Sean’s ADHD? Part 3: Dark Times in 1st Grade

Sean is a 1^st-grader who is bright and active and distractible. He’s also funny and talkative. Consistently finishing his classroom work before the rest of the class, he has been viewed as a behavior problem by his teacher. Even in my office, he is more fidgety than most kids his age. But I couldn’t get around the fact that for the first half of the term, he had a different teacher, with whom he never got in trouble. He didn’t sit quietly, exactly. The previous teacher gave him stuff to do to keep him occupied instead of bored. So even though I thought he might indeed have ADHD, I wasn’t ready to medicate him before figuring out why this became a problem as soon as the new teacher, Mr. Dickson, took over.

I re-evaluated Sean and he was just as before: fidgety, happy, talkative. But he never left the chair during a long discussion, and to each of my questions he responded with a full and articulate answer. As promised in Sean’s ADHD Part 2, I wrote a letter to the teacher. Here’s what I wrote:

Dear Mr. Dickson:

Sean’s parents asked me to evaluate their son, and to write you about some of my assessment. He’s a great kid and I enjoyed the time I spent with him.

As you know, Sean has been struggling somewhat in school. His distractibility, talking out of turn, and occasional disrespect have been issues for him. 

There’s no question that he’s an active child, with some of the motor traits of hyperactivity. He is also a bright child, who clearly understands and retains a lot of the academic material presented to him. It’s important to note that he is not uninterested in school work, and is curious and motivated to learn new things.

He has been disrespectful and sometimes even disobedient. Even so, he absolutely does not meet any of the diagnostic criteria for any disorder characterized by oppositionality, defiance, or conduct problems.

Though his hyperkineticism is longstanding, this has not caused problems for him until a recent change in his classroom situation. Thus even though he might be hyperactive when compared to most children his age, this hyperactivity does not mean that he has ADHD requiring medical treatment. In cases such as his, a behavioral approach will often result in the best outcome.

Sean has said that he is sometimes bored in class. He should be taken at his word. He is not very responsive to negative consequences, so these are of marginal value and might serve to frustrate him. A more effective approach would be to channel his energy in productive ways. If he’s done with his class work, for example, he should be able to access a ‘Bored Bag’ containing 4-5 quiet activities that he can do alone. It would be helpful if he chooses these activities from many choices given to him. 

From what Sean has told me, these might include:

• Some extra or more advanced math problems;
• Headphones and a recorded book;
• Coloring;
• Books.

It is essential that he be able to access these materials without permission, so he doesn’t interrupt you or the class. Ideally, he would also have the freedom to get out of his seat and walk quietly over to another spot, where he could work on some other task. I think he will be relieved to have this freedom.
These recommendations do not imply that he should be allowed to be disrespectful of teachers or disruptive to the class. Before starting this with him, you and his parents should meet with Sean and come up with a set of written rules. They don’t need to be extensive, but they need to be written. They should be simple and specific. For example, ‘you must not have a bad attitude’ is vague and difficult for a child his age to understand. ‘No talking during class,’ is something more likely to be understood. Taking away, as punishment, access to this Bored Bag or to recess—during which he gets to redirect some of that excess motor energy—would be particularly counterproductive. Those are the things that will keep him focused and motivated in the classroom. Try to enlist his help. If he’s fidgety and wanting to get out of his chair, there is no enforcement mechanism that will stop this. He doesn’t do it by choice and it not easy for him to control. Making a rule about him sitting still is setting him up to fail. If this is an issue, ask him to get up and do something helpful, then praise him for it. In this way, he will feel appreciated and not trapped.

There are certain things that ADHD medication can and cannot do. It can help some children sustain their attention, but it won’t do this if they have finished their work and are required to sit still with nothing to do. Indeed, none of us can do that.

Sean is a warm and kind child with a good sense of humor. He needs our help to plan what to do when he’s ‘bored’ and he needs the tools to work with that plan.

Please feel free to call me with your questions.

Only a day or two after mailing the letter, I received a forwarded email from Sean’s mother. She was active in the school, and received this note from a parent of one of Sean’s classmates.

Hello everyone,
I am sending this message because my son has reported to me some very disturbing comments that have been made to some of our children in the classroom.  I have not had an opportunity to speak with Mr. Dickson directly nor have I had the chance to inform the principal of this report because I was just made aware of this tonight. However, if these statements were directed to my child I would be very concerned! 

My son has reported to me that he (Mr. Dickson) told one child (Alice) that kids who talk too much in another country have their "tongues cut out". He said he told the child this because she was talking.    He also reported to me that he told one of the girls to sit her "fat butt" on the chair today when she was attempting to pick up her papers and color pencils off the ground.  He also told me that he often refers to two other boys (directly) as "rotten children" (Sean and Michael).  I am totally shocked that this man would speak to our kids like this!

I do not believe that this is a constructive way to reprimand children but it is a sure way to make them develop low self-esteem.

I am certainly not sending my child to school to be verbally abused by an adult.  I will be at the school bright and early Monday to speak with the principal about this.  The last thing we need is someone belittling our children.  Please speak with your children to confirm this. 

It is our responsibility to make sure that our children receive a good education in an environment that is conducive for them.

Suddenly, the pieces of this story started to fit together really well. More in the next post.

