ADHD

Did you know that most children diagnosed with ADHD are boys (10% males: 4% females?). Is this a problem with boys? Or a problem with expecting boys to be not-boys? (Or merely a problem with diagnoses?)

Where did ADHD come from? The University of Chicago linked ADHD to a "gene that regulates the actions of the neurotransmitter dopamine." Although I do indeed believe that God purposefully created all that is, I also believe in microevolution; I have to ask: What benefit did this gene confer? and Might it be useful? Is ADHD a disorder? or merely one more aspect of the wonderful variety of attributes that make up the human population? One more aspect that has been labeled as a disorder to provide more specialties for psychologists and clinicians to specialize in? I'm not saying that the so-called symptoms don't exist -- surely I know that they do -- I am questioning if they represent a disorder.

Here is the official diagnostic criteria:

DSM-IV Criteria for ADHD

I. Either A or B:

A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.

B. Six or more of the following symptoms of hyperactivity -impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.


Impulsiveness

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

. . . Is ADHD a disorder? or merely one more aspect of the wonderful variety of attributes that make up the human population? One more aspect that has been labeled as a disorder to provide more specialties for psychologists and clinicians to specialize in? . . .

I've put into bold all the ones we live with (yeah, it is pretty much all of them ~ do we get extra points for fulfilling both A & B?).

We recently received the report from the school district psychologist. Although he didn't come right out and say it (I wonder why not?) he included all this language multiple times. Maybe he thinks he'll have to break it to us gently, like we didn't already know . . .




:: this post is included in the 36th edition of the brain blogging carnival hosted over at the BrainBlogger.

Deborah Gray

Last Monday -- thanks to my dear cousin who took the kids -- I got to attend an all day conference at which spoke. I learned quite a bit and was reminded of many things I had rather forgotten about. Deborah Gray is the author of Attaching in Adoption: Practical Tools for Today's Parents and Nurturing Adoptions: Creating Resilience After Neglect and Trauma. We got to hear her speak once before; I so wish we lived close enough to go see her for therapy.

. . . be not dismissive of their tender needs . . .

I'm going to type up my notes here because, well to be honest, I have a better chance of finding the blog post months from now than I have of finding the paper in my files. Here is what I jotted down, in no particular order.


When infants move away from their primary caregiver, they experience psychobiologic disregulation. Garbanzo who recently finally got a primary caregiver, also does this. When he gets too far from me he gets physically wired up and his ability to make good decisions and control his impulses goes downhill. This is part of why keeping him home and keeping him close is so helpful. I wonder if it will still work when he is 18. Hmmmm . . .

Garbanzo is likely at the Disorganized Attachment category, always questioning "How is Mom going to be with me today?" with competing claims of "she's safe" and "watch out". Deborah did a great illustration of this, dividing the audience into thirds and asking us to shout out either "she's safe" or "watch out" or "run away" all at the same time as she asked a volunteer for a hug. This is what many of our kids experience each time they try to draw close.

Deborah mentioned that neglect is the highest predictor of anti-sociality. Kids from neglectful backgrounds have trouble recognizing some expressions on people's faces (this is Garbanzo, he sees everything, but doesn't interpret and/or register looks of annoyance etc.).

Deborah described how she talks with children about how empty hearts fill with mad and sad and we need to fill the hearts with loves. She also shared about a young woman who stole, and didn't know that stealing hurts people's feelings, hurts their hearts. We often run into similar things with Garbanzo; where he doesn't know things, doesn't 'see' things that are so obvious to us. Note to self: explicitly explain everything.

Prevent the kids from getting lonely and bored as that leads to anger, and with time and opportunity, mischief will ensue. We have seen this borne out over and over: keep him busy; keep him close.

With Garbanzo, we need to improve attachment to reduce anxiety to reduce need for control. Alas, easier said than done.

Kids that were abandoned question if they are worth coming back to. When returning to the kids, especially Tater, we need to talk up how happy we are to be reunited, how we thought about them while we were gone, etc.

