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Categories: 2012, February

Responding with Compassion

You can learn to pause and find your most skillful reaction when challenged by raising a child with ADHD or dealing with your own executive function deficits

by Mark Bertin, MD



“I was putting so much pressure on myself, and my son Stephan. He has ADHD. We’ve tried so many different things to get him to listen. And we go to my mother-in-law’s, and there’s this look she gives me. It’s like, without saying a word, she’s staring me down. I know what she’s thinking—honey, do something and get your monster under control. Or it might be in a restaurant, not that we really go anymore. Everyone is watching, and I get so angry at myself for even trying to go out for a meal. And I’m angry at Stephan. I’m doing everything I can, don’t they all realize?”

* * *

The list of biologically driven, ADHD-related behaviors parents blame themselves for is long. Something happens—a shove on the playground, or a social rejection—and a visceral reaction starts. I should have known this was going to happen, why didn’t I do something? It’s often amplified when parents do not fully comprehend or believe the biology of ADHD. Or maybe they do, but their spouse doesn’t. If you cannot see ADHD as a medical condition, it’s easy to assume the persistent behavior is somebody’s fault.

My kid does not get invited to parties anymore. They don’t seem to have any close friends. My spouse feels I should be doing something different with the children. My parents think I should be stricter. My friends think I should be more lenient. Their teacher thinks I am too indulgent. Their other teacher feels I should motivate them. For each of these ADHD-driven thoughts, a twinge or a deluge of self-doubt may follow. Am I doing the right thing?

You’re trying to make a change, and there may be a practical step to take. But the hectoring, often abusive voice of judgment may linger. You’re not good enough, you have to work harder, if only you were a better parent. If only I was a better person or you were or he was, then everything would be different. Or you think about your family. If you were a more motivated child, or if you were the kind of dad who spends more time with his kids.

We are frequently led to assume that we find happiness only when we get our act together, reach some state of perfection and answer the voices. Instead, we can notice those voices for what they are, a combination of what we actually hear from the world and our own inner commentaries. And then instead of taking it all at face value, we can train ourselves toward a more compassionate, insightful way of living.

* * *

When we are driven by an endless sense of letting ourselves down, or letting down our families, our boss, or whomever else, we exhaust our mental resources and make unskilled decisions. When we begin to notice the voice of judgment, we can begin to let it go. Thanks for the feedback, I’ll take it under consideration, I did everything I could.

A subtle (or less-than-subtle) inner message criticizes every move, never satisfied. I messed up again, I should have done that better. I’ll never get it right. Or it constantly compares everything to what it “should” be. Do I have the job I should, the house I should, the kids I should, or even the spouse I should?

Perhaps one day you’re hanging out on a blanket at a picnic, and someone playing Frisbee accidently steps in your food. Looking up, you see one of your closest friends—and you smile and shrug it off. But if you look up and see someone you don’t like, or don’t trust at all, what then? It’s the same accident, but instead you become annoyed.

Typically, we don’t treat ourselves like we treat our friends. You’re playing Frisbee and accidently step in your boss’s food. Immediately, you are flooded with a pile of thoughts, feelings, body sensations. Maybe your stomach flips, your palms sweat. You might have reflexive thoughts about yourself. How careless. Fool. Why weren’t you more careful? All without nearly the patience or grace you would have had for your closest friend, a moment ago. Driven by these unconscious, negative judgments, where does your behavior go? What might you say or do? How clear would you be in your next choices?

Aware of their influence, you might notice when they arise—and choose not to listen. By cultivating for yourself the attitude you’d have toward a close friend, and by giving yourself a break, you may discover something new. I messed up, and I’m sorry. What is my next step?

The section above is excerpted from The Family ADHD Solution by Mark Bertin, MD. Copyright © 2011 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.

You’re on an airplane and your eight-year-old son throws an epic tantrum, legs flailing and ear splitting screams. He doesn’t want any of the meal choices available, only grilled cheese, which is not on the menu at thirty thousand feet. A situation difficult enough to manage on its own… and then your own mental habits add fuel to the fire. You may imagine the entire plane staring you down, be ashamed you’re causing a scene, or simply denigrate yourself for not knowing how to solve a situation that doesn’t in fact have a perfect answer.

None of us are at our best when overly influenced by these voices of judgment and inadequacy. So instead, in the midst of the mental conflagration you can pause and aim to give yourself a break. Take a few breaths while privately acknowledging that you’re striving to stay calm and to find an answer, whatever it may look like from the outside. What would you advise your best friend dealing with the same situation?

Or maybe you’re an adult with ADHD. You’re rushing to pick up your child from an after-school program. Late once again, you’re anticipating polite condescension from the staff waiting for you to arrive. Or perhaps you’re picturing your spouse’s anger or your child sitting on the bench outside alone and resigned, waiting for you. Maybe there’s a bill you suddenly realize required payment last week, or a project not quite on time when you told your boss you wouldn’t run behind again. Subtly or not so subtly, the internal dialogue begins—you should know better, you blew it again.

Left unattended the feelings perpetuate themselves, reactions like self-blame, shutting down, or lashing out, and they limit the possibility of change. You’re not intentionally doing anything wrong. You have ADHD and on a neurological level it is difficult to manage time and to keep organized. You’ve been working on your own and maybe with a therapist or an ADHD coach. Perhaps you and your significant other have started to discuss better communication or household logistics. Maybe none of that has happened but you’re moving internally, mustering your resolve. You’re doing your best and not even vaguely giving yourself the type of pep talk you would give your closest friend. That sounds like an awful experience, you’ve already accomplished so much, look how far you’ve come. You’ll do better next time.

