If each historical period comes with its own popular diagnoses, then ADHD would be a likely candidate for a diagnosis that characterizes our society at this point in history. One can hardly watch a television show or read a popular magazine without seeing an advertisement for a new or improved medication for treating children diagnosed with this disorder.
With all the attention this disorder has received in the popular press recently, the label of ADHD has taken on a power of its own. Media outlets would have us believe that ADHD has grown to epidemic proportions. Researchers estimate that 3 to 7 percent of all school-aged children have been given the diagnosis of ADHD (American Psychiatric Association 2000). ADHD is three times more likely to be diagnosed in boys than in girls (Barkley 2000). Estimates indicate that the rates of diagnosis of ADHD have increased 400 percent since 1988 (Stein 1999), although the explosion of this disorder seems confined to the United States. Some experts suggest that the increase indicates increasing misdiagnosis. As developmental psychologist Rhonda Goldstein writes, “Parents and teachers worried by the increase in ADD need to know that there are a variety of other, more common reasons why a young child would have trouble listening to adults or paying attention to his responsibilities” (Goldstein 2002, 163). Dr. Goldstein points to some clear guidelines for addressing these reasons, including finding more flexible day-care arrangements, limiting TV, and making discipline a priority.
As a parent of a child with ADHD, you may find comfort that you are not alone in facing the recent explosion of information, services, and medications aimed at treating ADHD. You may also feel confused by so much information, much of it contradictory.
What Is ADHD?
The term ADHD is often used in an offhand manner to describe children who seem to be out of control. However, it is actually a diagnosis that requires many specific criteria in order to be met. The two major dimensions of ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 2000), are inattention and hyperactivity/impulsivity.
The behavioral symptoms of inattention include making careless mistakes, being easily distracted, and having a difficult time completing projects. Other behavioral manifestations of inattention include difficulty listening, difficulty following directions, and difficulty with organization; a person may often lose homework and other things, run late, or forget appointments.
The symptoms of hyperactivity include fidgeting, difficulty sitting still, excessive talking, and difficulty doing quiet activities. Children with hyperactivity often feel as if they are being driven by a motor. Symptoms of impulsivity include blurting out inappropriate comments, being unable to wait for one’s turn, and acting without thinking.
Although many children display some of these symptoms some of the time, a diagnosis of ADHD requires that there be evidence that these symptoms are severe enough to impair functioning in more than one setting. Usually this means that the child is disruptive both in a school setting and at home. Furthermore, a diagnosis of ADHD requires that other possible disorders be ruled out. For example, a child who is anxious, depressed, or oppositional may have many symptoms that look like ADHD. However, if the symptoms are better explained by another diagnosis, ADHD will not be given as a diagnosis.
A diagnosis of ADHD requires a thorough assessment and usually entails testing and collecting information from children, parents, and teachers. Because the diagnosis requires evidence that the behavioral disruptions occur in more than one setting, teachers and parents play an important role in a formal assessment process. If your child has been given a diagnosis of ADHD without a very thorough assessment involving parents and teachers, you may want to consider getting a second opinion. Because the diagnosis may have an impact on your child’s expectations and feelings of self-worth, you want to be sure that a thorough evaluation has been conducted by a trained professional.
Whom This Book Is for, and How It’s Different
This book is intended for parents of children who are six to twelve years old and have been diagnosed with ADHD by a trained professional. It is written for parents who are interested in transforming not only their child’s symptoms but also their own vision of what ADHD means. Even if your child’s ADHD diagnosis came as a relief, because it seemed to answer many of your questions about your child’s behavior, this book will be helpful to you. A child with ADHD is different from other children in predictable ways, and this book will help you to see that though your child’s differences pose many challenges they also offer many gifts. So whether you were happy, relieved, distressed, or distraught when your child was diagnosed with ADHD, this book will guide you toward transforming your vision of your child—as well as your relationship with your child and his symptoms.
