January 4, 2021
Cindy Lopez:
Hi, I’m Cindy Lopez, and I’m happy to welcome you to our Voices of Compassion podcast series, where we hope you’ll find a little courage, some connection and a whole lot of compassion. Today’s episode is focused on looking at ADHD through the lens of distance learning. Distance learning is a challenge at best. Add ADHD to the mix and you get a whole new kind of challenge. In this episode, you’re going to hear a little about the ADHD brain and how that all mixes with distance learning. Also make sure to tune in next week for part two of this episode where I’ll talk with Dr. Glen Elliott about strategies parents can use to support their kids with ADHD during distance learning. So let me introduce our guest today. Really excited to introduce our guest today, Dr. Glen Elliott, Chief Psychiatrist and Medical Director here at CHC. Dr. Elliot diagnoses and treats psychiatric disorders in children and adolescents and he is also an internationally known expert in ADHD interventions. We are so fortunate to have Dr. Elliot here with us today to share from his wealth of experience and knowledge. Dr. Elliott, is there anything else you’d like to share with our listeners about yourself?
Glen Elliott:
Yes, I just want to point out I’ve actually been working with children with ADHD and their families since 1984. But we’re in a very unique situation where we as professionals are having to learn just as much as families do about how to deal with the problems that kids with ADHD have in this very new environment. And we’ve never had anything like it before. So we’re learning right along, unfortunately, with everybody else.
Cindy:
We are in this kind of novel time, so to speak. So it’s good to remind us, like, we’re not quite sure what works in the situation. Dr. Elliott, thinking about ADHD and distance learning, what can parents and educators do? What can parents expect from their kids with ADHD? All of our brains are wired differently. How is the ADHD brain different?
Glen:
So it’s a little tricky with ADHD because there’s no single description that fits all of the kids. There are two broad areas both of which are very relevant for this program. One has to do with attention and focus and that obviously is a major concern when the kids are trying to learn and being required to spend a long period of time in front of the computer listening to subjects that aren’t necessarily particularly interesting to them, really is a challenge for a lot of these kids.
And the other is hyperactivity and impulsivity, which also can be manifest in sitting still and trying to participate is potentially problematic for kids who have those kinds of issues. And again, that is going to be more complicated when, you know, the teacher doesn’t have the immediate ability to provide feedback to the child which often is available and recommended when you’re in a classroom setting. The other thing that is not really part of the diagnosis, but this is also present, is the ongoing issue of executive functioning issues. The ability to plan, to organize, all of those are no better in this setting than they are in other kinds of settings. So if your child happens to have those kinds of issues he or she is still gonna need a lot of external structure to make this work. And in some ways it’s a little bit simplified because some of the things that are problematic when kids are going to school, such as successful communication between the teacher and the parents about what needs to be done, rather than things getting lost in the bottom of the backpack, some of those may be easier because they’ll be on the computer, parents can look at them, but they’re still there and the parents again are gonna have to make sure not only the child does the homework but that he gets it submitted in the appropriate fashion.
Cindy:
You mentioned executive functioning. Can you just talk about that a little bit more? One, like, what is it? You said a few words about it, but maybe just a little bit more. And then, is struggles with executive functioning part of every ADHD kind of profile?
Glen:
Great question! Executive functioning right now stands in somewhat of a limbo. It’s not a formally recognized diagnosis, even though it’s been very well studied. And there’s lots of information known about it, including some evidence of where the pathways are in the brain, which are really quite separate from ADHD. It’s not present in every child with ADHD. There are some children where it really is sort of a profound additional problem. There are other kids where that really isn’t the issue at all. Not that that’s not enough, but just attention and just hyperactivity may be the primary things that one focuses on. The issues with executive functioning become increasingly important as kids get into class situations, usually fourth and fifth grade where planning ahead and planning out a complex project become part of the expectation of the school. Up until that age usually schools provide a lot of external structure and things work well. There are a lot of teenagers where frankly the ADHD part of what’s going on with them has become relatively minor and it really is the executive functioning issues as they have to balance demands across multiple classes and multiple deadlines that are often not very well coordinated. A lot of kids that’s really where the problem becomes paramount, usually sort of mid-teens, sophomore, junior year, senior year.
Cindy:
So if kids with ADHD are struggling with executive function issues, is the distance learning situation, could it possibly be better for them in that instance, or is it kind of a toss up?
Glen:
I think it can be better because parents have more information. In general, certainly up until the kids are 14 or 15 or a little older really, the strategies that we use to help with executive functioning are external: it’s parents and teachers providing a structure and expectations and helping to break things down into smaller doable pieces and that all relies on information. So, with distance learning that information is usually much more readily available to parents or tutors or however the family is helping children deal with that. And because of that I think it actually may be a relative advantage for a lot of kids.
