ADHD and Your Child: ADHD Experts Address Your Questions

"ADHD and Your Child" webinarFollowing our free “ADHD and Your Child” webinar last spring, we received a number of questions from parents and teachers alike on understanding and supporting persons with ADHD. For National ADHD Awareness Month, we wanted to revisit a number of these questions and invite you to watch the archived webinar with ADHD experts Doug Bouman, S. Psy. S. and Robert Bulten, M.D. This webinar, hosted by Christian Schools International, covers the symptoms and treatments of ADD/ADHD.

Q: Is ADHD hereditary?

Dr. Bulten: Very much so. It the second most heritable condition in the human genome.  The first is height.

Q: Are there similarities between teenage boys and ADHD?  When should we seek testing and treatment for ADHD?

Dr. Bulten: It used to be thought that ADHD in boys far outnumbered that in girls. But we’ve now realized that this is no longer true, and ADHD is common in both boys and girls. During the teen years, the hyperactive component (which is so common in younger boys) tends to become less noticeable. Testing and treatment should be looked into when the symptoms become a functional impairment.

Q: How much does a child’s diet help or hinder a child with ADHD?

Dr. Bulten: Diet does not usually have much positive or negative effect on a child with ADHD. Now and then, someone will find a particular food (e.g. dairy, gluten, dyes, etc.) that they believe helps to a degree, and then they take that out of the diet. But the return is so small that I don’t recommend that to start treatment. By the time my patients get to me, they will have tried all the non-medical options.

Young Boy PhotoQ: What are some particular gifts kids or teens with ADHD possess?

Mr. Bouman: ADHD in and of itself provides zero benefits to the student with ADHD.  For example, the gift of creativity or artistic ability and ADHD are not linked. However, just like students without ADHD, students with ADHD possess incredible gifts, strengths, and abilities.

Q: Are students with ADD/ADHD more likely highly intelligent and gifted than not?

Mr. Bouman: Students with ADHD are not more gifted and talented than those without ADHD.  ADHD impacts the entire range of abilities.  In fact, highly intelligent children with ADHD frequently experience more frustration since they are painfully aware that their performance and output is markedly below their intellectual abilities and peer performance.  How frustrating and painful for a bright student to “know” what to do, yet are unable “to do what they know”.

Q: Do you see the emotional issues, such as loss of confidence and “self prosecution” (especially in newly diagnosed teenagers) improve over time?

Mr. Bouman: Yes, for sure.  The first step is for the teenager and the significant adults (parents, school staff, etc.) to understand and accept ADHD, and how it is impacting this student’s daily functioning.  Once effective strategies and medication are in place, the student experiences authentic success (i.e. they can now “do and produce what they know”).  This frequently buoys their confidence and eliminates their self-persecution.

Q:  What is one thing you wish parents knew about ADHD?

Mr. Bouman: There is a tremendous amount of misinformation in the media, trade magazines, etc.  Parents need to know ADHD hugely impacts a student’s learning and productivity in school even though their child is not hyperactive or impulsive.  Quiet, hidden (inattentive type) ADHD is more dangerous since it is easily missed or misinterpreted as not trying or a bad attitude.  Complicating things is the remarkable inconsistency observed in a student with ADHD, sometimes called a “picket fence” up-down functioning.  Children, adolescents and adults with ADHD are frequently able to focus and sustain concentration if what they are doing is preferred, highly stimulating, high interest (think video games, legos, T.V., even reading high interest books).  The real test of an individual’s attention is when they must complete tasks that are important yet boring.  Another important parent “tip”, is to watch for limited improvement (e.g. learning, producing, grades, behavior) when individuals, student, teachers, and school support staff have honestly tried their best to overcome the problem using methods that work for most kids.

Dr. Bulten: Probably that they are not the cause of their kid’s ADHD – unless you consider the genetics. It’s not bad parenting–more discipline will not change things—it will probably make things worse.

Students learningQ: What is one thing you wish teachers knew about ADHD?

Mr. Bouman:
(1) All of what I wish parents knew (see above)

(2) Please be careful to simply and thoroughly report to parents what you notice in class and avoid saying a student has or does not have ADHD.