Many books for helping children and parents with ADHD offer very complicated, labor-intensive exercises for parents and children to do. These are not so helpful because children, and sometimes parents, have difficulty completing and following through with complex plans and long, drawn-out exercises. This book is different because it recognizes that an effective treatment plan has to match the difference that your child exhibits. In fact, the techniques in the book are designed to cater to your child’s differences. They will use his need for concrete sensory engagement rather than abstract theorizing as a strategy for learning new information. Also, many of the exercises ask you to build on your child’s areas of specialized interest and enthusiasm, whether it’s Harry Potter or American Idol. You will help your child channel his existing energy for special interests into pretend games that transform his symptoms.
As you go through the book, keep in mind that there are more than enough exercises throughout to help transform your child’s problems into strengths. If you or your child doesn’t like some of the exercises, don’t push it. Just move on to another exercise. The best strategy will be to find a handful of exercises that your child enjoys—the ones that are so much fun that they seem like playing—and to use those exercises over time. You can think of this approach as similar to going to the gym to build muscles. The more your child learns how to manage his thoughts, behaviors, and sense of self-worth, the more powerful his transformation will be. These exercises are not just one more thing that pits you and your child against each other. Rather, they will be fun activities for you and your child to share, and they will help you build your relationship and closeness with each other.
ADHD as a Gift: A Paradigm Shift
This book will offer you not just information but rather a radical new way of looking at your child’s diagnosis: although your child is different, the constellation of traits labeled as ADHD is in fact a gift. To go from seeing your child as having a deficit disorder to seeing your child as having a unique gift would be a major shift that would help both you and your child.
This radical way of looking at your child and his differences will be the starting point for a program of change that will help you shift from being your child’s apologist to being your child’s advocate. As an apologist for your child, you may have accepted the critical comments of his teachers and felt like you had to apologize for his behavior. As an advocate for your child, you will learn to gently challenge the teacher’s criticism and reframe your child’s behavior in a more positive light, providing the teacher with helpful suggestions for handling your child’s differences.
At first you may greet this positive reframing of ADHD as welcome news, but you may also find it difficult to believe—because perhaps your child’s teachers, pediatrician, and psychiatrist have all told you that your child has a serious problem. It can be very difficult to consider that all these experts might be wrong. You may have even found yourself frustrated with your child’s behavior and lack of motivation and perhaps feeling relieved to know that there is a name for your child’s problems.
The many educators and health professionals you have encountered are not necessarily wrong; your child is indeed different, just different in a way that our culture has not learned to fully appreciate. They are also correct in their observations that some problematic behaviors have emerged. Where they may not be entirely right is in their view of these differences—they may be seeing the differences as elements that define your child rather than as potential gifts and opportunities. And they may have failed to notice the ways in which the diagnosis of ADHD itself can cause problems in behavior, attention, and motivation. This book will help reveal how your child’s differences have a lot to offer, both to him and to the world.
My first encounter with ADHD occurred when my own brother was diagnosed with it, long before it was a popular diagnosis or even a widely known condition. My mother never understood my brother’s ADHD as a disorder. She regaled us with stories about how intuitive my brother was and how sensitive he was to people’s emotions. We all noticed it. As a family, we saw that, although he often burst out with irreverent comments about the people we encountered, he was amazingly perceptive. When my mother reluctantly agreed to put him on medication, she viewed it as a concession to particular teachers who had complained about my brother in the classroom. She also found that whether he “needed” the medication or not depended on the teacher he had that year. Some years he would need the medication, but other years, he would do well and did not need medication at school. It was my mother’s understanding that the medication was a means of appeasing others. For example, she would give my brother his medication when her own mother came to visit. My grandmother had a hard time tolerating my brother’s rambunctious behavior; as a result, my mom would give the medication to my brother so my grandmother would not get so disturbed.
As a clinical psychologist I have spent years training to be sensitive to other people’s emotions and to understand interpersonal interactions. Despite all my training, I have found that my brother’s ability to capture the complexities of interpersonal interactions and other people’s emotional states far surpasses my own—and the abilities of many of my well-trained colleagues. He possesses an interpersonal intuition that no amount of training could bestow.
It’s true that children with ADHD have a keen ability to perceive insincerity and are not fooled by people’s efforts to appear to be something they are not. Certainly, this represents a gift of interpersonal intuition, but you can see that, without some training in how to use this gift, it can create relationship problems for your ADHD child, who may be prone to making irreverent or inappropriate comments based on his perceptions.
