The Self-Driven Child

by William Stixrud

  Several researchers are also looking at whether mindfulness practices can improve ADHD symptoms in kids. While there are few well-controlled studies, there’s promising evidence that mindfulness practices can be of help.10 In Bill’s experience, although nothing comes close to the power of stimulant medication when it works well (and it doesn’t always), anything that lowers stress levels will make the brains of kids with ADHD work more efficiently.

  Bill recently evaluated Adam, a six-year-old with ADHD and behavioral problems. His teachers told his mother that although he is a very kind boy, he is one of the most difficult and disruptive children the teachers have ever tried to teach. At home, Adam’s oppositional tendencies make him very hard to manage, and his resistance to his mother’s direction commonly leads to painful and unproductive fights. A few days after his neuropsychological evaluation, Bill met with Adam’s mother to discuss the test results and to talk about ways of promoting his sense of autonomy. Bill talked through the collaborative problem-solving approach we discussed in Chapter Three and told her she was unlikely to see progress if she simply tried to force Adam to comply. A couple of days later, his mother sent Bill this e-mail:

  “I tried dealing with Adam’s defiance through collaboration, and not by forcing or using authoritarian measures. It worked like a charm. When I said, ‘We’re going to bed in five minutes,’ Adam immediately screamed, ‘No, we’re not!’ He even stood up in a fighting pose, ready to bring me down. Normally I’d scream back, saying, ‘Oh yes, you are!’ But this time, I didn’t fight him. I just looked at him, and then I walked over and hugged him and kissed him on the head, telling him that he didn’t have to scream like that. He relaxed and almost melted, and he then decided on his own to turn off the TV and go upstairs. Although he bargained with me about listening to music on my phone before he fell asleep, we averted a major blowup and had a peaceful night.”

  Margaret Sibley’s STAND program takes the same angle, as it recommends a respectful, noncoercive approach to helping adolescents and their parents clarify their own personal goals and assess their need and desire to change. Research on the STAND approach has shown improvement in things like organizational skills, homework behavior, parent-teen contracting, and parenting stress. Not surprisingly, studies have also found that parents enrolled in the STAND program are more likely than parents participating in more traditional therapies to adopt an autonomy-supportive parenting style by the end of treatment.11

  Ned recently met with a kid with moderate learning disabilities and ADHD. He also had an incredible sense of himself and what he needed to thrive. After going through which classes he liked and didn’t, Ned asked him what he liked to do outside of school and learned he was a big fan of video games.

  “How much do you play?” Ned asked.

  “Lots.”

  “Does it interfere with school or do you get all that done okay?”

  “I get my homework done at school during the day,” he said. “By five o’clock, my meds are wearing off and it takes me twice as long to do things, so I push to get it done while I’m focused.”

  “I love that,” Ned said. “I’m amazed how often people put stuff off and spend twice as much time because they’re doing it later in the day when they’re less efficient.”

  “I know,” he said. “I have my homework done and I can just play video games.”

  “Are you able to manage how much you play?” Ned asked. “Or do you find yourself up all night?”

  “Oh no,” he said. “I don’t like being tired. I can’t focus as well. So no, I’m not up all night.”

  What this story emphasizes is that ADHD does not prohibit self-knowledge, discipline, and self-control. It’s not easy being a kid with a short attention span, limited ability to focus on anything that’s not highly interesting, or trouble sitting still and behaving appropriately. And it’s not easy to raise kids like this. But it’s easier for everyone if we remember that, like all kids, children with ADHD need a sense of autonomy to be happy and to function optimally. Although they sometimes need to be tweaked, the strategies we’ve talked about in this book can help these kids as much as they help kids with laser focus.

  There are some cases in which proactive behavior management strategies such as spending private time with your child, engaging in positive attention, using natural and logical consequences, and collaborative problem solving are not enough. If your child’s behavior cannot be brought under control, if he repeatedly makes bad decisions and cannot engage in the kind of dialogue required to make informed decisions, or if he simply cannot motivate himself, we support the use of structured behavioral programs involving rewards and consequences—at least for short periods. (We recommend our friend Dr. Dan Shapiro’s book Parent Child Journey: An Individualized Approach to Raising Your Challenging Child for in-depth instruction in the use of behavioral strategies.)

  Autism Spectrum Disorders (ASD)

  In addition to the social difficulty and rigidity that define autism spectrum disorders, kids with autism struggle with stress tolerance and self-motivation.

