Ep. 5 – The 5R Solutions for Everyday Living
This is the fifth segment in a series about executive functioning (EF): our “5 R Solutions for Everyday Living.” In this episode, we discuss how and why “Rewards and Reinforcers” can alleviate problems with EF.
Rewards and reinforcers are an important and valuable component for supporting children practice and develop EF skills.
By definition, a “reinforcer” is something that increases the likelihood that a desired behavior will increase. Positive reinforcement is an extremely powerful tool—arguably the most powerful tool you have in your toolbox as a parent or teacher! And the research says positive reinforcement produces faster and longer-lasting results than punishment!
Rewards and reinforcers come in many forms, including “edibles,” experiences, tangibles, activities, and social interactions. Another powerful reinforcer is affirmations! Rewards and reinforcers do not have to be huge or cost money. They can be very simple. Examples include putting a marble in a jar, a sticker on a chart, or keeping a weekly log in a journal. The reward for a completed task or goal could be relaxing with a movie, or spending one-on-one time together with someone special.
When I bring up rewards and reinforcers, parents and teachers are sometimes resistant to the idea because they are not on board with “paying kids” to do things they should be doing anyway. I can totally understand how it might feel this way at first. However, it is human nature to seek what is pleasurable and avoid what hurts. We are wired this way! So, use this innate part of human nature to help your children and students learn skills, build strategies, and find success! And don’t worry, once a strategy or skills is established and integrated into daily living, the need for the reinforcer will fade away.
In addition to serving as an incentive, rewards and reinforcers also help a child self-monitor and mark progress. If you recall, self-monitoring and completing “the final lap” are both EF skills. Reinforcers help the child monitor and mark that a task is complete. For example, when the morning check list is finished, a marble is placed in the jar. Five days of morning checklist completion leads to five marbles. And five marbles might equal an hour of game time with Dad!
In summary, the importance of rewards and reinforcers cannot be overstated. They tap into a fundamental trait of human nature: the tendency to seek pleasure or happiness, while avoiding things that are less enjoyable or lead to suffering. Rewards and reinforcers motivate the behaviors that we want to see in others (rather than punish the behaviors that we don’t want). And, when used correctly, they help an individual monitor progress towards an end-goal. Give these a shot and see what a difference positive reinforcement can make in your child’s life!
-Dr. Katen
©2021 Individual Matters, LLC. All rights reserved. Feel free to republish so long as credit is given.
- Published in ADHD and Executive Function, Dr. Katen's Blog, Healthy Living, Learning, Achievement, and Academics, neurodevelopmental disorder
Not All Learning Assessments are Created Equal
A Look at the Different Types of Learning Evaluations
There are many different types of testing available for learning-related issues.
Not All Learning Assessments are Created Equal
Where and why you seek testing for your child (or yourself) will determine who evaluates your child, which tests are administered, how results are interpreted and communicated to you, what findings and recommendations follow, and the total amount of time and costs involved in the process. Discussed below are a few different types of testing, as well as related factors parents should consider when choosing the most appropriate option for their children.
Why are you seeking an assessment?
Answering this question is the first and most important step in the assessment process. What are your desired outcomes for testing? Are you hoping to understand your child’s gifts? Would you like to help your child understand his or her temperament? Are concerned about your child’s academic performance? Do you think your child may have a learning or attention disorder? Are you uneasy about your child’s emotional, social, or behavioral functioning? Has your school or pediatrician recommended testing?
There are all sorts of reasons that parents consider having their children tested. By outlining your goals, you will have a clearer idea about what type of testing is most appropriate for your child.
Who should conduct a learning assessment?
There is not a simple answer to this question. Many types of professionals administer “learning assessments,” but they often have dissimilar qualifications. To complicate the matter, professional credentials and licensure vary by state. For that matter, so do the ways that schools classify learning issues.
