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Attention Deficit Disorder: Is It Really a Deficit and Really Attentional?

Homework: The Big Struggle

When Your Child Is Not Making It At School

When Kids and Parents Don't Click

Parental Permissiveness and Emotional Communication

The Psycho-Educational Evaluation: Helping Parents to Help Kids with Learning Difficulties

 




Attention Deficit Disorder: Is It Really a Deficit and Really Attentional?

Attention Deficit Disorder (ADD), a syndrome characterized by inattention, hyperactivity, and impulsively, has received increased professional and public interest. For clinicians, the rising number of children and adults diagnosed with ADD is of concern. Research suggests that ADD is a non-specific and heterogeneous group of disorders for which multiple etiologies have been proposed. As such, the etiological factors may vary with different subgroups. Consequently, the prevailing treatment focus (i.e. combining stimulant medication with educational management, behavior modification, and parenting training) may be too narrow or not specific enough for different subtypes of the disorder. Given the fact that many children (and even adults) present with some of the symptoms of ADD and that ADD is co-morbid with several other disorders (i.e. oppositional defiant disorder, conduct disorder, depression), the danger of viewing ADD as homogeneous and treatable with a non-specific therapeutic approach is significant.

A more constructive and promising approach to conceptualizing and treating attentional disorders is the area of self-regulation. For example, recent research suggests that there is little evidence that attentional capacity itself is different in individuals with ADD. It appears, however, that the regulation of attentional capacity is the problem.

Individuals who have the developed capacity to regulate their emotions (particularly the negative ones like frustration, anger, irritability) are better able to attend. While genetic and constitutional factors always play a part, contextual variables like the match between parent and child have been virtually overlooked. We all have observed what happens when either the parent or the child are not a good match for each other. When this occurs, parent and child do not function as a team. As a result, the task of internalizing the psychological skills to tolerate and constructively channel the kinds of stimulation and contact encountered in everyday life does not go well. Instead, parents and children reciprocally under or overstimulate each other, resulting in frustration, anger, and repetitive patterns on non-constructive behavior.

Treatment approaches that pay attention to this lack of match and provide parents and children with an increased capacity to tolerate and digest internal and external stimulation will find increased ability to regulate attention as a byproduct.



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Homework: The Big Struggle

Getting kids to do their homework probably ranks high on the list of challenges parents face on a daily basis. A quick glance at the bookstore shelves and newspaper columns reveals that there has been much advice dispensed about helping parents to help their children complete their homework. The purpose of this piece is not to reassemble the known information, but to attempt to address the obstacles faced by parents and kids in trying to apply what is known.

Childrens' reasons for not doing their homework range from finding the homework difficult to feeling it is boring and not worthy of their time. Some (the aspiring attorneys) claim that being assigned homework after a full day of school is unfair and cite their constitutional right to refuse. Avoiding homework often inspires creative thinking like forgetting to bring home the assignment, erasing the assignment in the notepad (this reguires a very good eraser!), or swearing that it was done and either the dog ate it (see the new ad for Dell computers with a big canine on it), a friend or sibling took it, or the teacher lost it.

The greatest obstacle to successfully navigating homework refusal is emotional regulation. Childrens' refusals will often evoke negative emotions in parents who just want their kids to "Do it!" (This is an admirable wish which is often counterbalanced by the childs' wish that parents just leave them alone to do homework when and if they choose). Managing the emotional responsiveness of adults and children to one another is complicated by the time pressures of daily life, and worries about earning poor grades in our competitive world.

The most important goal for parents when dealing with homework struggles is to find a way to preserve the relationship with their children. Today's assignment will come and go, but a positive relationship with one's child is an absolute necessity in the long haul as parenting is a lifelong task.

Parents may wish to consider the following:

1. Attempt to investigate the source of children's objections with a curious rather than a critical ear; (This may need to be done at a time where neither parent nor child is pressured to do anything);

2. Consider the idea that children's refusals constitute an indirect communication of something important that they are unable to say in a straight forward way;

3. Find a way to help children to say what is not being expressed directly. This may include getting professional help if parents' efforts prove unsuccessful.

4. One 1-3 above is accomplished, then commonsense advice (i.e. providing structure, a quite place, a time, etc.) can be more easily utilized.



