles to work together at once. This is called a fine motor disability.

A child with gross motor disabilities may always be tripping over her own feet. She might fall a lot, spill her milk, bump into things, and drop things often. The child will find it hard to learn how to swim or ride a bike.

A child with a fine motor disability may have trouble writing or speaking. The child who has trouble speaking because of a fine motor disability may find it difficult to coordinate all the parts of the mouth, tongue, throat, and face used in speech. Writing, on the other hand, requires coordinating the use of many muscles in the hand at the same time. Children with handwriting problems may write slowly, or have messy handwriting. The child may even find that the writing hand, when writing, develops a cramp.

This should be considered a very broad overview of a complicated subject. For more information, follow the links for deeper reading. If you suspect your child has an information processing problem or learning disability, it’s important to have the child evaluated.

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Manage ADHD by Developing Skills

You can’t manage ADHD with drugs alone. Anyone who has ever parented one of the 6 million children in the United States age 4-17 diagnosed with the condition knows that. But with school now back in session, frustrated parents and their children may be asking what more can be done to manage ADHD and its symptoms. Because taking drugs isn’t enough, and may not even be the right way to go.

ADHD is complicated. It makes learning difficult. That’s why children with ADHD need a great deal of support from their parents, teachers, and school counselors. A school counselor, in particular, can play a special role in helping students with ADHD by serving as an intermediary between parents and teachers.

With so many children experiencing ADHD, it becomes crucial to offer them some sort of support system that goes beyond purchasing a prescription and hoping for the best. Here, school counselors can fulfill an important function, by serving as the pipeline for communication between parents and teachers. School counselors can also be an important resource for all those who work with children with ADHD, both in and out of the classroom. While most children are diagnosed with the combined form of ADHD, the presentation of symptoms can change over time. The school counselor can offer strategies to cope with changing behaviors as these changes arise.

In order to manage ADHD, however, it is important to gain an understanding of the skills a student with ADHD must develop. The aim of any therapies for ADHD must have, as their ultimate goal, improved impulse control, time management, and the ability to focus or concentrate on tasks. If students fail to develop these critical skills, they will remain in perpetual frustration, become worn out from trying so hard, develop poor self-esteem, and suffer from acute embarrassment, as well.

One practical way to help students with ADHD develop these skills is to provide them with a dependable structure. A student who struggles with forgetfulness, for instance, should be made to do homework at the same time every day. Over time, the student internalizes that homework is always done at 4 PM, so that when 4 PM rolls around, the student knows just what to do and never forgets. A student who tends to forgetfulness can also be instructed to store his schoolbooks in one designated space. Since the item is always placed in the same spot, there will never be a time when the child cannot find the item. These are meaningful methods for developing time management and organizational skills to really address and manage ADHD.

But let’s say there is to be a school field trip at 4 PM on a certain date. That can throw the student with ADHD for a loop, since 4 PM is homework time. The student should be prepared well in advance of any such changes in schedule or routine. Talking about how and when the child will get dressed, do homework, and eat on that day is going to be a necessary conversation that may have to be reviewed several times over several days or weeks. Students with ADHD need lots of help and much spatience in learning to organize their time.

As for developing a student’s powers of concentration and focus, ADHD expert Dr. Edward Hallowell believes Dr. Edward Hallowell, ADHD expertthat staying focused for shorter periods of time is the right way to go. “Kids with ADHD must learn to manage large projects. Break down large topics or tasks into small, manageable bits. For example, a book report might be subdivided into eight steps, or a science project outlined in a dozen doable steps. This helps the child with ADHD not feel overwhelmed.”

Strategies to Manage ADHD

These coping tips and tricks help students manage ADHD symptoms by teaching them strategies that have been proven to work, based on evidence. Such strategies are called evidence-based interventions (EBIs). An example of an EBI would be helping the parents of the student with ADHD to develop and put into place a system of organization to assist the student in carrying out more homework assignments and chores and getting them done on time. Parents might use calendars, charts, notebook or computer, and class syllabi to make it work.

Anil Chacko, a professor for Counseling@NYU’s online master’s in school counseling program from NYU Steinhardt, describes some strategies that school counselors can use when working with students who have ADHD. “School counselors should utilize methods that support students’ time management, planning, and organization,” Chacko says, citing the work of Joshua Langberg at Virginia Commonwealth University (VCU) and Howard Abikoff at New York University’s (NYU) School of Medicine, leading scholars in the field of ADHD in children and adolescents. “I would also encourage school counselors to work directly with parents to create a school-home note system to support cross-setting changes.”

Dr. Langberg developed and published the successful Homework, Organization, and Planning Skills (HOPS) intervention. HOPS is about teaching kids to use physical organization tools, for instance book bags, binders, and lockers, and homework management tools such as writing down assignments and recording them accurately, entering test dates on a calendar, and in general, planning things out.

Dr. Abikoff researches interventions and training in children with ADHD, for instance Organizational Skills Training (OST). OST targets specific organizational skills goals. Here is a description of the OST program from program’s creators:

OST is a 20-session, twice-weekly, clinic-based program, which focused on building organizational skills in four areas:

  • Tracking Assignments: Teaching students a system for consistently recording assignments and due dates in a specially designed planner.
  • Managing Materials: Providing students with methods for storing and organizing their papers and materials through the use of an accordion binder system, materials checklists included in their planner, systems for organizing their desks, and by developing prominently visible checklists for backpacks and other tools for material transfer, as well as other related strategies.
  • Time Management: Helping students become more aware of their use of time and how to plan ahead to structure their time effectively through the use of an afternoon scheduling component in their planners; helping students improve their time estimation skills and their awareness of how much time they need to complete tasks; teaching students to work efficiently by minimizing distractions in their work spaces.
  • Task Planning: Showing students how to break larger projects and goals into steps and create schedules for task completion through the use of task-planning pages in their planners.

OST students are taught that each OTMP (organization, time management, and planning) problem area is the result of a brain “glitch.” Each glitch is depicted as a naughty character who likes to watch children make mistakes due to organizational problems. This concept helps motivate the students and makes the program “lighthearted and fun.” The concept of glitches is also meant to make the issues encountered by students with ADHD less personal. Kids come to understand that it’s not they who fail, but the symptoms of ADHD getting in the way of their academic and social success.

Each organizational skill is taught using the same basic method:

1) The new skill is discussed, defined, and explained. A rationale is given for the importance of the skill. The child hears about the settings in which the skill might be used.

2) The skill is demonstrated

3) The skill is practiced by the child under the guidance of an instructor and feedback is given. The skill is practiced many times. The student is taught to identify situations in which the skill should be used.

Studies as recent as this one from 2016, have found that early behavioral therapy (HOPS, OST, and the like), begun before any other interventions, such as medication, had “four fewer rules violations an hour at school than the medication-first group.” That’s not to say that behavioral therapy takes the place of medication. Medication has proven benefits for children with ADHD. What we should take away from the research is that 1) We shouldn’t begin with medication and 2) Teaching children to develop their OTMP skills even before they reach school age, can really make a difference. In terms of cost, by the way, behavior-first therapy is estimated to cost an annual $700 less per year when compared to medication-first treatment.

