For Parents Interested in Teaching Their Children Who Are Attentionally Challenged  By Bonnie Klein

ADD/ADHD. The term used for this condition has changed over the years, yet the symptoms remain the same. In fact, the term “ADD” is no longer used. The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) now uses only the term “AD/HD”. There is talk that when the Diagnostic and Statistical Manual, 5th Edition is released that the term will be changed again.

 Regardless of what it is called…we have a struggling child: inattentive and impulsive, sometimes high energy in addition. Do they have a hearing problem? Is it that red punch I allowed them to have at that party? Is it simply sin and they refuse to bridle their tongue? Am I doing a poor job at parenting?

 These are just a few of the questions that run through the mind of a parent of a child with the symptoms of AD/HD. While we still do not know the exact cause of AD/HD, researchers strongly suspect that it is a real physical issue of a chemical delivery difficulty of the neurotransmitter Dopamine to the frontal cortex of the brain. It appears to be genetic and run in families.

 I am grateful to now understand this. As a home educating mother with a structured, sheltered environment, I was constantly asking myself those questions, trying to figure out why some of our children were struggling with their behavior. The environment was the same, the teacher was the same (ME!), the principal was the same (my husband!), the Biblical discipline was the same; in fact it was often more consistent with the struggling ones!

 Consistency is important. However, as with most children with special needs, it is not the only answer.  Consistency is essential in child training, but if your child has the challenges that AD/HD brings, they will ALWAYS struggle with these weaknesses. If you are being consistent in your Biblical child training and your child isn’t responding appropriately for their age level, there could be a physiological problem.

 If we are striving for perfection, we will be disappointed. God has made all of us with special strengths and weaknesses. We live in a sinful world with bodies that are not perfect. That is easier for us to accept if our children have a weakness we can visual see. We don’t get frustrated and angry with a crippled child that walks slowly. We do get frustrated and angry with an AD/HD child.

 The child with AD/HD is struggling, however as Christians we “see” other things: lack of self-control, rudeness, sloppiness, forgetfulness and selfishness. How to discern whether it is a spiritual/sin problem or a physiological weakness is our challenge! There are no easy answers.

 There is so much information out there on AD/HD and as Christians we need to be careful to be discerning and make sure the Bible is our plumb line. For those of us that have hung wallpaper, you know how easy it is to get “off”. You might only be a tiny bit “off” at the beginning, but as you go on your error increases and you end up significantly “off”. So you start with a plumb line (a weighted line that will hang perfectly straight) to set your first piece of wallpaper. In the same way our knowledge of AD/HD must be lined up to the scripture. Much that is written is significantly “off” and as Christians we need to discard that information, just like we would discard a strip of wallpaper with a huge flaw through it. We have to be firmly grounded in the study of God’s word in order to discern what is flawed and of man and what is truth and of God. We also need to be praying for discernment; that the Holy Spirit will cause a check in our spirit when something should be discarded.

 The other dilemma that the Christian parent of an AD/HD child will probably face is that many of their fellow believers tend to “throw the baby out with the bathwater”. I really dislike that analogy, however for AD/HD and many Christians, it fits. Many of them, though well intended, refuse to consider that AD/HD could have a physiological basis. They label the children as brats and the parents as slothful. Their reasoning is it can’t be scientifically proven by a blood test.

 This can be very difficult when this view is held by one of the parents of a struggling child. It can become a cause for dissention in their marriage. Again, we return to the scripture and what it says about our relationship in marriage, (1 Peter 3) prayer (Ephesians 6:18, 1 Thessalonians 5:14-18) and speaking the truth in love. (Ephesians 4:14-15)

 I am reminded of a time in history when the maternal and neonatal mortality rates were considerably lower when delivered at home and attended by a midwife. It was dangerous to deliver at the local hospital with a doctor attending you. No one knew why, they just knew it was the way things were. Years later it was discovered that the doctor (lacking the knowledge we now have) would attend to an infectious person and then without washing his hands attend to a delivery. Just because today there is no scientific test for AD/HD does not mean it does not exist. The human body is a marvelous creation by our Lord, however at this time in this sinful world it is often flawed in many different ways.

One of the most balanced things I have read on AD/HD is taken from Edward T. Welch’s book Blame It On the Brain;

 “Both the spiritual and the physical must be taken seriously. If you ignore the spiritual, there will never be a place for repentance and faith in your child’s life. Sinful behavior will be excused. The power of the Gospel will be ignored. If you ignore physical or brain-based strengths and weaknesses, you will never find the creative methods you need to help the person learn…The truth is that ADD sits at an intersection where physical and spiritual meet. Like other psychiatric labels, the root cause may be physical or spiritual; it is typically both.”

