CHAPTER 1

When Medication Isn’t the Answer or Isn’t Enough

This book was written to give valuable information to parents, teachers, and counselors. But, first and foremost, it is an activity book written for you, the “helper,” to use with kids from ages nine to thirteen. The activities are designed to “exercise” their frontal lobes and reduce behavior problems associated with Attention Deficit/ Hyperactivity Disorder (ADHD) and other frontal lobe deficits. ADD/ ADHD Drug Free shows you how to impart important skills to kids who need to deal with troubling behavioral and cognitive traits that are most likely biological in nature.

Let’s get the elephant out of the room right from the get-go, and begin by telling you what we’re not and what this book is not. We are not scientists, and this is not a scientific book. That’s not to say that we haven’t studied some of the most recent and most fascinating books and research articles about the brain and how it functions. We have studied those books, particularly the ones about the area of our brain called the frontal lobes and about what problems can occur when this part of our brain isn’t working up to its potential (more about the frontal lobes later). In fact, you can find references to these works throughout the text, and the titles of these books and articles in the references at the back of this book. These works contain amazing cutting-edge stuff written by people such as Elkhonon Goldberg, Joseph LeDoux, Bruce Perry, Daniel Amen, and Russell Barkley. Now, these folks are scientists! Their books make for fascinating reading for those interested in the science, and we highly recommend them. But we’re not experts on the brain or, for that matter, on the neurobiology of ADHD (we’ll compare and contrast the types of ADHD in a later chapter). To limit redundancy for now, please note that when we write ADHD, we are referring to all types, whether the problem is primarily inattention, hyperactivity, or both.

As such, we have no double-blind studies with which to convince you of our ideas, but we make no apologies. Science, after all, is very concrete and therefore can sometimes be limiting. If you’re looking for “ev-idenced-based” books on treating the symptoms of ADHD, you’re likely to find some, but they will probably be difficult to read and understand. And it’s very unlikely that you will find any activity book at all. A practical, enjoyable, hands-on, and effective workbook for kids is long overdue. We are pleased to deliver such a book to you here.

Having gotten that out of the way, we want you to know we’re very excited to have this chance to tell you what’s worked for the kids we have met—and why. But first, let us tell you what we are and a bit more about the book. We are a Mental Health Clinician (Frank) and a Special Educator (Lynn Ann) with more than 40 years combined experience on the front lines in classrooms and counseling offices, providing direct services to kids with frontal lobe problems. Individually, and together, we have treated and taught hundreds of kids who’ve been pinned with a variety of unflattering labels, such as lazy, angry, crazy, difficult, uncooperative, “bouncing off the walls,” or just plain “slow.” Over the course of treating all those kids for all those years, we began to notice a few things, and we began to try a few new ideas to address those things we noticed. And what happened was amazing. This book is about sharing our ideas with you: the parents, counselors, and teachers of kids with ADHD and other frontal lobe problems.

But let’s back up for a minute. We’ve known for a long time that kids don’t all learn the same way. The funny thing is, despite the truth of it, we (meaning most all well-meaning adults) insist on teaching kids in the same way. We insist on talking at them and putting things in front of them to read. This method of teaching may have some real benefit for kids who are good at processing language, but what about the kids who aren’t? These are often the kids who won’t pay attention, don’t follow our rules, may be “bouncing off the walls,” or just plain don’t get it! What about these kids with less than perfect frontal lobe function? Well, we can tell you that these kids most definitely do not learn best through language (the learning style referred to as verbal-linguistic) (Armstrong, 1993). When it comes to “teaching” kids about behaving, dealing with anger, managing emotions (however we want to refer to it), we mostly tell them how to behave, what not to do, and, our personal least-favorite, what to feel.

Well, one of the first things to dawn on Frank (and we’re going back more years than he wishes to count) was that some of the kids he saw in counseling made progress at a snail’s pace, while others seemed to blossom before his eyes. Most, particularly those with trouble learning in school, getting along, managing their anger, and completing tasks, didn’t seem to take away much from the counseling session. Frank would sometimes watch the child leave his office, feeling a little discouraged in his work. Thank goodness for those others, the one’s who were “smart” enough to listen attentively to his eloquence and even feed something back to him from the previous session, perhaps about some coping skill that he had recommended. After being told that it had worked like a charm, he could sit back self-assuredly and revel in the fact that he still “had it!” But deep down, Frank didn’t believe that it was about “smarts.” And, furthermore, a technique that he considered right on the money (for example, one where the child was asked to look at a page of faces and discuss with him how that person might be feeling) might work great with one kid who was having trouble anticipating the actions of others, but the same intervention with another kid with the same problem might result in the kid looking at Frank as if to say, “you want me to do what, and what was the name of that planet you’re from again?”

