Thoughts on the Diagnosis of ADHD

Last week my 10-year-old daughter was diagnosed with ADHD. It took me a while to find the mental space to read the material the doctor gave me. Here are some of my thoughts while reading it through.

On the behaviour modification suggestions: Yes, I figured almost all of that out myself. I already do 90% of it.

When my kids were little I trained them so well that now, when I go out in the mall with my 17-year-old who has mild autism and my 10-year-old with ADHD, they still hold hands. When I turn to leave the store, they keep an eye on me and follow right away.  I love it!

A friend read a book awhile back about how extrinsic rewards can diminish a child’s internal motivation.  I knew I had a problem with that, but I wasn’t sure quite what it was.  The pediatrician who diagnosed my daughter gave me Dr. Russell A. Barkley’s “A Theory of ADHD.”  In “Core Principles for Managing ADHD Children: 4, Saliency of Consequences” he says, “ADHD children seem to need more salient, higher magnitude consequences than normal children to manage their behaviour.  Be more materialistic without apology. You are not replacing their natural internal motivation because they don’t have internal motivation. A payoff for work is OK.” [His emphasis throughout.]  So that’s what it was that was bothering me about that book….

The best my daughter ever did at cleaning up was when we made it a video game – I held the appropriate garbage or toy container, and made bleeps and dings and gave points whenever she put something in. It worked great!  But was sadly too labour intensive for me. Faster to clean it up myself. Now she cleans smaller chunks but with less assistance. But apparently small, immediate rewards is exactly the type of motivation she needs.  “Time is the enemy,” says Barkley in “Implications for Understanding ADHD,” and I have to agree.

Barkley’s ultimate level of punishment is to put the child in an empty room until they stop screaming, and be prepared to replace plaster.  I won’t say that has never happened at my house.  However, I found the more effective ultimate punishment to be what I think of as the “strait-jacket hold.” I take the child on my lap, wrap my legs around their feet so they can’t kick me, hold their arms across their body with my arms so they can’t hit or pinch me, and tuck their head nice and tight under my chin so they can’t head-butt me.  They hate it, but being held calms them down much faster. Once they’ve calmed down, served their time-out, and decided on a better course of action, I let them go with a hug. Both kids (the one with autism and the one with ADHD) fought this out for a couple hours the first time, fought for a much shorter time the next time, and calmed down very quickly once in the hold thereafter. It takes a bit of experimentation to figure out how to hold them so they can’t hurt themselves or you. The first time I did it with the second child, she quickly realized she was quite stuck, and I laughed and told her “Sorry, your big brother taught me all the tricks!”

I don’t cry often.  But I had a good cry when I read (again in Barkley): “Your methods and programs will not work all the time with an ADHD child. When they fail, do not necessarily attribute this to your own failure or inadequacies as a caregiver to this child. ADHD children typically show wide variability in their behavioural control and work production for no apparent reason. … Give up the guilt.” [His emphasis.] It’s not my fault! When my son was diagnosed with Muscular Dystrophy and later with Autism, relief that it’s not my fault was my most immediate and strongest emotional reaction.  With my daughter, I’m also angry that I have another “special” child to deal with, another diagnosis to learn about, another situation that will never be perfect no matter how well I manage it.  I wanted her to grow out of it… but she won’t. We’ll both get better at managing.  Now ADHD will be the obstacle, both of us working together against ADHD to accomplish a goal we agree on – instead of us fighting each other, her for the immediate gratification and me for the long-term goal. But it’s nice to know, even with two diagnosed children, that it’s not because I’m a bad mom that my kids struggle in public, in school, and sometimes in extended family gatherings. It will be okay. It may even get better.