Wednesday, December 1
For School Social Workers: Helping Parents and Teachers Support Children with ADHD
During the five years I worked in outpatient mental health and the thirty years in school social work, one of the most recurrent issues has been to support family and teacher efforts to serve children with attention deficit hyperactivity disorder (ADHD). Although you can find numerous books on the subject and almost unlimited references via the internet, I would like to share my perspective on characteristics and interventions that have helped parents and teachers gain a better appreciation of the children and how to help them be more successful.
Intelligence. They typically have average to superior intelligence. They are much brighter than their grades would indicate due to incomplete assignments and failure to prepare for tests.
Failure Sensitivity. They are extremely sensitive to potential failure and overuse avoidance as a coping mechanism. They would rather take an “F” than to work hard for a “C” or “D”. They especially resist long, difficult, boring, or new tasks that they assume they cannot do successfully (often based upon experience).
Poor Planners. They tend to put off tasks until the last minute. Then they may just throw things together or just not do them because, “It will be wrong anyway,” or “There is not enough time to do it right.” They often try to blame others: “Too long a task,” “Nobody will help me,” “Directions were not clear,” etc.
Poor Locus of Control. They do not see that the amount of effort corresponds to the grade. They can produce some correct work through making intuitive leaps, but they can’t/won’t show the steps required to arrive at the answer, so they lose credit. Or they will have an innate talent, such as playing an instrument, with a minimum of effort. Therefore they relate a good grade to a teacher being in a good mood, to parents having helped/forced the work to be done correctly, or they are “just good at” something. They cannot gain a sense of accomplishment when success equals good grades with minimal effort.
Disorganization. Although disorganized, they often resist suggestions for getting organized. They see suggestions as taking too much time, too much work, or believe they will remember later (And actually believe they will remember later). This often results in them fabricating stories or denying what the agreement was to cover the fact that they forgot. This often results in adults engaging in power/control issues by trying to make the child get organized.
“Islands of Competence”. They often have an area or two where they are particularly creative and gifted—art/crafts, music, sports. It is critically important to develop these areas since working for good grades may never be a strong motivation for completing high school or staying out of trouble.
Vulnerability. These individuals are vulnerable every day due to things they forgot to do and are much more sensitive to criticism than most people realize. One of the most certain ways to not gain their cooperation is to yell at them and/or humiliate them in front of their peers. You may never regain their trust.
Problems At Home and At School. Part of the DSM-IV-TR criteria for ADHD is that the problems occur in more than one setting. Most parents are very aware that their children have difficulties as listed above, and may present even more challenges at home. This may be due to medication wearing off by evening, parents giving up on trying to change behaviors, parental differences over child-rearing practices, etc.
Fifteen Minute Rule. Accept that the most important issue for many children with ADHD is having fun within the immediate to fifteen-minute span of time. What will happen in an hour or yesterday does not exist. Living in the moment can have some very positive aspects if the person can be focused on accomplishing the tasks necessary to be prepared for tomorrow, as we know. Don’t assume the children can do this automatically, however.
Ten Word Rule. As satisfying as it may feel to lecture and question for an extended period to be sure children with ADHD “get the message”, most children lose track of the message beyond ten words at a time. If you are lucky, they will obediently look at you and wait for you to run out of breath, but they stopped listening to more than the tone of voice long ago. Lessons are not learned by volume or length of lecture.
No “WHY” Questions. People do not realize that asking, “Why did you ___?” is an invitation to give a rational explanation for a behavior. The children will either try to give a justifiable reason for their behavior, say “I don’t know”, or lie or blame others. In fact, it is better to not ask questions at all. If the children are old enough to write/print, it is better to have them take a sheet of paper and write down two things: what did they do that got them into trouble and what they could do differently next time. This gives you time to calm down, it avoids an opportunity for them to argue, and it will build thinking/writing skills. After this task is completed, review the product to see if they made a legitimate effort to answer the two questions, explain that they made a mistake, and suggest that they can learn from their mistakes. (Don’t get caught up in spelling or grammar errors.) If the mistake requires a consequence, they may learn even more by helping in selecting an appropriate one.
1, 2, 3 Magic. Buy, rent, or borrow this CD or video by Thomas Phelan, PhD. There are many practical suggestions for training yourself to cope with situations when children fail to respond to a request of direction. They need to know when you are serious about an issue without having to wait for your voice to reach a certain volume/pitch or your unique magic words like “That’s IT!”
(Children and Adults with Attention-Deficit/Hyperactivity Disorder). This organization has been the best resource for parents and teachers that I have found over the years. If a local chapter is available through their Web site, join in the meetings (http://www.chadd.org/
). Attend one of the annual conferences to get the most current research and recommendations for home and classroom support to help children (and adults) with ADHD.
Good Communication Among Adults. It is critically important for the adults to avoid having the child get set-up as the “victim” and play the adults against one another, whether that is home-school, parent-parent, or parent-grandparent. If the adults will not work together to address the children’s issues, the children are in control. This makes it almost impossible for the children to accept responsibility for changing the way they cope with the challenges presented by the ADHD characteristics mentioned earlier.
Medication. Last but not least is the issue of medication. Although as many as 80% of children can benefit from appropriate medical management, it is not a cure. Medical evaluation should first rule out medical factors that may contribute to the behaviors of concern, as well as identify other emotional or behavioral factors that are present. Medication can allow children to finally be capable of focusing their efforts for longer periods of time and being receptive to educational opportunities. A multimodal approach has the greatest benefit through a combination of parent support, behavior management training, appropriate educational modifications, medication monitoring, and family or individual counseling, as needed.
Although I realize many of the characteristics listed carry negative connotations, they are balanced with the charm, quick-witted verbal skills, and positive characteristics that children have often developed to compensate for the problems that their ADHD creates for them. Most people do not reflect on the courage it takes to return to a place (school) where the children have so often experienced failure, frustration, and lack of understanding from peers and adults. If we faced such obstacles in a job, we would probably change jobs. They do not have that option. If interventions are not successful, these children are very vulnerable after exiting public school. Adults need to work together to help them learn how to cope with the effects of having ADHD.
Galen R. Thomas has been a member of NASW since attending graduate school in 1974–1975. He is currently a member of NASW Illinois Legislative Committee and the
NASW Standards for School Social Work Committee. He served twenty-five years with the Illinois Association of School Social Workers, including time spent as its president and legislative co-chair.
His work experience has included: five years as outpatient mental health therapist; thirty years as school social worker; and nineteen years as a part-time instructor at Southern Illinois University at Carbondale. He continues to work as a social work consultant to facilities for individuals with developmental disabilities. His publications have included co-authorship of chapters in the fifth, sixth, and seventh editions of School Social Work: Practice, Policy, and Research published by Lyceum Books.
Posted on 12/01/10 at 07:57 AM