Any discussion of persons in this blog are materially changed for reasons of confidentiality.
We live in a world filled with subtitles and complexities that fascinate us. The exception, the example that does not fit the rule, the kind of oddity that proves the case that makes for dramatic turns in a Sherlock Holmes story or a TV drama. It is easy for us to veer to fascinating exotic topics, processes and causalities. And while I too can be fascinated by them, I also like to remember that "when you hear hooves, think horses not zebras." What's most common? What's most basic? I've had a run of these topics with kids and parents recently that I believe highlight this principle.
Sleep: I've had a couple of kids who have been struggling with their morning routines - a common complaint for kids, particularly for kids with ADHD. I always note that the largest transition we make in any 24 hour period is that from sleep to awake. It's huge and verges on the traumatic for some of us. Just think how much cultural time is spent on "Monday mornings" in joke, song, excuses and coffee.
So when discussing the challenges to the AM routine, I first search for the horses: "What's the bedtime routine like?" I've received some interesting answers. From one 11 year old child, lets call him Robert, now living with his mother and not his father (which is a whole 'nuther discussion). On weekends he's been playing video games until 1:30 - 2 AM as his video gamer "friends" (another whole 'nuther discussion) are in different time zones. Is there any surprise that his re-adjustment to a (still too late) 10 PM weekday bedtime is hard - taking 2-3 days in which to recover? So despite the mom's and the school's desire to put him on the couch to delve deep into his psyche; his avoidance; his feelings about his father; double checking with his psychiatrist about his medications etc., I think the proper first start is to allow this young man the full compliment of sleep that he needs. So I suggested the draconian: one bedtime, one wake up time 7 days a week. Pleasant shock: he suggested a 9:30 bedtime. My conclusion: he actually does want some structure in his life, it's just been hard - for lots of different reasons - for his parents to exert it. As I learned years ago from my friend Sarah Ninan, a gifted psychiatric nurse practitioner - young kids who have a lot of power in the family can become terrified at what they can do with it and the result can be a lot of ambivalence and a lot of bad behavior.
Lenny's morning issues were similar. He's a 14 y/o boy from a pretty normal family. Mom and dad are married, dad works full time, mom part time to be able to take the kids to their activities etc. He has anxiety that's pretty well managed by medication, but his waking up and getting ready for school is a notorious flash point for the family. Alas, as we explored his "issues" his use of his phone/computer at bedtime came up. You know the rest, texting, Facebook, Snapchat etc all eating away at his bedtime. More horses.
School: Brenda is an engaging if mischievous 12 year old girl with ADHD that is fairly well managed, but she does have a penchant for some impulsive behavior that can get her in trouble. She's been caught lying at school and more recently was suspected of cheating, which in her upscale private Atlanta middle school was a pretty big violation. The school's response was, as my old choir professor Dr. Orland Johnson used to say when we over reacted to one of his instructions on how to sing the music "taking out a hammer 'cause there's a fly on baby's head." Now I don't condone cheating or lying, but I do remember that Brenda has ADHD. Thus, she's predisposed to impulsive behaviors. Her folks who are not trained educators or mental health practitioners get this. I get this. So why does her school not? She's now in what amounts to detention for the rest of the year, to help her learn the character traits that this school is wanting to instill in its students. She's close to being asked to leave. And - how surprising is this - she now is shutting down with the school's counselor and administration, fearing that anything she says will get her in trouble.
Kids with ADHD do not have bad characters by definition. They have a neurological disorder that effects from 5% to 10% of kids - the most common psychiatric diagnoses kids receive. More horses.
With Robert and Lenny it's also the basics of what is called "sleep hygiene." Having a set bedtime and sticking to it. Understanding how much sleep kids and adolescents need (adults as well) and experimenting a bit to find out whether a kid does better with a bit more or a bit less sleep. The results can be surprising.
In Brenda's case it's about the basics of educating kids. Given the numbers, this school may have close to 100 kids with ADHD enrolled. Detention does not fix the basic signs and symptoms of ADHD: distractability, hyperactivity and impulsivity. Nor would I say a year long detention is the fix for a lack of moral strength, not that a 12 year old kid cheating is a high level of moral defect in my book. Isn't it more of a teachable moment? Engage her in a discussion about morals and character. Explore the context of what was going on for her that led her to the cheating (there was lots of valuable context that the school didn't bother to explore before using the detention stick.) But they missed the opportunity. They chose punishment over engagement.
An attending physician I once worked with in a hospital was bound and determined to find a kid with an obscure diagnoses he had read about and then was the focus of a popular movie. He was all but giddy with fascination of the disease. It was a good movie, but did it merit the cost of the lab tests he repeatedly performed on the kids on his service? Did it distract from the other, more obvious and common issues kids have? To my knowledge he never found one - but who knows, maybe if he continues to look, he'll find that zebra. In the meantime, I'll continue to be on the lookout for horses before I consider the zebras.
