Tuesday, September 4, 2007

Difficult or Undiagnosed?

Ask anyone who's worked with children and/or teenagers for any period of time and they'll tell you that yes, they've definitely worked with someone described as "that kid." You know the ones I'm talking about. They're the ones who are constantly disrupting when you're trying to get serious. They're the ones who you have to have a volunteer on "special assignment" to help out with. They're the ones who have a hard time focusing on something for more than just a few minutes, and even then seem distracted.

These kids often get a bad rap. Sometimes the adults who work with them think they aren't well disciplined. Or sometimes they just get labeled a "difficult kid."

Sometimes there are discipline issues or things stemming from exterior influences. But sometimes it's not that. All too often a large percentage of these kids actually do have the disorder known as ADHD, and they frequently go undiagnosed and untreated. The number of these kids is on the rise. According to a study published in the Archives of Pediatrics & Adolescent Medicine now 9% of kids suffer from ADHD and a high percentage of them go untreated. You can read more about this study here.

I'm not an expert on ADHD, but I do have significant experience having worked with kids with ADHD in the Church. So I can't talk about why it's on the rise or even about treatment. But I do want to talk a bit about ways the Church might be able to help.

Start addressing Psychological or Psychosocial Illness in the same terms as physical illness. There has been a tendency in the Church to overlook Psychological/Psychosocial illnesses, or to address them in less-than-helpful terms. In some churches these types of illnesses are addressed only as "spiritual" problems. While our spiritual state has a dramatic impact on the state of our physical and mental well-being, they need to be addressed by professionals. Refusing to acknowledge these illnesses and to address them through trained medical professionals is just as detrimental as refusing to acknowledge that a heart attack is a condition that needs medical treatment.

Remove the taboos surrounding the issues. Often times in faith communities people with any sort of psychological disorder are looked upon as "weak" or "strange." Parents often have trouble coping with disorders their kids may have because of how others will see them. The church needs to be a safe place, a refuge for families in these situations. Encourage people to treat everyone as equals (this should go without saying) and ensure that no one is ever addressed as "weak" or "strange" especially in ways that are not vocalized. Additionally, make sure the way you yourself handle the person/situation does not show discomfort or anxiety because other people will follow your lead. And if a family is having trouble coping with such a situation, they may need to hear someone say, "There's nothing to be ashamed of."

Talk openly and honestly with parents. When we work with kids who are "difficult" for an extended period of time it can become difficult to deal with them objectively. This is even further complicated when their situation is undiagnosed or untreated. An undiagnosed or untreated kid can have expectations put upon them that are unfair or unattainable. It's easier to work with someone when you have a good understanding of their limits or their challenges. When working with an undiagnosed or untreated child and the problems/symptoms exist for an extended period of time, you may need to talk to the parents about it. I can't tell you when the right time to ask "Have you talked to your doctor about the possibility your child might have ADHD?" is, or even how to ask that question. But at some point it may need to be asked.

Don't jump the gun. While many kids with ADHD go undiagnosed or untreated, not every "difficult" kid has it. Some kids are labeled as ADHD when there are really other issues going on. This can result in more complex unresolved issues and even over-medication. Be careful not to assume that a kid has it. Like all disorders ADHD has a very specific set of symptoms that doctors and psychiatrists use to diagnose it. Unless you are one of these, don't tell parents their kid has ADHD. Remember, above I talked about asking, not about telling. Allow a professional to diagnose the problems. But if you think you need to refer someone, first read up here , or make an appointment with a mental health professional just to ask questions about ADHD and ways you can help kids/families in your congregation who are dealing with it.

Adjust your programming. While we can't make one program or model that miraculously fits everyone, we also have a responsibility to make adjustments for people. It's no different than putting in an updated restroom or a ramp where the stairs used to be. Without these things some people might not be able to fully participate. When you're planning your youth ministry programming be sure to take the kids in your group with ADHD into consideration. Careful consideration of their attention spans and ability to focus may change some of what you're doing. Make sure you're doing your best to help them participate as fully as possible. Also educate the rest of your staff/volunteers so they know what they're dealing with. Remember, the goal is not to single anyone out. The goal is healthy integration.

I'd also like to tag a few fellow bloggers to see what they have to say about working with kids who have ADHD, whether treated or untreated. Let's see what these folks have to say:
Brian and Jacob
And feel free to invite anyone else to this conversation, too.


Danny said...

My own son has ADHD as well as anxiety. He's 10 and he loves to read and write, but I need to sit with him for the hour it takes him to do his math homework every day. It's not that he doesn't know how to do it, he just needs me to sit there with him to keep him on track.

I'm learning as I go, trying to figure this out, and I think anyone who works with youth needs to do the same.

BTW, you might want to check out the book "Prayer for People Who Can't Sit Still" by William Tenney-Brittian (published by Chalice Press). It is a great resource for developing spiritual practices for everyone, but especially those who have ADHD.

Doug Jones said...

I am no expert on ADHD - thanks Danny for the book on spiritual disciplines for those who can't sit still... I will check that one out!

From my experience one of the things I often do/did was have a couple of stations in the back that allowed people to draw, cut, move around a little during the program... just a place for folks to busy their hands (in a farily non-disruptive way) while the programming was happening.

I often also try to make the program as multi-sensory and as interactive as possible. Understanding that many people struggle with attention and with the need to be kinesthetic in their learning style.

Finally I think it is also having folks who volunteer be sensitive to the individual needs of all our kids. Having volunteers who see students not in categories as nice kids, spiritual kids, disruptive kids and pagan kids... but who just see kids - uniquely made by God. Who see each one as an individual worthy of our attention and worthy of taking the time to know them, learn from them, serve them and encourage them in their journey toward Christ.

Adult mentors/volunteers taking an interest in our kids and accepting them is in my mind one of the areas that the church must become better at fostering. (we are good at the factory approach - great for counting noses and nickels and such - not so great at handcrafting... which is probably the needed skills necessary for pulling off exceptional ministry to students).

Great question Dan!

Dan said...

Danny and Doug,

Thanks for the comments. Danny, thanks especially for your first-hand knowledge. It's good to hear a parent's take. Perhaps that's the best resource for youthworkers. I'll check out that book. Doug, these are pretty good ideas. I think you've got a good grasp on making this a positive situation. The centers at the back of the room are a great idea.


Brian said...

I think you've done a fine job laying out the major issues here. I was an elementary school teacher in my former life and worked with many children diagnosed with ADHD. Most were boys. For some, medication seemed to help. For others, it made them sluggish and unable to be productive. After several years, I began to wonder if we were over-diagnosing. It seemed we were medicating boys for acting like boys! I've spent many summers working in camps and often these children are allowed to go off their medication when not in school. For some it is a reprieve -- a chance to return to their normal, if somewhat exhuberant, personalities.
There have been times when I've had youth with ADHD in my group and had to figure it out for myself. Some parents still see the lable as stigmatizing and don't reveal the child's condition unless asked. I will say that this seems less and less the norm.
As you and others have affirmed above, I agree that we have to be sensitive to the needs all the different learning styles in our group. I aim to make my activities appeal to both the ones who like to sit still and talk and those who like to move around and touch and explore.