Understanding ADHD
Understanding ADHD
Helping to make sense of the murk
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In this week’s episode of Raising Good Humans Podcast, Dr. Dave Anderson, Vice-President, Public Engagement and Education; Senior Psychologist, ADHD and Behavior Disorders Center, helps us get through the murk around ADHD diagnosis, and what parents can do to help support their children - whether they have a formal diagnosis or not.
What is ADHD? As Dr. Anderson explains, an ADHD diagnosis is made on a collection of behaviors - either inattentive symptoms or hyperactive impulsive symptoms - that are interfering with activities of daily life. This means that these behaviors are very frequent, intense, persisting over time, and showing up across multiple settings.
“The essence of diagnosis is that we have a list of behaviors that are reliably described enough that most clinicians know what it is when they see it. And, when we notice that a kid is demonstrating those behaviors, that they are impairing the child so much that if we don't treat them, worse things can happen.”
Though we know that science is always changing, that our field is always growing, learning and revising, we also know that there is lots of data around ADHD, and what does and does not work with kids. In the episode, we outline some of the standard interventions for ADHD, and highlight how many children with subclinical symptoms - some symptoms of ADHD without meeting diagnosis - can benefit from these as well.
“The adult has to know what the skill is, and have good behavioral skills to promote it with that child in the context of a supportive relationship. And then, as someone gets older, they need the adults less and less, and they might be more motivated to take on that skill as their own.”
Behavioral training for adults:
Dr. Anderson breaks this down simply as an “I do, we do, you do” model. Parents help kids to break down and incrementalize tasks and skills that are challenging. In a beautiful analogy, Dr. Anderson describes how mundane and routine tasks can feel overwhelming to a child with ADHD. In this analogy, Dr. Anderson asks you to imagine that I tell you to go out, get a violin and learn to play a Beethoven concerto by tomorrow. Assuming you’re not a classical violinist, this demand feels way outside of your capabilities, causes stress, and maybe a bit of panic. This is what being asked to do a task that feels outside of their abilities can be like to a child with ADHD. Breaking down tasks helps to support your child in finding the Zone of Proximal Development. The Zone of Proximal Development is a concept developed by Russian psychologist Lev Vygotsky that refers to the range of tasks that a child can perform with the guidance and assistance of others, but cannot yet perform independently. It is the sweet spot in which kids can learn to stretch themselves, in small increments, to learn more through the right amount of help. But what is the right amount of help?
“What we often think about, in behavioral work around ADHD, is that there are two facets of it. You teach parents strategies, and you also manage their expectations so they don't drive themselves crazy.”
Parents of children with ADHD often face two sides to their child’s challenges on a daily basis. On the one hand, you have “warrior” parents that work to use their own executive function skills to support their child - taking over tasks, tracking, communication and micromanaging for their child. This behavior makes sense! These parents are trying to help their children to succeed by lending their own skills and ensuring that things don’t fall through the cracks. Other parents of children with ADHD are feeling endlessly frustrated and mystified by their child’s behaviors. They are trying to set harsher limits, use punishments, and set consequences for behaviors that are persistent and frustrating. This behavior also makes sense! These parents are enduring endless hours of arguing, struggling, and meeting resistance. Of course, like all things, supporting parents means helping to find a middle ground. Doing, then modeling, and finally working towards more and more independence can help children with ADHD to gain skills toward adulthood - even if the road is bumpy and full of setbacks. As Dr. Anderson describes, this cycle of “I do, we do, you do” repeats over and over in the life of a child with ADHD. As children grow, parents continue to teach what skills look like, help children to set goals, and work toward ways to practice that skill independently.
“It is an ‘I do, we do, you do’ model where parents demonstrate how each step in a list goes, do it with their children for a painstakingly long time, and get to a place where their child can do it alone.”
Three parent behaviors that could help better support a child who is presenting symptoms of ADHD:
Realize that ADHD is but one particular descriptor for your child
Our children have so many strengths and weaknesses. Though ADHD may highlight some of the things that they struggle with, or need to work on more, our children have many incredible talents and interests and abilities that we want to celebrate. As much as we want to help them, we also want to avoid extinguishing the light that makes them who they are, brings them joy, and fills their buckets. Everything can’t be about ADHD in a child’s life, and we want to always work towards finding and celebrating the richness of our childrens’ whole self.
Get behavioral training that supports a strong parent-child relationship
As we reviewed above, getting support with the practical tools you can use can help us maintain a supportive relationship with our children. Staying united, being a team, and feeling grounded in relationships, helps to make progress. Being combative, standoffish, or in a battle for control, can erode relationships and undermine growth.
Look for allies and build a village
It is clear that parents of children with ADHD cannot be on this journey alone. We all (from society at large all the way to our small school communities and neighbors) have a role to play in supporting kids in ways that help them thrive. Looking for adults - wherever they may hide - who believe in your child, support them, and encourage them, is essential to walking through this journey.
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