Disciplining Inattentive ADHD versus Disciplining Combined Type ADHD

Disciplining Inattentive ADHD versus Disciplining Combined Type ADHD

This is the last in a series of posts that I have been writing about how the inattentive subtype of ADHD differs from the Combined type. In the first post I wrote about Inattentive ADD differences in response to ADHD medications. In the next two posts I described Inattentive ADD classroom strategy differences and in last week’s post I began a discussion on how disciplining kids with inattentive ADHD can differ from the disciplining approaches used for combined type kids.

I have written before about how ADHD expert Russell Barkley has described a function of our brain that speak to us about what behavior is appropriate. Barkley has examined this trait in people with attention deficit issues and has found that, in people with ADHD, this internal brain voice is faulty. The internalized speech that Barkley is describing is a key part of the executive function known as ‘Self regulation’. It is Barkley’s belief that this particular executive function is a key problem of the combined type of ADHD. Barkley, however, also believes that this internal voice is partially intact in kids with inattentive ADHD and this is the reason why they are often less impulsive, less positional and more self reflective.

Inattentive kids have trouble regulating their attention and motivation but the “internal voice” that speaks to them about appropriate speech and behaviors is loud and clear. I mention these executive function differences because the number one approach to disciplining my inattentive son involves using his intact internal voice and just reasoning with him.

My combined type son tends to be pretty oppositional and argumentative. Reasoning with him, or just talking out our differences, is not an option. I can go to my inattentive son, however, and ask him about his transgressions, discuss with him how best to improve the problematic behavior, and ask him to come up with an appropriate punishment. Believe it or not, he often is more hard on himself than I would be.

When the above strategy does not work, there are other disciplining tools that we have used at our house that have also worked pretty well. Plain, old fashion punishment sometimes are pretty effective. The negative incentives that have motivated him to behave appropriately include:

1. · Removing or decreasing his allowance
2. · Removing or decreasing his allotted screen time
3. · Increased household chores
4. · Removing dessert (he absolutely loves dessert)

Positive incentives have worked less well but on occasion we have used them with success. Examples of positive incentives include:

1. · Increased Screen Time
2. · Increased Allowance
3. · Buying him a gift.
4. · Taking him out to his favorite restaurant

The disciplining of kids with inattentive ADHD can be difficult. Strategies such as the removal of social opportunities or the removal from participation in sports activities, as I discussed in my last post, are often not effective. Punishments such as restriction, detention or “Time Outs” are also sometimes worthless because these kids are especially happiest when they are just left alone. Inattentive kids are generally a bit more cooperative than combined type kids however, so reasoning with them often works as do both negative and positive disciplining strategies.

Parenting Predominantly Inattentive Children vs. Parenting Combined Type Children

Parenting Predominantly Inattentive Children vs. Parenting Combined Type Children

So this is the fourth in a series of posts that I am writing about the differences between Combined type ADHD (ADHD-C) and Predominantly Inattentive ADD (ADHD-I). In the first post I wrote about the best course of action for folks with ADHD-PI who do not respond well to stimulants. In the second and third posts I wrote about classroom interventions for inattentive ADD and in this and the next post I am going to address ADHD-I parenting advice.

As many of you know, I have two children with ADHD. One is inattentive and one is combined type ADHD. They are as different as night and day, chalk and cheese and hot and cold, . The combined type child is a fairly typical combined type ADHD kid. He is hyperactive, impulsive, extroverted, very social, lives in the moment, is not a worrier but is also not very reflective and can be pretty oppositional, combative and difficult.

The inattentive ADD son is also pretty typical of the inattentive type of ADHD. He is socially awkward, can be hypoactive, tends to be wary and is a worrier.  On the other hand, this son is highly reflective, thinks a lot about consequences and is never oppositional or combative.

At first blush it would seem that the combined type child would be really difficult to parent and the inattentive child easier. Parenting is never easy and I would say that they are both easy and difficult to discipline but they are easy and difficult for completely different reasons.

As I am sure you have guessed the combined type child will argue with us.  If we say fast, he will say slow, if we say yes, he will say no and if you say walk, he is sure to run. Kind of a pain, right? Sure, but the inattentive son sometimes does not move at all no matter what you say. They both get themselves into trouble though. One for being too aggressive and hyperactive and the other for being too passive and inactive.

What make the disciplining of the combined type sometimes easier than the disciplining of the inattentive child is that the combined type kid has lots of stuff that he loves to do. Even more importantly he really loves to do these things.  Because he loves these activities so much, we have an arsenal of punishments that we can propose to him. These include:

· No sleepovers
· No Laser tag
· No sports
· No paintball
· No movies
· No screen time

The threat of removing these activites, because he loves them, motivate him to behave.

The inattentive son hates movies (too loud), laser tag (too fast), paintball (too violent), sleepovers (ruins his sleep habits) and sports (too uncoordinated). He does like screen time but as you can see, our punishment choices are kind of limited when it comes to motivating and disciplining our inattentive son. To make matters even worse, he is not very passionate about much so even removing screen time does not always have the impact that you would hope. He is pretty happy to sit in his room, lost in his "own private Idaho", doing nothing at all.

