When and How Should We Adjust Treatment?

What Is an ADHD Prosthetic?

The textbook definition is a device that replaces something which may be lost through trauma, disease, or a condition present at birth. In my daughter’s case, it was not a device but rather a series of scaffolds that helped her build habits hampered by ADHD. For your child, it might be something else entirely.

Boy in goofy glasses

The parent of my 9-year-old client sat across from me with a scowl on her face. She had just come from the eye doctor, who proclaimed that her child needed glasses. She didn’t buy it. “He could see, if he tried harder,” the parent said. I nodded, understanding.

This parent was so exhausted trying to get her child to see. She’d tried everything — nagging, scolding, punishing. Instead, all her child did was defy her over and over by not seeing clearly. And, unbelievably, her child had the nerve to get upset by the request. To fly into a rage, to lie about seeing, to say he had tried to see, he was intending to see, but instead played with his toys.

“My concern,” the parent continued. “Is that if we get him glasses, we are sending him the message that it’s okay not to try to see. It feels like an excuse. Like we’re enabling him. I mean, he has to learn to see someday, right? He can’t go through life using his poor vision as an excuse not to see.”

Said no parent ever.

But I will admit: When my daughter was little, this was my concern, in a way. I worried that if I told her she had ADHD and that was why she struggled, she would use it as an excuse. It was my ADD. That if I backed off of pushing her, she would think that not trying was an option. That if I didn’t helicopter her success, I would not be modeling the proper way for her to try to achieve. That ADHD medication would be a life-long crutch and she shouldn’t need it. ADHD, I told myself, would not be the excuse for her behavior.

But it is the explanation.

[Download This: The Parent’s Guide to ADHD Medications]

And, like a child with poor vision, with diabetes, or with a physical disability might need help in the form, perhaps, of eyeglasses, insulin, or a wheelchair, so too the child with ADHD needs help. Or, as I have heard ADHD guru David Nowell, PhD, call it: a prosthetic. In medicine, a prosthetic is a device that replaces something which may be lost through trauma, disease, or a condition present at birth. Prosthetics are intended to restore normal functioning. Prosthetics are not an excuse for the disability; they are meant to scaffold the disability.

So, what is an ADHD prosthetic? With ADHD, prosthetics come in different shapes and sizes. For some, it might be medication. For most, it should be support around behavior, time, motivation, planning, and memory — both at home and at school. If a child is blind, you would curate the environment so that he doesn’t bump into things. With ADHD, you need to curate the environment by putting systems in place that make things easier for your child to learn.

When my daughter was 9, she knew that when she came home from school, she was supposed to remove from her backpack the crusty lunchbox, her wet towel from swim practice, and her homework for the night. It wasn’t a difficult task — empty the backpack. My communication of the expectation was clear. Yet, day after day, she would drop the pack at the door and barrel into the house to flop in front of the TV. Why can’t you remember to unpack your backpack?!

Oh, so many reasons why!

[Free Guide: What to Ask Before Starting ADHD Medication]

Working memory problems, for one. Exhaustion from a long day of instructions, another possibility. And a very likely third: she didn’t understand how.

I had a hard time wrapping my mind around that last one. It’s a backpack, after all. What’s not to understand? But for her ADHD brain — a brain that was actually more like a 6-year-old’s than a 9-year-old’s—there were too many steps involved. What am I supposed to do with the lunch box? Where do I put the wet towel? Homework? What homework?

As ridiculous as it seemed for my adult/non-ADHD brain, the prosthetic she needed in order to complete this task was for it to be broken down into tiny, tiny steps — and to be reminded of it daily, until she was able to consolidate the task and no longer need the prosthetic. The first day, her task was to simply unzip the pack for me. I did the rest. Once she had the unzipping down, I added a step. Unzip — plus hand me your lunchbox only. And, so it went, until some time much later, she had it all rote and no longer needed my prosthetic.

As parents of children with ADHD, we need prosthetics, too. They come in the form of therapy, support groups, books, and blogs. Just as our children need scaffolding, sometimes we need it too. There was no excuse for the unrealistic demands I was placing on my child when expecting her to try harder at unpacking her pack. Just the explanation that before I learned how to approach her ADHD behavior differently, I didn’t understand what kind of help she needed.

[Take This Test: Could My Child Have ADHD?]

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