Caffeine, ADHD and Stimming Behaviours

Today I was prompted to recall how about ten years ago, I attended a very interesting seminar presented by a visiting psychologist from Sydney. Sadly, I can't remember his name anymore. The presenter described himself as having undiagnosed ADHD, paced back and forth rapidly and constantly as he spoke, and presented a lot of information in a very condensed, speedy fashion. A great deal of concentration was required to take it all in.

But boy was there a wealth of good stuff in there. I think that seminar helped me to see my son more clearly and with a deeper compassion. And in many respects, I think this has coloured most of my interactions with my son and my decisions since then. Below are a couple of key things I got out of the seminar.

Caffeine & ADHD

The presenter told us about the medications used for ADHD, and how their stimulant effect would allow neural connections to happen between the frontal lobe and the base of the brain, creating calm and more organised thought, and hence allowing clear and better decision making to occur. Impulse control is made possible by these medications, and he explained how terrifying it must be for kids who were unable to control themselves. He described how without these connections, spontaneous and risky decisions could be made because once an idea was present, the neural connections were not there to prevent the action from taking place. By way of explanation he mentioned that scars on the fingers of young children had at one time been used as a diagnostic observation for autism, because if the child had been told "Don't touch the stove, it's hot," they would automatically reach out and touch the stove. The idea had been presented, but there was no connection to the part of the brain that would prevent the action from occurring. (I guess this is also an early indication of the many overlaps between autism and ADHD).

He then went on to say that caffeine, also being a stimulant, could have a similar effect. He said that giving caffeine to a child with genuine ADHD would calm them, and could even help with sleep problems. He also touched on the frequent misdiagnosis of energetic young boys with ADHD and described how caffeine could be used as a rudimentary diagnostic test. "Give your child a glass of coke," he said, "And if they calm down or even get sleepy, they more than likely have ADHD. You should then get them properly assessed."


It's interesting to see the studies play out this caffeine theory. Here's an interesting research-based article on the subject - Caffeine's Effect on ADHD Symptoms. 

There are many other articles out there on the internet on this topic. Plenty of stuff to read. There's heaps of info out there about the benefits and side-effects, be sure to do your research before you start pumping your children full of caffeine! And make sure to look at the scientific/medical studies as well as anecdotal evidence. The long term effects of excessive caffeine use can be quite harmful if you're not careful. A quick Google search will be worth the effort.

Stimming behaviours

Another thing I found extremely useful that day was a lengthy discussion about what we call "stimming" behaviours. Stimming is a term used to encompass a number of different physical behaviours which provide much needed and specific stimulation for the nervous system of the individual concerned. Some of the more common of these seen in autism are hand-flapping, spinning, jumping/bouncing, rocking, swinging and licking/mouthing. In someone with ADHD, it might look like something simple like a jiggly foot while seated, or a wriggly bottom in a seat.

The key message from the psychologist was never to simply suppress the behaviour. He made it abundantly clear that if we try to suppress the unusual behaviour, a more bizarre (and/or more annoying) behaviour will usually move in to replace it. If we try to stop someone jiggling their foot, they still need an action, so they might start tapping their pencil on the table, or repeatedly clicking the button on the end of their pen. If we try to physically hold down flappy hands (yes, I was once advised to do this by a supposed autism "expert" - but I was horrified and never did it), the nervous system still needs whatever it is seeking through flapping, so another behaviour will pop up in its place. And what that might be is unpredictable. It might be something much more awkward or embarrassing, like hands down pants in public places.

So his advice was, if you want to get rid of a certain behaviour, first of all decide whether your need to do so is really that important. What is motivating your desire to remove that behaviour? Who really benefits from getting rid of it? Does it really matter? Are you just allowing yourself to be embarrassed by something which isn't a big deal in the bigger picture? Are you being too controlling or worrying too much what other people think? Will it be more distressing for your child to get rid of it than to just allow it to continue?

Is it really causing any harm?

Then, if you have a socially unacceptable behaviour to deal with - such as hands down pants in public places, always be sure to negotiate something more socially appropriate to replace it, or you could find yourself with a much bigger problem. Maybe offer a fidget toy. Try many options until something works.

For example, the psychologist, throughout the presentation, was fiddling with his wedding ring and twirling it around his finger. Until he pointed this out though, I was completely oblivious. He explained that this was a behaviour he had given himself which was virtually invisible and completely acceptable, but helped him to organise his thoughts and served the physical need he had to fidget.

