Kids with ADHD have "gifts" -- and by helping them develop these gifts, parents give their children more control of problem behaviors, a child psychologist argues in her popular book.
In The Gift of ADHD, child psychologist Lara Honos-Webb, PhD, tells parents not to focus on the disturbing words "deficit" and "disorder" in their children's ADHD diagnosis.
"I tell parents it is a brain difference, not a brain disorder," Honos-Webb says. "Children's sense of identity is not yet formed at the time of ADHD diagnosis. Reframing the disorder as a gift helps them define themselves by what is working, not by what isn't working."
What isn't working for ADHD kids usually becomes apparent in school. Kids with ADHD have trouble sitting still. They have trouble focusing their attention on a single task. They're given to outbursts of emotion.
Despite their challenges, Honos-Webb says, these children tend to be gifted in specific areas: creativity, exuberance, emotional expressiveness, interpersonal intuition, a special relationship with nature, and leadership.
It's more than just a way of looking at ADHD, she says. It's a treatment strategy that motivates ADHD kids and improves their self-esteem.
"Just by finding and focusing on gifts, people change in positive, noticeable ways," Honos-Webb says. "You build on strengths and motivation; you give them the confidence to try harder. And the more they try, the more they can change their brains."
Gifted or Not, Children With ADHD Suffer
Is ADHD a gift? Emory University psychologist Ann Abramowitz, PhD, doesn't see it that way. Abramowitz, an ADHD and special education expert, directed Emory's Center for Learning and Attention Deficit Disorders from 1989 to 2001.
"ADHD is not a gift," she says. "If a child has ADHD symptoms but is not impaired, we don't diagnose ADHD. So by definition, there is suffering going on."
Abramowitz and Honos-Webb agree that ADHD too often is carelessly diagnosed, often by a child's primary care provider under pressure from frustrated teachers and distraught parents. Since there's no definitive test for ADHD, proper evaluation takes time, expertise, and judgment to rule out other factors that might affect a child's behavior, such as a disruptive family situation or an unmet medical need.
Abramowitz doesn't agree that ADHD kids are specially gifted, or that being told they have ADHD necessarily harms their self-esteem. But she does agree that it's important to build on whatever special strengths a child with ADHD may have.
That approach makes sense to Elza Vasconcellos, MD, a pediatric neurologist at Miami Children's Hospital. Vasconcellos treats children with ADHD -- and is the mother of a child who has ADHD.
"ADHD kids have a lot of gifts and a lot of good things about them," she says. "Many are very artistic with music, with art. They are talkative, able to multitask, and social. When I talk to parents, I try to encourage those gifts."
On the other hand, Vasconcellos says, ADHD often makes it hard for children to use their gifts.
"With drawing, for example, some of these children cannot even focus long enough to draw a straight line," she says. "And while they may tend to be more social, some are so impulsive other kids have trouble being around them."
Gifted ADHD Children Less Impaired?
There's a lot to like about the Honos-Webb approach, says behavioral-developmental pediatrician Lawrence Diller, MD, author of Remembering Ritalin.
Like Honos-Webb, Diller sees ADHD "more as personality- and temperament-based rather than a mental disorder or a chemical imbalance."
"Impulsivity can be seen as spontaneity, and hyperactivity could be vitality -- but. There is a big 'but,'" he says. "The 'but' is that her work applies only to children with mild qualities of hyperactivity and impulsivity. Once you go beyond the mild, ADHD is the flip side of something positive. The children's struggles with family, schools, and peers diminish the positiveness of it."
Honos-Webb doesn't make this distinction. Her view is that ADHD is not something a child has, but a set of behaviors a child does. By working to understand why their child behaves in those ways, she feels parents can find ways to motivate the child to change those behaviors.
"Many parents actually buy into the idea their child cannot succeed, and many more are fearful their children will fail," she says. "If they find a child's gifts, it is like a jet stream. They get to where they want to go with less pushing."
ADHD Gifts, ADHD Meds
Reading The Gift of ADHD, you may get the idea Honos-Webb is against giving ADHD children Ritalin or other medications. Vasconcellos, for example, got that impression from looking over Honos-Webb's web site.
It's true that Honos-Webb does not see medication as a first-line treatment.
"The first thing I recommend is a child and family get 12 sessions of psychotherapy first before they even get evaluation for diagnosis, and certainly before trying medication," Honos-Webb says.
Though other experts aren't likely to insist on so many sessions before trying medication, Honos-Webb agrees that ADHD drugs help many children respond to behavioral therapies.
"Of course you need to consider medications if a child is about to fail to meet a major developmental milestone, or faces getting kicked out of school or being totally socially ostracized because they can't manage themselves," she says.
Abramowitz says after she diagnoses a child with ADHD, she is sure to bring up the topic of medication in her first feedback session with parents.
"There are many times when I recommend medications," she says. "If the parent is comfortable with the idea, I say, 'Let's do a trial.' And then we talk about what makes a trial good instead of sloppy, and I tell them what I hope their physician will do."
When parents don't want their child to take ADHD medications, Abramowitz supports the decision -- up to a point.
"If they want to try interventions without medications, I say fine. But I want them to know that studies clearly show the thing most likely to impact ADHD is medication," she says.
Whether or not a child needs ADHD drugs -- indeed, whether or not a child has ADHD -- Honos-Webb says her approach is good for mental health.
"The question parents should ask is, 'What is right with my child?'" she says. "I recommend that everyone ask, 'What is right with me?'"
Daniel J. DeNoon - WebMD
