One of the issues often forgotten in ADHD land is the underlying variable of social judgment and difficulty in being able to “read” cause and effect. Difficulty with reading cause and effect impacts both social and academic functioning.
This is one of the reasons I struggle with the notion of treating ADHD as if it represents a whole pie chart with one treatment to consider, as in the “take this pill and call me in three months” approach.
Stimulant medication stimulates. Its purpose is to help you focus better. That’s it.
There’s always more in the pie chart (or the soup pot) that a pill will not address, such as difficulty reading cause and effect.
For the life of me, I don’t understand how a stimulant will help someone who doesn’t read social cues or has difficulty interpreting while reading.
Let’s take Justin, a 15 year old I saw recently who has been diagnosed with “ADHD” by medical practitioners. When I meet Justin and start to review what’s going on it is clear that there is more in the pie (there always is) than the, “He’s ADHD…that’s it.”
It was noted that Justin has a tendency to do the following:
- Not think before doing.
- Not realize certain actions bothers others.
- Not notice when behavior causes negative reactions in others.
Variables of anger, oppositional tendencies and not “reading” situations well, result in all kinds of personal mayhem for Justin, not to mention Justin’s tendency to meltdown when he faces frustration without giving his behavior much thought.
In other words, in this soup pot was a good helping of a bunch of other stuff.
What does Justin need?
From my perspective, Justin needs to understand and practice the skill of cause and effect (yes, it is a skill).
For example, Justin recently mouthed off to a coach of his who ended up sitting him on the bench because of his mouthiness. From Justin’s point of view, he was being treated unfairly and the coach “benched him for no reason.” Even when his parents tried to explain it to him, Justin was outraged at the unfairness of it all.
This type of interaction experienced by Justin, is something that all kids may experience, but the fact of the matter is ADHD-style kids have these type of behaviors more often since they do not intuitively pick up on the cues or understand “cause and effect” (i.e., if I say something that is rude or inappropriate, I don’t consider that there will be a cost).
Justin needs to have these interactions broken down in ways that he can have them pointed out to him in terms that he does not get overly defensive in order for him to potentially process what went wrong and where the break down occurred.
As you can imagine, since people are defensive by nature and (adolescents particularly so), this is not easy work and takes a long time with lots of back and forth over time for a kid like Justin to begin to look at himself.
If your child is “diagnosed” with ADHD and the primary (and perhaps only) recommendation is to be put on medication, you may want to ask something like, “Well, how will this address his difficulty with social cues? What about the fact that comprehension is affected by inability to read certain aspects of the text.”
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