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Okay, I know it seems like this subject has been beaten to death. You've probably done all the research you can possibly do, and have already made your decision about whether or not you will give your ADHD child Ritalin.

So to set the record straight, I'm not going to tell you whether or not to give Ritalin. Instead, I'd like to point out one very important point to consider when deciding whether or not to give Ritalin: could it possible your child has an auditory processing disorder, not ADD?

I've spoken to numerous parents and teachers who complain to me about their child being inattentive, hyperactive, impulsive, or otherwise not in line with the program. They have taken their child for testing, and been told their child could benefit from Ritalin.

Then I do an evaluation with their child, and lo and behold, their child has a significant language disorder. The two most well known areas for possible language dysfunction are receptive (understanding) and expressive (speaking) language. There are, however, a lot of other different areas a child can have difficulty with.

For example, I tested one seven year old who was bilingual, and spoke beautifully in both languages. She seemed articulate, perceptive- an unlikely candidate for a language issue. However, testing showed that she did in fact have a language disorder. How could this be?

There are two types of speech, automatic and literate. Automatic language is everyday language. It is the language you use to talk to your friends, what you hear on TV, in movies, or on the radio. Literate language is the language of learning- what you find in a textbook, professional article, or literature assignment.

This little girl's parents were quite surprised when the results came in, since their daughter seemingly spoke so well. However, it is not as uncommon as you might imagine. They are two separate language functions, and therefore a child could be good in one and lousy in the other.

There are actually six levels of language. Think of an upside down pyramid. At the bottom are phonemes. These are the sounds that make up language. Then next are morphemes, which are the smallest bits of words that we can have that still make sense. These are prefixes and suffixes. The third level involves semantics, or word meanings. The fourth involves language on the sentence level, or syntax. The fifth, is called discourse processing, and refers to language on the paragraph level, while the sixth level, metalinguistics, is how we think about language.

All this may seem confusing, but really you only need to understand one thing: if your child has trouble in even one of these areas, she could have serious trouble functioning in class.

Not all of these skills develop in top to bottom order. Children first improve in syntax, and only later, in middle school or high school, are they faced with the more technical language that many subjects require. Don't assume, therefore, that because your child has done well up until now, she couldn't possibly have a problem. A child could have language breakdown at any developmental level.

Pay attention to your child; notice when they seem to be right with you, and when they seem to suddenly get hyperactive, or spacey. Do you often have to repeat directions? Does your child have trouble keeping up with the rest of the family during a fast and furious conversation?

When doing homework with your child, does it seem as if your child needs a lot of help understanding what they read? Do they have tend to speak in short sentences?  Are they able to gather new information from what they read?

Keep a journal if you need to, for about a two weeks, in order to help you see the overall picture. Children who have language issues may show an uneven ability to concentrate in school. Their math teacher may say they do just fine, while their science teacher may throw up his hands in frustration.

Sometimes a child will seem to do well on Ritalin for the first month or two. Then teachers start complaining, begin suggesting an increase. So the parents succumb after a while- the doctor did say this was a starting dose- and up the medicine. The teacher sees an improvement, but then in a year, the teacher says she sees a drop-off in his behavior...

You get the idea. Of course I'm not suggesting that Ritalin may not be the answer for some children; I've seen it work wonders for some children. The point here is that before you give Ritalin you need to make sure that a language delay is not the real reason they cannot pay attention.

By the way, the fact that there was improvement on Ritalin is not proof your child has ADD (although some people would like you to believe this). Many people -even non ADD- will see an improvement using it. Why do you think so many teenagers and adults use it illegally?

If you suspect your child may have a language disorder, have him or tested, preferably with a didactic evaluation. If you find your child does have a language issue, contact an educational therapist, who can help your child both compensate for his weakness, and improve his language skills. Doing so may just save you from going for a ride on the "Ritalin roller coaster."

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