ADHD and Language issues often go hand-in-hand. Dr. Doug Emch helps us out with some ADHD FAQs.
What Exactly is ADHD?
As a child and adolescent psychiatrist, one of the main problems that I get approached with regards the question of ADHD. It usually stems from a concern about school performance, but the real underlying query has to do with whether the given problem is or is not ADHD. 
ADHD at heart is a problem of self-regulation and can manifest in problems with attention, mood, and behavior. It is composed of three core features: inattention/distractibility, impulsivity and hyperactivity (which is actually an optional symptom which when absent was formerly called ADD).
Our present understanding is that it is a lifelong neurobehavioral/neurodevelopmental disorder that effect roughly 3-7% of the population. Symptoms must be present by 7 years of age, but the diagnosis can occur at any age. In fact, one report indicated that the average age of diagnosis with ADHD in America is 39. The symptoms must also occur in multiple settings such as school, home and church. It is one of the more heritable conditions in psychiatry, but the symptoms can also be acquired through trauma and toxic exposure. In fact, recent research suggests that a western “unhealthy” (i.e. toxic) diet is implicated in ADHD occurrence.
The area of the brain most affected is the frontal lobes, that area just behind your eyes. It is perhaps the most evolved area of our brains and likely what makes us all-too human. The frontal lobes are the seat of what is termed the executive functions. For a good review of this in relation to ADHD, please see Dr. Ari Tuckman’s More Attention, Less Deficit, the first chapter of which is about executive functions and is available to download through is website,  In general, executive functions involve the ability to regulate attention, organize, shift, sequence, hold items in working memory, problem solve, and self-direct. Thus ADHD can manifest in deficits in any of these areas.
Severity of ADHD
ADHD as a disorder tends to have a wide spectrum of severity, frequently presenting with a co-occurring illness, or comorbidity. In general, 60% of kids with ADHD have a co-occurring learning disability.  Contrary to popular belief, kids (and adults) with ADHD can pay attention fantastically well provided that they are interested in the topic. These interests are most commonly witnessed in kids with video games, television and sports, but it isn’t that uncommon for kids who really enjoy reading to get sucked into a book to the exclusion of the world. The problem manifests with an inability to then shift away from that interesting item, often requiring escalating in tone or stepping in front of the television to break that intense focus, or hyperfocus.  The fact that kids can pay attention often throws families off because of the misconception that with ADHD you cannot pay attention to anything. What you usually see is that when the novelty is gone, such as after the first month of school, boredom sets in and problematic behaviors arise.   Sometimes the pattern occurs whereby school grades gradually plummet over the course of a term from A’s to F’s.
Do Kids Outgrow ADHD?
All research seems to indicate that the underlying deficits with ADHD (i.e. executive dysfunction) are life-long. The presentation tends to change over the life-course.  In general, the hyperactivity subsides with puberty, leading people to believe that they’ve outgrown the illness. However, the underlying impulsivity and distraction generally persist, obviously so in 40-60% of adults diagnosed with ADHD as children.  In adults, because school is generally no longer the problematic area, one sees symptoms emerging with finding and keeping jobs, poor relationships, poor job performance, poor concentration, poor organization, poor self-discipline, and low self-esteem.  These co-occurring symptoms or disorders are often the presenting issue if the ADHD has gone untreated. Treatment of these issues often only leads to marginal responses until the underlying ADHD is addressed.
Although ADHD is thought of as a life-long problem, the brain is highly plastic and changes in response to the environment. The brain continues to actively grow until about 25 years of age, and after that, continues to change dramatically in response to its stimulus. So it is not unreasonable to think that the brain, including areas of executive function, can change with training and that the problematic symptoms can be disciplined away, so to speak.   In fact, therapy for ADHD often focuses on skill sets and tasks to help discipline the often problematic issues, like having a place to put your keys every time you come in the door so that excessive time is not spent searching for them each morning. Mindfulness and meditation can also help improve concentration. Dr. Lidia Zylowska ( from UCLA has published research on mindfulness in ADHD and has promising results.  It might be that symptoms can diminish to the point of non-interference.
Dr. Doug Emch is a child and adolescent psychiatrist who works with Centerstone and has a private practice in the Belle Meade area where he also treats adults. For more information, visit  

All Nighter

Exam Study Tips: Snooze It or Lose It!
The all nighter, sleep deprivation, and last minute cramming are all typical approaches to exam time, but brain research shows that a tired brain is an ineffective brain. By planning ahead,  studying over several days, and getting plenty of rest, your child’s brain will be primed for success.

