As a result of a groundbreaking new study, researchers conclude that ADHD should no longer be viewed as a disorder primarily affecting the behavior and learning of children, but as a major health condition with lifelong implications and need for effective treatment.
Ron remarks: It’s about time!!!
Most Children With ADHD Face Mental Health Problems as Adults
Written by Beth Arky.
This story is part of Speak Up for Kids, an annual public education program held during National Children’s Mental Health Awareness Week (May 6-12, 2012).
It usually happens in the preschool years. You notice that your toddler seems to have an unusual aversion to noise or light. A teacher observes that, compared to other kids her age, your daughter is clumsy and has difficulty with fine motor skills like wielding a pencil. You’ve noticed that she is very, very picky about shoes, which are often deemed too tight, and clothes that are “too scratchy.”
More baffling – and alarming – to parents are their children’s meltdowns over things like their faces getting splashed or being dressed. Or a child might crash into walls (and people), touch everything or put inedible items, including rocks and paint, into his mouth.
These behaviors are all signs of problems with what’s known as sensory processing, found in children who have difficulty integrating information from their senses. In its extreme form, when it interferes seriously with a child’s functioning, it’s called Sensory Processing Disorder, or SPD, although it’s not recognized by the psychiatrists’ bible, the Diagnostic and Statistical Manual.
Sensory issues are associated with autism because they are common in children and adults on the autism spectrum, though most children with SPD are not on the spectrum. They can also be found in those with ADHD, OCD and other developmental delays – or with no other diagnosis at all. In fact, a 2009 study suggests that one in every six children has sensory issues that impede their daily functioning, socialization and learning.
What parents often notice first is odd behavior and wild, inexplicable mood swings. For instance, a first-grader may do fine in a quiet setting with a calm adult. But place that child in a grocery store filled with an overload of visual and auditory stimulation and you might have the makings of an extreme meltdown.
“These kids’ tantrums are so intense, so prolonged, so impossible to stop once they’ve started, you just can’t ignore it,” notes Nancy Peske, whose son Cole, now 13, was diagnosed at 3 with SPD and developmental delays. Peske is coauthor with occupational therapist Lindsey Biel, who worked with Cole, of “Raising a Sensory Smart Child.”
Another response to being overwhelmed is to flee. If a child dashes out across the playground or parking lot, oblivious to the danger, Peske says that’s a big red flag that he may be heading away from something upsetting, which may not be apparent to the rest of us, or toward an environment or sensation that will calm his system. This “fight-or-flight response is why someone with SPD will shut down, escape the situation quickly, or become aggressive when in sensory overload,” she says. “They’re actually having a neurological ‘panic’ response to everyday sensations the rest of us take for granted.”
Children, teens and adults with SPD experience either over-sensitivity (hypersensitivity) or under-sensitivity (hyposensitivity) to an impairing or overwhelming degree. The theory behind SPD is based on the work of occupational therapist Dr. A. Jean Ayres. In the 1970s, Dr. Ayres introduced the idea that certain people’s brains can’t do what most people take for granted: process all the information coming in through seven – not the traditional five – senses to provide a clear picture of what’s happening both internally and externally.
Along with touch, hearing, taste, smell and sight, Dr. Ayres added the “internal” senses of body awareness (proprioceptive) and movement (vestibular). When the brain can’t synthesize all this information coming in simultaneously, “It’s like a traffic jam in your head,” Peske says, “with conflicting signals quickly coming from all directions, so that you don’t know how to make sense of it all.”
What are these two “extra” senses in Dr. Ayres’ work?
Proprioceptive receptors are located in the joints and ligaments, allowing for motor control and posture. The proprioceptive system tells the brain where the body is in relation to other objects and how to move. Those who are hyposensitive crave input; they love jumping, bumping and crashing activities, as well as deep pressure such as that provided by tight bear hugs. If they’re hypersensitive, they have difficulty understanding where their body is in relation to other objects and may bump into things and appear clumsy; because they have trouble sensing the amount of force they’re applying, they may rip the paper when erasing, pinch too hard or slam objects down.
The vestibular receptors, located in the inner ear; tell the brain where the body is in space by providing the information related to movement and head position. These are key elements of balance and coordination, among other things. Those with hyposensitivity are in constant motion; crave fast, spinning and/or intense movement; and love being tossed in the air and jumping on furniture and trampolines. Those who are hypersensitive may be fearful of activities that require good balance, including climbing on playground equipment, riding a bike, or balancing on one foot, especially with eyes closed. They, too, may appear clumsy.
