by Guest Blogger Dr Nigel Williams (Email:email@example.com)
Dr Nigel Williams has recently completed his PhD which identifies drug free strategies that enable many children, who qualify for a diagnosis of AD/HD, to engage in activities they normally find boring and thus avoid.
This new research, which was supported by funding from Healthway, explored how parents, who had decided not to have their children medicated, parented their children. One of the surprising results was how some parents were able to help their child engage in an activity when they found it boring. In essence they were able to help their child change the way they interpreted the activity so that they found it interesting instead of boring. The child then had no difficulties in doing the activity…even activities like homework!
This research revealed certain patterns and commonalities in the way that these parents were able to consistently achieve these positive outcomes. These results are important because, although it has been recognised that these children can do things that they are interested in, this is the first time that processes and strategies have been identified that appear to be able to actually change the way that the child interprets an activity. Thus these children can be helped to perform at much higher levels and without medication. Let’s face it no-one likes to do boring stuff, and if these children can see something as sufficiently interesting it would seem to be a much better, and a less stressful, option than forcing a child to do something against their will.
The results from this research are consistent with an extensive amount of published research. The need for the child to either receive additional stimulation or for the child to perceive sufficient stimulation has been proposed in many models and theories of AD/HD (Glow & Glow, 1979; Haenlein & Caul, 1987; Sagvolden & Sergeant, 1998; Sergeant, 2000; Zentall & Zentall, 1983). The dynamic developmental theory proposed by Sagvolden, Johansen, Aase & Russell (2005) indicates that children who may be diagnosed as AD/HD need more stimulation that a ‘normal’ child. Further, it is the mismatched interplay between the child’s characteristics and the environment that results in what we would see as AD/HD symptomatology. If the child finds an activity boring then the inattentive, hyperactive and impulsive behaviours may be seen as attempts to elevate the stimulation they receive from the environment.
The notion that elevated stimulation (interest) or an increased density of reinforcement is associated with elevated performance, has also been noted in numerous studies (for example: Carlson & Tamm, 2000; Kuntsi, Wood, Van der Meere & Asherson, 2009, Luman, Oosterlaan & Sergeant, 2005; Scheres, Oosterlaan & Sergeant, 2001). The avoidance of low stimulation situations has also been noted (Sonuga-Barke, Taylor, Sembi & Smith, 1992; Sonuga-Barke, Williams, Hall & Saxton, 1996) and poorer performance in low reinforcement conditions (Aase & Sagvolden, 2006). The ability of the child to inhibit impulsivity has also been reported in higher reinforcement conditions (Huang-Pollock, Mikami, Pfiffner & McBurnett, 2007; Slusarek, Velling, Bunk & Eggers, 2001).
This new research builds on previous research and enables us to tentatively pose an interesting question. If a child who has inattentive, hyperactive and impulsive characteristics, and who would normally qualify for a diagnosis of AD/HD, is able to engage in activities he previously found boring, does it mean the child is cured? Or does it mean that perhaps AD/HD may instead be a set of behavioural characteristics at a particular end of a normal range? Further, that by a child simply having these characteristics it does not necessarily mean that this has to lead to pathology.
The indications from this research are possibly that these children need an environment, or set of conditions, where they can perform consistently to a high standard. This is by no means an easy option as even the most successful parents found their child’s behaviours very challenging. However, parents who were able to implement these innovative strategies did seem to experience much less distress, and appeared more at ease with the prospective outlook for their child’s future.
Ultimately it seems that these parents are creating an environment that best meets the child’s characteristics, and achieving a high degree of success in doing so. The conclusion being that perhaps instead of trying to put the square peg in the round hole, we should consider putting the square peg in the square hole.
Aase, H., & Sagvolden, T. (2006). Infrequent but not frequent reinforcers produce more variable responding and deficient sustained attention in young children with attention-deficit/hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, 47(5), 457-471.
Carlson, C., & Tamm, L. (2000). Responsiveness of children with Attention Deficit- Hyperactivity Disorder to reward and response cost: Differential impact on performance and motivation. Journal of Consulting and Clinical Psychology,68(1), 73-83.
Haenlein, M., & Caul, W. (1987). Attention Deficit Disorder with Hyperactivity: A specific hypothesis of reward dysfunction. Journal of the American Academy of Child and Adolescent Psychiatry, 26(3), 356-362.
Huang-Pollock, C.L., Mikami, A.Y., Pfiffner, L., & McBurnett, K. (2007). ADHD subtype differences in motivational responsivity but not inhibitory control: Evidence from a reward-based variation of the stop signal paradigm. Journal of Clinical Child and Adolescent Psychology, 36(2), 127-136.
Kuntsi, J., Wood, A., Van der Meere, J., & Asherson, P. (2009). Why cognitive performance in ADHD may not reveal true potential: Findings from a large population-based sample. Journal of the Neuropsychological Society, 15, 570-579.
Luman, M., Oosterlaan, J., Sergeant. J.A. (2005). The impact of reinforcement on AD/HD: A review and theoretical appraisal. Clinical Psychology Review, 25, 183-213.
Sagvolden, T., Johansen, E., Aase, H., & Russell, V. (2005). A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behavioral and Brain Sciences, 28, 397-468.
Sagvolden, T., & Sergeant, J. (1998). Attention deficit/hyperactivity disorder-from brain dysfunctions to behaviour. Behavioural Brain Research, 94, 1-10. 720.
Scheres, A., Oosterlaan, J., & Sergeant, J. (2001). Response inhibition in children with DSM-IV subtypes of AD/HD and related disruptive disorders: The role of reward. Child Neuropsychology, 7, 172-189.
Sergeant, J. (2000). The cognitive-energetic model: An empirical approach to attention deficit hyperactivity disorder. Neuroscience and Biobehavioral Reviews, 24, 7-12.
Slusarek, M., Velling, S., Bunk, D., & Eggers, C. (2001). Motivational effects on inhibitory control in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 40(3), 355-363.
Sonuga-Barke, E.J.S., Tayor, E., Sembi, S., & Smith, J. (1992). Hyperactivity and delay aversion -I. The effect of delay on choice. Journal of Child Psychology and Psychiatry, 33(2), 387-398.
Sonuga-Barke, E.J.S., Williams, E., Hall, M., & Saxton, T. (1996). Hyperactivity and delay aversion III: The effect on cognitive style of imposing delay after errors. Journal of Child Psychology and Psychiatry, 37(2), 189-194.
Zentall, S.S., & Zentall, T. R. (1983). Optimal stimulation: A model of disordered activity and performance in normal and deviant children. Psychological Bulletin, 94, 446-471.