To Empower! - Not Control!  A Holistic Approach to ADHD

by Thomas Armstrong, Ph.D.

(first published in Educational Leadership, September, 1996, modified and
republished in present form in Reaching Today?s Youth, Winter, 1998)

© Thomas Armstrong, 1998

Thousands of studies tell us what children with ADHD can't do, but few tell us what they can do.  This article presents holistic strategies for helping children with ADHD 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 on new techniques for teaching spelling.  During my visit to his elementary school classroom in upstate New York, Bill), 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 & Henker, 1990).  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 teaming 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 teaming 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   

Use focusing and attention-training techniques.  For example, see how long a child can sit still in a chair using a stopwatch (make it into a competitive game) or help kids visualize their favorite place when they need to calmdown.

Teach self-talk skills.  For example, teach kids to say to themselves: "If at first you don't succeed, try, try again," or show them ways of talking through the steps to solving a math problem.

Help with organizational skills.  Help each student develop a folder that contains sections for each subject, a calendar for due dates, a place to hold accessories, etc.

Ecological   

Use music to calm or focus.  Sometimes rock or rap music may paradoxically calm some kids down just as Ritalin (a stimulant) does.

Limit television and video games to one hour per day and eliminate all violent programming, because research is clear that this provokes aggressive behavior in kids.

Find the time when the child is most alert.  Mornings are usually best for focused work (e.g., seat-work, lectures, etc.); afternoons are best for open-ended activities (e.g., projects, arts, cooperative groups, etc.).

Provide a balanced breakfast.  Research suggests that balancing protein with carbohydrates (e.g., eggs and toast) is better for helping foster focused activity than simply a carbohydrate breakfast (e.g., pastries and orange juice).

Physical   

Emphasize a strong physical education program in the schools.  Include aerobic activity, individual sports (e.g., swimming, gymnastics), walking, and martial arts.

Allow appropriate movement in the classroom.  Give kids chores to do, allow them to use a squeeze ball to keep their hands busy while listening to the teacher talk, give them active projects that involve frequent changes of
seating, teach skills using physical movement (e.g., in group choral spelling, standing up on the vowels and sitting down on the consonants).

Use hands-on teaming.  Give students frequent opportunities to build things with their hands (e.g., dioramas i history, models of science concepts, props for plays in literature) and to use manipulatives (e.g., in math) whe teaming about new concepts.

Emotional   

Provide positive role models.  Study the lives of great people who had difficulty with behavior in school (e.g., Winston Churchill, Florence Nightingale, Louis Armstrong).

Identify talents, strengths, and abilities.  Find out which combination of Howard Gardner's eight intelligences (linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, naturalist, interpersonal, or intrapersonal) each student has most highly developed and use that information to provide appropriate instruction.

Envision positive futures.  Help students see roles and careers for themselves in the world that make use of their special talents and abilities.

Behavioral   

Use behavior contracting.  Let the student have an important say in writing up a contract that includes the problem behavior(s), and what will happen (e.g., rewards, etc.) if the difficulties are removed.

Provide immediate feedback.  Videotape a child acting out and show it to him or her right away.  Give answers on tests right away.  Count the number of times a problem behavior occurs and give the child the figure in a nonjudgmental way each day.  Help them keep track of their own behaviors (self-monitoring).

Have consistent routines in the classroom and involve the student in them (e.g., the student is selected to collect papers, to signal others to get ready for lunch, etc.).

Social   

Hold class meetings.  Use these meetings as opportunities to air grievances, work out interpersonal problems between class members, plan for parties, and share other feelings and thoughts about how the class is going.

Use effective communication strategies.  For example, practice using "I" language ("I am disturbed by your language") rather than "you" communication ("You have a filthy mouth"), and help the student practice them as well.

Have the student be a "buddy" to a younger student, so that he needs to become the responsible member of the duo.  Ask him to teach another student something he knows how to do (this helps teach organizational skills).

Educational   

Create a highly stimulating educational environment.  Research suggests that kids labeled AD/HD do better under high-stimulation than low-stimulation conditions (e.g., use role playing, field trips, project building, music, humor, expressive arts, etc.).

Use attention-grabbing strategies, such as a hand signal or musical cue to alert students to the need to begin cleaning up for lunch.

Employ computer software that is interactive, colorful, provides immediate feedback, and is instructionally sound.

This 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 underaroused (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 psychostimulant 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 & 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!

Thomas Armstrong, Ph.D., is the author of eight books including The Myth of the ADD Child: 50 Ways to Improve Your Child's Behavior and Attention Span without Drugs, Labels, or Coercion.   To order this book call:  1-800-247-6553. Visit his website at:  www.thomasarmstrong.com


REFERENCES   

Armstrong, T (1995).  The Myth of the ADD Child.  New York: Dutton.    

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

Gardner, H. (I 983).  Frames of mind.  New York: Basic Books.

Goertzel, V., & 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. (I 993).  Punished by rewards.  Boston: Houghton Mifflin.

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

Whalen, C., & Henker, B. (I 980).  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), 549-563.