“ADHD?…they used to think I had that. Now they know I have Mad Cow Disease!” -11 y.o. Academy MetroWest participant
When new kids enroll in our program, the first step in the process is undergoing an initial interview. We run through some activities in our gym with them to help us get a sense of their physical skills, overall developmental level, and personality. Then we spend some time in the office with their parents. Part of that process involves collecting background information on their child to help us make an appropriate group placement and to give his or her counselor some context to work with. One of the last things we do is to ask the parents what goals they’d like to see us address with their child.
Given that this is a social skills program, most of the goals revolve around issues such as developing greater awareness of social cues, becoming less rigid, focusing on how their behavior impacts other children and the like. In most cases, the goals that parents set are realistic and appropriate. However, there are instances in which we need to help parents develop a fuller understanding of what is and what isn’t realistic.
One of the most frequent misunderstandings arises with parents of children with ADHD. ADHD is a neurologically based disorder in which the primary symptoms are impulsiveness, distractibility, and hyperactivity. So when we ask parents of children with ADHD what they’d like to see us address with their kids, it’s not surprising that we often hear “Well, I’d like to see him become less impulsive.”
I have both an internal and external response to parents in those instances. Internally, my response is usually “Well, so would I but I can’t do anything to help you there.” So far, MY impulse control has been sufficient to squelch that response before it gets anywhere near enough to my mouth to create problems for me. My verbalized response is usually a much more respectful and responsible explanation about realistic expectations with kids who have ADHD.
First off, let me say that the primary symptoms of ADHD can often be addressed quite well through a number of different types of interventions. Medication, usually but not always stimulant medication, as well as alternatives like neurofeedback can offer effective ways of managing impulsiveness, distractibility, and hyperactivity. There are plenty of other treatments out there, with varying levels of empirical support behind them, that purport to help people get a handle on the core symptoms of ADHD.
When working on the formulation of realistic goals, in the context of a social skills group, with parents of kids with ADHD, I like to use the Alcoholics Anonymous Serenity Prayer as a guide:
God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.
Aside from the comedic potential of an “ADHD Anonymous” meeting –
“Hello, my name is Bob and I have ADHD”
“I’d like to talk to you all about my experiences with distractibility and impulsiveness but I got so wrapped up in what I was doing that I forgot to bring my notes and…Oh look! A bird just flew by the window!”
– there is good reason to focus on what’s realistic and what’s not realistic when dealing with kids who have ADHD and it all comes down to a focus on self-image. A parent who focuses efforts on pushing their child to unattainable levels of performance is going to engender a good deal of resentment, frustration, and conflict with that child. For children with ADHD, even if they find the proper medication and work diligently at improving their behavior, it’s inevitable that they’re going to do some impulsive things and get distracted at inopportune moments. These issues need to be addressed but with the proper understanding of the underlying issues and challenges they entail, along with a realistic set of expectations for continued improvement.
So if one of the tenets of the serenity prayer is the quest for courage to change the things you can, what should you focus on when it comes to working with children who have ADHD? For me, the most important, realistic goal to work on with ADHD kids is helping them take responsibility for their actions. Again, we’ll start with a given: Kids with ADHD are inevitably going to behave impulsively, get distracted, and most of them are going to become overstimulated as well. The question is, once that happens, what do they do next? Do they deny responsibility? Do they blow off the incident entirely? Do they try to shift responsibility to another child? Or, do they own their behavior and make an honest effort to make amends? The answer to that question goes a long way in determining how other kids will come to view that child. If a child cannot or does not take responsibility for his or her behavior, it is likely that they will come to be viewed by peers as being untrustworthy, mean, or irresponsible. It’s going to be hard for that child to form anything other than superficial relationships as his or her peers are likely to shy away. On the other hand, when a child can own up to their actions, apologize when necessary, and then figure out what to do in order to make things right, that child will find that peers are much more likely to cut him or her a good deal of slack. Other kids are likely to focus on the good things that an ADHD child can bring to the table and are more apt to take the time to cultivate the relationship.
Incidentally, the process of apologizing has to be more than just lip service. I’ve known many kids over the years who seem to define “sorry” as the word that makes people go away and get off my back. When I talk to kids about this process, I stress to them that taking responsibility usually involves more than a cursory apology. It involves taking the time to figure out how to make things right and then going about doing just that.
Taking responsibility for mistakes can involve threats to self-image. Many ADHD kids face a continuing cycle of frustration and failure in their lives. They struggle with their parents and siblings to get out the door on time and prepared in the morning and face similar battles at night. Their issues around organization and behavior often lead to problems in school. Their attentional issues can often leave them isolated, scapegoated, or rejected socially. They are often faced with the consistent message – no matter how unintentionally it’s presented – that they’re not good enough or that something is wrong with them. With that experience behind them, it can be difficult for them to take the initiative and own up to their shortcomings before others point them out. It involves taking a step back with the faith that it will lead to two steps forward. For some kids, that’s a leap they’re not ready to make.
Helping kids get to a point at which they’re ready to take responsibility for their behavior can involve walking a fine line between balancing the need to teach them new skills with the imperative of helping them maintain a healthy self-image. Kids need to be challenged but if you find that they’re often falling short in meeting those challenges, there’s a good chance the bar is being set too high. If it’s set high enough to be challenging but low enough so that kids rise usually rise to that challenge, they’re likely to learn new skills and to view themselves as capable people worthy of others’ acceptance and friendship.