AD/HD symptoms often arise in early childhood. AD/HD is diagnosed using the criteria in the Diagnostic and Statistical Manual, 4th Edition (DSM-IV). To meet the diagnostic criteria for AD/HD, six or more symptoms must be evident for at least six months, with onset before age seven.

Diagnostic criteria are as follows:

Inattention:

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

2. often has difficulty sustaining attention in tasks or play activities

3. often does not seem to listen when spoken to directly

4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

5. often has difficulty organizing tasks and activities

6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

7. often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)

8. is often easily distracted by extraneous stimuli

9. is often forgetful in daily activities

Hyperactivity-Impulsivity

1. often fidgets with hands or feet or squirms in seat

2. often leaves seat in classroom or in other situations in which remaining seated is expected

3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

4. often has difficulty playing or engaging in leisure activities quietly

5. is often "on the go" or often acts as "driven by a motor"

6. often talks excessively

7. often blurts out answers before questions have been completed

8. often has difficulty awaiting turn

9. often interrupts or intrudes on others

The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) identifies three types of AD/HD: Predominantly Hyperactive-Impulsive Type, Predominantly Inattentive Type, and Combined Type. Children with the mainly Inattentive type of AD/HD tend to daydream and have difficulty focusing.

The following criteria are used to diagnose children with AD/HD, Predominantly Inattentive Type. Six or more symptoms must have been present for at least six months, with onset before age seven:

a.      often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

b.      often has difficulty sustaining attention in tasks or play activities

c.      often does not seem to listen when spoken to directly

d.      often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

e.      often has difficulty organizing tasks and activities

f.        often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

g.      often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)

h.      is often easily distracted by extraneous stimuli

i.         is often forgetful in daily activities

Not all parents will choose to have their children formally diagnosed. They do not want their children labeled and I understand that completely. We have gone back and forth, depending on the child. Some children will be able to do well with environmental changes and compensation skills, which home education readily affords. For others, that isn’t enough.

 AD/HD has a vast range of complexity. Seventy-five percent are accompanied by an additional condition. For example, fifty percent of children with AD/HD also have dyslexia. So, if your child happens to fall in that 25% that is struggling with inattentiveness and impulsivity and is not too severe, you might not need the additional help a professional can offer.

 I endeavored to have one of our children, who struggled with hyperactivity, to be formally diagnosed. I spent hours filling out forms…while teaching older children and diapering babies…only to have the “professional” (resident) at a local University Hospital not able to even diagnose him, much less offer me any solutions. In hindsight I can see he was classic AD/HD, the hyperactivity being the most difficult to deal with. I literally had years of having only one friend’s house I could go to. She lived in the country and by some miracle he never broke anything at her house. J

 I should insert here that this child has grown into a fine young man. Following Dr. Doris Rapp’s allergy elimination diet at age 5 revealed a severe allergy to eggs. Eggs did contribute to increased hyperactivity. Eggs did NOT cause the hyperactivity. Still high energy? Yes, but in a very productive way! He is a wonderful worker, diligent and gives 200%. When he is hired to do a job by someone, we get the comments, “He is worth his weight in gold!” “He worked like a man, not a teenager!” He is currently doing well and has learned to compensate for his weaknesses and make the most of his strengths.  

 I would say that this is a result of several things, first most, the Lord’s work in his life. This young man has given his life to the Lord Jesus and that sanctifying work has produced much fruit to the seed we planted and watered over the years.

 So the first question of a parent with a child with these symptoms is “Do I need to pursue getting a formal diagnose?”  This question should be bathed in prayer. One of the main reasons for a formal diagnose would be if you were considering medication. Another reason would be simply for your peace of mind and helping you to learn to cope with a struggling child. I personally think you can educate yourself and unless you are at the point of considering medication then I would think you could bypass a formal diagnose. At this point there is no clear test to prove AD/HD. Some researchers believe that by 2010 they will have a gene test that can clearly diagnose AD/HD.

 CHADD, the nation’s leading non-profit organization serving individuals with ADD/ADHD, states the following:

“All children may be overly active at times, their attention spans may be short, and they may act without thinking. However, if your child seems more active than others the same age; if your child is notoriously forgetful, disorganized, and always losing things; if the teacher complains that your child can’t stay seated or quiet, blurts out answers instead of waiting to be called on, pays more attention to the traffic in the hall than to her, behaves aggressively, or struggles academically, then you may want to have your child evaluated for AD/HD. Determining if a child has AD/HD is a multifaceted process. Many biological and psychological problems can contribute to symptoms similar to those exhibited by children with AD/HD. For example, anxiety, depression and certain types of learning disabilities may cause similar symptoms.”

