ASK DR. BAUGHAN                                                              October 10, 1997

BEHAVIOR AND ATTENTION DEFICIT DISORDER

“My teenager has attention deficit disorder.  How can I tell which behaviors he should be able to control and what is part of his disorder?”

Tough question!  Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) affects 3-5% of children.  In at least 30-50% (maybe more) of cases, there may be a hereditary pattern.  We do not yet have a definitive laboratory test to prove a chemical imbalance, but despite 40 years of on-going controversy, many children and adults with ADD think, feel, and function better on medications.  Medications are never the whole story, though, and certain behavioral considerations should always be part of a treatment plan.

CLARIFY DIAGNOSES:  ADD is not the same as learning disorders.  Other psychological conditions can occur in the same person and overlap in symptoms.  IQ testing and learning and social skill assessments should always be considered when ADD is suspected.  This requires the collaboration of the school system and the medical system.  This will help the parents better understand what to expect from their child.  If intelligence is limited or another condition makes the child act more immature than their physical age, the parents need to think, “Although my child is 17, his/her emotional age may be more like 9.  So if he/she is acting like a nine-year-old, that’s why.  If I want him/her to act like a 17 year old (however that is), that’s my problem of false expectation, not his or hers.”

SELECT KEY BEHAVIORS:  ADD may make control more difficult, but not impossible.  People with ADD can learn and make choices.  Parents need to help focus on a few important behaviors for learning and training.  If they want to help a child learn to finish tasks, they cannot expect them to finish all tasks consistently.  If they want to “teach responsibility,” they must select a  few tasks to do this, not as a general concept.  Select which behaviors have an initial chance of success and which may teach habits.  For example, a parent might select “Getting ready for school on time” or “Doing the dishes adequately in 30 minutes.”  Avoid tackling too many issues at once, and issues universally hopeless in teenagers; for example, if you know how to have a teenager keep their room clean, let me know.

SET AND MAINTAIN STRUCTURE:  Once you select a behavior, set clear measures of accomplishment - On Time/Late - Adequately Clean/Inadequate.  Make your assessments decisively - no discussions or debates.  Determine a reward system for successes.  Start small; kids with ADD cannot start with long-term, vague goals.  Gradually increase the time needed to reach the reward.  For example, start with a small daily reward for each day the child is ready for school on time;  increase to larger rewards for on-time for a whole week.  The reward must be important to the child.  THE PARENTS MUST BE CONSISTENT IN MAINTAINING THE STRUCTURE, which is very difficult for many busy parents, who may have a mild form of ADD, also.  The key here is avoiding harping, lecturing, criticizing, bewailing and bemoaning the child’s fate if they don’t “shape up.”  It’s all wasted breath.  Assess and act (On Time/Late - Reward/No Reward); don’t talk so much.  Much less tension once you get the hang of it.

PRAISE YOUR CHILD:  It’s easy to praise and love a high achiever.  It is more of a challenge to praise and love a lower achiever.  But they need love and praise just as much if not more.  If your resentment and frustration is getting in the way of showing love and giving praise, that’s your problem - take care of it so you can be the parent you want to be.  Jesus said to love your enemies, he didn’t say not to have any.  If you try to love even your enemies, be sure to love your demanding child.  Catch them doing something right - be imaginative if need be - and let them know you notice them.  This is the most powerful way to help them learn to shape their behaviors.