To help parents determine if their child’s behavior indicates possible SPD, Peske and Biel have created a detailed sensory checklist that covers responses to all types of input, from walking barefoot to smelling objects that aren’t food, as well as questions involving fine and gross motor function, such as using scissors (fine) and catching a ball (gross). The SPD Foundation also offers a litany of “red flags.” The list for infants and toddlers includes a resistance to cuddling, to the point of arching away when held, which may be attributed to feeling actual pain when being touched. By preschool, over-stimulated children’s anxiety may lead to frequent or long temper tantrums. Grade-schoolers who are hyposensitive may display “negative behaviors” including what looks like hyperactivity, when in fact they’re seeking input.
Peske sums up the way sensory issues can affect kids this way: “If you’re a child who is oversensitive to certain sensations, you are not only likely to be anxious or irritable, even angry or fearful, you’re likely to be called ‘picky’ and ‘oversensitive.’ If you rush away because you’re anxious or you’re over-stimulated and not using your executive function well because your body has such a powerful need to get away, you’re ‘impulsive.’ If you have trouble with planning and executing your movements due to poor body awareness and poor organization in the motor areas of the brain, you’re ‘clumsy.’ Because you’re distracted by your sensory issues and trying to make sense of it all, you may be developmentally delayed in some ways, making you a bit ‘immature’ or young for your age.”
Amid this confusion, there may be relief for more than a few parents in recognizing what may be causing otherwise inexplicable behavior – and in the potential for kids to get help in the form of specialized occupational therapy and what are called sensory gyms.
“When I describe sensory issues to parents whose kids have it,” Peske says, “the usual reaction is ‘Oh, my gosh, that’s it!’ They’ve been trying to put a finger on ‘it’ for many months, even years! The sense of relief that they finally know what ‘it’ is is humongous.”
Child Mind Institute’s Speak Up for Kids is an annual public education program held during National Children’s Mental Health Awareness Week (May 6-12, 2012) aimed at ending the stigma, lack of awareness, and misinformation that cause children to miss out on treatment that can change their lives.
I used to joke with parents that if they could make a grocery list, they could change a child’s behavior. The idea behind this is that most behavioral change takes parental attention and consistency. The truth is that we are constantly shaping our child’s behaviors every day. And, one might say, they are changing ours too! This is a natural process of interaction. The question is really, what are your shaping? Our you modeling positive habits? Do you reward positive behavior? Shifting our attention away from negative behavior (what you don’t want) and refocusing on positive behaviors (what you do want) can be as easy as making a list or creating a chart.
Here are 3 keys to successfully changing a child’s behavior with a behavior chart:
1. Have a clear, achievable goal in mind: If you don’t know where you are going, you won’t get there. Don’t confuse the goal by making it too vague or complex. Focus on a specific behavior you WANT to see happen. Don’t write it in the negative. State what you want to see different. Be age appropriate when focusing on change. A 4 year old can’t do what a 14 year old can do.
2. Make it rewarding: The power of a behavior chart is that a child will get a reward for doing what you want. What motivates your child? What can you realistically afford to do? How long will it take to get the reward? Some children need daily, if not hourly rewards. Break a big reward down into smaller rewards if necessary to keep children motivated. The last thing you want is a defiant child who refuses to do a chart because it is too difficult or they feel like they will fail and so they don’t even try. Also, remember the best reward is you! Your smile, hug and words of praise should always be given regardless of any other physical reward.
3. Be open to change: If the chart is not working, make changes. It is just a parenting tool, not a magical wand. Use the success or lack of it as feedback on how to create the chart. Use family meetings and intimate discussions about what is working for the child. Continue to celebrate any small success or effort. You might find that using a chart changes your parenting time and energy as well. That is good modeling and parenting improvement.
Someone once joked that God gave us two ears and one mouth so that we could listen twice as much as we talked. Not bad advice actually. Many parents would do well to heed that advice. This doesn’t mean that parents shouldn’t talk to their children. It’s just that they shouldn’t be so quick to give advice or lecture of the right and wrongs of a problem. Listen first, then talk. Better yet, ask questions to get at the solutions to children’s problems. This causes them to feel as if they came up with the answer and take more ownership for the problem. E.A.R.S. is a helpful acronym for parents who want to improve their problem-solving skills with their children.