Regardless where you live, a licensed clinical psychologist (Ph.D. or Psy.D.) has the prerequisite education and licensure for conducting psychological testing and issuing clinical diagnoses. But not all psychologists specialize in testing – some only provide therapy, while others assess mental health rather than educational performance or neuropsychological functioning. Any professional – psychologist or not – who provides psychoeducational testing should have not only the minimal licensure and credentials, but also specialized training and experience in assessment.
Typically, schools and colleges will only accept diagnoses and recommendations from an evaluation provided by a doctoral-level psychologist. Furthermore, these institutions require “gold standard” instruments – standardized tests produced by reputable companies and backed by years of scientific research.
What type of learning assessment will you need?
Depending on your goals, there are a variety of assessment options:
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Comprehensive psychoeducational assessment
This is a wide-ranging yet in-depth approach to understanding your child as a “whole person.” Comprehensive psychoeducational assessment evaluates neurological processes and cognitive functioning (IQ, attention, memory, processing speed, executive function, etc.), as well as academic achievement (skills in math, reading, and writing). Furthermore, the process will assess visual-motor integration, sensory processing, social and emotional functioning, visual and auditory processing, behavior, temperament and personality, gifts and strengths, learning styles, overexcitabilities, interests, life experience, and neurodevelopmental disorders. A skilled evaluator will be adept not only at administering the actual tests, but also at analyzing and integrating the results (including both quantitative and qualitative data). Essentially, this process should produce a manual that explains your child’s overall “operating system.” Since it evaluates multiple facets of your child – and not just learning issues – this process also supports conclusive diagnosis, generates specific recommendations, and guides the referral process.
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Learning disability (dyslexia) testing
This type of assessment is recommended for the purpose of evaluating and diagnosing a suspected learning disability. In these cases, a qualified professional is someone who holds appropriate licensure and can issue a correct and pertinent diagnosis. The learning assessment will measure and compare a child’s IQ with his or her academic achievement – the traditional method for identifying a learning disability. If indicated, diagnosis of a specific learning disorder by a clinical psychologist qualifies a child to be considered for learning accommodations at school. While a “learning specialist” might test for dyslexia, it is important to understand that “dyslexia” is not a clinical diagnosis (per the DSM-V). By itself, identification of dyslexia may not be sufficient to qualify your child for special services at school. Furthermore, limited assessments such as these may not reveal or conclusively rule out other causes of learning problems – in fact, sometimes they produce more questions than they answer.
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ADHD assessment
Attention-Deficity/Hyperactive Disorder (ADHD) is a complex neurodevelopmental disorder (not a learning disorder). Who can diagnose ADHD? Generally speaking, only a medical doctor (M.D.), psychiatrist (M.D.), or psychologist (Ph.D. or Psy.D.). In most cases, diagnosis is based solely upon results of behavioral checklists and interview with the child and parents. However, there are many reasons for a more in-depth evaluation. As a result, some psychologists assess ADHD using not just checklists and interviews – but also neuropsychological measures of IQ, attention, memory, and executive function. Unfortunately, there is no single, decisive test for identifying ADHD.
What are the costs of a learning assessment?
Just as the types and scopes of testing vary, so do the costs. Some learning professionals and tutors provide “learning assessments” for as little as $300 or $400. These can be completed in a few hours and may (or may not) utilize standardized tests of IQ or achievement, result in diagnoses, or provide individualized recommendations. Unless completed by a doctoral-level clinical psychologist, these evaluations may not qualify a student for accommodations at school.
Evaluations conducted by schools may be more extensive, but schools do not diagnose learning disorders or ADHD. Schools may assess for learning “issues” like dyslexia and make recommendations for special education services, but only psychologists and doctors diagnose clinical or medical disorders. Furthermore, school evaluations are not intended to assess your child as a “whole person” – only whether he or she has a condition that affects functioning in the classroom. Since educational classifications and resultant accommodations are based upon your child’s current grade-level and classroom functioning, they may not be pertinent a year from now.
