August 18, 2019

Sometimes School Issues Are Not Always Just About The Diagnosis

Hello Everyone,

      I hope you are having a pleasant, preferably un-hectic, last couple of weeks before the school year ramps back up.  Looks like were getting ready to put existing education plans back to work, while scrambling to schedule meetings with teachers and support staff so that our kids get the best deal they can in the classroom.  This month's post will, hopefully, be brief, and focus on the importance of not only focusing on the impact of the diagnosis on a child's performance in school, or other areas of life. I would like to say that understanding diagnoses are critical to helping kids get the best they can in school and do relate in many significant ways to behavior/academic challenges.  Much can be explained by the diagnosis and is a direct expression of it.  Accommodations are hugely important and need to be encouraged, not with-held or offered only after a kid has suffered shattering collapse of self in front of their peers in the classroom.  I agree that it is a necessity to evaluate behavior causes and outcomes and consider all options, however those are not the only pieces to explore.
      Kids with ADHD and other developmental diagnoses are, for many reasons, usually evaluated through the lens of their diagnoses, particularly how it impacts their ability to move through the school system.  Consequently, there is still a prevalence of the medical model of treatment where problems are seen and identified to be treated.  This is especially true regarding schools and other environments where kids with these diagnoses have to perform, whether it is academics, sports, music, etc.  The medical model approach gets used so much because it's easy.  Identify, diagnose, treat, evaluate outcomes.  Societal organizations such as schools, have to, by necessity, function like a machine in order to pass kids through their academic odyssey.  Any hiccups to the machine, such as challenges with learning or behavior, can be very disruptive in a classroom that has 30+ kids.  The machine, as we know, is strenuously overworked.  So of course the process of identify, diagnose and treat is a god-send for an over-taxed system.  However, there are some other aspects to this model, which often comes into use at the start of the school year, which ought not to be overlooked with respect to the impact of the well-intentioned focus on the kid with the diagnosis.
      I will be the first to admit, that I am guilty of getting into the identify, diagnose, and treat mindset, especially when a parent who is really distraught comes to me for help.  Who would not want to help?  That's what we do best and it's also very easy for us to launch into that find out what is wrong, tie it to a diagnosis, and come up with solutions.  I have to remember, especially about my own experiences with ADHD, that tying everything back to the diagnosis is not always helpful to the kid, but can often times perpetuate a sense of other-izing and tying their identity to their diagnosis.   A kid can have ADHD which makes it challenging to focus in class due to their "computer wiring".  That may be a reason that sets them apart from their peers.  The equally important reason to the kid is that the teacher sucks or they just don't like the subject.  That is what makes them like their peers and must be equally addressed if we are going to move beyond talking rhetoric about normalizing to putting it into practice.  The following is a personal example.
     I have had severe ADHD my entire life and am now completely un-repentant and living well without medication.  However, growing up, especially in my critical identity forming teen years, ADHD was a label I could not escape.  I had an IEP and accommodations, which were updated at regular meetings, which we are all very familiar with.  Teachers would come to the meetings and complain about my behavior or issues with my work, to which the resource staff and school psychologist would say it's because of ADHD!  I now appreciate, but certainly did not, at the time, their efforts at trying to offer some perspective for the teachers.  However, I began to really internalize that something was wrong with me because I had ADHD and that it was a bad condition that I lived with.  It's hard to love yourself when you are constantly at war with a part of you that you can't get rid of and is characterized as a bane of existence.  Could I not have school issues just because I was like everyone else?  Could I not fail or be given an equal chance at failure like everyone else?  Truth is that accommodations for myself and many others whom I have and do work with, while really helpful, often can contribute to a certain shame around failure.  We got "easy tools" and we still screwed it up! "Oh but you have a diagnosis".  So now I had tools that did not help me battle myself and I still failed!  That's really tough to deal with.
       I had one of the high school guys who I work with come in last week with his mother and father yelling at him because he still had not done his summer work.  I immediately went into "helpful mode" and started examining what were contributing factors such as attention, distraction, and so on.  I wanted to help.  The kid yelled at me "shut the  expletive deleted up!  Do you think that maybe I just don't want to do the work?  Why does it always have to be about me having autism?!"  True story.  That got me thinking really hard about myself and my own experiences.
      As a mental health professional, someone with ADHD and a new father recently diagnosed with medical student disorder by proxy, I completely understand where and why all the focus is on the diagnosis.  For myself and others, the challenges and difficulties are waaaaaaaay much more visible than the aspects of the self that are doing fine.  So what to do when dealing with someone you work with? 
First, I try to give myself some grace and acknowledge that when I start off with the diagnosis, it's coming from a good place. 
I also try to remind myself that just because I started out using the diagnosis lens does not mean I can't backtrack and start over. 
I then try to take a pause and reflect for a moment on my own experiences in the past dealing with such situations and try to come up with a reason not diagnosis related why I knew that I was having trouble or was not even aware might be diagnosis related.
(Please remember that as professionals with academic training and experience we have more of the objective knowledge about what might be causing difficulties.  Kids are much more concrete, subjective and experiential in their self-appraisals).
The next thing I would do is to then ask them about their own reasons and explore those with them first to get that alliance going again and to also put more of a focus on the positives about them and their own awareness.
So what have I found?  Kids with ADHD or other developmental diagnoses are too often aware of their shortcomings from a disability/challenge perspective as well as critical focus on their differences.  They want to be treated like all their peers, especially with respect to their opinions and behaviors, which are critical to their identity development.  So what does this mean?  A kid with ADHD does not have to have his diagnosis explain why he/she struggles in class.  He/she can, like the others, screw up, hate the teacher, not like the subject, and make poor decisions, just because they are a kid and do not have the development or life experience to do otherwise or cope with it in a more mature manner.  Believe it or not, a kid with autism can be a psychopath because they genuinely are a psychopath and not because they have autism.  I know...I worked with one for two years in child welfare.  Anyway, my point is that those of us with developmental diagnoses have challenges at school that can be explained and treated in many ways that are related to our diagnoses.  We can also have challenges in the classroom because we are also people and just very well may be exercising our own, and not well thought out (because that's something we who are impulsive or struggle to organize our thoughts and feelings to send a message) views about a class or assignment as we continue to figure out how to sort out who we are as a whole person.  Whether we are professionals or parents, we must remember this.

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