It
is this one sentence that makes all the difference, one to which parents
invariably reply, “Oh, now I get it!”
Individuals
with ADHD generally function at a 30% developmental delay in areas of
performance that rely on executive functions.
It’s
the 30% part that they get.
“Oh, so my 12 year old actually
functions like he is eight?,” says a mother.
“Yes,” I reply.
“That makes so much sense,” she says,
her husband nodding away beside her.
Now
the conversation can really take off:
Me: “So, would you expect an 8-year-old to
complete his homework without reminders and guidance?”
Parent: “No, I wouldn’t.”
Me: “Would you expect him to remember to
brush his teeth, put his clothes in the hamper, and get his backpack ready for
school on his own?”
Parent: “No way.”
And
so it goes, through the conversation about cleaning his room, getting ready for
school in the morning, leaving his belongings all over the place, remembering
to do chores.
ADHD
is a disorder of inhibition and self-regulation seen in deficits in executive
functioning that cause impairments in an individual’s ability to perform at an
age-appropriate level. One might think
of the executive functions as the use of self-directed actions to choose goals
and then select, enact, and sustain actions across time in furtherance of those
goals. Individuals with ADHD cannot
demonstrate the expected level of skill in selecting goals and then behaving in
the manner needed to attain those goals.
Their thinking is predominantly (and at young ages even exclusively) of
the now, rather than the later and so working toward a goal (in the future) is
quite difficult.
An
understanding of the 30% developmental delay enables adults who work with the
youngster to think of his or her chronological age (e.g., 15 years) as well as the
ever important executive age (e.g., 10).
In doing so it is easier to set and support expectations that are
appropriate to the student’s current ability (as opposed to expectations based
predominately on age-based norms).
By
its nature, ADHD is a performance disorder, not a problem in the acquisition of
knowledge. The individual’s intelligence
is intact as is her knowledge base; she understands what to do. The problem lays in performance, despite
knowing what to do, she cannot do it.
We
must thus think about interventions like this:
- What structures does this child need to succeed?
- How much guidance must be inherent in those structures?
- How do we motivate this particular child?
Those
interventions then need to be modified at the point of performance such as the
classroom or during the completion of homework, not later. And appropriate changes in expectations must
be made and sustained.
Remember,
if your child is operating at a 30% delay in executive functioning, he or she is
unable to self-regulate at an age-appropriate level. Expecting him to is setting him up for
frustration and failure. It’s setting
yourself up for the same.
- What expectations have you been putting on your child that he is not ready to fulfill?
- How have you been reacting when she has failed to meet them?
- How is he telling you he feels when he fails to live up to your expectations?
If
you would like to learn more about executive functions and practical ways to
address their development in the home and classroom, there are many books
available for resource. Two that I often recommend to parents in my practice
is: Late,
Lost, and Unprepared: A Parent's Guide Guide to Helping Children with Executive
Functioning by Joyce Cooper-Kahn & Laurie Deitzel or Smart but Scattered, by Peg Dawson.
Thanks, Jennifer
Jennifer Jackson Holden, Psy.D.
Clinical and Educational Psychologist
Center for Psychological Services
Paoli, Pennsylvania
610-647-6406, ext 3
No comments:
Post a Comment