Janet Dunn, Director of the Akin Learning Center at Kents Hill School chats with us about the center’s new building and the story behind it.

Kents Hill (a coed boarding school in Kents Hill, ME) has been on the fore of learning differences programs having had a program (that started in Dunn’s living room) for 32 years.  The new building is the latest step in the center’s journey from living room, to library, to dedicated, purpose built facility.

A seven year process brought the Akin Learning Center from idea to realization.  Like all good architecture the process began with the students and faculty who use the building and worked outward toward design.  The center’s new home provides students a comfortable setting into which kids want to come, collaborate, and be proud of what they accomplish.

Kents Hill alumni carry a structure and routine into college and adulthood that they’ve absorbed from the KHS experience.  They know how to keep a schedule and when to study and they are comfortable and secure in their interactions with teachers and adults.

Additional resources:

Akin Learning Center

Kents Hill School – www.kentshill.org

Boarding schools in ME

Learning differences boarding schools

Interestingly, I’ve come across a pediatrician, Claudia M. Gold, MD, with questions (Diagnosing ADHD Under Age 6: A mistaken Idea). As usual (confessing a personal bias), I like the complexity and nuance she adds to the discussion.

Dr. Gold takes “no issue with extending the age of diagnosis upward. But the new recommendation to extend the diagnosis down to age 4 is very worrisome.”(Dr. Gold)

Arguing that the AAP treatment guidelines are much like over the counter cold remedies addressing only symptoms- failing, unable, or unwilling to address the root cause of the cold, or, in this case a child’s ADHD behaviors, she raises her concerns this way:

“…what is now called ADHD is a constellation of symptoms that represent problems of regulation of behavior, attention and emotions. These problems have complex causes. There may be a biological vulnerabilities, which often have a genetic component. Often there are associated sensory processing problems. Family conflict, including parent-child conflict as well as marital conflict, is clearly associated with problems of self regulation. Sleep and eating problems often occur within the context of family conflict and can exacerbate problems of self-regulation.

Children who are struggling in a variety of ways are scheduled in pediatric practices for an ‘ADHD evaluation.’ The question asked is: ‘Do symptoms meet diagnostic criteria?’ The more appropriate question should be ‘What is the experience of this particular child and what can we do to set things in a better direction?’ By invoking the label of ADHD, thinking may stop. Curiosity about the meaning of behavior ends. However, years of longitudinal research, as I describe in my book, Keeping Your Child in Mind, has shown that children develop the capacity for empathy, flexible thinking and emotional regulation when parents respond to the meaning of behavior rather than simply the behavior itself…

…Certainly children with problems of self-regulation are struggling, and they absolutely should receive treatment. But receiving a diagnosis of ADHD should not be the only route to receiving treatment, particularly if that treatment consist primarily of ‘parent training’ ‘behavior management’ or medication. There are a whole range of other interventions that can be very helpful to these struggling children and families. These include parent-child psychotherapy and occupational therapy that aim specifically to improve a child’s capacity for self-regulation. Getting a label should not be a prerequisite for getting help.

Addressing ‘comorbidities’ does not solve the problem. What this means is simply adding more letters to the child’s diagnosis such as ODD (oppositional defiant disorder) CD (conduct disorder) that represent meaningless descriptions of symptoms without any consideration of underlying cause. In my experience, almost all children who have the diagnosis of ADHD are oppositional and defiant. But there are as many variations to the causes of this behavior as there are families.”(Dr. Gold)

Dr. Gold goes on to argue for a variety of interventions and therapies- especially for children under six- that address possible root causes of the ADHD behaviors rather than treating the the behaviors/symptoms.

She soberly concludes that, until we accept, and are willing to put the necessary labor into understanding the complexity of a child’s ADD/ADHD behaviors, we will continue on the upward trend of ADHD diagnosis and treatment by medication.

The fast track to medication is a shame, shortchanging both the professional’s ability to assess the situation and the child’s ability to learn and grow.

Time and money seem to stand as the real issues. Doctors don’t often have the time for longer, complex appointments and analyses. Parents are stretched for time and money. And, health insurers don’t like to pay for longer more involved analyses and diagnoses.

Something tells me the roots of these issues lay in the speeds at which we live. Might we, and our children, benefit from slowing down?