Strategies for Teachers

Besides using EBIs like OST and HOPS in their work with children, school counselors can also train teachers to support children who are coping with ADHD in the classroom. A school counselor might, for instance, suggest the teacher give out points or tokens for good behavior. Here are some other practical tips from the National Resource Center (NRC) on ADHD:

For the easily distracted student (predominantly inattentive)

  • Seat the student close to the teacher’s desk and away from distractions such as windows or school corridors
  • Split long assignments into smaller segments
  • Offer more breaks during class time

For the students that fidgets and squirms (predominantly hyperactive/impulsive)

  • Seat the student where the fidgeting and squirming will be least likely to disturb classmates, for instance along the side of the classroom
  • Offer opportunities throughout the day that allow the fidgety student to move, for instance, handing out work sheets.

More Tips to Manage ADHD

Scott Ertl, M.Ed., was an elementary school counselor for 18 years before he became the CEO of BouncyBands, a device to help fidgety students cope in the classroom. Here are Ertl’s top 5 tips for helping students with ADHD succeed in the classroom:

1) The child or teacher, depending on the child’s maturity, should clean out the child’s desk every Friday afternoon so the week starts off as organized and prepared as possible.

2) Allow movement. Let the child earn the ability to deliver a book to the media center, a note to the front office, or a message to a teacher when their work is completed correctly. Bouncy Bands, yoga balls, and standing desks in class are also great ways to allow movement throughout the day. Kids need appropriate ways to release their extra energy without distracting others.

3) Set them up for success. Give them advance notice that you are going to call on them to answer a question in class so they are ready. This works much better than catching them off task as a way to shame them into paying attention.

4) Have specific goals on their desk to accomplish, like: Check over my work when completed, Make sure all of my homework is written down before leaving class, and Raise my hand to ask for help when unsure of what to do in class.

5) Communicate. Give specific feedback during the day when these goals are being accomplished to recognize their improvements. Use them as model in class to encourage other students to improve those behaviors as well.

Teachers who must manage ADHD in the classroom may also want to try using sentences that suggest an order of action, for instance, “First read all the questions, then answer them,” or, “First put your crayons away, then take out your geography book.” In addition, enlisting a student’s help can increase self-worth and help refocus the child’s energy. Teachers and parents should always watch for good behavior and give praise whenever and wherever it happens!

How Can Parents Manage ADHD?

Here are some things parents can do at home to help their children who struggle with ADHD:

  • Use a system to acknowledge and reward good behavior, for instance, a chart with stickers
  • Stick to a home routine with as little deviation as possible (e.g. homework, dinner, bedtime, and etc., are at the same time each day)
  • Create written to-do lists for chores so that the child can cross things off the list as they are done
  • Practice at home, OTMP strategies learned at therapy sessions

Professor Chacko encourages parents to educate themselves. If you have a child with ADHD, seek out information on behavior parent training programs in your area. Some consider these programs to be the most important and most effective means to manage ADHD behaviors both in and out of the classroom. Parents, along with teachers and school counselors, should also be aware that ADHD often coexists (see: Comorbidity and ADHD: It’s Not Just About ADHD) with learning disabilities and difficulties. “The challenges these children face may be more than just ‘ADHD,’” says Chacko.

What do you do at home to help support your child with ADHD?

Fidget Spinners: Help or Hindrance

Fidget spinners have been wildly popular since they burst on the scene in December 2016. Touted as a way to alleviate anxiety and the symptoms of attention deficit hyperactivity disorder (ADHD) and autism, spinners have also created not a little controversy. Teachers have had to ban them from the classroom, since the toys tend to distract, well, anyone who isn’t using one. And that would include the teachers.

Imagine a classroom filled with kids turning these things around in their hands all day long, and you begin to get a picture of what today’s classroom looks like. Unless the teacher should intervene to ban the toys. How do you teach students to conjugate French verbs or draw an isosceles triangle while 30 of them are spinning their fidget spinners?

In case you live in a cave, and have no idea what a fidget spinner might be, these handheld devices are like small propellers attached to ball-bearings. The user rotates the toy between the fingers to make it spin. The vibrations of the ever-cycling fidget spinner provide a sensory experience. The sensations help relieve sensory overload, enabling the user to regain focus, for instance in the classroom.

Fidget spinner marketing may describe the toys as aids for those with learning disabilities like ADHD, or as a device that can free up the mind to reach its fullest potential. Scientists and experts remain unimpressed. Marriage and family therapist Lisa Bahar is concerned with children developing a dependency on spinners. “The goal is to have a mindful and participatory experience in life situations. If a student is focusing on the fidget spinner the pupil is not engaged in the moment with the full sensory experience.

“Fidget Spinners are good for a beginning, but ideally children would be encouraged not to depend on them for the long process and to taper off with mindfulness practice and being present and participating. This takes practice,” says Bahar.

Dr. Fran Walfish, Beverly Hills family and relationship psychotherapist, author, The Self-Aware Parent, disagrees. “Fidget spinners are intended to help children with ADHD and Sensory Integration Disorder focus their attention. Squeezing a golf ball-sized Nerf ball or spinning a spinner helps distract the jittery, impulsive child from acting out of turn in the classroom.

“For example, if the impulsive child quickly calls out answers to the teacher’s questions before giving his classmates a chance to raise their hands, he can try spinning a fidget spinner to serve as a helpful reminder to ‘Stop, spin, raise your hand, and wait for the teacher to call your name.'”

There are, on the other hand, other toys that provide sensory stimulation without causing so much disruption. Fidget cubes, for instance are quiet and don’t draw the eye like a spinner. These dice-shaped objects fit in the palm of the hand and have various interactive doodads on the sides, for example dials and push buttons. Users simply press, click, or dial, to release pent up nervous energy. The cubes have a modest following among executives, who like to fiddle with the cubes during dull conference call meetings or while stuck in traffic jams.

Teachers might prefer their students use fidget cubes. But the fidget spinner is the runaway bestseller. It’s a fad, a trend, and the irony is that what is supposed to help kids focus, is distracting the heck out of everyone else. Especially those who must confront a classroom full of fidget spinning students each day. Dr. Wendy Hirsch Weiner, a principal and social studies teacher at a small school with an outsized population of students with ADHD finds fidget spinners make learning impossible. “Several of our students came to school with the spinners last semester and we as teachers all found that the students became very focused on the spinners and were not able to concentrate on anything else. The spinners would drop from their hands and the students would spend time finding them on the floor. Several of the kids had light-up spinners, which became even more of a stimulant and increased the hyperactivity of our already distracted students. Our school will be banning spinners this coming fall.”

Dr. John Mayer, a leading expert on kids and families and the author of Family Fit: Find Your Balance In Life, says it even stronger. “Horrible, horrible, horrible!

“First, even if they have some therapeutic benefit, a diversion device like this, takes the person away from developing ‘compensation techniques’ that are necessary for the long-term control of their condition and better functioning.

“Second, by allowing spinners in the classroom and other settings such as activities, clubs, church, what effect do these have on the remainder of the kids??

“Third, in that same respect, these spinners have disastrous effects on classroom discipline and order.”

Asked what parents should do to help their children with special needs, Mayer says, “Work with them to overcome their lack of focus in ways that are socially appropriate and build life-long skills, such as taking more time to read the material; have them make notes in the margins of books; help them to memorize material; and work with them using flash-cards and learning drills rather than toys and gimmicks.”

The fidget spinner may be the bane of every teacher’s existence, but the toys have accomplished something positive. There’s more awareness of attention deficit. There’s more awareness of the need of some children (and adults) for extra sensory stimulation as a result of the fidget spinner’s popularity.

