Does your child seem like a “Square Peg in a Round Hole”?

When Your Child Doesn’t Seem to “Fit”: Understanding and Supporting Neurodivergent Kids

Picture trying to fit a square block into a round hole in a shape sorter. No matter how hard you push or turn it, it just won’t fit. This is how many neurodivergent children feel every day in schools, social situations, and even at home. These are the kids who might have ADHD or autism or simply think and experience the world differently than most. But here’s the thing – they’re not broken blocks that need reshaping. They’re unique individuals who need the right space to shine.

“Why Can’t My Child Just…?”

If you’ve ever asked yourself, “Why can’t my child just follow simple directions?” or “Why do they struggle with things other kids find easy?” you’re not alone. Dr. Ross Greene, who has worked with countless families, puts it beautifully: “Kids do well if they can.” This simple but powerful idea turns traditional thinking on its head. When our children struggle, it’s not because they’re being difficult – it’s because something in their environment doesn’t match their needs or abilities.

It’s Not About Trying Harder

Consider asking someone nearsighted to “just try harder” to see clearly. Sounds ridiculous, right? Yet we often expect neurodivergent kids to “try harder” to fit into situations that aren’t designed for their way of thinking or processing information.

Robyn Gobbel, who specializes in helping parents better understand their children, explains that connecting with our kids is more important than trying to correct their behavior. When children feel understood and supported, they’re much more likely to develop the skills they need to navigate challenging situations.

Your Child’s Brain: A Different Kind of Beautiful

Dr. Daniel Siegel helps us understand that every child’s brain develops in its own unique way. Just like some people are naturally artistic while others are mathematical, neurodivergent children have unique ways of thinking and learning. Instead of seeing this as a problem to fix, we can view it as a different kind of gift to nurture.

Making Room for All Shapes

So, how can we help our square pegs thrive in a world full of round holes? Here are some practical ideas:

  • Create “just right” challenges: Break big tasks into smaller, manageable pieces
  • Look for the message behind the behavior: When your child struggles, ask, “What’s making this hard?” instead of “Why won’t they cooperate?”
  • Celebrate different ways of doing things: Maybe your child needs to move while learning or draw while listening.
  • Trust your instincts. You know your child best. If something isn’t working, it’s okay to try a different approach.

A New Way Forward

Instead of trying to make our children fit into spaces that weren’t designed for them, we can work on creating spaces that welcome all kinds of minds. This might mean:

  • Talking with teachers about flexible learning options
  • Finding activities where your child’s unique traits are strengths, not challenges
  • Connecting with other parents who understand your journey
  • Most importantly, helping your child understand that different isn’t wrong – it’s just different

The Real Goal

The goal isn’t to turn square pegs into round ones. It’s to create a world where all shapes are welcomed and valued. Your child isn’t a problem to solve – they’re a person to understand and support.

Recommended Resources

For parents wanting to learn more:

  1. “The Explosive Child” by Dr. Ross Greene
  • Learn about collaborative problem-solving and working with your child instead of against them
  1. “Lost at School” by Dr. Ross Greene
  • Understanding how to advocate for your child in educational settings
  1. “The Whole-Brain Child” by Dr. Daniel Siegel and Dr. Tina Payne Bryson
  • Practical strategies for understanding your child’s development and behavior
  1. “Beyond Behaviors” by Mona Delahooke
  • Understanding and helping children with behavioral challenges
  1. “Building the Bonds of Attachment” by Daniel Hughes
  • Insights into connection-based parenting approaches

Online Resources:

Remember, you’re not alone on this journey. These resources are here to support both you and your child as you navigate this path together.

Helping Your ADHD Child Succeed in School

Strategies for Parents of Children with ADHD

Raising a child with ADHD presents unique challenges, especially when it comes to succeeding in school. Understanding these challenges and implementing effective strategies can make a significant difference in your child’s educational experience.

