Peter: A Day in the Life of an Attention Deficit Child
G. Emerson Dickman, J.D.
Hyperactive, hyperkinetic and minimum brain damage or minimum brain dysfunction are some of the names which have been used to describe the child suffering from what is now referred to as ATTENTION DEFICIT Hyperactivity Disorder. A problem shared by many such children is that the people with whom they associate have difficulty understanding their behavior and responding appropriately. The failure to understand the causality of what is perceived as problematic behavior creates a hostile environment which nurtures the development of conduct disorders and lifetime of anxiety, fear, acting out and underachievement. The following was prepared to draw attention to the ease with which such an understanding can be acquired. With understanding comes solutions.
Peter is an ATTENTION DEFICIT child. The following are comments from people close to Peter, regarding one day in his life.
Last night Peter came home with a “B” on a Social Studies paper.
I know he needs a pat on the back sometimes so he can feel good about himself.
I told him I thought his work was wonderful, that he has the potential to get “B”s, or even “A”s, anytime he wanted. I told him I was proud and that his dad would be happy.
I asked him what he did to deserve such a good grade?
You know what he said?
He said “it was an easy test” he “lucked out” that’s just what he said and then he walked away from me.
Peter is always the last to be picked when we choose up teams. I don’t blame the other kids.
Peter gets into fights, doesn’t want to follow the rules, is always looking off into space, never listens, plays to rough and doesn’t seem to care about winning or losing.
Just today, when we were on the field some of the kids were kicking the ball around, I saw Peter on the sidelines, I felt sorry for him. I thought I could get him involved. I called over to him; he didn’t seem to hear me. I went closer, he didn’t respond. I went even closer; he still didn’t pay attention.
Here I am trying to do something nice for the kid and he ignores me.
I got right next to him and blew my whistle oe that got his attention and every one else’s too. He made some fresh remark that I couldn’t overlook and I sent him to the principal. What choice did I have?
I had him in my class before he was classified. I referred him to the CST because he wouldn’t sit still or focus on his assignments.
That was last year.
Now he is getting help in reading and math in the resource room, he is on medication and, I understand he and his family are seeing a psychologist.
Peter is much better in the class; he sits reasonably still and doesn’t cause as much trouble.
But he still doesn’t listen, and never does his homework.
The other day he told me he read a book on his own that he liked. I was very pleased and we talked about it for awhile. I told him to write a book report on that book instead of the assignment I gave to the other kids. He seemed to like the idea.
I told him to be sure not to give the plot away, the other kids might want to read it.
Today he came in with a one-sentence book report. He said he “didn’t want to give the plot away.”
It’s now easy to know what to do.
Its homework! When I’m home the only topic of conversation is Peter’s homework.
I try to help.
We sit with him; we help him, we cajole him. We offer him rewards; we give him punishment. Nothing seems to work.
Sometimes he just sits there looking at the paper.
I wouldn’t mind if he didn’t know the subject. That’s not the problem. He knows what to do and how to do it.
I can’t believe he prefers what we go through every night, as an alternative to doing homework.
I know what you’re thinking! Your thinking “he’s looking for attention.” I thought that too. That’s not it. There is something more.
The whole family is affected. My wife doesn’t think I’m patient enough with Peter; meanwhile she has no patience left for me and no one pays any attention to Sally.
Peter doesn’t have many friends.
When we play games with other guys he’s always yelling, he always makes up his own rules. Sometimes he just gets angry for no reason.
Today, after school, we were walking home; he told me he got in trouble with Mrs. Wilson because he wrote only one sentence for his book report. I told him that writing one sentence was “crazy”. He went off the deep end, he screamed that I was a jerk and not his friend, I think he wanted to him me, then he ran home.
He played all weekend with little kids.
Sometimes I can’t figure him.
Yeah, people are always yelling or criticizing me.
I guess I do a lot of bad things.
Its one thing to annoy people, I do that, I can’t help it. It’s another thing to hurt people.
Just this morning my sister, Sally, went by me at the head of the stairs. I could have tripped her. I thought about it. It just popped into my head. But I didn’t trip her.
No one gives me credit for not doing the really bad things that sometimes pop into my mind.
Mom: “I wish Peter was happier.”
Coach: “He’s not a team play”
Teacher: “Peter doesn’t really try.”
Dad: “He’s bringing down the whole family”
Friend: “It’s real hard to be Peter’s friend.”
Peter: “Sometimes I think I was adopted, I don’t fit anywhere.”
The persons closest to Peter have all described experiences which may be better understood in terms of the dynamics of ATTENTION DEFICIT Hyperactivity Disorder.