Being formally diagnosed really depends on your family and your child. There is no one right answer. However now that I know that 75% of these children have other issues in addition to ADHD, I am tending to lean more towards self-testing and calling it what it is. I now realize that I have probably been schooling three other children with ADHD and Dyslexia. Much of my frustration with them would have been lessened had I realized what I was dealing with. Knowledge can offer us options in helping them and teaching them better.

I am also more open to medications, as a last resort, when the child is not doing well even with environment changes and when they are in a good spiritual condition. Having struggled personally for years with hormonal imbalances, I am very aware how a physiological struggle can affect your spiritual life. If I know my child is in a good place spiritually and we have tried all the compensation techniques out there, I am not going to allow my PRIDE to keep me from allowing my child a trial of medication. It is my personal opinion that medication should be a last resort, as we want to be very careful that all other issues have been dealt with.

As of January 2003 there is a brand new type of medication on the market especially for AD/HD. It is not considered a class 2 drug like Ritalin is. It is called Strattera. From the website: www.strattera.com it says:

“Strattera is a selective norepinephrine reuptake inhibitor, a new class of treatment that works differently from the other ADHD medications available. Strattera is the first non-stimulant medication approved for the treatment of ADHD in children, adolescents, and adults.”

When we saw our youngest son, our special prayer warrior, struggling with depression and doubting the work the Lord Jesus had done in him, my husband and I decided it was time to consider medication for his AD/HD. Puberty seemed to have pushed him over the edge. After prayer, the Lord led us to this new medication. At the time it was so new it wasn’t even in our doctor’s monthly PDR update for January 2003. Within days we saw an improvement.

Some of the improvements we saw were:

• Less defensive

• Less argumentative, more reasonable

• More focused with tasks

• Schoolwork is easier

• Less problems with interacting with friends

• More productive energy (not hyper destructive energy)

• More even tempered (high-low swing is gone)

• Better decisions in picking out clothing (the ability to match)

 Let me make it very clear that this child still struggles with sin and still needs Biblical discipline. Medication is not a cure-all. For our family it has helped us define the true attitudes that need to be worked on and committed to Christ daily.

 Let’s return to Edward T. Welch’s book Blame It On the Brain;

 “Both the spiritual and the physical must be taken seriously. If you ignore the spiritual, there will never be a place for repentance and faith in your child’s life. Sinful behavior will be excused. The power of the Gospel will be ignored. If you ignore physical or brain-based strengths and weaknesses, you will never find the creative methods you need to help the person learn…The truth is that ADD sits at an intersection where physical and spiritual meet. Like other psychiatric labels, the root cause may be physical or spiritual; it is typically both.”

Psalms 139:1-17

O LORD, Thou hast searched me and known {me.}

Thou dost know when I sit down and when I rise up;

Thou dost understand my thought from afar.

Thou dost scrutinize my path and my lying down,

and art intimately acquainted with all my ways.

Even before there is a word on my tongue,

behold, O LORD, Thou dost know it all.

Thou hast enclosed me behind and before, and laid Thy hand upon me.

{Such} knowledge is too wonderful for me; it is {too} high, I cannot attain to it. Where can I go from Thy Spirit? Or where can I flee from Thy presence?

If I ascend to heaven, Thou art there;

if I make my bed in Sheol, behold, Thou art there.

If I take the wings of the dawn, if I dwell in the remotest part of the sea,

even there Thy hand will lead me, and Thy right hand will lay hold of me.

If I say, "Surely the darkness will overwhelm me, and the light around me will be night," Even the darkness is not dark to Thee, and the night is as bright as the day. Darkness and light are alike {to Thee.}

For Thou didst form my inward parts; Thou didst weave me in my mother's womb. I will give thanks to Thee, for I am fearfully and wonderfully made;

Wonderful are Thy works, and my soul knows it very well.

My frame was not hidden from Thee, when I was made in secret,

{and} skillfully wrought in the depths of the earth.

Thine eyes have seen my unformed substance;

and in Thy book they were all written,

the days that were ordained {for me} when as yet there was not one of them.

How precious also are Thy thoughts to me, O God! How vast is the sum of them! (NAS)

How I praise the Lord for giving us children with AD/HD. They have been fearfully and wonderfully made. May our weaknesses cause us to fall to our knees, crying out to our Savior for his mercy, grace and discernment; as we endeavor to train our children in the fear and admonition of the Lord.

 By Bonnie K