Q: My 11-year-old son has always been extremely active and has a hard time sitting still for long periods of time. He is a smart boy and has a happy disposition, but school (and life, for that matter,) continues to be difficult for him. He can be very impulsive with his siblings and classmates, and wants everything immediately — often causing havoc in our home. His rebbi thinks he has ADHD, and we should look into the possibility of medicating him in school. What are your thoughts about this whole issue?
A: Impulsive behavior is only a partial description of an ADHD child. There are other bio-chemical factors that play a part in this diagnosis, and which need to be understood in order to work better with such a child. The two most important factors in helping an ADHD child behaviorally are those of creating structure in the child’s schedule and giving positive reinforcement for his various commendable activities.
Unfortunately, natural consequences of negative actions are not perceived easily by certain children. Thus, again we see that an ADHD child must see and understand the consequences of his actions, but he will not necessarily learn from negative behavioral consequences. Positive reinforcement has proven to be the most effective form of behavior modification for ADHD children.
Giving structure to a child who doesn’t create his own natural structure is similar to giving a navigation system to a sailor with a directional disability.
The origin of ADHD (Attention Deficit and Hyperactivity Disorder) is not yet clear, but it is a problem that can definitely be helped by modifying certain conditions in a child’s environment. Some parents find decreasing a child’s sugar intake or avoiding certain food additives to be helpful, but the benefits of these actions have not always been proven statistically. Testing and receiving written anecdotal reports from school staff helps clarify if a child does have this condition, or any other possible learning disability that may be an impediment to a child’s learning. By testing and determining the severity of the disorder, a parent can help judge what seems best for the child. If a child’s behavior is severely disrupting his classmates’ learning or severely disrupting his own learning, the possibility of using medication to help his condition may need to be explored.
However, in general, a parent needs to initially work with a child’s environment in order to deal with his natural inclination to be distracted. Children such as these need much positive reinforcement and structure. Since they are so easily distractible, establishing a definite beginning and end to activities adds a sense of security to the world around them. Emphasizing time limits and using timers are other means of providing structure.
Immediate rewards for positive actions are needed in relation to positive reinforcement. The goals for such children should be small, as large goals may seem insurmountable for children who seem to view life as quick, fleeting moments on a screen. These children (like all children) need consequences for their negative behavior. Yet they generally are less responsive to punishment than reward. They often view punishment as criticism of their very personality make-up — especially if their punishments are inconsistent and unstructured.
If a parent or teacher only punishes a child for disruptive behavior, this punishment is unlikely to have a long-lasting effect on the child. They would accomplish more, for example, by complimenting the child’s understanding of the parashah in front of family members and changing the child’s view of himself as always being “the problem.” Perhaps the greatest challenge for parents in dealing with such children is to exercise patience after seeing continual disruptive behavior, and to constantly redirect the child to short-term goals and rewards.
NEXT WEEK: Working with your ADHD child’s teacher.