I met with Tom's parents to review my clinical evaluation of their nine-year-old son. During my initial interview, Tom’s father kept one leg crossed over the other and his foot swinging up and down. Occasionally, he would place both feet on the floor. When he did, his toes touched the floor and his heels moved up and down. He seemed to follow what I was saying, but he was looking at the pictures on the walls.
Tom’s parents came to see me after a recent meeting with their son’s fourth-grade teacher, who expressed concern about Tom’s inability to stay in his seat and to keep his desk, notebook, backpack, and homework organized, so that he could find things. His parents were not surprised by this feedback. They had heard about these same problems in his third, second, and first grades, and, as Mom explained, “We live with the same problems at home.”
I reviewed my impressions. I explained that Tom had ADHD. Tom showed a chronic and pervasive history of hyperactivity and inattention. His inattention led to problems with executive function — organization and time planning. His parents agreed to start a trial of medication. I explained that once the benefits of medication were clarified, coaching, tutoring, or other approaches would be added.
A Family Thing
I said that ADHD was often inherited and commented that Tom’s father seemed fidgety. I asked him if, like his son, he also had difficulties with organization and time planning. He was annoyed. “Of course not! I am an engineer. At work, I manage a team of professionals. We are assigned complicated tasks — and we complete them on time.”
The more he described his career, and his past and current positions, the more it became apparent that he had succeeded by developing organization strategies and time management techniques. He had lists of tasks and time lines on his computer. He trained his secretary to remind him of meetings and the day’s agenda. She laid out the papers and other items he needed at the meeting.
His wife sighed and said, “I wish I had his secretary at home. I wish you would work as hard there to be organized and aware of time.” She gave examples of his forgetting to do things or forgetting something at the store, or his not showing up somewhere on time. At home, his study was heaped with piles of magazines, journals, and paper. It has always been his wife’s job to keep him on task and on time.
“The acorn does not fall far from the tree,” I said. I explained the familial pattern often found with ADHD, and asked Tom’s father if, perhaps, he had ADHD. He did not appreciate my question one bit. “I did not come here to talk about me.” I explained that not all individuals with ADHD are hyperactive or impulsive. Many have what is called Executive Function Disorder, leading to poor organization and time planning.
Accepting His Son
It took several sessions — and a lot of discussion — to get Tom’s father not to see his son as lazy, unmotivated, or stubborn. During this time, his wife spoke to her mother-in-law about her husband’s school experiences. During one of our meetings, she said, “Your mother tells me that you had the same problems in school.” Dad frowned. He did not appreciate his wife’s frank comments.
To decrease the tension in the room, I quickly commented on how successful Tom’s father has been. If he has ADHD, he has certainly learned how to compensate for his problems. At work, he is super-organized, using charts and time lines. I suggested that he could teach Tom to help keep himself organized and on time.
They returned the following week with plans for helping Tom. His mother met with his teacher and the two worked out a system. Homework assignments or dates for pending tests were e-mailed to Tom’s mother. Each night she sat with Tom when he got home and made a list of everything he needed to do for the next day at school, as well as a list of home chores. She and Tom made notes on what would be done before dinner, after dinner, or the next morning. When he started his homework, she sat with him and helped him organize what he had to do and what he would need.
She then helped him prioritize what he would do first, second, and so on. She left Tom to do the work, without nagging him. Before bedtime, she checked that everything he needed for the next day was in his backpack. His teacher cooperated by reminding him to get his homework out and to place it on her desk. She also checked to find out if he had his homework assignments written down.
But how could Tom’s dad help his son? I introduced the idea of helping him with sports and extracurricular activities. Perhaps he could be an assistant coach and help his son stay on task. Since both were hyperactive, I suggested that Tom might like track or cross-country. If so, they might jog together. As he became more accepting of his son’s problems, they got a lot closer.
Boys need to identify with their fathers and to be accepted by them. The male self-image is formed by this relationship. Medication helped Tom, and a 504 Plan listed strategies for structure and organization at school. But Tom really blossomed as he and his father did more things together.
Are things perfect now? Perhaps not, but things are immeasurably better. Tom is improving at school, although we all worry about middle school, with its multiple teachers, teaching styles, and types of homework. Home time is better. Dad showed his son how he learned to manage his disorganization at work. Tom now keeps a message board near his desk. If he has an appointment or plans to be some place, he writes it on a card and attaches it to the board. He also has a “checklist” board. He attaches a note to it to remind him of something he needs to do, and removes it when the task is done. His father put a sign on the back of Tom’s bedroom door that reads “Did you check your lists?”
At our last session, his mom said: “I think they are both a little odd. But, hey, the new system works for them, and life is much easier for all of us.” I couldn’t agree more.