The Child and Family Mental Health blog is pleased to present a guest post from Dr. Gloria Vanderhorst, Ph. D., a psychologist in Silver Spring, MD, with over 30 years experience working with children with ADHD and learning disabilities and their families.
One of the common fears for parents is that a diagnosis of ADHD will be stigmatizing for their child. Sometimes an evaluation is put off because of this fear. In my work with clients who have ADHD, I have learned that knowing the diagnosis is the entry card to the mysterious world of the brain. Exploring how our brain works and understanding what goes on inside of this world will enable the child to take charge of his own functioning and facilitate progress in learning how to cope with this unique brain.
In my office, I have a basket of “stuff”, collected over time that can be used to construct or symbolize various brain parts and functions. One of the first exercises in working with a child who has ADHD is to use this “stuff” to construct their unique brain. There are race cars for the fast parts, feathers for the flighty parts, nuts, bolts and washers for the machine like working parts, clay for the more malleable, flexible parts and many other items that can be used creatively.
As the results of a neuro-psychological evaluation are transformed into these 3 dimensional models, the child begins to take ownership of the various strengths and weaknesses identified by the evaluation. Suddenly, many parts of day to day functioning take on new meaning. We can now discuss the neuro-cognitive aspects of living and working with an ADHD brain.
Neuro-cognitive Psychotherapy is a brain-based treatment approach that is a unique blend of cognitive-behavioral therapy and cognitive rehabilitation. This approach is a team approach based in the most recent research on brain functioning and ADHD. The process integrates the client, the parents, the school and other important caretakers in a coordinated plan for learning and managing the symptoms of ADHD. The key to building a treatment plan is to understand how the brain works in general and to discover how the brain of a particular child is functioning specifically. This brain based approach starts with a neuro-psychological evaluation that enables us to measure various aspects of executive function, memory function, and processing abilities. This evaluation may also examine emotional strengths and resources that the child has been using to cope with the stress of learning and living.
Once a diagnosis of ADHD has been made, educating the child about the specific strengths and weaknesses in their brain is the next step. In addition to building our own brain models, we may view images of brains from various websites. Pictures of brains from web sites showing fMRIs have been very helpful. With the fMRI, we can see different areas of the brain light up as one thinks and problem solves. One of the most detailed collections of fMRIs can be found at the Amen Clinic site: www.amenclinic.com. You may want to log on to take your own tour of different brain images. We may also make drawings or abstract art that represents the various functions of the brain and how they interact with each other.
As a child comes to understand how his own brain is working, he is encouraged to present his understanding in a family session as a means of educating others in the family. In this way, the child is given power over the ADHD. The stigma that has been associated with inattentive or hyperactive behavior is replaced by knowledge that empowers the child to take more control over his life. The earlier this empowering process can begin, the more opportunity the child has to build compensating strategies, make changes in his environment and develop supportive relationships. Educating the child about his own brain, how it works, and how he can help make it work best is a central part of neuro-cognitive psychotherapy – de-stigmatizing the brain patterns we refer to as ADHD and giving the child a sense of understanding and control.
Gloria Kay Vanderhorst, Ph.D.