The Self-Driven Child
Page 25
Bill tested an eleven-year-old named Michael, a very bright and sweet-natured boy who struggled with math and had significant difficulty regulating his emotions. Although Michael worked very well with Bill during the morning portion of the testing, he became extremely stressed and started to lose control when one of Bill’s associates asked him to solve math problems after lunch. He began chanting “no, no, no,” and at one point he even hissed and made clawing motions at the associate, clearly indicating that he’d had enough of math. After letting Michael cool down for a few minutes in the waiting room, Bill spoke to his mother about whether to try to finish testing that day or to have him come back for another visit. Michael overheard them and shouted that he had to finish that day so he could go to Toys“R”Us as a reward for working hard during the testing. Bill wanted him to finish, too, but he clearly would not be able to complete the math assessment with a brain that was in panic mode.
Bill took Michael aside and asked him why he freaked out doing math. Michael explained that he felt panicked and frustrated. Bill listened to Michael’s answer and then told him that his amygdala had gone into overdrive and alerted the rest of his brain to look out for potential danger. He knew he could be embarrassed, frustrated, or humiliated because math was hard for him. Michael did what he needed to do to escape the threat. This seemed to make sense to Michael. Bill then explained to him that if they could figure out a way for him to feel safe and in control when he was working on math, even though it was hard, they could finish the testing that afternoon. Throughout the conversation, Michael made it clear that he felt safe with Bill and also with Ernie, a small dog who “worked” in Bill’s office. They agreed that Michael would return to Bill’s office and do the math with Ernie sitting next to him, and that if he started to get stressed he would stop and play with Ernie for a couple of minutes. After two or three minutes Michael was solving math problems, petting Ernie, and humming to himself. This was a dramatic illustration of how increasing a child’s sense of control can make it possible for him to work hard, even on tasks that are inherently difficult and frustrating.
Many kids with learning disabilities are like Michael. Jerome Schultz, whose book Nowhere to Hide highlights the stressors facing students with learning disabilities, emphasizes that in the classroom, these kids are often unable to mask their deficits from their teachers and classmates. He points out that kids with learning disabilities not only worry about what all kids worry about—like whether or not their friend is still mad at them for sitting at a different table at lunch—they also worry about being teased and called stupid or being judged for getting special help or accommodations.
Kids with learning disabilities do need those accommodations. They also need the reading specialist or the math specialist, ideally working with them one-on-one, as intensity of intervention is one of the variables that best predicts good outcomes for students with learning disabilities. The problem is that children commonly experience interventions as being forced upon them. Children of all ages can feel coerced and resentful when they’re pulled out of class for special help, and they often perceive that they’re being “made to go” for tutoring, speech and language therapy, or occupational therapy after school. When they feel forced, kids resist even things that are helpful to them in order to gain a sense of control.
Rather than being grateful for help, many kids with learning disabilities are angry and resentful and perceive that the problem is with their parents, their teachers, or the tutor who is making them do this extra work. This tension harms the sense of relatedness that’s important for all kids, but particularly those with special needs. In the end, help that is forced on kids usually doesn’t do much good. What makes this situation particularly stressful for parents is that if they pull the help, they know their kid is likely to fall further behind. Parents often feel, “He’s already so discouraged, I’m afraid that if we pull out the supports he’s fighting he’ll fail completely and get depressed.” Parents and teachers have to walk a tightrope between providing enough support to address academic needs, while encouraging kids’ autonomy and trying not to force help down their throats.