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When Your Child Is Not Making It At School

Helping children to be all they can be with respect to their school performance requires that parents, children, and professionals work together to remove any emotional obstacles to learning. In fact, when children are underachieving, the first step in resolving the problem is to make a careful assessment of the distinction between an actual limitation in skills and emotional factors which interfere with maximizing the skills that do exist. For example, many children with academic difficulties also manifest problems in the regulation of their emotions. Some may be very aggressive while others may be overly shy, withdrawn, and inattentive. Success in school (and in life) may be achieved when children are able to constructively harness their emotional energy and channel it in the form of such positive traits as initiative, persistence, curiosity, and assertiveness.

Disregulation of emotions, however, may lead to the creation of resistances to learning and performing. While it is sometimes difficult to determine whether emotion disregulation was the cause or result of learning problems, building and maintaining children's self-esteem and their will to bear the slings and arrows of attending school for more than a decade is key.

Here are some helpful hints for parents when your child is just "not getting it" at school:

1. DON'T PANIC -children who are having learning difficulties are probably already frustrated and embarrassed by their problems. Seeing panic, doubt, and criticalness in the face of a parent only makes matters worse.

2. TRY NOT TO BE CRITICAL -it is difficult to keep perspective when your child is hurting. Do not assume that they are unintelligent or doomed to be failures for life.

3. GATHER INFORMATION about the nature of the difficulty from your child and the teacher. If you are considering having your child evaluated (which may either be a constructive step or a response motivated by one's panic), be certain that the individual who assesses your child knows children and the kinds of psychological interference which may block learning.

4. IMPLEMENT REALISTIC STRATEGIES to help your child. Since the preservation of your relationship with your child is essential (if both of you are to survive at least 13 years of schooling), enlist the aid of professionals (i.e. psychologist, educational tutor) wherever appropriate so your time with your child can be positive time.

Talk therapy for children may prove beneficial. Frustrations children experience at school that are proactively addressed may actually enhance children's existing potential to learn.

 

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When Kids and Parents Don’t Click 

                “My son/daughter has been difficult from birth!” “Why can’t he just listen?” “I have to tell her ten times before she does what I ask!” “My oldest is just like me and we get along. I don’t know who my youngest is-I just don’t understand him/her!”

                The chemistry or “click” between each child and each parent is determined by a complex set of factors, including genetic make-up, temperament, gender, physical health, and the degree to which each fulfills the expectations of the other. When children and parents are operating as a maturational team, there is a reciprocal exchange of more positive than negative feelings. Simply put, parents and kids like each other because they feel they are like each other. This makes the job of parents-to help develop in the child insulation or a protective barrier as a buttress against the outside world-easier. However, when any one of the above variables results in parents and kids feeling dissimilar-not alike-there can develop a feeling of discomfort, misunderstanding, or even dislike in the dyad. In short, when parents and kids don’t “click,” life becomes more difficult. Some parents are not “good” parents for some kids and some kids are not “good” kids for some parents. While this may be mitigated when the other parent can make up for the lack of match, it becomes a significant dilemma if the parent (still most often the mother) that spends the majority of time with a child feels no click with that child.

                There are many examples of this lack of “click”. Kids and parents may have different temperaments. This is often reflected in the degree of contact an individual desires. If a child has a greater need for contact than a parent does, then the child may create situations-even negative ones-to create the desired contact. The child may become clingy or develop separation anxiety, requiring an already reluctant parent to spend more time together. A child’s aggression or impulsivity may frighten and “turn off” a parent. This occurs frequently in mixed gender dyads where the child is male and the mother just doesn’t “get” the child. Passive children frustrate type A parents who are stymied by the difference between their own curiosity and capacity for initiative in contrast to their child’s lack of interest in the world and need for prodding in order to do schoolwork, get a job, etc. Similarly, when children do not fulfill parents’ expressed or unexpressed wishes for the kind of child they wanted (i.e. someone like themselves), the resulting disappointment can feel devastating. Disappointment in children for any reason may lead to emotional communications from parents that are critical and destructive to children’s development and the parent-child chemistry.  Kids, too, can either choose to move closer to/identify with or reject parents based upon a felt experience of being like or unlike one another.