The Frustration of Being Misunderstood
The following is a example of what typically happens to children with ADHD in treatment settings.
Jack was a seven-year-old patient in a child and adolescent psychiatric unit. One day, as he was sitting in a session of group therapy, Jack noticed that the nurse running the session seemed to have a permanently sour expression and was treating the young group members with disdain. She displayed little compassion for the struggles the patients were facing. Jack, who had been given the diagnosis of ADHD, was making faces at her—in some way mirroring her sour expression but amplifying it. He was not deliberately trying to be disrespectful and perhaps wasn’t even aware of the effect of his behavior—he was just naturally mirroring her body language. His behavior was appropriate for a seven-year-old boy. Although he was somewhat impulsive in his display, he created a very accurate characterization of the nurse. Unfortunately, the nurse overreacted, threatening the boy with severe punishment if he didn’t stop making faces at her. As she escalated her threats, his mocking behavior escalated to the point where two large male staff members intervened, putting Jack in isolation and one-to-one watch for the rest of the day.
As Jack was being carried out, his behavior had escalated to the point where he did in fact look like an immensely disturbed child. He thrashed around, screaming loudly about the injustice in the way he was being treated. However, blame could also be assigned to the nurse, whose behavior had been unprofessional. It’s easy to understand why a small child who is emotionally sensitive and interpersonally astute would become angry and disturbed in this situation. However, in part because of his diagnosis, the setting of an inpatient hospital, and the nurse’s own disposition, the situation escalated, resulting in behavioral excesses that seemed to prove how disturbed the boy was.
As a teacher and clinical psychologist, I’ve found that my observations about my brother also applied to other individuals who had been given the diagnosis of ADHD. Although it is true that the students with ADHD often received the lowest grades in the courses I taught, they far surpassed their peers in their ability to engage the material in creative ways. They were often stimulated by what they were learning, but not interested in mastering it in the ways that are assessed through standard educational testing. Students with ADHD often made me think in ways I’d never considered before, and they wanted to forge their own understandings and push the limits of what was known by asking new questions, rather than settling for the accepted answers.
You have likely noted these very same gifts in your child, but you may feel steamrolled by the health care and educational systems, representatives of which insist that these very same traits are symptoms of disturbance. You may also have struggled with the fact that your child really is quite a handful. Children with this diagnosis are a lot of work, and they do act in problematic ways that disrupt others. This book will acknowledge both sides of this reality—the gift and the disruption it causes to others. It’s important to keep in mind that a difference of any sort is likely to be disruptive. For example, intellectually precocious children who haven’t been diagnosed with ADHD can also be disruptive in traditional educational settings, because they get bored and may act out, distracting other students. This book will show you how to understand your child’s differences as a gift and help change those behaviors that hinder him.
Changing Problematic Behaviors
In addition to trying to provide a balance between the vision of ADHD as a gift and the difficult reality of managing your child’s behavior and the system he interacts with, I will present a balance between shifting your vision and offering concrete exercises for changing problematic expressions of your child’s behavior. This may seem like a contradiction. You may be thinking, “On the one hand, it seems like you’re saying that my child is gifted, and on the other hand, it seems like you’re telling me how to change my child.” And it’s true. But both of these things are needed, for many reasons.
Even though your child is gifted, the label of ADHD can have a negative impact, which can lead to problematic behaviors. For example, if your son thinks he is stupid, then he will have a hard time motivating himself in school. Similarly, if children with ADHD believe that they will fail because of their ADHD, then they will avoid trying, in order to protect their self-esteem. It is easier to say “I didn’t try” than to say “I tried and failed.” As a result of his differences and the challenges of being diagnosed with a disorder, your child may have adopted coping strategies like these, which are in fact problematic. This book will offer strategies for changing these unhelpful coping strategies.
Another reason your child may need to alter some behaviors is that the school system and health care system have not yet recognized your child’s differences as a gift. This failure has probably led to negative interactions between your child and professionals in these fields, which may, in turn, have led to problematic behavior in your child. This is a common occurrence in school and treatment settings, where your child is likely to detect when he is being negated or undervalued and to have strong emotional reactions. He sees clearly how he is being dismissed and feels intensely hurt and humiliated by these interactions. These intense feelings, combined with impulsiveness, often lead to episodes of acting out that, when escalated by intolerant teachers and professionals, may be perceived as profoundly disturbed behavior.