So what can you do? How do you walk this tightrope? We recommend that you start with three simple steps:
Fight homework that isn’t necessary. Homework for kids with learning disabilities can be extremely stressful for the whole family. If reading is hard for a kid, the requirement to read, orally or silently, for thirty minutes a night when he’s tired can feel like cruel and unusual punishment (and tends to be equally stressful for his parents). Similarly, tackling an assignment of twenty math problems when ten would do can feel like running a hundred yards on hot pavement. This is where your advocacy efforts can pay off. It isn’t to say that you shouldn’t encourage reading, writing, or math at home. Quite the opposite: if your child is alert and up to putting in time to practice something that’s hard for him, go for it. But if your child has reading difficulties and hates reading at night, read to him or let him listen to a recorded book. The same brain systems are involved in language comprehension, whether the language is written or spoken, which means that being read to or listening to a recorded book develops the same parts of the brain that will eventually engage in reading comprehension.
Encourage self-understanding. Help your child understand his learning challenges as well as his strengths. If you do not feel qualified, ask the professional who identified the learning disability or a teacher or tutor who works with your child to talk to him about his strengths and weaknesses. Also help your child understand that having this challenge is “normal.” Tell them that one in three kids has some sort of an issue. This should help to alleviate the stress he may feel about being “different.” Also, because learning disabilities are rooted, in part, in genetics, tell your child about other family members who have had similar challenges, particularly those who have been able to do well in life. Tell your child about the dozens of famous people who have acknowledged that, as children, they had dyslexia or another learning disability, like problems with math, writing, or reading comprehension. (A quick Google search will provide you plenty of examples.) In addition, explain that many students with learning disabilities are often late bloomers, as it can take a while for them to develop their weaker skill areas and find their strengths. They will develop those areas—they just need to be patient.
Offer but don’t force help. Talk through the pros and cons of resource services, tutoring, or working with a speech/language pathologist or occupational therapist, but unless it’s crazy, let your child make the final call. It’s far better for him to choose one day a week of tutoring that he is committed to than to force him to do two days of tutoring that he’s resisting with all his might. The latter is just a waste of time, money, and goodwill. That doesn’t mean you can’t negotiate, especially if you think he needs more help than he thinks he does. If the extra tutoring means he’s working more than most of his friends have to, offer an incentive to him if he tries. But emphasize that he can quit if it doesn’t seem to be helping. If younger school-aged kids resist special help, Bill recommends saying something like, “As a parent, it’s my job to make sure that you get the right kind of help because all the experts who really know about learning say that’s what you need. However, I want to provide help that is actually going to help you, and I won’t know without your input. So if you hate seeing the resource teacher in school, we can opt for more private tutoring, or if you feel that seeing a tutor isn’t working, we’ll find another way to help you.” In Bill’s experience, even children who protest initially frequently come to like their tutor or their resource teacher or learning specialist in school and appreciate the benefit that they gain from working with somebody who “gets them.” Because children want to do well, we are confident that they will eventually come around as long as they don’t feel forced.
When I talk to children about the findings from testing, I start by emphas
izing their strengths. When I transition to their challenges, I try to tell them something they already know about themselves, which minimizes the likelihood that they will “fight” me and helps to get their buy-in for treatment. For example, if a child has dyslexia, I will say, “I can tell that sounding out words is not easy for you and that reading is slow and really hard work.” If I find they have ADHD, I will say something like, “What I’ve learned is that it’s harder for you than it is for most kids to make yourself pay attention to stuff that’s boring, and that it’s hard to do something fast without making mistakes.” After explaining to kids the things that are hard for them, I usually ask, “Would you like this to be easier for you?” to which the child almost invariably says yes. With school-age children, I then say, “I’m going to work with your school to see how they can help, and I’ll help your parents find someone who’s great at teaching kids like you whom you could see outside of school.” Because these kids generally do want help, they rarely put up a fight. With older children and adolescents, I usually say, “If you want, I can help find a tutor for you, or I could work on getting you accommodations (like extra time for tests) in school. Do you want me to work on this?” I then explain to kids of all ages that if they focus and try hard, the intervention will help them make new connections in their brain that will, over time, make reading, writing, or math a lot easier.