  Children and teens on the spectrum appear to be wired in a way that makes them very easily stressed. Many scientists believe that this is due to abnormalities in the functioning of the amygdala, and in the connection between the amygdala and the circuits in the prefrontal cortex that process emotions and social interactions.12 Kids on the spectrum find all but the most familiar environments and interactions stressful and unpredictable. It can take them six months to feel safe in a new classroom or with a new therapist. Assemblies and field trips aren’t special treats but obstacles that reduce the predictability of the school day. Many kids on the spectrum experience the sensory world more intensely and as more of a threat than most kids. They commonly feel a low sense of control because of their trouble understanding the logic of the social world and their difficulty directing their behavior. According to one theory of autism, many kids on the spectrum will adopt rigid behaviors like flapping, rocking, spinning, pacing, or saying the same thing over and over to help them maintain a sense of order in what feels like a chaotic world. That rigidity places limits on their adaptability. Not surprisingly, anxiety disorders and sleep disturbances are extremely common in kids with ASDs.

  Kids on the spectrum benefit greatly from strategies that reduce novelty and unpredictability, and that increase their sense of control. (Remember the N.U.T.S. acronym for stress-causing events.) These strategies include visual schedules (pictorial representations of the activities scheduled in a school day, presented in a sequence), minimizing the number of transitions children have to make, telling them stories to make the world more understandable, teaching them how to understand other people and social relationships, and making sure they have a safe place to go in school if they’re too stressed. All these widely used and successful interventions help kids on the spectrum feel safe. Kids with ASD also benefit from learning how to take control of their own thinking. An excellent new program uses Plan B thinking and encourages kids to ask themselves, when they start to get upset, “Is it a big deal or a little deal?”13 Studies show that other stress-reduction practices like cognitive behavioral therapy, yoga, mindfulness training, and Transcendental Meditation also hold great promise for kids with ASD.14 Because these strategies reduce stress, they enable kids to focus their minds on academic learning and allow them to activate their brains’ social engagement system more effectively.15

  In Bill’s pilot study on the effect of TM on ADHD kids, one of the students who benefited most dramatically, Bill later learned, had also been diagnosed with autism. Before he started TM, he didn’t make eye contact, was socially isolated, and didn’t have any friends at school. After three months of meditation, his teachers said that he was starting to joke around with the other kids, and he had asked another kid to come over to his house and play video games. He even set up a meeting to talk with the headmaster about starting a new social clu
b for kids who love video games. By lowering his stress response, he was able to activate the parts of his brain he needed to engage with other kids.

  In Bill’s second study, a girl who was on the spectrum agreed to meditate if her parents would let her taper her multiple psychiatric medications and eventually let her be drug free. With the support of her psychiatrist, they did, and her teachers told Bill at the end of the study that she was doing better than she’d ever done. This doesn’t mean that if kids meditate they will not need medication, but it does suggest that kids on the spectrum can meditate regularly and benefit quite dramatically from it.

  Bill recently evaluated a high school student with ASD who, along with his parents, practiced a yoga-based relaxation technique called yoga nidra (presented on a CD). The parents reported that when they did this technique together, the student’s day went dramatically better. When Bill asked how often they did it, he was surprised to hear that they did it only once a week. He asked why they didn’t do it every day if it made such a big difference, and they simply answered, “We’ve never thought about it.” We are big fans of building in practices for destressing on a regular basis.

  All that said, the best documented intervention for autism, applied behavior analysis (ABA), uses predetermined goals and a specific set of behavioral strategies (including rewards and negative consequences) to reach young children on the spectrum, and places minimal emphasis on promoting a sense of autonomy. This would seem on the surface to contradict our argument, but it is important to remember that the brain’s motivation system works differently in children with ASDs. They are less responsive to the kinds of social rewards (like a smiling parent or enthusiastic praise) which motivate most kids. By working on precise goals and using specific rewards to enforce target behaviors, ABA is often very effective at enabling children to engage with others, develop language skills, and behave in a socially acceptable way. Therapeutic approaches that involve controlling the behavior of children with ASD through rewards, pressures, or constraints can be useful for building the basic skills that are necessary if a child is to develop autonomy.16

  At the same time, many experts on autism believe that behavioral methods should be married with a focus on autonomy. There has been very little actual research in the area, but as noted above, at least one study has shown that when parents and teachers support autonomy, kids with ASD improve both socially and academically.17 Bill has found wide consensus in his conversations with autism specialists that if children with autism are eventually to become self-motivated and independent, they have to experience autonomy. They have to be able to perceive themselves as initiators of their own activities and to feel that they have a choice about how to direct their own lives. He thus supports interventions that place a strong emphasis on supporting autonomy in children on the spectrum.18 Given that a high percentage of adults with ASD have trouble holding a job, due, in part, to difficulty with self-motivation and low stress tolerance, placing an emphasis on the promotion of autonomy and self-determination as early as possible would appear to be very important.

  Parents should, as much as possible, be responsive to their children’s passions and allow kids with ASD to channel the energy that goes into their intense interests so that they may experience flow. Strong interests (like in Pokémon, anime, dinosaurs, or Dora the Explorer) can also be a means through which kids with ASD are able to connect with other kids. Birds of a feather flock together socially, which means that kids with ASD are most likely to befriend other kids with social challenges, especially those who have similar interests.