E = Elicit
The starting point for problem-solving with children is to elicit possible solutions that already exist in the child’s repertoire. Ask questions such as, “What would you think would make the situation better?” This implies that there is a solution and that the child has the ability to utilize it. If they don’t have an answer to this question, try this one: “What would your _______ (supply a relevant name here) say you are doing about the situation?”
This implies that the child is already solving his problem. The fact of the matter is that every response to a problem is a solution to a problem. Only some responses are better than others and have fewer severe consequences. The job of parents is to acknowledge children’s efforts and then direct them to use better responses.
If the child persists that there wasn’t anything good about what he did in the situation, then ask, “What was the part of the situation that was better than the other parts?” And if the child does recite some ‘better than other parts’ of the situation, ask, “How did you do that?” This encourages the child to learn from their own behaviors and increase positive responses.
If the child suffered severe consequences for his response to the situation, ask, “What did you learn from the situation?” Most successes are the result of trial and error and determining what doesn’t work.
A = Amplify
Amplify refers to the use of questions to get more details about any positive efforts toward problem-solving. Use who, what, where, when, and how questions. For example, “Who noticed you do that?” or “When did you decide to do that?” or “How did they respond to your solution?” Never use why questions. Why is a very judgemental word and will stop all attempts to help the child problem-solving because he feels bad about his efforts. Over time this can develop into a pattern of behavior where the child never tries anything new because he is afraid of failing. If he doesn’t try, he doesn’t fail. At least that is the rationale.
R = Reinforce
Years of behavioral change research have taught us that there are two ways to create change in others. Reward desired behaviors and ignore or mildly punish undesirable behavior. So be sure to reinforce any effort to solving a problem. Even failed attempts are worthy of acknowledgment. The child must want and value positive change. Reinforcement will be the motivating force for this value. Be sure, though, that you use verbal or social reinforcement. Don’t give in to bribes (candy, toys, and money) to reinforce the child. This will reinforce dependent and manipulative behavior and decrease independent problem-solution. The best reinforcers are a surprise. When children do not know when to expect a reinforcer (a compliment or public acknowledgment) they will be more motivated, ready for reinforcement at any moment in time.
S = Start again
Learning to problem-solving and listening to our children to help them, is a process. It can’t be done once and then left alone. It must be done over and over again. Repetition is a fundamental principle of learning. The more you do something the better you get at it. And now that the child has found a solution to a problem, plan for the next one. Most problems pop up again in life. Brainstorm solutions for the next time. And finally, treat every problem as an experiment where new and clever solutions can be tested. So use those two ears to listen more then you talk but when you do talk, ask solution-focused questions to help children problem-solve.
Have you seen our new Parenting Reports Section yet? There are several ebook, reports, whitepapers and charts for parents to build stronger, happier families. Today we are featuring one of our general behavior charts. Get it here: http://www.parentingtoolbox.com/parenting-reports/
Behavior charts are a great tool for parents to set structure and limits in the home. Be sure to communicate clearly with children about your expectations and get their buy in. Additionally, be sure that they are developmental appropriate to age and stage. A younger child can’t do as much as an older child but older child also have (or can earn) more freedom and independence. Evaluate your progress on a weekly basis to ensure the tool is working properly. Lastly, remember that a chart is just a tool and not a magic wand. If it doesn’t work for your child, use something else or feel free to alter it as needed.
Tell us how it went by leaving us a comment below or tweeting us or sharing on our Facebook page.
If you didn’t catch my radio show interview this morning you can listen to the archived mp3 at http://toginet.com/shows/theparentsplate/articles/1314 Brenda Nixon, host of the Parents Plate radio show, invited me to chat about the controversial diagnosis of Reactive Attachment Disorder (RAD) and the current state of mental health treatment of traumatized children today. I shared some great ideas in our hour long discussion that you will want to listen in on…everything from how children are diagnosed to attachment neuroscience to practical parenting tools. I even shared on why children with attachment impairments “Monster Up!” – a phrase I coined. Take a moment to download or stream the show at http://toginet.com/shows/theparentsplate/articles/1314
Ron Huxley LMFT 