Be­yond the be­hav­ioral mask of an ADHD Child, Part I

The Jerusalem Post Magazine - - PSYCHOLOGY - • DR. MIKE GROPPER

Josh is an eight-year-old third grader whose par­ents are very upset with their son’s be­hav­ior. His teach­ers com­plain that Josh talks all the time in school, and can never wait his turn when stand­ing in line for any ac­tiv­ity. He can­not stay seated and seems to be con­stantly both­er­ing other pupils. He reg­u­larly blurts out an­swers be­fore his teacher has a chance to fin­ish ask­ing the ques­tion. Josh’s mother feels like her son is giv­ing her a ner­vous break­down. He does not lis­ten to any of her de­mands, and seems to ig­nore or for­get her re­quests.

Karen is a fourth-grade pupil. She does not bother any­one and sits qui­etly in her seat. Her teacher is very con­cerned be­cause she never com­pletes any of her home­work. Her friends de­scribe her as a space cadet. In fact, when her mother asks her, she of­ten states that she does not re­mem­ber that her teacher had given her any home­work. Josh and Karen have at­ten­tion-deficit hy­per­ac­tiv­ity dis­or­der (ADHD). They are not alone. ADHD is the most com­mon de­vel­op­men­tal dis­or­der of child­hood, af­fect­ing 3% to 7% of chil­dren and of­ten con­tin­u­ing into adult­hood.

The Di­ag­nos­tic and Sta­tis­ti­cal Man­ual of Men­tal Dis­or­ders (DSM-V-TR 2013) iden­ti­fies three pat­terns of be­hav­ior that in­di­cate ADHD. There is the pre­dom­i­nantly hy­per­ac­tive-im­pul­sive type (Josh), the pre­dom­i­nantly inat­ten­tive type that does not show sig­nif­i­cant hy­per­ac­tive-im­pul­sive be­hav­ior (Karen) and the com­bined type (that dis­plays both inat­ten­tive and hy­per­ac­tive-im­pul­sive symp­toms).

A com­pe­tent physi­cian such as a pe­di­a­tri­cian, child neu­rol­o­gist or child psy­chi­a­trist can di­ag­nose ADHD. Many non-med­i­cal pro­fes­sion­als such as ed­u­ca­tional psy­chol­o­gists, clin­i­cal so­cial work­ers and clin­i­cal psy­chol­o­gists can also eval­u­ate chil­dren sus­pected of hav­ing ADHD. Re­gard­less of the spe­cial­ist’s pro­fes­sion, his/ her first task is to gather in­for­ma­tion that will rule out other pos­si­ble rea­sons for the child’s be­hav­ior. Among pos­si­ble causes of ADHD-like be­hav­ior are emo­tional loss, trauma, learn­ing dis­abil­i­ties, mood dis­or­ders such as de­pres­sion or bipo­lar dis­or­der or ill­ness.

To as­sess whether a child has ADHD, spe­cial­ists con­sider sev­eral crit­i­cal ques­tions: Are these be­hav­iors ex­ces­sive, long-term, and per­va­sive? Do they oc­cur more of­ten with this child than they do in other chil­dren the same age? Are they a con­tin­u­ous prob­lem and not just a re­sponse to a tem­po­rary sit­u­a­tion? Do the be­hav­iors oc­cur in sev­eral set­tings, rather than ap­pear­ing only in one spe­cific place like at the play­ground or in the class­room? In or­der to be con­sid­ered ADHD, these be­hav­iors must ap­pear early in life, be­fore age seven, and con­tinue for at least six months. Above all, the be­hav­iors must cre­ate a real hand­i­cap in at least two ar­eas of a per­son’s life, which may in­clude the class­room, the play­ground, at home, in the com­mu­nity or in so­cial set­tings.

For ex­am­ple, a child who shows some symp­toms, but whose school­work and friend­ships are not im­paired by these be­hav­iors would not be di­ag­nosed with ADHD. Nor would a child who seems overly ac­tive on the play­ground but func­tions well else­where, re­ceive an ADHD di­ag­no­sis. Dur­ing the in­for­ma­tion-gath­er­ing pe­riod, the child’s teach­ers, past and present, are asked to rate their ob­ser­va­tions of the child’s be­hav­ior on stan­dard­ized eval­u­a­tion forms, known as be­hav­ior rat­ing scales, to com­pare the child’s be­hav­ior to that of other chil­dren who are the same age.

Ex­perts to­day be­lieve that ADHD is a neu­ro­chem­i­cal dis­or­der. Call­ing the prob­lem an at­ten­tion deficit dis­or­der is ac­tu­ally mis­lead­ing, since most ADHD chil­dren can con­cen­trate just fine in ac­tiv­i­ties that in­ter­est them, whether com­puter games, sports or in­ter­est­ing con­ver­sa­tions. How­ever, these kids strug­gle to stay fo­cused when the de­mand or ac­tiv­ity, like lis­ten­ing in class, is mun­dane or not stim­u­lat­ing. Dis­rup­tive be­hav­ior, hy­per­ac­tiv­ity and day­dream­ing are in fact the child’s way to com­pen­sate for the un­der stim­u­la­tion of the spe­cific neu­ro­chem­i­cal, dopamine that is re­spon­si­ble for at­ten­tion and stay­ing on task. It is para­dox­i­cal that what ADHD chil­dren do to make them­selves feel more nor­mal are the very same be­hav­iors that get them in trou­ble with their par­ents and teach­ers. Both par­ents and teach­ers com­pli­cate the mat­ter when they get an­gry with the child who ex­hibits hy­per­ac­tive-im­pul­sive be­hav­ior, or with the spacey child who does not lis­ten, since ADHD kids are su­per­sen­si­tive to crit­i­cism and dis­ap­proval. These chil­dren are more likely to be­come con­fronta­tional if they feel mis­un­der­stood or re­jected. Even­tu­ally, they may be la­beled as a trou­ble­maker, or in the case of an inat­ten­tive child, branded as lazy. There is a need for par­ents and teach­ers to un­der­stand the bio­chem­istry of ADHD that un­der­pins ADHD be­hav­ior, so that they do not blame the child for his or her be­hav­ior, and rather try to find more con­struc­tive ways to help these chil­dren.

ADHD chil­dren are in fact in­tel­li­gent, cre­ative and gifted, but of­ten poorly un­der­stood. Their sen­si­tiv­ity and dif­fi­cult be­hav­iors can be chan­neled in a pos­i­tive di­rec­tion that builds good self-es­teem. Par­ents and the ed­u­ca­tors of these chil­dren need guid­ance and ef­fec­tive strate­gies to get be­yond the mask that cov­ers up these chil­dren’s pos­i­tive ca­pa­bil­i­ties.

In Part 2, I will write about in­ter­ven­tions for par­ents and teach­ers that can be very ef­fec­tive in help­ing chil­dren with ADHD. The writer is a mar­i­tal, child and adult cog­ni­tive­be­hav­ioral psy­chother­a­pist with of­fices in Jerusalem and Ra’anana. www.face­book.com/dr­mikegrop­per;dr­mikegrop­[email protected]

Ex­perts to­day be­lieve that ADHD is a neu­ro­chem­i­cal dis­or­der. Call­ing the prob­lem an at­ten­tion deficit dis­or­der is ac­tu­ally mis­lead­ing

(TNS)

ADHD CHIL­DREN are in fact in­tel­li­gent, cre­ative and gifted, but of­ten poorly un­der­stood.

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