What was going on here? After all, didn’t Frank offer his highly skilled clinical ear and life-altering insights to all these kids the same way? It was past time for an ego check. How self-absorbed could he have been? Could it be that Frank had been imparting knowledge, providing choices, and offering support in the manner in which he was most comfortable, without any consideration for how his clients might learn best? Were the kids who were progressing in counseling doing so because they happened to be strong verbal-linguistic learners like he was? Had Frank neglected to pay attention to how the majority of these troubled kids learn best? Had he neglected the kids who learned best hands-on (bod-ily-kinesthetic learners)? And the ones who loved to solve puzzles and try experiments (logical-mathematical learners)? There are seven learning styles in all (Gardner, 1983; Armstrong, 1993).

Ouch!

It was about that time that Frank met his coauthor, L.A. Watson, a highly skilled, thoroughly experienced Special Educator and about the most creative, solution-focused individual Frank had ever met. Many, many conversations followed. Frank learned that individual learning styles had been getting attention for several years (Gardner, 1983; Armstrong, 1993; Lazear, 1994) in the field of Special Education and that the more progressive programs were applying this information to “Special Education kids” with learning and behavior problems. Lynn Ann understood early in life (herself a strong visual-spatial learner) how a student could become distracted from the words of a high-school French teacher because of the teacher’s unusual mannerisms and style of dress. Some 30 years later, Lynn can recall almost no conversational French, but she will forever remember (and be capable of drawing) a striking caricature of her eccentric French teacher, including high-heeled shoes, vibrant tight-fitted dresses, red nails, and lipstick.

So, how widely was this information about learning styles being applied to kids with behavior problems? How many special educators were applying it, let alone regular classroom teachers? What about counselors and other mental health professionals? And, maybe the most important question of all, were parents paying attention to how their kids learned best? Was anyone communicating the importance of learning styles to parents?

Where was the workbook for ADHD kids and other kids with frontal lobe deficits so they could learn about feelings, getting along with others, and dealing with anger? We couldn’t find it, and so we came up with one, an evolved form of which you are now reading. The coup de grace occurred when our completed, but yet unpublished, workbook came to the attention of best-selling author, Dr. Jay Carter. Dr. Jay confirmed the need for such a book and the absence of anything like it. We are indebted to Dr. Jay for his tweaking of our thinking, for his invaluable and insightful contributions to this text and, most importantly, for his sincere belief that this workbook will make a real difference in the lives of kids.

Why Yet Another Book About ADHD?

The “brain exercises” (found in Appendix II) are a compilation of all the structured intervention the authors have used with kids over the years. Some worked, and others did not. We believe the ones that worked did so for two important reasons. The first reason, we just discussed: The interventions were presented in the learning style best suited to the particular child. Drawing from the previously mentioned example, the visual-spatial learner could look at the page of faces, engage in a productive discussion about body language, and then anticipate the actions of others.

The second reason is that the interventions in these exercises served to jump-start a part of our kids’ brains recognized as being the brain’s orchestra leader, battlefield general, or air-traffic controller. The frontal lobes (Figure 1-1) allow us to anticipate the consequences of our actions, anticipate the actions of others, manage our impulses, and see ourselves “situationally.”

Situational awareness allows you, the reader, at this very moment, to be aware of where you are and what is going on around you while you read this page. You are aware that you are reading this page. You are most likely aware of about how much time you have to devote to reading this book today, and when you must put it down so as to meet other demands in your schedule. And you are most likely aware of the potential consequences of not meeting those demands. Who will be affected? Who might be disappointed? What might happen to the security of your job, or the welfare of your family? You are aware. As a matter of fact, you are aware that you are aware. If this sounds like you, then congratulations! Seems as though your frontal lobes are purring like kittens.

Now imagine having a brain with dysfunctional frontal lobes. Imagine being a child with little or no situational awareness. If Billy were giving you a hard time in class, why think twice about reaching across the aisle and giving him a good smack? Would it occur to you ahead of time that the teacher will not only notice, but will also send a note home to his parents for the third time this week? Would you think twice about the undeniable fact that Billy is 20 pounds heavier than you, and he’s known for handing out black eyes? Not without situational awareness you wouldn’t. Sound like anyone you know? We’re betting the answer is yes, otherwise you’d likely be reading the new Grisham book right now instead.

