Raised On Ritalin Going Beyond Drugs Parents, Teachers Find That A Structured And Consistent Environment Helps Kids With Add Do Better In School

When parents get together, they talk about good school years and bad school years and teachers who made a difference.

Parents with children labeled classroom terrors and goof-offs because of a disability called attention deficit disorder are no different.

Researchers studying the disorder are beginning to talk that way, too. They are learning that drugs alone are not enough to turn an inattentive, impulsive child into a successful student.

It takes trained teachers working with trained parents.

For years, most research on the controversial disorder had been devoted to testing drugs such as Ritalin. Now, scientists are exploring how behavior management, close communication between school and home and simple ideas such as seating the child near the teacher can help.

“We have no doubt ADD kids can pay attention. They just need some help doing that,” said James Swanson of the University of California at Irvine, whose center for hyperactive children is part of a massive research project paid for by the National Institutes of Health.

Experts say the disorder probably is genetic, possibly caused by underactive brain chemicals, and often is misdiagnosed.

While research continues, Inland Northwest teachers and parents struggle to find ways to help children with attention deficit disorder do well at school. Many grope for answers while relying mostly on drugs such as Ritalin.

A few, such as East Valley teacher Nancy Larson, whose son has the disorder, prefer to steer clear of drugs.

Eleven-year-old Alice Shaw, diagnosed three years ago with the disorder, just finished a good school year at Skyview Elementary in Larson’s fifth-grade class.

Alice memorized her multiplication tables and became a better reader. She stopped taking Cylert, a drug similar to Ritalin. Alice’s mother, Cindy Shaw, believes her daughter sleeps and eats better now.

“The No. 1 key is structure,” said Larson. “If everything is structured in their day, they are calm and they can produce.”

Larson’s frustrations raising her 6-year-old son led her to learn about the disorder.

“Any teacher who has one of these kids and doesn’t reach out for help is going to have one miserable year.”

Drugs have their place, Larson said, but if she can wean a child from them with the parents’ permission, she will. Her son took Ritalin for a year, learned better behavior and now is off the drug.

Portrait of tomorrow’s dropout

Despite average to above-average intelligence, ADD children have a one in three chance of dropping out. Only 5 percent who go to college graduate.

Mary Brown of Spokane School District 81 said she sees two common threads among dropouts: Often they have flunked a grade; often they have been on Ritalin, the most popular drug treatment for the disorder.

Every note home, every scolding, every bad grade tells an ADD child that school is not for him, said Karen Blaine. She has a son with the disorder and heads the Spokane chapter of CHADD, Children and Adults with Attention Deficit Disorders.

“What if every day you went to work and had to do what was impossible for you to do? You’d probably quit,” Blaine said.

Assignment sheets, rewards and special seating can improve the school year for children and their teachers - with or without drugs, researchers say. These strategies also may help the children’s chances of staying in school.

Despite dramatic short-term results noticed by parents and teachers, researchers find no evidence that Ritalin or other stimulants have long-term effects on school performance.

Drugs may make a child easier for teachers to handle, but they don’t mean the child does better in school. In fact, too high a dose can produce an extremely compliant child too zonked out to learn.

Instead, drugs provide a way for an easier-to-manage child to learn lifelong strategies for listening better, learning better and making friends more easily.

Some children successfully go off drugs after a year or two, or when they hit puberty. Some children with few behavior problems don’t need drugs.

Researchers like Swanson encourage parents and teachers to reward specific good behavior. The children in Swanson’s research project also learn social skills, organization and how to deal with anger.

But numerous children in the Inland Northwest are treated solely with drugs, said Penny Fry, mother of a 16-year-old daughter with the disorder and leader of a Spokane parent support group.

And that treatment is flawed.

Many doctors are sloppy in monitoring medication, Fry said. In effect, they leave dosages up to parents’ judgment. Very few get feedback from schools.

‘A reason to try harder’

Meanwhile, schools and parents speak different languages.

