It’s amazing how long it took me to realize that my son has ADHD. I suppose it’s because I had seen worse. I expected it to look somehow different than it did. My son as a young child wasn’t hyper. He could focus efficiently and wasn’t particularly spacey. He did have an incredibly hard time with emotion regulation, going from ‘0-to-60’ in a blink and sometimes taking hours to calm back down. He would act out rage in his room or in my arms. He would attempt to leave school, or storm out of a basketball game he was playing. It was horrible to watch and incredibly distressing to me.
I felt like I tried everything I could think of to help him — I was a therapist. I knew what to do, but nothing seemed to work, so in the end I blamed myself. I was too permissive, perhaps, and maybe didn’t provide enough structure. This idea was reinforced by those around me, family and friends. I was patient, but it was frustrating. I didn’t understand it and felt judged by others, assumed to be the cause of my son’s bad behavior and poor choices. They understood of course — they knew that being a single mother was hard and I might overcompensate for feeling guilty or give up and give in, following exhaustive attempts to provide boundaries and consequences.
It wasn’t until he reached seventh grade that it was suggested to me that he be evaluated for Attention Deficit Disorder. His teachers noticed him having a hard time staying in his seat, saw that he needed to constantly have things to keep his hands busy, and was falling behind because he was not turning in assignments. I suppose no one brought this up with me in sixth grade because the first year of middle school is a huge period of adjustment both socially and academically. My son had also experienced significant stress due to both his father and step-mother’s battles with cancer in their home. There was also my remarriage and subsequent pregnancy in our home. By seventh grade, though, things had calmed down in his home environment and his symptoms could no longer be explained by other variables. And that’s when I looked back at his elementary school years and wondered how I could have missed the signs: He simply could not sit still at meal time, twisting, turning, even laying down at the table; during class plays, he was constantly fidgeting. The more I recalled, the more evidence I found.
Let me start by saying this: As a therapist and as a woman, I have extremely mixed feelings about diagnosis (to account for the concept, not the plural thing itself). I have seen the terrible effects of pathologizing people. I have seen the burden of stigma, and how easily a diagnosis can become an identity. But I have seen, too, the relief a name that a cluster of symptoms can bring to someone who did not know what was wrong; why they seemed to experience life in a different way than the majority of those around them;who felt confused and ashamed and overwhelmed by the way they were thinking, feeling, or acting, before realizing that they were not alone. This diagnosis, this title, meant something, something known, that could explain his challenges. As a mother, when my son was evaluated and diagnosed as having Attention Deficit Disorder with Hyperactivity, what I first felt was grief. I can’t explain why. It was common and there were good things, strengths that came along with it. But still. It was my son. It was a diagnosis. And I was terrified he would feel the shame of being singled out — like something was wrong with him.
I started to read everything I could find — books, articles. And in doing so my fears significantly dwindled. I discovered a way of viewing it that was healthy, adaptive, positive. I came to understand the ways that this framework, this way of being, could be utilized in creative and productive ways. Interestingly, when I finally figured out how to address it with my son in a way that didn’t feel like I was breaking awful news to him, he was, in fact, unsurprised by it.
When I listed things that kids diagnosed with ADHD typically struggle with, he smiled and agreed with almost all of them. It made sense. Of course, he had a few basic questions:
Will I need to take medication? Am I going to be pulled out of my classroom at school?
The answers were “No” and “No,” which reassured him. We talked a bit about what we wanted to do with this information, and he was open to seeing a counselor who specialized in ADHD as long as I went too. He was open minded about it and had no real expectations. He had trust.
So here’s where things start to get a little less perfect. After doing some research about recommended doctors who accepted our insurance, we ended up at an “ADHD Treatment Center,” a name which immediately rubbed me the wrong way. I was fighting so hard not to pathologize my child,to make it clear that there was nothing wrong with him and that we just needed to learn more about the way his brain worked so he could maximize his already great potential and learn new strategies to help him out. But nothing makes it clearer that you are sick, damaged, or have a problem, than going to a “treatment center.” — a place that identifies your “problem” in big letters when you walk through the door.
