Running head: THE SOCIAL CHALLENGES OF ADHD

The Social Challenges of the ADHD Child Nicholle Judith Greaves Caribbean Nazarene College

In partial fulfilment of the requirements for PS240 Paul Bunsee 3rd December 2010

Running head: THE SOCIAL CHALLENGES OF ADHD

In recent years we have heard much talk about the emergence of this apparent disorder found in children now known as ADHD. Opinions have swayed back and forth as they do with the prospect of any change, from denial and attribution of the behaviour of difficult children being blamed on bad parenting or a strong will, to labelling across the board every child throwing a tantrum as having ADHD. The latter reaction has caused both laymen and professionals alike to become weary and almost dismissive of the term, and consequently intolerant of the traits, returning to casting blame, on parents, the child, the media and so on. Sadly, while the pendulum of opinion swings back and forth, we are running out of time; as the child with a body that betrays him, is left alone and falling through the cracks of our share ignorance. It is the prospect of this aloneness that we address in this paper, as we examine the many ways that this inborn disorder conspires to bring him defeat. I aim to spark an awareness of the very real challenges that he faces so that regardless of what the enduring opinion is on the subject, his can be- I can make it. ADHD Defined Attention Deficit Hyperactivity Disorder has been acknowledged from as early as 1863 when the famous poem Fidgety Phil was written describing its key characteristics. It has been known by such names as Minimal Brain Dysfunction Hyperactivity and Attention Deficit Disorder. The latest term Attention Deficit Hyperactivity Disorder (ADHD), has been chosen by the American Psychiatric Association and is recorded in the DSM-IV TR along with lists of the characteristics that accompany its different strains/concentrations namely: Impulsivity/ Hyperactivity and Inattention. (Wender 2000a). For a child to be diagnosed with this psychiatric disorder they must persistently exhibit at least six of the symptoms of either concentrations, in more than two settings e.g. at home and at school, and some of these symptoms should have been present before the age of 7. Also critical in identifying this disorder is the degree to which these

Running head: THE SOCIAL CHALLENGES OF ADHD

traits disrupt the childs development socially, academically and otherwise. There are three possible categories used to identify the particular grouping of symptoms that a child displays and they are Hyperactivity/Impulsivity, Inattention and the Combined grouping. ADHD is unique in that its symptoms are not catastrophic in themselves and indeed most normal children exhibit these behaviours to some degree with no ill effects to their development. This has led many parents, teachers and even some professionals to both over and under-diagnose this condition to the disadvantage of the mislabelled/mistreated children. What differentiates the ADHD child is the extremity, frequency and patterning of his/her symptoms. (Wender 2000c) This psychiatric disorder affects the childs ability to sustain attention in varying situations, as well as his inability to resist impulses. A few evidences of these challenges are: excessive talking, repeatedly leaving their seat, interrupting and intruding on others, not paying close attending to details/making careless mistakes, not following through with instructions, leaving tasks uncompleted and avoiding tasks that require sustained mental effort. (Bee and Boyd 2010d). The full list of traits is available via the Diagnostic Statistical Manual IV Text Revision. Again the ADHD child exhibits these traits frequently, consistently in multiple environments to the extent that they and significantly hampered. The diagnosis of this condition is very extensive and can only be undertaken by a doctor, psychologist or psychiatrist who has extensive experience in this area. All other possible conditions would need to be ruled out and the childs behaviour and performance at home and school, and other environments examined. Their entire history including the mothers pregnancy, birth and the childs infancy is scrutinized and considered in making the final determination. The Social Development Process in Infants and Toddlers