Dr. Bulten: Again, that they are not the cause of the student’s ADHD. “Carrot and stick” discipline will not change anything.

Q: What are a few practical strategies a teacher can use in the classroom to support a student with ADHD?

Mr. Bouman: Move the student close to the teacher. Having the student in close physical proximity to the teacher affords closer monitoring of the student and increased accountability.  Teachers can cue the student that important directions are coming their way (e.g. “students the next two instructions are really important” – sometimes referred to as “verbal highlighting”).  Close proximity also allows ongoing accountability with high frequency feedback (e.g. “do this first row of math computations and then check back with me”).

Students with ADHD need understanding and empathy from their teacher; their teacher needs to recognize that they are fighting upstream against a roadblock that their peers are not.  Teachers can create a “prosthetic classroom” by externalizing (making visible and permanent) instructions, requirements, rules, and steps (e.g. use of post-it-notes, lists, pictures).

Q: What is one thing you wish kids/teens knew about ADHD?

Mr. Bouman: Kids really like the truth about how ADHD is negatively impacting the use of their gifts.  Many students have conjured up something far worse (e.g. “I’m stupid”, “I’m dumb”) than ADHD.  Kids need to understand ADHD is not their fault any more than it is their fault for having brown eyes. Kids need to know there are effective interventions that can ‘even the playing field’ for them. They need to know that things will get better and there is great hope for the future.

Dr. Bulten: I wish kids with ADHD knew they were not lazy. As I interview adults with ADHD and ask them what one comment they remember their parents and teachers said was, “If you would only try harder. You have so much potential and you just don’t apply yourself.” If we could measure “effort”, especially in young kids, we’d find they are trying harder than other kids and the results are poorer. As they get older, they start to give up and they stop trying altogether.

Q: What are some practical strategies persons with ADHD can use to accomplish tasks in their daily life?

Mr. Bouman: First, make sure any prescribed medication is at optimal levels.  Students and adults with ADHD are ideally completing a one or two page symptom reduction form each time they meet with their physician.  Other strategies include:

(1) Writing down your top three non-negotiables for taking good care of yourself.

(2) Enlisting accountability supports – a trusted friend or life coach.

(3) Use technology as a work-around.

Q: Do you have any recommended books or websites to learn more about ADHD?

Mr. Bouman: The best organization with incredible resources is CHADD – Children and Adults with Attention Deficit/Hyeractivity Disorder.

The best book for adults is Reaching for a New Potential: A Life Guide for Adults with ADD From a Fellow Traveler by Oren Mason.  Also check out Dr. Mason’s blog, Attentionality.

At CLC Network, we daily evaluate and create plans for struggling students based on their strengths and areas of need. Learn more about our perspective in this video and visit our website to learn more.

And of course, Dr. Bulten at Behavioral Medicine Clinic does an incredible job monitoring and supporting patients.

 Doug Bouman photoDoug Bouman, S. Psy. S. is the director of evaluation services at CLC Network (Christian Learning Center) in Grand Rapids, MI, a Nationally Certified School Psychologist and a Licensed Master’s Social Worker. He is a graduate of Calvin College and Central Michigan University.

 

 

Dr. Bulten photoRobert Bulten, M.D. previously practiced general pediatrics for 12 years and has been practicing behavioral medicine (including ADHD, Autism Spectrum Disorder, and mood disorders) for the past 30 years. He is a graduate of Wheaton College and the University of Michigan Medical School.

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Eye Opening Documentary Addresses Challenging Behavior

WhoCaresKelseyposterIn today’s post, Phil Stegink reviews Who Cares About Kelsey?an eye-opening film that raises questions about school practices and strategies that create a supportive school environment. 

In the documentary, filmmaker Dan Habib (director of Including Samuel) confronts a challenging and critically important issue facing students, families, and schools:  supporting students with emotional and behavioral challenges. In this film, Habib tells the story of Kelsey, a high school student who is significantly at risk for dropping out of school and becoming, in her words, “… a screw up like my brothers and sisters.”