Common Challenges for Children with ADHD in School

  1. Distractibility and Inattention: Children with ADHD often struggle to focus on tasks. They can be easily distracted by noises or their own thoughts. This distraction leads to missed classroom information[5].
  2. Hyperactivity and Impulsivity: The need to move and difficulty with impulse control can make it hard for children to sit still. These children often struggle to stay seated. Listening quietly is often required in a classroom setting[5].
  3. Organizational Difficulties: Many children with ADHD have trouble organizing their school materials, managing time, and breaking assignments into manageable parts[2].
  4. Social Challenges: ADHD can affect social interactions, leading to difficulties in maintaining friendships and interacting with peers and teachers[3].
  5. Emotional Regulation: Children with ADHD may struggle with managing their emotions. This can lead to frustration and stress. This is especially true when tasks seem overwhelming[4].

Strategies to Help Children with ADHD Succeed in School

  1. Create a Structured Environment: Provide a consistent routine at home and work with teachers to make sure a structured classroom environment. This helps children know what to expect and reduces anxiety[1][2].
  2. Positive Reinforcement: Use a rewards system to encourage positive behavior and academic engagement. Recognizing achievements, no matter how small, can boost confidence and motivation[4].
  3. Develop Organizational Skills: Teach your child how to organize their schoolwork and break tasks into smaller, more manageable steps. Tools like planners or checklists can be helpful[2].
  4. Encourage Physical Activity: Allow for regular breaks and physical activity to help manage hyperactivity. This can include short exercises or simply allowing the child to move around during lessons[4].
  5. Collaborate with Educators: Keep open communication with your child’s teachers. Ensure they understand your child’s needs. They can then provide appropriate accommodations, such as extra time for tests or a quiet space for work[5].
  6. Focus on Social Skills: Help your child develop social skills through role-playing or social skills groups. Encourage positive interactions with peers to build friendships[3].
  7. Emotional Support: Teach your child strategies for managing emotions, such as deep breathing or positive self-talk. Building self-awareness can help them cope with stress and frustration[1].

Parents can play a crucial role in helping their children with ADHD succeed in school and beyond. This can be achieved by understanding the challenges and implementing these strategies.

Citations:
[1] https://www.beyondbooksmart.com/executive-functioning-strategies-blog/how-does-adhd-in-children-impact-academic-performance
[2] https://rvapediatrics.com/ADHD%E2%80%94Why-Is-My-Child-Having-Trouble-in-School
[3] https://www.cdc.gov/adhd/articles/school-changes-helping-children.html
[4] https://www.graduateprogram.org/2022/08/the-challenges-adhd-students-face/
[5] https://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-and-school.htm
[6] https://childmind.org/article/whats-adhd-and-whats-not-in-the-classroom/
[7] https://kidshealth.org/en/parents/adhd-school.html
[8] https://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-in-children.htm

Parenting Through the Behavioral Storm: Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder (DMDD) is a relatively newly recognized mental health disorder that primarily affects children and adolescents. It is characterized by severe and recurrent temper outbursts that are out of proportion to the situation, along with a persistently irritable or angry mood between outbursts. These symptoms must be present for at least 12 months and be severe in at least two settings (e.g., home, school, with peers).

DMDD was introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which was published in May 2013. It was created to address concerns about overdiagnosis of bipolar disorder in children and to provide a more accurate diagnosis for children who exhibit chronic irritability and temper outbursts without meeting the criteria for bipolar disorder.

DMDD is seen as a way to better classify and treat children with severe irritability and temper outbursts, helping to differentiate them from those with bipolar disorder or oppositional defiant disorder. It’s important to note that DMDD is a relatively new diagnosis and research into its causes and treatment is ongoing.

Treatment for children with Disruptive Mood Dysregulation Disorder (DMDD) typically involves a combination of therapeutic interventions and, in some cases, medication management. Here are some common treatment options:

  1. Psychotherapy: Various forms of psychotherapy can be beneficial for children with DMDD:
  • Cognitive Behavioral Therapy (CBT): Helps children learn to identify and challenge negative thought patterns and develop coping strategies to manage their emotions and behavior.
  • Parent Management Training (PMT): Teaches parents effective techniques for managing their child’s behavior, setting appropriate limits, and providing positive reinforcement.
  • Family Therapy: Addresses family dynamics and communication patterns, improves conflict resolution skills, and fosters a supportive environment for the child.
  1. Social Skills Training: Helps children develop interpersonal skills, such as problem-solving, conflict resolution, empathy, and communication skills, which can improve their relationships with peers and family members.
  2. Medication: In some cases, medication may be prescribed to manage specific symptoms associated with DMDD or co-occurring conditions:
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) or other antidepressants may be prescribed to alleviate symptoms of depression or anxiety.
  • Mood Stabilizers: In cases where mood swings are severe or resemble bipolar disorder, mood stabilizers such as lithium or atypical antipsychotics may be considered.
  1. Parent Education and Support: Providing parents with education about DMDD, guidance on effective parenting strategies, and support in managing their child’s behavior can be crucial in improving family functioning and reducing stress.
  2. School Interventions: Collaboration with teachers and school staff to implement behavior management strategies, accommodations, and supports can help address academic and social difficulties and create a more supportive learning environment for the child.
  3. Stress Management Techniques: Teaching the child relaxation techniques, such as deep breathing exercises, mindfulness, or progressive muscle relaxation, can help them regulate their emotions and reduce stress levels.

Treatment plans should be individualized to meet the specific needs of each child and may involve a multidisciplinary approach involving mental health professionals, educators, and medical providers. Regular monitoring and adjustment of treatment strategies based on the child’s progress are also important for optimal outcomes.

Here are some books and resources that provide information and support specifically on Disruptive Mood Dysregulation Disorder (DMDD):

  1. “The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children” by Ross W. Greene – While not exclusively focused on DMDD, this book offers valuable insights and strategies for parenting children with explosive behaviors, including those with DMDD.
  2. “Your Defiant Child, Second Edition: Eight Steps to Better Behavior” by Russell A. Barkley and Christine M. Benton – This book provides practical guidance for parents dealing with challenging behaviors in children, including those with DMDD or oppositional defiant disorder (ODD).
  3. “Parenting Your Child with Autism: Practical Solutions, Strategies, and Advice for Helping Your Family” by Anjali Sastry and Blaise Aguirre – Although targeted towards parents of children with autism, this book offers strategies for managing challenging behaviors that may apply to children with DMDD.
  4. “Managing the Meltdown: A Parent’s Guide to The Disruptive Mood Dysregulation Disorder” by Naomi Henderson – This book specifically focuses on DMDD and offers guidance for parents on understanding the disorder, managing meltdowns, and supporting their child’s emotional well-being.
  5. “Raising An Emotionally Intelligent Child: The Heart of Parenting” by John Gottman – While not specifically about DMDD, this book provides insights into fostering emotional intelligence in children, which can be beneficial for parents navigating the challenges of DMDD.
  6. “Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach” by Vincent J. Monastra – While ADHD and DMDD are distinct disorders, they can share some overlapping symptoms and challenges. This book provides practical advice for parents dealing with behavioral issues in children, including those with DMDD.
  7. “The Highly Sensitive Child: Helping Our Children Thrive When the World Overwhelms Them” by Elaine N. Aron – While not directly related to DMDD, this book offers insights into understanding and supporting highly sensitive children, which may be relevant for parents of children with DMDD who are easily overwhelmed by emotions.

These resources can provide valuable information and support for parents seeking to better understand and manage DMDD in their children. It’s important to consult with mental health professionals for personalized guidance and treatment recommendations tailored to the individual needs of the child and family.

How to Focus When You Have ADHD

Parenting a child with ADHD can present its own unique challenges, especially when it comes to helping them focus on tasks and activities. ADHD, or attention-deficit/hyperactivity disorder, can make it difficult for children to concentrate and stay on track, but there are strategies that parents can use to help their child improve their focus and attention. Here are some tips on how to help your child focus when they have ADHD.