—Bill
ADHD
Bill’s clinical practice evaluates hundreds of children, adolescents, and adults with ADHD every year. For some, the condition is a source of extreme embarrassment and even shame, whereas others are accepting and, in fact, have a sense of humor about it. Within the last year, Bill’s seen teenagers come in with T-shirts reading:
“My parents say I don’t listen—or something like that.”
“Organized people are just too lazy to look for things.”
We think this is a great trend. If kids can have a sense of humor about their challenges, they can use that self-knowledge to manage their ADHD and strengthen their sense of control.
By definition, kids with ADHD have trouble controlling their attention. This is the case for kids who are diagnosed with the “predominantly inattentive” presentation of ADHD, who tend to be unfocused and disorganized, and those with the “combined presentation,” who are impulsive and/or hyperactive as well as unfocused and disorganized. It’s hard for kids with ADHD to get themselves to do what’s asked of them and, for many, even to stick with things they want to do and that are important to them. Kids with ADHD tend to have low baseline levels of dopamine, and their brains use dopamine less efficiently than most kids. (Stimulant medications like Ritalin work by improving the processing of dopamine.) As a result, they tend to prefer small, immediate rewards to larger, long-term ones. As we explained in Chapter Five, although dopamine used to be linked primarily to pleasure, recent studies have found that it’s strongly connected with motivation, drive, and effort.
John Salamone, a researcher at the University of Connecticut, has helped to clarify the link between dopamine, motivation, and effort. He conducted a study in which rats were given a choice between two piles of food—one that was close to them but small, and the other that was twice the size but behind a small fence. The rats with lower levels of dopamine almost always took the easy way out, choosing the small pile instead of jumping the fence for greater reward. Salamone explains, “Low levels of dopamine make people and other animals less likely to work for things, so it has more to do with motivation and cost/benefit analysis than pleasure itself.” Research with depressed patients has corroborated the impact of dopamine on motivation.6 The lower your dopamine, the less inclined you are to jump that fence for a greater treat—or even to get out of bed.
Further complicating things for kids with ADHD is the fact that those with immature impulse control frequently act in ways they regret and, as a result, lack confidence that they’ll handle things well. Things get worse if they’re corrected or told to stop repeatedly, as if they could simply “behave” through their own willpower. Try as they might, they can’t make themselves “be good.” They also tend to be very inconsistent in their thinking and behavior, which leads to a sense of unpredictability. They’re often told to “try harder,” but as some brain-scan studies have shown, the harder they try to focus, the less their brains activate. Remember, stress compromises attention. So if your son is struggling to get dressed in the morning, the last thing you want to do is to stress him out by insistently nagging him.
Many of the interventions that are prescribed to help kids with ADHD involve trying to protect them from themselves. This can be helpful in the short term but problematic down the road. Many kids with ADHD benefit from organizational help throughout their academic career. But if the system is forced on them or managed by Mom, it will lower their sense of control and academic motivation and reinforce the idea that someone other than the child is responsible for his learning, his work, and his behavior. It only postpones the day of reckoning, or the moment when the kid will embrace the idea that he’s responsible for his own life.
Margaret Sibley points out that because they have difficulty getting started on things independently and sustaining attention and effort, teens with ADHD can miss opportunities to develop independent skills. This can be triggered by their own task avoidance or by a tendency for adults to provide continual assistance. Sibley estimates that 40 percent of parents who have children with ADHD feel helpless and hopeless by the time their kids are teens, leading to an uninvolved parenting profile, while another 40 percent tighten the reins and are overinvolved in the adolescent’s daily life.7 Bill sees the latter all the time. He often asks kids with ADHD who have trouble turning in their homework, “Who’s the most upset if you don’t turn in an assignment?” Occasionally a kid will say, “Me. It’s so frustrating. I do well on tests, but I get Cs because I can’t remember to turn in my work.” For the vast majority, however, the answer is almost always “My mom.” When Bill asks “Who’s next most upset?” they commonly answer, “My dad, then my teacher, then my tutor, then my therapist, then my sister . . .” The kid himself is rarely even on the list.
