Looking at ADHD With a Self-Regulation Lens

Self-regulation and the child with ADHD.

Posted Jan 09, 2019

Photo by Scott Webb on Unsplash
Source: Photo by Scott Webb on Unsplash

There is a widespread tendency to see self-regulation as a normative skill, akin to walking and talking— a milestone that children need to master if they are going to succeed in school. By this way of thinking, self-regulation rests on self-monitoring, self‐management, and self-control. If a child has trouble inhibiting impulses, paying attention, and regulating emotions, this can only mean that he has not yet mastered self-regulation.

Such a view can have – in far too many cases, has had – highly negative consequences. It leads us to add to the stress load of a child who is already over-stressed. This is one of the reasons why Self-Reg places so much emphasis on the original, psychophysiological definition of self-regulation:  to avoid harming a child because we failed to distinguish between misbehavior and stress-behavior.

When Walter Bradford Cannon introduced the concept of self-regulation, he was referring to the manner in which we respond to stress.

According to Cannon’s definition, a “stress” is anything that requires us to expend energy in order to keep a homeostatic system operating within its functional range. In Cannon’s famous example, cold weather is a stress that triggers physiological responses to maintain a core body temperature of 37 degrees (Cannon 1932). The hypothalamus triggers metabolic processes that burn energy in order to thermoregulate (shivering, which produces heat as a by-product); and we reduce the amount of energy that needs to be spent – i.e., we self-regulate – by wearing warm clothes and a hat.

We self-regulate in all sorts of ways, maladaptive as well as mindful.

Amongst these maladaptive habits are those that provide short-term relief but lead to greater stress down the road. For example, we may turn to foods that have been engineered to maximize the “bliss point” when feeling highly stressed, which can have a deleterious effect on health if carried to excess (Kessler 2010). Children are at especially high risk of acquiring maladaptive modes of self-regulation unless the interbrains in their lives recognize the stresses they are under and guide them into mindful practices.

This distinction between maladaptive and mindful modes of self-regulation is of the utmost importance when working with children with neurodevelopmental challenges. For example, an infant who is overly stressed by social interaction may self-regulate by gaze-aversion or by shutting down. But then, this behavior impedes language and social development, ultimately resulting in far greater stress. Clinicians, therefore, study how to reduce the stress of social interactions so that the child does not just tolerate, but positively enjoys social experiences and seeks them out for that reason (Casenhiser et al. 2011).

The Self-Reg View of ADHD leads to a very simple question: Are we responding to a child’s neurodevelopmental deficits in a way that ultimately promotes his wellbeing or the opposite? More complex is the follow-up question: If the opposite, why?

The data on students with ADHD is, unfortunately, all too clear regarding to the first question. An alarmingly high number of children with ADHD are developing internalizing, externalizing, and physical health problems, which has been tied at least in part to the manner in which they are treated at school. That is, instead of their stress-behaviors being understood as such and their stress-load attended to, they are regarded as “lazy, unmotivated, slow, oppositional, disrespectful, undisciplined” (Smith 2017).

Heightened threat-reactivity is seen as a matter of lacking the strength to ignore distractions; sensory-seeking is seen as being intentionally disruptive; defensive reactions are seen as non-compliance.

Such misperceptions lead to the routine use of punishment, and exclusion from group activities that are essential for social and prosocial development and recovery from the energy expended in class. As Mel Levine long ago pointed out (2004), students with ADHD expend more, not less energy than neurotypical peers who find ordinary classroom demands far less taxing. And yet they are regularly chastised for “not trying hard enough.”

Teachers clearly need to learn the neurodevelopmental facts about ADHD and their impact on learning and classroom behavior (Tannock 2007), but there is still a deeper issue that needs to be addressed: the influence of a pervasive Victorian bias that, whatever neurodevelopmental deficits these children might have been born with, it is up to them and not their teachers to inhibit their impulses and regulate their emotions.

One of the most influential expressions of this Victorian attitude can be found in Samuel Smiles’ wildly popular Self Help (1859) and Lives of the Engineers (1862). These books present a series of biographical vignettes intended to convey how anyone can succeed in any endeavor, regardless of their personal handicap, “by dint of sheer industry and perseverance.” The lesson is that: “With WILL one can do anything.”

"The maxim that 'Labour conquers all things' holds especially true in the case of the conquest of knowledge.  The road into learning is alike free to all who will give the labour and the study requisite to gather it. … In study, as in business, energy is the great thing.  … It is astonishing how much may be accomplished in self-culture by the energetic and the persevering."

We don’t, of course, think this way when it comes to hearing or vision problems, but to this day far too many educators still believe that when it comes to ADHD, children must choose how they act. The implicit assumption is that, for their own wellbeing, children with ADHD must be taught that if they choose to give in to their impulses they must live with the consequences. But the most important lesson that Self-Reg teaches us is that the behaviors in question have nothing whatsoever to do with choice or lack of effort. They are a consequence of the child’s biological deficits, stress-behaviors, triggered by excessive stress and geared to reduce that stress.

It is not enough for teachers to respond empathetically to the needs of students with ADHD, which, at the very least, means not adding to their burden by reprimanding that which needs to be understood. More important, they have a unique opportunity to help students with ADHD develop mindful modes of self-regulation, which, because of their neurodevelopmental deficits, may require considerably longer scaffolding than might be expected for neurotypical children.

Educators can play a pivotal role in helping children with ADHD learn how to identify and reduce those negative stresses that they can, so as to have more resources to cope with the positive stresses that education affords. To help them learn – in an embodied sense – the true meaning of calmness.

This experiential knowledge will help them to identify and avoid maladaptive modes of self-regulation, such as immersing themselves in video games as a means of escaping from troubling thoughts, and discover what is truly calming for them, which by definition means restorative.

Students – all students — will only be able to master these fundamentals of Self-Reg if they feel safe and secure. In a Self-Reg Haven, all students – not just those with a diagnosed disorder – feel this way, because all receive the support they need to manage their stress-load.

That is the essence of a Self-Reg Haven: an inclusive environment in which all students receive the help they require to work on their self-regulation, in the original psychophysiological meaning of the term.

In such an environment, the child with ADHD who struggles with inhibition and attention will nonetheless thrive.

References

Shanker, S. (2016). Self-Reg: how to help your child (and you) break the stress cycle and successfully engage with life. Canada: Penguin Random House (foreign editions Korea, Poland, Germany, Netherlands, Czech Republic, China, Taiwan, Japan, UK, USA)

Cannon, W. B. (1932) The Wisdom of the Body. New York, NY: W.W. Norton and Company Inc.

Casenhiser, D., Shanker, S. & Stieben, J. (2011) Learning through interaction in children with autism. Autism 17(2):220-241

Kessler, D. (2009) The End of Overeating: Taking control of the insatiable American appetite. Toronto, ON: McClelland & Stewart Ltd.. 

Levine, M. (2004) The Myth of Laziness. New York, NY: Simon & Schuster.

Smiles, S. (1897) Self-Help. London, UK: John Murray.

Smiles, S. (1879) Lives of the Engineers. London, UK: John Murray.

Tannock, R. (2007) The educational implications of Attention Deficit Hyperactivity Disorder. What Works? Research into Practice. Toronto, ON: The Literacy and Numeracy Secretariat.