During sleep the hippocampus takes everything the brain learned during the day and refires/reactivates neural networks over and over, consolidating information into long term memory. If networks are not allowed to refire and reactivate during sleep, they will weaken and information will be lost.
How does this apply to exam prep? More days of studying followed by more nights of rest translates into more information stored in long-term memory!How much sleep is recommended? 9.2 hours for adolescents, 7-8 for adults….you have to enter the REM phase for the hippocampus to work effectively.

What else does sleep affect? Creativity and emotions, even eating disorders (binge eating, obesity). Tired people also have trouble with impulsivity, attention, and perseveration (getting stuck on something).
Advance preparation is the key to being able to study effectively AND get enough rest. By having all materials gathered and organized, having tests and study materials corrected, and having questions about format and content of exams answered prior to actual studying, your child will be able to fit a good night’s rest into his or her study schedule.
To help facilitate advance exam prep, Marianne P. Sperry & Associates is hosting an Exam Prep Session on May 13 from 6:30-8:00 for grades 6-12 at their office. For more information call 356-6339 or go to

Picky Eaters

Food Jags and Picky Eaters
Welcome to the preschool/toddler years where every parent struggles with picky eaters! This phase of life is such an exciting time with new discoveries each day for both parent and child.  If you are the parent of a toddler, you probably have encountered some picky eating habits or even food jags, where your child will only eat one particular food or type of food at each meal.  During this exciting time for toddlers and parents, growth actually slows, development excels, and calorie and nutrient needs are high especially in vitamins A, C, B6, iron, zinc and calcium. 
This is also a time where children will begin to assert more independence, including their eating habits.  If your child begins to eat a little less, don’t be alarmed since intake with a toddler can often vary from day to day and meal to meal.  One minute your toddler loves bananas and the next he seems to hate them.  The quirky eating behavior of a toddler can often be very stressful for parents.  If you are concerned, it is always a good idea to check with your pediatrician to make sure your child’s growth is within normal range.

Picky eating and food jags are very common between the ages of 1- 4 years. The following tips  can help parents move through this fickle eating stage:

  • Offer meals and snacks around the same time each day
  • Keep serving sizes toddler friendly
  • Serve at least one food you know your child likes at each meal
  • Offer a new food when you know your child is ready for a meal/snack, well rested and happy
  • Remember your child learns from your example; always be a positive role model when eating
  • Offer foods with different textures, colors, shapes, flavor, and temperature (warm, cold)
  • Always offer  a variety of foods at each meal or snack
  • Encourage your child to get involved in meal preparation and meal planning
  • Try not to let your child see your frustration but focus on the positive aspect of eating
  • Use encouraging words like “Good Job” or  “Proud of you” when your child does try a new food but try not to over praise
  • Use short phrasing like “ Take Bite” or “Bite Please”
  • Let your child tell  you when he or she is done or full….watch for “all done” cues
  • If your child gets stuck on a food, it’s OK to serve that food at meal times but make sure you are also offering a variety of other foods as well
  • Make sure your toddler eats from all food groups (starch, fruit, vegetable, protein and dairy).
  • Remember that this is a time when toddlers are asserting food independence but also a time where parents need to watch for choking hazards. Hot dogs, nuts, hard peanuts, hard candies, grapes, raw carrots and raw apples pose the greatest choking risk.
  • Never force feed your child and please do not try to enforce the old “clean your plate” rule…Eating should be enjoyable!

Preventing food jags is a methodical process. Prevention is not always possible for some children. If you have a child who seems to jag on a particular food, but you are not able to vary the food in any way and his or her diet choices continue to decrease along with caloric intake, it may be time to seek professional assistance.  Speech Language Pathologists, Occupational Therapists, and Pediatric Dietitians can team with your child’s pediatrician to increase food and caloric intake and ultimately increase healthy growth in your child.

Jenny Beth Kroplin, RD, LDN, CLC                Marianne P. Sperry, M.A., CCC/SLP

Stuttering Myths

Myths about stuttering

Myth: People who stutter are not smart.
Reality: There is no link whatsoever between stuttering and intelligence. 

Myth: Nervousness causes stuttering.
Reality: Nervousness does not cause stuttering. Nor should we assume that people who stutter are prone to be nervous, fearful, anxious, or shy. They have the same full range of personality traits as those who do not stutter.

Myth: Stuttering can be “caught” through imitation or by hearing another person stutter.
Reality: You can’t “catch” stuttering. No one knows the exact causes of stuttering, but recent research indicates that family history (genetics), neurological development, and the child’s environment, including family dynamics, all play a role in the onset of stuttering.

