Why therapy and medication alone will not help children with ADHD

Early self-control intervention is necessary if you want your child to have a chance at leading a successful life regardless of ADHD. We need to enhance our own self-control skills in order to help kids develop theirs.


As a professional who has worked with numerous children with behavioural problems in schools, the mother of a child with ADHD, and having been married to someone with ADHD, I know the difficulties of handling this disorder first hand. I know the frustration, desperation and agony of feeling powerless to assist the person you love.
ADHD is an actual brain disability, no matter how hard people try to make it seem otherwise. The name of this disability also does injustice to the real issues faced by people living with ADHD. We should stop thinking of ADHD as an attention deficit problem, since those of us who live with ADHD people will know that they can concentrate perfectly and even hyper-concentrate when they feel fascinated and interested in the topic.
ADHD is actually an inability to self-regulate. This means that these children cannot regulate their emotions or their actions in a way that works towards a goal in the future, unless they are totally absorbed in the topic and it provides some sort of instant gratification.
Normal self-control develops as children learn certain skills:

1. The skill of mental imagery – Being able to think through a process in your mind and see the outcome before it actually happens (foresight). An example of this would be for the child to visualise in their mind the process they would have to follow from waking up in the morning to leaving for school.
   
2. Internalised speech (usually somewhat developed by the age of 5) – This is the ability of the child to reason with themselves mentally in order to decide on a course of action for a problem or decision they are faced with. They rehearse what they are going to do in their mind before taking action. Internalised speech also includes the ability of the child to reassure themselves that they are safe when they feel threatened.
   
3. Emotional management – Children learn how to handle different emotions, as well as, learning to use their emotions to motivate themselves to do something they do not feel like doing.
   
4. The skill to stop and wait – Children learn to create a pause between when something happens and when they react.
   
5. The ability to plan and problem solve – This is the highest executive function in the self-control developmental phase. This is when the child is able to identify a challenge and mentally simulate multiple possibilities of solving the problem before choosing the option they believe will handle the situation in the best way.
   

The age between three to six years old is the time period when self-control naturally develops if the circumstances are ideal. Unfortunately there are factors that prohibit or slow the natural development of self-control.
These factors are:

• Genetics
  
• Environmental factors such as the living conditions the child grows up in.
  
• Lack of exposure to self-control teaching or the lack of good examples around them.
  
• Adult role-models who exhibit negative self-control actions.
  

For the purpose of this article, I am not going to elaborate on the first two factors mentioned. The exciting part for me as a therapist and coach is that I am able to see the positive effects that exposure to and teaching of self-control to parents and teachers have in assisting children to better handle emotional situations that they are faced with. When parents and adult role-models such as teachers focus on enhancing their own self-control mechanisms in a way that provides the child with positive examples of how to handle tough situations, the child feels more secure and able to adapt and learn from the examples shown by the adults in their life.  
However, as with most complex topics, there is a trick.
These skills can only be taught to children with ADHD in real-life situations. This is because people with ADHD have a working memory problem. This means that they have a problem applying previously learned information in a current situation. They might know what to do, but when they need the knowledge, the fact that they lack self-control prevents them from accessing the applicable information.
One could think of the brain as play dough (malleable), because of its ability to adapt. This concept gives us hope because it means that brain patterns can develop if children are taught self-control mechanisms repetitively in a realistic situation that requires the specific pattern of behaviour.
Unfortunately because the behaviour of children with ADHD causes so much frustration in the people around them, and they are often only diagnosed when everybody has nearly given up on them, they suffer severe emotional distress due to their inability to regulate themselves. They know how people perceive them and they get extremely frustrated with their own inability to “get their ducks in a row”. This just contributes to a downward spiral of negative self-worth and subsequent bad behaviour.
What is the answer?
The solution is to provide the adults (parents and teachers) in the ADHD child’s life, with the skills to teach self-control in the moment when it is needed, without losing control themselves. This often requires a complete mind shift - It requires developing your own “SUPER self-control powers”!