Eliezer doesn’t call me often, but when he does it is usually important, time sensitive and - for good measure - quite to the point. So when I saw an incoming call from Eliezer last week, I was quick to pick up.
“What’s up, Eliezer?”
“Would it make sense that a kid with ADHD can spend hours building model airplanes uninterrupted, but behave very disruptively at dinner with the family?”
“Absolutely. The term ‘Attention Disorder’ is really a misnomer.” I explained, “ADHD really refers to the inability to control focus rather than the inability to focus. The difference is that rather than being unable to focus on anything, the attention of someone with ADHD is powerfully drawn to the easiest place for it to focus. This is usually not the front of a classroom. Rather, it is frequently drawn to what we ADHD professionals refer to as ‘the shiniest toy in the room’ - referring the item or occurrence in the room most likely to catch someone’s attention, but sometimes it is simply whatever they personally find interesting. This can be anything from books to video games.”
“That explains a lot!” Eliezer replied excitedly. “I have long suspected that my son in eighth grade has ADHD. My wife, however, questioned that assertion, wondering how it would then be possible for him to spend so much time on one hobby. At a time like this we really need to get a handle on what is going on. Thank you!”
True to form, Eliezer made it important, timely, and quick once again. More importantly, though, he highlighted a prevalent challenge many families are currently facing: as we are all hunkered down at home due to the COVID-19 crisis, individuals - as well as families of individuals - with ADHD are faced with a unique challenge. Those with ADHD are not wired all that well for quarantine. Their frustration with this can likely not only impact them, but can be disruptive to family members as well. The following is a list of potential challenges of being at home for preteens and teens with ADHD, as well as how this may impact the family, along with some tips as to how to navigate them. (It only addresses the challenges of being home over Yom Tov vacation. School time has its own separate set of challenges.) Please be advised that there is no one-size-fits-all solution, and any suggestions need to be adapted for a particular home and situation.
Although the part of the term “ADHD” that means “attention deficit,” as previously mentioned, is a misnomer, the description of “hyperactivity” is certainly not. Dr. Russell Barkley, one of the world’s leading experts on ADHD, says that even ADHD with inattentive presentation (colloquially referred to as “ADD”, though not referred to as such in the most recent edition of the DSM) must have some element of hyperactivity in order to qualify for a diagnosis on ADHD. This can be manifest as typical hyperactivity, restlessness, or even excessive talking, and can be exacerbated by being cooped up at home. Additionally, it can be annoying or disruptive to family members - taking up space and making noise while everyone is home trying to work or just experience some peace and quiet.
The first thing to do about this is to understand that this behavior is not being done to annoy anyone deliberately (we’ll get to that kind of behavior shortly). It is simply how their brain is wired. Having this knowledge and sharing it appropriately with family members can help inspire much needed patience and understanding. It is more important than any practical strategy.
Additional strategies involve giving your teen some way to release his pent up energy. Speak to your medical advisor about taking solo walks, jogs, hikes, or bike rides. If those are not an option then jumping rope, an exercise bike, or even lifting weights can be helpful. It is best if they can do this on a porch or in a backyard, but if that is not an option then even doing it inside can release energy. An additional benefit is that exercise in general contributes toward mitigating ADHD symptoms.
Stimulation Seeking and Impulsivity
Without boring anyone with details of neuroscience, the ADHD brain seeks stimulation (to compensate for a lack of the neurotransmitter called dopamine). An additional symptom of ADHD is impulsivity - acting without thinking. A teen or preteen with ADHD who is stuck at home all day will likely begin to feel bored. Jeff Copper, MBA, ADHD Coach, and host of Attention Talk Radio explains the feeling of boredom among those with ADHD to be comparable to standing outside in the freezing cold without a coat! It is unbearable, and they may do some very surprising things to avoid it. If a teen or preteen ADHD inexplicably pokes, provokes, or annoys their siblings (more than normal sibling relationships) this may explain why. Simply, he is bored.
The first suggestion for this is once again to understand that, although this behavior does seem to be a deliberate attempt to annoy people, it is really being done to satisfy a neurological need that they have. Although this does not make it acceptable, framing it this way will help family members be more understanding. At times when other solutions don’t work (which can definitely happen), this patience can help family members ignore the disruptive behavior (to the best of their ability) until it abates.