Charity, Haiti, and The Teachable Moment

We all think of ourselves as generous.  Obviously, that can’t be right because we definitely think of some people we know as not being generous at all.  From their point of view, however, I’ll bet they would say they are very generous (as generous as they feel they can afford to be).  People who are more giving, in their view, aren’t more generous, they are simply foolish or misguided.  So an empathic perspective is that we each give what we feel we can.  We know there are those who give much more of themselves, and those who give much less.  I hope most people aren’t too judgmental about this, but I think we all tend to label people when we perceive a mismatch between what some people appear to have and what they appear to give.  We are unforgiving of those who seem to have a lot yet give little, and impressed by those who seem to have little yet give a lot.

Research in early child development has rid us of the antiquated idea that all babies are born as a blank slate, equal in capacity but either blessed or limited by their nurturing situations.  Let’s face it, some people are really good at math and some people find it really hard.  But this skill or weakness isn’t destiny.  With some sympathetic tutoring and lots of patience and practice, even the math-phobic can get through high school.

But how can parents teach important things that they themselves were never taught?  How can children learn concepts that don’t come in workbooks or sets of DVDs or in listings for tutors?

Empathy isn’t a course you can sign up for.  It’s a way of looking at other people and trying to imagine what it would be like to be them.  This is a teachable skill.  Empathy is a particularly human ability, and those that don’t show much of it are not well liked.  We are born with our brain chemistry wired for a particularly great amount of it, or maybe a lesser amount in some people.  Some have an intuitive skill and some don’t.  I’ve seen this in children:  some find it easy to sense a playmate’s feelings, and some seem oblivious.  Can we teach it?

Teaching children feelings is much more complex than teaching them behaviors or factual knowledge.  Each child is different in how their experiences affect their own feelings.  For this reason, talking to them about what they should feel is likely to be fruitless.  If they don’t feel sorry for the crying child in the park, your telling them they should will just be confusing, inexplicable, frustrating, or insulting.  If they do feel they way you think they should, then your telling them about it is simply unproductive.  It’s great to try and help your children get a vocabulary that helps them express their feelings verbally, so talking about feelings is an important exercise to do with your child, whether the feelings are strong or mild.

But how can we get them to see what they don’t?  How do we teach them to open their hearts?

Since I suspect we each believe ourselves to be appropriately generous—open handed but not profligate—I also suspect we want to instill these values in our children.  As with most behaviors, what we tell our children is mostly irrelevant and what we force them to do largely backfires.  So forcing them to give part of their allowance to some charity—no matter how worthy—when we don’t show them our paychecks and how much we are giving, is preying on their arithmetic naivite.  What happens when they get to high school and find out that you weren’t giving 20% to the poor, it was more like $20?  You will have created yet another reason that you can never undo for them to avoid calling you or visiting when you’re 70.  I wonder if, at that age, you’ll be thinking it was worth the money you saved.

To those not naturally inclined, we teach math through gentle encouragement, positive feedback, and practice.  And perhaps most effectively, through real-life examples.

The important aspects of life are there every day, all around us in our lives.  They might not lend themselves to school books, but they are everywhere.  If you want to teach your child something really difficult, like altruism or charity, master the teachable moment.

A teachable moment is defined (by me) as an important event that gets your child’s attention without direction from you.  It could be when he comes to you in the park and tells you that a child is crying.  It could be when she asks you where Haiti is.  Once the teachable moment is brought to you, it’s up to you what to do with it.  You can certainly show her where Haiti is on a map.  You could look it up online together and map its leading agricultural products by topography.  To me, that’s a teachable moment squandered.

She’s asking about Haiti because she hears about it on the news.  Maybe she’s seen some pictures.  Her words might be asking where it is, but she’s really asking why it’s important, why it’s on TV, why people are talking about it.  Tell her—she deserves to know, and will continue to come to you for these important questions.


Here’s what I did.  I took some of the ties out of the top shelf in my closet.  Over the years, I have received many as gifts that for one reason or another I was never going to wear.  I hope I was always gracious about the generosity, but I knew I would never wear them.  The Garfield tie above..well, that’s obvious.  The Save the Children tie was nice, but not useful as a prop when I examine a preschooler.  I sold them on eBay, and designated 100% of the proceeds to go to Medecins Sans Frontières, an amazing group that was already on the ground in Haiti.  I donated the ties and the shipping and the fees for listing the items.  Anything people paid would go to MSF in Haiti.  They sold really well!  I’m also selling a camera lens I’ll never use.  Haiti needs whatever it will bring more than my closet needs a lens.

When your child asks you about Haiti, tell them that you want to help and ask her if she wants to help, too.  What does she have on her shelf or closet that she can give up?  She must make her own decision!  And she has to see you do it, too.  If you’ve never sold anything on eBay, now’s the time.  This is a real teachable moment, and it will make a lifetime impression on her to see you take a photo of the stuff and then write the listing.  It doesn’t matter if you only get a dollar.  The lesson isn’t about how much, it’s about identifying the feelings, then taking action.  There aren’t too many more important lessons than working with your child to make the world just a tiny bit better.  That’s incredibly empowering for a child, who often feels unable to change the world around her.  Besides, we both know how long that stuff has been in your closet.