Showing posts with label system. Show all posts
Showing posts with label system. Show all posts

Monday, June 3, 2013

LET THE GAMES BEGIN - ADHD and Videogames

      One example of this attention dysregulation that deserve special comment is the fascination that boys often have for video games.  One of the reasons they can play for hours is because the Nintendo demands interaction on many levels.  There is a colorful, rapid-paced animation, loud sound effects and dramatic theme music, multiple buttons and levers requiring fine motor coordination while possibly receiving jolting vibrations from the controller itself.  Add to all this a mysterious quest with seemingly endless trails and worlds to discover while being constantly rewarded with objects or new skills or weapons and the allure of games makes perfect sense.
           As we know too well, the real world is often confusing to children with ADHD and their best efforts are not rewarded.  The problem is that these games are not the real world and probably do little to prepare children for our twin goals of academic and social success.  They are addicting to us as well because our child is finally quiet and is not irritating his sister, running around the room or loudly refusing to do his homework.  As the game system develop better graphics and unlimited capability through internet connections the addiction potential multiples and more and more time and energy may be devoted to them. 
          We need to teach our children moderation in all their activities whether it be TV watching, eating, practicing or playing sports or other activities such as dance or gymnastics , or going to church or playing video games.  It may be true that the games increase fine motor coordination or self-esteem because of the “expertise” they develop but it is surely a small gain at a huge price.  There is evidence that despite their devotion to their “DS” those children with ADHD score lower than their peers because they still have deficits in attention, distractibility and impulsivity.  Let the games begin but control them with reason and let them end just as frequently.
     It is helpful to think of distractibility as a mental rather than physical hyperactivity.  It seems that these minds of these children are working just as fast as their bodies.  Thoughts come and go with blazing speed and travel on “to boldly go where no man has gone before”.  They make a thousand journeys of one step but never arrive anywhere.  They multitask but never achieve anything.  It is difficult for them to screen things out or ignore the noise around them then to focus and complete the task at hand. 
          The problem is not that they cannot pay attention, but that they pay attention to everything. They listen to the sounds outside the door, the buses going buy, the overhead lights humming or air-conditioning, the patterns in the floor and their own thoughts.  One mother recently told me that her only chance with her son was to hold his head in both hands, come down to eye level with him and slowly repeat one phrase at a time.  Even then he would take off with a new idea or observation that seemed very important to him but had little to do with the job that needed to be done.  I thought had finally reached my son when he kept the eye contact going after my heartfelt instruction but was brought back to earth when he said “Do you know I can see myself in your glasses especially when your eyes get so big when you yell?”  So much for my parenting techniques.  We want to speak the truth in love but don’t know the specifics on how to do it.

Saturday, December 22, 2012

PLANS VS LISTS

I am a little tired of ADHD “numbers” articles. I mean the ones that list the “7 Secrets to Improve Your Child’s Attention”, “5 Ways to Eliminate Homework Problems”, and “32 Sure Fire Steps to Save Your Marriage” (that one seems to requires a little more work). Getting ADHD under control is just not that simple. What really is needed is a system, not a list.
            Of course, lists have a place when used to remind, prioritize, and teach us. For example, one for successful brain surgery might be:
1.    Get plenty of sleep the night before.
2.    Wear comfortable shoes.
3.    Make sure your scalpel is sharp.
They may be good rules, but we expect our neurosurgeon will also have the required knowledge, experience, skills, and clinical judgment to do the job correctly. Every professional from hairdresser to plumber to policeman has a reliable plan to deal with bad hair, clogged drains and criminals. Parents too need a problem-solving process to help their ADHD child consistently achieve their best potential in school, relationships, and self-esteem.
Years ago I was unexpectically given the responsibility to provide medical care for a large number of children who had ADHD and were in trouble at school. Although I had received excellent training in managing premature infants on ventilators and severely injured children in the Shock Trauma Unit, I had no idea what to do with this group. But what I discovered is that the medical problem-solving system I used to diagnosis and treat fever, pain, rash or whatever could work for ADHD as well. Although I realize this looks suspiciously like another list, I prefer to think of it as an algorithm or the sequence of steps that all doctors use to solve a problem.
1.    Describe the chief complaint (fever)
2.    Take a history (ask questions such as “Does your throat hurt?”)
3.    Do a physical exam (open your mouth and say “Ahh”)
4.    Perform a laboratory test (swab the throat and perform a rapid strep test)
5.    Make a working diagnosis (probable strep throat)
6.    Decide on best treatment ( usually penicillin)
7.    Evaluate the accuracy of your diagnosis and treatment (call the next day and ask about improvement or side effects)