Ever wonder if your child has ADHD/ADD?
Many of the parents I’ve known and worked with have expressed concerns about whether their child has ADHD/ADD. And why not? It’s a popular diagnosis!
Recently a colleague of mine (we’ll refer to her by her initials) met with me to ask some questions about my work with kids with ADHD/ADD. I’m sharing that interview here! (And from here on out I’ll be using the term ADHD instead of ADHD/ADD, but the term is meant to refer to both diagnoses.)
KE: When we talked about whether Wits’ End Parenting readers would find information on ADHD to be relevant to them, you said that this would be a “popular topic.” Can you say more about that? After all, most kids do not have this diagnosis, right?
Rebecah Freeling: Yes, that’s true. But people are afraid of ADHD! And partly this is because the discourse on ADHD is fairly pervasive in the United States. The parents I work with are often afraid their kid might have it. And teachers are often on the lookout for it – and I don’t mean that to be snarky, but the reasoning is, “If you have a diagnosis, you have access to tools you wouldn’t have without the diagnosis.” Then, too, parents of difficult kids figure that if there is something wrong with the child, they are being irresponsible if they’re not addressing that. Their priority may be to fix the difficult behavior, but they also have to ask – is he even capable of good behavior? “If my child has a disorder then I need to be responsible and address that.”
KE: Hmmm, that’s an interesting point. Do you ask yourself that question when you’re working with a family? “What if this child has ADHD?” And if you thought the child might have the disorder, would you refer them to a psychiatrist?
Rebecah Freeling: Well, first, I believe that it is the very rare person whose diagnosis makes it impossible for them to manage their behavior. And there is always more than one path to the desired behavior. Even with drug-based treatments for ADHD, there’s the stimulant path and there’s the non-stimulant path. And behavioral approaches such as the one I use are a recognized treatment for ADHD. So parents can choose from a number of interventions.
When I work with parents who have chosen medication for their child, we work pretty much the same way we would if the child were not medicated. Of course, with a child with ADHD-related deficits, we would work with the child to build skills in those areas. So we would teach time-management, or we’d teach how to break a big task into smaller parts, or what to do when experiencing a compulsion to move when you’re supposed to be still.
But a key piece of my approach includes teaching the child the broader skills in 1) cooperating with parents while also 2) taking a main role in developing alternatives to the problem behavior. And this is a life skill every child needs to learn. Everyone needs to learn to take responsibility for their behavior, and to meet needs and solve problems in ways that work for everyone. Everyone needs to learn to do things they’d rather not do, and we all need to learn impulse control – to not do some things we may want to do. And medications don’t teach this.
KE: Can you talk to me about all the controversy related to the ADHD diagnosis?
Rebecah Freeling: Well, yes, the diagnosis is controversial. Some people don’t believe that this is actually an illness. And of course the medical community frames the data in ways that support the opposite view. Really, I’m not interested in taking a stand on this. This argument doesn’t help you to have a nice dinner at home with your kid. If we solve the argument, “knowing the truth” won’t help your child be more confident. It won’t help you to develop the communication patterns and behavior you want with your child. The answer to this controversy wouldn’t really impact the work I do with these kids.
KE: You’ve answered this question to some extent, but let me ask it this way: What do you do to help kids with the ADHD diagnosis?
Rebecah Freeling: Well, like I said, we teach kids to manage their behavior, their focus, their time… but we take a very practical approach. So we look at the child’s functioning in specific areas. We work with the child to develop systems or processes that solve specific problems. So rather than start with, say, games or exercises that are designed to develop executive skills, we first look at how that problem is manifesting in real life, and we develop a system to manage that. Games and more abstract skills-building are fine, but working within the context of real life provides the added benefit of teaching kids about self-responsibility and real-world problem-solving.
And all this is very individualized. That’s key. Each kid has their own way of making sense of things. I like to track my tasks and keep track of my things one way; my partner likes to do these another way. So a big part of my work is, again, to develop systems with the child. There’s a LOT of information available on task- and time management, but what I do is start with, How does this young person think, what are their ideas, what are their preferences… vs. just throwing some great ideas at her and then she feels bad because she can’t implement it. And again, this approach teaches kids to take the lead in solving their problems and regulating their behavior.
KE: I’ve heard you say that with some kids, your “prescription” has been that they stop doing homework! You have a background in education and child development, and you believe that kids tend not to get the physical activity and downtime they need. So, I realize it depends on age, but, how much should we expect kids to sit still and pay attention?
Rebecah Freeling: Well, of course the older the kid, the more we can expect him to be able to sit still. But much of infancy and early childhood – the period from birth to age 8 – is defined by movement, imagination, skipping around and being active. And most schools are not designed around what the child actually needs in terms of movement and play.
The fact that a lot of kids can be trained to “be good” and do things beyond their developmental age, doesn’t mean it’s developmentally appropriate. Just because a 6-year-old can sit still for an hour doesn’t mean he should. That’s not developmentally appropriate. So we do need to ask, are we expecting too much of the kid who’s not doing what that 6-year-old is doing?
On the other hand, I have parents who say, We don’t eat together because the kids can’t sit at the table – but kids as young as 3 can sit at the table for dinner for 15 minutes. That is a reasonable expectation. Three-year-olds can’t sit for a lecture, but they can sit and eat or do a craft, they can sit for something more active and engaging.
So some of what I do is give parents a little training in child development. So when someone calls me and says, My 8-year-old won’t come home from a full day of schoolwork and do her 2 hours of homework, I say, Yeah, her body is telling her that this would be bad for her! And we need to help her and teach her: Yes, movement and play is what you need, and how can you integrate this with the demands your school places on you? Again, the answer depends on the child and the family. Some kids decide to play and work in 15-minute intervals. Some kids decide to knock the homework out before they come home from school. Some families decide that the child doesn’t need homework after a full day at school. But before we give the child a psychiatric disorder, I believe we need to ask whether she’s getting what she needs and whether what we’re asking is actually appropriate.
KE: Based on everything you’ve said so far, I’m guessing you are not a fan of medication. But what’s your stand on ADHD meds?
Rebecah Freeling: Well, generally speaking, I see that when parents are considering the ADHD diagnosis, most parents reach for medication too soon, before they’ve really done what they can to teach kids the alternative behaviors. Which includes getting help from someone like me if need be. Yes, some will say “He wouldn’t sit still and now he’s on meds and he sits still.” But in all likelihood he could have been taught to do that. Most people with ADHD can learn to pay attention, they can learn not to interrupt, they can learn to control their bodies.
And what I’ve seen is that a lot of “ADHD symptoms” are actually bad habits. For example, one thing I do to teach kids to pay attention is tell parents, No more “drive-by” communication. If your kid asks you for something and isn’t looking at you and is walking or running past you as she’s asking – and you answer or give her what she wants – you’re teaching her how not to focus. She doesn’t have to really be there in that communication with you; she can multi-task, and this is the opposite of what we want to teach someone with ADHD.
People often want to pin interrupting, or poor impulse control, or not listening, on ADHD. I’m not going to say that these behaviors are not symptoms, but on the other hand, everyone has to learn these things – what I mean is, everyone faces effort and a learning curve with behaviors that require self-discipline. So maybe it’s ADHD. Or maybe it’s a bad habit, or a lack of education. Bottom line, I think we really want to do our best to teach executive functioning and teach the child more appropriate behaviors before we decide they have a mental disorder.
KE: Thanks for sharing your thoughts, Rebecah! I like your practical perspective.
Rebecah Freeling: You’re welcome! And I’m giving a talk on ADHD at Cambiati Wellness Center in September. There’s more information on that talk here.