Resources:

Boarding School for Students with ADHD

“…’ADHD is a chronic condition. We can provide symptomatic treatment, but it doesn’t cure the condition. Treatment has to be an ongoing process. Symptoms may change over time, and there needs to be consideration for change in treatment as a child develops,’” Dr. Mark Wolraich, CMRI Shaun Walters Professor of Pediatrics and the Edith Kinney Gaylord Presidential Professor at the University of Oklahoma Health Sciences Center in Oklahoma City told Healthday.(HD)

Quietly present in the study but not garnering the lion’s share of attention is that the doctors are now recognizing ADHD as chronic condition to be managed over a lifetime and for which no cure exists.

Establishing ADHD as a chronic illness raises a host of issues around life-long management/treatment.

• What kids of treatments/interventions come first- behavioral therapies? Medication?
• Can an individual outgrow ADHD? Funding?
• Can classrooms be modified to work effectively with young ADHD students?
• Is ADHD simply part of one’s nature?
• Does ADHD as chronic condition mean a lifetime of cognitive and/or drug therapies?
• Will the ADHD patient be able to self-manage?
• Can we teach ADHD students to self-manage in preparation for adulthood?
• Along with the larger, are we looking at a condition/illness that’s real or something we’ve constructed to explain what we see and can’t fully address or cure?

Dr. Wolraich again:

“I think the most significant changes are expanding the ages from preschool through adolescence. The original guidelines were from 6 to 12, because that’s where the evidence was. We’ve been able to broaden the scope of the guidelines because there was more evidence available for preschoolers and adolescents…

…Although there is less evidence [on outcomes for this age group], the hope is that starting treatment in preschool if a child has serious problems will lead to better outcomes.”(HD)

Behavioral therapy stands as the first line of treatment in the newly included 4 to 6 year old group with medication as a second line alternative.

There is of course an opposing viewpoint and that’s the topic the next post.

“ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents”

“New ADHD Guidelines Include Preschoolers, Older Teens”

“Kids As Young As 4 Can Be Diagnosed, Treated For ADHD”

Boarding School for Students with ADHD

“Are Americans More Prone to A.D.H.D.?” is a recent “Room for Debate” question.

ADHD rages as a topic among educators, parents, and researchers. The experts’ responses in “Room for Debate” makes clear that ADHD diagnosis and treatment is far from a settled issue.

Is it a legitimate disorder? Is it even real? How come it skews in populations whose parents can afford a diagnosis? Are some mental illnesses social constructs? Suffice to say there are experts on all sides of the issue.

The NYT frames the discussion this way:

“For some conditions, perhaps wealth explains the disparity: in developing nations, more people are focused on pressing needs like food and shelter, making depression a “luxury disorder” in wealthy nations like the United States.

But are there other factors at play for conditions like attention deficit/hyperactivity disorder, that may be “culture-specific”? Maybe the condition is more common in the United States because the high-energy, risk-taking traits of A.D.H.D. are part of America’s pioneer DNA. Or maybe the same behavior is common elsewhere, but given another label? Some critics would argue that American doctors, teachers and parents are simply too quick to diagnose A.D.H.D. and medicate children. Do the American medical and educational systems inflate the numbers?”(NYT)

The NYT discussion includes views ranging from the true believing (Ned Hallowell), to the skeptic (Peter R. Breggin), to the race, gender and class lens (Donna Ford), to the nuanced (Ethan Watters).

I have to say I’m partial to the work and views of Ford and Watters. I really like the way that Watters works to get at the root of the issue:

“…The really mind-bending fact — the one that Americans can rarely seem to grasp — is that just because these disorders are culturally shaped does not make them necessarily less real. Those Victorian-era women really did faint and experience the paralysis, tics and fainting spells found in their symptom pool. Their unconscious learned, in short, to speak the language of suffering for their time.

In certain historical moments, a given diagnosis will hit such a resonant cultural note that it catches fire. This, I believe, is the story of A.D.H.D. Parents, teachers and mental health healers are critical parts of a feedback loop by which a child unconsciously apprehends their symptom pool. This is not to lay blame at anyone’s doorstep — a similar dynamic is in play with all mental illnesses. We won’t fully understand these illnesses until we add this knowledge to the mix, but that new understanding won’t magically make the disorders disappear.

