Shimmy gazed off into the distance. His dark brown eyes appeared lost in the woods that are visible from my office window. His dark, calloused hands fidgeted mindlessly on the lip of my desk. Was he still with me? I wasn’t sure, but waited patiently. He finally responded.
“Nothing,” he replied, “Basically nothing. They diagnosed it because I was acting out in school, and I think it has to do with why I was always the funniest kid in school, but that’s about it.” This was just the sort of answer I have come to expect (unless the client is obviously not funny….).
“I apologize in advance,” I replied, “but do you mind if I tell you a little bit about what exactly ADHD is - what happens in the ADHD brain differently than in the non-ADHD brain, and what symptoms that generates? It can be very helpful to know this, and if you start to get bored I’ll stop the second you say to. You have my word.”
He allowed me to proceed, and effectively lecture - something that is otherwise practically taboo in my field of coaching. (Incidentally, it’s not a home run in my classroom teaching either.) I began to teach him about neurotransmitters, cautiously watching to see if he was following without getting bored or distracted. Then something shocking happened. He took out a notebook and began taking notes! I spent about fifteen minutes giving an overview of the neurobiology of ADHD and its resulting wide ranging behavioral symptoms. I explained, among other things, that the ADHD brain is deficient in dopamine, causing stimulation seeking behavior, and how an underdeveloped prefrontal cortex creates challenges in the brain’s executive function - leading to issues such as poor organization of time and space, poor working memory (working memory refers to the ability to retrieve or access information necessary to complete a task) and impulsive decision making. This young man with ADHD who had struggled his way through school followed and took notes with rapt attention the entire time! Apparently, he sensed the relevance - the value in this knowledge - to the point where he was able to focus.
I was amazed the first time this happened, but have since learned that it is actually common. After discussing a client’s personal history of living with ADHD - their experience at home, school, and work - I ask the simple question I asked Shimmy: “Do you know what exactly ADHD is?” The answer is almost invariably in the negative. Their interest to hear, on the other hand, is consistently positive. They listen carefully to a relatively dry topic for several minutes. Listening attentively does not tend to be their strong suit in general, but they seem very able and motivated to make it happen easily in this context. Apparently, this information is meaningful - and, more importantly, interesting - to them. As ADHD professionals, we know what a difference that can make.
This anecdote raises an important question: How can it be that a twenty eight year old whose schooling and early career have been ravaged by ADHD doesn’t quite know what ADHD really is? There are probably a number of good reasons for this. Sometimes the client is diagnosed at a young age at which they might not understand. Other times, there may be so much emphasis on solving the presenting issues at home, school, or work, that this detail of educating him about his challenge may be overlooked. These are all valid explanations. However, I’d like to suggest that the value of teaching those with ADHD about the nature of this condition is well worth the attention and effort.
When I present in schools about ADHD, I show the teachers a copy of the book You Mean I’m Not Lazy, Stupid, or Crazy (Kate Kelly, Peggy Ramundo, 2006). The objective in doing this is to impress upon educators how badly students with poorly managed ADHD often feel about themselves, beneath the playful surface. Years of harsh criticism for being unable to sit obediently in a classroom, follow instructions, complete and hand in homework on time, as well as the many other challenges with which students who have ADHD struggle, can contribute to a severely compromised self-image - one of being “lazy, stupid, or crazy.” This is then often compounded in adulthood by failures in the workplace or in relationships. We know, of course, that being diagnosed with ADHD is not a moral assessment, but by the time they hear that, the psychological damage is often internalized. Understanding their brain’s differences can help them appreciate that their ADHD related behaviors are not a moral failing. They are merely a function of their neurobiology.
There is another benefit of teaching clients with ADHD about their brain’s wiring that is evident in the story about Shimmy. Those with ADHD often know what the presenting issues that led to their ADHD diagnosis were, but may not realize how many other areas of life are impacted by their ADHD. They may be engaging in a number of other behaviors that are disruptive to them or others without being aware of it. This lack of awareness can be manifest in three basic ways: lack of awareness that the disruptive behavior is a function of ADHD, lack of awareness that the behavior is disruptive, or even lack of awareness that the behavior is taking place at all.
Let us take, for example, the tendency to interrupt others while they are in middle of speaking. This behavior is a common challenge for those who have ADHD. One who is diagnosed with ADHD, but isn’t taught about the wide range of behaviors it impacts, might not realize that interrupting others is a function of their ADHD, might not realize that it is disruptive, or might not even realize that they do it. Educating clients about their unique neurobiology and the relevant symptoms it can affect can create the necessary awareness to address these behaviors.
Clearing the Hurdles
The aforementioned challenges in teaching this to clients are in fact real, and therefore are essential to be addressed. Some suggestions are as follows. A particular resource that can be helpful for some young clients: Dr. Martin L. Kutscher’s outstanding book ADHD - Living Without Brakes (2008), in which there is a chapter (Chapter 7, pg. 123) that is written specifically for children to understand the wiring of their ADHD brain. It is even written in the larger font of a children’s book, for user-friendly consumption. This can be an option for teaching some young clients. When the child being diagnosed is too young for this, the parents can be informed until the child is old enough to understand. Having an ADHD diagnosis and the challenges that come with it can be daunting- but getting the right support, including understanding the science behind it and the evidence-based strategies for how to deal with it, makes all the difference for the client, family, and educators.
Rabbi Shmuel Reich AAPC is an ADHD life coach in private practice in Monsey, NY (remote coaching also available) as well as a rebbi in Yeshivas Ohr Reuven in Suffern, NY. He can be reached for coaching of individuals or couples, as well as for speaking or writing engagements, at firstname.lastname@example.org or 646-262-8257.