When ADD Means 'Acceptance Deficit Disorder'?

Sometimes you can feel the bristles in the air when a family comes in for help with their child with attention-deficit/hyperactivity disorder. Not only the child, but you also are in trouble!

As a group, individuals with ADHD are more likely to have oppositional defiant disorder, school retention, and school failure; they also are more likely to drop out of school, and eventually to have multiple job changes and broken marriages.

Are these serious problems really inevitable for your patient? In fact, the outcome of ADHD ranges widely, from exceptionally creative, energetic, multitasking, wealthy CEOs to felons in lockup. Is the difference between these outcomes a flip of the coin? Or is there something we as clinicians can do to shift the odds?

Optimizing medication use and teacher input makes the greatest difference in current symptoms, and IQ and absence of learning disabilities are the strongest intrinsic predictors of outcome. But support and acceptance are the protective factors most within the family’s control. Support clearly includes ensuring appropriate medical and educational services, and structuring family routines and homework time. But acceptance is more subtle, and is determined by many personal and family factors worth eliciting.

How can you begin to promote acceptance of a child with ADHD? When you think about it, most people do not know that their child has ADHD before being told by a medical professional. Teachers are generally not even allowed to mention the "A[DHD]" word to parents. How we give this news and relate to the issues over time can make a significant difference in the family’s basic perception of their child, in the child’s perception of him- or herself, and even in outcomes.

We are not helped in setting a positive perception for the family by the official name: attention-deficit/hyperactivity "disorder." I explain to families that although differences in attention and activity are normal, a disorder is defined by symptoms that interfere with day-to-day activities. The fact that daily life is harder for their child than for other kids comes as no surprise to this family, and eases the impact of these words.

When I explain ADHD to parents, I find that relating the "wiring difference of ADHD" to different breeds of dog can reduce judgmentalism. Suggesting that they got a Jack Russell terrier rather than a Labrador sometimes makes acceptance easier than a conversation about the abstract concept of temperament. After all, who is surprised when a terrier jumps on a visitor? But training a dog does not engage all the emotions, hopes, dreams, fears, and altered perceptions of parenting. Even parents who raised a dog together in preparation for parenthood lose that valuable objectivity when the developing creature is their child.

Helping families see ADHD symptoms as including assets such as energy, creativity, spontaneity, sometimes athletic or musical talent, and joyfulness can be a big contribution to developing a positive perception of their child. Finding and fostering their child’s talents may be the most important thing parents can do in the long run. You may need to brainstorm together over the years to figure out what might work for each child, especially because academics is often not a strength in a child with ADHD. My patients have grown to be good at drawing anime, leading hunting trips, doing karate, participating on rock-climbing teams, drumming, providing lawn service, singing, programming, baking, doing construction, working in theater, doing videography, volunteering with the elderly, and providing child care, among other things.

Start this conversation early in your management of ADHD, both to make sure a talent is found and to foster optimism about the child’s adult future. Asking the child (and parents) "What are you best at?" or "What would you like to do after you graduate?" can open this topic. Children with one real ability to distinguish themselves as capable have the seed for self-esteem that can sustain them over time. Try to find a talent that might work before they hit middle school, when kids need to have a social standing but are already reluctant to try something new. Otherwise, they may choose unproductive ways to be a big shot, like hanging out at the mall rather than being a musician or athlete. Did you hear what was said about one hyperactive kid who ended up on the Olympic team? When Jonathan Horton climbed to the ceiling of a store as a 4-year old "some parents might have scolded him; his parents gave him gymnastic lessons." He competed in the 2012 Olympics as part of the men’s gymnastics team. Michael Phelps, winner of the most Olympic medals ever, took up swimming as a way to handle his ADHD.