Unfortunately, the debate about the “realness” or universality of a disorder like A.D.H.D. often distracts from a discussion of what might have given rise to the need for so many children to express distress. The underlying disquiet in the children of our time is more important than the symptom cluster that we declare as legitimate…”(NYT)

Resources:

Boarding School for Students with ADHD

Stewart Miller, Head of School, The Greenwood School

Brian Fisher (BF): What’s the impetus behind growing to include a high school? Does Greenwood just work better for some kids to have a consistent Greenwood environment 9-12?

Stewart Miller (SM): For years Greenwood families and Educational Consultants encouraged us to extend our program into the high school grades. With a small nurturing community of 50 boys, a 2:1 student teacher ratio, high level of personalized programming, integrated educational therapies (Occupational Therapy, Social Pragmatics, Speech and Language), and innovative assistive technologies, Greenwood is unique.

For boys who are seeking an alternative to a traditional high school, or who are looking for intensive programming to gain needed skills and confidence to successfully transition to a traditional high school, Greenwood is an excellent option.

BF: Why is the time to establish a high school program ‘right’ now?

SM: The encouragement from Educational Consultants and current families to expand programming has never been more robust.

Now, with the construction of our new cottage dormitory, we have the facilities that provide us the flexibility to effectively program for the developmental range of students that is necessary when considering an expansion into a high school. We have added life-skills programs that foster independence in ways we could only dream of doing before the new dormitory.

For example, our older students learn to wash, dry and fold laundry, learn to cook, are responsible for cleaning their common room, and have opportunities to earn freedoms and responsibilities. We are also exploring different off-campus internship opportunities for our 10th graders.

BF: What will be the ‘Greenwood Advantage’ for boys as they work through their high school years and earn a Greenwood diploma?

SM: We see the advantages being the alternative we offer to more traditional high school experiences. Greenwood high school students are young men who are happy in a smaller environment, who could benefit from a high degree of individual programming including speech and language, social pragmatics, and/or occupational therapy, who want to grow without the typical pressures of high school.

BF: What’s been the most challenging part of making these changes?

SM: The biggest challenge has been to shift our thinking from that of a middle school culture to that of creating and including a high school culture. Fundamentally, this means taking an approach of educating students instead of restricting their access to certain freedoms and responsibilities like allowing student cell phones, access to social media, and increased availability of interaction with the internet. It means seeking new ways to foster independence. We see this as a positive, pedagogically–driven evolution of our programming.

Greenwood (Putney, VT) is adding a full high school with the first graduating class scheduled for spring 2014.

The school will now be able to work the boys from the fourth to twelfth grades, having previously focused their program on the elementary and junior high school grades.

This expansion of Greenwood’s mission will allow the school to serve the needs of high potential boys “who struggle with complex learning challenges, ADHD, and/or executive dysfunction”(TGS) through completion of high school. The program expansion will be supported with capital growth including a new dormitory, woodshop, and continuing capital investment in the school’s innovative Assistive Technologies.

Stay tuned for a follow-up interview with Greenwood headmaster, Stewart Miller.

The program will allow the school to effectively serve boys who may be struggling with language based learning differences. St. Stanislaus teachers will receive training in Dyslexia education using Orton-Gillingham methods.

“Experts estimate that as much as 20% of the general population struggles with a form of reading disability related to dyslexia,” St. Stanislaus President, Brother Bernard Couvillion explained.

The program is made possible by a $25,000 grant from the Pugh Family Fund at the Community Foundation of Acadiana.

The Akin Learning Center will support the 40-50 KHS students who receive instruction as part of the school’s learning differences program.

The center takes its name from Kents Hill trustee chair Steven P. Akin whose daughter, Susan, is a Kents Hill alumnus and learning center beneficiary. (TME)

Janet Dunn, Kents Hill, learning center director, explained to The Morning Sentinel (Waterville, ME):

“I think the most important thing that (the students) and we were trying to achieve was that it not be a classroom building, that it be more of a comfortable place for them to come and study.” (TME)

This donation affirms The Alfond Foundation’s ongoing support of Kents Hill. Two of the foundation’s previous large gifts to the school “include support for the Harold and Ted Alfond Athletics Center, built in 2001 and $2.7 million given in 2007 for the Harold Alfond Athletics Fields…”(TME)

Janet Dunn, Kents Hill, learning center director, explained:

“I think the most important thing that (the students) and we were trying to achieve was that it not be a classroom building, that it be more of a comfortable place for them to come and study.”(TME)

The center is scheduled to open spring 2012.