Through this video, Habib confronts the real difficulty of supporting students who, like Kelsey, have difficulty regulating their emotions and modulating their behavior. He shows the raw pain of isolation, abuse, and self-mutilation. In this story, we meet committed school staff who seek to reach Kelsey and we learn about Kelsey’s family, who want the best for her, but who do not know how to consistently support her. The story ends with Kelsey’s graduation from high school and her finding a powerful purpose to move forward with her life.

Who is Kelsey?

Who Cares About Kelsey? opens by introducing us to the players in her story: Kelsey, who lives with her dad and stepmother; her dad; her mother; her siblings; and, her boyfriend, who is four years her elder. Though we don’t know this until the end of the film, if Kelsey graduates from high school, she will be the first one from her family to do so.

Failing Grades + ADHD + Self-Mutilation + Abuse Does Not Equal DropoutThe story begins when Kelsey is a senior in her fifth year of school. She was retained during her middle school years, and reports that she was diagnosed with ADHD in 4th grade,. Kelsey says she is a “… mean person …,” supposing that she is “mentally disabled,” but “… not really disabled. You know?” Teachers and support staff of Kelsey’s high school report that she is, among other things, “… stubborn, obstinate, mature, immature, and a champion of the underdog.” Kelsey says that she usually wins arguments, because she has the “… ultimate meanness.”

Positive Behavior Intervention and Supports

During Kelsey’s first year of high school, the administration decided on a very intentional effort to change the trajectory of graduation percentages. They implemented a program known as Positive Behavior Intervention and Supports (PBIS), designed as a school-wide approach to creating a safe school culture. The goal of this program is to reduce the dropout rate for all students, particularly those who are at significant risk of dropping out. Empowerment, rather than control, is an essential element of this program. At Kelsey’s school, this program was known as “RENEW.”

Kelsey receiving help with schoolworkA team of school staff, including teachers, administrators, and support professionals was created to envelope Kelsey in order to support her throughout her high school career. The RENEW team began with and returned often to visioning and goal setting with Kelsey. As is true for many students who struggle with emotions and behavior in school, Kelsey’s vision of self was grounded on her personal definition as “mean,” which led her to view her future as short term. Before she began to give voice to personal dreams in the context of the RENEW team, her vision for self centered on dropping out of school and finding a job. Through supportive planning and visioning with the RENEW team, Kelsey came to articulate hopes and dreams that including having a home, having an intact family, having kids, and having a job that would fulfill her desire to help others.

The Journey Forward

Firefighter KelseyThroughout Kelsey’s story we journey through the ups and downs of her holding and molding a vision that evolves from the “mean girl” persona, to a time when Kelsey is able to accept the reality that it is OK to seek and accept support from others. This isn’t a smooth, forward motion journey, however; steps forward are balanced with steps backward. Finally, after ups and downs, Kelsey passes a final exam for an Emergency Medical Technologist course, which allows her to graduate; the first person from her family to do so.The film ends a year later with Kelsey returning to her high school to speak with students who are participating in the same program from which she received support.

Final Notes

This documentary is not an easy movie to watch. It is not a simple how-to video. Though it ends well, it is not a feel good film. Habib and his associates explore the painful life in which many students live. The filmmakers do not presuppose a positive outcome, though by the end Kelsey has made great progress to managing her challenges and in letting down the walls that formed her boundaries for many years. Throughout the film, the viewer wonders, however, whether or how she can possibly “make it.” There are times when the film brings the viewer to the edge of despair as Kelsey struggles mightily with who she is and what she will be. The producers do not expunge harsh language used by Kelsey as she confronts challenges and speaks out her frustrations. If harsh language is upsetting, I suggest a viewer activate the “bleep” function in the DVD settings.

I think this film is targeted to schools that struggle with high dropout rates for emotionally at-risk students and that are looking for ways to include successfully those students in a positive learning community. The content of the film can be used to stimulate discussion about what faculty and staff believe about school culture and climate. Questions will emerge regarding practices intended to promote positive school culture and strategies used to manage students. The producers of Who Cares About Kelsey? partnered with a variety of educators to prepare discussion guides that should be useful to guide school development teams. I recommend this film to schools interested in implementing PBIS for students who bring challenging behavior to school.

