ADHD: Same Label, Different Settings
By: Dale Borman Fink, Ph.D. (2004)
My overall approach in solving behavioral problems is crystallized in the title of a small book I wrote for School-Age Notes in 1995, Discipline in School-Age Care: Control the Climate, Not the Children. In it, I asked providers to think about an essential question: Do the behavior problems we see "live" within certain children and will they inevitably act out these unacceptable behaviors once they enter our space? Or do they "come alive" in our environments? In other words, do we generate a great many of the problems we observe by the decisions we ourselves make? I claimed that we could increase or decrease behavior problems by our activity choices, our room arrangements, our rules, and the ways we choose to convey our expectations and reward appropriate behavior.
I had a rare opportunity to witness the validity of this insight when I observed a boy I'll call David, aged 12 and diagnosed with ADHD (Attention Deficit Hyperactivity Disorder), in two different Boy Scout troops. He was brought to my attention by one of his Boy Scout leaders as a very difficult troop member whose presence exasperated both the leaders and his peers. The leader viewed him as typical case of why it is so hard to have kids with ADD (Attention Deficit Disorder) or ADHD included in mainstream activities. I interviewed David and his mom together in the trailer park where they lived, and got permission from both his scout leaders and his family to attend his meetings.
David soon dropped out of this troop, but not out of the Boy Scouts. He rejoined a troop in a nearby town where he had been a member before the family moved. I was able to observe his participation and interview his leaders in both troops.
The first troop met in a big, lofty barn and comprised about 14 boys. David's physical appearance was bulky, pudgy, and awkward. Every meeting stared informally with 15 to 20 minutes of hard-driving basketball. David had told me that he did not enjoy this at all and I saw that he participated in it without enthusiasm and without much skill. There was no coaching or instruction during this activity; the leaders occupied themselves with greeting parents and preparing for the meeting and viewed this as something the boys did on their own.
The balance of the meeting were run in a straight-laced, no-nonsense manner. David frequently engaged in off-task behaviors. When everyone was supposed to practicing tying different knots, he was wandering to another part of the barn, hanging upside down, or playing with the ropes in an unapproved manner. His personality came across as goofy and a bit contrary, and the leaders called his name only to give him negative feedback. The other boys ignored him. I never saw him in a physical altercation, but I could easily see how his personality, his physical awkwardness and size, as well as a chip-on-the-shoulder attitude he projected would lead him to shove or knock into someone (or worse) without much caring about the consequences.
When David with his other troop, he was considerably more engaging and likable-although still definitely a handful. A barded Vietnam veteran named J. R. led a much smaller troop (only 6-8 boys), and clearly knew how to humor David. If David said something gross at the first troop and a leader heard it, he was reprimanded. J. K.'s response was to come back with something equally gross-and then get David back on task. He saw beyond David's imagination; he's in his own world sometimes. (His mom had told me that in spite of his ADHD, he could concentrate on Nintendo for hours.)
J. R. described a problem he had had and how he resolved it. David had been boasting and threatening other troop members with kicks and thrusts, based on some martial arts lessons he had taken. J. R. challenged him to a fight. David then tried to get out of it, according to J. R., saying that "We don't do that in the Boy Scouts". But I got permission from his mom, "to fight him." The duel was never consummated. But -- attention-deficit or no attention deficit -- J. R. had gotten the boy's attention. He had done it in a way that asserted his won authority and still produced a good relationship with David. David clearly thought very highly of him, and was much more eager to go to Boy Scouts activities after he switched back to J. R.'s troop.
What insights can we draw from this brief piece of research? David brought the same baggage (his personality, his ADHD) with him into both environments. However, his more serious problem behaviors were produced in inter-action with one environment, and not the other.
Not all of the key environmental elements were under the control of the leaders: the smaller number of boys and the more confined space of the second troop definitely made it easier to keep David focused and positively engaged. But other elements were under their control. In starting off each meeting with basketball, where David felt like an incompetent, oversized loser, the leaders of the first troop were perpetuating his inability to succeed with his peer group. In taking his goofy comments and behaviors seriously, they put him farther on the defensive and increased his sense of social isolation. Their reprimands only made the chip on his shoulder get larger and increased the likely hood of his acting out in an anti-social manner. J. R. knew that underneath all that beef and bluster was just a 12-year-old who wanted to be part of a peer group -- even if he had never been very good at it. His decisions led David in a very different Direction.
It's something for us all to think about.
Dale Fink, a former SAC director, is a writer and researcher. He is available for consultations, workshops and writing projects related to quality in school-age care and the inclusion of youth with disabilities. he can be contacted at P.O. Box 363, Williamstown, MA 01267, fax or telephone 413-458-5334, email: firstname.lastname@example.org.
School-Age NOTES, January 1999