The road from mild organic disabilities too serious, potentially threatening, emotional problems is traveled by many. The myth of mildness is one that attracts us because it satisfies our need to see the future as a safe place for our children. The road signs signaling “danger!” are obvious, but go unrecognized because other aspects of our lives compete for our attention. It is easy to accept optimistic platitudes such as: “He’ll grow out of it”, “Its just a stage”, or “We’re doing everything that can be done.” By the time we recognize the need, the problems are so significant that we would gladly give up a weekend, a vacation, or the equivalent of the cost of a college education to get our child back. The significance of the problem should be recognized and responded to before the problem becomes significant. Nowhere is the axiom “An ounce of prevention is worth a pound of cure,” more appropriate.
MOM: “I know he needs a pat on the back sometimes so he can feel good about himself.”
The first and the most obvious casualty along the road to emotional problems isself-esteem. The gradual decay of self-image is a result of the constant negative feedback experienced in all aspects of such a child’s environment. Rather than experiencing a warm, nurturing world of interdependent being, the ATTENTION DEFICIT child often faces a cold, hostile world of lonely isolation.
“Sit down, I’m tired!”
“I know you can do it, why don’t you try?”
It seems that half the world wants him to “Sit down and shut up,” while the other half wants him to “Wake up and get going.” No one is happy with where he is.
MOM: “I told him I thought his work was wonderful, that he has the potential to get “B”s, or even “A”s anytime we wanted.”
Often the child hears that he would achieve, get good grades, if he “wanted” because he “has the potential.” Statements like this infer that he gets bad grades because hewants bad grades. The truth is he wants good grades and his failure to produce them is proof that those who attribute a higher potential to him are wrong. Such a child is developing an additional burden of the secret of his own stupidity.
MOM: ”I told him I was proud and that his dad would be happy.”
Feedback relating to the feelings of the child will help him understand better the meaning of his successes. Knowledge of how he makes others feel has limited relevance if he doesn’t know how he feels himself. “You make me proud” is an abstraction; whereas “I’ll bet that made you feel really good,” is concrete and identifies the feelings he should be experiencing.
MOM: ”I asked him what he did to deserve such a good grade? You know what he said? He said, “it was an easy test,” he “lucked out” that’s just what he said and then he walked away from me.”
A child who carries the secret of his stupidity, does not automatically experience an appropriate emotional response and, without intervention, will often devalue or denigrate a success experience. It is not sufficient to provide such a child with opportunities for success, it is necessary also to teach them to recognize and accept success.
The learning disabled ATTENTION DEFICIT child is by definition an underachiever, i.e., his potential exceeds his achievement. The diminished ego of such a child will not allow him to believe the potential attributed to him by others. Therefore he is faced with a paradox: He will be credited with potential even if he continues to fail. However, if he exhibits a real effort to achieve he risks disappointing the significant others in his life. Failure becomes comfortable and success is anxiety producing. Such a “failure oriented” child will often actually avoid an opportunity for success and turn away from activities where he/she has exhibited true skill and promise. One must learn to succeed before one can deal successfully with failure.
A child developing normally encounters an ever increasing variety of experiences. By discovering how he reacts to those experiences, he learns about himself and what to expect from himself under similar circumstances. This “network of expectancies”, both experienced and extrapolated, is the “self” which is the object of the adolescent’s search. When a child is failure oriented, he devalues his experiences to the extent that he fails to develop a network of expectancies and acquire an image of self.
COACH: ”Peter gets into fights, doesn’t want to follow the rules, is always looking off into space, never listens, plays to rough and doesn’t seem to care about winning or losing.
It doesn’t take a medical degree to recognize behaviors often associated with an ATTENTION DEFICIT child suffering from diminished self-esteem.
COACH: ”I called over to him, he didn’t seem to hear me. I went closer, he didn’t respond. I went even closer, he still didn’t pay attention.”
Auditory figure-ground discrimination problems often result in others feeling the child doesn’t listen. In truth he listens too much. Frank Wolkenberg an ATTENTION DEFICIT adult said it best in an article he wrote for The New York Times.
“At lunch, a nearby conversation threatens your ability to listen to the person across the table, however interesting; in the quiet of a library, the noise of someone adjusting his chair can disrupt a train of thought. Disorganized, unwanted information pours in ceaselessly. It is a very egalitarian kind of disability: the trash collector in the alley demands as much attention as the boss on the phone.”