There are some parents of children with disabilities who praise the fidget spinner to the skies. Children and adults with autism engage in repetitive behaviors to relieve sensory overload. This is called “stimming.”

Chewing on chewelry, or handling items like Koosh balls or even something as simple as a rubber ice cube tray, can help those with autism self-treat and calm their sensory overload. The fidget spinner is just the latest iteration of an old-school group of toys for this purpose. But children with autism who are mainstreamed may depend on such sensory toys to relieve the stress that builds up during the school day. It may, in fact, not be possible for the child with autism to be mainstreamed without that crutch. For such a child, stimming with a fidget spinner tends to level the playing field and make the child with autism feel less different, less stand-out, and more cool; more like her neurotypical classmates.

That’s why banning the fidget spinner can seem almost cruel. Some educators and therapists see the fidget spinners as tools rather than toys. These experts believe that fidget spinners can enhance classroom performance if accepted as part of classroom culture. In this sense, fidget spinners would be considered part and parcel of a student’s learning strategy.

Most teachers believe, however, that the spinner is thought of as a toy, used like a toy, and an annoying toy at that.

Research suggests that children with ADHD who are allowed to move around the classroom may do better at tasks that involve the working memory. This is the type of memory that is used to process new information. Another study found that children with ADHD do better in their schoolwork after exercising. “Ensuring that children, with or without special needs, have opportunities to move, stretch, and release energy throughout the school day is critical to managing anxiety, boosting focus, and helping children manage their impulses. Building in extra recess time, ensuring that kids are encouraged to move and play during breaks and recess (as opposed to habitually losing time as a punishment), and implementing curriculum that teaches stress management skills such as meditation and mindfulness are excellent ways to help students cope with restlessness and improve focus,” says Stephanie O’Leary, Psy.D., a clinical child neuropsychologist, expert in child behavior, and author of Parenting in the Real World.

Fidget Spinners Too New For Research

While no studies have specifically targeted fidget spinners—they’re too new—at least one study suggests that fidget spinners can improve the academic performance in children with ADHD. The aforementioned study found that children with ADHD who receive sensory intervention therapy sessions were better able to focus and learn without distraction in a noisy classroom environment. The therapy sessions for the students in this study included brushing the skin both lightly and deeply, swinging on swings, and working with an exercise ball.

The research does suggest that both movement and sensory stimulation improve academic performance in children with ADHD. These same studies would also appear to suggest, however, that a child who uses a fidget spinner outside of the classroom for a long enough time may also receive the full benefit from fiddling with a spinner. If your child’s teacher bans spinners from the classroom, this may be the way to go: have your child use his spinner outside the classroom at every opportunity and then see if his classroom performance improves.

Using a spinner in the hours outside of school would also solve the problem of creating a distraction for neurotypical students and teachers. Not to mention that fidget spinners are arguably dangerous. Some fidget spinners have been found to contain unacceptable levels of lead and/or mercury. Some children have choked on the small parts of broken spinners. One child had to have a piece of a spinner removed from his finger under general anesthesia. And the spinners aren’t sturdy. They break all too easily, increasing the danger to children from choking on small parts.

Experts suggest that parents read and follow age labels on fidget spinners and only purchase them at reputable toy shops. The better shops only stock toys that have undergone U.S. testing. Fidget spinners that light up should have a locked in battery. After purchase, look over the toy at least daily, keeping an eye out for broken parts that can serve as choking hazards. If the spinner breaks, replace it with a new one, following the same guidelines.

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This is How Much Sleep Kids Need to Be Healthy

How much sleep do kids need to be at their best? It’s a question parents struggle with when their children beg to sleep just a little longer on school days. Letting them sleep in means letting them be tardy for school. But letting them sleep in means healthier, happier kids, more able to take in their lessons.

On weekends and in summer, on the other hand, how long kids sleep is far less of a problem. School’s not in session, so kids can sleep ’til the cows come home, and it won’t make a lick of a difference. For this reason, summer comes to many parents as a big relief. Kids can stay up late and wake up late and there’s no need to fuss or freak out.

Of course, parents often think to themselves during the school year, if kids would only go to bed on time, they’d wake up on time. Except science tells us it’s not like that at all. The American Medical Association (AMA) has found that puberty comes with a natural shift in circadian rhythm that cause kids go to sleep later and wake up later. Which is why the AMA has recommended school start times begin no earlier than 8:30 a.m.

In addition to actively pushing middle and high schools across the U.S. to have later start times, the AMA is encouraging doctors to educate parents and teachers about the importance of sleep for good mental and physical health. By now, scientists know exactly how much sleep kids need to be healthy. They also know the impact on kids of not getting enough sleep. “Sleep deprivation is a growing public health issue affecting our nation’s adolescents, putting them at risk for mental, physical and emotional distress and disorders,” said AMA Board Member William E. Kobler, M.D.

“Scientific evidence strongly suggests that allowing adolescents more time for sleep at the appropriate hours results in improvements in health, academic performance, behavior, and general well-being. We believe delaying school start times will help ensure middle and high school students get enough sleep, and that it will improve the overall mental and physical health of our nation’s young people,” says Kobler.

How Much Sleep Should Teens Get?

How much sleep kids need is an issue that is now front and center, since just 32% of American teens are getting, on average, the bare minimum of 8 hours of sleep on school nights. Meanwhile, the American Academy of Sleep Medicine (AASM) just issued consensus guidelines on how much sleep kids need, according to age. AASM says “teenagers 13 to 18 years of age should sleep eight to 10 hours per 24 hours on a regular basis to promote optimal health.”

It’s Official!

The American Academy of Sleep Medicine (AASM) has released, for the first time, official consensus recommendations for the amount of sleep needed to promote best health in children and teenagers and to avoid the health risks of insufficient sleep:
• Infants four to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children one to two years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children three to five years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children six to 12 years of age should sleep nine to 12 hours per 24 hours on a regular basis to promote optimal health.
• Teenagers 13 to 18 years of age should sleep eight to 10 hours per 24 hours on a regular basis to promote optimal health.

“Sleep is essential for a healthy life, and it is important to promote healthy sleep habits in early childhood,” said Dr. Shalini Paruthi, Pediatric Consensus Panel moderator and fellow of the American Academy of Sleep Medicine. “It is especially important as children reach adolescence to continue to ensure that teens are able to get sufficient sleep.”

So you’ve got fewer than half of all American teenagers getting the minimum amount of sleep they need to be healthy and do well in school. And we know that teens need to go to bed later and wake up later according to their natural biological sleep cycles. At the same time, some 10% of all U.S. high schools have start times of 7:30 a.m. or even earlier.

Why the early start times, if kids need more sleep, and later sleep and wake times? Schools are trying to cram in extra classes for things like sports and extracurricular activities. There just aren’t enough hours in the school day to get them all in.

Meantime, research shows that not getting enough sleep affects health, academic performance, and behavior. Lack of sleep results in poor memory and mood disorders. Teens who sleep fewer than 6 hours of sleep per night, are more likely to exhibit symptoms of anxiety and depression.

As for health, sleep deprivation can bring on high blood pressure, metabolic conditions like diabetes, and a weakened immune system. Researchers have also found a connection between body mass index (BMI) and sleep. It seems those who don’t get enough sleep are more likely to be underweight, overweight, or even obese.