Practical suggestions should involve alleviating boredom - either at the onset, or preferably before. The most direct way to do this is to talk to your teen in advance about how to predict or detect that they are going to feel bored, and plan an interesting activity to preempt or address it. This is a good time to get creative: make up in advance a list of activities they may want to do to avoid boredom. This can include simple things like reading a book, playing a video game, or listening to music. It can also include things they have thought of doing, but never before had the time, such as learning to play an instrument (note: your teen practicing the kazoo will probably not be the reprieve you were hoping for), learning to speak a new language, art projects, building projects (model airplanes, etc.) or even learning to juggle. (There are apps and YouTube videos for many of these things.) Have a conversation with him during a time of calm, planning in advance. Understand that the more he feels like part of the process, the more likely he is to buy into it. Leave the materials for these projects in a visible and accessible place to make for an easy reminder and transition. If they still don’t remember in the moment (there is a strong possibility of this happening) you or a family member can remind them. Remember that, as always, nothing is guaranteed to work all the time.
Many people with ADHD feel emotions more intensely than their counterparts. Generally, this can lead to surprising bouts of anger, frustration, or other emotions. During these difficult times, tensions and anxieties are high for everyone. For those with ADHD it can be all the more so.
Once again, the most important thing is awareness and understanding. Exercises such as deep breathing, mindfulness, physical exertion, and fresh air (if possible) can help calm the emotions, though they won’t always. They have a much better chance of working if there is a plan in place from before as to what to do when this happens. Good preemptive conversations listening to your teen’s concerns and feelings (both with regard to issues at home and in the world), and how to address them when they flair up has the potential to be the proverbial “ounce of prevention.”
Excessive Use of Screens
Although the current prevailing theory is that the excessive use of screens does not cause ADHD, the correlation between ADHD and excessive use of screens in unmistakable. The understanding is that the ADHD brain is drawn to what it finds interesting or stimulating (as discussed previously) - in this case both - and latches on to it. This is commonly referred to as hyperfocus. A teen or preteen playing a video game may be very difficult to disturb or stop. They may react with frustration or agitation. They might not even hear you calling them.
As always, the most important thing is to understand where this is coming from, and exhibit appropriate patience and understanding. It is worth noting that under the current conditions a teen may feel that this is all he has to do to alleviate boredom, and may not have the self-awareness to express this. It may instead come out as anger or frustration.
One way to address the challenge of excessive use of screens is a preemptive conversation during a calm time. Ask them how much time they think is reasonable, and when and how it should be used. This will vary greatly from family to family, and relies heavily on your dynamic with your child.
Another way to address the challenge of both excessive screen time and boredom is to create a set daily schedule with your teen. This should involve a time to wake up, meal times, a time to go to sleep, and set times to do set activities during the day. The ADHD brain needs structure, but struggles to create it for itself. It therefore needs the help to come from the outside (until it is taught the skill for itself. This does not happen as naturally as it does for those who do not have ADHD.) This is another time to get creative. Fun family activities together will not only structure the day, but will help build bonds and create memories. (To be sure, there will be fights and a bit of drama at times, but that happens in all families.) Doing puzzles, playing family board (note the spelling difference) games, and scavenger hunts are some ideas. If you can’t think of ideas, there are lists of “things to do” online. Additionally, if you have any friends who are elementary school teachers or rabbeim, they may have some creative ideas for activities.
An additional possibility to include in their daily schedule is chores that help at home. The feasibility of this option will vary greatly from home to home and teen to teen. The conversation with your teen would be about the value of learning skills, having competence for life, and contributing as a “team player.” Make sure it is a conversation rather than a lecture. Using some kind of incentive if possible tends to be the best way to get their buy-in.
In general, sufficient sleep and healthy nutrition can help to mitigate ADHD symptoms. Set meal times as a family can create a sense of stability and healthy human interaction. Calling friends, family, or rabbeim - especially video calls - can also serve as strong venues of healthy social interaction. (Perhaps this may be one more thing to put into the schedule.) The most important thing, however, is understanding your child’s differences and having the patience to approach their challenges with that mindset and proper empathy.
Wishing everyone a chag kosher v’sameach, safety, and good health.