ADHD: A Path to Success
Chapter 2 of
first 6 Chapters
ADHD: Historical Change in Labeling the Disorder
(continued)
At this point, though both parents were involved in Luke's therapy, the focus turned to mother and son and dealing with the emotional history that caused Luke's mother's depression and Luke's academic anxiety and anger.
Luke's mother spent six CAER sessions reviewing her background of neglect and abuse, which laid beneath her depression. As her depression lifted, she became better able to administer systematic discipline for Luke's antics without caving in or feeling guilty. To her surprise, as she became firmer and more consistent with Luke, he respected her more, wanted to spend more time with her, and became more compliant.
Luke's father spent three sessions extinguishing the resentments toward his wife that kept him from being a fully cooperative parent, as well as the resentment that he had built up toward Luke for all the years of family uproar he had caused. These emotional changes led him to be a more supportive husband and a more engaged father.
After Luke, his mother, and his father had all taken their turns in the CAER machine, extinguishing their responses to the tapes, the family conflict was minimal, and Luke now gets B's and C's with little effort. He is no longer a bully at home or school.
Three-year follow-up indicates that these changes are stable. Luke is now in his senior year of high school. He plans to attend the community college next year. His mother has had no reoccurrence of depression. His mom and dad are finding more things to share and spend more time together.
ADHD, Current State of the Art Debunked
Numerous names have been given to the learning and behavioral problems that are common in children today. These labels represent non-distinct, overlapping categories that are often used as much on the basis of current popularity or the availability of funding as on the characteristics of the child.
Because of this, many children carry multiple labels, either at the same time or across time. The three most common labels used today are Attention Deficit Hyperactivity Disorder (ADHD), Learning Disabilities, and Behavior Disabilities.
Since categorization and diagnostic efforts have primarily focused on describing and measuring the alleged differences between these types of children's problems, there has been little interest in understanding the predominant commonalties they share. Yet, they are simply variations of the same theme, and they are far more alike than different.
Therefore, my efforts have been directed toward understanding the common forces that drive children who carry any of these three diagnoses and finding effective treatment for the shared patterns — contrary to the interests of most investigators in this area. And since ADHD is the most inclusive of the three disorders, the following discussion begins with it and then shows the relationship to Learning Disabilities and Behavior Disabilities.
History of ADHD Labeling and Treatment
Over the years, numerous labels have been given to children with ADHD. In the 1960s they were called brats. With the growing medicalization of common problems, they were labeled Minimal Brain Dysfunction. As behaviorism became popular, they were called hyperactive. Eventually these children were labeled Attention Deficit Disorder, or ADD.
From the last two labels evolved the currently accepted diagnosis of Attention Deficit Hyperactivity Disorder, ADHD. There seemed to be something curative about finding exactly the right name for these troubled children.
ADHD was originally thought of as a neurological disorder that damaged a child's ability to focus his attention. During the 1970s, stimuli of the outside world were seen as involuntarily intruding into the patient's consciousness, similar to how delusions intrude into a schizophrenic's consciousness.
These children were thought to be unable to filter out unwanted intrusions. Their attention was dragged to and fro by whatever surrounded them. In other words, children were helpless victims of environmental stimuli.
Treatment during this era consisted in part of placing the child into a low-distraction environment — such as a quiet study booth with nothing on the walls. Classrooms with high or few windows were built. The idea was to reduce the number of potential distractions that might lure the child from the desired task.
This approach went through its placebo-effect period of success. With increasing experience, however, the placebo effect wore off, and windowless rooms did not seem to be of much help. In moments of desperation, though, this treatment is still occasionally used.
Treatment efforts were then directed toward teaching children to "control themselves," meaning control their own attention levels. The idea was that the children lacked the skills to control their own wandering minds.
Since this was a nice philosophical fit with the educational setting in which most of the children were identified and treated, an action plan was easily developed. Children were taught cognitive behavior therapy techniques.
This means they were taught to think differently about problems and to talk to themselves in special ways, ways that would help them make "better choices" — as if the children had chosen to be ADHD in the first place.
In a recent consultation with school staffers of an ADHD child I was treating, I was struck by what the principal said. She proudly explained in detail that whenever Brandon, the ADHD child in question, misbehaved, she would take him into her office and "go over what choices he had and each of their consequences."
What Brandon really got was the undivided attention of the highest status person in the school, in the highest status room in the school.
The principal, counselor, and teacher attending this meeting were so entrenched in their educational/cognitive model that they were completely unaware of the powerful social reinforcement they were providing Brandon for his rather minor acting out behavior.
Bewildered, they could not see why such a rational, logical approach was not working. They could not see the obvious because it lay outside their favored cognitive model.
Cognitive behavior therapy or this "teach the child to think differently" therapy, is still quite prevalent in school-based treatment efforts because it fits philosophically with school administrators, counselors and teachers. Today, teachers still ask children "Why did you do it?" referring to "bad choices," and want the ADHD students to "learn new skills."
Research on cognitive strategies do show some short-term benefits, but the gains fade quickly.
More recently, the notion of distractions intruding on the ADHD child's consciousness is no longer postulated.
ADHD is viewed, instead, as a motivational disorder characterized by quick boredom with rewards (Barkley, 1991). In other words, the child is so easily bored with his reinforcers that he has difficulty focusing his attention on the current activity. This boredom causes the child to search his world for alternative, novel, reinforcing stimuli.
From the child's perspective, seeking alternative stimulus is viewed as an active, adaptive strategy, despite the fact that it is often in conflict with his environment. For our purposes, viewing the child as an active agent versus a passive victim is critical to our understanding. Nintendo's Mario points up the fallacy of the theory that the strength of reinforcers fades. More on that later.