Schools may struggle (as parents have struggled all these years) with finding enough hours in the school day to serve students all they want to give them, now that the AMA is pushing for later start times. But in the end, it looks like something’s got to give, and that something has got to be the schools. “While implementing a delayed school start time can be an emotional and potentially stressful issue for school districts, families, and members of the community, the health benefits for adolescents far outweigh any potential negative consequences,” said Dr. Kobler.

Ten Top Misconceptions About ADHD

Misconceptions about ADHD abound, despite the fact that at least 1 in 20 U.S. children are affected. These misconceptions about ADHD make it more difficult to identify and treat the condition, with the result that some children and adults go undiagnosed and untreated. Here are the top ten misconceptions about ADHD—some of them are bound to surprise you, while others will have you nodding your head:

#1 Misconception: ADHD is something someone made up to excuse bad behavior and poor grades

Reality Check: ADHD is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a genuine disorder that is “characterized by a pattern of behavior, present in multiple settings (e.g., school and home), that can result in performance issues in social, education, or work settings.”

The DSM-5 specifies that children must have at least six symptoms of inattention and/or hyperactivity and impulsivity to be diagnosed with ADHD, while teens and adults must have five such symptoms.

Conclusion: ADHD is all too real, affects daily life for millions of sufferers, and since it tends to run in families, may even have a genetic component.

#2 Misconception: A quiet child who sits nicely in class, cannot possibly have ADHD

Reality Check: Not all children with ADHD have symptoms of hyperactivity. ADHD has three subtypes:

  • Combined Presentation with symptoms of both inattention and hyperactivity/impulsivity
  • Predominantly Inattentive Presentation with mostly symptoms of inattention
  • Predominantly Hyperactive-Impulsive Presentation with mostly symptoms of hyperactivity/impulsivity

The second type of ADHD, Predominantly Inattentive Presentation, used to be known as “ADD” because this type of ADHD presents without hyperactivity or impulsivity. Children and adults with this type of ADHD tend to look as though they are daydreaming. They seem to be off in their own little worlds. Those with this type of ADHD often go undiagnosed because the symptoms are less obvious. By the way, people with ADHD can have one subtype of ADHD and go on to develop a different subtype.

Conclusion: You don’t have to be bouncing off the walls to have an all-too-real case of ADHD.

#3 Misconception: Kids with ADHD just need some firm parenting

Reality Check: ADHD has nothing to do with poor or lax parenting. It’s not about putting your foot down and making that child behave. While children with ADHD can be wild and out of control, this is the result of a brain-based medical condition. It’s not helpful to criticize parents who are struggling to raise kids with ADHD and will only make things worse by generating hurt feelings.

Conclusion: Parenting doesn’t cause ADHD, a medical condition that is looking more and more like a genetic disorder every day.

#4 Misconception: Girls don’t get ADHD

Reality check: More boys are diagnosed with ADHD. That’s because they are more likely to present with the more obvious symptoms of hyperactivity and impulsivity. Girls tend to get the second subtype of ADHD, Predominantly Inattentive Presentation, which is the type without hyperactivity/impulsivity. A teacher may not realize that a quiet girl who tends to daydream in class a lot, is actually showing signs of ADHD. That’s why experts believe that a lot of girls with ADHD are falling under the radar. They simply escape notice and go untreated for the condition, which is a shame.

Conclusion: Statistics show more boys have ADHD than girls, because girls with ADHD get the quieter type of ADHD and are going undetected, undiagnosed, and untreated.

#5 Misconception: ADHD is way over diagnosed

Reality Check: As awareness of ADHD grows, more people than ever before are being diagnosed with ADHD. It sometimes looks as though just about everyone has it. Because of this new awareness there is also a kneejerk tendency to diagnose and medicate children for ADHD without careful examination, when they act out in class. At the same time, research shows that ADHD is also under diagnosed among girls and minorities.

Conclusion: ADHD is both over and under diagnosed.

#6 Misconception: Kids can outgrow ADHD

Reality Check: ADHD doesn’t go away. Someone with ADHD is stuck with it for life. The symptoms may change over time and one can get better at coping with the symptoms of ADHD, but that’s not the same thing as outgrowing the condition. The symptoms continue into adulthood.

Conclusion: Kids with ADHD grow up to be adults with ADHD.

#7 Misconception:  Medication is the only thing you need to treat ADHD

Reality Check: Medications such as Adderall and Ritalin are the first line of treatment for ADHD. But there are other things one can do to help cope with the symptoms of ADHD. Behavioral therapy, for instance, can be very helpful in curbing impulsivity, and writing up and sticking to a schedule can be helpful for maintaining order in a child or adult’s everyday life. Using a system like Google Calendar is a great help here, as reminders can be scheduled, to prevent the person with ADHD from forgetting important tasks.

Conclusion: Medication is a big help for treating the symptoms of ADHD, but there are other helpful therapies and steps to take, as well.

#8 Misconception: Ritalin and other meds don’t help adults with ADHD

Reality Check: Ritalin and other stimulants used to treat ADHD are most useful in younger children. The medications help children to sit attentively and/or without fidgeting in class. After a few years of taking the medication, the children have effectively been trained to manage their symptoms and can often take  a smaller dose of medication or stop taking the medication altogether. But every case of ADHD is different and some children will continue to need medication. Sometimes, adults are not diagnosed as children, and the medication may be a tremendous help to them in managing their symptoms of ADHD.

Conclusion: Every case of ADHD is different. For some adults with ADHD, medication is very helpful for symptom management.

#9 Misconception: If you have trouble concentrating, you for sure have ADHD

Reality Check: At one time or another, everyone has trouble focusing. Not getting enough sleep, or being stressed out can affect your ability to concentrate. Vitamin deficiencies, depression, and even not getting enough exercise can make it difficult to concentrate, too. Most of the reasons behind an inability to pay attention are easy to fix and have nothing to do with ADHD.

Conclusion: ADHD should not be the only or even the first thing you think of, when you see yourself or your child having trouble concentrating.

#10 Misconception: ADHD isn’t so bad

Reality Check: People with ADHD struggle for a lifetime with managing even simple chores like paying the bills on time (which can affect credit ratings), or not leaving the sugar out of the recipe when baking a cake, for instance. The challenges of ADHD are also rough on relationships.  Finally, ADHD makes it hard to manage lifestyle issues, which leads to higher rates of obesity, which in turn may lead to higher levels of blood cholesterol, and a risk for heart disease, stroke, and diabetes.

Conclusion: Living with ADHD is hard. Minimizing the struggle and the suffering of those with ADHD is demeaning and uncaring.

Melatonin for Kids: Is it Safe

Melatonin for Kids: Is it Safe?Melatonin is a hormone that helps us know when to sleep and when to be awake. At night, our brains make and release more melatonin and this makes us sleepy. When the sun comes up, the brain slows its production and release of melatonin, so we feel wide awake.

It is light and darkness that tell the brain when to make and release melatonin. The brain produces and releases more melatonin at night in response to darkness, and less of it in the morning, when the sun is high in the sky. As long as there is sunlight or another source of light, such as a computer screen, we feel wakeful. When we stop looking at our computer screens and the sun sets for the day, we begin to get sleepy as our levels of melatonin gradually rise. This is how melatonin teaches us to be sleepy at night and awake during the day. This is called the sleep-wake cycle.