Some teachers don’t believe in the disorder. They think ADD children intentionally disrupt their classrooms.

“I think in schools there’s a lack of acceptance of the disorder,” said Spokane therapist Randy Garrett, who conducts group therapy for ADD children and their parents. “There’s an underlying assumption these children can make choices the way other people can.”

Rising rates of diagnosis drive up education costs because the law requires schools to give the ADD children special attention. That increases the price tag in Washington schools by nearly $24 million a year.

Those costs make school administrators flinch when parents ask for help for their children. Teachers resent what they see as requests for unfair treatment such as shorter tests or reduced homework.

Coeur d’Alene Special Education Director Pat Pickens is concerned about the tendency to deny ADD children’s responsibility for their actions.

“Every once in a while you hear someone say, ‘He can’t help it,”’ Pickens said. “These kids need consistency and structure. Instead of lightening up, I want to tighten the parameters. That doesn’t always meet with smiles.”

Parents, meanwhile, don’t want schools to punish their children for what they see as a disability.

They resent being judged as bad parents because their children suffer from the disorder. They emphasize that fair doesn’t have to mean equal treatment; fair means each child gets what he or she needs.

Parents and teachers must find a middle ground between “He’s a troublemaker” and “It’s not his fault,” experts advise.

Alice Shaw’s mother, Cindy, has found that midpoint. She tells her daughter, “You have ADD. It’s not an excuse to not do well. It’s a reason to try harder.”

Parents fight schools for help

Some parents who seek special help for their children complain about getting the runaround.

Their stories are similar to Spokane parent Bill Dillon’s.

After spending hours sitting beside his son to make sure he did his homework, after fielding countless calls from teachers about incomplete assignments, Dillon asked Sacajawea Middle School to test his son to identify the problem.

He asked again and again, but nothing happened. Teachers viewed his son’s inattentive behavior as a discipline problem, not a disability.

“Most teachers don’t know anything about ADD and some don’t want to know anything about it,” Dillon said. One teacher called it “mumbo jumbo.”

Then an acquaintance who worked for the school district suggested Dillon write a letter requesting his son be made “a focus of concern,” alerting the district Dillon knew his legal rights.

“I needed to learn the magic words,” Dillon said. “Once I did, the doors swung open.”

But not wide enough. On the basis of an intelligence test, the district told Dillon his son was ineligible for special education.

“We were just absolutely shocked,” Dillon said. “We lost about a year and for him it was crucial. He began to hate school and we couldn’t keep him in school.”

Two years ago, the boy was also diagnosed with conduct disorder, which means he disobeys rules and laws. Dillon feels his son, now 16, became a defiant troublemaker because schools viewed him as one.

“School was a torturous, demeaning and very negative experience, the opposite of what it should be,” Dillon said.

Parents have federal law on their side since a shift four years ago in interpretation of special education and anti-discrimination laws.

After a campaign by parent support groups and researchers, the U.S. Department of Education spelled out the rights of ADD students in 1991.

It said they could qualify for extra help in school, either special education or other help through Section 504 of the Rehabilitation and Disabilities Act.

Extra help can mean moving a child’s desk to the front of the room or providing a tutor or a note-taker.

If a child qualifies for special education, parents gain more legal rights and schools must provide specially trained teachers.

Since the decision, schools have braced for what one educators’ magazine termed the “approaching epidemic of Attention Deficit Disorder.”

Courts, however, recognize school districts’ financial limits.

The 1991 action was a response to claims of ADD advocates that a large percentage of children were being denied special education.

In Spokane, most children with the disorder do not receive special education.

Fewer than 10 percent of the 556 children taking medication for ADD in the Spokane School District last spring received special ed services.

The district could not supply numbers of children who get less-intensive help through less-formal arrangements.

Good teachers highly sought

Nancy Larson and Cindy Shaw prove that school and home don’t have to be enemy camps.

But teachers well-versed in the disorder are so rare they get more than their share of problem kids. Word spreads among parents who request these saintly teachers for their children.