Persons with the ability to make figure ground distinctions best relate to the restaurant experience where they can pick and chose the table they wish to overhear and “tune out” competing conversations, even at closer tables. The disabled person has so much input he has difficulty discerning what messages are important versus unimportant, directed at him or directed at someone else. Auditory figure-ground problems result in comments like “What! Are you deaf?” Why don’t you come when I call?” “You have to learn to pay attention.”
Visual figure-ground problems result in even more subtle annoyances. The sale shaker is s effectively hidden on a crowded dinner table as if it were in another room, even if it is “right in front of you.”
COACH: “He made some fresh remark which I couldn’t overlook and I sent him to the principal. What choice did I have?”
The ATTENTION DEFICIT child often finds himself in situations where he is made to feel or look foolish. A logical and easily anticipated response to such a situation is a display of bravado to defend against the real or imagined insult. The ATTENTION DEFICIT child often experiences such insults in his social contacts, thereby triggering the hurt, anger, guilt cycle which often results in acting out behaviors and/or withdrawal and isolation.
TEACHER: ”Now he is getting help in reading and math in the resource room, he is on medication and, I understand, he and his family are seeming a psychologist.”
Remediation for the ATTENTION DEFICIT child is often focused on solving the problems of the persons who interact with him. Medication, behavior modification and reduced student/teacher ratios are often used simply to make such a child easier to deal with. Further, the initial programs developed for the ATTENTION DEFICIT child focus on current needs without apparently recognizing or responding to the need to intervene to offset the negative impact this disability has on the development of personality and ego. Unfortunately, the focus of special education is on remediation of what exists and not on prevention of what will exist. We focus on a particular slice of time and ignore the lessons of the past and the clouds on the horizon.
TEACHER: ”But he still doesn’t listen, and never does his homework.”
“Homework”, which requires written expressive language, is a problem for the vast majority of ATTENTION DEFICIT children. “Dad” has more to say on this subject. Suffice to say, at this time, that the teacher should determine her goals for assigning homework. Homework should only be used to reinforce what has already been learned, it should never involve learning new things. Assignments must be modified to take into consideration the pupils unique problems with both receptive and expressive information processing. Less homework, with short individual assignments that can each be completed in less than ten minutes with a minimum requirements for written expression will often result in more success and less stress.
TEACHER: ”I told him to be sure not to give the plot away, the other kids might want to read it. Next day he came in with a one sentence book report. He said he: `didn’t want to give the plot away’.”
A tendency to literal interpretation of input is characteristic of many ATTENTION DEFICIT persons. There are few gray areas in such a persons life. Subtlety is lost on such a child. “Don’t say too much.” Is interpreted “Don’t say anything.” Peter’s friend has experienced the social side of this neurobiologically based concreteness which so devastatingly interferes with normal communications with many ATTENTION DEFICIT children.
DAD: ”It’s homework! When I’m home the only topic of conversation is Peter’s homework. I try to help. We sit with him; we help him; we cajole him. We offer him rewards; we give him punishment. Nothing seems to work. Sometimes he just sits there looking at the paper.”
A major problem in the home centers around the child’s apparent unwillingness to do homework. The ATTENTION DEFICIT child typically has problems with written expressive language. Fine and gross motor problems, processing lags, and difficulty in organizing thoughtful responses to specific questions combine to make standard homework assignment in impossible task. Parents should only monitorhomework, not do it. Communication between the parent and teacher regarding the parent’s observations is essential. Homework should not be allowed to become an area of significant stress for the family.
Spontaneous language is often easy for such a child, they are considered veryverbal. However, demand language, an organized thoughtful response to a specific question either written or oral, is often very difficult.
Homework must be broken down into management chunks of time to avoid processing lag problems. Specific assignments should recognize the child’s difficulty with written expression and demand language.
DAD: ”I wouldn’t mind if he didn’t know the subject. That’s not the problem. He knows what to do and how to do it.”
Dad assumes that since his son is intelligent, he shouldn’t be having the problems he exhibits. Invisible disabilities do not engender the sympathy, empathy, and deference that help the more obviously disabled to overcome the obstacles created by their disability. It is most important, for all concerned, to have detailed knowledge of the disability and all of its manifestations, e.g., a child that doesn’t come when called may be exhibiting an auditory figure ground deficit rather than oppositional behavior.
DAD: ”Your thinking he’s looking for attention.”
“He’s just looking for attention” is a cliche used by well meaning friends seeking simple answers to complicated problems. Their children don’t have such problems because, it is to be inferred, they know how to raise their kids. Such comments are, in fact, criticisms of parenting skills and only serve to inflame the relationships in the family.