Some children have difficulties in falling asleep. Their parents, looking for a way to help them get the sleep they need, may  think about giving children melatonin pills. After all, melatonin can be found in every drugstore, in some health food stores, and in many supermarkets. You don’t need a prescription to buy melatonin.

Melatonin is thought of as a natural supplement. Since the body produces melatonin, we may see this hormone as both natural and safe. We also know that melatonin plays a role in helping us sleep and that without this hormone, we would toss and turn.

While some parents praise melatonin to the skies as a safe and natural sleep aid, other parents may express concern. Is it really safe to give children melatonin to help them sleep? Isn’t melatonin, used as a sleep aid, just a kind of sleeping pill?

Some parents find melatonin effective in helping their children sleep and continue to use it long term. They feel it is safe to do so, since melatonin is a natural substance created by the body. They see the supplements as giving natural melatonin production a boost.

Melatonin: Sleep Vitamin?

Parents may not even consult their physicians before giving their children melatonin. They reason that it would not be so easy to buy melatonin, if it was a true drug. These parents see melatonin as a sort of vitamin for sleep.

Children given melatonin may have sleep problems that are behavioral. That means that parents may not be strict enough in making kids go to sleep at a certain hour every night. It may be that the children are spending time at the computer, too close to bedtime, so that their brains don’t have time to make and release melatonin before bed. It seems obvious that instead of popping melatonin pills, it would be better to stop looking at a computer screen an hour or so before bed. That way, the body can work as it should.

Other children may have conditions that make it difficult for them to fall asleep at night. ADHD, for instance, can make it difficult for children to wind down and fall asleep at night. It’s even more difficult for kids to fall asleep at night if they are taking medication for ADHD, such as Ritalin, during the day. Autism is also a condition which can make it difficult for children to fall asleep at night. When children have true conditions that make it difficult to fall asleep and stay asleep throughout the night, here is a true reason to look into taking melatonin supplements.

But here too, parents can run into difficulties. Melatonin is not a sleeping pill. It needs to be taken at least an hour before bed. And melatonin is a hormone. Parents should consider whether they want their children taking a hormone supplement on a regular basis, long-term.

Sleep experts at the University of Adelaide, in Australia, are warning parents that melatonin, given to children as sleep aids, may cause serious side effects that show up later. No one knows for certain what melatonin, used for a long time during childhood, will do to the body. There have been no long-term studies.

The author of the Australian study, Professor David Kennaway says that the United States is the only place where melatonin is not regulated. Kennaway talks about lab studies showing all sorts of changes to body systems as a result of taking melatonin. He mentions changes to cardiovascular, immune, and metabolic systems and also says that melatonin affects reproduction in animals.

“Melatonin is also a registered veterinary drug which is used for changing the seasonal patterns of sheep and goats, so they are more productive for industry. If doctors told parents that information before prescribing the drug to their children, I’m sure most would think twice about giving it to their child,” Professor Kennaway says.

“The word ‘safe’ is used very freely and loosely with this drug, but there have been no rigorous, long-term safety studies of the use of melatonin to treat sleep disorders in children and adolescents,” says Professor Kennaway. “There is also the potential for melatonin to interact with other drugs commonly prescribed for children, but it’s difficult to know without clinical trials assessing its safety.”

Kennaway should know. He’s been researching melatonin for 40 years. His concerns, however, are going unnoticed and ignored. “Considering the small advances melatonin provides to the timing of sleep, and considering what we know about how melatonin works in the body, it is not worth the risk to child and adolescent safety,” says Kennaway, but his words are mostly falling on deaf ears.

Canadian physicians, such as Dr. Shelly Weiss, are also cautious about the use of melatonin for sleep problems in children. “Melatonin is not a magic pill. It’s a hormone,” says Weiss.

Still, for children with chronic sleep onset insomnia, which is the failure to fall asleep within 30 minutes after laying down, melatonin can be a godsend. Chronic insomnia is no joke. Lack of sleep can lead to depression, learning difficulties, and poor school performance. If melatonin can help such children, for whom sleep never comes easy, then it is important to consider melatonin as an available option.

How many children suffer from chronic insomnia? Experts believe that some 15%-25% of all children and adolescents find it hard to sleep on a regular basis. Melatonin does work for most of them and with few side effects. But again, there are no long-term studies to prove that melatonin is safe for children.

One National Institutes of Health (NIH) study followed children with ADHD taking melatonin regularly for almost 4 years and  found no terrible long term side effects or issues. Not nearly long enough to be called a long-term study. And even the NIH recommends against melatonin pills for children because they might be unsafe, and because as a hormone, melatonin could affect a child’s development.

The bottom line is that melatonin should not be thought of as some sort of vitamin pill that makes the body work better. If your child is having sleep problems, you shouldn’t be turning to melatonin first. And certainly not without consulting your child’s doctor.

Helpful Sleep Tips

If your child has trouble falling asleep at night, here are some helpful steps to try:

Put Sleep First
If your child is busy with lots of after school activities, this may be the reason he is not getting enough sleep. And sleep isn’t something he can make up in his spare time. Children need a consistent amount of sleep every night. Does your child go to extracurricular classes and then come home to do his homework until quite late? If so, he may end up going to sleep too late to get enough rest. The solution? Cut out those after school activities. Sleep has to come first.

Stick to the Plan

Children should have a regular bedtime and stick to it every night. This helps regulate your child’s sleep-wake cycle: his body clock. Give your child an hour to wind down and do the things that help make him ready for sleep: bath, book, soft lights, and finally, lights out.

No Screens in the Bedroom

Anything that has a bright screen, such as an iPad or tablet, a cell phone, or a television, should be thought of as light sources that keep your child’s brain from making and releasing melatonin.  A no screens in the bedroom rule is a good one.

No Screens Before Bed

Your child’s brain will make and release melatonin to help him get sleepy, as long as he’s not looking at a screen. So put a limit on using electronics. Make a no screens from at least an hour before bedtime rule. Give your child’s body a chance to make its own melatonin. That is how things are supposed to work.

Get a Checkup

If these measures don’t help your child fall asleep at night, talk to the doctor. Your child may benefit from seeing a sleep specialist. The specialist may use cognitive behavioral therapy to help your child sleep. And he may end up suggesting melatonin. If so, the expert will tell you how to use it, and will monitor your child’s progress.
Have you used melatonin to help your child sleep? Does it work?  Do you have any concerns about your child using melatonin?

Immunization Debate: Do You Say Yes to Vaccines?

Immunization Awareness Month: Do You Say Yes to Vaccines?
(credit: ChameleonsEye /

Immunization Awareness Month is upon us which means we wake up the sleeping beast: the debate for and against vaccination. There’s a lot of hot feeling on either side of the debate which is only natural. These are our children we’re talking about and their lives are in our hands. As parents, it’s our duty to protect them.

But just try and read through all the medical mumbo jumbo on the web. Most parents are not doctors. We just want to understand what it is we need to know about immunization to make the right decision, for or against.

And then of course there’s the problem of whose “facts” to believe. How can you, as a parent without medical training, know which facts about immunization are true? Is the decision to vaccinate your child going to come down to a crapshoot, or perhaps, a leap of faith (to one side or the other)?

Let’s take a look at the facts, and the pros and cons of immunization, dumbed down:

Fact: Immunization Recommended/Not A Law

The Centers for Disease Control (CDC) says children up to age six should be getting 28 doses of 10 vaccines. But that’s only a recommendation. There is no federal law that says children must be vaccinated. In other words, the medical establishment says you should vaccinate your child, but you won’t go to jail if you don’t.