                Talk psychotherapy can help in repairing ruptures in the parent-child relationship when chemistry is missing. Helping parents and children to become a functioning team requires that each learn to tolerate their differences and accept each other. Difficulties arise when the feelings of disappointment, frustration, or anger are not expressed in words. Nevertheless, kids’ felt experience of these emotions from their parents and vice versa produce powerful waves that influence the lives of both. When these feelings-especially the negative (“taboo”) ones-can be put into words, the intensity of the unverbalized but felt negative emotions can be diminished and a meaningful dialogue can be sustained.

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Parental Permissiveness and Emotional Communication 

            If your practice is anything like mine, you have seen countless examples of parents either overindulging children or abdicating their job of providing limits while at the same time proclaiming their helplessness in the face of the unending onslaught of demands and challenges from their seemingly insatiable offspring. I recall the mother of an upper elementary school boy who had been to the principal’s office so frequently that they were considering naming the chair in the hallway after him. She sat on my couch stroking her son’s hair with a feeling of pride as he expressed his disdain for authority. Whether it is a child who refuses to go to bed without a parent in the room, one who wants everything at the supermarket or mall, or another who cannot stop talking or kicking the back of your seat at a movie theatre or in an airplane, the preponderance of evidence is enough to convince anyone that these ubiquitous behaviors constitute an epidemic. Many children today demonstrate a lack of emotional awareness of how what they say or do effects others.

While explanations (i.e. our narcissistic culture; temperament; the “bastardization” of the progressive psychoanalytic principles of childrearing) for this phenomenon abound, I would like to focus on one that has received less attention. That is, the invisible, reciprocal, and powerful emotional communications shared in the parent-child dyad that determine to a great degree the eventual maturational trajectory of the child and the fate of the dyad as a well functioning team. In an ideal world, parents create the right atmospheric conditions (“good enough parenting”) for their children to mature. The development of a cooperative parent child team requires that the adults provide the evolving child with an optimal balance of frustration and gratification. Too much of either can lead to a derailment (i.e. permissiveness) of the trajectory. In this perfect world scenario, parents intuitively sense what kind of emotional communications children need to progressively develop and they provide them. Although parents will inevitably fall short of this ideal, the accumulated history of satisfying interactions creates a reservoir of positive feeling that serves to soften the disappointments and they are “optimal” rather than catastrophic or assaultive. Part of this process involves giving children the feeling that when they are with their parents, they are with people like them. This process of mirroring sets in motion a series of events that go something like this: if I am like you, then I like you, and then you like me. Children learn to mature and to be like their parents through reflected appraisals. In fact, discipline, which may be thought of as the opposite of permissiveness, is instilled by teaching and modeling attitudes that children are willing to adopt because they love their parents and want their parents love in return. When there is a bad match between parent and child, these appraisals are critical rather than positive. This makes children feel unsafe and their subsequent defiance or unwillingness to comply may in fact be their way of fighting for their own survival. Moreover, they fail to develop the necessary insulation to tolerate the inevitable frustration they will encounter.

An obstacle to the smooth evolution of this process of maturation is the management (or mismanagement) of aggression in the parent-child dyad. (Aggression, which has gotten a bad name, is referred to here as a capacity that on a continuum includes such important components as initiative, assertiveness, curiosity, motivation, and perseverance and its’ constructive use is the hallmark of an individual’s capacity to separate). The important task of learning to safely love and to hate begins in the parent-child dyad. Children (and parents) need to tolerate their inevitable anger. After all, childhood is a frustrating time with its many restrictions and the growing awareness that despite the best parenting, the adults in a child’s life will be disappointing. For example, perhaps the biggest and most long lasting narcissistic injury inflicted on a child by his or her parents is to have another child. As one child said to me, “ Wasn’t I enough?” Parents are also unable to predict future events or to fashion the world in ways that their child would like. For parents, they may have mixed feelings about parenthood. Being a parent may be experienced for some like a lifetime sentence replete with its own set of restrictions on time, energy, and money. When parents do not like children because they are not like the parents in some important way (i.e. physical appearance; temperament; intelligence), they may try to hide their disappointment or anger. After all, parents are always supposed to love their children. This resulting guilt may cause them to be permissive as a defense against their own rage.

