ADHD

adhd

The lightning speed of the ADHD child’s emotional responses to instructions often preempts listening to  what a parent or teacher says. The parent says, “Clean up your room.” But before the parent finishes saying the word “clean,” the child is furious and their listening shut down.

That’s because this interaction has a history. The child has a conditioned emotional response to the parent’s voice, tone and words. That response is to his feelings of anger, rather than his parent’s instruction to clean up his room. Indeed, the response is so strong that the full request is barely, if at all, heard. The child then acts on his feelings of anger, rather than the merits of the parental request.

This conditioned emotional response blocks, or at least delays, the intellectual evaluation of the instruction. This conflict and emotional arousal is difficult, not only for the adults but also for the child. Some children learn to avoid much of it, particularly in the classroom, by learning attentional avoidance of the whole experience.

Susan, an 8-Year-Old ADHD Girl

Susan is an example of how emotions blocked positive responding to most anyone around her, and how, once these emotions were extinguished, her behavior changed dramatically. Susan was an 8-year-old, girl who had a long history of unsuccessful treatment for ADHD. This included parent training, behavior modification, and three years on ritalin. These approaches had some short-term, positive effect. But as time passed, her behavior worsened. When I first met her, her medication had been discontinued for several months due to its ineffectiveness.

By the time I began treating Susan, she was very agitated, hostile, antagonistic, and hyperactive. She was constantly wiggling, moving around the room, impulsively interrupting conversations, acting out with outbursts of anger, playing roughly with other children, and showing poor attention span — characterized by moving from task to task every few moments.

She constantly provoked adults around her, particularly her mother. Any comment or instruction from her mother roused Susan to explode before her mother could stop speaking. Her boredom tolerance was nominal, compliance was minimal, and she never stopped moving.

Initial treatment with caer was difficult because of her limited attention span. Every few moments she would ask questions, sit up in the chair (an early version of caer) , or ask to do something else. Within the first treatment hour, the behavior subsided. She began to attend for five or six minutes, uninterrupted.

On succeeding sessions, she listened to a tape of her mother giving her directions, which typically provoked her misbehavior, or remembered times at school that made her angry. Initially these procedures caused strong emotional responses including yelling, grimaces, hand waving and wiggling. After several repetitions, the emotional arousal quieted to relaxation.

Susan’s mother noted significant improvements at home and school by the third session. By the sixth session, no further problem behaviors could be identified. Her mother related that Susan’s behavior had been very good at both school and home. She said that Susan is “calmer, minds better, attends better, and her behavior has changed 180 degrees.” Her compliance with mother’s requests no longer roused angry outbursts and they were often obeyed without comment. Her attention was quite normal. In a conversational setting, she now sat calmly, made continuous eye contact, and listened.

By the end of treatment (seven sessions, then hourly sessions), Susan could attend continuously to CAER for 15 minutes or more without complaining and with no noticeable breaks in attention or superfluous bodily movement. Her general presentation was that of a normal, well-behaved child.

Watching Susan play with other children in the waiting room revealed a normal child capable of playing well, sharing toys, and sustaining interaction. Other children seemed to enjoy her too.

Her mother was also treated on CAER. The primary focus was on the ways her daughter irritated her. Treatment for the mother substantially reduced the negative reactions she had towards her daughter. Their positive interactions were greatly improved.

At four months follow-up, no regression was reported in either mother or daughter. Extinguishing the emotional arousal transformed behavior.