DAD: ”The whole family is affected. My wife doesn’t think I’m patient enough with Peter; meanwhile she has no patience left for me and no one pays any attention to Sally.”
Parents often blame each other. Friends and professionals alike often unwittingly add to the pressures of the family.
Parents are invariably categorized as being permissive or strict. In virtually every case, one parent can be seen as more permissive than the other. In the mind of the professional, such disparity provides fertile ground to nurture the manipulative behavior experienced from the emotionally troubled child. Depending upon the therapist, either perspective (permissive or strict) may be seen as the proper course to follow. The parent being asked to conform to the other parent for the sake of creating a united front (consistency) is often viewed as the one to blame. Not true! The therapeutic goal is simply to promote consistency for the purpose of avoiding confusion of the all too literal information processing channels of the ATTENTION DEFICIT person. Assigning blame is not the intention of the therapist.
Simply because a change in the status quo is recommended, it doesn’t mean that the fault lies with the party being asked to change. It may simply mean that there is something positive to be derived from the new dynamics set in motion by the change itself. (The goal is the change, not to avoid that which is changed from, e.g., consistency versus either permissive or strict.) Whether one is permissive or strict, liberal or conservative, old fashioned or thoroughly modern, it does not matter; as long as what was inappropriate behavior yesterday is inappropriate today. Knowing the rules and where a parent stands is more important than what the rules are or the quantum of punishment to be expected if a rule is broken.
“Dad” also points out the effect of the ATTENTION DEFICIT child on other children in the family. Simply put, there is very little left over for Sally. Time must be made for her. However, equality of treatment does not equal fairness. Fairness requires that we meet the unique needs of each child. Some children need a lot from their parents and some require very little. The fact that parents do not share their time equally with their children does not mean that they are being unfair or have a reason to feel guilty.
The integrity of the entire family unit is often dependent upon the health of each member. Coping with disability is a litmus test which discloses the strengths or weaknesses of the family unit. The need to cope is often said to have brought a family together. In fact, such a family had inherent resilience and the need to cope is often said to have brought a family together. In fact, such a family had inherent resilience and the need to cope simply disclosed such strength to the more casual observer. Similarly, family with an inherent weakness will have that weakness exposed, should it be faced with a significant need to cope. It is a mistake to blame family dynamics as the reason for a child’s problems without thoroughly investigating the possibility that the need to cope with the child has simply disclosed a lack of resilience within the family unit.
FRIEND: ”Yesterday, after school, we were walking home, he told me he got in trouble with Mrs. Wilson because he wrote only one sentence for his book report. I told him that writing one sentence was “crazy”. He went off the deep end, he screamed that I was a jerk and not his friend, I think he wanted to hit me, then he ran home.”
Peter’s teacher told of an experience where his literaness affected his performance in school. Peter takes that very same brain into the schoolyard, out to the play field, and into his home every day.
The perceptual processing deficiencies suffered by learning disabled pupils are not limited to processing academic input. Processing problems also often interfere with the ability to interpret nonverbal information from the general environment. Often this takes the form of being unable to recognize subtleties. Inferences, sarcasm, hyperbole, and innuendo as well as paralinguistic cues such as facial expression, body language, and prosody go unrecognized or are misinterpreted. This phenomenon, currently recognized as a nonverbal learning disability, often occurs with ATTENTION DEFICITS (comorbidity) and often results in misunderstandings and social isolation.
Such a child is constantly overacting to teasing because teasing is processed, not as it is intended, but as a sincere expression of a true feeling. How often does the parent of an ATTENTION DEFICIT child say: “I was just kidding.” “You can’t take a joke.” “Grandma didn’t mean it like it sounded.”? How often does the parent hear himself say: “He is always being punished for fights he doesn’t start.”? The nonverbal learning-disabled ATTENTION DEFICIT (NLD/ADD) child is like oxygen that is ignites by a spark of insensitivity. In other words, the other child started it, but it was our child’s perceived overreaction that allowed the matter to escalate to the point that an authority figure was required to intervene.
Such a world is very threatening and adds to the general feeling of vulnerability suffered by the ATTENTION DEFICIT child. For such a child reading people is far more difficult than reading words.
FRIEND: “He played all weekend with little kids.”
Often the ATTENTION DEFICIT child will be drawn to younger children as playmates. In contrast to the usual conclusion that he wants to be “in charge,” such a child may, in fact, not be motorically ready to play successfully with his own peer group. The ATTENTION DEFICIT child will often exhibit a developmental delay in the acquisition of motor skills. Therefore, the gross motor type of play exhibited by five-year-olds may be more comfortable for the seven-year-old ATTENTION DEFICIT child. Also, for the NLD/ADD child, the more concrete communications style of the younger child, especially in the presence of the older child, is free of the nonverbal cues that are relied upon to communicate in age equivalent peer groups. Younger children offer a respite from the nonverbal static which causes an age appropriate environment to be so stressful for the NLD/ADD child.