The proliferation of competitive rather than cooperative attitudes and behaviors in the parent child dyad results when the reciprocal emotional communications hinder rather than facilitate maturation. I mentioned the lack of an optimal parent-child match above as one scenario that may result in the evolution of permissiveness rather than discipline and self-regulation. In this instance, parents are unable to intuit what kids need because they are so different from one another. The confusion, worry, and frustration that result gets reflected back to the child, causing anxiety and a host of other problematical behaviors. Another is a parental attitude that does not encourage separation. This is not unusual in families where parents are separated or divorced and the custodial parent may induce regressive behaviors (i.e. sleeping with the parent) in kids to parent them. Still another common occurrence is the communication of attitudes that unconsciously resonate with unresolved issues in the parents’ own families of origin. For example, parents who feel they were brought up in a strict or harsh manner may opt to rear their children in the opposite direction. A subtler situation arises when adults who harbor resentment toward their own parents seek revenge by being unsuccessful as parents, sentencing them to a lifetime punishment of having incompetent children and out-of-control grandchildren.

In summary, permissiveness may be the result of parents’ overindulgence. However, it is more likely that a complex set of factors, including the attitudes parents and children consciously and unconsciously induce in each other, play a significant role in determining whether a child will have the discipline to tolerate the slings and arrows of frustration inherent in the world or lack the necessary insulation, resulting in their becoming individuals with insatiable appetites and unquenchable thirsts.

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The Psycho-Educational Evaluation: Helping Parents to Help Kids with Learning Difficulties

 

Each day there are parents who feel assaulted and anxious upon receiving the news that their child is experiencing  “a learning problem.”  More alarming is the fact that there are children who either have learning difficulties that go undetected or are minimized by the wish, “He/she will “grow out of it.” Finally, there are children whose individual learning styles do not match the methods of instruction and are considered unintelligent, unmotivated, distractible, or lazy. 

              . For example:

- Children with slow processing speed may look unintelligent when called upon in class to answer questions or do independent work at their seat.

 -Some children may have difficulty understanding directions or questions on tests because of an underlying language based problem. They may, in fact, be quite intelligent but cannot either process information quickly enough or need extra time or discussion in order to “get it.” 

-Others may have short-term memory difficulties that interfere with the retention of recently studied information, causing them to be unable to retrieve answers on tests even after studying.

-Similarly, children whose intelligence is average or even superior but whose learning style is incongruent with the way material is being taught may have learning problems. For example, visual learners often have great difficulty managing the bulk of information presented in class because its’ presentation is via auditory and verbal channels. Left undetected, these problems or styles of learning may lead to successive disappointments in academic performance, low self-esteem, and decreased motivation or interest in schoolwork.

                What is the best way to begin to help parents who are probably emotionally upset about their child’s difficulties and do not know where to turn?

                The first step is making an early and accurate identification of learning and related difficulties via a comprehensive psycho-educational evaluation. This consists of two parts. Psychological testing would rule out cognitive deficits that might be obstructing learning and give a reading on a child’s overall ability level.  Educational testing measures a child’s performance across the significant areas (i.e. oral expression; written expression; reading; mathematical and perceptual reasoning) required to be successful in school. A discrepancy analysis of the differences between children’s’ expected results based on their abilities and their actual scores tells us if there are any areas in which their performance is not congruent with their abilities.  Testing along with other data sources (i.e. developmental, familial, medical, academic, social histories; contact with parents, teachers, and pediatricians) needs to be skillfully blended in order to understand learning styles and to make recommendations.  While testing is used to answer questions, it may also be utilized to ask new and better questions. Consequently, the assessment may determine the need for other types of evaluations (i.e. pediatric, neurological, psychiatric).

      Analyzing test results and viewing them in the context of all of the information gathered about a child requires the capacity to ‘read between the lines.” Akin to reading a medical x-ray, the “reading” of test scores is only as good as the person who is analyzing the data. For more than twenty seven years, I have performed these evaluations while teaching assessment at the doctoral level for about half of this time.  My expertise and interest in this area has recently been rekindled by the many requests I have received for this type of evaluation. Consequently, in line with my current effort to devote more time to help parents in aiding their children, I am planning to make myself available to do comprehensive assessments as a way of assisting and supporting parents who wish to understand their children. As a former teacher, university professor, and school psychologist, I am able to work with parents and schools to navigate the hazardous waters of learning challenges and the attendant psychological sequellae.

                 



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Copyright © 2001 Steven Korner PH.D, Licensed Psychologist. All Rights Reserved.