Fact: Immunization A Must For Public School Kids With Few Exceptions

All 50 states require some vaccinations for children going to public school. Almost every state offers exemptions on the grounds of medical or religious issues while some state allow exemptions for philosophical reasons. In other words, if your religion forbids vaccination or your child has a medical problem which means he can’t be vaccinated, you can get out of vaccinating your child. If you are against immunization for other reasons, you may be able to get out of vaccinating your child, depending on where you live. You can check what laws apply in your state HERE.

Pro: Immunization Is Safe/Reactions Rare

Bad reactions to vaccines are very rare. Experts don’t have an exact statistic, but agree that the odds are very small of having a severe allergic reaction (anaphylaxis) to a vaccine. Some say the number is one severe allergic reaction per every several hundred thousand vaccinations, while other experts say the chance of a bad reaction is one in one million vaccinations.

Con: Immunization Is Risky/Dangerous

Some kids do actually die as a result of getting vaccinated. While reactions to vaccines are rare, they do happen to an unfortunate few. Bad reactions to vaccines include seizures, paralysis, and even death.

Pro: Immunization Prevents Illness, Saves Lives

Those in favor of immunization say that vaccination is the greatest medical advancement of our time. Thanks to vaccination, smallpox, polio, diphtheria, rubella (German measles), and whooping cough have been wiped out, at least for now. These are diseases that have killed children in the past. Pro-immunization medical experts estimate that vaccines have saved millions of children’s lives.

Con: Immunization Unnecessary/Risk Not Worth Taking

Those against immunization say that a child’s immune system can fight against most diseases without any help from vaccines. They say that putting the substances of a vaccine into a child’s body can not only cause serious side effects but may be the trigger for a lot of the health problems and learning disabilities we see in children today, such as autism, diabetes, and ADHD.

Pro: Link Between Immunization And Autism Not Proven

Andrew Wakefield had a study published in 1998 in the Lancet, an important medical journal. The study showed a link between the Measles Mumps Rubella (MMR) vaccine and autism. As a result of the study, many parents stopped vaccinating their children. They feared their children would develop autism as the result of immunization.

Wakefield’s study was small. There were only 12 children studied. Eight of them supposedly developed symptoms of what Wakefield called “regressive autism” within days of receiving the shot. The problem was that no one could replicate Wakefield’s results, though they tried again and again.

The results of a study are accepted only after others repeat the study and gets the same results. That just didn’t happen with Wakefield’s study. By 2004, people were getting suspicious and a reporter began investigating. Finally, Wakefield was called before a review board and in 2010, was exposed as a complete fraud. The Lancet withdrew the paper saying their experts been deceived, and Wakefield lost his medical license.

Even though Wakefield was proven a fraud, parents continue to claim their children developed autism as a result of immunization. Other parents may not have heard that Wakefield was a phony. They continue to believe that the MMR vaccine causes autism. You will see plenty of web pages that continue to insist there is a link between autism and the MMR shot.

The Wakefield study is believed to be the reason for the Disneyland measles outbreak in California. Parents stopped vaccinating their kids after Wakefield’s study was published. They were scared  their children would develop autism.

While most parents in American vaccinated their children (at least until the Wakefield report), parents in poorer countries may not have had good medical care for their children. Children in those countries may be vulnerable to diseases like the measles, because they were not immunized. If a child with measles should come to visit Disneyland in America, and spends time with children who were not vaccinated, those children can get and spread the measles.

Some parents who stopped vaccinating their children because of the Wakefield report thought their children were safe from the measles, because vaccination had for the most part wiped out the disease in America. They thought: “Why vaccinate our children when there is no measles in America? Why risk autism or worse, when the disease has been mostly wiped out?”

The problem is, so many parents had this thought, that many American children ended up getting the measles as a result of contact with a tourist at Disneyland. The Disneyland outbreak brought more hot debate about immunization, both for and against. The media scrambled to cover it all.

One media story did a lot to explain how immunization works. The father of six year-old boy, Rhett Krawitt, asked school officials not to let kids come to school who were not vaccinated because of their families’ religious or personal beliefs. Rhett is getting over leukemia and it would be dangerous for him to get the measles vaccine. His system is too weak and the vaccine could make him actually get the measles. Because he is so weak, measles could be especially dangerous to him and might even kill him.

Since Rhett cannot be immunized, his parents feel it is dangerous for him to be around healthy children who have not been vaccinated. They fear that with the all the measles outbreaks, Rhett could be exposed to the measles from these children. It seems unfair to them that their child has to stay home from school because of parents who refuse to vaccinate their healthy children.

There are many other issues around the immunization debate. For instance, some people say that vaccines are unethical because some of the ingredients of the vaccines are animal byproducts, while other ingredients may cause cancer. Part of the debate on immunization has to do with government: should the government force people to get vaccinated or would that take away peoples’ basic freedoms.

A good website for reading more about the pros and cons of vaccination is the webpage on vaccination at

Nutrient Dense Diet: The New Old Way to Eat

Nutrient dense diet tips flood the web. It’s the new way to eat. But actually, it’s the old way to eat. It’s how people ate in the days before sodium-laden, sugar-laden, fat-heavy processed foods. And it’s how we’d eat now if we weren’t so lazy.

The nutrient dense diet is simple, and as a matter of fact, it’s not a diet at all but a way of life. It boils down to this: eating foods that nourish the body and shunning those that don’t.

What does that mean, exactly? It means that before you put anything in your mouth, you stop and think if it’s as wholesome as possible. It means changing the way you cook so that if you’re planning a side dish, you choose brown rice over white, whole wheat pasta over regular, whole grains over refined. It means NOT EATING foods that aren’t good for you, because there’s always a choice. You can always eat something in which every calorie provides precious nutrients, instead of grabbing that bag of chips and rationalizing to yourself that potatoes are a vegetable.

Nutrient Dense Diets: More Planning

I’m not going to kid you: it’s a lot harder to eat a nutrient dense diet. I know because I began eating a nutrient dense diet just after the Passover holiday ended. It takes more planning, careful shopping, and means more work in the kitchen, too. It also takes discipline to say no to the non-nutritious foods I’ve grown to love.

Now if you think about it, you fed your infant this way—fed him a nutrient dense diet. You prepared wholesome meals for your baby and never would have thought of giving him junk. That is, until he grew a bit bigger and you thought it would be cute, for instance, to give him a taste of cotton candy, or ice cream, or a French fry.  And things went downhill from there.

Once we get a taste of high calorie foods, the brain develops a thing for those foods. It’s a harbinger to the caveman days when surviving meant packing in as many calories as possible at any one time, because cavemen didn’t know when their next meal would be. It all depended on the day’s catch or hunt and whatever produce could be foraged in the wild.

Foods with large amounts of salt, sugar, combined with built-in fats also provide lots of sensory pleasure and when we eat them, our brains tell us to keep coming back for more. Unlike in the days of our cavemen ancestors, however, the food never runs out. We can always buy another bag of chips. Hence, the problem of childhood obesity in America has, if you’ll excuse the pun, grown enormously, with one in every six children qualifying as obese.

Fast food restaurants and junk food makers have latched on to this notion that the brain is attracted to high-calorie food. They pack in the calories in the food items they plug and layer the flavors, using this time-proven formula to create addictive foods. It’s just that simple.