“The Food and Drug Administration is meeting Wednesday and Thursday to examine whether artificial food dyes cause hyperactivity in children. Artificial food dyes are made from petroleum and approved for use by the FDA to enhance the color of processed foods.

They’ve been around for decades and are found in everything from pudding to potato chips to soft drinks.

But recent studies linking food coloring to hyperactivity in kids is causing some experts to call on the FDA to ban foods containing them — or at least require a warning label….”(NPR)

April Fulton’s coverage (FDA Probes Link Between Food Dyes, Kids’ Behavior) at NPR does two things quickly, and, well (listen below). She provides a nice quick history of dietary links to child behavior and the ‘elimination diets’ of the 1970’s. She also presents the skeptics.

“Before Wednesday’s meeting, the FDA released its analysis of 35 years of scientific studies. It finds no conclusive proof that food dyes cause hyperactivity in most kids, although it suggests that some kids with ADHD may be particularly sensitive to them.

Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York, says more studies are needed and that the current studies leave a lot of room for doubt.

“Some of the studies are difficult or imperfect in that they don’t always tease out specific chemicals in isolation,” he says. “But there is this body of literature that does suggest that food colorings are not as benign as people have been led to believe.”(NPR)

As we begin to understand the brain, more and more, as a collection of chemical and molecular processes we may find that the chemicals we ingest can affect our brain processes, and function, more than we suspect. However, the science still seems a long way from allowing us to draw any strong conclusions.

Dr. Adesman makes a simple, blunt observation:

“We’re not putting food coloring into broccoli or other fresh fruits and vegetables. It’s going into processed foods, concentrated sweets, things like that.”(NPR)

Photo credit: kayaker1204 via Creative Commons

As an educator, I’ve seen diet changes work wonders in students whose behavior was virtually unmanageable before their gluten allergies were confirmed and gluten removed from their diets.

In once case the change was mystifyingly amazing; a young man who was virtually unmanageable at the boarding school where I taught became a solid student and citizen once doctors isolated his gluten allergy and the boy switched to a gluten free diet.

Despite the anecdotal evidence linking diet to behavior, the science establishing the connection had been pretty thin over the years, which is why I exhaled a soft “ah ha” this weekend when I heard Dr. Lidy Pelsser speaking with NPR’s Guy Raz (listen below).

Pelsser’s work isolated diet as the root cause of 64% of ADHD diagnoses in her study subjects. Her results are published in The Lancet.

Dr. Pelsser has done the research and produced the evidence that many families had been seeing, and addressing, anecdotally over the years. Diet directly correlates to ADHD, and, adjusting or removing foods in the child’s diet can improve student behavior.

I’m especially partial to her observation that, right now, we treat ADHD like the common cold. We see the symptoms/behaviors. We fall back on pharmacology to treat the symptoms. But, we never go after treating and addressing the root causes of ADHD.

Talking with NPR’s Guy Raz, Pelsser explains:

“ADHD, it’s just a couple of symptoms – it’s not a disease.”

“There is a paradigm shift needed. If a child is diagnosed ADHD, we should say, ‘OK, we have got those symptoms, now let’s start looking for a cause.’ ”

“In all children, we should start with diet research.But now we are giving them all drugs, and I think that’s a huge mistake.”

“In fact, they [teachers and doctors] were flabbergasted.After the diet, they were just normal children with normal behavior.”

“We have got good news – that food is the main cause of ADHD.We’ve got bad news – that we have to train physicians to monitor this procedure because it cannot be done by a physician who is not trained.”

Even with Dr. Pelsser’s caveat, her research represents a fundamental shift in moving to find a cause rather than treating symptoms.

Read the summary, “Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial“

Full Lancet article available only by subscription.

Study: Diet May Help ADHD Kids More Than Drugs

Photo credit: Kath B via Creative Commons