Myth: It helps to tell a person to “take a deep breath before talking,” or “think about what you want to say first.”
Reality: This advice only makes a person more self-conscious, making the stuttering worse. More helpful responses include listening patiently and modeling slow and clear speech yourself.

Myth: Stress causes stuttering.
Reality: As mentioned above, many complex factors are involved. Stress is not the cause, but it certainly can aggravate stuttering just as it aggravates many other problems.

Book Club For Kids

Starting a book club for kids could be a great way to encourage and engage your child in reading. Not only are bookclubs a fun, social activity, they are also a great way for your child to interact with the text, which increases comprehension. 
  • Gather 4-6 readers if possible
  • Have them decide on a book from a booklist (the library has booklists available if your child does not have a requirement). They may need some guidance but let them lead the discussion as much as possible.
  • Help them set a meeting and reading schedule
  • Provide art supplies, dress up clothes, snacks, etc
  • Come up with fun places to hold the meetings (a park, a coffeehouse—they can order steamers or frappacinos and feel like an adult book club)
  • Help them preview the books…go to Amazon and read summaries or reviews, research settings or eras related to the book online, have them use the front/back cover info to act out a “preview” of the book.
  • Have them draw pictures of important events/characters, act out scenes, write letters to the authors or characters, create character trading cards, create a large timeline of events on a roll of craft paper.
  • Let them take turns leading the discussion. They can prepare questions and activities in advance.
  • great templates to create book covers, trading cards, story maps and more.
  • Plan activities upon completion of the book—a field trip, the movie version, or just a party.

Summer Reading Tips

In addition to vacations, camp and general relaxation, summertime also means summer reading for many children. For some students this can mean stress and procrastination. How can you help your child complete and comprehend summer reading assignments without all the frustration?

  1. Try to pick a book based on interest level, not length or difficulty. Usually summer reading lists have a variety of books on a variety of topics meant to offer something for everyone. Instead of going for the easiest or shortest book, spend some time finding a book that taps into your child’s interest. Use past experiences (hobbies, trips, life situations) to narrow down the list of books so that your child can find a character or topic he or she can relate to. If a child is not able to connect to the story, it won’t matter how short or easy the book is.
  2. Preview the book with your child. Previewing is one of the most important and effective strategies you can do with your child. Think about movie previews—they tell you the plot, setting, main characters, mood and main conflicts before you ever see the movie, yet they actually increase your interest in the film. You can do the same thing with books. Analyze the front cover, read the summary on the back, look at chapter headings and pictures. Talk about the main characters and the plot. Supplement this information by going on-line and researching the setting or topic. By previewing a book, your child will have prior background knowledge upon which he or she can build. It is like creating a file in the brain to which new knowledge can be added. Without this “file” your brain has a harder time processing the information.
  3. Set a schedule for reading. Creating a schedule and sticking to it can keep your child on pace and avoid conflict. Work with your child to determine the best times to read. Look at a calendar and take into consideration all camps, playtime, family vacations and events. Once you’ve looked at all these factors, set your schedule and post it so that there is no confusion or room for argument. Reading a little every day, setting a manageable pace and creating a reward system can help avoid procrastination and conflict.
  4. Interact with the text. Most summer reading requirements require some sort of test or report when school begins. In order to retain information read during the break, students need to interact with the text as much as possible. Have your child keep character lists, write brief chapter summaries (use post-it notes in your book), verbally discuss and retell the chapters, and draw pictures/maps/graphs/timelines of important events or characters in the book. Create a folder for each book with all of the notes, pictures, preview material (see #2), supplemental info from the internet, etc. After reading the book, you can also watch the movie if available and discuss how the book and movie are the same and different. By doing this, your child will be able to review effectively prior to taking the test. Another great idea—Book Clubs (see below).
  5. Keep a positive attitude. Reading develops vocabulary, critical thinking skills, writing skills, etc. Practicing comprehension during the summer months will help your child across all aspects of the curriculum in the fall.

What if your child is in preschool? Here are some preschool summer reading tips:

One of the foundations for reading is familiarity with print and books. Your child should understand that people read words, not pictures and should know how books work—front to back, right side up, one page at a time. The more you read with your child, the more familiar he will become with the printed word.
To build early phonics skills—another foundation of reading—do these simple activities with your young children:
  • The alphabet song—try mixing it up by changing the tune, starting with a different letter, etc.
  • Play “I Spy” with objects that begin with different letters. “I spy something that begins with a ‘p’.”
  • Play with letters—blocks, magnets, even tracing letters in the sandbox
  • Talk about signs that children see while riding in the car (i.e. McDonald’s, Stop, Kroger’s, etc.)
  • Buy a disposable camera when you go on a trip and have your child take pictures. Put those pictures in an album and have your child label them.
  • Make labels for objects around the house. Put the written words by the objects.