When this dynamic is repeated, your child may develop coping strategies that appear to be ingrained behavioral problems. If these behaviors are changed, then others will be less likely to make negative judgments about your child, in turn causing even more disruptive behavior and continuing the pattern. Because of these tensions, this book will strike a balance between changing your vision of your child, helping you change your child’s vision of himself, and offering specific exercises for changing and managing problematic behaviors.
Powerful or Powerless
As a parent, you may feel powerless in your interactions with the educational and health care systems, but you do have an enormous amount of power to heal your child. The school and health care settings may not have conveyed this message to you, yet it’s true.
You may have felt angry with these systems for conveying such disempowering messages to you. You may have heard that your child is profoundly disturbed, that his brain is dysfunctional, or that you must have done something wrong in raising him. These messages are not necessarily true and can be defeating to you and your child.
When you heard a seemingly hopeless diagnosis and the misguided notions about your child from people who were in positions of authority, you may have felt more powerless, assuming that they knew better than you about your child’s condition. While you may not be a psychologist or teacher, the paradigm shift described in this book may be in line with your inner voice that told you the negative descriptions of your child just weren’t right. While you may have struggled with your child yourself, perhaps you’ve found yourself resisting the severity of the diagnosis of ADHD, which may have felt more like an insult than a medical term.
Your own perceptions of your child’s gifts may have become a “still, small voice” (1 Kings 19:12) by now as other authorities have drowned out your own, more-positive reactions to your child’s exuberance, surplus of energy, and emotional sensitivity. The Gift of ADHD will help you reclaim your power in relation to yourself, your child, the school system, and your health care providers. It offers information to help you to connect with your own feelings that your child may not be as “bad” as some of the authority figures have implied. It will help you reconnect with your own belief in your child’s abilities, strengths, and gifts. Your own expectations for your child will be a powerful source of inspiration. So if you can trust your own positive feelings about your child’s strengths, amplify those feelings, and communicate them clearly to your child, you can influence your child for the better.
The first four chapters will review the paradigm shift represented in the vision of this book—that ADHD is a gift. Chapter 1 will review current understandings of the diagnosis as a disorder and review a countertrend in psychology that argues that differences are not disorders. In line with this paradigm shift, chapter 2 will introduce you to the cognitive behavioral approach to transforming your child. Specific strategies for strengthening your bond to your child will be offered. Chapter 3 will suggest that this sweeping revision of this diagnostic label can also have the therapeutic effect of raising your child’s self-esteem. This chapter will also review how self-esteem can be lowered by the diagnosis of ADHD and how each symptom of the disorder, such as impulsiveness, lack of motivation, and lack of attention can also be seen as resulting from lowered self-esteem, not only from the purported brain differences alleged to cause ADHD. Chapter 4 will encourage and support you in shifting both your vision and your behavior as you become an advocate, rather than apologist, for your child.
In chapters 5 through 9 we will review the specific nature of your child’s gifts. In chapter 5 we will review the ways in which children who have been diagnosed with ADHD are creative. We will see, for example, how goofing off is often a necessary requirement for creativity. In chapter 6, we will review how your child may be gifted with an ecological consciousness—this means an attunement with the natural world. In chapter 7, we will review the interpersonal intuition common in children diagnosed with ADHD. In chapter 8, we will review the ways in which hyperactivity can be viewed as a surplus of energy and exuberance that can be tapped and rather than managed and minimized. In this chapter, specific strategies will be offered for channeling this energy in ways that do not disrupt others. In chapter 9, we’ll discuss the ways in which ADHD children are emotionally sensitive and expressive. The balance between appreciating the gift and managing the lack of control it can bring will be addressed with specific strategies. The tenth and final chapter will review strategies for navigating both educational and mental health treatment systems.
As you can see, The Gift of ADHD will offer you practical suggestions and strategies that accommodate both your inner voice that has appreciated your child’s differences and the one that has grown impatient with his behavior and frustrated with the knowledge that his behavior can be a problem for others.