A Series on Executive Functioning
This is the second segment in a series about executive functioning (EF): our “5 R Solutions for Everyday Living.” In this episode, we discuss how and why to “Reframe and Redefine” problems with EF.
Before we can implement an effective solution in any situation, we must first accurately define the problem. Before we can help a student with any struggle, we must first identify what is really going on. Once we correctly call it what it is, we begin the process of solving the problem without blame and shame and with accountability.
For example, there is a common belief that procrastinators are simply perfectionistic, and the fear of not being perfect interferes with their ability to get started and get it done. There is also a common belief that procrastination is deliberate avoidance. While these might be true sometimes, often there is a different reason—a skill deficit.
So if perfectionism and deliberate avoidance are not the causes…what is going on?! In many cases, the true culprit is a deficit in executive functioning, and specifically in the area of activation.
Correctly reframing and redefining the root of the problem helps (1) avoid blaming and shaming, (2) sets problem-solving in the right direction, and (3) creates space for accountability and success.
Activation is one subset of EF skills and includes getting started, organizing, prioritizing. A deficit in activation is essentially a broken “start button.”
Obviously, the solution to a broken start button (or deficit in activation) is very different than the solution to deliberate avoidance or perfection anxiety. If the start button does not work properly, then that child’s brain needs an override. The override can be internal, such as panic or strong interest. The override can also be external, such as support from a person or a change in the environment (more on this next time).
Before we can help a student with any problem, we must first accurately reframe and redefine the true nature of the problem. There is always more to a student than what we can observe. Behavior is communication. And… when the root of the behavior is mislabeled, we miss what the behavior is trying to tell us, which often leads to unwarranted blaming, shaming, and continued failures.
Perspectives of a Clinical Psychologist
Although Attention-Deficit/Hyperactive Disorder (ADHD) is a household word, there are a lot of misunderstandings and misconceptions about the disorder.
Below are 10 myths about ADHD that I frequently encounter in the media and when working with families.
1. ADHD is a straightforward diagnosis.
This may seem true based upon the prevalence of ADHD in the U.S.. Indeed, one might be tempted to assume the diagnosis is uncomplicated, simple, or quick. In fact, the opposite is true. ADHD is a complex disorder and diagnosis should only be made following a careful evaluation by a licensed clinical psychologist or other qualified professional. The abundance of ADHD diagnoses has led some to ask whether the disorder is being been handed out too lightly, while others suggest that ADHD may also be “under-diagnosed” in many cases. Both arguments undoubtedly have their merits. In the absence of a comprehensive assessment by a qualified professional, the risk of ADHD misdiagnosis is a legitimate concern.
2. ADHD is a behavioral disorder.
In fact, ADHD is a neurodevelopmental disorder. While ADHD is well known for its behavioral symptoms, the underlying cause and mechanisms of the disorder are neurological. As such, the diagnostic process should take into account not only an individual’s behaviors, but his or her overall neurodevelopmental profile. While behavioral checklists are a good first step, results to not ensure accurate diagnosis. Checklists should be supported by clinical interview and neuropsychological assessment by a psychologist or other professional with expertise in diagnosing ADHD.
3. ADHD is an attention deficit problem.
Actually, ADHD is an attention regulation problem. In fact, many individuals with ADHD can “hyperfocus” on a topic of interest for long periods of time. Their problem is not that they cannot sustain attention to a task; it is that they cannot regulate (i.e., moderate or switch) their attention. Sometimes their attention is fleeting, while other times it’s laser-focused. The possibility of ADHD should not be discounted in individuals who demonstrate the ability to work on a project of interest or play video games for hours at a time.
4. ADHD only affects attention.
Unfortunately, this is not true. If undiagnosed or ignored, ADHD can lead to other problems like anxiety and depression. The consequences can be enormously damaging across an individual’s social, academic, and professional lives. Having ADHD is like walking across a minefield every day of your life. It’s not a matter of whether you will step on a mine; it’s simply a matter of when. Years of living with fear of making mistakes, forgetting, and “screwing up” is not only frustrating and confusing, it’s possibly traumatic. It’s little surprise that the disorder has been correlated with low self-esteem, anxiety, and depression in both kids and adults.
5. Behavioral symptoms are sufficient for diagnosing ADHD.
This is a common misconception. Just because an individual exhibits the symptoms of ADHD does not mean he or she actually has the disorder. After all, ADHD shares many behavioral symptoms with other problems like anxiety, depression, stress, impaired executive function, auditory processing disorder, visual processing weaknesses, and other neurological pathologies/abnormalities. An evaluation that takes into account an individual’s overall neurodevelopmental profile – and not just his or her behavioral symptoms – will improve the probability of accurate diagnosis.
6. ADHD looks the same in everyone.
Again, not true. We are each unique in our circumstances, temperaments, interests, abilities, skills, strengths and weaknesses. Not surprisingly, ADHD affects everyone differently. Inattention, hyperactivity, and impulsivity can manifest in different ways and at different times for different people. For example, extroverts with impulsivity may display more obvious symptoms than an introvert who works to hide these symptoms. Some kids can appear hyperactive, while others seem quiet and reserved. Certain students struggle more with ADHD when they are overstimulated, while others are more challenged when under-stimulated. Alternatively, visual-spatial learners can look inattentive for reasons that have nothing to do with ADHD. And whenever environmental and learning environments are a “poor fit,” ADHD-like symptoms typically worsen.
7. There is a single test for diagnosing ADHD.
Unfortunately, this is not true. Because ADHD is so complex – and it affects everyone differently – the ADHD diagnostic process should incorporate not only behavioral checklists and patient history, but also neuropsychological assessments. ADHD “profiles” can be gleaned from a battery of tests that measures IQ, attention, memory, and executive function. Developing a comprehensive profile of the “whole person” helps confirm (or rule out) the presence of ADHD, even if behavioral symptoms are not obvious. Comprehensive assessment also supports differential diagnosis – in other words, “teasing out” other factors that may be causing ADHD-like behavioral problems.
8. A diagnosis of ADHD guarantees a prescription for medication.
This is not just a myth, but a harmful one. In some cases, parents who suspect an attention issue (and know in their heart that their child is struggling) avoid seeking diagnostic help out of fear that their child will be medicated. The truth is that medication is a highly individualized choice, and it’s not for everyone who has ADHD. Depending on personal preference and circumstances, medication may not be desirable or even effective. Furthermore, there are other ways to support, treat, and embrace ADHD – for example, behavioral interventions, lifestyle changes, family supports, and skills-building approaches. Don’t be afraid of an ADHD diagnosis simply because you think it means you’ll have to take medication.
9. ADHD is all bad.
Actually, there may be many upsides to ADHD. One of the greatest is creativity. The ability to jump from idea to idea, to synthesize seemingly unrelated topics, and to wander inside a world of imaginative creativity has probably contributed to the success of some of history’s great entrepreneurs, artists, inventors, scientists, writers, and teachers.
10. ADHD is an excuse for unruly behavior.
No one chooses to “have ADHD.” But while having the disorder is not anyone’s fault, managing ADHD is ultimately the individual’s responsibility. Successful living is rooted in self-awareness and self-understanding, both of which can be supported by an accurate and clear diagnosis of ADHD. Next, coaching and skill-building can scaffold ownership of ADHD symptoms by helping an individual understand the disorder and how it affects him or her. By developing strategies for circumventing limitations and designing a lifestyle that capitalizes upon advantages, ADHD becomes just another part of life. And like life, ADHD is simply what you make of it.
— Dr. Katen
“Live the life you were meant to live!”
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