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MENTAL HEALTH SERIES, PART 5
TUNING IN TO ATTENTION DISORDERS
This is the Fifth blog in the Mental Health Series. These blogs correspond to six foster parent training classes that I am facilitating at San Bernardino Valley College on Tuesday and Friday mornings from 9 a. m. to Noon, starting September 28 and concluding on October 15, 2010. If you live nearby and want to attend the classes, email me.
Here are the topics covered to date with corresponding links to the material covered.
What Does Mental Health Look Like?
Responding To Depression In Foster Children
Soothng The Anxious Child
Understanding The Diagnosis Of Bipolar Disorder
Today we are going to discuss Attention disorders, learn to recognize some of the outstanding symptoms, and learn ways to talk to children and teens who have been diagnosed with an attention disorder. Notice I did not say HAVE an attention disorder, but diagnosed with.
You have several brief but informative articles on Attention Deficit Disorder and Attention Deficit with Hyperactivity Disorder. For those not in class, check out the link
There are brief articles plus links on this site about the diagnosis, diet, medications, and treatment. Check it out.
WHAT DO WE SEE
-Making careless mistakes in schoolwork
-Difficulty sustaining attention to tasks
-Not listening to what is being said
-Losing and misplacing belongings
-Fidgeting and squirming when seated
-Interrupting or intruding on others
-Difficulty in playing quietly
These observed behaviors make sense when we take a look at what we have learned about brain chemistry in children identified as having an attention deficit.
Studies have led scientists to believe that three areas of the brain are involved in children diagnosed with ADD or ADHD: the prefrontal cortex, part of the cerebellum, and the basal ganglia. In particular the prefrontal cortex and basal ganglia are smaller in children identified with attention deficit disorders than other children. The prefrontal cortex and basal ganglia are parts of the brain that are involved in executive functioning, for example, making decisions about behavior and impulse control. They have theorized that these areas are smaller because of gene mutation and it seems that the mutation involves more than one gene.
In addition, research seems to indicate that a key player here is the neurotransmitter Dopamine. There are both receptors and transporters of Dopamine. Dopamine transporters gather up unused Dopamine. In children identified with attention disorder, these transporters are either unreceptive or overly receptive. In either case an imbalance of dopamine results.
The incorrect transportation of dopamine in the brain causes a person to have less control over his executive functioning. "These executive functions include four operations: the operation of working memory, the internalization of self-directed speech, the controlling of emotions, and the reconstitution of behavior.
The use of psychostimulants, which unfortunately are related chemically to cocaine, seems to prevent the transporters from receiving Dopamine which then keeps the Dopamine level in the brain balanced and executive functions working normally.
So in a sense, a hyperactive child does not have a hyperactive brain, as such, but an underactive prefrontal cortex and basal ganglia.
I am not a researcher, and I probably need to become one, as more and more people want one to back up their commentary with facts. I have, however, been in the mental health field since 1967 and in private practice since 1982. I have worked with many many many children with the diagnosis of either ADD or ADHD.
I find that there is a high correlation between the diagnosis and temperament or personality style. It seems to me that there is a high percentage of these children who are also identified as tactile learners, and within the Myers Briggs Temperament lingo are identified as SP’s. SP’s are people, both adults and children, who are very hands on, very present focused, don’t think too much about the past or future (think consequences), are easily bored, in fact bored out of their minds. They are risk takers, and ironically, sometimes are extremely good at resolving a crisis. However, once a crisis is resolved, they are liable to get bored and create a new crisis. They do not relate well AT ALL to authority, so to establish a relationship with them, it is important to find a way to be an equal with them, even if you are the boss. And they will always get even if you hurt them by using your authority over them.
I have no data indicating whether folks identified as SP’s have the same brain anomalies cited above for children with ADHD.
*Just as we did with our discussion on bipolar last Friday, we want to look at other explanations for someone being "hyper" and unable to focus and control their impulses. So let’s start by asking ourselves, when does that happen for us as adults? What can happen in my life that will make it impossible for me to pay attention, to focus, to control my impulses, to make good decisions?
Let’s take a few moments to think, reflect, and then share.
*We identified very important chemical processes that seem to correlate with Attention Deficit, so it also makes sense that children exposed to drug use during gestation, or brain injury during anytime of one’s life could have similar brain anomolies due to the drug exposure or injury.
*And what about the impact of trauma on our brain chemistry? What happens behaviorally when we resort to survival mode as a way to cope? Might there be times that our survival behavior will look similar to the child diagnosed with attention disorder? And what about depression? Depression, as we indicated before, causes a similar disruption between the prefrontal cortex and the limbic system, particularly the hippocampus, so we have a difficult time making decisions about stressful events.