  1. Create a structured routine: Children with ADHD thrive on structure and routine. Establishing a consistent daily schedule can help them know what to expect and when, which can in turn help them stay focused on tasks. Set specific times for waking up, meals, homework, and bedtime, and try to stick to this routine as much as possible.
  2. Break tasks into smaller steps: Large tasks can be overwhelming for children with ADHD, making it difficult for them to focus. Break down tasks into smaller, more manageable steps, and provide clear instructions for each step. This can help your child stay on track and feel a sense of accomplishment as they complete each step.
  3. Minimize distractions: Create a quiet, clutter-free environment for your child to work on tasks. Minimize distractions by turning off the TV, removing toys or other items that may be distracting, and finding a quiet space for your child to focus. Consider using noise-cancelling headphones or white noise machines to help block out distractions.
  4. Use visual aids: Visual aids, such as charts, checklists, and timers, can help children with ADHD stay focused and organized. Use visual schedules to help your child understand what needs to be done and when, and use timers to help them stay on track and manage their time effectively.
  5. Provide positive reinforcement: Positive reinforcement can be a powerful motivator for children with ADHD. Offer praise and rewards when your child can stay focused and complete tasks. This can help build their confidence and encourage them to continue working on their focus and attention skills.
  6. Encourage physical activity: Regular physical activity can help children with ADHD release excess energy and improve their ability to focus. Encourage your child to engage in activities they enjoy, such as sports, dance, or outdoor play. Exercise can help improve attention and concentration, so make sure your child has opportunities to be active every day.
  7. Seek professional help: If you are struggling to help your child focus, consider seeking support from a professional. A pediatrician, psychologist, or other mental health professional can provide guidance and support for managing ADHD symptoms and improving focus and attention.

Parenting a child with ADHD can be challenging, but by implementing these strategies, you can help your child improve their focus and attention. Remember to be patient and understanding, and seek support when needed. With the right support and strategies in place, children with ADHD can learn to focus and succeed in their daily activities.

Your Body is a Brain…

Great writers and painters have known this fact for decades: The body acts like a brain…

Walt Whitman understood that the flesh was the source of meaning; Auguste Escoffier discovered that taste is actually a smell; Paul Cézanne realized that the brain can decipher an image from minimal brushstrokes.

Jonah Lehrer has written a book called Proust Was a Neuroscientist

In my own trauma-informed trainings I discuss how our central nervous system, specifically the nerves surrounding our “guts”, acts as a second brain.

Did you know that there are 43 different pairs of nerves which connect the nervous system to every part of our body. Twelve of these nerve pairs are connected to the brain, while the remaining 31 are connected to the spinal cord.

Did you know that the gut has 100 million nerve cells that make up it’s own nervous system separate from the brain!

Did you know that one of the major nerve pathways from the gut to the brain is called the Vagus Nerve. The brain interprets signals from the Vagus Nerve as actual emotional information. It really doesn’t know the difference. 

Did you know that there is more and more research on how the gut and gastrointestinal conditions are linked to depression, anxiety, autism, and ADHD. What we are talking about here is nutrition and not just medication can change our mental health.

And did you know that there is a reason we call certain kinds of food “comfort food”? Comfort foods affect our moods. Can someone say chocolate please?

Understanding the brain/body connection can help us overcome trauma in ways that traditional talk therapy cannot. This is because a lot of times there are no words to express what trauma is doing in our lives or the trauma is so far back in infancy and during pregnancy that there was no ability to form words.

This will require a new approach to doing therapy that involves movement, sensory processing, art therapy and my own NeuroResilience Play Therapy Approach. Click here for more info.

What is your body telling you?  Perhaps its time to follow your “gut” instincts today and find the help you need. Hey, writers and artists have been telling us for years this truth about our body acting like a brain. Let’s listen to what it is saying!

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sensorycalm:

(via Weighted Blankets for Anxiety Autism Insomnia Soothing Comforting by Mosaic Weighted Blankets in Austin Texas|Seen on NBC Parenthood Show)

Mosaic Weighted Blankets for sensory processing disorders in Autims, ADHD, Trauma and more. 

The Benefits of Mosaic Weighted Blankets® for Anxiety, Stress, and Insomnia

Adults, teens, and children can benefit from weighted blanket therapy. Mosaic Weighted Blankets are a safe and effective non-drug therapy for anyone seeking a solution for loss of sleep and relaxation.

“In psychiatric care, weighted blankets are one of our most powerful tools for helping people who are anxious, upset, and possibly on the verge of losing control,” says Karen Moore, OTR/L, an occupational therapist in Franconia, N.H.