Finally, comprehensive psychoeducational assessments are conducted by doctoral-level clinical psychologists. Prices typically range from $1500 to $5000. The entire process involves 8-15 hours of testing, twenty or more hours of scoring and analysis, an extensive and detailed written report (15-25 pages), a feedback session with parents, and school consultation. Clinical diagnosis of a learning disorder by a psychologist who utilizes “gold standard” test instruments is often required by schools before they will consider a student for school-based learning services and supports. Furthermore, a high quality assessment will accurately capture your child’s gifts, strengths, personality, and underlying areas of challenge (the “whole person”) – and stay relevant for years to come.
Want more information?
As a parent, you justifiably want to ensure that whoever evaluates your child can deliver outcomes that support your specific goals for testing. How do you do this?
One way to find out is simply to call their offices and inquire. Some will provide basic information over the phone.
Another option is to schedule an initial consultation. During this meeting, you can ask the assessment professional about his or her background and scope of expertise. Also, find out what specific tests they use, whether they issue clinical diagnoses (as contained in the DSM-V), and if their findings can and will be accepted by your child’s school. You might also inquire about their overall philosophy towards assessment, learning, and ADHD – in other words, how they approach testing, and why. While psychologists are unlikely to share client testimonials (due to patient privacy policies), they might offer generic samples of past reports. Furthermore, consultation with an experienced assessment psychologist sometimes results in immediate referrals that save you time and money. In any case, this initial step will give you solid information – a “road map” for action – that helps you to be more informed about, and comfortable with, the testing process.
– Dr. Katen
“Live the life you were meant to live!”
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
10 Myths About ADHD
Perspectives of a Clinical Psychologist
Although Attention-Deficit/Hyperactive Disorder (ADHD) is a household word, there are a lot of misunderstandings and misconceptions about the disorder.
Below are 10 myths about ADHD that I frequently encounter in the media and when working with families.
1. ADHD is a straightforward diagnosis.
This may seem true based upon the prevalence of ADHD in the U.S.. Indeed, one might be tempted to assume the diagnosis is uncomplicated, simple, or quick. In fact, the opposite is true. ADHD is a complex disorder and diagnosis should only be made following a careful evaluation by a licensed clinical psychologist or other qualified professional. The abundance of ADHD diagnoses has led some to ask whether the disorder is being been handed out too lightly, while others suggest that ADHD may also be “under-diagnosed” in many cases. Both arguments undoubtedly have their merits. In the absence of a comprehensive assessment by a qualified professional, the risk of ADHD misdiagnosis is a legitimate concern.
2. ADHD is a behavioral disorder.
In fact, ADHD is a neurodevelopmental disorder. While ADHD is well known for its behavioral symptoms, the underlying cause and mechanisms of the disorder are neurological. As such, the diagnostic process should take into account not only an individual’s behaviors, but his or her overall neurodevelopmental profile. While behavioral checklists are a good first step, results to not ensure accurate diagnosis. Checklists should be supported by clinical interview and neuropsychological assessment by a psychologist or other professional with expertise in diagnosing ADHD.
3. ADHD is an attention deficit problem.
Actually, ADHD is an attention regulation problem. In fact, many individuals with ADHD can “hyperfocus” on a topic of interest for long periods of time. Their problem is not that they cannot sustain attention to a task; it is that they cannot regulate (i.e., moderate or switch) their attention. Sometimes their attention is fleeting, while other times it’s laser-focused. The possibility of ADHD should not be discounted in individuals who demonstrate the ability to work on a project of interest or play video games for hours at a time.
4. ADHD only affects attention.
Unfortunately, this is not true. If undiagnosed or ignored, ADHD can lead to other problems like anxiety and depression. The consequences can be enormously damaging across an individual’s social, academic, and professional lives. Having ADHD is like walking across a minefield every day of your life. It’s not a matter of whether you will step on a mine; it’s simply a matter of when. Years of living with fear of making mistakes, forgetting, and “screwing up” is not only frustrating and confusing, it’s possibly traumatic. It’s little surprise that the disorder has been correlated with low self-esteem, anxiety, and depression in both kids and adults.
