ADHD and Emotional Maturity

From Not Wrong, Just Different

Emotional development in children with ADHD is 30% slower than their non-ADD peers. This means that a child that is 10 years old will have the emotional development of a 7 year old, a 20 year old will have the emotional maturity of a 14 year old.

What does this mean for our relationships with those with ADHD?

Manage your expectations.
When setting discipline and punishment, do the math in your head first.  If your child is 12 and gets into trouble, count down the 30% and ask if that was normal behavior for an 8 year old.  Then react.
When setting your boundaries, manage to the 30%.  The rest of the kids in that age group may have privileges that your child isn’t ready for.  Be careful not to “baby” or “enable”.  This also means you will need to be more purposeful and specific to teach your child how to make good choices. Do this with love, not shame or comparison.  Live by the motto, “Meet them where they are and love them forward.”

The Contradiction:
Those with ADHD are often intellectually advanced with an amazing vocabulary. When their words and intelligence are advanced and their emotional maturity behind, it is confusing.  My son was in fourth grade when I learned this statistic.  It put so many things in perspective for me.  My frustration eased and I learned to manage each of them separately, the intellect and the emotions.  I had a conversation with his teacher and she found it dead on from her experience and helpful for her teaching too.

ADHD and immaturity

Re-posting from the io9 article Are kids being diagnosed with ADHD just for being young?:

While ADHD is a very real disorder, many argue that it's diagnosed far more often than it should be. But why are kids being misdiagnosed with this disorder? According to a new Canadian study, it might just be because they're younger than their peers.In British Columbia, the age cutoff date for entering each grade is December 31st of whatever year — making those born in December the youngest in the class, and those born in January the eldest. Examining a cohort of more than 900,000 students, the researchers found a significant correlation between birth month and ADHD diagnosis. In fact, children born in December were 39% more likely to be diagnosed and 48% more likely to be treated with medication for ADHD than those born in January. The situation was even worse for young girls, where the December-born were 70% more likely to be diagnosed.
This research paints a picture of children who are immature due to age differences being treated as though they have a lifelong disorder.

"The relative age of children is influencing whether they are diagnosed and treated for ADHD," said lead author Richard Morrow in a statement. "Our study suggests younger, less mature children are inappropriately being labelled and treated. It is important not to expose children to potential harms from unnecessary diagnosis and use of medications." 

This has an obvious two-fold negative effect. The misdiagnosed children are put on medications they don't need, and the people who argue that ADHD doesn't exist get more ammunition. The researchers argue that more stringent analysis before diagnosis could help, specifically taking into account the child's relative age to their peers, and their behavior outside of school.

Is it time to rethink the treatment of Attention Deficit Disorder? [Afternoon Reading]

Is it time to rethink the treatment of Attention Deficit Disorder? [Afternoon Reading]:
The New York Times has published two thought-provoking opinion pieces relating to Attention Deficit Disorder and the medications used to treat it.

The first is written by L. Alan Sroufe — a professor emeritus of psychology at the University of Minnesota's Institute of Child Development — who contends that popular medications like Ritalin and Adderall, while effective in the short-term treatment of ADD, are impractical long-term solutions. He even goes so far as to claim that the success of these drugs has helped undermine more important research into the disorder's true origins.

The second piece — written by KJ Dell'Antonia, lead blogger for The Times' Motherlode — offers up a well-thought-out reaction to what some have interpreted as callousness on Sroufe's part, raising even more questions about the treatment and study of ADD in the process.

Regardless of your opinions on or experience with ADD and ADD medications, the two articles — especially taken together — definitely warrant a read. Included here is an excerpt from the piece by Sroufe, but you can check them both out in their entirety by clicking through the links below.

L. Alan Sroufe — "Ritalin Gone Wrong"

KJ Dell'Antonia — "If Ritalin Has ‘Gone Wrong,' What's the Right Way to Cope?"

Three million children in this country take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage of drugs like Ritalin and Adderall that they considered absolutely essential to their children's functioning.

But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled?

In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder.

As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs.

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.

What gets publicized are short-term results and studies on brain differences among children. Indeed, there are a number of incontrovertible facts that seem at first glance to support medication. It is because of this partial foundation in reality that the problem with the current approach to treating children has been so difficult to see.

Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.

In 1973, I reviewed the literature on drug treatment of children for The New England Journal of Medicine. Dozens of well-controlled studies showed that these drugs immediately improved children's performance on repetitive tasks requiring concentration and diligence. I had conducted one of these studies myself. Teachers and parents also reported improved behavior in almost every short-term study. This spurred an increase in drug treatment and led many to conclude that the "brain deficit" hypothesis had been confirmed.

But questions continued to be raised, especially concerning the drugs' mechanism of action and the durability of effects. Ritalin and Adderall, a combination of dextroamphetamine and amphetamine, are stimulants. So why do they appear to calm children down? Some experts argued that because the brains of children with attention problems were different, the drugs had a mysterious paradoxical effect on them.

However, there really was no paradox. Versions of these drugs had been given to World War II radar operators to help them stay awake and focus on boring, repetitive tasks. And when we reviewed the literature on attention-deficit drugs again in 1990 we found that all children, whether they had attention problems or not, responded to stimulant drugs the same way. Moreover, while the drugs helped children settle down in class, they actually increased activity in the playground. Stimulants generally have the same effects for all children and adults. They enhance the ability to concentrate, especially on tasks that are not inherently interesting or when one is fatigued or bored, but they don't improve broader learning abilities.

And just as in the many dieters who have used and abandoned similar drugs to lose weight, the effects of stimulants on children with attention problems fade after prolonged use. Some experts have argued that children with A.D.D. wouldn't develop such tolerance because their brains were somehow different. But in fact, the loss of appetite and sleeplessness in children first prescribed attention-deficit drugs do fade, and, as we now know, so do the effects on behavior. They apparently develop a tolerance to the drug, and thus its efficacy disappears. Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.

TO date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized, and some of them had other methodological flaws.

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

Top image via Shutterstock.

Aspergers and Relationships

Interesting article for friends and family with Austism Spectrum tendencies. From the NY Times article "Navigating Love and Autism"

Only since the mid-1990s have a group of socially impaired young people with otherwise normal intelligence and language development been recognized as the neurological cousins of nonverbal autistic children. Because they have a hard time grasping what another is feeling — a trait sometimes described as “mindblindness” — many assumed that those with such autism spectrum disorders were incapable of, or indifferent to, intimate relationships. Parents and teachers have focused instead on helping them with school, friendship and, more recently, the workplace.

Yet as they reach adulthood, the overarching quest of many in this first generation to be identified with Asperger syndrome is the same as many of their nonautistic peers: to find someone to love who will love them back.

The recent recognition that their social missteps arise from a neurological condition has lifted their romantic prospects, they say, allowing them to explain behavior once attributed to rudeness or a failure of character — and to ask for help. So has the recent proliferation of Web sites and forums where self-described “Aspies,” or “Aspergians,” trade dating tips and sometimes find actual dates. Lessons learned with the advent of social skills classes and therapies, typically intended to help them get jobs, are now being applied to the more treacherous work of forging intimacy.

The months that followed Jack and Kirsten’s first night together show how daunting it can be for the mindblind to achieve the kind of mutual understanding that so often eludes even nonautistic couples. But if the tendency to fixate on a narrow area of interest is sometimes considered a drawback, it may also explain one couple’s single-minded determination to keep trying.

Oh - and read this post about the minor correction to this story that the Times issued:
Correction: December 30, 2011
[The article] misidentified the character from the animated children's TV show "My Little Pony" that Ms. Lindsmith said she visualized to cheer herself up. It is Twilight Sparkle, the nerdy intellectual, not Fluttershy, the kind animal lover.

Self Discipline and Kids

From http://bigthink.com/ideas/40003

teaching your kids self-discipline is good parenting. He cites numerous longitudinal studies demonstrating that self-disciplined toddlers are more likely to grow into persistent, positive, healthy, and satisfied adults. Wang and co-author Sandra Aamodt explore this and other developmental issues with humor, scientific rigor, and reassuring pragmatism in their forthcoming book, Welcome to Your Child’s Brain.

