Q: My 9-year-old son’s teacher is complaining that he often doesn’t finish his class work, is disruptive to other students and is somewhat of a class clown. Previous teachers have mentioned these sorts of behaviors and I know that they are hinting about attention deficit hyperactivity disorder (ADHD). Personally, I feel that he can pay attention and complete the work, especially if it is interesting to him. I really don’t want to consider medication, but I don’t want him to fall behind in school or to develop a poor self-concept. How can I determine if he’s just being lazy or if he truly has an attention disorder?
A: I can’t tell you how many times a week that a new client will come to my office with this same concern. Attention deficit hyperactivity disorder has moved to the forefront of all childhood behavioral disorders and truly does affect many of our children, especially in the academic setting. When I’m asked to make a differential diagnosis between a behavioral disorder (laziness, lack of motivation, desire to be the class clown) and a true attention problem (significant difficulty maintaining focus especially in tedious or laborious situations), I consider several options. Unless the child is severely impulsive, hyperactive, or inattentive (suggesting that the youngster may benefit from consideration of a trial of medication), I try to handle the academic situation in a behavioral manner. That is, motivating the youngster to put forth a good effort throughout the day with significant consequences attached to both positive and negative outcomes.
It should be noted that children with attention deficit hyperactivity disorder do not display all of the symptoms at all times. The behaviors typically worsen when the task requires sustained attention or a great deal of mental effort, or when the child is placed in a situation that is not interesting to him, such as listening to lengthy lectures or working on repetitive tasks. When he is doing something that is fun, involved in a one-on-one activity, or playing on the playground, the impulsiveness and hyperactivity may not be noticed at all. Working alone he will be more calm, but in group situations it is more difficult for the impulsive youngster to stay on task.To help the parent and the teacher determine the basis for the behavioral and academic issues, I’ve developed a simple system that you may wish to propose to your child’s teacher. Ask her to tape a 3x5 card with five stars drawn on it on the corner of your child’s desk each morning. (Trust me, the other kids will be curious for about five minutes and then lose interest.) Your son will be told that the teacher will quietly cross off one star for any significantly disruptive behavior (getting out of seat while the teacher is talking, humming loudly, or throwing a wad of paper to a buddy in the next desk). A star will also be crossed out if your son doesn’t make a concerted effort to complete a class assignment. If the child worked diligently during the allotted time on the project, but didn’t complete it fully, then a star would not be lost. Clowning around would also merit loss of a star.At the end of the day, the teacher would initial the card and send it home with your son. If at least one of the five stars was not crossed out, then it would be considered a successful day and he would receive his normal privileges such as watching TV, playing video games, hanging out with his buddies, or going to bed at the regular time. In addition, he could earn a special treat, such as a daily allowance of 50 cents or a dollar, or a poker chip. He could save the chips and “cash” them in to see a movie or invite a few friends to spend the night. However, if the fifth (and final) star was crossed out, then he would lose all privileges and treats for that day.
The keys to success are twofold —the star card must be placed on your son’s desk so that he knows exactly where he stands throughout the day. He may not be concerned about the loss of the first few stars, but as he nears losing the fifth and final star, he should begin to use his self-discipline to the fullest. Second, the consequences that you give at home (both positive and negative) need to be significant to your child. Note that you need to be consistent and the consequences you choose must be important to your son.If you see within the first two weeks that your son generally earns his rewards (the fifth star is not crossed out), then praise his good effort and begin the next week with only four stars on his card. As he sees the benefits for using self-discipline, rather than giving in to the impulse to be lazy or to clown around, he’ll be able to keep his misbehavior or lack of work effort to a minimum. Eventually, you should soon be able to lower the number of stars on the card to two or three, and that’s when you can see that ADHD is not the culprit — it was lack of motivation and perhaps a tinge of laziness after all!
Many times, I’ve seen that this system works well enough that medication is not necessary. Even if the youngster has mild to moderate symptoms of ADHD, this behavioral system still may be beneficial, as it consistently lets the child know what he is doing wrong (e.g., blurting out answers in the classroom) and how close he is coming to either receiving or losing his daily rewards.Of course, there are other reasons for misbehavior or lack of task completion in the classroom. These include true ADHD, learning disabilities, cognitive deficits, anxiety, a lack of self-confidence, or gaps in knowledge. Please consider these as you try to determine the basis for your son’s classroom problems. And if you determine that your child is diligently trying to not lose the stars, but he is still impulsive and engaging in disruptive behavior, then a psycho-educational battery may be necessary to determine the nature and extent of the learning gaps or attention disorder. Talk with your school’s guidance counselor or your son’s pediatrician for an appropriate referral.
Dr. Peters is a clinical psychologist and regular contributor to “Today.” She is also the consultant psychologist for the Family Program at the Pritikin Longevity Center, a nutrition and exercise facility in Aventura, Fla. For more information you can visit her Web site at . Copyright ©2004 by Ruth A. Peters, Ph.D. All rights reserved.