Later this week, I’ll share strategies schools and educators can take to help students with challenging behavior and create a positive and supportive school community.

Phil SteginkPhil Stegink is the director of educational services at CLC Network and an assistant professor of education at Calvin College.

Practical Thoughts on Faith & ADHD

The following is the final piece in a 3 part series on faith & ADHD by Oren Mason, M.D. Read part 1 and 2 at these links: “How Treating ADHD Helped Heal My Faith” and “How My Faith Brought Healing to My ADHD

If you are disillusioned regarding spiritual matters, ADHD treatment might give you a new opportunity to re-experience your faith. Disillusionment may represent frustration over how ADHD degraded the practice of your faith. Maybe you are a discouraged believer, not an unbeliever. If you have left a church or the practice of a faith because you did not “fit in”, that might not mean you have lost your faith. Maybe it means that you feel left out or disconnected.

Consider that some changes may help you find a more “ADHD-friendly” worship experience. Several years ago, my family began attending a non-traditional church. It is multi-racial, located in a struggling inner-city neighborhood. There are many mixed-race couples in the church along with residents from a drug-rehab house, college students, immigrant families, suburban families and everybody else in between.

Nobody is “normal”, so anybody and everybody fits in. The music is lively and varied, the sermons are brief and thought-provoking, and the worship sequence changes every week, so that it is not predictable. This novelty factor is tremendously helpful for me, and, I suspect, would be for most people with ADHD.

Forgiveness is a central theme in most religions, and I believe it should be a central theme in our healing as well. We blame ourselves constantly; life is better when we learn to forgive ourselves. We blame others quickly; we need to learn to forgive them more easily. The practice of communion has been a wonderful part of my faith. The message of the service is: “God forgives you, so follow his example by forgiving yourself and others.” It’s been revolutionary for me.

To everyone who does believe in God, even if it only seems a tiny and inconsequential part of you, I encourage you to return to your roots and re-examine your spirituality. Life is hard, even after ADHD is well-treated. By the time he was nine, my son, Ben (who also has ADHD), could already tell you how harsh this world can be, and how much we need an anchor.

Anchors are pretty small things compared to the boats they secure. The question is not how big our anchors are. The question is rather how solid is the rock to which they are affixed.

“May the Lord make His face to shine upon you and be gracious to you. The Lord turn His face toward you and give you peace. Amen” 

This piece is an excerpt from “Reaching for a New Potential: A Life Guide for Adults with ADD from a Fellow Traveler” by Oren Mason, M.D.

Oren Mason IMGOren Mason, M.D. is a father, husband, ADHD patient, and physician at Attention MD. He wrote “Reaching for a New Potential” in 2009 after being diagnosed with adult ADHD. He hopes this book can serve as a source of encouragement and hope for those traveling a similar path. 

How My Faith Brought Healing to My ADHD

The following is part 2 in a 3 part series on faith & ADHD. To read part 1, “How Treating ADHD Helped Heal My Faith” click this link

There are several themes in my Christian faith that have been especially helpful to me in dealing with ADHD (even during the 40 years before I knew I had it). Christianity begins with the notion that God has high standards for how we should live, and that we have all failed his expectations. It’s called “sin” in theological circles.

Some of us have pretty high defenses and hate to admit we’re ever wrong, but in honest moments, most people with ADHD feel right at home with the notion that we are error-prone and fall short of what we should be.The real magic of the Christian faith for me begins with the notion that God still loves me, despite my failures. This is where the healing effect of my faith on my ADHD really begins.

Self-esteem is a tough issue for most everyone with ADHD. Many of us are social misfits. Even those of us that are the “life of the party” find that there is a limit to how much of our levity other people want in their lives. Many are divorced—literally rejected by people who once promised they would love us until we died. The sense of loneliness that is so common for people with ADHD arises from the failure to maintain close relationships over the years.

