Regardless of age, youngsters can begin working on developmental levels they have been unable to master, but they can do so only in the context of a close, personal relationship with a devoted adult.
—STANLEY GREENSPAN, M.D., The Growth of the Mind
BRIAN IS ELEVEN YEARS OLD, in Grade 5. His parents described the typical ADD signs of disorganization, short attention span, easy distractibility. His moods fluctuate. He can work himself into a rage or a sulk from one moment to the next. “I don’t even know what sets him off sometimes,” his mother said. “If I tell him to stop, he just covers his ears with his hands. He won’t listen.” The father said that bedtimes were impossible, school mornings a “nightmare,” suppertime “a zoo.” In his fits of anger, Brian could become sharply insulting toward his parents, to the point of obscenity. At such times, they could barely recognize in him the lively and engaging child they know him to be.
My advice to Brian’s mother and father was that they not bring their son in for assessment just yet, but instead put the emphasis on the dynamics of their interaction with him. The kind of hostility Brian was exhibiting has one source: an unconscious sense of being cut off from the parents, of having been abandoned. He experienced his parents’ frustrated criticisms and attempts at discipline as rejection. I felt that to deal with his behaviors as “the problem” would only evoke resistance in him and that, in any case, the behaviors were only an acting-out of deep emotions of pain and insecurity. I referred Brian’s parents to a highly skilled developmental psychologist for counseling. Before they could successfully embark on any effort to help their son with his ADD, they needed to reestablish their relationship with him on a much more safe, supportive and nonadversarial ground. To do that, this mother and father would have to understand just where in emotional development their son stood in relationship to them: at the maturational level of an anxiety-ridden toddler. We agreed we would meet in three months.
On their return visit, the parents reported a changed atmosphere in the home. Brian’s outbursts had mostly stopped. When they did come, they were considerably milder than before and did not last long. There was significantly less resistance to getting ready to go to school in the mornings and much less of a to-do at bedtimes. Brian’s attention problems continued, and he still had trouble being organized. He was far more motivated and resilient, however, and did not become discouraged nearly so easily. He was also less resistant to accepting help from his parents and able to acknowledge that he was having some difficulties, that he wasn’t being criticized because everyone was against him. I suggested that medications might be beneficial. The father was in favor of trying them, but the mother was not. She preferred to continue to build the relationship and Brian’s self-esteem, and to see how things went over the next half year or so.
This couple was helped by their son’s sensitivity, the same characteristic that in the past gave rise to so many difficulties. Children with ADD may be highly susceptible to the negative aspects of their environment, but the other side of the coin is that they are equally responsive to positive changes. The very sensitivity that makes them vulnerable is also an asset that gives them tremendous potential for development. Just as this boy was highly reactive to his parents’ anxiety-driven behaviors toward him, he was able to thrive as he felt greater security in his relationship with them. By nature a warm and affectionate child, as most children with ADD are, he soaked up the warmth his parents were now increasingly able to give him. This mother and father were surprised and delighted by how quickly, after only a few months of changing their approach, their son began to achieve important milestones of emotional growth.
Whether or not I prescribe medications, in all cases I tell the parents that what they do themselves to draw the child closer to them emotionally is far more important in the long run. In his work with autistic children, Stanley Greenspan describes this as wooing the child into relationship. It is the basis for everything else we try to do for the child. Learning techniques, behavioral modification and other strategies are all on a firm base only if the attachment relationship is maintained. Otherwise, they rest on sand.
The following principles help to restore and solidify the parent-child attachment. The reversal of ADD patterns in a child begins with them. They have been successfully employed by a number of parents I have worked with, and I can personally attest to their efficacy as well. Their value is not restricted to the ADD child; they are the fundamentals of working with any child, and particularly with any troubled child, ADD or not. The long-term project of promoting healthy development in a child with attention deficit disorder becomes next to hopeless without a consistent attempt to apply these principles.
