Ron Schworm, an educational consultant, was introduced by Judy Olson as someone who, through his evaluation technique and applied skills, helps kids determine and use their strengths.
Dr. Schworm said that for this evening, he would share his approach to the clinical situation which is but one aspect of the diagnostic process, the focus on attentional aspects. He noted the discussion would be centered around the whole idea of sustained focus and attention for the educational process.
Ron identified 5 types of students:
"We find that ADD is neurobiological. We know some meds work and why they work, but still don't know what causes it", he remarked.
Attention is a multi-faceted process which involves at least:
He also mentioned there is sometimes a hyperactive element some call impulsiveness. Further, he stated that those with ADD/ADHD are quantitatively different than those who don't have it. Some call this the inability to inhibit their actions.
Although the previous belief was that only boys age 4, 5, and 6 had it and that ADD "went away" after some time, we now know that girls have it and that ADD continues through the teens and into adulthood. We also now know that there are times those with ADD can focus and persist well but can't concentrate in given situations.
One observation was, "He/She doesn't remember what she reads." This was interpreted solely as a reading problem. Now we can suspect ADD. This is an example of not being able to sustain their concentration.
"The 3 most common complaints of adolescents with ADD are: Don't like to read, don't like to write, and don't like math. Curiously, they can be good at math and be very bright, but just don't like to do it.
Attentional problems influence the ability to:
We need to get those with ADD to try to focus in a passive situation in order to do a proper evaluation. This is due to the fact that when one is "busy" or has "Adrenalin flowing", there may not be a problem. Throughout his presentation, Dr. Schworm kept coming back to this as why it is difficult to assess someone either quickly, or when that person is busy or active. He maintained the atmosphere had to be passive so their actions were controlled by their basic self and not receiving outside stimulation.
When asked if the person can control their concentration, Ron responded that the surrounding environment can be very influential. Homework is passive, he noted, as they usually work on this independently and must rely on themselves to initiate the actions. Passive activities are quite different from "hands on" activities.
PASSIVE TASKS
Examples of passive tasks (but goal or outcome oriented) vs. more active in which there could be a difference in performance include:
Children with ADD like swimming and track as these activities keep their Adrenalin flowing. This helps keep their attention going. KEEP THEM BUSY! Do hands-on activities like sports and other action.
Passive activities include those which require a high degree of voluntary attention.
CONTINUING PERFORMANCE TASKS
These help sustain concentration over an expanse of time. Those with ADD can have a high degree of the inability to maintain concentration in a passive situation.
Ron noted there were three types of tests (tasks) used during his evaluations:
Dr. Schworm reiterated that it was essential, when evaluating a child, to look at concentration. He noted it would be very difficult to make a good diagnosis if this wasn't the case. He then went on to briefly describe some of the tests he used. Each of these could be rated with some sort of score, but his position was that wasn't the point. We get a little number happy sometimes, he said.
The tests all start with a lower level of requirement and then become increasingly complex. Ron looks for the point (time required) at which the child loses interest, or loses focus, or has a dramatic drop in performance.
Does the brain "go to sleep after a while?" Is there a loss of interest? How long does it take to lose their interest? When does the child "bail out?" "The answers to these questions will be missed if the situation is NOT passive." The earlier the child "breaks", the more the problem.
The Raven Test: The expected results are age-related. The pages are made up of a series of drawings or patterns with one piece missing. The patient is asked to "fill in the missing piece".
Matrix Tests: These are a bit more active. The items or figures/drawings are more functional but there is a similar reasoning process as the Raven Test. However, since it is more stimulating, those with ADD can do much better here than on the Raven.
Dr. Schworm noted he'd never found a kid without ADD who does poorly in the Raven and well in the Matrix tests. If the child is poor in both or good in both, he's concluded ADD is NOT present. The passive/active difference is where ADD performance differences can be significant.
Kaufman Brief Intelligence Test: This is a measure of memory. These are the folks who don't like to play "Trivial Pursuit". In this test, the patient is asked to name the picture. Dr. Schworm looks for how long it takes for the patient to respond. ADD may be responsible for excessive delays.
Part of this test involves "repeat after me" questions such as saying a string of numbers and then asking the patient to respond. People with ADD have trouble with their rote memory for conceptual thinking. ADD people can be very good at holistic thoughts but not very good at details. Ron called this "gliding through worlds" and "visual neglect" when details are missing.
Visual Memory Test: For this, the patient is shown a figure for 5 seconds, then it is hidden and the patient is asked to draw what the shape/figure was. The figures become increasingly complex, there are more of them, and they become random, unpredictable shapes. The measure for evaluation is how much detail is included/excluded, how many items are missing, etc.
Ron added the comment that Ritalin can improve handwriting because it allows the patient to organize information and give more attention to details. In developing coping skills, ADD kids learn to control their environment and get us onto their agenda rather than engaging us on our terms. They can be argumentative, escalate emotions to gain control, and adults have to be careful not to get drawn into this! They may try to change the subject or become argumentative. Ron maintains they do this to "get their Adrenalin going". He offers this as his hypothesis.
The Peabody Test, and other Multiple-Choice types: Again, these start at a low level and get harder. The evaluator reads a sentence and then turns the page to show the patient some pictures. The patient must select the picture which is most applicable to that which was read.
Picture Vocabulary Test: This is another in which a word is given verbally and the patient has to find the appropriate picture.
Ron couldn't stress enough that the environment during these tests had to be passive for the test to reveal accurate assessment/results. If the environment was not passive, the diagnosis could not be made as the ADD may not show up!
Dr. Schworm recommended the books and work of Drs. Hallowell and Ratey (Driven to Distraction).
In education, we can be most effective in teaching children with ADD by involving them in the activity. When asked, he's had many children say they learn the most in summer camp instead of during "stupid lectures".
THE SILENT SIDE OF ADD
"The silent side of ADD is the fear of failure", he noted. Dr. Schworm also said that depression and mood swings were common. Sometimes this is seen in the faces and actions of students returning from school and acting "stressed out".
In response to an audience question on what medicine influences, Ron responded, "passive test performance which includes memory".
Another question was about the effectiveness of anti-oxidants vs. Ritalin. Dr. Schworm expanded that to other "health foods, etc." and noted that although they may make you healthy, they had no demonstrated effect on ADD. He noted there were several theories and hypotheses "out there", but that he did not know of any research-substantiated treatments which were non-traditional as of yet.
For a question about the excessive use of Ritalin, Ron stated that there are likely a few such cases and that if you ever wanted to hear about them, to tune into daytime TV. Some of these shows actively solicit "problem cases". On a more serious note, Ron said it was necessary to take care in determining medication dosage and timing.
Ron concluded his remarks with the following tongue-in-cheek statement: "If you have ADD, only 2 people will get in the way of your life . . . your doctor and your teacher!"
Ed Note: Dr. Ron Schworm, is currently Director of the Reading and Learning Center here in Rochester. He is also a long time supporter of GRADDA and, in fact, attended the very first meeting at which the GRADDA organization was only an idea. We thanked him for his longstanding, continued support.
PO Box 23565, Rochester, New York 14692-3565.
(716) 251-2322
e-mail us at gradda@net2.netacc.net