Until school districts and teachers’ colleges begin using new training material from the Department of Education, a few experienced teachers will continue to shoulder more of the burden.

“Some teachers who are very good get some very difficult children. I talked to one teacher who had seven ADD children in her classroom,” said therapist Garrett.

As much as possible, Shaw selects teachers for her daughter, Alice.

“I go to the school and get familiar with the teachers and let them know I’m a very interested parent,” Shaw said. “I find out how familiar they are with ADD, whether they’ve handled ADD before. I don’t leave it to chance.”

Garrett suggested parents talk frequently with teachers. He tells them to acknowledge their child “probably does twice as much negative behavior as the other kids in the classroom.”

Swanson of the University of California counts himself as one researcher concerned about the rocketing popularity of Ritalin.

“We thought all too often medication was the only thing offered, and it didn’t solve all the problems,” he said.

In Swanson’s work with California schools, classroom aides help ADD students with five target behaviors: getting started, concentrating on tasks, getting along with peers and staff, completing work and switching activities.

They do this with time-honored behavior-management techniques. For example, they might say to a student, “I’ll come by three times during this period and if you are working I’ll give you four points.”

Students trade points for privileges at home, like having friends over, watching television or going to a movie. Students eventually learn to monitor their own behavior.

It boils down to Grandma’s Rule, Swanson said: “First you work, then you play.”

Many children in Swanson’s program get by without drugs. About one-third of students with the disorder in the program take stimulants, less than half the national rate.

New resources are available for teachers looking for ways to help their students.

The Department of Education collected “101 Ways to Help Children with ADD Learn,” methods that can be used regardless of whether a child is taking drugs. The kit includes two videotapes, one for parents and one for teachers.

The tips work, said Fry.

Her daughter’s grades stayed high as long as she was seated at the front of her sixth-grade classroom. Then one week the girl began bringing home F’s on her math papers.

Fry went to school and found out the teacher had moved her daughter to the back of the class because she was doing so well. Fry insisted on moving the girl back to the front. Her daughter returned to getting A’s in math.

“She couldn’t get new concepts with the added distractions of 30 students in front of her,” Fry said.

Leadership from principals, teacher training and schoolwide approaches are the common themes among schools doing the best work with ADD students, according to a University of Kentucky study.

Some school districts follow written procedures for referral to doctors, identification of the disorder and parent involvement.

“Consistency and structure can work for almost every child,” Larson said.

, DataTimes ILLUSTRATION: 2 Photos (1 Color) Graphic: ADD drugs and the schools

MEMO: This sidebar appeared with the story: For more information “Attention Deficit Hyperactivity Disorders Handbook.” A Washington task force wrote these guidelines for diagnosis and treatment. Includes tips for teachers. Published March 1994. Free. Order from state superintendent’s office, Old Capitol Building, P.O. Box 47200, Olympia, WA 98504-7200. Or call 1-360-753-6733. “Education of Children with Attention Deficit Disorder.” This kit from the U.S. Department of Education includes two videotapes and tips for parents and teachers. Costs $55, including shipping. Order from the Council for Exceptional Children, 1920 Association Drive, Reston, VA 22091. Or call 1-800-232-7323. A catalog of books, audio tapes and videotapes is available from the ADD WareHouse. Call 1-800-233-9273. CHADD (Children and Adults with Attention Deficit Disorders) publishes fact sheets, a newsletter and a magazine with the latest research and news about ADD. Sponsors annual conferences. Individual membership costs $35. Call 1-305-587-3700. National Attention Deficit Disorder Association provides a list of resources. Write NADDA at 42 Way to the River, West Newbury, MA 01985. Or call 1-800-487-2282. Children First! holds dissenting views from the mainstream concerning ADD and its treatment. Membership to Children First! is $25. For more information, write the Center for the Study of Psychiatry, 4628 Chestnut St., Bethesda, MD 20814.

The following fields overflowed: CREDIT = Carla K. Johnson staff writer Staff writer Susan Drumheller contributed to this report.