Always remember the behaviour has appeared for a physical reason, and never punish for doing it. This behaviour isn't intentionally there to annoy you, so don't take it personally and don't get angry about it. It is very difficult for people to drop compulsive habits, so a more supportive attitude is needed if you want to make positive headway.  Certainly offer regular rewards for any show of self control. How you do this is up to you, but it's vital to any chance of success.

Take what you want from these ideas - but for what it's worth, everything he presented that day has turned out to be excellent advice as far as I'm concerned.

Understanding Autism - Video Guide for Secondary School Teachers

I just came across this wonderful resource set of videos for teachers. Remember, every autistic student you meet is unique, and it is inappropriate to generalise what you think their needs are. Always remember to respectfully ask your student and gauge their responses to your interventions, adapting as needed.

Part 1 of 4

Click for  Part 2 - Part 3 - Part 4

ADHD Goes to School, by Mark Bertin, MD

Article Excerpt:

When a child has a language delay, people tend to accept this fact at face value: Joseph is 6 but speaks like a 3-year-old. While understandably upsetting to many parents, no one expects Joseph to speak differently before he is able. There's a scramble to start services and a patient approach while allowing language to develop.

The same attitude does not hold for attention deficit/hyperactivity disorder (ADHD). ADHD is a developmental delay in a broad skill set called executive function. A huge body of research defines it as a medical disorder; neither parents nor children benefit when people suggest otherwise.

Executive function represents our capacity to self-regulate, encompassing everything from focus and impulse control to long term planning, prioritizing, organizing our lives and emotional control. It is required for social interactions and classroom learning. Imaging studies confirm that children with ADHD experience immature brain development, showing again that it's neither a child's fault, nor a parent's, nor society's.

A child with ADHD may be 6 years old but going on 3 when it comes to self-regulation. Often parents hear, or even feel themselves: He's just lazy. He needs to get his act together. He knows better. Yet inconsistency is inherently part of ADHD, with moments of clarity balanced by a perplexing inability to hold it together over an entire day. So he probably does know better -- but without typical executive function, lacks the skills of other children his age to follow up.

Link to full article:
http://www.huffingtonpost.com/mark-bertin-md/adhd_b_1517445.html

What are transitions?

What's a transition? In short, it's the moment when we move from one activity to the next.

Some of us find this process pretty simple, and don't think much of dropping what we're currently doing, in order to take up a different task. But for people with executive functioning deficits, sensory, anxiety, attention and/or autism issues, transitions can be hellish propositions.

Imagine you're reading your favourite book, or watching your favourite TV show, writing an essay, drawing a picture - any task requiring your concentration. You're deeply engrossed in what you're doing, and you might even be having fun. Then someone pops up in front of you seemingly out of nowhere, demanding your attention, requiring you to focus on what they want. This can be rather startling, and is usually at least mildly irritating. That person then demands that you instantly drop what you're doing and take up something different, something they have determined to be more important. They won't allow you to finish the paragraph you're reading/writing. If you were baking a cake, they won't let you take it out of the oven. You must stop what you're doing right now, and move on, regardless of your internal dialogue. It happens to all of us at some point in our day.

Doesn't the very thought of that scenario irritate you? Do you feel a little bit of anxiety? Maybe you're imagining how you'd like to tell that person to take their instructions and shove them... well, you know where! ;) So now, take that discomfort and multiply it by a very large number, and you might be coming close to describing the difficulty faced by the student with an ASD. I'll try to explain further.

So, imagine it took you quite a while to settle down to the task you were doing, significantly longer than the average person. You had to fight off distractions, sensory sensitivities/overload, and various anxieties related to moving on from the previous task. Structuring and organising your thoughts, and building up the focus you've been applying to the task took immense effort. And now, when you finally are settled into the task, it feels like you've hardly had any time to get anything done.

Imagine it's your favourite thing to do in all the world, and you are now expected to drop it to take up something much less favoured, or at least less important to you. Then consider that it's very important to you to finish what you started, otherwise everything feels out of control, but you still have a little more to do and the person asking you to drop everything has not considered this fact. Letting go of that thought requires an incredible effort, and the anxiety is consequently building in your stomach. How are you supposed to be able to stop when you're not finished?! Why can't they consider your feelings?! Why should they get to determine what the priorities are?!