Tater falls easily from frustration into despair. It is as if she used up her frustration tolerance as an infant waiting to be feed/warmed/ tended to. When frustration/despair overwhelm her now, provide empathy and compassion (she needs this retroactively) but don't dwell on it, don't let it become a defining characteristic.

Help her make a plan for when big feelings swamp her.

When she starts to melt, ask her to count things, or name things, or ask if anyone smells butter or popcorn or something. Smelling and counting and naming all engage the brain in activities that distract from emotional disintegration.

Then I have a whole list of resolutions, without commentary:
:: be more playful
:: be more affectionate
:: stroke inside of their palms (triggers for attachment)
:: do not shame them ~ "be not dismissive of their tender needs"
:: use more role-playing and repetition
:: help name feelings
:: hold hands more
:: create more positive spaces & moments
:: notice and admire
:: compliment their thinking
:: say 'yes' just cause they are cute
:: be not frightening
:: make timelines of their lives, or roadmaps . . . road to a happy life
:: play more
:: use words like "repair" and "restoration" not "punishment" and "discipline"
:: ramp up procedural learning - practice over and over
:: tell them what I want, not what I don't want

to home-school or not to home-school? that is the question

We are in the midst of a big decision here. Remember when we pulled Garbanzo out of school for a couple weeks due to behavior that is unblogable? Well it has proven to be a good decision and we are now considering extending the hiatus for the rest of the year.

Pros
:: Many more hours available each day for wholesome family interactions to promote attachment.
:: No driving! I spend 1.5 hours a day dropping him off and picking him up.
:: Chickadee wouldn't have to wake up so early -- she is always tired. Neither she nor I are morning people.
:: Pleasant mornings, not racing-out-the-door mornings.
:: I would be responsible for his education.
:: He could take math, spelling, and chess at the homeschool/school partnership at no charge.
:: He can have regular social interactions with the kids in the aforementioned classes.
:: I spoke his current teacher about this plan, and she gave her blessing.
:: He could spend a lot more time with his very special person, Grandpa.
:: We would have time to do something like Awanas or 4H.
:: Mandatory roundtrips to town drop from 120 miles per week 18 miles per week.


Cons
:: I would be responsible for his education.
:: I may get a bit weary of hanging out all day with Mr. Intensity.
:: We'll have to be more proactive about finding kids for him to be friends with. This may mean that we will have to socialize with other families. Oh the horror.
:: Seems as if there should be more on the con list. What are we overlooking?

Parenting the Child Adopted at School-Age

When reading literature on parenting the adopted-when-older child, one will often -- very often -- read that the children need lots of structure.

. . . how do I reward a kid for good choices when all the rewards I can think of set him up for bad choices?

We can do structure. We have calendars that tell us what to do each day. Chore jars that help us organize our time. Cellphones that tell us when to wake, eat, and depart. We have a wall chart for school days that tells us what our activities and deadlines are (in addition to the little charts upstairs that help them remember to wash up, get dressed, etc.). And so on . . .

What we didn't realize, however, is that it is more than providing marching orders for every waking minute, it is also necessary to never ever lighten up. ever. even if you really really want to.

We have noticed that when we do lighten up, Garbanzo sees this newly-won permissiveness as open season. If any one boundary is relaxed, he things ALL boundaries are relaxed. So when we try to reward him for good behavior, he spirals down. As my B.I.L. says, "if you give him an inch, he'll take 40 miles, in about 20 seconds." And it's not just that he thinks all boundaries are off, but that he starts sporting an attitude.

When we are micromanaging his every move, he can graciously receive correction. But as soon as we allow an indulgence or two, he will chaff bitterly under correction, glowering and festering and acting as if we are trolls.

Today he lasted two minutes in Free-Play before he started cutting his sister's paper crown up with the scissors that had been returned to him just last night. (Note to face-to-face friends: no scissors for Garbanzo.) I guess the exhilaration of having both scissors and a half hour of free choice was just too much for him.

So, my question is, how do I reward a kid for good choices when all the rewards I can think of set him up for bad choices?