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CP and School Performance
Q: I have a very active child of six. He is in the first grade and is having behavioral problems. He is impatient, he fidgets, and has outbursts. His kindergarten teacher suggested I have him evaluated. I never did. He started having problems this year again. I requested his teacher to write down observations of him so that I could have him evaluated. She said she didn't think this was necessary; it was just him. Now the school guidance counselor has contacted me and basically seems to label him as ADHD -- even though the teacher does not think it is. I also told her that my son has a mild form of Cerebral Palsy and I learned that CP can affect behavior in the classroom. She is, I feel, second-guessing me and is pursuing the ADHD way to "help" him. I honestly do not feel he is ADHD. I am an education major and know the signs of ADHD. Now he does have some of the signs, but if you look hard enough at any child, you "find" these traits. My question is this: do you know anything about the complications of Cerebral Palsy in the classroom? The book I read stated that some were: hyperactivity, distractibility, lack of concentration, over excitability, causing poor behavior. Do you know any methods to help us to work with him on his behavior? Also, have you ever heard of CP complications in the classroom before? The counselor hasn't and can't suggest any. Honestly, I think that is her basis on why she is pushing ADHD. I feel ADHD is a generic term of the 90s. Thank you. I appreciate your time in answering this.
A: You are right that Cerebral Palsy can have an impact on school performance: Frustration, communication difficulties, muscle tone and control, etc. I suggest that you and the teachers visit the UCP website to gain as much understanding about this condition as you can.
The behaviors you describe suggest that it is quite possible that your son has ADHD as a co-existing condition. Your suggestion to have the teacher make records of his behavior is a very good idea, but since she seems to lack objectivity at this point, I would have some other professional do the observations and record the behavior. I would suggest the school psychologist or social worker, or better yet, an independent psychologist with expertise in both CP and ADHD -- perhaps from a local children's hospital. The school should pay for this consultation in the interest of objective data collection. This observation should be part of a diagnostic process, which uses information from you, the teachers, and from the observations. This is a complex situation and many teachers are not well versed in how CP manifests itself in the classroom. Therefore, this must be a team approach involving appropriately trained professionals. You might want to contact the local branch of United Cerebral Palsy and ask them for a consultation, IF they have someone on board who knows about the education of children with mild CP. (They often tend to work with more seriously involved adults.)
You are right that there seems to be an overuse and too often a misuse of the ADHD label. However, the behaviors that the teacher describes may best be treated using behavioral approaches that have been successful with children with ADHD, even though you may not be able to get a clear-cut diagnosis. A classroom with structure, firm expectations, behavior modification strategies, and a warm, empathic teacher can do wonders for a child like this.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.