NewYorkTimes.com
When a child has attention deficit hyperactivity disorder, it affects everybody in the family, said Dr. Mark Bertin, a developmental pediatrician in Pleasantville, N.Y. Parents need to understand the nature of A.D.H.D., he said, and appreciate that it affects “a host of self-management skills,” which play out in school but also in daily home routines.
Dr. Bertin, who is the author of “The Family A.D.H.D. Solution” (disclosure: I wrote a blurb for the book), and “Mindful Parenting for A.D.H.D.,” said research shows that parents of children with A.D.H.D. are more anxious, more stressed and less confident, and that their marriages may be strained.
It’s painful to watch your child struggle, and A.D.H.D. can present struggles all day long, from getting out of the house in the morning to getting homework done at night. “When a child has A.D.H.D., the level of independence is delayed compared to peers, and often just day-to-day life becomes more stressful at home,” Dr. Bertin said. “All the little things may be harder.”
Dr. Gabrielle Carlson said that she grew up with a brother who had attention problems, “and I was the perfect older sister.” She is a professor of psychiatry and pediatrics at Stony Brook University School of Medicine who became a child psychiatrist, in part, she said, because of an interest in these symptoms and in what could help.
“My brother drove my parents crazy,” she said. Their parents had both children tested, and “my goodness, it turned out my brother had the same I.Q. as I did!” So everyone was completely mystified about why one child was so successful in school and the other, well, “my mother said when his teachers saw her coming, they would cross the street.”
Dr. Carlson’s own son was a smart kid with A.D.H.D. “My son used to say, it’s not fair everybody else can get their homework done and I can’t,” she said. “You get demoralized after a while when you try hard to do something and you just can’t do it.
Part of the problem is that other people, including family members, don’t realize how difficult A.D.H.D. can make a child’s life. This is not about laziness or a lack of resolve. “People don’t truly understand what A.D.H.D. is and why a kid who’s bright can’t just grit his teeth and get it done,” Dr. Carlson said.
Sometimes “it’s surprising for parents to realize that A.D.H.D. is a proven medical condition and that part of the diagnosis is defining where it is disruptive in life,” Dr. Bertin said. Since kids may be better able to focus on things they find of absorbing interest — say, the Yankees’ starting lineup rather than the deadline for that science project — “it can look like it’s a motivational issue when it’s not,” he said. Sometimes just understanding different aspects of A.D.H.D. — that the child has executive function issues and needs help planning, or that the child cannot control his emotions and needs help with anger management — helps the parent cope.
And often, the kids are really trying, Dr. Carlson said. “The kids get up in the morning and they say, I’m going to do it today, I’m going to really work on this today, and then they can’t do it, their brains won’t let them do it.”
So the kids need help, and successfully treating A.D.H.D. has multiple components. There is that essential education — for the child and the family — about what A.D.H.D. means. There’s educational testing, supports and accommodations in school, behavior techniques and routines at home, especially around schoolwork as kids get older. “You have lists, and you have incentives, and the star charts,” Dr. Carlson said.
For parents, this means trying to provide structure, to give positive feedback and set consistent limits, all worthy goals for any child. But frustratingly, Dr. Bertin said, A.D.H.D. itself makes all those interventions much more stressful for everyone, and “when parents are feeling swamped and overwhelmed it’s really hard to do a lot of things that are recommended in taking care of A.D.H.D.”
And of course, there’s medication. The medication helps many struggling children, but “it doesn’t organize you,” Dr. Carlson said. On the other hand, “it focuses you, it decreases your impulsivity, it helps your mood regulation so you’re less volatile,” and all of that may help with the struggles and frustrations of academic work and family life.
“At the end of the day, you’re talking to a child psychiatrist who believes in treatment,” Dr. Carlson said. She tells parents that she likens refusing medication to refusing to wear glasses. “I can say, I refuse to wear glasses, I am pathologically opposed to glasses, so I’m going to have to get an aide, I’m going to have to have someone read to me and I can make people make the print large and I’m going to need a chauffeur,” she said. “If all you have to do is put the glasses on and that takes care of a lot of the problem, then for God’s sake put on the glasses!”
Families should not expect simple answers, or short-term solutions. Parents have to take care of themselves, and pay attention to the family dynamic, looking for ways to help everyone thrive. Look for areas of life where the child is successful and for ways to spend positive time together, Dr. Bertin suggested. Make sure the child is getting all the appropriate interventions at school, and look for resources to help with the home side of academics.
And watch for sibling issues. It may not be healthy for a child who does not have A.D.H.D. to be cast in the role of the “good child,” he said. Parents should make sure all children get their share of positive parental attention.
Dr. Bertin suggested thinking of A.D.H.D. “as a delay in self-management skills.” With help and support and time to develop, “they will do well over time,” he said. So kids with A.D.H.D. need a short-term strategy that helps them function, he said, tied to a long-term plan to eventually give them the skills they need, because whatever they pursue in life, they will need those executive function skills.
Looking at A.D.H.D. as a developmental delay, he said, “is a practical problem-solving way to look at challenging situations, though it doesn’t mean everyone is going to outgrow it; they’re going to work past their delays through the interventions.”
And everyone should understand that though self-management skills are delayed, “that doesn’t mean kids have a free pass for life,” Dr. Bertin said. “The long-term plan is get them fully independent and caught up, but short term, if their skills are such that they can’t manage their backpack, they have to work as hard as they can while we help them manage their backpack.”