Monday, November 3, 2014

ADHD is Not a Moral Issue: Notes From the Trenches

One of the most profound truths I've learned over these last 12-and-a-half years of mothering a special-needs child is this: ADHD is not a moral issue. These kids display some pretty frustrating, even shocking behaviors, and it's so tempting to look at them in disgust, wondering how they got so selfish and mean. Their behaviors are often attributed to bad parenting and it's no wonder. From the outside, the characteristics look like bad parenting:

~ intrudes on other's needs and space without regard to social cues (grabs toys, steals candy, takes over another's birthday, garners all attention)

~ excessive talking without regard to social cues (will follow you around talking incessantly, will talk all through a movie, sees your frustration but can't control impulse to talk, nevertheless)

~ reduced ability to delay gratification (sometimes, inability, other times, just reduced ability)

~ trouble waiting turn

~ disorganized, messy (some also forget everything, but not so much my son. My husband does forget personal belongings--glasses, keys, wallet, cell phone--as does one of my neighbors who has the condition. She is forever leaving things here at our house, and she leaves her homework at school, or at home.)

~ hyper-focuses on one thing (any intense single interest--i.e. animals or nature, or for some, computers) to the exclusion of all else (not even eating or sleeping right, which makes their ADHD symptoms worse)

~ trouble with aggression, but not always physical aggression toward others (could be throwing things, hitting walls, breaking things, etc.)

~ trouble staying seated at table for meals, trouble sitting for lessons or during movies, fidgets during sermons

~ maturity is three to four years behind unaffected peers

~ needs constant stimulation and creates it negatively during down times in schedule

~ has trouble with transitions of any kind (getting ready for bed, cleaning up, coming in from recess, starting school)

~ has trouble with holidays, special occasions, and weekends due to heightened excitement and inability to delay gratification

~ doesn't learn from mistakes (makes same ones over and over in the same day)

~ they appear to never be satisfied--the grass always looks greener on the other side for them, despite you lecturing about gratitude and thankfulness. This is not indicative of their hearts, as much as their difficulty in delaying gratification. Everything around them looks very good and they want it all, and right now!

The common denominator to their behaviors is this: lack of impulse control

The effect of irritating so many people over so many years is that the ADHD person never feels entirely loved. They crave love and try hard to get it, but instead, they only create more hostility in those around them. Oftentimes, I can think of only one word to describe the whole phenomena, at least from a human-needs perspective: tragic

The parents of these children want so hard to be loving, nurturing parents, but their stress levels are so high, that their best work as parents is often lacking. And no, this is not to say that they could cure the condition if only they could be good parents for a week. It's incurable, and medicines only create other problems with their side effects. Sure, many children are helped by medicine and need it to read, study, and complete their school work, but the quality of their lives is also reduced by their medicines.

My own son takes Strattera (not a controlled substance) for ADHD, rather than the stimulant drugs that are all similar to Ritalin. With Strattera there are no sleeping problems, no eating problems, and no trouble with the medicine wearing off just in time for nightly homework and familial interaction.

The down side is that Strattera doesn't work very well on impulsivity, and only takes the edge off the hyperactivity, in our case because he hasn't been able to tolerate more than a 10 mg dose, which is the dose for a six-year-old child's weight (Peter is 5 feet 2 inches, 100 pounds and gaining fast). We've tried twice to take it to 18 mg for better impulse/hyperactivity control, but in both cases he became increasingly angry/aggressive, evidenced by the hole in the drywall in his bedroom.

To never be able to reach your goals as a parent, except for tiny windows of opportunity, feels terrible, believe me. There is a learning curve here, of course, and we do get better at understanding and managing all of it.

The child, similarly, feels intense frustration trying to be good and compliant, and yet never being able to achieve it for more than a day or half-day.

Are there advantages to the condition, or is it all tragedy?

According to the famous ADHD psychologist Dr, Hallowell, author of Driven to Distraction, and himself an ADHD-sufferer, there are indeed advantages. This condition produces many entrepreneurs and CEO's, and the reason for this is that they are aggressive, risk-taking, engaging, outside-the-box thinkers, intelligent, creative, hyper-focusing people who make things happen. I imagine they can be especially successful when paired with a detail person who can fill in for their organizational, detail-oriented deficits.

Dr. Hallowell doesn't state if those with comorbid conditions--depression, anxiety, bipolar disorder, OCD, autism spectrum disorder, learning disabilities, Tourette's Syndrome, schizophrenia, oppositional-defiant disorder, conduct disorder--enjoy the same level of success as those with uncomplicated ADHD. My guess is that no, they don't, which is why some people are so angry at Dr. Hallowell for claiming that ADHD is a trait, not a disorder. This depends entirely on personal health history.

To his credit, Dr. Hallowell acknowledges that prison rolls are full of ADHD people, and there are scores of others living unhappy, unfulfilled lives.  Managing ADHD well and early--using medicine when appropriate, with therapy or coaching--produces the best outcomes.

As far as parenting goes, it's crucial to be consistent and to manage your own emotions well. 

These kids are off kilter even more when Mom or Dad are angry, or dole out ridiculous consequences that reflect more anger and punishment mentality than prudence. The goal is not to punish, but to give consequences that lead to change.

Success like Dr. Hallowell describes--entrepreneur or CEO status--can ensure financial security, but it can't bring love. It can bring admirers, but it can't bring marriage or child-rearing successes. Indeed, the financial success may come at the expense of family, due to the hyper-focusing involved in achieving it.

The key to adequate love and sufficient grace is internalizing the idea I began with: ADHD is not a moral issue.

I can't tell you how often over the years I've come to the conclusion that my son is a jerk (and my husband too, at times). Further down on the learning curve now, I realize how wrong those private sentiments were, and how tragic. These people cannot help their lack of impulse control. The only thing they can do, with coaching, is try to maintain a strict daily schedule, strict sleep habits, good dietary habits, and good exercise/stress-fighting habits. These help manage the symptoms, but the symptoms don't ever disappear--not even in adulthood. In cases where the adult seems completely cured, I would guess it was never a case of ADHD to begin with, but another condition, perhaps environmental, or something unrelated to neurology.

My son Peter is the boldest evangelist among us. He amazes me. I'm so proud of the young man he's becoming, especially when my daily interactions with him are flavored with grace, love, and knowledge of his condition.

He needs to know that I'm wildly in love with him, that I believe in him, and more importantly, he needs to understand that God's love is perfect, and where those around him fail, God never will.

He needs to bathe himself in grace, and all those who interact with him as well.

I want him to leave my home knowing he is without blemish in his Heavenly Father's eyes. He is whole, loved, set-apart, and saved for a purpose. With a heart of gratitude before the Lord, he can give thanks for his challenges, knowing that because of them, he needs the Lord even more.

And ditto for his parents.

1 comment: said...

Our family has its own set of special needs drive-you-up-the-wall traits, so although it's not exactly the same, I know where you're coming from! I admire your attitude and determination and I pray that you have the strength to handle all that is thrown at you, by grace. I suppose it is good to be shown daily how much we need grace!
Sandy x