“These blankets work by providing input to the deep pressure touch receptors throughout the body,” Moore says. “Deep pressure touch helps the body relax. Like a firm hug, weighted blankets help us feel secure, grounded, and safe.” Moore says this is the reason many people like to sleep under a comforter even in summer. (Source: Psychology Today)

Failing School? Sensory Issues Could be the Problem.

Parents are worried about children returning to school and failing!

Guest post by Marga Grey, OT

It’s a horrible thought…

Your little one, suffering at school. Whether they’re struggling to make sense of the lessons, or even being bullied for being “different”.

All you want to do is swoop in and protect them! I know, I’m a mom myself. And even as they get older, that protective feeling doesn’t get any less…

If I take my mom hat off for a minute, and put my Occupational Therapist one on, I can tell you a fact:

Poor Sensory Motor Skills are the culprit for most problems in the classroom.

It’s true.

Things like:

  • Concentration
  • Handwriting
  • Sitting still in their chair
  • Coordination
  • And more

Are all impacted by poor Sensory Motor Skills.

And how a child reacts to these problems is different in every case.

Some go into their shell, become anxious and have bad associations with school, even experiencing physical symptoms like stomach pain and headaches at the thought of going to school.

Others act out and are unfairly labeled “troublemaker” or “lazy” when they actually have no control over their ability to complete the allocated tasks.

One thing is consistent throughout every child I see though:

Improving their Sensory Motor Skills improves their performance in the classroom. Fact.

And as they have to be at school for 12 years (not counting further study after that) it is SO important to give them the best possible foundation for their schooling career!

Even if you feel they are doing “Okay” and there’s nothing really wrong… helping your child’s Sensory Motor Skill development will only give your child even more of an advantage.

Learn how to give your child the skill to focus and control their impulses before school starts! Click here for more info.

“WHEN IMPULSES RULE a CHILD’S LIFE | Psychology Today

WHEN IMPULSES RULE a CHILD’S LIFE

By David Lewis , Ph.D. on December 27, 2013 – 3:50am

Billy, an impulsive 11-year-old, is viewed by his teachers as somewhat lazy, easily distracted and lacking in motivation.

His parents, convinced their son’s poor performance was due to a ‘mental’ problem, insisted he be as tested by the school’s psychologist. When she reported Billy was a perfectly normal little boy they refused to accept her diagnosis. They went to three further psychologists all of whom confirmed their colleague’s original findings. Still dissatisfied they sent him to a yet another specialist who finally provided the diagnosis they sought. Billy, he said, was suffering from Attention Deficit Hyperactive Disorder (ADHD). Given the appropriate medication their son could well turn into a straight A student.

“We always knew it,” they told his teachers triumphantly. “Our son is not lazy – he’s sick.”

They are far from unusual in this desire to explain away behaviour which, even a decade ago, might have been viewed as a normal part of growing up as a medical condition for which a cure must be found.

In the US, ADHD is now the second most frequent long-term diagnosis made in children, beaten only narrowly by asthma. Data from the Center for Disease Control and Prevention indicate it has been diagnosed in up to 15% of high school-age children and that the number of youngsters being medicated for the disorder has risen from 600,000 in 1990 to 3.5 million today. By contrast, world-wide, ADHD affects only around 5% of children, the majority boys. (1)

It is, of course, essential that children with a genuine illness are speedily diagnosed and effectively treated. Medication, in such cases, is often an essential first step on the road to recovery.

The trouble is that between obviously healthy and manifestly sick youngsters there is a grey area which is growing in size with every passing year. Since, in the absence of pathology, there are at present no tests or scans that can detect mental illness, diagnosis tends to be subjective. What one psychologist considers perfectly ‘normal’, another may view as highly abnormal.

In a recent interview with the New York Times Dr Keith Conners, a psychologist and professor emeritus at Duke University, who for more than 50 years has led the fight to legitimise the disorder, called this increase:

“A national disaster of dangerous proportions…a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” (3)

The most widely used form of treatment is to use drugs, such as methylphenidate atomoxetine, and dexamfetamine. Unfortunately, around one in five ADHD sufferers fail to respond to drugs (4) while in many other cases the response is only partial. Furthermore, all drugs have side effects, can also be habit forming and open to abuse. Long-term follow-ups have found that when children stopped taking the drug their clinical symptoms of ADHD reappeared.