PETER: “Yeah, people are always yelling or criticizing me.”
As we have seen, Peter’s behavior is such that he faces constant criticism and negative feedback from the significant others in his life; family, friends, and teachers.
PETER: “I guess I do a lot of bad things.”
As a result Peter expresses his developing lack of self-image.
PETER: “It’s one thing to annoy people, I do that, I can’t help it.”
Peter also has a vivid awareness of the basis for his negative behavior, impulsivity. Impulsivity is, perhaps, the most fearful and devastating characteristic of the ATTENTION DEFICIT child. The world responds to his impulsive behavior in an angry and hostile manner. Such an environment fosters feels of vulnerability and isolation which, in turn, erodes self image and retards development of personality and social competence. On occasion an ATTENTION DEFICIT child will not be obviously hyperactive. However, such child will nevertheless exhibit, and be engaged in a constant battle against, impulsivity.
PETER: “It’s another thing to hurt people.”
Even the most impulsive persons exercise some control. The vast majority of us control impulses that may be considered rude, inappropriate or merely inconsiderate. We don’t struggle with impulses, even fleetingly, that may involve injury to others.
Controlling oneself from committing an inconsiderate act resolves itself on the plus side of the ledger of self-evaluation. Having to control what may be perceived as an evil act resolves itself on the negative side of the ledger even though it is effectively controlled, e.g., “How could I even have thought of that?” The ATTENTION DEFICIT child, therefore, provides himself, the most insidious insult of all to appropriate development of personality negative self-criticism.
There are many problems associated with the ATTENTION DEFICIT child that have not been discussed, but that also result in misunderstandings. Sequencing: he knows the months of the year but doesn’t know what month comes before July. He has difficulty completing multiple tasks presented sequentially, e.g., the directions“turn off the stove, feed the cat and put the milk away” result in a hungry cat.Organization: he goes out to play in the snow without gloves or scarf, he is “always forgetting something”. Short term memory: he interrupts a lot; he understands a concept one-minute and doesn’t understand it the next; “You know that! We just went over it a minute ago.” Auditory processing lag: as a flow of new information is presented he encounters periodic information overload. Often he is caught ”staring into space” while this overload of new information is being processed. If such a child is given the time he will absorb the overload and regain his ability to focus on additional input.
The ATTENTION DEFICIT child is a complicated amalgam of predictable physiological anomalies. In other words, he is different but we know what makes him different. With such knowledge we can recognize our child’s disabilities and strengths and turn failure into success.
Identifying the child who is at risk for developing emotional problems is the first important step in prevention. The second step is to recognize the importance of prevention.
Statistics gathered from drug and alcohol rehabilitation programs, from juvenile court systems and studies of adult prison populations show that the most prominent common factor shared by the persons involved is not race, environment or education, but learning disabilities. The dynamic involved is conceptually relatively simple. A learning disability and ADD carry a risk factor which often results in diminished self esteem and affects the appropriate development of ego and personality thereby interfering with the acquisition of social skills. Social competence, including problem solving skills, is the most significant casualty of such impaired development. The lack of social competence and self-esteemfosters self destructive behavior often accompanied by antisocial acting out.
The purpose of this article is to create a teachable moment to point out a need and create a desire to know more. A considerable body of knowledge, together with specific techniques and strategies for remediation, are available to effectively prevent the development of significant emotional problems in the ATTENTION DEFICIT child.
Learning about the ATTENTION DEFICIT child and why he does the things he does carries immediate rewards. Anger, hurt, guilt and confrontation are replaced by understanding. Parents and teachers can concentrate on building strengths rather than exposing weaknesses.
Simple decisions have been found to make important contributions to development, e.g., picking the right camp or promoting certain types of extra curricula activities.
However, there are a great many questions that cannot be answered without help: “What about medication?”, “Who should know?”, “Therapy?”, “Behavior Modification?”, Positive v. Negative reinforcement?”, “Which problem solving strategy is best?”, “How do we get the school, therapist and family to work together?”, etc., etc. Everyone in the life of the ATTENTION DEFICIT child plays an important role in his development. We must all accept the responsibility, and the rewards, of nurturing this bright and energetic child in such an environment as will allow him to reach his full potential.