5. Behavioral symptoms are sufficient for diagnosing ADHD.
This is a common misconception. Just because an individual exhibits the symptoms of ADHD does not mean he or she actually has the disorder. After all, ADHD shares many behavioral symptoms with other problems like anxiety, depression, stress, impaired executive function, auditory processing disorder, visual processing weaknesses, and other neurological pathologies/abnormalities. An evaluation that takes into account an individual’s overall neurodevelopmental profile – and not just his or her behavioral symptoms – will improve the probability of accurate diagnosis.
6. ADHD looks the same in everyone.
Fact: ADHD looks different in everyone.
Again, not true. We are each unique in our circumstances, temperaments, interests, abilities, skills, strengths and weaknesses. Not surprisingly, ADHD affects everyone differently. Inattention, hyperactivity, and impulsivity can manifest in different ways and at different times for different people. For example, extroverts with impulsivity may display more obvious symptoms than an introvert who works to hide these symptoms. Some kids can appear hyperactive, while others seem quiet and reserved. Certain students struggle more with ADHD when they are overstimulated, while others are more challenged when under-stimulated. Alternatively, visual-spatial learners can look inattentive for reasons that have nothing to do with ADHD. And whenever environmental and learning environments are a “poor fit,” ADHD-like symptoms typically worsen.
7. There is a single test for diagnosing ADHD.
Unfortunately, this is not true. Because ADHD is so complex – and it affects everyone differently – the ADHD diagnostic process should incorporate not only behavioral checklists and patient history, but also neuropsychological assessments. ADHD “profiles” can be gleaned from a battery of tests that measures IQ, attention, memory, and executive function. Developing a comprehensive profile of the “whole person” helps confirm (or rule out) the presence of ADHD, even if behavioral symptoms are not obvious. Comprehensive assessment also supports differential diagnosis – in other words, “teasing out” other factors that may be causing ADHD-like behavioral problems.
8. A diagnosis of ADHD guarantees a prescription for medication.
This is not just a myth, but a harmful one. In some cases, parents who suspect an attention issue (and know in their heart that their child is struggling) avoid seeking diagnostic help out of fear that their child will be medicated. The truth is that medication is a highly individualized choice, and it’s not for everyone who has ADHD. Depending on personal preference and circumstances, medication may not be desirable or even effective. Furthermore, there are other ways to support, treat, and embrace ADHD – for example, behavioral interventions, lifestyle changes, family supports, and skills-building approaches. Don’t be afraid of an ADHD diagnosis simply because you think it means you’ll have to take medication.
9. ADHD is all bad.
Actually, there may be many upsides to ADHD. One of the greatest is creativity. The ability to jump from idea to idea, to synthesize seemingly unrelated topics, and to wander inside a world of imaginative creativity has probably contributed to the success of some of history’s great entrepreneurs, artists, inventors, scientists, writers, and teachers.
10. ADHD is an excuse for unruly behavior.
No one chooses to “have ADHD.” But while having the disorder is not anyone’s fault, managing ADHD is ultimately the individual’s responsibility. Successful living is rooted in self-awareness and self-understanding, both of which can be supported by an accurate and clear diagnosis of ADHD. Next, coaching and skill-building can scaffold ownership of ADHD symptoms by helping an individual understand the disorder and how it affects him or her. By developing strategies for circumventing limitations and designing a lifestyle that capitalizes upon advantages, ADHD becomes just another part of life. And like life, ADHD is simply what you make of it.
— Dr. Katen
“Live the life you were meant to live!”
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
Is it ADHD, sensory processing, anxiety, or something else?
Behavioral Checklists Are Just the First Step Towards Accurate Diagnosis
Attention-Deficit/Hyperactive Disorder (ADHD) is an incredibly complex neurodevelopmental disorder. While behavioral checklists serve as useful starting points for identifying the possible presence of ADHD, they may be inadequate when used in isolation.
What is ADHD?
