ADHD: A Path to Success
Chapter 6 of
first 6 Chapters
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Emotional vs. Rational Controls of Behavior
(continued)
First Get Run Over Emotionally, Then Learn to Run, Attentionally
Once the ADHD child is aroused by feelings of anxiety and anger, his ability to learn attentional avoidance increases while his ability to learn math, spelling and the like declines. This happens in a two-stage process.
First, the child experiences both the discomfort of the emotion as well as its negative effects on his performance. And he is overwhelmed by this experience.
Second, he learns to escape this noxious experience through attentional avoidance. Although avoidance feels better in the short run, performance at home and school soon deteriorates.
Fragile Thoughts, Powerful Emotions
The heat of such emotion easily disrupts the calm, cool, and fragile mechanism of human rationality. In fact, emotional responses are much quicker and forceful than logical responses. Emotional responses are instantaneous, whereas a logical consideration of data, options, and a decision will take at minimum a few seconds and may take years.
If the emotional response happens first, the rational response won't materialize. If the rational chain of thoughts is already in progress, it will be preempted by the mobilization of emotion.
That's why the experience of "blanking out" in an emotionally laden situation, particularly, angry confrontations, is common. In the heat of battle we're suddenly inarticulate. Later, after emotions have cooled, we have greater access to our intellectual abilities. All the things we wish we had said become obvious.
In the heat of battle, did we develop a neurological abnormality, ADHD, or a learning disability? No! No more than the ADHD child does in the classroom. Rather, our emotional arousal temporarily supplanted our intellectual process. In adults, we talk about it as "blanking out", but for children, it is a diagnosis of ADHD.
And for the ADHD child, the classroom represents the heat of battle. The Nintendo game represents performance after the emotions have cooled off. Just because a child's cognitive ability is preempted by anger or anxiety, it most certainly does not mean he has a neurological defect or disability.
Emotions and Rational Decisions
Smoking is a good adult example of how emotions subvert the most well intended rational intentions.
Everyone knows the dangers of smoking. There are frequent articles decrying smoking in all manners of periodicals. Most smokers can articulate this well. But when deep in the throes of a nicotine fit (i.e., negative emotional arousal), the smoker's rationale, knowledge, training, beliefs, intentions are overpowered by the craving for nicotine.
This desperate need for a nicotine fix drives behavior; the fragile cognitive processes don't. So the smoking goes on. The smoking persists despite the rational, mental acknowledgment that smoking is hazardous to one's health and perhaps even fatal.
These same arguments apply to other dysfunctional behaviors — such as obesity, alcoholism, child abuse, or stress.
Similarly, emotional responses also wreak havoc on the child's ability to follow through on rational intentions and agreements with others. If simple cognitive knowledge and choices do not change these negative choices in adults, how can we expect like strategies to change ADHD behavior? That is essentially what we are expecting of children when we talk to them about their "bad choices" to punch a friend, hop around the room, or not do their work.
What consequences can a child's "bad choices" have that compare with the potentially fatal choices adults make? If adults cannot control their own emotionally driven behavior, how can we expect it of children?
The only difference is power. Adults have the power to impose strategies on children. If children cannot make these ill conceived strategies work, then adults have the power to impose diagnoses on children and drug them.
Once a child is emotionally aroused by, say, a parent’s words, a math book, or a teacher (as opposed to a craving for a cigarette), it is almost impossible for him to access logical abilities. The quiet and fragile insights and persuasive arguments that he has appreciated, understood, and agreed to are inaccessible because of emotional arousal. Emotions rather than reason are dictating action. This is often labeled impulsiveness and irresponsibility rather than emotionally driven behavior.
To deal with this impulsive behavior, the underlying emotions must be extinguished. Once negative emotions are extinguished, then cognitive understanding and resolve are much more likely to control behavior.
Clinically, the causal link between the anger and anxiety and the academic performance deficits are very clear. When this anger is extinguished by Computer Aided Emotional Restructuring, these children can perform as well in the classroom as in Nintendo. The child moves from a state of anger and anxiety to one of ability to attend normally — where he can access the same intellectual capabilities he possesses while playing Nintendo.
What You Say May Not be What They Hear
The lightning speed of the ADHD child's emotional responses to instructions often preempts what a parent or teacher says. The parent says, "Clean up your room." But before the parent finishes saying the word "clean," the child is furious.
That's because this interaction has a history. The child has a conditioned emotional response to the parent's voice, tone and words. That response is to his feelings of anger, rather than his parent's instruction to clean up his room. Indeed, the response is so strong that the full request is barely, if at all, heard. The child then acts on his feelings of anger, rather than the merits of the parental request.
This conditioned emotional response blocks, or at least delays, the intellectual evaluation of the instruction. This conflict and emotional arousal is difficult, not only for the adults but also for the child. Some children learn to avoid much of it, particularly in the classroom, by learning attentional avoidance of the whole experience.
Susan, an 8-Year-Old ADHD Girl
Susan was an 8-year-old, white female who had a long history of unsuccessful treatment for ADHD. This included parent training, behavior modification, and many years on Ritalin. These approaches had some short-term, positive effect. But as time passed, her behavior worsened. When I first met her in August 1992, her medication had been discontinued for several months due to its ineffectiveness.
By the time I began treating Susan, she was very agitated, hostile, antagonistic, and hyperactive. She was constantly wiggling, moving around the room, impulsively interrupting conversations, acting out with outbursts of anger, playing roughly with other children, and showing poor attention span — characterized by moving from task to task every few moments.
She constantly provoked adults around her, particularly her mother. Any comment or instruction from her mother roused Susan to explode before her mother could stop speaking. Her boredom tolerance was nominal, compliance was minimal, and she never stopped moving.
Initial treatment with CAER was difficult because of her limited attention span. Every few moments she would ask questions, sit up in the chair, or ask to do something else. Within the first treatment hour, the behavior subsided. She began to attend for five or six minutes, uninterrupted.
On succeeding sessions, she listened to a tape of her mother giving her directions, which typically provoked her misbehavior, or remembered times at school that made her angry. Initially these procedures caused strong emotional responses including yelling, grimaces, hand waving and wiggling. After several repetitions, the emotional arousal quieted to relaxation.
Susan's mother noted significant improvements at home and school by the third session. By the sixth session, no further problem behaviors could be identified. Her mother related that Susan's behavior had been very good at both school and home. She said that Susan is "calmer, minds better, attends better, and her behavior has changed 180 degrees." Her compliance with mother's requests no longer roused angry outbursts and they were often obeyed without comment. Her attention was quite normal. In a conversational setting, she now sat calmly, made continuous eye contact, and listened.
But by the end of treatment (seven sessions), Susan could attend continuously to CAER for 15 minutes or more without complaining and with no noticeable breaks in attention or superfluous bodily movement. Her general presentation was that of a normal, well-behaved child.
Watching Susan play with other children in the waiting room revealed a normal child capable of playing well, sharing toys, and sustaining interaction. Other children seemed to enjoy her too.
Her mother was also treated on CAER. The primary focus was on the ways her daughter irritated her. Treatment for the mother substantially reduced the negative reactions she had towards her daughter. Their positive interactions were greatly improved.
At four months follow-up, no regression was reported in either mother or daughter.
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