I am a 62-year-old psychiatrist who has both attention deficit hyperactivity disorder (ADHD) and dyslexia. Of all the people who helped me deal with these conditions, top prize goes to my 1st grade teacher, Mrs. Eldredge, at Chatham Elementary School in Cape Cod, Massachusetts.
She simply put her arm around me when it was my turn to read during reading period. No one laughed at my stammering and stuttering, because I had the mafia sitting next to me! Such a simple intervention, but profound in its impact.
Because of Mrs. Eldredge's arm, I didn't acquire the most damaging learning disabilities—shame, fear, and the conviction that you are stupid and defective. Many other teachers helped me along the way, but Mrs. Eldredge got me off to the right start. By eliminating fear, she enabled me to progress at my own pace, always believing that I could succeed.
To this day, I am a painfully slow reader and rarely read a book all the way through. But because of Mrs. Eldredge and the many other gifted teachers I was lucky enough to have along the way, I became an excellent student, graduating from Phillips Exeter Academy, Harvard (where I majored in English!), and Tulane Medical School. Now I am a psychiatrist as well as a writer. I specialize in helping children and adults who have, you guessed it, ADHD and dyslexia.
Which brings me to you—wonderful, dedicated, life-changing teachers. My dad was a teacher for the final 20 years of his life, so I know firsthand what goes into a life of teaching. Of all the professions, I believe yours is the most noble—and certainly, in the United States anyway, the most unfairly underpaid.
I'd like to give back to you a bit of what I owe you, not in the form of money (would that I could!), but in the form of knowledge I've gained over the years in how best to help students who have ADHD.
It all begins with Mrs. Eldredge. Get that arm of safety around your students in any way you can. All of us learn better and do better when we feel safe. Fear and humiliation, which once upon a time were standard teaching tools, should be relics of the past.
It is a neurological fact that feeling safe opens up the brain, whereas feeling anxious and afraid clamps it down. So step one is to make sure all students feel as safe as possible. Remember, learning itself can feel dangerous. You are asking a student to leave his or her comfort zone and enter into new territory. A teacher's best gift to all students—not just those who have ADHD—is to allay fear, provide encouragement, and make the safari into new jungles of knowledge feel safe enough for them to take the trip and want to come back forever after.
Step two is to adapt a strength-based model, which acknowledges that there is a potentially serious downside to ADHD but recognizes that there also is a potentially spectacular upside as well. The current medical model is deficit-based, as the name itself demonstrates: attention deficit hyperactivity disorder. Although preferable to the previous model that labeled students as "bad," "lazy," or even "incorrigible," the medical model slaps a pathological diagnosis on the student, and a pretty miserable-sounding one at that. True, it's not as miserable as its predecessor, which was "minimal brain dysfunction," but still, who wants to have a "deficit disorder"? How much enthusiasm can you expect someone to muster to deal with that? It's no wonder many students reject the diagnosis and refuse to accept the label.
Here is the model I use when I present the diagnosis to students. I say to the student, "I have great news for you." At that the student, and his or her parents, look up. This is not what they'd been expecting to hear.
"I've learned a lot about you," I go on. "I've taken your history, and I've read what your various teachers have had to say about you. As you know, we've also done some tests. After putting all this information together, I'm now able to tell you that you have an awesome brain."
"Your brain is very powerful. It's like a Ferrari—a race car. You have the power to win races and become a champion."
"However," I continue, "you do have one problem. You have bicycle brakes. Your brakes just aren't strong enough to control your powerful brain, so you can't slow down or stop when you need to. Your mind goes off wherever it wants to go, instead of staying on track. But not to worry! I'm a brake specialist, and if you work with me, we can strengthen your brakes."
Which is true. Treating ADHD is all about strengthening brakes. For individuals with ADHD, the inhibitory systems in the brain don't work well enough to control all the power the brain possesses. The brain can't inhibit incoming stimuli (hence the individual is distractible) or outgoing impulses (hence the individual is impulsive and hyperactive).
But consider also that each of those negative symptoms can lead to a corresponding positive one. The flip side of distractibility is curiosity, a valuable quality indeed. The flip side of impulsivity is creativity, a hugely valuable asset. You can't be creative if you aren't somewhat disinhibited. And the flip side of hyperactivity is a quality that, at my age, I'm grateful to have. It's called energy.
As a brake specialist, I can help these children strengthen their brakes. But what can you as a teacher do?
Above all, embrace the strength-based model. Make sure you and the student understand ADHD in the same way: race car brain, bicycle brakes. Then, when that student is disruptive you can simply say, "Joey, your brakes are failing you now." This sets a limit, but it does so in a nonshaming way—especially if Joey has already accepted you, the teacher, as someone who is going to be part of the team devoted to helping him strengthen his brakes.
These are some other interventions you can use in the classroom:
- Set up predictable schedules and rules. All children need structure, but for those who have ADHD, schedules and rules are as essential as maps and roads are for drivers. Without them, these kids can get completely lost.
- Have kids with ADHD sit near you. Being physically close to the teacher increases a student's level of attention. Being far away makes it easier to lose track of what's going on.
- Break down large tasks into small ones. A large task can intimidate anyone, but it completely bamboozles and overwhelms the student with ADHD, which can lead him or her to give up or suffer a meltdown.
- Introduce new material in terms of old. For example, "Today we start studying fractions. Fractions are just division written differently, and you've already mastered division."
- Balance structure with novelty, so that when the class gets overstimulated you introduce structure, and when the class gets bored you introduce novelty. Too much new material gets confusing, and too much drill gets boring.
- Make sure the class gets recess, and provide frequent brain breaks (brief periods of exercise in which students stand near their desks or stations). Physical exercise, even for one minute, presses the reset button on the brain and refreshes students mentally.
All these strategies, and many more, can help. But the most important one of all goes back to Mrs. Eldredge: Make sure students with ADHD know you like them and are on their side.
These kids really need you. You can help them turn what could be disastrous outcomes into spectacular successes. Helping kids with ADHD excel takes a lot of time and energy. But your energy is much better spent if you think of your work not as treating a disability, but as helping your students unwrap a gift.
Diagnosing Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition characterized by high levels of distractibility, impulsivity, and restlessness as compared to one's peers. Magnetic resonance imaging (MRI) studies show small but measurable differences in brain size in several regions of the brain—the prefrontal cortex, the corpus callosum, the caudate nucleus, and the vermis of the cerebellum—that correlate with the symptoms observed in the condition.
A diagnosis of ADHD is based on the individual's history, supplemented with teacher comments and neuropsychological testing. The symptoms must cause underachievement or some other form of impairment and be present in at least two settings—for example, home and school. The so-called "inattentive type" of ADHD, which is more common in girls than boys but can be present in either, is often missed because the child is not at all disruptive—indeed is often quiet and serene. However, he or she is underachieving because of inconsistent and frequently wandering attention.
ADHD is among the most heritable of all conditions in the behavioral sciences. If one parent has ADHD, the odds are about 1:3 that a given child will also have it. If both parents have it, the odds increase to 2:3.
Edward Hallowell is a child and adult psychiatrist. He has written 18 books, including Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood (Touchstone, 1995) and Superparenting for ADD: An Innovative Approach to Raising Your Distracted Child (Ballantine, 2010). His website is www.adhdforteachers.com.
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