Still, I was trying to keep an open mind. To trust in the experts like my son did. And it wasn’t an awful experience. But it wasn’t good, either. It was, without question, more clinical and dry than I would expect counseling to be for a twelve-year-old. Our doctor sat behind a clipboard and took notes. We didn’t play or use visual or manual tools, the very things he told me my son needed to stay better engaged and absorb more information. In other words, he was using none of the techniques during the session that he suggested we use at home. The office was sparse, aimed at minimizing distraction, but in my opinion served only to heighten my son’s boredom and discomfort. I learned some useful things, such as what accommodations to request on my son’s 504 plan (special provisions to ensure a child’s needs are considered by the school to allow for the highest potential for academic success), and some strategies he can try when he is either under- or overstimulated. But my son didn’t like going even though he felt like he had to. He was, understandably, bored. He didn’t say much.
The relationship that formed between him and his doctor was something counterintuitive to everything I know about therapy. I understood that working with a parent is a primary intervention while “treating” children diagnosed with ADD, but my son was in the room during many of the parental conversations, treated like his presence was virtually unnecessary. I had to fight to keep the session from being simply another place that adults talked about all the things we hoped to change about him. Probably the best part of going for both of us was the car ride there and back, when we did actually talk and connect. And as we did this, I learned all of the amazing ways he had already been trying to work with his body and brain. He told me about the tools supplied to us by the doctor that he had already figured out for himself years ago. I just wasn’t aware he was doing them. For me, this was a good reminder of our inherent ability to adapt and find creative solutions to the things we struggle with.
When I ask my adult clients with ADD or ADHD (ADHD is more common in childhood) if they went to therapy as a child, I can already hear my son’s future response echoing in their answer.
“My parents made me. I didn’t like it.”
These clients are talented and skilled professionals. They are lawyers and teachers and, perhaps most commonly, working in technology. They are computer whizzes and designers and engineers. They are smart and creative and interesting and totally dedicated to the field they work in as long as it interests them — which it almost always does.
Because one of the amazing things about ADD is that when you are into something, you are REALLY into something. That thing, that thing you love, that thing you are good at — you master.
It’s the other stuff, though, the stuff that is hard or boring, the stuff that doesn’t doesn’t come naturally to you or doesn’t immediately pay off, that you might avoid and that can, therefore, become a bit of a mess. Paying bills, cleaning the house, doing the work it takes to have a strong, healthy relationship. And this is where there are problems. Because, like I tell my son, life isn’t only about doing the things we enjoy doing.
The other accompanying problem with the traits leading to a diagnosis of ADD/ADHD is that of ‘Secondary symptoms,’ which are very common. Much of the time, they go hand in hand. These are issues such as low self-esteem, depression, anxiety, anger, and addiction. The reason these are so prevalent is because most children diagnosed with ADD are made to feel as if they are lazy, a disappointment, frustrating to those around them, or stupid. They are lead to believe that their inability to concentrate or to complete a task is a kind of failing on their part. They aren’t trying ‘hard’ enough, perhaps. They are just ‘too’ defiant, perhaps. Imagine the building hopelessness in a child’s outlook when surrounded by these messages. Imagine how these judgements become internalized and become the way the child sees himself.
In my practice, when adults with ADD come in, it is usually because of a lifetime of feeling this way, or because their partner has brought them in due to frustrations in their relationship. Their partner might describe not feeling seen or heard, not feeling like a priority. The client who may or may not have thus far been diagnosed with ADD probably doesn’t know exactly what they are doing wrong, but is acutely aware that they are somehow failing in their relationship. They might be trying to do the things their partner is asking of them but can’t seem to keep it consistent. Relationships too, then become another area of their life in which they fall short.
It’s hard to call something that effects approximately 10% of children a ‘Disorder.’ Something that occurs in males 2-3 times more often than in females. When I look at these statistics I can’t help but wonder: Is ADHD just one possible way that behaviors in childhood manifest? Especially behavior in boys?
