adhd - ADHD treatment is a systems, multi-faceted process for the whole family

Labels have the power to directly shape the behavior that is assigned to them. Once the word is out that "Jason" is ADHD, he lives up to his diagnosis — for himself and others. That it, if the doctor's diagnosis it not correct initially, it soon will be.

I’ll illustrate with a study.

It has long been known that attractive people make more positive first impressions. It turns out that these impressions can have a powerful effect on behavior.

Men were asked to have a 10-minute telephone conversation with a woman whose picture they had been given. The picture, however, was not of the women with whom they talked. When the men were given a picture of attractive woman rather than homely woman, the conversation was quite different.

In essence, during the short span of a telephone conversation, the women became what men expected. The women who were believed to be attractive became more animated, confident, and adept. By contrast, the women whom the men believed were homely became more withdrawn, lacking in confidence, and awkward. These changes in the women’s behavior were directly related to how men talked with them.

[Men] who thought they were talking to beautiful women were more sociable, sexually warm, interesting, independent, sexually permissive, bold, outgoing, humorous, and socially adept than the men who thought they were talking to homely women. The men assigned to ‘attractive’ women were also more comfortable, enjoyed themselves more, liked their partners more, took the initiative more often, and used their voices more effectively. In a nutshell, the men who thought they had attractive partners tried harder. Undoubtedly, this behavior caused the women to try harder in return. If the stereotypes held by men became reality within only 10 minutes of telephone conversation, one can imagine what happens over several years.

The ADHD label Shapes Behavior

If we place the teacher in the role of the men in this study, and the ADHD labeled children in place of the homely women, we may have a better understanding of part of the dynamics that shape the ADHD child’s behavior. It would then seem likely that the adults framing the child with “homely” ADHD features would be inclined to bring these characteristics out in the child.

However, the ADHD diagnosis makes "Jason’s" role much simpler for himself and others since that label allows all to know and agree upon the rules and roles. Diagnostic categories serve as a conceptual rallying point to help achieve consensus on action among the people who work with Jason.

Labeling Transfers the Problem to New Situations

The development and use of labels, such as ADHD, provides a mechanism for the efficient transfer of this pattern to other adults and other children. In a sense, others become infected with ADHD. The child and the adult each have their mechanisms that facilitate the epidemic. The adults use their superior verbal skills to communicate to one another the child’s ADHD label. The child generalizes his effective adaptation technique to other situations in which he feels uncomfortable.

Transferring the ADHD Label Between Adults

How adults respond to ADHD behaviors is influenced by the way they talk about it. The behaviors implied by ADHD label provide an organization for the teacher’s perception of the child and the way he behaves. The teacher then is more likely to respond to the ADHD and thereby amplify it.

For example, one teacher tells another teacher that the child is ADHD. The new teacher is then sensitized to look for ADHD. But before the child’s actions were labeled ADHD, his behaviors were less likely to trigger a response and thereby be reinforced.

ADHD kids intuitively sense this problem and that is the reason they often do not want anyone to know they take ritalin and often object strongly to having to go to the office to take their noontime tablet. By contrast, a child’s ADHD-like behavior that is not noticed, and thereby does not elicit a response from the environment, is less likely to reoccur. The child will only continue to do what, from his perspective, works, at least in the short term.

Drawing attention to the behaviors increases the probability that they will “work” and, therefore, be reinforced. In this limited sense, if you do not see it, (which is different from ignoring it) it is more likely to go away.

That’s why, even though the time-released ritalin spanuals do not work as well, sometimes it is better to use them (although I do not support using any medications). Then the child can avoid being labeled defective and can avoid being shamed for having to take medication.

This is not a prescription for ignoring the child. Many times, “ignoring” the child’s label does not work because he can easily detect that this is not genuine. And he really is getting the emotional response he wants from the adult. The size of the adult’s emotional display is not what is important. Rather, it is the information it conveys about the adult’s emotional state. Only a small vignette of the adult’s behavior is necessary to convey the internal state.

An old but clever study demonstrates this quite graphically. Before the beginning of the school year, experimenters manipulated teachers’ expectancies about how well some students were anticipated to perform the following year. Then they followed the children’s performance over the next year.

The children tended to live up to teacher expectations. Compared to a control group, those who were expected to “bloom” intellectually in fact did. This was most apparent with first and second graders, which is when most ADHD children are identified. Not only do reactions to children labeled with ADHD spread to other adults, the child’s behavior spreads across situations.

The Child’s Generalization of a Strategy that Works

A parallel strategy works for children. Once a child’s emotional patterns are established and work in one situation, be it math or spelling, they tend to spread to other situations that stimulate the same uncomfortable feelings. At first, the problem is only manifest in math or Mrs. Smith’s class. Later when he feels uncomfortable in social studies, he begins to use his ADHD behaviors there. No one really notices at first. But as the strategy works, it spreads untl adults begin to notice and label the child as ADHD.

In the same manner, adults sensitized to one ADHD child transfer this to other children who provoke similar feelings in them. Thus, other children who elicit the same feelings in them are likely to be subject to the same strategies applied to the first child. Once the behavior is resonating in one feedback loop, the child and the teacher are both likely to generalize their strategies to other situations and persons.

I remember Ellen, a fourth year elementary school teacher who came for therapy because she was so stressed from teaching. She was thinking about quitting at the end of the year. She loved teaching, but there were a few ADHD children who upset her greatly. Ellen felt helpless and incompetent to deal with them.

She had sought help from her principal and other teachers. Though their advice seemed sound and she resolved to try it, when faced with these children’s antics, she became so upset and frustrated that she found herself yelling at them. She knew this wasn’t appropriate, but they got to her.

While she was in the caer machine, we traced back in her personal life and teaching life the feelings the ADHD children in her current class provoked in her. Though there were many small repetitions of these feelings, there seemed to be two primary historical roots to her current experience.

In her first year of teaching, she got “the child from hell.” He seemed bent on making her life miserable. She worked with school psychologists, special education teachers, and consultants with no success managing this child. After several months, he was removed from her class and put into a behavior disabilities classroom. Though he was gone, she remained phobic of ever having another child like this.

These feelings of helplessness and frustration also dated back to her childhood when her older brother used to tease and taunt her for hours. Once these historical feelings were extinguished with caer, her job seemed much more manageable. Though ADHD children were still difficult, Ellen no longer felt helpless and incompetent to deal with them. She continues to be a successful elementary school teacher.

Children train adults and adults train children in ADHD patterns. This is part of the energy behind the current epidemic of ADHD.

The Label Obscures Small Improvements so More Effective Behaviors are Not Shaped

The ADHD label traps the child in another way. Because of his ADHD label, the school and family are sensitive to his diagnosis and the behaviors it implies. Conversely, this means that the parents, teachers, and friends often fail to respond to the incremental improvements brought by treatment.

Many times improvement for these children consists of a reduction in negative behavior, such as moving around less and speaking out less. Today "Jason" stays in his seat for 10 minutes instead of his usual five minutes. This is a huge improvement for him since he has doubled his performance.

However, he is still labeled ADHD, and being out of his seat is still ADHD behavior. The fact that he did better today, which should be seen and reinforced as a step in the right direction, often is not noticed. His move in the right direction is not reinforced. So, the probability of a repeat of his increased “staying in seat behavior” is reduced.

The environment must reinforce the new, more positive behaviors. No treatment makes the child impervious to further insult. The child is only likely to  continue positive behavior if those new behaviors are noticed and reinforced.