Life is hard for a person with an ADHD-style nervous system. He is over-aroused and disorganized most of the time, yet he has to live with and enjoy neurotypical people in a neurotypical world. It is hard work, and it is best started early, before bad habits and low self-esteem set in.
During his early years of development, no child, whether he has ADHD or not, has the ability or insight to participate in the therapeutic process. We should not wait, though, to step in and assist children who have ADHD. The earlier we recognize that they have the condition, and respond accordingly, the better for everyone.
The treatment tools that work for an ADHD-style nervous system are comparatively easy to acquire. It is hard, though, to undo the years of harsh and unhelpful feedback to which a person with ADHD has been exposed. It is equally hard to undo adjustments and habits that a person has built up over a lifetime to compensate for a nervous system that plays by different rules.
So here is a treatment plan based on how ADHDers think, feel, and live. One caution: ADHD treatment is at high risk to fail unless a trusted significant other is involved — and stays involved — from the beginning. For at least the first year, the motivation for treatment and the ability to see the benefits will reside primarily in someone other than the patient.
BE TRUE TO YOUR ADHDER
I have been amazed that some people with ADHD and co-existing conditions grow up to be fully functioning adults. They are successful in their jobs and have strong relationships. They raise healthy, resilient children (half of whom also have ADHD-style nervous systems). What is it about them and their upbringing that helped them become happy, loving adults?
The most important factor is someone who unshakably believes that the child or adult with ADHD is a good person. A young child needs someone to tell her that she is hardworking, intelligent, and loving: a parent, brother or sister, a grandparent, neighbor, or a teacher. This cheerleader distinguishes between the child’s worth and her achievements — to say, “I know you. I know that if anyone could have been successful through hard work and perseverance, you would have been. Something we haven’t yet identified must be getting in your way. I want you to know that I will stick with you until we figure out what is getting in your way and fix it.”
Since most parents and spouses do not understand how the ADHD brain is wired, they try what worked for them as kids, or say what their parents told them when they failed or fell short. The most common response is to admonish the child and insist that he re-try the techniques that just failed him. The implication is that the child did something wrong or did not apply the technique hard enough or long enough. Either way, it is the child who is wrong, not the technique. This approach suggests that the child failed because he has a fundamental flaw. He has bad character (“You’re lazy”) or is consciously defying you (“You can do it if you really try”).
The parent or non-ADHD spouse has to ask, and honestly answer, the question: Do I really want my child or spouse to be neurotypical and do things the way I do them? Or do I want him to be the best ADHDer he can be?
KNOW THY ADHD
ADHD therapy must start with understanding what ADHD is, what is possible for the person to achieve, and what is not. Accountability and responsibility are good things, but only if they lead to success. Such judgment calls are among the most difficult that a parent, spouse, or loved one has to make. Sometimes it is not clear what is possible and what is not. What is not possible now may be possible later.
Do not hold people accountable for things that are impossible for them to accomplish. This has been the basis of many therapeutic methods that have never shown lasting benefits. Their only outcome is serial failure. The more the ADHD person loves the authority figure and wants to please him, the greater the pain and frustration of failure.
The person with ADHD should not be the sole focus of therapeutic intervention. It is important that everyone in the family knows what is going on and how to be part of the solution. It is also important to acknowledge the problems encountered by other children in the family. Most non-ADHD siblings spend their childhoods feeling shortchanged or neglected because they were good and didn’t require a lot of attention.
LEVEL THE NEUROLOGICAL PLAYING FIELD
The successful treatment of ADHD symptoms should include medication that is consistently taken. Several years ago, a group of practitioners argued about whether to require their clients to take medication before coming to therapy sessions. They talked with other ADHD practices and research clinics to see what they did. We concluded that our clients should be on medication when they came in for their sessions. If they weren’t, they were sent home and charged for the session. My advice to ADHD patients and their spouses is:
> If you’ve tried ADHD counseling or coaching without ADHD medication and didn’t get the outcome you expected, try it again with medication.
> If you tried medication and did not like how you felt on it, find a clinician with more experience treating ADHD and try again. Most patients eventually find the medication and the dose that work well without side effects or changes in personality.
> For an ADHD child who might also have learning disabilities, the American Academy of Child and Adolescent Psychiatry recommends that psycho-educational testing wait until ADHD medication has been optimized. Untreated ADHD may confuse the testing results.
> If the ADHDer doesn’t believe in medication, and won’t try it long enough to see what it has to offer, he is insisting that things have to happen on his terms. Nothing will change for the better. Not ADHD or anything else. The recovery community embraces the acronym HOW. So should the ADHD community:
1. Honesty — admit the effect that ADHD has had on your life and on your loved ones
2. Openness — don’t hold anything back out of fear of being humiliated, blamed, or shamed
3. Willingness to do what it takes to take control of your life.
Medication can return the patient’s attention span, impulsivity, and motor movements to higher levels. With medication, most ADHDers are on a level playing field, often for the first time in their lives.