New Approaches to Attention Deficit Disorder
by Dr. Tina Rochford
Family Matters, Vernon Morning Star
Attention Deficit Disorder is an increasingly common term which we hear applied to children and even adults. What exactly does this label mean? Firstly, it is important to realize that the ADD label is an arbitrary name for a cluster of characteristics around themes of inattention, impulsiveness and restlessness. The diagnosis is both a matter of degree (the severity of symptoms) and the time of onset (typically before age 7). It is also completely subjective and simply describes the symptoms, but does not explain them in any way. What is known is that this cluster of characteristics indeed exists, that some neurological differences accompany these characteristics and that medication can alleviate some of the symptoms. What is not known is the root cause of this cluster of characteristics or the role of neurological differences (in other words, do brain differences cause ADD or does ADD lead to changes in the brain?).
Dr. Gordon Neufeld, a psychologist and expert in the field of ADD was in Vernon recently to present some provocative new approaches to both understanding and working with children with ADD. Dr. Neufeld sees the root cause of ADD as associated with a condition he refers to as "defended against vulnerability." or DAV. In other words he feels that children with ADD may be society's most sensitive children who are easily overwhelmed by both external and internal stimuli. Such stimulation triggers defenses in the brain to insulate against these experiences. This sensitivity may be first noticeable in extreme discomfort wearing certain types of clothing or reactions to loud noises or being touched. Dr. Neufeld relates the concept of DAV to experiences that distress, that conflict, or are novel to these children.
- What distresses: These children tune out whatever makes them feel most vulnerable-eg-being rejected, making a mistake, being yelled at, not understanding, etc. In so doing, they leave themselves open to being perpetually in a state of anxiety or frustration. As they are unable to deal with the distressing events, they are caught in a scanning mode where their attention is constantly flitting. Research has shown that adults lose up to twenty (20 %) IQ points when we are anxious so our ability to solve problems is clearly impaired. Not surprisingly, this scanning behaviour on the part of children interferes tremendously with concentration.
- What conflicts: These children build barriers against feeling vulnerable, which compounds the problems of egocentrism (inability to consider the needs of others) impulsivity (inability to reflect on the consequences of their actions). They may be hugging one moment and swearing the next, but are unable to explain their behaviour. This inability to hold two conflicting thoughts or feelings at the same time (eg-I want that bike/Taking that bike would be considered stealing, I would be in trouble) leads to major problems in social interaction and value development.
- What is novel: These children are more dependent, more sensitive and more easily stressed; the interaction of these three variables makes the child more prone to feeling vulnerable. This lack of curiosity about that which they do not recognize leads them to dislike travelling, seasonal festivities, etc.
Of course, as any parent or educator experienced with children with ADD knows, there is a paradox at work: These children have built so much armor to protect themselves from vulnerability that they appear insensitive, even aggressive, they may not talk about their feelings, they may seem demanding, restless and compulsive. In short, the whole family may be in a chronic state of anxiety, even chaos.
Dr. Neufeld's approaches to helping these children are based on a "foundation of insight and understanding." Parents need to understand the problem and their child and accept that the child truly can't stop from exhibiting many of the troubling behaviours. He suggests that this is one occasion where parents cannot trust their own instincts because the appearance of the problem (insensitive) is actually the opposite of the problem (highly sensitive). He suggests retreating from a battle against the symptoms and instead "coming along side the child." Parents might soften their demeanour and say things such as "Your brain lets you down sometimes, doesn't it?" Another fundamental aspect of Dr. Neufeld's approach is to cultivate a good working attachment between parent and child, and, if possible, cultivate attachments with others who are working with the child. These children are attachment-based learners who cannot learn from anyone to whom they are unattached. The relationship with the child should be a priority over conduct and achievement.
Dr. Neufeld further advocates the following common sense responses to help children with ADD:
- reduce stress wherever responsible
- refrain from discipline which fosters separation-eg-no time outs with separation
- impose order such as structure, routine, simple instructions, changing situations and circumstances, etc, without using threats or separation
- focus on a single element of a problem at any time
- reduce stimulation by experimenting with such patterning input as baroque music, drums, flickering of a fire or even television (some children may actually need to watch television to concentrate on their homework), walking, pacing, sounds which match heartbeats (particularly for infants) etc.
- provide opportunities for physical activities, ideally every two hours
- control diet if possible-avoid the frustration of hunger and focus on complex carbohydrates, proteins and fats, rather than the simple sugars. Be alert for food sensitivities as these children tend to be allergy prone.
- orient the ADD child. Pay special attention to greetings and goodbyes. Let the child know what is happening next. One father reported that calling his son from work and letting him know if they were to run an unexpected errand on the way home from daycare greatly reduced the outbursts
- reduce peer interaction. Dr. Neufeld feels that these children need to become more adult oriented and suggests family holidays and outings, without friends along
- softening the defenses-the parent must lead the way by modelling warmth and affection but in a non-threatening way. Dr. Neufeld suggests "gently touching the bruises" in terms of what is distressing the child. The parent finds a vulnerable moment, such as at bedtime, briefly mentions a sensitive area, such as "you must have felt sad when the picnic was cancelled", then retreats from the topic. The key is to go slow and repeat this process numerous times a day. The parent is attempting to tune in what the child is tuning out.
- finally , the child will eventually be able to attend to and talk about feelings of frustration, insecurity, fear, vulnerability and the impulses associated with those experiences.
More information on ADD is available through the Learning Disabilities Association of B.C., Vernon Chapter at 542-5033
Dr. Rochford and her husband Dr. Gordon Davidson conduct a child, marital, and family counselling practice in Vernon. Questions, or suggestions for future articles to 542-0660.
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