The driver of tomorrow is not thinking Green...

The driver of tomorrow is not thinking Green...
He's thinking Classic. (click on photo)


Blog Archive

Mar 13, 2009

MSN:Helping kids with ADHD handle difficulties with inhibition.

When I was a school counselor, one of my favorite students was bright, funny and full of life. She was motivated to work on her school problems, but she also frequently voiced frustration. She'd say things like "I know I'm smart, and I work hard, but nothing works! " or "I'm always in trouble. My teachers hate me. They're always yelling at me, and it's not fair!"

Julia (not her real name) felt overwhelmed with homework, and couldn't handle getting blamed when she didn't finish or had the wrong answers.

I met with Julia's parents and recommended psycho-educational testing to see if she had ADHD or other learning disabilities. Unfortunately, they took the referrals but didn't follow up. Her mother believed Julia could focus—if she only wanted to. She saw Julia as a difficult child who refused to do her homework and who had no respect for her mother or her teachers.

Julia was misunderstood, and because of that she didn't get the help she needed. One day, after being scolded at school, she threw a book across the room and was expelled. But expelling children like Julia doesn't solve their problems.

An empathetic approach to ADHD

ADHD traditionally has been seen as a disorder of attention span, but inattention may be just the tip of the iceberg, says Martin L. Kutscher, M.D., a pediatric neurologist and author of ADHD—Living without Brakes (Jessica Kingsley Publishers, 2008).Just focusing on attention span doesn't address the wide range of difficulties faced by those with ADHD and their families. Kutscher believes that it's because of this misunderstanding that kids like Julia are often labeled "bad," "disrespectful" or "selfish."

In fact, according to Kutscher, people with ADHD are struggling with real deficits in their executive functioning (EF) processes, which occur in the frontal and pre-frontal lobes of the brain. Understanding this is the first step to gaining empathy for the child with ADHD and developing a plan that will help.

The brain's executive functions include:

Inhibition (the ability to stop or filter oneself)
Orchestrating the brain (organizing yourself)
Self talk (talking yourself through a situation)
Working memory (the ability to access and juggle thoughts about past, present and future simultaneously)
Initiation (the ability to start something, like homework)
Hindsight/foresight (the ability to think about past and future consequences)
Shifting agenda (moving from one task to another)
Separating emotion from fact (every event has an objective reality and an emotion attached to it; this is about accurately judging the significance of an event)
Adding emotion to fact (the ability to remember and connect a feeling to an event; for example, remembering how a success makes you feel helps you stay motivated)
No brakes

Of these executive functions, the most important one is inhibition. Unless we can stop our impulses we can never use the other EFs, such as learning from mistakes. And kids with ADHD are "brakeless." They cannot keep from being distracted, impulsive or hyperactive. They're also so stuck in the "now" that they are unable to think about the future.

For example, imagine not eating all day and coming home starving. You have a choice. You can eat an apple, or dive into that bag of potato chips. If you're hungry enough, you probably will reach into that bag of potato chips, and once you start you'll finish the whole bag. The part of you that says "stop" has completely turned off. But for kids with ADHD, the "stop" message is always turned off.

Think of the child who keeps grabbing the phone out of your hand because she wants to talk to daddy now, the kid who chases the neighbor's cat and never learns that it makes the cat run away, or even the child who can't stop watching "The Simpsons" when you need to go somewhere.

Such kids may not be trying to be difficult—they may instead be having trouble with the braking function.

Chemicals behind the chaos

Studies show that children with ADHD have a lack of the neurotransmitters norepinephrine and dopamine in the frontal lobe and pre-frontal lobe regions of the brain—the areas responsible for executive functioning.

When there is too little norepinephrine operating in the frontal lobes, the brakes don't work at all. If there's a lack of dopamine in the frontal lobe area, the brakes are weak; it's like the brake pads are worn down. Without both neurotransmitters working fully, you have a brain with weak brakes that are asleep. The reason that children are put on stimulant medication like Ritalin or Adderall is to both "wake up" and strengthen these frontal-lobe brakes.

A combination of the correct medication to stimulate the frontal lobe brakes, plus using strategies at home and school that take the blame out of the disorganized behavior, can work to help the child as well as the entire family.

Strategies that work

Keep it positive.

It is important for parents to be positive. Reframe the outlook from the child being "bad" to the child having a condition or disability. Kutscher says, "The child is going to be labeled one way or another. 'ADHD' leads to empathy, 'bad' leads to an attempt to squash the kid into submission."

Use punishment only if it helps. The purpose of punishment is to change future behavior. If the child can't stop him or herself long enough to make a decision about consequences, then he or she can't learn from the punishment. Furthermore, it does nothing to fix the underlying problem. (If a child breaks the rules, you can still enforce the consequences; just stay calm and positive as you do it.)

Keep it calm.

Kids who have ADHD get easily overwhelmed. An overwhelmed child can't use any of their executive functions. If things even start to escalate at home, take a break to cool down. "When a car is speeding out of control, the last thing it needs is a push from behind," says Kutscher. Stop and announce a 10-minute chill-out time. This will allow time for the EFs to start working again. Then, start a calm negotiation.

Keep it organized.

The more organized you are at home, the easier it will be to help your child stay organized. Remember, the child knows what to do, but has trouble doing it. Organizational skills will need to be taught and encouraged. Try to break down responsibilities into smaller steps. Warn and prepare the child for transitions. And provide help at the moment it's needed, not after it's already too late.

Keep it going.

Keep doing rules 1 through 3. This is a long-term plan. Don't give up.

For further information on ADHD resources, visit

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