Technique: Invite the child
Goal: Fostering the child’s self-acceptance
The parents enthusiastically and genuinely invite the child into relationship. They do not issue declarations of love; they demonstrate day by day that they want the child’s company. They think of things to do together, or they just “hang out” with the child, with an attitude of active attention. When they are with the child, they are fully there, not just being dutiful, putting in time. They have active energy that radiates toward the child. They make sure they have space in their lives for the child.
Being wanted and enjoyed is the greatest gift the child can receive. It is the basis of self-acceptance. ADD children, without exception, harbor a deep insecurity about themselves. It is essential to demonstrate to such a child that his very existence is appreciated. The parent may put out this message verbally, but if she does not live the message by a commitment of time and energy, the child will receive mixed signals at best.
Whenever possible, the parent does the inviting. That may be a chore. A highly insecure child can be exhaustingly demanding of time and attention. Understandably, the parent may long for respite, not more engagement. The conundrum is that attention given at the request of the child is never satisfactory: it leaves an uncertainty that the parent is only responding to demands, not voluntarily giving of himself, or herself, to the child. The demands only escalate, without the emotional need underlying them ever being filled. The solution is to seize the moment, to invite contact exactly when the child is not demanding it. Or, if responding to the child’s request, the parent can take the initiative, expressing more interest and enthusiasm than the child herself anticipates: “Oh, that’s a great idea. I was wondering how we could spend time together! I’m so glad you thought of it.” This will take the child by surprise and make her feel that she is the one receiving the invitation.
Woo the child, as one would woo anyone with whom one wanted a relationship.
Technique: Avoid pointing out faults, mistakes, shortcomings
Goal: To increase security, reduce shame
Shame, as we have seen, is the physiological-emotional state resulting from the sense of being isolated, cut off. The ADD child is mired in shame. She will express it in many ways. There may be self-abusive statements such as “I’m stupid.” There may also be their opposite: a complete denial of the child’s own negative contributions to her interactions with others: “So-and-so is mean. She is always starting fights.” When someone’s shame is deep, he may defend himself by rejecting even the slightest suggestion of wrong-doing on his own part. There is no point countering with logic either the self-putdowns or the self-protective attitude of the child. Shame does not arise in the left hemisphere of the brain; it will not be dislodged by left-brain logical and verbal means. One weakens shame by not feeding it, by not doing anything to make the child feel isolated or deficient.
Criticism from the parent is devastating to a sensitive child with low self-esteem. As parents, we sometimes do not hear the critical tone in our words. The child, on the other hand, hears only the tone, not the words. The emotion-processing centers on the right side of the brain interpret the tone as rejection and invalidation. If the parent wants to help the child improve a skill or an attitude, it’s best to do it warmly, respecting the child’s vulnerability. It should not even be attempted if the relationship happens to be on shaky ground. When in doubt, it is best to bite the parental tongue rather than to utter a critical comment. At all times, the child must sense that the parent’s acceptance of him does not depend on how well he does something. It is not threatened by poor performance. It is unconditional.
As a child develops a stronger self-concept, she becomes more and more open to help or correction in areas of difficulty. Acknowledging that she may have shortcomings is no longer so scary if she feels that these do not threaten her relationship with the parent.
Technique: Give praise in measured terms; reflect back the child’s feelings
Goal: Reinforcing the child’s confidence that achievements are not needed to earn the parent’s acceptance and respect
Too much praise can be almost as harmful as too much criticism. They seem opposite, but the underlying message is the same: the parent puts a high value not on who the child is, but on what he does. This is why many ADD children, no matter how much they crave and court attention, are uncomfortable with praise. Nature’s own agenda is hindered when parents foster what the developmental psychologist Gordon Neufeld calls acquired self-esteem, that based on external evaluations. “We don’t want to build a child’s self-esteem on how pretty they are, how popular they are, how smart they are, how good they are in baseball, how well they do in school,” he says. “There is a much, much truer, more solid type of self-esteem we can provide for our children than something that just follows cultural trends and approximates cultural norms. We should avoid making children believe that these things influence how we feel about them.”
