‘Pills don’t teach skills’ says ADHD parent

NICOLA MILTZ

The successful clinical psychologist and mother of three has two sons (she has asked for them not to be named) with a form of attention deficit hyperactivity disorder (ADHD).

Her second child was diagnosed first with Attention Deficit Disorder (ADD) when he was very young. He was dreamy, unfocused, and distracted. Her first born was diagnosed later with ADHD, and he was prone to outbursts, tantrums, obsessive nagging, arguing, and anxiety.

Attention deficit hyperactivity disorder comprises three distinct subtypes namely inattentive (traditionally called ADD), hyperactive-impulse (traditionally called ADHD), and a combination. Symptoms can vary widely from the bouncing-off-the-walls energy to quiet spaciness and profound disorganisation.

Phillips gives talks at schools that relate to the lessons she learnt in bringing up these children. She delves into this complex and highly misunderstood neurological condition that often leaves parents (and teachers) frustrated and bewildered.

After trying to fathom what made her boys tick, it finally clicked that they had a neurological condition, and that their behaviour was out of their control and not their fault.

It was then that she realised that her job going forward – if she wanted to maintain her sanity – was to teach them how to manage themselves so they could function better.

Instead of viewing them as being “put on earth to punish her”, she began to see them as little boys struggling to regulate themselves, and most likely feeling quite frightened and overwhelmed, she told the SA Jewish Report.

She read all she could on the subject, and gained a deeper understanding of how the brains of children with ADHD work. It changed how she dealt with her boys, and led to her developing her ADHD parenting course.

In a nutshell, she explains how all the functions affected by ADHD are located in the frontal lobes of the brain. This is the part of the brain that has to be awake to carry out vital functions such as sustained attention, organisation, planning and prioritising, time management, emotional and behavioural control, and working memory, for example. She calls these “executive skills” as they “execute our daily ability to function effectively”.

In all of us, dopamine is the main brain chemical and neurotransmitter responsible for waking up our brain to carry out all these executive functions such as to sit still and calm down.

In the brain of a person with ADHD, a message is fired off by dopamine, and then there is a “re-uptake system” which, she explains, literally acts like a vacuum cleaner sucking the dopamine back so that the message doesn’t get across fully . There is no scientific way to measure how much dopamine gets sucked back, which explains the wide range in behaviour.

Medication triggers more dopamine being absorbed, which goes a long way, but there is often still a gap. Medication also does not teach a child how to think or plan.

“Pills don’t teach skills,” said Phillips.

“We have to do the teaching very consciously, intensely, and for much longer than for a non-ADD child,” in order to alter and lay down new neural pathways, she said.

She realised that her job was to play the role of being “my children’s frontal lobe”, while at the same time teaching them the skills they needed.

“Both ADHD and ADD kids are distracted. While ADHD kids are distracted by their external world, everything going on around them, ADD kids are distracted by their internal worlds – their thoughts and ideas – and so become dreamy and lost in their own thoughts.”

She learnt some fundamental lessons along the way which she shares with parents and teachers.

She learnt to stop telling her boys to sit still or stop fidgeting. The movement wakes the brain up to stimulate dopamine production. Instead, let them use a fidget cube, squeeze a stress ball, or sit on a bouncy ball.

She learnt that she had to engage and activate her sons’ brains in order to keep them producing dopamine. She had to gain their interest and engagement. This required imagination and consistency.

“The best method to stimulate the uninterested brain is short-term rewards. These kids thrive on reward, and they do badly on punishment.”

Phillips has many creative ideas for parents when it comes to homework which helps keep the dopamine levels flowing and the tantrums or apathy at bay. Break the work down into sections, put in short movement breaks, use lots of different mediums like crayons or window markers.

Getting dressed for school can be torturous. “Make it fun by playing a favourite song, or challenge them to get ready by the time you count to a certain number,” she said.

“It is very draining and exhausting initially,” but eventually new behaviours kick in, she said.

Children with this condition can lag behind in maturation by two to three years, so she urges parents to keep their expectations reasonable, and not compare their children to others as it can be damaging to their self-esteem.

To encourage self-interest, say to the child that if you do your maths now, then you can play soccer afterwards. “If they know that they will get their reward by doing what you want, they are far more likely to go along with it and it reduces the tantrums.”

Phillips encourages a growth mind set, so that with effort and practice they can improve and change.

Tied into this is the importance of praise. “These kids get so undermined, sometimes by us in our frustration, that they desperately need positive affirmation.”

Other helpful tips from Phillips include keeping instructions short, and maintaining daily structure and routine which creates a feeling of control and safety.

It is important to stay calm (as difficult as this can be) and not lose one’s temper, as this rattles them and leads to greater outbursts.

Choose a time when they are in a good space to communicate with them about their feelings and discuss ways of coping with difficult situations.

Phillips’ relationship with her boys has blossomed. Her oldest is now 19. “We have a close relationship and a bond that I would never have imagined.”

Her second “inattentive” son is almost 17 in Grade 11. “From being quite floaty and often disorganised, and having to teach him many organisational and planning skills up to last year, he seems to have had a maturational shift and is working consistently and organising himself well.”

Phillips stresses that children with this condition are “unique individuals with different strengths and weaknesses”.

In her experience, it’s an ongoing process, with different challenges at different stages but “things do get easier”.