Add to that the distracting buzz of people around you as they begin to pack up, thus making it more difficult to organise your panicky thoughts and manage your intense feelings. Next, take into account the enormous effort it will take to get organised for and then settle into the next task, the difficulty of which is only exacerbated by all these feelings! Your mind is racing, your heart is fluttering, your stomach is churning, your work isn't finished yet, you want to please the person who is making demands of you but you are simultaneously furious at them for their lack of caring and overwhelmingly anxious about how you are going to get through this moment.

Now imagine you have no names for those feelings, no way to express your fears, frustrations and fury. It's so overwhelming that words simply escape you; your mind is screaming; your voice box seems to be frozen solid; your muscles are rigid. All you have left in your armory is to cry, or throw something, or sit there frozen, shaking your head, trying to block out all the expectations and demands of people around you, or maybe even attempt to plough on and try to finish the task despite the fact that you are likely to be disciplined for not following instruction.

Once you've moved on though, that initial task is still not complete, so you're utterly stuck on that thought, like gum boots in concrete, unable to budge. Even when you can manage all the anxiety and move onto the next task, you might take quite a long time to let go of that thought, and relax enough to settle into the next activity and get some work done.

And so the cycle repeats, in the end, with very little work commenced, and hardly anything actually completed.

So the recommendations for teachers to assist with transitions are:

1. Patience, Patience, Patience. And take the recommended daily dose of compassion. If you put your cranky pants on this morning, go home and get changed. They are the wrong pants for teaching anyway.

2. Give this student smaller chunks of work to do at a time, taking into account that they might not be able to complete what you have planned for the whole class, and they will have added distress if they have work incomplete. So you might hand out a worksheet with ten questions and tell this student to complete questions one through three. Then if there is time remaining, you can suggest that they might like to do more, but beware of added stress this might cause. Sometimes it's better to simply rejoice that the smaller task is completed.

3. Give advance warning to this child that a transition time is getting closer. This will give them the opportunity to mentally prepare and manage anxiety. You might need to give them a five minute warning, then three minute and again at one minute.

4. Upon giving them the transition warning, take note of how much work they have left to do. Reduce/modify if it doesn't look like it will be achieved. If adapting expectations on the fly helps your student to complete their work, then you should do so. You are naturally better at adapting than they are, so the onus is on you to make that effort.

The key point here is: make it predictable, achievable and adaptive and the stress levels will fall. 

5. Once the current task is set aside, provide visual aides and/or verbal prompts to assist the student to prepare for the next task.

Patience Please

A deficit in executive functioning can cause some interpersonal communication issues. I regularly hear, "Mum?!" as an introduction to conversation (just like all mothers). I of course answer "Yes". Then there is a looooong pause (several beats) while he tries to organise his thoughts into a coherent sentence or question.

I have to really restrain myself sometimes from jumping in impatiently and telling him to hurry up (which I will admit I sometimes say anyway, I'm human after all!). If I do jump in without thinking, he has to start over and it takes him twice as long to communicate, so effectively I have made the situation more difficult for myself by being impatient.

Once, when he was about nine years old, he approached a teacher by name. She answered him, and then he said, "Uhm..." while he was gathering his thoughts together. She immediately said, "I don't listen to people who say uhm," turned on her heel, and walked off, leaving him confused and sad.

I know, I know - you're incensed to read that story (and if you're not, please read it again). Let me tell you, it certainly fires me up to share it. I can't bear the way adults so often disrespect children.

But do you know what? Instead of getting all enraged, I like to wonder to myself what wonderful warm little moment that mean-spirited woman cheated herself out of that day, all because she couldn't wait a few measly seconds.

Common reasons kids avoid getting started

There are lots of reasons why students (not just people with Autism/Asperger's) have trouble getting started. Below are a few clues.

Please note: these are not ALL the possible reasons for someone having difficulty getting started, and any assumptions based on the following could turn out to be incorrect for the individual student you're dealing with. It is absolutely vital that we parents and teachers be respectful enough to ask them. You never know, that one simple question might save months or even years of angst.

Fear of failure - We all hate feeling like a failure. Young people/adults/children refuse to partake of activities often because they are afraid to be laughed at, or even simply afraid of finding out they aren't very good at something.

Fear of success - my son once told me that he didn't want to excel at school, because that would set up an expectation of success level from the adults at school - an expectation he didn't feel he could consistently work to. Sometimes people are also afraid of success because they don't have a concept of what that successful experience could look/feel like. The unknown terrifies them and thus holds them back.

It's all too much Type 1 - the student could be in overwhelm for any number of reasons. Try to learn what this looks like and be alert to when it might be happening. Work out a management strategy with your student, such as giving them a ten minute break from the noisy classroom so that they can re-group. Wherever possible, try to incorporate strategies like this as preventative steps rather than reactive solutions. This gives the child some control over their own behaviour management as well.

