Normally, when I write an article, I discuss topics and problems which have solutions. Today I’d like to discuss an important issue which confounds me as a parent and also gives me difficulties as a therapist. I firmly believe that ADHD is difficult for others to accept and tolerate because it is invisible, and has so many manifestations and so many contributing factors. Let me explain.
My son was recently diagnosed with ADHD, combined type. He scored in the 96th percentile for hyperactivity. If he were seeking perfection, he got pretty close – perfectly hyperactive. On the BASC (Behavior Assessment for School Children) his teacher noted his inability to sit still, stay focused in a group setting and his “weird” (her term, not mine) habits. My son chews his clothes, pokes holes in his clothes, picks at his hair, touches his face oddly and spins on his knees. He has also been known to roll around on the floor when the rest of his class is in circle time. On the other hand, the teacher commented that my son is gifted academically. He taught himself to read and he has a natural ability to sound out words and spell them. He is in kindergarten and he is reading Harry Potter and the Sorcerer’s Stone with just a smidgen of help. His math abilities exceed all his classmates. And his drawings show an unusual attention to detail for a 6 year old. He is good at adult problem solving apps like “Cut the Rope” and “Doodle Fit”.
The whole point of this narrative is that given my son’s intellectual and detail skills, you would expect that he would understand that his behavior is not like the other children’s. You would think that he could control his “weird” behaviors if he has the ability to read and comprehend advanced content. You might expect that he would know that he is different. Yet he doesn’t understand or control any of these things. I am extremely grateful that his teacher does understand this dichotomy and has the skill and patience to do the right thing. Unfortunately, not everyone who has to interact with my son is as enlightened as his teacher.
ADHD is so frustrating for parents and teachers because the child does understand intellectually what is wrong. If you ask my son “Is it okay to chew your clothes?” he would give you a definitive “no”. He knows he shouldn’t talk back, or that he can’t fidget an entire music lesson. But his awareness is absent every time he chews, or talks back, or fidgets.
To make matters worse, ADHD often presents with one or more co-morbid conditions. Oppositional defiant disorder, mood disorders, conduct disorder and bi-polar disorder can co-exist with the ADHD. Children with ADHD can have CAPD (auditory processing problems), dysgraphia, coordination issues, and motor planning issues (dyspraxia or apraxia), Dyslexia, sensory processing disorder and more. My son has issues with coordination and motor planning. He failed miserably at karate. I think he was the only student who never progressed to the next belt. He spent all his session time investigating his belly button in the mirror and making funny faces. He has trouble catching, throwing and kicking a ball. Fortunately, after a lot of effort from his instructors, my son started to excel at skiing. But until he caught on, I used to get disturbing comments from his instructors. One coach dropped him off in the nursery when my son was 5. It seems my son’s behavior infuriated him. My son didn’t listen and hid in a ski locker during lunch break.
No one who deals with my son and expects him to “toe the line” cares that I’m an O.T. and that I have a lot of experience with ADHD. The instructors who believe that “it’s a boy thing” and that he needs to shape up don’t want to hear that he needs help when he is over tired or over stressed or over stimulated. What they believe they understand is that he is a smart boy who is badly behaved. And that is the crux of the matter.
Children with ADHD aren’t just badly behaved, and they can’t just “toe the line”. But who can tell given the fact that they’re smart and social and seem to understand wrong from right? Unenlightened teachers think these children are underperforming and are lazy. Misinformed parents think they can threaten or prod their child into doing better and behaving better. Oh that it were that simple!
Think about it for a moment. A child is smart and has good aptitude. Why shouldn’t he be able to perform better at school or at home? The answer to that is easy if, and only if, you can solve these issues – give him better impulse control, improve sensory responses, improve internal organization, decrease distractibility, treat each and every co-morbid condition and treat each and every learning disability. Nothing to it. When all problems converge that are related to the ADHD, all an uneducated eye sees is a badly behaved, underperforming and unmotivated child. They cannot see what I know to be true as a mom and as a therapist. My son is not generally badly behaved. He has ADHD. It is an enormous task to educate those who don’t understand it for what it is.
I’ll tell you a little story which highlights my point. I seriously injured my shoulder from too many years of lifting and treating very involved children. There are tears in my rotator cuff. I will soon have surgery to fix it. But I can still ski. What I can’t do is lift and carry my skis. So my husband picks up my skis when I take them off and carries them for me. Someone noticed this and commented on how “doted on” I was by my husband. My friends and I had a good laugh at that one. Then one of them said “you need to hang a sign on you saying ‘I’m not a princess, I’m disabled’”. Because no one can see that I’m injured, they jump to the wrong conclusion. Wouldn’t it be easy if everyone wore a sign? When a disability is invisible, people frequently make the wrong assumptions. Damage done. Here is my request. Please don’t make assumptions. Just because you don’t see it doesn’t mean it isn’t so.
Nancy Konigsberg is a pediatric occuational therapist with more than 16 years of clinical experience. She specializes in neuro-muscular disorders, behavior problems and genetic disorders. Read her O.T. blog Milestone Mom in which she describes developmental disorders and offers treatment protocols and advice.