To Empower! Not Control! A Holistic Approach to ADHD
|To Empower! Not Control! A Holistic Approach to ADHD|
Thousands of studies tell us what children with ADHD can’t do, but few tell us what they can do. This article presents holistic strategies for helping children with ADHD succeed at home and in school by building on their interests, learning styles, and many talents.
Eight-year-old Billy, in the front row, will have nothing to do with my demonstration on new techniques for teaching spelling. During my visit to his elementary school classroom in upstate New York, Billy is out of his seat during most of the lesson. When I ask the children to visualize their spelling words, however, I am amazed to see Billy return to his seat and remain perfectly still. Covering his eyes, Billy “looks” intently at his imaginary words—fascinated with the images in his mind!
Later on, I realize that something more important than a spelling lesson went on that afternoon: Billy was able to transform his external physical hyperactivity into internal mental motion and, by internalizing his outer activity level, was able to gain control over it. This incident occurred some time ago but remains memorable to me. Why? Because it suggests that internal empowerment, rather than external control, is often the best way to help kids diagnosed with ADHD.
A Decidedly Unholistic Approach
Much of the current work in the field of ADHD looks at the issue from an external control perspective. The two interventions touted in almost all books and programs about ADHD are medication and behavior modification. While these approaches are often dramatically effective in young people with ADHD, both have troubling features that often receive scant attention. Some researchers suggest that when children receive medication, they may attribute their improved behaviors to the pills rather than to their own inner resources (Whalen & Henker, 1990). Others may expect the medication to do all the work and thus neglect underlying issues that may be the true causes of a child’s attention and/or behavior difficulties.
Behavior modification programs, which abound, seek to control children’s behaviors through some combination of rewards, punishments, or response costs (the taking away of rewards). Some programs rely on token economy systems, while others use behavior charts, stickers, and even machines. For example, the Attention Training System sits on a child’s desk and automatically awards a point every 60 seconds for on-task behavior. The teacher can also deduct points for bad behavior using a remote control. Students trade points for prizes and privileges. Although behavior modification programs may influence children to change their behavior, they do it for the wrong reason: to get rewards. Such programs can discourage risk-taking, blunt creativity, decrease levels of intrinsic motivation, and even impair academic performance (Kohn, 1993).
Looking at the Whole Child
Most ADHD researchers and practitioners see children labeled with ADHD in terms of their deficits. Thousands of studies tell us what these kids can’t do, but few tell us what they can do and who they really are. Two exceptions are Crammond (1994) and Hartmann (1993). Where are the studies that tell us what these kids are interested in, what kinds of positive teaming styles or combinations of intelligences they use successfully in the classroom? What sorts of artistic, mechanical, scientific, dramatic, or personal contributions can they make to their schools and communities?
A new vision of educational interventions is needed to reflect a deeper appreciation for the whole child based on a wellness paradigm, rather than a deficit perspective rooted in a medical or disease-based model. We need to initiate a new field of study to help children with behavior and attention difficulties—one based on discovering their strengths rather than fixing their faults. Parents and teachers tell me about cases of ADHD-labeled kids who are talented dancers, musicians, sculptors, and dramatists. The ADHD community needs to conduct research on the positive qualities of these children and what their abilities could mean in contributing to their success in the classroom and in life.
Such research could develop assessment strategies geared toward identifying their inner capabilities. Gardner’s theory of multiple intelligences (1983) is one possible framework for developing appropriate assessment instruments to help identify such abilities—a refreshing change from the behavior rating scales and artificial performance tests currently used to assess ADHD in children. We must develop individualized educational plans (IEP) that give more than lip service to a child’s strengths and have goals and objectives that solidly reflect a desire to help children achieve success, rather than to “overcome their problems.”
While the ADHD worldview tacitly approves of a teacher centered, worksheet- and textbook-driven model of education (almost all of its educational suggestions are based on this kind of classroom), current research suggests that all students benefit from project-based environments in which they actively construct new meanings based on their existing knowledge of a subject. Some research suggests that students with ADHD do better in environments that are active, self-paced, and hands-on (McGuinness, 1985). Video games and computers are powerful teaming tools for many of these children. In fact, their high-speed behavior and thinking lend themselves quite well to such cutting-edge technologies as hypertext and multimedia (Armstrong, 1995).
Finally, interventions need to go beyond strategies such as smiley faces, points, and medications, and reflect a full sense of the child’s true nature. Here are a few approaches for use at home and school that might help children identified as having ADHD:
Use focusing and attention-training techniques. For example, see how long a child can sit still in a chair using a stopwatch (make it into a competitive game) or help kids visualize their favorite place when they need to calm down.