Running head: THE SOCIAL CHALLENGES OF ADHD

The development of the childs ability to relate to others begins prior to birth. Assuming that all components are ideal and both mother and baby are healthy and happy and receiving optimum prenatal care and diet, the period before birth serves as a time when the baby begins to assimilate information, developing her perception of what the world is like. Bee and Boyd (2010a) make reference to Ainsworth and Bowlby, who argue that the propensity to make strong emotional bonds to particular individuals is a basic component of human nature, already present in germinal form in the neonate. They see this as set of innate survival traits- as the baby cries, smiles, makes eye contact, he compels his caregiver(s) to nurture him. Once parents respond to these signals from the infant, in a predictable way, a sort of rhythm develops and the youngster begins to get a sense of comfort and security in the predictability of their relating. Erik Erikson refers to this stage of psychosocial development in the babys first year as the Trust versus Mistrust phase. He suggests that once the baby has pleasant experiences during this time, she develops healthy and positive expectations of the world. Likewise the opposite is true. (Santrock 2008a). This is the very beginning of her social connection and lays good foundation for what Ainsworth defines as an affectional bond or a long-term essential connecting, with one particular person that the infant shares with no one else. Most times this happens with the mother, even when other caregivers are present. This usually occurs at around the age of 6 months. This attachment Ainsworth says provides the core sense of safety that will be the foundation for the childs schema for this relationship, or as Bowlby puts it, her internal working model. Expectations pertaining to what behaviours are acceptable and which ones would bring a reprimand are determined here. (Bee and Boyd 2010a) The ADHD child has several major challenges to overcome from the onset of his life. Some of these children are prone from early infancy to being restless, having difficulty in feeding,

Running head: THE SOCIAL CHALLENGES OF ADHD

as well as having sporadic crying for no obvious reason. Others fall asleep very deeply and are difficult to awaken. It is easy to see how these symptoms can frustrate the best efforts of attentive, well meaning parents, particularly when this is not a first child, and their methods worked previously. At the very least, this can interrupt the natural rhythm between parent and infant, from which the baby is forming his social schema, at the most, the child may begin to deduce that the world is not a safe place to be. These perceptions both positive and negative are so dominating, that they actually affect the memory of the child in later years; so that they are more prone to remember details of an event that are consistent with their own established pattern of interpreting this relationship, and conversely are unable to recall elements of these interactions that are inconsistent with this schema. (Bee and Boyd 2010a) This explains why a teacher can have such positive results with one student, and such negative results with another. Their relational schemas have created a very powerful bias, that colours their interpretation of all their social interactions. Assuming that their initial interactions have been healthy and they have a foundation of trust in their caregivers, normal children begin to explore wider social connections i.e. they reach for or smile with other babies at around 6 months of age. At a year and a half they play next to each other. Between the ages of 1 and 3, Erikson proposes that the child goes through the Autonomy versus Shame stage. This is where infants are developing their first sense of their ability to cause things to happen. Harsh punishment, or overly restricting them in this stage, can cause them to develop a shameful self perception. (Santrock 2008b). As the ADHD infant becomes a toddler, those that exhibit the hyperactivity trait, are exuberant and constantly active and getting into everything. This childs natural inquisitiveness is accentuated by the malfunctioning of his already limited sense of danger- his impulsivity- thus

Running head: THE SOCIAL CHALLENGES OF ADHD

launches him forward when a normal child might hesitate long enough to be restrained. Hence he often finds himself in dangerous situations in the blink of an eye, and frequently ends up seriously injured. (Wender 2000d). The scolding, punishment or even trauma that is likely to come from an incident such as this will very probably contribute to a sense of shame versus confidence at this stage. For the inactive child, messages meant to coax them to action can be mistaken as disapproval or even inadequacy. The Social Development Process in Young Children Children usually begin interactive play at approximately 36 to 48 months. This falls into the category that Erikson calls Initiative versus Guilt usually 3 to 5 yr olds. In this stage children are expected to take care of themselves, pick up after themselves and interact with a much wider social environment- at school. (Santrock 2008b). It is usual for them to develop an appreciation for having a friend at this age. Through their play and interactions, they continue to develop social skills such as; learning to be sensitive to the feelings of the other, learning to share, to postpone their own wishes in preference of the others and learning how to resolve conflict. The ADHD child has the same developmental need to establish healthy initiative and indeed this is expected of her. Unfortunately her condition simultaneously causes her act in ways that sabotage her fulfilment of this need. Her inattention would undoubtedly become apparent when she is always one of those with the chore unfinished, or something on her person is left unattended to. Where chores have been designated at home, hers is likely to be forgotten or incomplete. Stern scolding and disciplinary measures are likely to follow as her caregivers have been known to assume that the child is just absent minded. These measures though, serve only to compound possible negative messages that she may have already deduced from her earlier years, and possibly serve to form a guilt complex. If she is coached encouragingly though and