The adults supporting these kids have the best intentions. They just want to make sure nothing slips through the cracks. But trying to protect a kid from himself year after year will weaken him. If he wants to turn in his assignments more consistently, offer him the option of sending in his work electronically to avoid the challenge of remembering to turn them in in class. Or encourage him to ask his teacher to remind him at the beginning or end of every class period. Or brainstorm with the child about a home-school communication system that can help ensure he’s getting his assignments done, bringing home the necessary materials, and getting his work turned in. Remember that ultimately his schoolwork is his problem, and that if you work harder to help him than he does, you are doing him no favors.
Offer help, but don’t force it. (Remember that opposition and defiance are some kids’ way of maintaining a sense of control, and of fighting stress.) Make sure your child knows what’s going on in his brain and how he can ask for the help he needs. If it’s necessary to motivate a child to do schoolwork or to get ready for school in the morning, you can offer rewards. These can be effective motivators in the short term, as a way of making the child’s brain work more optimally (by increasing dopamine), but in most cases don’t think of them as a means to get him to do what you want him to do. Remind him that as he matures, things will get better and easier for him. Some kids largely outgrow their ADHD symptoms in their teenage years, and others learn effective techniques to mitigate the problem. If your child works hard, things will improve. However, it’s important for parents and kids with ADHD to understand that the maturation of the prefrontal cortex in adolescents with ADHD tends to lag years behind that of other children their age.8 This is why kids with ADHD are so often late bloomers, as they simply have to “wait” until their prefrontal cortex
matures and comes fully online to find ways of doing things that they could not do successfully before. We recommend that parents of kids with ADHD voice their understanding that the child is doing the best he can and encourage him to be patient with himself. That is a good message of hope and confidence and one likely to foster a growth mindset.
Issues regarding agency often come up in relation to medication, as children with ADHD are usually encouraged to take stimulant medication such as Adderall, CONCERTA®, or Ritalin to help them focus. Many kids, especially teenagers, tell their parents that they focus better but don’t like the way they feel on the medication. When their parents ask Bill for his advice, he usually suggests they tell their child that no one is going to make him take medication—and no one wants him to take medicine that makes him feel bad. We only want him to take medicine if it significantly improves his life with minimal side effects. Parents can tell their kids that different medicines have different side effects and they can try other medications. There may be things he can do (exercise vigorously, get more calories during the day by drinking a protein shake) that could help him tolerate the medication better.
If your child is motivated to seek other ways to improve his ADHD symptoms, there are some options. For instance, we’ve already spoken about the benefits of cognitive behavioral therapy and the collaborative problem-solving approach in this book, and again we encourage you to study the work of Ross Greene and J. Stuart Ablon, who developed the technique. Also, tell your child that exercise will help boost his natural dopamine production. Some evidence shows that meditation is also helpful in reducing ADHD symptoms, lowering anxiety, and improving brain functioning. In 2009, Bill and his colleague Sarina Grosswald collaborated on a pilot study of the effects of TM on middle school students with ADHD. They found that young teenagers with ADHD could actually sit and meditate for fifteen minutes, and after three months of twice-daily meditation, the students reported a 43 percent reduction in symptoms of stress and anxiety. The study also found better behavioral regulation and emotional control. A second well-controlled study, led by Fred Travis, an expert in the assessment of brain waves, looked at the effects of TM on the brain-wave activity of middle school students with ADHD. This brain-wave activity was of interest because theta waves are usually too powerful in relation to beta waves in kids with ADHD. The subjects were randomly assigned to the TM group or a delayed-start group, the latter of which served as controls for the first three months before learning TM themselves. Three months into the study, the theta/beta ratios increased in the delayed-start group, which is the opposite of the desired effect, while the TM subjects moved closer to normal values. At the six-month mark, after both groups were practicing the TM technique, theta/beta ratios decreased in both groups.9