We see children diagnosed with ADHD, children like my son who are uncomfortable in their own bodies, taking more risks, hunting for the added stimulation they aren’t receiving. It’s not a bad way of being and can, in fact, be adaptive, and useful. When I first figured out I was an introvert in an extroverted world, I knew I needed to figure out how to use my relational style to my best advantage. I needed to understand the strengths of being introverted, and it ultimately wasn’t hard. Every personality style has its strengths, and every culture needs variety and diversity in its people to survive.
We need children who are quiet, slower to process, and more sensitive, and we need children who take chances and seek out excitement and act quickly. This is how we survive as a species, and this is how we learn acceptance, appreciation, and tolerance as an individual.
In our culture, children are largely expected to listen to their parents, follow directions, and sit still — all things that are painfully difficult for most children, but especially so for some. Those children are often diagnosed with ADHD. And while I won’t deny that there is a neurological component to ADHD, as there is for most personality types and behaviors, I also believe that part of the reason it is so commonly diagnosed is because it is based on culturally-defined values. We find it annoying, even inappropriate. In other words, it is a value-laden diagnosis, which is problematic especially given how debilitating those secondary symptoms can be. In many cases it is those secondary symptoms that cause long term problems, not even the “symptoms” of ADHD itself. Roughly 40% of adults have ended up “outgrowing” their ADHD diagnosis. I also find it problematic that many of our cultural practices, such as being highly sedentary in our daily lives, and eating foods loaded with preservatives and chemicals, may well directly contribute the behaviors in children we are trying to diagnose and “extinguish.”
Children diagnosed with ADHD don’t tend to find stimulation stuck behind a desk at school, or engaging in activities at home that are redundant, highly structured, or not of their choosing. However, they do find the stimulation they crave while out in the world, using their bodies and exploring, and not while in front of what even adults are seemingly obsessed with — a screen.
The internet and video games my son loves so much, provide endless stimulation, tremendous variety, and immediate gratification. And though I may have my gripes about our technology-dependent world and may feel wistful at my best times, disgusted at my worst, the fact is that this is our world now. Most children simply don’t roam free in the way they used to.
We are more aware as parents of the dangers our world can inflict on our children, from second hand smoke, to BPA in our water bottles, to abduction. We have become more protective, more fear-based. This can, and does, save lives. But we haven’t yet figured out how to balance this new information, this new way of living, in a way that incorporates healthy boundaries and diversity in our daily activities and play. Or even if we have, our brains and the brains of our children haven’t really gotten on board, drawn understandably to the thing that will meet its need the fastest and, on the surface, most efficiently.
What does this mean in the long run? It probably means that my son is going to make a lot more money in his future career than I ever will in mine. And that’s about it. All of the other things I worry about, such as how he will learn to take care of himself, are things that every single human of every generation figures out eventually. Even if it means finding yourself in therapy and then deciding on a path towards a better relationship or a more organized life.
It’s hard for me not to get defensive, even angry about the way we view things in this country. Western medicine searches for biological root causes to things our governing medical bodies decide are “disorders.” ADHD in America is described as a “Brain Disorder,” and therefore the most common approach to dealing with it is the use of pharmaceutical drugs. This fits well into our general preference for a quick fix, a magic pill that solves our problems and makes our lives easier. With ADHD diagnoses we are medicating children to fit our “one size fits all” model of education, rather than looking at ways to change the larger system or find one that works better for them.
Other countries are more inclined to look at what we call “ADHD” in a broader context, taking social and psychological variables into account and adjusting these as a way to address areas in the child’s life that are causing problems. Obviously, this takes more work. But as I am finding at home, as I try to give my son more varied, stimulating options for his chores or how he does his homework, it’s not impossible and it absolutely pays off. Rather than resisting the way he needs, not wants, but needs to do things, I am finding ways to work with them. We argue less. I am less frustrated. He feels empowered. It’s a win all around.
I’d love to have met my adult clients diagnosed with ADHD when they were children. I wish I could have helped them, helped their parents understand. I wish I had known ten years ago what I know now. But you work with what you have when you have it. My hope is that as ADHD diagnosis rates continue to rise we find another way to view it and to talk about it. I hope we medicate less and adapt more, becoming flexible in the way we treat our children, our people. It’s a lofty goal and one that extends far beyond a conversation about ADHD. But it’s a good place to start.