Running head: THE SOCIAL CHALLENGES OF ADHD

given cues and reminders, this can go a long way to empower her to achieve set goals and ultimately achieve a much healthier more confident sense of self. The Social Development Process in Growing Children Industry versus Inferiority follows this stage and these are our 5 and 6 year olds. In this stage they enter the primary school arena and there is another vast change of environments for them. Children now have to develop new social skills to cope with a yet wider social body. (Santrock 2008b). The focus on initiative in the previous stage opens them up to a multiplicity of new events. This is accompanied by an unparalleled drive to excel academically, and develop their pedantic skills and concurrently their academic demands also increase. If the child feels that they are falling short of expectations, they can develop a significant inferiority complex, diminishing their sense of self efficacy. (Santrock 2008b). The Social Development Process in the Face of Puberty In middle childhood between the ages of 6 and puberty, as the demands continue to increase the limitations of ADHD become more apparent. The child begins to slowly be differentiated from her counterparts, as she is unable to stay on course with complicated or multifaceted tasks. Frequently she would exhibit aggressive behaviour; another spin off from her poor impulsivity control. ADHD children have been known to taunt, hit and kick peers and often this is the behaviour that commands the attention of the teacher, alerting them to the possibility of a problem. One tell-tale sign is that the behaviour is often fitting for a child years younger than the childs actual age. Their intolerance for change, often propels them to act out when their expectations of peers, teachers and even parents are not met. (Wender 2000b). As the child grows, their dependence on the affirmation of teachers diminishes and is replaced by the influence of peer affiliation. In many cases the ADHD child resorts to clowning to mask the embarrassment that

Running head: THE SOCIAL CHALLENGES OF ADHD

comes from being reprimanded so often, but this most times leads to even stiffer punishments. Many times this clowning secures this childs social status, but also forges alliances and allegiances with negative influences. This more often than not creates for them a hostile social environment, with their peers avoiding them, and their caregivers trying desperately to bring them in line often reverting to extreme and many times; physical means of punishment. When this happens, the message of inferiority becomes cemented in the childs mind, coupled by the sting of misjudgement, as their behaviour is often times attributed to ill intentions. Their impulsive retaliations to this type of treatment does much to confirm this thinking in the minds of peers and caregivers. When the childs symptoms do not command the teachers attention, as is the case when the hyperactivity trait is absent, they are often neglected- assumed to be alright and capable, or at least more capable than the trouble makers. Their issues are assumed to be thoughtlessness and not enough effort given to their work. Just as with the hyperactive student, their needs are overlooked. They usually have much more challenges with making and sustaining friendships as their preoccupation with things outside of the subject matter makes them poor team players, unwitting class participants, and generally unpopular. Unfortunately for them, their need for peer identification is no less. A trained guardian, can use these opportunities to teach offended peers about personal responsibility, and self management, while they work with the ADHD child in an non-judgmental and supportive way teaching him to understand and take responsibility for his particular challenges, and cultivate the skills that would counteract them. This would do much to build their self confidence, their sense of self worth, and as a result; their willingness to put in the extra effort that they will need to extend to build and maintain healthy relationships.