Given that inattentive kids can be perfectly happy in “Time Out", what is a parent to do when disciplining and motivation are in order? My next posts will give you suggestions for addressing these problems.

Part Two: Inattentive ADD Classroom Strategy Differences

Part Two: Inattentive ADD Classroom Strategy Differences

This is the third in a series of post that I am writing about the differences between Inattentive ADD and the more common type of ADHD, combined type ADHD (ADHD-C). In the last post I started to outline how classroom interventions for Inattentive ADD are different. This is part two of that post.

You remember that in the last post we described how positive statements by a teacher that were specific to the child with Inattentive ADD made a huge difference in "on task" time in the classroom.  In the last post I promised that I would explain why psychologists believe this matters.  There are several reasons why a teacher's positive attention might make all the difference in the success of an inattentive student.  The two most likely reasons that this type of teacher interaction helps is that we all perform better and more consistently when we:

1. Perceive ourselves to be part of a group.

People with Inattentive ADD in a classroom can socially distant themselves from the teacher and the rest of the students. Kids with Inattentive ADD can be introverted as well and this type of simple positive teacher attention can bring kids with ADHD-I into the social group. Studies have shown that a phenomena known as social facilitation or the act of being part of a group increases our arousal levels, improves the accuracy of tasks performed and also improves the speed of task performed.

2. Think we are being watched.

Psychologists have demonstrated that being observed changes our behavior for the better. Thomas Jefferson knew this. He is quoted as having said, “Whenever you do a thing, act as if all the world were watching.” An interesting study found that even a big poster with pair of eyes improved peoples behavior. Being watched is known to put us all on our best behavior and this likely applies to inattentive kids in a classroom as well.

The famous ADHD psychologist Russell Barkley has stated that emotional control problems, impulsive acts and problems with an executive function known as "inner dialogue" that allows people to consider the consequence of their own actions is NOT a part of Inattentive ADD. People with ADHD-I often have a very rich inner dialogue and sometimes over think the consequence of their own actions. Teachers need to understand these differences and use the positive benefits of having a rich capacity for inner dialogue, a positive response to belonging to a group, and a positive response to the perception of being watched in their classrooms.

I would love to hear what you think.  Write to me or leave a comment!!

Differences in Classroom Interventions For ADHD Inattentive Kids

Differences in Classroom Interventions For Inattentive Kids

This is the second post in a series of posts that I am writing about the differences between combined type ADHD and the inattentive type of ADD. In my first "differences post I wrote about how people with inattentive ADD react to ADHD medications. In this post I will be writing about why ADHD classroom interventions for ADHD Combined type students do not generally help inattentive kids.

If you go to any medical or educational site and read the list of classroom management suggestions for ADHD kids in kindergarten to 8th grade you will find that some of the suggestions listed at the very top of the list involve controlling a child who is a disciplinary problem, who does consider the consequence of their own actions, or who is hyperactive, impulsive, hostile or aggressive. Further down this list you might find suggestions for improving attention.

If a classroom had only one ADHD child and that child happened to be inattentive, then teachers would likely start at the bottom of the ADHD classroom management list and implement only those interventions that helped the ADHD-I child. Unfortunately, most classrooms have at least three ADHD kids and at least two of them are combined type kids. What this means from a practical standpoint is that the teacher controls the most disruptive children in his or her classroom first by implementing the disciplinary, hyperactive and impulsive behavior controls and only when these are working do the interventions for inattention get addressed.

This is why the parenting of Inattentive ADD child is different and why a child advocate is essential. Kids with ADHD-I will happily sit back and focus on their entertaining "inner brain dialogue" while the combined type kids get disciplined. The teacher may not even recognize that they are not paying attention as kids with this type of ADHD (especially as they get older) are masterful at looking like any other non-disruptive kid in the classroom. You as a parent know that your child is spacing out so it is up to you to make sure that your kid's teacher knows this too.

The very best news about classroom intervention tips for ADHD-I is that these kids respond really well to the attention of a teacher, parent or student mentor. The attention does not even have to be constant as some people would imagine. Students with Inattentive ADD will engage if they have a reason to. Relationships can really make a difference to them. These kids are not combative or uncooperative and they do not even always need to be reminded that they are spacing out. What they do need is an attentive teacher. One really interesting study demonstrated that if a teacher engaged an inattentive child by simply acknowledging them in some way when they entered the classroom, "that shirt looks really nice on you", "I found that doodling you did on your last assignment really fascinating", their "on task" time improved from 15%-30% of the time at the beginning of the seven week study to 40% to 90% of the time by week seven.

What that study demonstrated is that inattention in a classroom can be improved if the inattentive child perceives that the teacher is paying attention to them. As I have mentioned before on this blog, this type of intervention does not only help kids with ADHD-I, this type of classroom intervention would help any child. In my next post I will explain to you what the pyshology medical literature reports on why this type of teacher intervention helps kids with Inattentive ADD.

Shoot me an email or leave a comment.  I would love to hear from you!!