And what about those other voices lambasting you for your supposed failings? If someone else was whispering in your ear, providing an ongoing critique of your life, how would you handle that? You’d likely turn away, dismiss the person as unhelpful, and move on. You can practice the same in life: Observing those inner patterns, recognizing them. The thoughts may not go away, but you train yourself to pay them far less attention—to notice them and walk away.

Maybe none of those situations apply, and you’re a school administrator at a table across from two scared and angry parents. You’ve lost six staff members and twenty percent of your special education budget to cuts. You’ve spent your entire career trying your best to help and something isn’t working for their child. You have the same immediate goal as these parents, even though you don’t agree with everything they say. And, in fact, your own child is failing algebra or you have a sick relative or maybe you just didn’t sleep at all the night before and aren’t feeling as sharp as usual.

Whether you’re the parent, the administrator, or an adult with ADHD, being compassionate doesn’t mean becoming a doormat for the world. You can entirely disagree with someone’s actions and still recognize their basic humanity—and then choose to firmly take a stand for yourself. Similarly, giving yourself the benefit of the doubt doesn’t require letting go of reality or pretending it is okay that you left your child waiting.

The practice of compassion often breaks entrenched patterns in our lives, ones that fuel negative self-talk and reactivity, anger and anxiety, and all the rest. Routines that seem fixed and unchangeable, ways that we relate to ourselves, to our children and to the world, are more malleable than they usually appear. While always aiming to make changes that take care of ourselves and our families we can remember that everyone is struggling in some way.

Muddied by an impending sense that we’re about to fail, losing track of the fact that we’re all simply trying our best, we limit ourselves, our children, and anyone else we encounter. By pausing and choosing a broader point of view, we start entirely new habits. We increase the odds of finding not only compassion and happiness, but also far more skillful solutions to the problems we face day-to-day.

Responding with compassion

Much as we do with ourselves, we can love our children unconditionally and not be fully empathetic of their challenges. Without liking the fact that they have ADHD, without giving up on a desire for change, compassion implies unguarded empathy that recognizes the entire experience of a struggling child. Our own fear, frustration, embarrassment, and countless other emotions cloud our perspective. We love our children but really, really wish they could just get it together.

Our interactions may be clouded by another voice of judgment. We may not quite fully accept that beneath the surface of academic struggle or misbehavior is a child trying his or her best to succeed. The child would just as soon have an easy time of it, but is getting in his or her own way because of poor executive function—the child’s brain isn’t allowing the child to behave his or her best. An overall sense that the child “should” act differently or behave “better” impacts our communication and the decisions we make about everything, from how to manage an argument to treatment options.

ADHD is a deficit in certain cognitive skills, not a character flaw. We can empathize with a child’s inner struggle without giving up on teaching skills, trying to modify behavior, and expecting long-term progress. We can acknowledge our own challenges as parents, and feel sadness, frustration, anxiety or anything else without reflecting back the intensity of these emotions onto our children.

Never losing sight of our long-term goals, all we can do is offer skillful support, day after day, without blaming anyone for what is nothing more or less than a chronic medical condition. A focus on compassion may intuitively lead to more emphasis on praise and reward, both vital for children with ADHD. Fully taking a child’s perspective equally recognizes the value of setting limits and consistent discipline, approaching rules and boundaries with a clear understanding that they support healthy development. It also means accepting our children as they are—with plenty of strengths and flaws like everyone else—and then doing everything we can so that tomorrow, or in a year, or a decade from now they have what they need to thrive on their own.

Compassion often influences decision making. Children with ADHD have a developmental delay in executive function as concrete as a language disorder or a physical disability. Yet somehow there is often an assumption that ADHD is more ephemeral, that a child could choose to be different through effort alone. Empathizing with ADHD, even when it may not fit our picture of how family life “should” be, we may decide to change how we run a household, how we emphasize consistency in schedules, or how we respond when angry. Compulsively upholding routines or pausing before responding quietly when upset may not be our natural style, yet we recognize the needs of our children and modify our own behavior.

In any moment, we can attempt to put ourselves in the shoes of our children. In spite of intensive support at home and school, or maybe a plan involving behavioral therapy and various complementary interventions, a child continues to act out. But think: What is it like to fight your own biochemical tendencies, moment to moment? Would we ever say to a child with asthma, “Now go to school and pull yourself together, stop wheezing already!” Perhaps balancing a universal desire to avoid unneeded medications against the bare facts: What are the actual potential side effects and benefits, as opposed to fears or misconceptions? Not prejudging the situation, not advocating for or against any particular choice, but taking into account the perspective of a struggling, individual child.

So, your child, having been asked eight times to play Frisbee on the other side of the yard, steps on your picnic lunch. Pausing to respond instead of lashing out, what is your most skillful reaction? Your frustration, anger, and uncertainty about what the guests will have left to eat are all real. But from there, which perspective do you take? Do you lash out reactively, or impose layers of blame on an already difficult situation? Or, instead, do you respond with the compassion you’d show your closest friend?

Mark Bertin, MD, is a pioneering developmental pediatrician in private practice in Pleasantville, New York and assistant professor of pediatrics at New York Medical College. He trains physicians, teachers, and psychologists in ADHD care and leads stress-reduction classes for parents. From 2003 to 2010, he was director of developmental pediatrics at the Westchester Institute for Human Development.

This article originally appeared in the February 2012 issue of Attention magazine. Copyright © 2012 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights reserved. No portion of this article may be reproduced without written permission from CHADD.