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by John Durall, M.A., MFCC
Josh can't keep his hands to himself when waiting
in line. Seth seems to act irresponsibly. Megan never completes an
arts and crafts project. These campers' behaviors may have a
common link - attention deficit hyperactivity disorder.
Attention deficit hyperactivity disorder (ADHD) is one of the most studied
and controversial disorders in child development. This disorder, which
is present in approximately 4 to 7 percent of the childhood population
in the United States, is characterized by behavior difficulties such
as inattention, impulsiveness, and hyperactivity. The child, or adult,
with ADHD has problems starting, staying with, or completing tasks. The
result is a life that may often be chaotic.
Characteristics of ADHD
Current research theorizes that ADHD is a developmental disorder of
self-regulation. A person's ability to exhibit self-regulation or self-control
flows along a continuum. At one end, a person would have all the internal
arousal, motivation, and persistence needed to self-regulate toward his
future best interests. In the middle of the continuum, a person would
have a great deal of self-regulation and self-control but still need
outside performance or compliance incentives or consequences, such as
laws or rituals.
As the person moves toward the other end of the
continuum, he begins to exhibit less self-control. As the person moves
even further down the continuum of self-regulation, his or her life
begins to appear chaotic and disorganized or without direction to one's
future best interests. The person may show little hindsight, forethought,
or preparatory action. This level of interruption causes serious impairments
in social, academic, or vocational functioning. ADHD is a diagnosis
for those at this lower end of the continuum.
A Developmental Delay
These difficulties in self-regulation represent a delay in development
rather than a halt in development. This means, that with age, people
diagnosed with ADHD will always be improving, but they will always be
behind their same-aged, non-ADHD peers. The ADHD person does not, age
appropriately, gain the progressively internalized capabilities of self-control.
As a person matures, his capacity to self-regulate his own behavior
comes more from internal or self-imposed neurological processes. At birth
a child has practically no internalized mechanisms to self-regulate.
He relies entirely on regulation or guidance imposed by others. After
a few years of normal development, the child gains more internalized
processes of behavioral self-control, while still needing lots of externally
applied rules, guidelines, and incentives. With adulthood maturity comes
behavior that is controlled via one's own internalized self-regulatory
mechanisms.
The developmental delay in the person with ADHD is in the internalization
of the ability to self-regulate his behavior. It consists of a problem
of "behavioral inhibition" interacting with what developmental
psychologists and neuro-psychologists call "executive functions." These
functions are operations within the brain that promote and allow for
self-regulation or self-control. This includes non-verbal memory, verbal
memory, self-talk, emotions, motivation, arousal states, problem analyzing,
problem solving, and thought and behavioral sequencing.
Living in the Moment
The ADHD person, in the presence of stimuli, is less able to stop or
prevent an immediate, powerful, or automatic (helpful or harmful) response.
This diminished behavioral inhibition then interacts with and leads to
diminished functioning of the other brain operations dealing with self-regulation.
The combination of these factors cuts or blocks the connection that
leads a person's thoughts to action and his knowledge to performance.
It prevents the person from using the past to work toward or maximize
his future. The person is often called a repeat offender. He commits
the same error over and over again. This is because the inhibitory response
system has not allowed for the effective employment of the thinking and
problem-solving processes of self-regulation, so the person does not
plan or apply new strategies that would normally result from processing
one's past mistakes. Therefore, the person's behavior often appears disorganized,
irresponsible, chaotic, and ill
directed.
A person with ADHD may have difficulties waiting in line or taking turns.
Their brain functioning leads them to anticipate and feel that the time
period will last excessively and unbearably long. They then show high
levels of impatience or frustration with the delay and sooner or later
act to escape from it. The delay is seen as boring or bothersome and,
therefore, escape behaviors become difficult or impossible to prevent.
Difficulty Remaining Focused
Another very important part of the executive functioning of the brain
is the utilization of arousal, motivation, and persistence in goal-directed
behavior. Through normal maturational development the brain shifts from
being dependent on external incentives to being independent through internal
self-generated arousal, motivation, and persistence. This is seen when
an adolescent carries out the decision to go to college, continue with
graduate school, and survive a long internship training. This represents
goal-directed behavior aimed over a prolonged period of time.
On the other hand, a person with ADHD will be more focused on the present
moment with its immediate interests. If a task such as homework lacks
immediate, external incentives, then there will be a resultant lack of
arousal, motivation, and persistence. If a task is deemed of little importance
or is too distant into the future, then the performance of the ADHD person
drops dramatically. The failure to perform is not an issue of irresponsibility
or laziness. The child with ADHD fails to perform because the internal
mechanisms to self-create the arousal, motivation, and persistence are
lagging behind developmentally.
Developing Social Skills
A lag in social development is another result of ADHD. There may be
poor performance in applying social skills (sharing or cooperating),
minding his manners, following moral conduct codes, and acquiring adaptive
behaviors (rule development and safety consciousness). The deficiency
is not in having knowledge of these skills, but rather, in the deployment
of the skill at a strategic moment in time when it would be most adaptive
to one's own immediate or distant well being. This deficiency may lead
to extreme behaviors, such as lying, stealing, selfishness, and possibly
impulsive social aggression.
As a result of the brain determined functioning in self regulation,
there is often an effect on psychological and emotional development.
A person with ADHD may develop less competencies, make more mistakes,
have fewer successes, or be labeled as irresponsible or lazy. It is not
uncommon for the child with ADHD to experience more pessimism with resultant
passivity. It is not infrequent that the person with ADHD have or develop
a co-existing problem of an oppositional defiant disorder, a conduct
disorder, a depression disorder, an anxiety disorder, an obsessive-compulsive
disorder, Tourette's syndrome, or other disorders.
The Positive Side of ADHD
ADHD is not all negative. The same ADHD brain functioning that causes
problems for a child may also give that child qualities for success,
such as intuition and spontaneity, excitement and energy, creativity
and artistic skills. A comprehensive treatment program, an educational
understanding of ADHD, and a focus on the skills and positive
qualities that the child possesses are important for the child's success.
Long-term Outlook
The long-range outcome for a child with ADHD varies and is often dependent
on what help or interventions he receives. For some, the prognosis is
a life of chaos and disorganization combined with depression, anxiety,
anti-social conduct, or other mental disorders. For many the prognosis
is less severe, but they may have many interruptions or disappointments
in careers and relationships. Still others have very satisfactory, happy,
and or productive lives.
Camp's Place
Camp can provide a very positive experience and therefore can be an
asset in the developmental life of the child with ADHD. Many ADHD children
attend and fit will into resident and day camps. More severe ADHD or
those who have moderate to severe co-existing opposition and defiance
may need camps that provide special assistance or staff. Seek
a mental health professional for guidance.
Camp staff need to be knowledgeable about ADHD. They need to
avoid making negative judgment statements to or about children, for example, "You
are so irresponsible," "She never finishes anything," or "You
don't try hard enough." They should also keep in mind that an ADHD
child will need immediate, age-appropriate, and valued "performance
incentives" to behave appropriately. Secondly, camp staff can, through
their knowledge of ADHD, develop programs that consider emotional or
social enhancements for this population. Camp experiences can focus on
and magnify the assets, islands of competencies, and other skills in
ways that can be a powerful counter to the child's previous negative
experiences.
By learning more about ADHD, you can begin to understand why campers
may behave in certain ways. This may help you formulate strategies to
help them focus their energy on positive activities and ensure that all
campers have an enjoyable camp experience.
Originally published in the 1999 January/February
issue of Camping Magazine. |