Cindy:
So, thinking about ADHD and distance learning, what kinds of extra pressure is there for kids with ADHD regarding distance learning? You just talked a little bit about that around executive functioning.
Glen:
So, again it’s a balance. It’s not all bad news because anybody who has observed their child in a classroom setting knows that putting a child with ADHD into a complex social situation like that, where there are lots of other kids doing things that are much more interesting than what the teacher has to say can be really difficult. So potentially there’s less distractibility with the one to one connection between the teacher and the parent through the video. On the other hand I had a family I met with actually just last week where they were aware that their child had at the bottom of his screen some way of observing what was going on with a game that is particularly popular with him. And if he saw that his friends had gotten onto that game the competition between listening to the teacher or moving over to the game was irresistible. And that’s where the impulsivity and then sort of poor judgment comes in. So parents do have to be kind of careful to make sure that those kinds of potential distractions are minimized or are taken away if at all possible. And that’s frankly easier said sometimes than done. My own experience as my kids were growing up and I think it’s even worse now is that often children are more successful with the computer and programming the equipment that they got than the parents. So, it’s really sometimes quite challenging to figure out a way to do it. One strategy that I often recommend is to try to get a discussion between the patient and the family about, we’re concerned about this, are there ways that you can help us so that this doesn’t become a distraction for you? Because we know you’re really eager to succeed. Again, one of the lovely things about many kids with ADHD is that they don’t have much of a filter, so if they’ve got ideas of what parents can do, they’ll spout it out and the parents can follow the instruction.
Cindy:
So that’s great, that’s a great tip. I think for parents to actually invite their child into the conversation and say you know, here’s what we see happening and what ideas do you have that might help with this?
Glen:
And that’s a strategy I’ll be talking about over and over again. There’s a wonderful book which will include in our book list called “Raising Human Beings” by somebody called Ross Greene. And it’s really not focused on ADHD, although he does have books that are focused on that, this is really just focused on how do parents function best in terms of raising children and what he emphasizes from a very early age and certainly by the time we get into six, seven, eight and above that, the best way to deal with the problem is to bring the child in as part of the solution, rather than trying to impose what we think is going to be the optimal maneuver whatever that might be.
Cindy:
So Glen, this is kind of an outlier question. But wondering about parents whose kids are now doing distance learning, maybe their child does not have a diagnosis of ADHD, how would you advise parents if they think they’re seeing something, what would that look like and what should they do?
Glen:
That’s an excellent question and again, one that we’re facing because of the times we’re in. Where this is most likely to become an issue is around 10, 11 or 12 and relates to mostly attention and distractibility. Hyperactivity and impulsivity, if that’s what’s going on, particularly at that age, it’s very unlikely to be ADHD and more likely to be boredom or really a mismatch between expectations of sitting still. I mean, if you think about the average classroom situation, kids are not sitting still for hours on end. And, I don’t have children in my house right now, so I don’t observe this, but it’s not clear to me that all of the schools are giving adequate breaks and times for disengagement which is really crucial, I think for kids in general, but particularly crucial for kids with ADHD. But often inattentive ADHD really isn’t diagnosed until 10, 11 or 12. Again, partly because that’s when the expectations rise that kids are going to be responsible for paying attention and being able to absorb material as it’s presented. So, it’s an interesting bind because a 15 or 17 year old, I think the likelihood of that being the problem is very small, but if it’s a child who’s sort of in their tweens, they’re just sort of hitting puberty or just past puberty this is a real stressor and it might be bringing out problems with attention that we wouldn’t be seeing under normal circumstances. I think certainly considering an evaluation at that point would be well worthwhile. That doesn’t necessarily mean that we would make that diagnosis or that we would even recommend a specific treatment for it. Keeping in mind that kids try to please parents most of the time, if they’re having trouble functioning in this setting doing at least one of our 30 minute free consultations that’s available at Children’s Health Council might be a nice step just to have a reality check: is this normal behavior or is there something more serious going on?
Cindy:
Yeah, thank you. So Dr. Elliott just mentioned that we have a free 30 minute consultation opportunity option for parents at CHC. So if you have questions and you’re not sure what next steps might look like, that could be a good option for you. And you can find out more about that at chconline.org. So Dr. Elliott, you’ve been talking a little bit about this, but what behaviors might kids with ADHD be exhibiting during this time? And that question, we just asked how do parents know when to seek additional help. I think most people associate ADHD with inattention and distractibility. But I’ve also seen you know, in 30 years of working with kids and education, kids with ADHD can be very focused. And so if parents are seeing that, like, so if they have a child with ADHD and they’re seeing their child being very focused, they’re thinking oh, well maybe he doesn’t have ADHD anymore at all. Can you speak to that a little bit? What’s that ability to get kind of really focused in on something versus the distractibility.
