AskHal

One week, in your answer to the question about the kid with possible bi-polar disorder, you mentioned the risk of being careful with the diagnosis, as sometimes lifelong "accommodation behaviors " can be created which can truly cripple the child later. I sat with that thought for a few minutes and felt such pain for my son. I can see in my son a total fear of rejection and failure, as this issue influences other parts of his behavior. I guess my question is this. How can I begin to help my son break free of some of these "accommodation behaviors?" What does my role in changing the pattern need to be? I can see how I have helped to get to this place, but I have no idea where to begin to change myself.

First of all, I love your question! (Mainly because it's so complimentary of me! :) But I really love it because it speaks so clearly of a mom dedicated to her own growth for the benefit of the whole family.

The issue of diagnoses and accommodation is thorny, but obviously common. And I certainly am not going to attempt to solve the problem here. But I do have some observations that may be helpful.

In my experience as a therapist, and now as an author and speaker, I feel surrounded by two extreme perspectives. And representatives from both sides seem very eager for me to see it their way. One extreme is the large group of folks who decry that ADHD and other similar child psychology diagnoses are rampantly over-diagnosed. Or worse, an entirely made-up disease that's simply an excuse for the symptoms of bad parenting. And the whole phenomenon is creating, they fear, an entire generation of kids unable and unwilling to tackle life's challenges, an entire generation with a ready excuse hanging around their neck, justifying their own failures.

On the other side are those parents who couldn't seem to wait for the ADHD diagnosis because it was this godsend answer to all the unanswerable problems in their home. These are the parents who then preface every statement about their children and their relationship with them with "First of all, you have to know that my son has ADHD." For these folks, this diagnosis is both a curse to complain about and a blessing that excuses them from all their own struggles with their kids.

The truth is, both extremes usually scare me. The "ADHD doesn't exist" crowd frightens me with their almost sanctimonious ability to assume an expert position over all struggling parents and children. The "ADHD is a godsend" gang scares me with their double-sidedness. They hate that ADHD exists because it's causing all the family struggles they're experiencing, but they seem to love the disease because it provides a convenient excuse from tackling all the family struggles they're experiencing.

Somewhere in the middle are lots of folks with lots of questions. Questions like yours. In this middle are parents who find themselves, at times, at a loss. "What's going on with my child? Does anyone else have battles like this? Worries like this? Why does it seem like nothing works, nothing makes any difference? I don't like the idea that he/she has a 'disorder', and I certainly don't like the idea of medicating my kid, but what if? Would it be so wrong to get a little help from science? I'm not looking for a way to abdicate my responsibilities as a parent, but something's got to change."

ADHD is an attempt to explain a common set of observed symptoms. Like depression, or a learning disorder, there is no blood test to diagnose it. All we have is an exhaustive, scientific effort to collect, organize, and differentiate observed behaviors. But because all observation is up to interpretation, and affected by the natural biases of the observer, behavioral science can never be as "exact" as a biological science. Never. (And even biological science struggles with its own levels of “certainty,” but that’s a topic for another time).

That doesn't mean ADHD isn't “real.” It means it is only as real as those observing it already believe it to be. (I know this is confusing.) What this means is that as scientists deem it to be real, more and more parents and doctors will follow suit. And so on. This means that yes, all behavioral diagnoses have the potential to be mis- and over-diagnosed, because once an explanation exists for someone else, it increases the chances of you becoming convinced that it might exist for you or your child.

So, yes, ADHD and other diagnoses are in fact, labels. And you are correct, I devote an entire chapter in ScreamFree Parenting to the damaging power of labels, all such labels. So does that mean I think there’s no place for such diagnoses, except to damage those that receive them? No. What I believe is that all behavior occurs in a context. All behavior, including the distractibility and hyperactivity of ADHD, occurs in a pattern of everyone’s behavior around it.

We all would like to find a definite “cause” for a certain behavior, because we are all trained to think scientifically about cause and effect. We’re observing a certain effect, so we try then to identify a single cause. If we can do that, then we can find a remedy. Applying the remedy, we thereby eliminate the cause and therefore, eliminate the effect.

In the case of ADHD, we observe Johnny struggling in school. And it keeps getting worse. He can’t remember to turn in the homework he’s already finished, he can’t remember to bring home notes, he can’t stay focused during class. At home he’s belligerent, argumentative, and extremely resistant to efforts to push him toward improvement.

The question is this: how do we account for the seriousness of behavioral symptoms without accommodating to those symptoms and letting them become the primary identification of the person?

The accommodating behaviors to worry about are not your son’s, they’re yours. Yes, he can begin to accommodate himself to the idea that he’s “damaged goods,” but that begins by watching whether you think the same thing. One of the most important principles I work with is that what we say about our kids is more powerful than what we say to them. What we say about them begins to frame the entire context of their lives—it shapes how we prepare for every interaction with them, it shapes how others do the same, and it shapes how kids view themselves. Think about it—you begin to talk about your daughter being lazy, then you ask your friends if their daughters are just as lazy. Soon the label gets fixated and miraculously, she continues to demonstrate her laziness. So you battle directly against that, tell her to get off her rear, and then she gets worse, openly, defiantly, lazy.

Well the same process happens with ADHD. Only we introduce another, even higher source, to pronounce upon the situation, and our child. The diagnosis, from a psychologist and a medical doctor, begins then to take on a life of its own. You begin to preface every discussion about your child with it, using it as the introductory explanation of his/her personality.

Once you decide that your child “has” ADHD, you may as well say that ADHD “has” your child. It becomes a badge with a double-meaning.

One way out of this mess: self-focus and self-restraint. Instead of focusing so much on your child’s behavior, return the focus to your own. You’ve already done that by asking what you can do differently. But you’re asking about your son’s accommodating behaviors, not your own. And yours are the only ones you can control. You can begin by altering your language. Your son does not “have” these “conditions,” he exhibits symptoms. That is all. And if so, then you can treat the symptoms. Put him on medication; keep him on it, that’s fine. One of the fascinating (and at times, maddening) phenomena about ADHD is that even after it’s been diagnosed, even after medication treatment has begun, it’s still being talked about as the defining explanation of that child. My response is this: if it’s being treated, then why do you talk as if it’s still driving the boat?

But it doesn’t sound like you’re doing that at all. It sounds like you want to stop the negative power of labels in your son’s life. It sounds like you want to focus on the things you can control—your own behavior and attitudes. And that’s where it all begins. And because of that, you’ve already begun.

Thanks so much for your feedback, and thanks so much for your courage. That you are posing this question tells the world that you are working hard to do right by both yourself and your kids. And your willingness to do so, especially by focusing on yourself and your own patterns, gives you every reason to hope.

Take care,

Hal