Figure 1-1. Lobes of the brain

We believe that the frontal lobes can become fit, or at least fitter, through “brain exercise” in much the same way pumping iron builds the muscles of the body. The neurobiologists study the brain’s limited ability to regenerate, build new connections, and adapt, and call it “brain plasticity,” “vascularization,” and “synaptogenesis” (Amen, 2002; Ledoux, 2002; Gold, Reeves, Graziano, and Gross, 1999; Hamm, Temple, O’Dell, Pike, and Lyeth, 1996). We are practitioners, not neuroscientists, and we don’t claim expertise in the intricacies of the latest neurological research. We believe it, just because it makes sense on a practical level. That is what we have discovered in our work, and that’s what this workbook is about.

The brain exercises in this book are specific to kids with behavior problems related to ADHD, and they are organized according to learning style. But don’t rely solely on these brain exercises for teaching the kids you’re helping to exercise their brains. You will likely find it necessary to drag these kids over to their frontal lobes so often that their brains will hurt! (We included that last idea in our first draft of this book and when our agent read it, she immediately phoned us and said to us, “I’m not sure you want to say that their kids’ brains will hurt. They might think this book is going to cause a stroke or an aneurysm or something.” Well, if you’re reading this now, then it means our agent decided to let us leave it in. And if she did, it’s a fair bet that the following explanation was enough to satisfy her.)

Can you remember ever taking a college class in statistics? How about learning the computer before the days of Windows? How about taking a foreign language class during the summer session, the one where you get immersed in the language for three hours a day, four days a week? Did your brain hurt? Probably! You were asking things of your frontal lobes that they were just not used to giving. And we’re betting that at some point during that adventure, you weren’t sure your brain could rise to the occasion. Well that’s the kind of hurt your kids are likely to experience as you ask them to repeatedly exercise their frontal lobes. Exercise hurts ... but in a good way. And the exercises, unlike learning statistics, are fun! And it’s a good thing.

If the exercises weren’t fun for kids with ADHD, their attempts to concentrate on the exercise would actually cause the frontal lobes to under-perform (Amen, 2001). Surely, you’ve observed your ADHD kids become less attentive and more distractible when asked to concentrate on any task they don’t happen to find particularly interesting or novel. The same is true if they are feeling pressured to perform a task. It’s important, therefore, that your attitude in working with them on the exercises is patient, supportive, and rewarding (more on this in a later chapter).

Games, such as checkers, chess, and battleship, are excellent ways to supplement this workbook by dragging kids to their frontal lobes, as are some of the old-standard computer games, such as Oregon Trail and Mine Field. Martial arts, taught by a good instructor, is another wonderful way for kids with frontal lobe problems to learn to anticipate the actions of others, to learn cause and effect, and to think situationally (all frontal lobe functions). “Brain Age,” a videogame developed by Japanese neuroscientist Dr. Ryuta Kawashima, may prove to be on the cutting edge of game technology that can improve frontal lobe function in kids.

Now a word about the title of this book: Why did we decide to call it ADD/ADHD Drug Free? Because we have something we believe is important to offer, and we wanted your attention. Let’s clear the air once again. We have seen hundreds of kids “saved” by medications, such as Ritalin, Cylert, Adderall, and Strattera, prescribed by competent physicians in the treatment of ADHD. We’ve also seen hundreds of kids go without medication and continue to struggle because their parents declined the physicians’ advice. Another large group of kids began medications and stopped because of intolerable side effects. Still another significant number continued taking their medication with little or no positive reduction in symptoms. Within this last group, most were receiving counseling as well. A few were even receiving individual and family counseling, and Special Education services. Why, then, were these kids’ lives not significantly improved? Well, we’ll leave the neurobiology to the scientists, but we know a thing or two about learning styles, and we know about exercising the frontal lobes. We know what’s worked.

So, if you think we’re suggesting that medication for ADHD is never a good thing, then we’ve not made this introduction clear (in which case, it may be that our own frontal lobes are due for a tune up). If we’ve conveyed to you that our work has taught us that the frontal lobes in ADHD kids can be exercised to improve behavior and make for happier kids and that often medication is beneficial and sometimes it isn’t, and if we’ve conveyed that in all cases there needs to be a plan for the child that includes exercising the brain’s air-traffic controller, then our introduction is a success, and apparently these old frontal lobes still have what it takes!

Finally, we realize that not everyone will have the time or the inclination to read the entire book. Perhaps you’re not interested in what the experts have to say about the brain or ADHD, or how the two are related. Perhaps you would just as soon skip ahead to the activities in Appendix II and start using them with your kids. If this sounds like you, we suggest you have a look at the table of contents and scan the chapter titles for the ones that interest you most. If you elect to get right to the activities, we strongly encourage you to at least have a look at Chapter 8 beforehand. Chapter 8 is a short and to-the-point description of how to make the most of the activities with your kids.

For the rest of you, let’s talk kids in Chapter 2.