It's all too much Type 2 - sometimes the task is just too complicated or detailed for your student. Or there could be too many steps involved. Quite often students on the spectrum will have fine motor delay, which will mean they are slower to get work done. If the task seems too big or time-consuming, they will avoid it. In this case it's a good idea to cut the task down into smaller chunks (you teachers know that word "chunking"!), and give your Aspie student a reduced list of steps to achieve. How much you cut this down will depend on your student, but a good rule of thumb is to take the chunking you think is age appropriate and double the number of chunks (i.e.: create smaller bites to chew). You might even need to give them one small step at a time, as the awareness of the second step could be enough of a distraction to prevent commencement. NB: I have had a teacher say that they don't like this idea, as it felt like he was treating the student as someone much younger, and he didn't think that was okay. But please remember, it's never condescending to give your student what they need in order to learn. You're doing them a favour by adapting to their needs instead of forcing them into your worldview, and they don't know (or care) what level of chunking is age-appropriate, so it's really (honestly) a good thing for you to do it. Very small chunks could mean that your student finally experiences success. Isn't it exciting to think you could be the catalyst for that experience?

It's all too much Type 3 - Your student might have poor executive functioning (ability to plan and organise their work/thoughts/body). Around age 7, my son found this so difficult that when he was asked to sit and write something, he would sit with a piece of paper in front of him, behaving perfectly, but he would write nothing. As it turned out, the reason he had not begun was because it had not occurred to him to bring a pencil to the table, and he couldn't figure out what was missing when it came time to get started. This is a very intelligent child who simply could not work out what to do, because he couldn't think that many steps ahead. So you might find that with your student, you will have to do a lot of organising for them. Your objective is to build independence though, so try to give them systems to follow, rather than hand-holding through every step (although you will have to be diligent and patient as they build the neural pathways to be able to do this for themselves). A simple idea might be to have checklists stuck to their desk (such as 'What equipment do I need?'), so that they can work through a list of what to do next for fundamental tasks like preparing to write. But remember to be patient. It will take a long time and a lot of support for this skill to find its place.

Didn't catch all the instructions - a student with attention difficulties (this is also a common side effect of sensory overwhelm), might only hear part of the instructions. This student will frequently be unwilling to ask you to tell them again, because they have often found themselves being disciplined for not listening properly. Often instructions called out from the front of the classroom don't work for the student with Autism, because all that student hears is "yelling". After instructing your class, approach this student and (rather than repeating everything you just said), ask her to tell you in her own words what she needs to get done. This will give you some awareness of what she has understood, and an opportunity to clear up any miscommunications. It is also helpful to list instructions on the board as a ready reference, as your student might not be able to retain more than one step at a time.

Perfectionism - we see perfectionism in young children all the time, and it's a tough one to break, but it's vital that we do, because the anxiety related to this can completely prevent commencement and cause much bigger problems down the track. This is fear of failure at its worst. I recommend having a Mistakes Are Good Because We Learn From Them whole classroom culture. Also, many teachers make kids earn a pen licence (they must be able to write to a certain quality before they are allowed to use a pen for their classwork). I recommend doing the complete opposite, because kids can't erase pen mistakes, so they can get used to seeing that they aren't the only ones who have errors in their work. Another positive side-effect is that teachers can see what errors individual students are making, discover gaps in learning and plan future classes accordingly. Also, the child with fine-motor delay is rarely if ever going to meet the standard and thus earn the pen licence. Do you really want them to feel so bad by pointing out that they can never, ever measure up to their peers?

Sensory reasons - sometimes you will have a student on the spectrum who will refuse to start an activity or join in, but there doesn't appear to be any rational reason for this decision, and they aren't telling you what's wrong. Look for reasons such as those outlined above, but also be sure to ask a clear question such as, "Is there something specific about this activity which is preventing you from joining in?" My son has an irrational fear of styrofoam (related to the squeaky noise it makes). As articulate and verbal as he is, when faced with the prospect of an activity involving styrofoam, he will completely shut down and refuse to even enter the room, quickly losing the capacity to explain what is wrong, without adult intervention and assistance. If the issue is a fear like this, there is no reason worth forcing them to face the fear in front of their peers. Let it go, find another activity for this student, or change what you are doing in the classroom so as to include them.

And don't forget - it's imperative that we ask the direct questions, or we'll never really be sure we have the correct answers.