Nutrient Dense Diet Vs. Processed Foods

Adopting a nutrient dense diet, means shunning popular processed foods and snacks. In so doing, we go up against years of food and marketing research underwritten by mega companies determined to sell you products. Fresh, home-cooked brown rice with stir-fried chicken breast and broccoli florets is going to have a hard time competing with a Big Mac and fries. It’s also going to have a hard time competing with packaged prepared versions of the same thing because your homemade version won’t have all the sodium and artificial flavors to which our tongues have grown accustomed.

And I’m going to level with you: the nutrient dense diet is not something your child will automatically (if at all) embrace.

But as parents, we have a duty to try and provide our families with a nutrient dense diet, and especially our children who are still growing and learning. They need the nutrients provided by wholesome foods to be healthy and do their best in school. Moreover, getting children used to a nutrient dense diet, sets them on the road to a healthier future as adults, too. Whole foods have antioxidants and other good things that protect us from illnesses like cancer.

You just can’t get that in a Big Mac.

Nutrient Dense Diet Superfoods

Need some ideas on how to get your children started on a nutrient dense diet? Here are some foods to try adding to family meals:

Basil is jam-packed with good things like antioxidants and vitamins A, C, and K. The herb is also a great source of iron, calcium and potassium and can aid digestion. If your child is the adventuresome type, use basil to whip up a pesto sauce for pasta or chicken breasts. If, on the other hand, your kid freaks out at the sight of anything green, mix it into meat balls. He’ll never know it’s there.

Pesto anyone?

Black Beans

Beans are a nutrient dense diet must and a fantastic source of protein, fiber, and calcium—things that kids may not get enough of on their own. The darker the bean, the more nutrients provided. And by the way, beans fight high cholesterol and heart disease. Make refried bean wraps or quesadillas or set out some black bean hummus with carrot sticks for some satisfying crunch.

Blueberries are way up there on the list of healthiest fruits. The plump little guys are filled with antioxidants to protect the heart, prevent diabetes, and improve brain function. Now new research shows that blueberries can help take off belly fat, which is linked with obesity and metabolic syndrome. Toss blueberries into salads or a bowl of granola, eat them for dessert, or make a blueberry smoothie with yogurt and cinnamon (add honey for children over the age of one year) for a cool, nutritious treat.

Blueberries: eat ’em until your tongue turns purple.


Cabbage has a milder flavor than most greens and kids like it because of the crunch factor. This superfood protects the body against cancer and is good for the digestion. Make an Asian cabbage and noodle salad, something guaranteed to please.

Cinnamon should be a part of every nutrient dense diet. The spice stabilizes blood sugar to prevent mid-morning slump. Add cinnamon to anything you can: baked goods, cereals, yogurt, and desserts.

You can add it to almost anything for that nice spice kick.
You can add it to almost anything for that nice spice kick.

We’re not talking hot cocoa here, but cocoa powder, which is chock full of flavonoids, good for blood pressure, the heart, and guarantees a good checkup at the dentist to boot. Cocoa may even help protect your child’s skin from sun damage. Avoid Dutch process cocoa if you want to get the health benefits from flavonoids, and add cocoa to pancake or waffle batter, French toast, or um, just eat your chocolate straight up. 70% cocoa and up is best for the nutrient dense diet.


Vitamin D is something we mostly get from the sun. But eggs are a natural food source for vitamin D, which aids the body in absorbing calcium. Eggs are a great protein source and kids who eat eggs for breakfast are less likely to suffer hunger pangs in the classroom way before it’s time for lunch. Eggs keep kids (and adults) feeling full longer.

Blueberries were mentioned above, but really, any fruit is good for children. Each type of fruit has its own nutritional benefits and of course, fruit offers a sweet form of dietary fiber. Try to vary the fruit you serve your child to get the full complement of vitamins and minerals.

Greek Yogurt
Greek yogurt isn’t just a fad—it’s really an almost perfect food and certainly belongs in the nutrient dense diet. The white stuff has probiotics, a kind of good bacteria that boosts the immune system and aids digestion. Greek yogurt also has more protein and less sugar than any other type of yogurt. Use a healthy sweetener, for instance honey in kids over one year, or try some maple syrup, to make Greek yogurt nutritious and delicious.

Greek yogurt: it's creamy and so good with maple syrup.
Greek yogurt: it’s creamy and so good with maple syrup.

Dairy products provide protein and calcium: fuel for the brain, bones, body, and teeth. Fortunately, kids love cereal and melted cheese, so it’s not hard to get dairy into their diets!

Nuts have the good kind of fat that fights high cholesterol and protects the heart. Kids also need healthy fat for their growth and development. A handful of almonds as a snack can give your child extra energy for the morning ahead. Eating a spoonful of peanut butter before bed can prevent mid-morning slump.

Nuts have healthy fats. Not to mention crunch!
Nuts have healthy fats. Not to mention crunch!

It’s proven: kids who eat oatmeal for breakfast pay better attention in school. Oatmeal has lots of fiber so it takes a long time to digest, which keeps kids energy levels steadier over the course of the morning.

Salmon has those special omega-3 fats that are good for the heart and brain. Some say this fish-derived fat even serves as a treatment for ADHD. Salmon also fights inflammation and besides, it’s delish and versatile, so definitely belongs in the nutrient dense diet. Chances are, you won’t have a hard time finding a way to prepare salmon so your child will eat and enjoy this beautifully pink fish. Salmon burgers will always be seen as a treat.


Soy has low-fat protein and calcium and it wards off cancer. Make a stir-fry with tofu cubes or whip up silken tofu to make smoothies. Looking for a new snack food? Try boiling edamame (green soybeans) in the pod and after draining, toss in some soy sauce and sprinkle on some salt. Kids love shooting them out of their pods.They’re addictive!

Tomatoes fight cancer, but mostly when they’ve been cooked long enough to release their lycopene. That means red sauce. Yup. Red sauce belongs in the nutrient dense diet. Luckily, kids love anything with red sauce: lasagna, tacos, spaghetti and meatballs, chili, and of course, PIZZA. There’s a reason that so many tomato recipes include olive oil, which helps the body absorb more tomato nutrients.

What’s your favorite superfood for making sure your child eats a nutrient dense diet?


Celiac Disease: Does Your Child Get Sick from Gluten?

Celiac Disease: Does Your Child Get Sick from Gluten?

Celiac disease is an incurable autoimmune condition in which eating foods with gluten can cause damage to the small intestine. Gluten is a protein found in wheat, rye, and barley. When people with celiac eat foods containing this protein, their bodies respond by launching an attack on the small intestine.

Celiac tends to run in families, so if someone in your family has celiac (a parent, child, or sibling), you have a 1 in 10 chance of getting it, too. It’s thought that  1 in 100 people have celiac worldwide, though the disease often goes undiagnosed. Experts believe that 250,000,000 Americans may have undiagnosed celiac disease, putting them at risk for all sorts of long-term health issues.

In the healthy person, the small intestine is lined with hair-like villi (pronounced VILL-eye) that look like the fibers in a carpet. These villa help the gut take in the nutrients from the food we eat. When the person with celiac eats gluten, it is these villi that are attacked by the body’s immune system. Damage to the villi means that nutrients from food cannot be properly absorbed by the body.