Problems such as these have led some therapists, especially in the US, to start using a form of treatment known as EEG-Neurofeedback training.

This involves teaching sufferers how to control their ‘brain waves’ by playing computer games via sensors attached to their head. (5) The results appear promising, with improvements being found in around 40 percent of cases at six month follow-up.

In a recent study in my laboratory* two teenage boys played a computer game involving a race between a red and a blue caterpillar. Thin wires ran from electrodes pasted to their scalps to a control box. This detects electrical activity in their brains and uses these ‘brain waves’ to move the caterpillars across the screen.

Mark, aged 13 has been diagnosed with ADHD his friend, 14-year-old Ryan exhibits no such symptoms. During the game, Ryan’s red caterpillar speeds quickly along the track as he reduces his output of slow moving ‘theta waves’ while simultaneously increasing faster moving ‘beta waves’. Mark’s brains produces higher levels of theta and lower levels of beta waves his blue caterpillar barely moves off the start line.

Over a period of time, however, Mark trains himself to reduce his theta and boost his beta waves. In doing so he learns to control his impulsive behaviours.

While researching for my new book, Impulse, I came across several examples of behaviour which our forefathers would have shrugged off but which present-day parents see as requiring medical intervention. Given the lifestyle of many youngsters these days this may not be so surprising.

Many youngsters are discouraged from engaging in activities, such as exploring, getting into and out of scrapes, climbing trees and falling over, that earlier generations accepted as a normal part of childhood down. Even the amount of time they have for exercise is so constrained these days, especially for urban children, by parental concerns for their safety. Some children may be exhibiting the symptoms of hyperactivity simply because they’re not getting enough physically demanding exercise!

Taking risks and learning from the consequences of their mistakes is an essential part of growing up and developing independence.

The teenage years, especially, are the most intense and exciting of a child’s life. They’ll be unhappy, do silly things, take reckless decisions and make foolish misjudgements of people and situations.

But if they behave impulsively and fall flat on their faces from time to time, this doesn’t mean they need a diagnosis or a pill. It just means they’re being kids.

* Mindlab International is purely a research laboratory and does not offer any neurofeedback training. There are, however, many practitioners in both the USA and UK

References

(1) Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., Rohde L. A., (2007) The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis. American Journal of Psychiatry, 164(6), 942–948.

(2) Faraone, S. V., Biederman, J., Mick, E., (2006) The Age-Dependent Decline of Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Follow-Up Studies. Psychological Medicine, 36(2), 159–165.

(3) Schwarz, A. (2013) The Selling of Attention Deficit Disorder, New York Times, Dec 14

(4) Charach, A., Figueroa, M., Chen, S., Ickowicz, A., & Schachar, R. (2006) Stimulant treatment over 5 years: effects on growth. Journal of American Academic Child Adolescent Psychiatry, 45: 415–421.

(5) Lansbergen, M. M., van-Dongen-Boomsma, M., Buitelaar, J. K., Slaats-Willemse, D., (2010) ADHD and EEG-Neurofeedback: A Double-Blind Randomized Placebo-Controlled Feasibility Study. Journal of Neural Transmission, 118(2), 275-284

“WHEN IMPULSES RULE a CHILD’S LIFE | Psychology Today

Comparison of Mother, Father, and Teacher Reports of ADHD Core Symptoms in a Sample of Child Psychiatric Outpatients

Review by Ron Huxley

A study in the Journal of Attention Disorders looked at the differences or similarities of identifying ADHD symptoms in children between Fathers, Mothers and Teachers. It didn’t surprise me that fathers reported fewer symptoms than did mom and dads. This is probably due to the fact that dads, typically, spend less time with children than do moms and teachers. It isn’t a gender issue as a teacher could easily be a man as well as a women. Having said that, parental roles played out by gender may have some influence over what is noticed and what is not. The interesting finding of the study was that moms and dads correctly diagnosed the problem at the same rating. Apparently, dads can spot ADHD when they see it – the question, I suppose, is do they see it. 

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Comparison of Mother, Father, and Teacher Reports of ADHD Core Symptoms in a Sample of Child Psychiatric Outpatients