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)
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.
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