Tuesday, December 1, 2015

ADHD - Typical Versus Atypical Behavior (James W. Forgan, Ph.D., and Mary Anne Richey)

We’re often asked, “How do you determine if this is normal boy behavior or behavior that is unusual?” You can probably arrive at an answer on your own, but you need to consider these three questions to know if your son’s behavior is unusual: 
  • How frequently does the disruptive behavior occur? 
  • How long do your son’s disruptive behaviors last? 
  • How intense is your son’s behavior during this time? 

Think about how frequently your son’s disruptive behaviors occur. Once an hour? Once a day? Once per week? It is unusual for a child to get into trouble on a daily basis. We talked to one mom who felt like she had to keep her 7-year-old away from the other neighborhood boys because every time her son went out to play, he came home crying. He had an explosive temper and yelled at the other boys when he got mad but couldn’t handle it when the neighborhood kids yelled back, and he’d run home in tears. This was unusual behavior because it happened so consistently. 

Consider the parent with several sons who all have similar behavior patterns. They may think their children are behaving typically because their reference group of boys may be their only comparison. Thus, parents may think that everything is fine until their sons go to school. Once a young boy enters the school system, the parents are surprised to learn that their son’s behavior is considered problematic. 

Or what about the preschool boy who urinates on a tree during recess? Think about the middle school boy who taunts other children. Are these typical boy behaviors or alarming actions? In both situations, parents and teachers have to consider the context of the behaviors. The boy who urinated on the tree may have done this on occasion when there was an emergency and a bathroom was too far away. Maybe he and Daddy go on trees when hunting, fishing, or camping, and he genuinely thought it was OK in the schoolyard as well. The middle school student may live in a neighborhood or home environment where taunting is considered part of survival and standing up for himself. Remember, in order for a behavior to fall under the ADHD umbrella, it must interfere with the boy’s functioning and occur so frequency that it is considered problematic. 

The second question was, “How long do your son’s disruptive behaviors last?” Are the behaviors like a brief passing rain shower or long and drawn-out? Think about a boy who is upset because he wants to play video games but has to do his homework. Depending on their age, most boys become upset and huff and puff around, and yet recover within an age-appropriate amount of time. Time tends to heal things with most boys. Take the same situation for the boy with ADHD. You give him a 5- minute warning to prepare him for the change. Then you give a 2-minute warning that video game time is almost finished. Still, he just can’t seem to stop playing or being upset that game time is over. It takes the boy with ADHD much longer to redirect his focus from one fixation toward something else, particularly something he perceives as unpleasant (like homework). At home and school, boys with ADHD are constantly required to shift their thoughts. Boys who have difficulty with cognitive flexibility often dislike unexpected changes in routine. 

The third question we asked you to consider was, “How intense is your son’s behavior during this time?” If your son’s temper tantrum goes on for hours and is so severe that no one wants to (or is able to) get near him, the intensity would be considered severe. When parents, teachers, and school staff meet to discuss the boy’s disruptive behavior in relation to frequency, duration, and intensity, parents’ eyes may be opened to recognize that a potential problem exists. 

Other groups of parents suspect, from an early age, that their son is having behaviors related to inattention or hyperactivity. These parents either may have other children without behavior difficulties or may be alert to the differences they see by observing friends’ children in play groups, sports, or church activities. They realize their child may be more emotional or active than other children. These parents often seek help on their own. 

Eventually both groups of parents reach a point when they understand their child may have behaviors related to ADHD. At this point they begin to learn more about what ADHD means. For example, Joan’s son was only 4 years old but had been kicked out of three preschools for biting, kicking, hitting, and disruptive behavior. The fourth school worked with her until Sam entered a public kindergarten, where within the first month he was in trouble for his behavior in afterschool care. The family came to see Jim when Sam’s parents were told he could not return to afterschool care once the month ended. Even the classroom teacher had difficulty managing Sam. Clearly, the parent was not surprised that Sam’s behavior went beyond typical boy behavior. 

Jim completed a comprehensive evaluation and used tools to assess Sam’s memory, attention, auditory and visual processing, and academics. He talked to Sam’s parents and teacher. They also completed rating scales. At the end of the evaluation process, Jim sat down with Sam’s parents and explained how their son met the criteria for ADHD and not other disorders that could have caused the behavior problems. Together, they set up an action plan so the parents knew exactly what to do. This was a better option for everyone—Sam, his family, his teacher, and his school—than taking a “wait- and-see” approach. 

Source : James W. Forgan, Ph.D., and Mary Anne Richey. Raising Boys with ADHD. Prufrock Press Inc. 2012 

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