The villi in the gut of a healthy person makes the small intestine look as though it is lined with a plush carpet. In the person with celiac, the gut will look less like a carpet and more like a tile floor. If you spill water on a rug, the fibers will soak up the water. If you spill water on a tile floor, the water just sits on the surface until it dries up. In the same way, in a person with celiac, the nutrients in food will not be absorbed by the gut, because the nutrient-absorbing villa are damaged, worn down, with the nutrients having nowhere to go.

WikipedianProlific at the English language Wikipedia [GFDL ( or CC-BY-SA-3.0 (], via Wikimedia Commons
What Celiac looks like. (via Wikimedia Commons)

A person can develop celiac disease at any age, as a response to having eaten foods or taken medications containing gluten. When celiac goes untreated, other health problems can develop. Some of the health issues that can affect people with celiac include autoimmune diseases like multiple sclerosis (MS) and Type 1 diabetes, anemia, infertility, migraines, epilepsy, osteoporosis (bone loss), intestinal cancer, and an itchy skin rash called dermatitis herpetiformis.

There’s no cure for celiac and the only treatment for the disease is to avoid eating anything containing gluten (for instance bread and beer), and that’s forever. Even a small amount of gluten, for example crumbs on a cutting board, can bring on an attack that can damage the small intestine. People with celiac have to check the labels of everything they eat and drink. Sometimes, lipsticks will have gluten and this can be a problem, too, since lipstick tends to get chewed off and ingested by the wearer.

Celiac disease has other names. The other names for celiac disease include coeliac disease, celiac sprue, non-tropical sprue, and gluten sensitive enteropathy.

Chronic Conditions From Untreated Celiac

The damage from untreated celiac can bring on any of these long-term health conditions:

  • Iron deficiency anemia
  • Early onset osteoporosis or osteopenia
  • Infertility and recurrent miscarriage
  • Lactose intolerance
  • Vitamin and mineral deficiencies
  • Central and peripheral nervous system disorders
  • Pancreatic insufficiency
  • Intestinal lymphomas and other GI cancers (malignancies)
  • Gall bladder malfunction
  • Neurological manifestations including migraine, ataxia (lack of involuntary muscle coordination), epileptic seizures, dementia, , neuropathy (nerve pain), myopathy (muscle tissue disease), and multifocal leucoencephalopathy (damage to the brain’s white matter)

Celiac is not easily diagnosed because different people with celiac will have different symptoms. There are some 300 symptoms that are known to come with celiac. Some of these symptoms look like tummy trouble and other symptoms have nothing to do with the stomach. Meantime, some people with celiac don’t seem to have any symptoms at all. Still, they could be damaging their small intestines and not realizing it, leaving them at risk for all sorts of long-term health issues.

Symptoms of Celiac Disease in Children

Children with celiac disease are more likely to have stomach problems. Here are some of the symptoms that are common in children with celiac:

  • Bloated stomach, stomach pain
  • Often has diarrhea
  • Vomiting
  • Constipation
  • Light-colored, smelly or fatty bowel movements
  • Losing weight
  • Always tired
  • Cranky, acts out
  • Permanent teeth have thinning or pitted enamel
  • Slow growth or late-onset puberty
  • Short for age
  • Doesn’t seem strong or healthy (failure to thrive)
  • Attention Deficit Hyperactivity Disorder (ADHD)

Other Celiac Symptoms

Adults with celiac don’t always have stomach distress. Only one-third will report having chronic diarrhea. On the other hand, adults with celiac are more likely than children to have the following symptoms:

  • Iron-deficiency anemia not explained by diet
  • Fatigue
  • Joint and bone pain
  • Arthritis
  • Osteoporosis (bone loss)
  • Depression or anxiety
  • Tingling or numbness in the hands and feet
  • Migraines or seizures
  • Skipped menstrual periods
  • Infertility or recurrent miscarriage
  • Canker sores in the mouth
  • Dermatitis herpetiformis (a very itchy blistery skin rash)

Celiac Disease Diagnosis

Celiac diagnosis involves two steps:  a blood test to screen for the possibility of celiac and a biopsy of your small intestine to confirm or disprove the disease. Anyone over the age of three with celiac symptoms or those who have close relatives (parent, child, sibling) with celiac should be tested for celiac because of the danger of long-term health issues. If you have celiac, there’s a 1 in ten chance your close relatives will have it, too.

Since celiac cannot be cured, it is essential that once diagnosed, a strict, no-gluten diet is followed for life. People with celiac need close monitoring by a doctor to make sure that they’re sticking to their gluten-free diets and to ensure that any nutritional deficiencies are treated. The doctor can also watch for and treat any of the health conditions that tend to come with celiac.

Screening for celiac involves taking one of several blood tests. The most common blood test used to screen for celiac disease is the tTG-IgA test. If the results of your blood test show you might have celiac, your doctor may decide to send you for a biopsy of your small intestine. The biopsy is the only way to know for sure whether or not someone has celiac. In a biopsy, a small sample of tissue is taken and sent to a lab to be analyzed. The doctor will base the diagnosis on the lab findings and also from the patient’s response to a  gluten-free diet.

During the screening and biopsy it is important that you NOT be on a gluten-free diet. In fact, experts recommend that those on a gluten-free diet who want to find out if they have celiac should take the “Gluten Challenge.” This means eating the equivalent of 4 slices of bread for 1-3 months followed by an endoscopic biopsy of the small intestine, an outpatient procedure. In this case, the blood test is unnecessary.

Other Celiac Considerations

Celiac is a response to the ingestion of gluten, or eating and drinking products with gluten. But breathing is considered similar to ingestion. That means it’s probably not a good idea for someone with celiac disease to work in a bakery, where he would be likely to inhale flour particles in the air.

While gluten can be absorbed through eating, drinking, and breathing, it cannot be absorbed by the skin. That means you don’t have to worry about using shampoos and soaps that might contain gluten, if you have celiac.

Lipstick, on the other hand, could be a problem for you, if it contains gluten. Best to stick with gluten-free lip products.

Lipstick can contain gluten.
Lipstick can contain gluten.

Celiac and School Lunches

The Americans with Disabilities Act (ADA) means that schools are require to provide children with celiac gluten-free lunches. That doesn’t mean that your child will receive a gluten-free version of mac and cheese on the day that the other “normal” kids are having the normal version of that classic. Children with a 504 plan or those who can document their disability, are entitled not only to lunch but to a plan for classroom management of their celiac disease. That might mean that small children with celiac will not have access to paste or other gluten-containing art class items they might taste or put in their mouths. It might mean that such children will not have field trips where they might come in contact with gluten, such as a tour of a bread factory.

Old-fashioned flour paste can be dangerous to small children with celiac who might decide to give that paste a taste.
Old-fashioned flour paste can be dangerous to small children with celiac who might decide to give that paste a taste. IgorGolovniov /

Celiac? Or a Gluten Sensitivity?

Not everyone who is sensitive to gluten has celiac. Some people have the same symptoms as those with celiac, but without intestinal damage and without having blood test results that show the presence of celiac disease antibodies. These people are said to have non-celiac gluten sensitivity.

Doctor are still learning about non-celiac gluten sensitivity. Right now, there is no way to diagnose the condition accurately or know how many people really have this condition. If you don’t have a wheat allergy and you don’t have celiac, but you feel better when you avoid gluten, you can be considered to have non-celiac gluten sensitivity.