I want to make it clear from the beginning of this post that everyone understands that I am writing my opinion as a person who has all of the symptoms of ADD, mom of two kids with “focus problems”, and a clinician who has seen hundreds of kids of all ages with ADD and ADHD. Everything I write is based on anecdotal evidence not research based evidence.
What I have come to believe over time is that there are more than the three diagnosable types of ADHD. The three that I can diagnose as a psychologist are: 1) Attention Deficit Hyperactivity Disorder Primarily Inattentive Type (what most people think of as ADD) 2) Attention Deficit Hyperactivity Disorder Primarily Hyper-Impulsive Type (what most people think of as ADHD) and 3) Attention Deficit Hyperactivity Combined Type (a combination of the two).
Dr. Daniel Amen has written a book titled Healing ADD where he proposes six types of ADD. I won’t go into them all, but the point is, ADHD is not always a hyperactive boy climbing the walls. Things I like about the book: He proposes six type of ADHD, he talks about nutrition, he talks about supplements, he lists behavioral solutions/considerations. Things I don’t like about the book: The way he medicates kids. He comes at the topic of ADHD from a psychiatric perspective so he sees extreme cases, therefore, he medicates with what I think of as heavy duty psychiatric medication. I also don’t like the title. ADD is a temperament, in my opinion. It would be like saying, let’s heal you of those blue eyes. It’s not going to, nor does it need to, happen. I wouldn’t give up my…..focus problems even if I could!
Why wouldn’t I give them up? Because I have the type of ADD Dr. Amen calls Over-focused ADD. I think of it as my superpower! When I set my mind to something, and I am passionate about it, I will keep at it. I decided in 7th grade that I was going to be a child psychologist. I finished my Ph.D. when I was 26-years-old. I’m not bragging, I’m just trying to make the point. I would not give up my ability to hyper-focus.
One the other hand, hyper-focus can turn around and bite you in the rear end if you let it. Hyper-focus usually gets a person in trouble if they also tend toward anxiety and/or depression. Then the hyper-focus gets wrapped around whatever is making the person anxious/depressed and it becomes a hamster wheel of negative, unproductive, thought. Many of the young children I see who come in for anxiety also have ADHD. I don’t diagnose it because I don’t believe in diagnosing children under 1st grade with ADHD. There is too much overlap in immaturity, especially with boys, and ADHD symptoms.
Another opinion I have developed after seeing hundreds and hundreds of kids may be provocative to some. I believe that ADHD is a continuum. At one end, very mild ADHD symptoms. At the other end, very severe Autism. The line where they meet is very fuzzy. People who fall around that line are usually very, very smart. Genius level smart.
Why do I think this continuum exists? Because I have seen so many kids come in, again of all ages, who have been evaluated for an Autistic Spectrum Disorder, sometimes more than once. One of my favorites was in 5th grade at the time. Her mom brought me all the testing they had done over the years. Her IQ score put her in, what some would call, genius territory. My first question was, why isn’t she in the gifted program? Her mom said that the administration had told her that the kid did not qualify for gifted services because of her standard test scores that she had taken in a classroom setting.
I told her mom that I thought she had ADHD, but I did’t have the data to back it up because all the teachers could see was the girl’s often belligerent behavior. We found a psychiatrist who would help us, and it was a dramatic difference for the better….at least initially. I’ll talk more about this girl coming up.
It’s a Temperament NOT a Disorder
I am not disordered. Actually, I function relatively well, most of the time. Particularly, if there is not a lot of transition and change going on in my day. Not life. Day. I work on a hour to hour schedule in my clinic. I see 21 kids in three days, back to back. On Friday morning, when I am released from that schedule, I’m a mess. I can not focus.
Over reactivity to the environment is why kids and adults who have, what I am going to refer to from now on when writing about ADHD or ADD, Attention Deficit Hyperactivity Temperament (ADHT) and Attention Deficit Temperament (ADT) look fine some days and all over the place the next. Clearly defined schedule and rules in an interesting, supportive, environment (like a classroom with a great teacher) will make it appear as if all the symptoms go away!
People with this temperament, have the most difficultly when they are bored, don’t understand something, or don’t want to do something. For me, it’s my workout. My procrastination goes into high gear if I don’t have a schedule that day. If I have a full schedule, I am up at 5:00 a.m. to make sure I get it in.
Carrot and Fire Method of Living
The secret to living with and parenting a child with ADHT and ADT is fairly simple. I call it the Carrot and Fire Method of Living. The Carrot part of my method is motivation. There is a lot of psychologists and experts out there right now saying, “don’t reward your children.” These experts obviously do not have ADHT or ADT themselves, nor do they have a child that has either temperament.