Teach self-talk skills. For example, teach kids to say to themselves: “If at first you don’t succeed, try, try again,” or show them ways of talking through the steps to solving a math problem.
Help with organizational skills. Help each student develop a folder that contains sections for each subject, a calendar for due dates, a place to hold accessories, etc.
Use music to calm or focus. Sometimes rock or rap music may paradoxically calm some kids down just as Ritalin, a stimulant, does.
Limit television and video games to one hour per day and eliminate all violent programming; research is clear that this provokes aggressive behavior in kids.
Find the time when the child is most alert. Mornings are usually best for focused work (e.g., seat-work, lectures, etc.); afternoons are best for open-ended activities (e.g., projects, arts, cooperative groups, etc.)
Provide a balanced breakfast. Research suggests that balancing protein with carbohydrates (e.g., eggs and toast) is better for helping foster focused activity than simply a carbohydrate breakfast (e.g., pastries and orange juice).
Provide positive role models. Study the lives of great people who had difficulty with behavior in school, including Winston Churchill, Florence Nightingale, and Louis Armstrong.
Identify talents, strengths, and abilities. Find out which combination of Howard Gardner’s eight intelligences (linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, naturalist, interpersonal, or intrapersonal) each student has most highly developed and use that information to provide appropriate instruction.
Envision positive futures. Help students see roles and careers for themselves in the world that make use of their special talents and abilities.
Use behavior contracting. Let the student have an important say in writing up a contract that includes the problem behavior(s), and what will happen (rewards, etc.) if the difficulties are removed.
Provide immediate feedback. Videotape a child acting out and show it to him or her right away. Give answers on tests right away. Count the number of times a problem behavior occurs and give the child the figure in a nonjudgmental way each day.
Help them self-monitor to keep track of their own behaviors. Have consistent routines in the classroom and involve the student in them (e.g., select the student to collect papers, signal others to get ready for lunch, etc.)
Hold class meetings. Use these meetings as opportunities to air grievances, work out interpersonal problems between class members, plan for parties, and share other feelings and thoughts about how the class is going.
Use effective communication strategies. For example, practice using “I” language (“I am disturbed by your language”) rather than “you” communication (“You have a filthy mouth”), and help the student practice them as well.
Have the student be a “buddy” to a younger student, so that he needs to become the responsible member of the duo. Ask him to teach another student something he knows how to do; this helps teach organizational skills.
Create a highly stimulating educational environment. Research suggests that kids labeled ADHD do better under high-stimulation than low-stimulation conditions (e.g., use role playing, field trips, project building, music, humor, expressive arts, etc.).
Use attention-grabbing strategies, such as a hand signal or musical cue to alert students to the need to begin cleaning up for lunch.
Employ computer software that is interactive, colorful, provides immediate feedback, and is instructionally sound.
This list provides a far richer storehouse of interventions than the instructional strategies given in the mainstream ADHD literature—for example, seating the child next to the teacher, posting assignments on a child’s desk, maintaining eye contact, and breaking up assignments into small chunks. A deficit-oriented perspective gives differential treatment to the “ADHD child.” Most of the above strategies, in contrast, are good for all children. Thus, in an inclusive classroom, the child labeled ADHD can thrive with the same kinds of nourishing and stimulating activities as everyone else and be viewed in the same way as everyone else: as a unique human being.
The Creative Roots of ADHD
Research has long suggested that many children labeled ADHD are actually under-aroused (Zentall, 1975.) Ritalin provides enough medical stimulation to bring their nervous systems to an optimal level of arousal, but a strength-based approach makes more sense than a deficit-based one. By providing these students with high-stimulation learning environments grounded in what they enjoy and can succeed in, we are essentially providing them with a kind of educational psychostimulant that can work as well as Ritalin but is internally empowering rather than externally controlling.
Remember that a hyperactive child is an active child. These young people often possess great vitality—a valuable resource that society needs for its own renewal. Look at the great figures who transformed society, and you will find that many of them had behavior problems or were hyperactive as children: Thomas Edison, Winston Churchill, Pablo Picasso, Charles Darwin, Florence Nightingale, Friedrich Nietzsche (see Goertzel and Goertzel, 1962). As educators, we can make a big difference in the lives of these students, if we stop getting bogged down in their deficits and start highlighting their strengths.
This article appeared in Pathways to Family Wellness magazine, Issue #19.
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