ADHD is classified as a neurodevelopmental disorder whose essential feature is “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (DSM-V). The disorder begins in childhood and lasts into adulthood, often causing a lifetime of personal, academic, and professional struggles.
What causes ADHD?
Unraveling the neurodevelopmental causes of ADHD is still at the frontier of neuropsychological research. Numerous theoretical models have been proposed for understanding what causes the disorder, how it impacts daily functioning, and how it correlates with other issues. In recent decades, ADHD has had an assortment of other labels, including “minimal brain dysfunction”, “hyperkinetic reaction of childhood”, “executive function disorder”, and “attention deficit disorder (ADD).” Some experts simply refer to ADHD as a “symptom complex” – that is, a cluster of behavioral symptoms whose neurological cause is not well understood. Other experts regard ADHD a “context disorder” – a group of behaviors that stem from a mismatch between an individual and his/her environment.
How is ADHD diagnosed?
Overlapping Symptoms of ADHD and Other Psychiatric Disorders. From A.D.D. Resource Center.
In most cases, ADHD is assessed in a medical setting and the diagnosis based upon an individual’s behavioral symptoms. Since no genetic or blood test exist for ADHD, the diagnostic process often relies upon behavioral checklists completed by (and dependent upon the observations of) parents and teachers. Checklists ask parents and teachers to rate the severity of a child’s conduct at home and in the classroom.
Why might checklists be insufficient?
ADHD is not a behavioral disorder—it is a neurodevelopmental disorder. Behavioral checklists, as the name suggests, measure the presence of specific behaviors. These behaviors may be symptomatic of a neurodevelopmental disorder like ADHD, or they might be due to something else. The most informative way to assess the neurodevelopmental workings of a child’s brain is to use objective neuropsychological testing.
Since checklists only emphasize behaviors, relying solely upon them to make an ADHD diagnosis invites the risk of misdiagnosis. The behaviors listed on ADHD checklists can be caused by a variety of other factors, including anxiety, auditory and visual processing issues, temperament, fine motor delays, learning styles, learning disabilities, sensory processing difficulties, poor environmental fit, physical health problems, and/or other neurological pathologies/abnormalities. In other words, just because a child displays a large number of behaviors that are typically associated with ADHD, this is not confirmation of the presence of ADHD.
Why does accurate diagnosis of ADHD matter?
Accurate diagnosis is essential for effective intervention. For example, a child with sensory issues may display behaviors that are nearly identical to symptoms of ADHD. Based upon a checklist, this child might be diagnosed with ADHD. Interventions for ADHD can include behavioral strategies, skills-building, environmental modifications and, in some cases, medication. While a child with a sensory processing may benefit from behavioral strategies and environmental modifications, medication would not be appropriate. Furthermore, a child with sensory issues needs occupational therapy. If diagnosed with ADHD, he may be less likely to be assessed and treated by a sensory processing expert.
In addition to the possibility of over-diagnosing ADHD, behavioral checklists can also lead to under-diagnosing. Some children do not display obvious symptoms of ADHD and, therefore, will not score highly enough on a behavioral checklist completed by their parents or teachers. This is particularly true for children who have only an inattentive type of ADHD, as well as introverts, highly compliant children (aka “pleasers”), and the intellectually gifted. Under-diagnosis is also common among girls who suffer from the inattentive form of ADHD. As a result, girls often develop social anxiety and depression, for which they may seek help. In these cases, intervention usually focuses on their anxiety and mood symptoms, while the underlying ADHD goes undetected.
Takeaway
In short, if you have met one child with ADHD, you have met one child with ADHD. It is not a behavioral disorder, but a neurodevelopmental one – and it is exceptionally complex. ADHD affects everyone differently, and not everyone who displays ADHD-like symptoms truly has the disorder. While behavioral checklists are a good first step, individuals suspected of having ADHD should be referred to a psychologist or other professional who specializes in this disorder and provides objective neuropsychological assessments.
– Dr. Katen
©2016 Individual Matters. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.