Exam Prep

Exam Prep Comprehensive Exams
Starting exam prep two weeks in advance may seem like overkill to your child, but advance preparation, organization and time management are essential to effectively study for comprehensive exams.
Two Weeks -One Week Before Exams:
  • Encourage your child to talk to his or her teacher about content and format of exams. Will the exam come from old tests? Will a study guide be provided? Will there be an essay? Will the test include fill-in-the blank, true/false, matching or a combination of these? Will the teacher emphasize overall themes or specific details? Knowing these answers will help your child study in a way that reflects the way he or she will be tested. If your child struggles when talking to teachers, you can help them create a checklist to use when talking to teachers.
  • Begin Gathering Materials Now! You do not want to wait until the night before to realize you are missing key study materials.
    • Go through backpacks, binders, lockers, desks, and books to find loose papers, old tests, important notes and worksheets.
    • Make copies of any missing papers
    • Make sure all important documents are CORRECTED!
  • Create an Exam Binder with a section for each class, so that you will have a central location for all of your study materials. Each section should have the following:
    • Review materials provided by teacher
    • Old tests/quizzes (corrected!!)
    • Important handouts/notes/worksheets
    • Any practice tests/flashcards/study guides used during semester
  • Create a Study Schedule
    • Prioritize your time…study the material from earlier in the year or the most difficult concepts first and then review them again later
    • Study in Manageable Chunks of Time. Studying smaller amounts of material in smaller increments of time (20-30 min) can be more effective than sitting down for several hours with a big stack of papers
    • Block out time to move, eat, relax…put it on your study schedule

Memory Strategies

When it comes to memory strategies there are a lot of opinions about what the best may be. Here are some we’ve found to be tried and true.

  • Repetition…Look at it, say it, write it, draw it
  • Association…Group info, relate to something you already know
  • Visualize…draw pictures to illustrate important points and vocabulary
  • Color code…use colored flash cards or highlighters to categorize info
  • Acronyms…great for memorizing lists Graphic Organizers-use charts, webs, and other visuals to organize info

Good Brain Food

Looking for some good brain food to help your child be successful in school and, in particular, be ready for taking tests? Here’s a nice list!

  • Green Tea (decaf)
  • Broccoli
  • Avocados
  • Oatmeal
  • Red Bell Peppers
  • Oranges
  • Salmon
  • Spinach
  • Tuna
  • Turkey
  • Walnuts
  • Multivitamins
  • Fish Oil
  • Flaxseed Oil

Adapted from Dr. Amen’s PBS Special, Change Your Brain, Change Your Life.

Test Anxiety

The Amygdala is a part of the brain that is our “alarm system.” It is on patrol 24/7 looking for danger. It is constantly monitoring for potential harm. It will also remember stressful situations and will trigger when similar situations recur (certain classrooms, test anxiety, dental office). The Amygdala is where test anxiety comes from.

When the Amygdala is triggered, stress hormones are released in the brain. These hormones make it difficult to either learn something new or remember information you have learned previously. Your brain will start focusing on the stress instead of the learning task.

Your goal is to stop the flow of stress hormones as quickly as possible. Here are a few tips:

  • Flip the test over and start writing down simple facts you know about the material (formulas, math facts, acronyms, diagrams). This redirects your brain by focusing on data rather than emotion.
  • Think of something funny. Humor decreases stress and anxiety.
  • Smile. Your brain actually has a motor memory of facial patterns. You may be able to trick your brain into thinking you are happier than you actually are!
  • Water lowers levels of the stress hormone in the brain. Stay hydrated. Drink 5-10 minutes before a test.
  • Repetition of a phrase, mantra, scripture, quote, or verse can help to relax the brain. 
  • Sleep is essential for memory storage. 8-9 hours is needed. Less than 6 hours and your brain will be impaired the next day.

Adapted from Emotion and Learning Seminar by Kimberly Carraway. Kimberly is a local educational consultant who specializes in brain based teaching and learning strategies. She lectures in Nashville and around the country on how to practically apply the latest neuroscience research to student learning. For upcoming seminars and conferences, please visit