The parent acknowledges warmly when the child does something well or achieves a new milestone but makes his comments about the deed rather than about the child, about the effort rather than about the result. And he refers to the child’s own emotions. “You really worked hard on that. Good for you. You stuck with it even though it was difficult.” How the child feels about what he does is far more important than what the parent thinks about it. A positive evaluation by the parent is still an evaluation, a judgment. It leaves a question: how would they feel about me if they could not judge me favorably? People do not need judgments—they need acceptance.
Technique: When the parent feels anger, he refrains from criticizing, giving orders, expressing opinions
Goal: To avoid faulting the child for even a momentary break in the relationship with the parent
The shame bound into the personality of any child (or adult) with ADD is easily activated. When the child is confronted by a parent’s anger—face tight, voice harsh, words cutting—he immediately experiences a loss of contact with the loving mother or father. He is thrown into the physiological shame state, or into a reactive and aggressive rage meant to keep shame at bay. He feels keenly the accusation, which the parent may or may not intend, that he, the child, is responsible for the parent’s emotional withdrawal. The loss of the loving parental presence is especially frightening for an insecure and sensitive child. He also feels confirmed in his core belief that he does not deserve warm contact with anyone. He may not show this directly, and may even react with seeming indifference and arrogant dismissal. But the most defiant behavior is nothing more than a defense against overwhelming shame. The more entrenched the child’s psychological defenses become, the more difficult the parent will find it to build the relationship.
Avoiding feeling anger altogether is an impossible goal for any parent, and especially for the parent of an ADD child. One should not set oneself up for failure by thinking that it is just a matter of resolutions and good intentions. The behavior and impulsiveness of the child would try the patience of saints—parents are bound to react. The parent may himself have a volatile personality. It is unrealistic to expect to be able to remain calm all the time, but when a parent feels the anger rising, he may disqualify himself from parenting for as long as it takes to cool down and regain some balance: “I’m feeling too upset right now. It’s not your fault. I’m not feeling in control. I can handle it, but I need time out.” Gordon Neufeld likens this to throwing the clutch into neutral when the motor starts racing too fast. It is of great help if one is able to call on a spouse or some other trusted adult to take the steering wheel at such moments.
To try to teach a child any useful lessons when cold anger seizes hold is self-defeating. In the biochemical soup of stress and shame, no learning can take place. The child’s nervous system is simply not receptive; it is too concerned with survival. At best, the child adopts techniques to avoid the parent’s rage. There is a type of anger that we may call warm anger, which is not damaging. This is anger under control. It addresses the deed without attacking the child, and it does not carry the threat of parental withdrawal. Children can handle this type of anger and can learn from it, especially if in general they feel secure in the relationship with the parent.
Technique: Do not wait for the child to reestablish contact after a fight
Goal: Allowing the child to feel that the attachment relationship is greater than whatever argument or disagreement may come between him and the parent
As parents, we may as well accept that we will “lose it” at times. Perfect equanimity is beyond us. Temporary breaks in the relationship with the child are inevitable and are not in themselves harmful, unless they are frequent and catastrophic. The real harm is inflicted when the parent makes the child work at reestablishing contact, as in forcing a child to apologize before granting “forgiveness.” There is neither genuine remorse nor genuine forgiveness in such situations, only humiliation. Since in principle nothing the child does should threaten the relationship in the first place, he should have to do no work to restore it.
So, if the parent has lost it, it is his responsibility to restore the interpersonal bridge. This should not take the form of abject apologies, and promises not to be “mean” any more. Assuredly, we will lose it again—no point pledging not to. Restoring the bridge simply means acknowledging that we see what has happened and understand how the child might feel about it and hearing nondefensively what the child has to say. When she expresses her feelings about the negative interaction—and even if she does so in a form difficult for the parent to take—the parent does not explain himself or try to justify his behavior. He just listens with empathy.
When they give priority to the attachment relationship, parents are not only building the child’s sense of security and self-acceptance. They are themselves modeling the most important lesson for the child to learn: the importance of remembering the future. They are putting the emphasis on development and healing, not on short-term—and short-lived—objectives.