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119 JANUARY 2009
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To empower not control: A holistic approach to AD/HD

Thomas Armstrong

Thousands of studies tell us what children with AD/HD can’t do, but few tell us what they can do. This article presents holistic strategies for helping children with AD/HD succeed at home and in school by building on their interests, learning styles, and many talents.

Eight-year-old Billy, in the front row, will have nothing to do with my demonstration of new techniques for teaching spelling. During my visit to his elementary school classroom in upstate New York, Billy is out of his seat during most of the lesson.

When I ask the children to visualize their spelling words, however, I am amazed to see Billy return to his seat and remain perfectly still. Covering his eyes, Billy “looks” intently at his imaginary words fascinated with the images in his mind!

Later on, I realize that something more important than a spelling lesson went on that afternoon: Billy was able to transform his external physical hyperactivity into internal mental motion and, by internalizing his outer activity level, was able to gain control over it.

* * *

This incident occurred some time ago but remains memorable to me. Why? Because it suggests that internal empowerment, rather than external control, is often the best way to help kids diagnosed as having AD/HD.

A decidedly unholistic approach
Much of the work currently being undertaken in the field of AD/HD looks at the issue from an external control perspective. The two interventions touted in almost all books and programs about AD/HD (and in several of the articles in this journal issue) are medication and behavior modification. While these approaches are often dramatically effective with young people with AD/HD, both have troubling features that often receive scant attention.

Some researchers suggest that when children receive medication, they may attribute their improved behaviors to the pills rather than to their own inner resources (Whalen and Henker, 1980). Others may expect the medication to do all the work and thus neglect underlying issues that may be the true causes of a child's attention and/or behavior difficulties.

Behavior modification programs, which abound, seek to control children's behaviors through some combination of rewards, punishments, or response costs (the taking away of rewards). Some programs rely on token economy systems, while others use behavior charts, stickers, and even machines. For example, the Attention Training System sits on a child's desk and automatically awards a point every 60 seconds for on-task behavior. The teacher can also deduct points for bad behavior using a remote control. Students trade points for prizes and privileges.

Although behavior modification programs may influence children to change their behavior, they do it for the wrong reason “to get rewards. Such programs can discourage risk-taking, blunt creativity, decrease levels of intrinsic motivation, and even impair academic performance (Kohn, 1993).

Looking at the whole child
Most AD/HD researchers and practitioners see children labeled with AD/HD in terms of their deficits. Thousands of studies tell us what these kids can’t do, but few tell us what they can do and who they really are. (Two exceptions are Crammond, 1994 and Hartmann, 1993.) Where are the studies that tell us what these kids are interested in, what kinds of positive learning styles or combinations of intelligences they use successfully in the classroom, and what sorts of artistic, mechanical, scientific, dramatic, or personal contributions they can make to their schools and communities?

A new vision of educational interventions is needed to reflect a deeper appreciation for the whole child based upon a wellness paradigm, rather than a deficit perspective rooted in a medical or disease-based model. We need to initiate a new field of study to help children with behavior and attention difficulties “one based upon discovering their strengths rather than fixing their faults. Parents and teachers tell me about cases of AD/HD-labeled kids who are talented dancers, musicians, sculptors, and dramatists. The AD/HD community needs to conduct research on the positive qualities of these children and what their abilities could mean in contributing to their success in the classroom and in life.

Such research would develop assessment strategies geared toward identifying their inner capabilities. Gardner’s theory of multiple intelligences (Gardner, 1983) is one possible framework for developing appropriate assessment instruments to help identify such abilities (a refreshing change from the behavior rating scales and artificial performance tests currently used to assess AD/HD in children). We must develop individualized educational plans (IEPs) that give more than lip service to a child's strengths and that solidly reflect, in their goals and objectives, a desire to help children achieve success (rather than to “overcome their problems–).

While the AD/HD worldview tacitly approves of a teacher-centered, worksheet- and textbook-driven model of education (almost all of its educational suggestions are based on this kind of classroom), current research suggests that all students benefit from project-based environments in which they actively construct new meanings based upon their existing knowledge of a subject. Some research suggests that students with AD/HD do better in environments that are active, self-paced, and hands-on (McGuinness, 1985). Video games and computers are powerful learning tools for many of these children. In fact, their high-speed behavior and thinking lend themselves quite well to such cutting-edge technologies as hypertext and multimedia (Armstrong, 1995).

Finally, interventions need to go beyond strategies such as smiley faces, points, and medications, and reflect a full sense of the child's true nature. Here are a few approaches for use at home and school that might help children identified as having AD/HD:

Cognitive

Ecological

Physical

Emotional

Behavioral

Social

Educational

This tentative list provides a far richer storehouse of interventions than the instructional strategies given in the mainstream AD/HD literature “for example, seating the child next to the teacher, posting assignments on a child's desk, maintaining eye contact, and breaking up assignments into small chunks. Such a deficit-oriented perspective gives differential treatment to the AD/HD child: Most of the above strategies, in contrast, are good for all children. Thus, in an inclusive classroom, the child labeled AD/HD can thrive with the same kinds of nourishing and stimulating activities as everyone else and be viewed in the same way as everyone else: as a unique human being.

The creative roots of AD/HD
Because research (Zentall, 1975) has long suggested that many children labeled AD/HD are actually under-aroused (Ritalin provides enough medical stimulation to bring their nervous systems to an optimal level of arousal), a strength-based approach makes more sense than a deficit-based one. By providing these students with high-stimulation learning environments grounded in what they enjoy and can succeed in, we are essentially providing them with a kind of educational psycho-stimulant that can work as well as Ritalin but is internally empowering rather than externally controlling.

Remember that a hyperactive child is an active child. These young people often possess great vitality “a valuable resource that society needs for its own renewal. Look at the great figures who transformed society, and you will find that many of them were behavior problems or hyperactive as children: Thomas Edison, Winston Churchill, Pablo Picasso, Charles Darwin, Florence Nightingale, Friedrich Nietzsche (see Goertzel and Goertzel, 1962). As educators, we can make a big difference in the lives of these students if we stop getting bogged down in their deficits and start highlighting their strengths!

References

Armstrong, T. (1995). The myth of the ADD child. New York: Dutton.

Crammond, B. (1994). Attention-deficit hyperactivity disorder and creativity: What is the connection? Journal of Creative Behavior, 28, 3. pp. 193-210.

Gardner, H. (1983). Frames of mind. New York: Basic Books.

Goertzel, V. and Goertzel, M. G. (1962). Cradles of eminence. Boston: Little, Brown.

Hartmann, T. (1993). Attention Deficit Disorder: A different perception. Lancaster, PA: Underwood-Miller.

Kohn, A. (1993). Punished by rewards. Boston: Houghton Mifflin.

McGuinness, D. (1985). When children don’t learn. New York: Basic Books.

Whalen, C. and Henker, B. (1980). Hyperactive children: The social ecology of identification and treatment. New York: Academic Press.

Zentall, S. (1975). Optimal stimulation as a theoretical basis of hyperactivity. American Journal of Orthopsychiatry, 45, 4. pp. 549-563.


This feature: Armstrong, T. (1998). To empower, not control: A holistic approach to AD/HD. Reaching Today’s Youth, 2, 2. pp. 3-5.

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