There is little I find more affirming than to be desired. It is an antidote to the expectation of rejection experienced by many of us with ADHD. I am fortunate to have had parents who did a great job of instilling a healthy sense of self-worth in me from an early age, so I’ve suffered less than others. The basis of their attitude was their firm belief that God made me uniquely for His own purpose. Despite my flaws, they always helped me feel I was someone special—not just special to them, but special to God as well.

Now, think what it would be like if your favorite current or recent president knew you by name. Imagine you’re at a political gathering, and he spots you in the crowd of a thousand people and waves you to come over. He smiles broadly and introduces you to the other dignitaries.

Hey, everybody, I want you to meet [insert your name] from [insert your hometown], one of my favorite friends. I’m so glad you’re here. This really makes my day.

It’s hard to imagine just how good that would feel.

But this isn’t merely the president we’re talking about; this is the God of the universe, the One who is so powerful that He knows seven billion people by name and cares immensely for each one. I grew up hearing that He knew my name and smiled when He thought of me. Imagine what it does for me to think that God is happy to see me. He could be done with me. My behavior is not up to His standards. I’m not His type. However, for reasons that must have more to do with love than fairness, He wants me to come home in the end and live with Him forever.

This piece is an excerpt from “Reaching for a New Potential: A Life Guide for Adults with ADD from a Fellow Traveler” by Oren Mason, M.D.

Oren Mason IMGOren Mason, M.D. is a father, husband, ADHD patient, and physician at Attention MD. He wrote “Reaching for a New Potential” in 2009 after being diagnosed with adult ADHD. He hopes this book can serve as a source of encouragement and hope for those traveling a similar path. 

How Treating ADHD Helped Heal My Faith

Earlier this month, we shared a piece of this post from Oren Mason’s book, “Reaching for a New Potential” on the church experience for a child or adult with ADHD. This week we will hear more of Oren’s story as he shares how ADHD treatment impacted his faith and vice versa. This post is part 1 in a 3 part series on faith & ADHD. 

ADHD can make it tough to be a Christian. Two major components of a typical worship service are the sermon and the prayers. Participation in either takes major concentration. Most of the Christians with ADD with whom I have talked feel guilty about how little they participate in traditional worship. Many have abandoned the regular practice of their faith, not because of disbelief, but because of a sense of being ‘out of place’ in a worship service.

Before I was diagnosed with ADHD, I thought that some patterns in my life represented sinfulness, and they caused a perpetual sense of shame in my life. Christians are called to be patient, and I am often impulsive. We are called to pray and read the Scriptures, and I almost always have trouble focusing on God. We are called to think of others and I am often self-centered. Christians are instructed to live in communities and love each other, but I am not very good at the friendship, intimacy and commitment that requires.

But something remarkable happened when I began medication for ADHD. My patience improved, my prayer life got better and I could listen to sermons and remember them later in the week. I found myself more able to think about others and able to act in their interest with less regard for myself. It was hard to understand and characterize what was going on. Had a pill actually improved my morality, my spirituality?

C.S. Lewis, in Mere Christianity, wrote about the difference between mental health and morality. A person’s morality has to do with the efforts made to do what is right. While mental health problems may hinder those efforts, God knows how much ability we possess to be good and expects us to exercise improvement beginning with what we are given. Improved mental health is simply more “raw material” available to do what is right. In other words, someone who is born with very little patience and who displays “all of it” is probably more morally advanced than someone who is born with much patience and exercises only some of it. (Lewis, C.S., Mere Christianity, p. 71, 1943, Scribner)

So there is no morality in a pill. Medications only give us a stronger foundation upon which to base our efforts to become better people—IF being better people is what we were seeking even before the pills came along. I suppose they will give you a stronger foundation upon which to become more cruel or dishonest, if that is what you hope for, too.

This piece is an excerpt from “Reaching for a New Potential: A Life Guide for Adults with ADD from a Fellow Traveler” by Oren Mason, M.D. Later this week, Oren will share how his faith brought healing to his ADHD.
Oren Mason IMGOren Mason, M.D. is a father, husband, ADD patient, and physician at Attention MD. He wrote “Reaching for a New Potential” in 2009 after being diagnosed with adult ADD. He hopes this book can serve as a source of encouragement and hope for those traveling a similar path.