Running head: THE SOCIAL CHALLENGES OF ADHD

When negative impulses surface, the ADHD child is much less able than the normal child to resist them. Consequently, they are more prone than others to carry out forbidden acts such as stealing and lying to cover their tracks without thinking the whole story through, playing with fire or engaging in risky behaviour simply because it seemed like a good idea. (Wender 2000b). Because these behaviours seriously endanger the child and often others, increased pressure is usually applied on the child to give an explanation for their actions, which of course they cannot because the impulse is gone. The ADHD child is in no way intellectually deficient, and on questioning will many times agree that their actions were neither logical nor wise, and often experience confusion as to why they decided to do them. To the untrained ear, it might seem as if the child is lying or concealing their motives to avoid punishment, and the guardian is tempted to apply their own reasoning and motives to the situation. Other times the child holds blindly to their decision to carry out the act, unable to follow through the reasoning that the consequences make the action unfavourable. If the child on the other end of this interrogation has grown up in an unsupportive or ill-equipped home, and has discerned messages that have proven the world to be an unsafe, unfair place, and has since developed a shame based identity, and strong feelings of inferiority, coupled with being repeatedly misjudged, this child is more likely to resist correction, or any attempts to reach out to them. At this stage they have limitless energy and a mind that keeps inventing new things to do; with little impulse restriction and now the rage of injustice added to the confusion as to why they cannot measure up, it is very clear that un-arrested, this youngster is at high risk of becoming involved in increasingly risky and even self destructive behaviour. If we couple this with the hormonal spikes and lows that puberty is throwing at him/her, it is not a far stretch to understand, how their acting out can snowball and land them into the hands of the law or state at

Running head: THE SOCIAL CHALLENGES OF ADHD

10

worst, or set the stage for their dropping out of mainstream society and giving up on trying to fit in or achieve success as we know it- making them later vulnerable to conditions such as depression and bipolar disorder. What is vitally important here, is that their behaviour, even though it may be negative and may even be wilful at times, is not driven by a desire to be deviant, but is a reaction to what they have found to be their fate. It is my belief that even at this stage, if consistent supportvia counselling, proper evaluation and medicines where necessary is introduced, and their caregivers commit to working with them, supporting and bringing structure that help them to train their minds to cultivate sound habits that counteract their deficiencies, that they still have a fighting chance of regaining some semblance of normalcy. The Social Development Process in the Teen - Adolescent Children enter Eriksons stage of Identity versus Identity Confusion stage between ages 10 and 17. Here the predominant need is to form a clear perception of who they are and where their life is headed. Many new roles are introduced e.g. toward the end of this stage- occupational and romantic. Once the youngster is able to explore these different roles freely, he/she finds their best fit and arrives at a healthy sense of self. If they are restricted from this in any way or forced in a particular direction, their sense of identity is confused. This stage is of critical importance to the ADHD child. All of their experiences from infancy, through their middle childhood, and the responses, support or lack thereof, will culminate in their determining their opinion of self. Where they have received adequate support and have been able to stay on par with their regular counterparts, experiencing the full range of opportunities available to them, and learning to manage the social relationships effectively, they are well positioned to explore different options, with little fear, and a healthy confidence in the balancing mechanisms that they have proven, or otherwise a support system that is reliable. When they

Running head: THE SOCIAL CHALLENGES OF ADHD

11

have not, the very nature of their disorder, has robbed them of various bits and pieces of their developmental processes, leaving them with feelings of gross intimidation and lack of self confidence at least, and a disbelief in their abilities and subsequent abandonment of the process, and a commitment to deviant compensatory behaviour at worst. In the latter case these children are labelled and many times told that they do not have any plausible future ahead of them, most times in the hopes that such warnings would propel them to change. However, since the root of their behaviour is psychiatric, and they do not possess by share will power, the ability to change, all this serves to be is the prediction of a self fulfilling prophecy. A caring and knowledgeable teacher can work with the student, helping them to recognise and acknowledge their particular challenges. They can also be sensitive to the childs needs- e.g. to take a break more often than the other classmates, or otherwise to have more visually and audibly stimulating material incorporated into either the lesson or their particular assignments. In the classroom, they can be sure to involve them asking them questions that they are likely to know the answers to, to boost their confidence and self image, scaffolding them when they are unsure of the answer. A caring parent or guardian, can be there, to listen and be support for the child at home, cushioning them from the trauma of it. They can be, if nothing else, an ear, which is one act that speaks volumes to a child that they are valuable. They can consistently affirm them, and engage them in setting realistic goals, and celebrating with them when these are achieved. They can help them to identify their strengths and weaknesses, giving support whatever their choices. In this way, they can be a safety net of sorts, catching them where their prior experiences have let them fall, birthing and nurturing a healthy trust in themselves and the reward that awaits their consistent effort.

