Wednesday, August 29, 2007

After High School?

Sunday night we dropped my son Andrew off for his second partial week at a Maryland Department of Rehabilitation Services (DORS) program to help Andrew think about employment options.

The literature on AD/HD emphasizes that transitions from stages in life—to elementary school, to middle school, to high school, to college, and to the work world—are particularly stressful and difficult for many individuals with AD/HD and related disorders. Some speculate that the transition to work from school may be the most difficult of these transitions.

I have previously discussed what a disaster ninth grade was for Andrew and his family. Tenth grade in a totally different school environment was a tremendous success, and our happy and growing young man looks forward to the upcoming eleventh and twelfth grades. While the public school system in our county failed to appropriately meet Andrew’s needs in ninth grade, during the transition from middle to high school the school system did encourage us to begin thinking about the after-high school experience. Because Andrew had an IEP (Individualized Education Plan under special education law), he was automatically referred to the state rehabilitation services program.

No one knows where Andrew’s skills and interests will be in another two years, but we felt it important to have us all begin thinking about options. The state rehab services program categorizes children by levels of challenge, and with severe funding restrictions, many children in need of vocational assessment and support do not get it. Andrew was accepted and enrolled; then we were told that funding cuts meant he would not participate this year; and then the state found a “slot” for him. Andrew returns to school two weeks after the regular public schools in Maryland begin, which probably helped open a “slot” for him. While next year would probably be a more ideal time for Andrew to have such an assessment experience, with governmental funding opportunities one takes them when they are offered.

Andrew stays at a vocational assessment and training center called the Workforce and Technology Center. Week one, he checked in Monday morning and departed Thursday afternoon. Week two, he checked in Sunday night and will depart Thursday afternoon. The two partial weeks are spent exposing Andrew to different job related areas to determine his ability and interest. He has yet to find something that he really enjoys. They don’t have baseball club related job areas (one of his passions in life), but they do offer a variety of computer skill areas. This summer at a school-camp program, Andrew learned PowerPoint skills. He prepared two baseball PowerPoints as well as one on the U.S.S. Ross.

While Andrew is unable to leave the Workforce Center unless there is a field trip (and none are planned during his two-week experience), he has more independence and responsibility at the facility than at school or home. He is also one of the youngest kids at the center these past two weeks. And unlike his current school, no one actively promotes social connections. He has made only one friend there, and that boy left two days after Andrew met him. So, he is lonely. He is not very interested in the skill tests and assessments. We are mildly concerned about the lack of close supervision, something he is accustomed to having. But it is also a good opportunity for Andrew to develop greater independent living skills and to begin thinking about what will follow high school. No decisions are being made, and we have two years before Andrew graduates from high school, so we have plenty of time.

If your child has an IEP, I encourage you to take advantage of job-related assessment and training opportunities that the schools or other public agencies offer.

CHADD realizes that we need to develop staffed program support of individuals facing the transition from high school and from college to the work world, as well as their families. We have submitted applications for funding support from two federal agencies—the Center for Mental Health Services (CMHS) and the Department of Labor . We will be submitting applications to private foundations to provide support to individuals in transition and their families. Our current planning focus is on individuals during the first ten years of transition from high school or college. We will continue to attempt to locate funding to employ staff specialists who can provide direct support to individuals facing this transition. Your support of this effort is also helpful and important.


Wednesday, August 15, 2007

Addressing Mistrust and Disparities Barriers

Last week I attended the annual conference of the National Medical Association (NMA), an African-American medical society in its 112th year of operation. For the fourth consecutive year, CHADD has hosted a dinner presentation on AD/HD for the NMA section on psychiatry and behavioral science. Former CHADD professional advisory board member Karen Taylor-Crawford, M.D., provided the address, speaking on “AD/HD Across the Lifespan, Questions and Quandaries.” Current CHADD PAB member Diane Buckingham, M.D., serves as the NMA section chair. This activity is consistent with CHADD's mission to provide science-based information on AD/HD and related disorders to all populations. Only two percent of the nation's psychiatrists are African Americans. At the NMA conference, 70 medical doctors discussed with CHADD how to bring the most recent science-based information on AD/HD and related disorders to their patients.

Last month, CHADD and the Black Mental Health Alliance of Baltimore conducted a public forum in Prince George's County, Maryland. Approximately 140 African-American families attended to learn about AD/HD. Moving personal stories were shared by audience participants and the all African-American faculty on dealing with the disparity in resources and information and responding to mistrust of professionals and the institutions of society.

The most recent issue of the Journal of the National Medical Association contains an article entitled, "Beyond Misdiagnosis, Misunderstanding, and Mistrust: Relevance of the Historical Perspective in the Medical and Mental Health Treatment of People of Color" (by Derek H. Suite, MD, MS; Robert La Bril, MDiv; Annelle Primm, MD, MPH; and Phyllis Harrison-Ross, MD). This article discusses how the attitudes within the clinical community and the disparities in resources have influenced African-American culture. The article reinforces the conclusion of former U.S. Surgeon General David Satcher's report, "Mental Health: Culture, Race, and Ethnicity": that mistrust is a major barrier to people of color receiving mental health treatment. This was evident at our Prince George's County forum. The article emphasizes that clinicians must be aware of and responsive to such attitudes and experiences of mistrust. As a voluntary health agency, CHADD must also be aware of and responsive to these attitudes. One of the authors of the JNMA article, Dr. Annelle Primm, attended the CHADD-NMA dinner.

Two areas of greatest concern to families attending the Maryland forum were that the use of medication to treat AD/HD might lead to substance abuse, and that placement in special education is not a service to enhance a child's ability to deal with their disability but a mechanism to isolate children, particularly boys, of color. The forum faculty, comprised of African Americans of multiple professional disciplines and family members, shared science-based information on the potential relationship between medication and substance abuse. While acknowledging that some schools and school districts have used special education as a way of segregating children, in the past and at present, many examples were given showing how special education can be extremely helpful for the growth and development of children.

CHADD's effort is to empower individuals with AD/HD and their families by providing practical, science-based information and compassionate support, allowing such persons and families to more effectively manage their lives throughout all the stages of life. We recognize that some populations and communities experience special challenges. I am proud that CHADD is able to engage in outreach and support to these communities. As a result of our Prince George’s County forum, 18 new individuals signed up to become part of the CHADD support group in their community.