The Search For Stimulation: Understanding Attention Deficit Hyperactivity Disorder
So when I was moseying the net Friday night on Ei’s reference to Dabrowski’s overexcitabilities and giftedness, not to mention ADHD, I came across the above article. I’d encourage anyone to read it, but I’m going to post here a couple paragraphs I particularly appreciated.
If I was in charge of renaming ADHDand Im notI would call it the “search for stimulation disorder.” To explain this, lets look at the problem of Timmys attention. Timmy has difficulty sticking to tasks such as homework or other relatively less interesting chores, such as cleaning up his room. To Timmys parents, it wasn’t that he couldn’t do his chores, but that he just didnt want to do them.
Timmy’s parents are partially right. Timmy can do things that he is interested in, but he has trouble with jobs that require more sustained effort. Its not because he doesnt care; its because, more than most other people, he needs to find something interesting for it to hold his attention.
Timmy searches for stimulation. That often gets him into trouble because he doesnt pay attention when hes supposed to. He turns to look out of the classroom window when he should be listening to the teacher. He gets up out of his seat during the middle of a lesson. He annoys other children when they are trying to listen or do their work. Although medical scientists do not know exactly what causes ADHD, I can tell you what I think it is, just as I explained it to Timmy’s parents.
This describes Tyler so aptly. I had commented to Tyler, you don’t act like that (the way he had on the bus) when you’re in the car with me. Ei’s question… what skills is Tyler lacking, made me ask, what’s different about the bus than my car?
Well, there are a heck of a lot more kids, for one. And Tyler has always been one to get wound up in an unstructured environment with a lot of other kids. There is one adult, whose primary attention is directed to what’s going on in front of her rather than what’s going on behind her. By the time a situation comes to her attention, it has already started to escalate, at which point Tyler is rarely able to reign himself in, and needs intervention from an external control. I’d also bet my bottom dollar that she’s trying to redirect Tyler (and the other kids) through her rear view mirror.
Since Tyler was diagnosed, I’ve made it a point to communicate with teachers, tutors, and parks/recreation staff that Tyler needs direct, eye contact anytime verbal instructions are given. I make it a point to let them know that if he’s ‘gone’ and not responding to verbal directions, he needs physical touch… something like a hand on the shoulder. I’ve had to cup my hands around his eyes in a super stimulating environment to maintain his attention. If I’m worried that the professionals working with my child every day don’t have adequate training on dealing with a gifted/ADHD, aka twice exceptional child, why would I assume his bus driver is any better equipped?
What else is different about mom’s car versus the school bus? Well, I don’t drive any length of time, particularly not in rush hour traffic, without something for Tyler to do. Meds or no meds, if he doesn’t have some activity to channel his energy into, he will ‘self stim’ with excessive fidgeting and noises that are distracting to me if he’s in the front seat, and irritating his sister’s if he’s in the back. I keep some handheld electronic games in the car, and carry a ‘fun bag’ when the kids are with me that has books for each of the kids, paper, pencils, crayons, and flashcards for the car and in case we wind up waiting for an extended period of time in any kind of boring place.
Behavior management
Behavior management can be extremely important. It is essential to understand, however, that medication is the only intervention that will actually reduce the individual’s symptoms. Without medication, only the environmentnot the individualcan be changed. Behavior management means changing the environment so that the inattentive and impulsive individual can function better.
I really liked this paragraph as well… I’ve always looked at behavioral management as me managing Tyler’s behavior in circumstances when he can’t, but it’s really more of me managing his environment. For example, if I need him to focus on anything, homework, chores, etc, I eliminate as many distractions from the environment as possible. I turn off the TV, I make sure any music provides white noise rather than being stimulating/distracting. If his sisters are a distraction, I occupy them in another room.
So Tyler’s medication doesn’t necessarily prevent him from self-stim if he has nothing else to do, plus his meds take 30-60 minutes to reach a therapeutic level, and he takes them 20-40 minutes before he gets on the bus. In a situation where medication can’t be depended on alone, what are the options for behavioral (environment) management?
Well, it seems that a great deal of the trouble Tyler is getting into on the bus is when he and his friends are talking about who knows what (Radio Disney lyrics?) and disagree about something, and then it becomes a shouting match, and Tyler is the loudest of the bunch trying to make his opinion heard. They also sit towards the back of the bus. Well, I can’t eliminate all the other kids, but it seems to me that Tyler needs to sit towards the front, and not with any of the other opinionated children he argues with. I know every kid he listed (my best friends’ son, his best friend, halle’s best friend, halle’s best friend’s cousin), and I love them all… they’re great kids… but Tyler needs to sit in a seat by himself. And he needs something to do.
And that’s a conundrum. What can I send? Chances are I’m not going to convince him to read on the bus, because I’m not sure how many books I’d find that could hold his attention in the force of that much stimulus. I know a handheld game would probably do it, but would he have the self control to only take it out while on the bus? I think he has a different driver in the morning than in the afternoon, as well. Besides, I’ve always been very ‘anti’ sending toys to school, and I’m pretty sure the school has some kind of rule about that too. Not to mention, how irritated would I be when it got lost or stolen or confiscated because he was playing with it in school?
I picked up a Rubik’s Cube yesterday at Target while Tyler was picking out a gift for Cameron, as well as a handheld Sudoku game. He seems interested in the Rubik’s Cube, which has the benefit of not being an electronic game/not making noise, and chances are I can find smaller/cheaper versions if I put my mind to it and it really works for him. I also printed out an easy sudoku puzzle, which Tyler says he did some of towards the end of 4th grade on the computer. He was excited about taking them to do on the bus to keep him busy. He also loves word searches, so maybe I can find some of those that are challenging enough to keep his attention, but not so hard he’d give up and start looking for other stimulation.
On Saturday, I had one of the most disconcerting and satisfying days ever. A frantic Mom had emailed me a 15-page report back from her child’s psychologist, asking if we could meet. The report didn’t tell the parents anything new. The parents already knew that their child struggled with this, that and the other. Instead of providing a deep understanding of WHY her son struggled with about 12 behaviors, the report merely attached scary labels to these behaviors in an effort to categorize them:Your son is suffering from sensory processing disorder, attention deficit disorder, auditory processing disorder, opposition defiant disorder, obsessive compulsive disorder, dysgraphia and fine motor skills difficulties that impact writing.Many of you have felt the fear and dread that accompanies such a diagnosis-imaging a childhood lost to endless therapy, headaches in school and thousands of dollars in testing and treatment. Many have no diagnosis, but you recognize the behaviors.
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Becky
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