  Owen Suskind, a young adult with ASD, is the subject of a beautiful book written by his Pulitzer Prize–winning father, Ron Suskind, called Life, Animated (which was also made into an Academy Award–nominated documentary by the same name). As the book indicates, Bill followed Owen from age three through his graduation from high school and had numerous conversations with him and his parents about his remarkable passion for Walt Disney movies. As a young child, Owen watched the movies over and over, and in these fictional worlds he felt safe and had a deep sense of control. Privately, he began to draw characters from the movies. Over time, Owen’s immersion in these films led to the development of great artistic talent (see his work on the Web site lifeanimated .net). It also led to a deep and even profound understanding of life and the responsibilities we have to each other in this world. When Owen was fourteen or so, he bravely spent time with his dying grandfather, reassuring him that, based on themes and moral lessons he’d absorbed from his beloved films, he had led a great life. While other members of the family anxiously avoided going upstairs to be with Owen’s grandfather for fear of not knowing what to say or do, Owen knew the right thing to do and did it with confidence and courage. Although the intense interests of children and teens with ASD used to be discouraged, children like Owen have helped to reshape our thinking, and conferences are now being held on “affinities therapies”—using the deep interests and passions of kids with ASD to help them manage the larger world.

  Professionals who work with children on the spectrum often say, “If you’ve met one child with ASD, you’ve met one child with ASD.” Because the spectrum is so broad, parents should feel emboldened to tailor their approach based on their kid. Kathleen Atmore is an award-winning autism specialist at Children’s National Medical Center and the mother of a child with ASD. She points out that some kids with ASD want more than anything to make friends and to be part of the crowd, while others are perfectly happy being by themselves in their own world. It doesn’t make sense to prescribe the same intervention for these very different kinds of kids. “If kids really want to do well socially,” she said, “I’ll recommend up to thirty hours a week of intervention that focuses on helping to develop their social understanding and their social skill. I know that these kids will be motivated to use the intervention and that it will probably help them a lot. For the kids with low social motivation, a really strong emphasis on social interaction would not only be exceedingly stressful for them, it would be completely ineffective, because they’d continually fight every attempt to help them do better socially. So we have to be thinking of who these kids are as people and what’s important to them—rather than thinking that we always know best and laying our treatments on them no matter what they think.”

  —

  None of what we recommend in this chapter is simple. If you’re the parent of a child with special needs, your job is hard. Parenting a child with special needs is stressful. Moms and dads have fears about their kids’ futures and about the impact of their negative behaviors on their siblings, and often feel guilty (“He got it from me”). Added to those concerns are the daily hassles of managing appointments and schlepping kids across town to see specialists, and, in many cases, the challenge of managing difficult behavior. Studies have found that the mothers of older adolescents and young adults with autism spectrum disorders have levels of the stress hormone cortisol that are, on average, comparable to those of soldiers in combat.19

  As we know, kids pick up on their parents’ stress. And yet focusing on your own stress reduction and happiness feels harder when your child has challenges. It’s tempting for the whole family to adapt around the child’s problems—“I can’t possibly go out to dinner when Johnny has a homework assignment due”—but all that does is sacrifice your well-being, which Johnny will pick up on. When our kids are struggling, most of our work as parents is really on ourselves. That’s why our most fundamental message is to focus on being a nonanxious presence.

  You may be fighting your own fears for your child, fighting your daily stressors, and maybe even fighting your child. Breathe. Make sure your own brain isn’t flooded before you act. In one family Ned works with, one of the kids has ASD and another is highly anxious. The one with ASD began to meditate, and the mom started to do so, too. She is remarkably tranquil in the midst of what must be a very challenging situation. Her calmness might not fix ev
erything for her kids, but it’s hard to think of any situation where being less stressed isn’t better. If meditation isn’t for you, that’s fine. But just as you are providing support for your child, make sure you’re doing something that provides support for you.

  What to Do Tonight

  Do everything you can to minimize homework-related stress. Even if your kids have significant learning difficulties, play a consultant role. It’s far more effective than that of a teacher or taskmaster.

  Offer your child as much choice as possible about the kinds of interventions he receives and when he receives them. Accept that it’s okay for him to say no—or to participate in fewer of them.

  If possible, find a school that will accommodate your child, so that he doesn’t feel stressed or unable to keep up.

  Encourage your child to try different ways of working and learning to figure out what works best for him. Students with special needs are often slow to develop an understanding of their strengths and weaknesses and can be reluctant to use strategies that “everyone else” isn’t using. Therefore, consider this a long-term goal, and keep working at it. Remind your child that “you’re the expert on you” and encourage him to pay attention to what helps and what doesn’t.