Glen:
Yeah, we have a term for it. We often call it hyperfocus and we think it’s actually a way that kids with ADHD learn to overcome the distractibility and inattention. In adults not necessarily with ADHD, it’s sort of the equivalent of what’s called spousal deafness. That you’re so focused on the TV that you don’t hear your spouse calling you for whatever it is.
Cindy:
Yeah, that never happens at my house.
Glen:
Mine either.
Usually this involves a favored activity. It rarely involves school, which unfortunately is not a favorite activity for most kids. I have a son who has inattentive ADHD even as an adult, but when he was a teenager, the way he handled being able to study left me unable to actually be in the room. He had music on, he was on the computer. I think back then they had chat groups and he was on three or four chat groups. And usually have a video going on as well and in the midst of all of that chaos, he was able to actually sort of stay focused and get done what needed to be done. More typically what you see particularly with younger kids is that they’re doing something, if they’re huge into the Legos and they have a new kit, yes, they can absolutely hone in on that. And the way to avoid distraction is, I’m not sure they’re doing it consciously, but is to just zero in on what I’m doing and ignore everything else. And under those circumstances, they’re not deliberately not responding to you, you really have to catch their attention. One of the things that we’d recommend anyway with kids of ADHD is if you really want them to hear something take the time to stop, get them to look at you, get some look at your eye, maybe even say, yes, I’m listening, and then tell them what it is you’d like to tell them and even have them repeat it. Even with that, I can’t guarantee that they’re gonna remember it five minutes from now, but under these circumstances, this hyperfocus situation, they’re just simply not taking in any other information than what they got.
Cindy:
Yeah. And that strategy you just mentioned of having the child to stop and look at you and acknowledge, yes, yes, I’m listening. You know, that’s not always easy to do, it’s kind of easier to yell at them from the kitchen and say hey, it’s time to you know, go on to the next Zoom, right? So in this case it would be better, it sounds like, if parents actually walked into the room and kind of got their attention, got them to look at them and say, time to move on to the next thing.
Glen:
Not only better, but less frustrating for both the child and the parent. If you think about what often happens in school is we typically recommend that kids with ADHD be at the front of the room, so that the teacher can touch them on the shoulder or in some other way indicate that you know, now it’s time to pay attention and we’re going to be moving from task A to task B. Expecting them to do that from, without making sure that they A heard and B are able to make the transition, is undoubtedly going to lead to frustration. They’re going to say, I didn’t hear you and you’re going to say, how could you not hear me, I was yelling at you at the top of my voice? A hard thing about ADHD again, I speak from experience, is essentially all of what they’re doing is not intended to drive parents crazy, but it does. So part of your role as parent is to realize that they’re doing things that are really tough for you and that you feel like you’ve done this a hundred times, why should I have to do it 101 times and then do it again anyway. And what we know about any of these strategies is that they only work while you have them in place. What tends to happen particularly with behavioral kind of intervention is that we adults, once the child is beginning to do well, we tend to sort of breathe a sigh of relief and back off – that for kids with ADHD is catastrophic because it isn’t that they’ve internalized, whatever it is that you’re hoping they learn, it’s that they’ve gotten used to a system that is supportive and structured and that they know what path to be following. And as soon as you’ve changed the rules, one of the fascinating things that behaviorists discovered years ago is that what seem to be minor changes from our point of view, for example, having, well this isn’t such a minor change, having a substitute teacher instead of a regular teacher is completely disruptive for many of these children. And it’s not that they are necessarily you know, trying to rag on the substitute teacher, it’s that they no longer know what the rules are. Sometimes it’s as simple as moving from room A to room B. It’s as if they’re a blank slate and they have to start all over again.
Cindy:
Yeah, that’s a good reminder. We often said to parents when I was in schools, we often said, you know, if they could, they would, right.
Glen:
That’s absolutely right.
Cindy:
And it goes back to what you said earlier too, like generally kids want to please their parents, generally kids you know, they want to please our teachers. So, so if they’re not then taking a closer look and figuring out what’s happening, and for kids with ADHD, I agree that change and any kind of change in the structure or the routine just kind of throws everything up in the air for them again. So, I think that’s a really good reminder for parents.
So Dr. Elliott, thank you so much for sharing your wisdom and expertise with us. We know it’s kind of a tricky time, to really understand ADHD and distance learning cause we haven’t been through this before, so we don’t really know um what to expect or how to respond in a way that makes sense, but really appreciate your strategies that you mentioned and how parents can support their kids with regard to ADHD and distance learning. Thank you so much. Listeners, if you tuned in today and you’re listening, we’d love for you to listen again next week when Dr. Elliott will share the second part of ADHD and distance learning. Thank you so much, Dr. Elliott.
Glen:
You’re welcome and it was a pleasure to talk with you.
Cindy:
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