Running head: THE SOCIAL CHALLENGES OF ADHD Conclusion

12

We have examined the ADHD condition. We have looked at the ADHD child from their extreme vulnerability in the prenatal stage, to their infancy and toddler stage where their condition rears its head, jeopardising the foundations of their vital trust mechanisms. Weve looked at how these symptoms to varying degrees endanger their healthy sense of self efficacy, which if not harnessed can leave them timid and socially inapt. Weve seen that in their early and middle childhood, because of their need to belong, incorrect handling of their symptoms can lead them to act out in ways that put them at further risk causing isolation, and finally, weve looked at how all this without intervention culminates to setting the stage, for a disillusion youngster, with a fragmented sense of identity that has no place in society as we know it. Being born with a disorder is not a crime. We must do our best to seek out, support, encourage and empower our ADHD youngsters, giving them the best possible chance to succeed. No matter what their circumstance, in the words of Gary and Sharon Rosenfeldt it shouldnt hurt to be a child.

Running head: THE SOCIAL CHALLENGES OF ADHD References

13

Bee H. and Boyd D. (2010a). The Development of Social Relationships: Attachment Theory The Developing Child, (pp. 284, 285). (12th ed.). Pearson Education Inc. Bee H. and Boyd D. (2010b). The Development of Social Relationships: Parent-Child Relationships in Adolescence: Increases in Conflict The Developing Child, (pp. 290, 291). (12th ed.). Pearson Education Inc. Bee H. and Boyd D. (2010c). The Development of Social Relationships: Peer Relationships in Infancy and the Pre-School Years. The Developing Child, (pp. 297). (12th ed.). Pearson Education Inc. Bee H. and Boyd D. (2010d). Atypical Development: Attention Deficit Hyperactivity DisorderDefining the Problem. The Developing Child, (pp. 401, 402). (12th ed.). Pearson Education Inc. Block J. and Smith M. (2010). ADD/ADHD and School: Helping Children Succeed at School Retrieved from http://helpguide.org/mental/adhd_add_teaching_strategies.htm Santrock, J. W. (2008a). Prenatal Development and Birth. Life Span Development, (pp. 108-115). (11th ed.). New York, NY: McGraw-Hill. Santrock, J. W. (2008b). The Science of Life-Span Development: Psychoanalytic Theories; Eriksons Psychosocial Theory. Life Span Development, (p. 41). (11th ed.). New York, NY: McGraw-Hill. Wender P. H (2000a). Preface. ADHD Attention Deficit Hyperactivity Disorder in Children, Adolescents and Adults, (p. n.a.). New York, NY: Oxford University Press Wender P. H (2000b). Introduction. ADHD Attention Deficit Hyperactivity Disorder in Children, Adolescents and Adults, (p. 5). New York, NY: Oxford University Press

Running head: THE SOCIAL CHALLENGES OF ADHD

14

Wender P. H (2000c). The Characteristics of Children with Attention-Deficit Hyperactivity Disorder. ADHD Attention Deficit Hyperactivity Disorder in Children, Adolescents and Adults, (p. 9). New York, NY: Oxford University Press Wender P. H (2000d). The Characteristics of Children with ADHD: Hyperactivity. ADHD Attention Deficit Hyperactivity Disorder in Children, Adolescents and Adults, (p. 12, 16). New York, NY: Oxford University Press