No one ever says to a working adult, “Why do you go to work for bribery?” I love my job, but I don’t go to work for community service. I also like my paycheck. Adults work for motivation, why shouldn’t kids? Rewards are free, motivators are earned.
The classic picture of the donkey that won’t move remedied by a stick held over the top of the donkey with a carrot tied to a string that lands right out of the donkey’s reach is what I mean by the carrot. If we do not have something that motivates us right in front of our face at all times, we don’t get anything accomplished.
Homework is probably the best, and most often asked about, example. When he was in middle school, my son always wanted Michael Jordan basketball shoes. If you aren’t aware, they cost at least $150.00! I don’t buy my kids $150.00 shoes. I set up a “checks” system for him. He had five things everyday that he could receive checks for. 1) Bringing home his planner 2) Actually writting the assignments in the planner (sounds simple, but I always thought I could remember, too!) 3) He had to bring home all the necessary materials to complete his homework 4) He had to sit down and do his homework without complaining and 5) He had to let me SPOT check it. I would check to see if he had the basic concept. If he had missed a few, I let him suffer the natural consequences of a lower grade at school. If he completely had the whole concept incorrect, he had to redo the paper without complaining.
For each expectation everyday he could earn one check, so a total of five things he could checkoff each day as accomplished or earned. Then, at the end of the week he could cash them in. In middle school, each check equalled one dollar. Checks were NEVER taken away after they were earned. If I make a mistake at work, no one comes to get some of my paycheck back! I am just expected to correct the mistake or suffer the natural consequences. Some people have problems with the $1.00 amount. There is a fine line between too much and not enough. If it was less, it would have taken him years to earn the $150.00 tennis shoes that he was hyper-focused on at the time. Money would not have motivated him anymore.
The six weeks of pure bliss that it got me as a parent because I wasn’t fighting him every night about his homework, was worth every penny. Insurance doesn’t usually cover the entire prescription cost for medication for ADHD. Currently, I am spending $130.00 a month to pay for my daughter’s prescription!
I used the Carrot continuously with my son from birth on without realizing it. You don’t have to promise a new pony or game console! It can be as simple as:
Mom: “Hey, do you want to go the park?”
Son: “Yes, let’s go to the park!”
Mom: “Okay, pick up the toys in the living room and we’ll go.”
Put the carrot right in front of them, and then either help, if they are really young, or start getting your own coat and shoes on if they are older. They will do it, usually without argument, because you are using their hyper-focus to your advantage!
The Fire is in reaction to procrastination. For example, I could never understand why I would get a spelling list on Monday, and study it on Monday, Tuesday, and Wednesday, when I could cram it on Thursday, get an A on Friday, and forget it on Monday. This worked out for me, because I got the A on Friday. It also set up a cycle of exhilarating procrastination that I eventually justified as “I work better under pressure.” The problem is, I do. It drives people around me crazy to see if I will, in fact, pull it out in the end.
The way to keep a kid from relying on the Fire, is to give them a Carrot, that they really care about. Don’t feel you are a failure as a parent when they continue to procrastinate. Procrastination is part of the temperament. You can’t change temperament. Use the knowledge that you and/or your child has ADHT or ADT as lens through which to view their behavior. Most of all, let them suffer the natural consequences of their procrastination from an early age. No one looks at 7th grade performance other than 7th grade teachers.
An example would be my son’s 7th grade science project. He was given benchmark dates by which he was to have certain parts of his project completed. He did not hit even one of them, and I was fully aware of what was going on. The last week he ran the experiment and did the research for his paper. At 11:00 p.m. the night before it was due, I was helping him type, not write, the paper. I watched as he zipped it in his backpack and went through the school doors. When I picked him up, I asked, “Did you hand in your science project?” “No, I lost it,” was his reply.
I did not get mad. This was his problem. Losing things is part of the diagnostic criteria for giving a diagnosis of ADD. When he came to the car the next day, I asked him about the science project, again. “Mrs. Smiley found it on top of the filing cabinet,” was his reply. Without asking, I knew what had happened. He did know it was important, so he took it out of his backpack to hand it in. He turned and put the rest of his things away and someone started talking to him. He walked away with them, completely forgetting where he had set it down.
He had solved the problem and, because the teacher liked him, did not suffer any major consequences. He’s not a bad seed trying to shirk all responsibility. He has an ADT. It can be debilitating. It may not be his fault, but it is his responsibility to solve the problem.
I will have several other posts about different considerations such as gender and multiple diagnoses, such as ADHT and OCD, in future posts!