Happily, it seems that we can have our cake and eat some of it, too. “An important point here,” says Wang, “is that willpower [i.e. self-discipline] training in children is most effective when the child is having fun.” Intense stress is a poor learning tool at best, and potentially harmful to the developing brain, especially in sensitive children. Gently guided play, a powerful approach exemplified by the school program “Tools of the Mind”, can incorporate self-discipline training into the imaginative play that children naturally engage in and enjoy.

The last link to the NPR article is particularly interesting. From http://www.npr.org/templates/story/story.php?storyId=76838288:

For most of human history, children played by roaming near or far in packs large and small. Younger children were supervised by older children and engaged in freewheeling imaginative play. They were pirates and princesses, aristocrats and heroes.
But, while all that play might have looked a lot like time spent doing nothing much at all, it actually helped build a critical cognitive skill called executive function. Executive function has a number of elements, such as working memory and cognitive flexibility. But perhaps the most important is self-regulation — the ability for kids to control their emotions and behavior, resist impulses, and exert self-control and discipline. Executive function — and its self-regulation element — is important. Poor executive function is associated with high dropout rates, drug use and crime. In fact, good executive function is a better predictor of success in school than a child's IQ.
[...]
Unfortunately, play has changed dramatically during the past half-century, and according to many psychological researchers, the play that kids engage in today does not help them build executive function skills. Kids spend more time in front of televisions and video games. When they aren't in front of a screen, they often spend their time in leagues and lessons — activities parents invest in because they believe that they will help their children to excel and achieve.
And while it's true that leagues and lessons are helpful to children in many ways, researcher Deborah Leong says they have one unfortunate drawback. Leong is professor emerita of psychology and director of the Tools of the Mind Project at Metropolitan State College of Denver. She says when kids are in leagues and lessons, they are usually being regulated by adults. That means they are not able to practice regulating themselves.

[...]
Diamond says there are potential benefits to this training that go beyond improved executive-function scores. She and several other researchers argue that children's reduced self-regulation skills may be showing up in the numbers of kids diagnosed with Attention Deficit Hyperactivity Disorder.
"I think a lot of kids get diagnosed with ADHD now, not all but many just because they never learned how to exercise self-control, self-regulation, the executive functions early," she says.

Stephen Fry - on ADHD and Star Trek

I knew I liked Stephen Fry, now I know why

Fascism and Divergent Thinking at Schools

Two links that seem unrelated are infact not.

First there is a great RSA Animate version of a talk on Changing Education Paradigms by Sir Ken Robinson



At about the 4 minute this he states a belief that ADHD is a "fictitious epidemic" and that children who are living in the most intensively stimulating period on earth are being regularly medicated and penalised for being distracted from boring stuff at school. They are being given drugs to get them focussed and settle down. We are getting them through school by anaesthetising them. We should be waking them up. And Sir Robinson notes that much of this drive for conformity is correlated with standardised testing and the way schools are modeled on the industrialisation and the production line mentality.

I could not agree more - and I speak as someone who could have probably benefited from these drugs at school - but just to help me fit in rather than to become a more creative student and be fully alive. It would have contained by ability to think divergently.

The second post is from http://www.ronjoneswriter.com/wave.html, which details a class 'exercise' from 1967 in Palo Alto, where a teacher named Ron Jones, tried to 'simulate what happened in Germany by having his students "basically follow instructions" for a day.'

The results were scary and worth reading. Towards the end, the author quotes Jones

"Fascism is always a possibility because it's so simple and people are frustrated. They lose their jobs, their dignity, their sense of worth, and someone comes along and says, "I've got the answer."

School systems prepare the ground, Jones says by using only standardized tests for success and failing to recognize alternative paths of learning, as well as a wider variety of individual achievements.

Educational institutions weed out troublemakers and those who are difficult to teach, he contends, rewarding placid students who want to succeed at any cost and will accept authority.

"That's the sad thing. Teachers can trigger it by telling students they're special, they're part of a community, that they can do special things. All they have to give is their loyalty," Jones concludes. "It happens every day in school, only the paraphernalia isn't there. Kids aren't learning to ask questions. You create a population where freedom's just a spelling word."

Can you see the connection now?