Again the bottom line is how will we respond to the child whether labeled with ADD or ADHD or some other label.
Again we are looking at issues related to regulation. We are looking at issues related to focusing, decision making, impulse control, inability to tune in and listen, inability to sit still and experience calm. Remember what we said last week about regulation
By regulation, we're talking about the need for an abundance of many life essentials. They need for the chaos in their lives to be kept to a minimum. They need to live in a predictable and somewhat scheduled routine, so going to be at a certain time, getting up at a certain time, eating meals at a certain time, and so on. They need to have sufficient time and affection from the big people in their lives so they can experience being loved even if they cannot take it in. When they are falling apart and tantruming, no matter what age, they need calm big people to surround them and scoop them up, so to speak, and gently put the pieces back together. They need a certain number of hours of sleep each night. They need sufficient amount of food and nutrients and vitamins on a daily basis, sufficient fluid, especially water, just like we all do. They need big people to coach them kindly when they are moving into extremes, whether it be extreme melancholy or extreme silliness. Note, they need coaching, not discipline or punishment. They need sufficient space and time to cry and cry a lot without someone implying that they have cried enough or that they are a cry baby. Knock it off macho s**theads!
SO HERE IS THE BIG QUESTION FOR YOU. IS WHAT I AM ABOUT TO SAY OR DO IN RELATIONSHIP TO THIS CHILD WHO IS IDENTIFIED WITH SOME FORM OF ATTENTION DISORDER, IS IT GOING TO SUPPORT THE CHILD DEVELOPING FOCUS, IMPULSE CONTROL? WILL I BE PROVIDING REGULATION AND SOOTHING FOR THIS CHILD OR AM I CREATING CHAOS, AM I PUSHING THE CHILD TO TUNE ME OUT?
AS ALWAYS SAMPLE SCRIPTS
Take child’s hands, if child is short, have child stand on stool or chair. Make pleasant eye contact. "Hey, how’s it going? Good! Gotta a couple of things I want you to do for me........Come back and tell me when you’re done." When the child comes back to tell you, do not add additional chores!
"You’re having a hard time sitting still, I can see. It’s okay. I get fidgety too sometimes. Come over and sit next to me."
"Okay, I see you are struggling with your homework. Let’s stand up and take a walk out to the back yard. Hold my hand.....Have you noticed......Okay, let’s go back in and give it another shot. I’m going to set this alarm for ten minutes and each time it goes off, I’m going to come over and give you some extra support......"
"You know, I get it. It is really hard for you when someone calls you a name, not to hit them. I get it. I really really do. And we also have a rule in our house that applies to everyone. No one is allowed to hit you either......"
"I know you get a little crazy when it’s time to visit. That’s okay. We’ll get through it."
"Alright, so let’s make this fun. I’m going to spell you words on your back and then you spell them outloud."
"Wow, you are so good at these video games. For some reason, I don’t have what it takes to stay with it, but you sure do. Look at your score, for crying out loud."
"Hey, you know I whine just like you are when I can’t handle the frustration. I just do it where no one can hear me. What can I do for you right now?"
"Okay, it’s time for a treatment.....Going to help you focus....."
"You know, someone told me that doodling helps to calm your nerves and helps you focus. Have you ever tried that?"
"You know someone told me that listening to music helps you concentrate while you work. Want to try it and see if it works? So let’s see how many pages you can get done in the next ten minutes with the headphones on?"
"What would make it possible for you to really give your best effort with this homework?....Well guess.....I’m interested in making you successful here."
"You are so funny. But shhhhhh, so we can hear the movie."
"I think it is so cool when you want to help.........You are so good with your hands. Wow, the stuff you create....make.....fix.....You are awesome. You know you could make money!!"
"Hey, let’‘s frame some of your artwork and take it to the art show."
"You have that second base position down pat. I noticed you get frustrated when you are up at bat. We’ll get there. You’re doing great."
"Hey, I saw what happened out there. I don’t know what to tell ya, but just between you and me, it’s kind of dumb to fight with the ref. You know what I mean? You get kicked out of the game just like you did!! Man, they need you in that game. So how can I support you the next time? Let’s have a plan."
AGAIN, NOTICE THE FLAVOR. You are setting limits. You are providing regulation. You are taking into consideration all the different possibilities of what is going on in the brain. You are avoiding punishment, but at the same time holding them accountable and responsible.
SHARE WITH US YOUR DIFFICULT KIDS. IF YOU ARE ON THE HUB, SHARE YOUR DIFFICULT KIDS IN THE COMMENT SECTION AND I WILL RESPOND.
THANKS FOR BEING HERE THIS MORNING AND PARTICIPATING.