AD/HD and Personality
by Harold S. Koplewicz, M.D
entnommen aus: ATTENTION
Zeitschrift des amerikanischen Verbandes C.H.A.D.D.
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Several years ago I was part of a group of psychiatrists and other clinicians who studied the effects of psychostimulants on preschoolers with AD/HD. I'll never
forget the day that Christopher, three-years-old, came in with his mother to be tested. Lirtle Christopher had one of the most severe cases of AD/HD most of us had ever encountered. He nearly tore up my
office that first day I met him, climbing on the furniture, scribbling on the tables, and tossing books and papers around the room. I ended up having to hold him in my lap... in order to interview him... Not
surprisingly, Christopher had long since been blacklisted by everv baby-sitter in his neighborhood. My diagnosis was AD/HD....
Christopher was by far the most impulsive, inattentive child who took part in
our study. During the ten minutes of free play the boy played wirh sixty-one different toys....In truth, he didn't play with any of therm; he'd just pick a toy up, throw it down, and move on to another.
Christopher's mother tried to get him to settle down, running after him and making a strenuous effort to engage him, hut nothing worked. The video camera caught it all. ...There was complete chaos in the
After the time for free play had elapsed, one of my colleagues went into the playroorn and told the boy and his mother thar it was time for cleanup. That's when Christopher really went ballistic. He
screamed, threw himself down on the ground, and categorially refused to have anything to do with picking up the sixty-one toys... After a minute of the tantrum we asked Christopher's mother to
handle the cleanup on her own.
The structured tasks were a total washout. Christopher would not even sit at the little table, let alone pick out red triangles and blue circles. His mother put him in the
chair, but he kept getting up and running round the room. Mom kept trying - "Christopher! Come on! Let's sit down and play some games!" she cried, over and over again - but nothing worked. The
mother became increasingly frustrated; she knew that Christopher was capable of accomplishing the tasks, but nothing she did could persuade him to sit down and do it. When the ten minutes were up, the little
boy had not completed one task. The mother was exhausted.
Most...a month later Christopher and his mom came back to do the test again, but by this time the boy was taking 40 milligrams a day of a
psychostimulant. Again, the whole thing was captured on videotape. During the free play Christopher chose a Fisher-Price toolbox, and he and his mother sat on the floor playing with it, and only it, for the
full ten minutes... Their conversation was lively and pleasant. Cleanup took only a few seconds; there was just one toy to put away, and Christopher did it as soon as he was asked. Finally, during rhe
structured-tasks portion of the test the youngster sat at the table with his mother and completed thirty-two of the forty assignments...
A few months later I had occasion to show the two videotapes of
Christopher and his mother - Before and After - ro a small group of medical students who were doing a rotation in child psychiatry. We asked the students, who knew nothing at all about the study, what they
thought had happened in the month between sessions. All of the students came to the same conclusion: the mother was taking medication. "In the first tape she's a mess. She's practically
driving the kid crazy, constantly yelling at him and giving hirn a hard time," one med student said. ,,She's so much calrner and quieter on the medication."
It's true: on the second tape the mother is
quieter and calmer thanks to medication, but she's not the one taking it, of course. The rnedication that brought on the changes in the mother's attitude and behavior...is her son's psychostirnulant.
"new" Christopher, the one who pays attention and enjoys laughing and playing and talking to his mother, is so much more pleasant to be with that the mother can't help but be
,"pleasanter" right back. And the cycle continues from there. The mother's yelling and nagging are converted to praise and approval, and the child flourishes. The more his mother likes him, the
more likable he becomes, not just to his mother but to everyone else around him as well. After a time, even the baby-sitters may have a change of heart.
I've described this study at length not to emphasize
the effectiveness of psychostimulants in the treatment of AD/HD...but to open a discussion of how a child's brain disorder affects the way he and the rest of the world interact. Christopher's AD/HD did a lot
more than make him impulsive and inattentive. It made him unpleasant and unlikable, even to the people who love him most. It made people avoid him yeIl at him, and refuse to baby-sit for him. Furthermore,
being constantly criticized and yelled at and infrequently praised probably made Christopher's situation even worse.
One of the things we learned in our study is that the mothers of children with AD/HD
don't praise their children as often as other mothers do, even when the children do something eminently praiseworthy. The rnothers of kids with AD/HD are more attuned to their children's negative behavior
than to their positive behavior; that is not surprising, since there's usually so much more of the negative than the positive.
Although it may not seem so, Christopher is one of the lucky ones. He was only
three-years-old when his brain disorder was discovered and treared. He'd had a couple of years of negativity out there in the world, but it had been largely contained within the family. He hadn't started
school, so he had not had a chance yet to alienate his teachers and annoy his classmates. Wich the help of psychostimulants and his conscientious parents, we hope he never will.
MARIO - A personality is born
Children are born with certain personality traits, which determine...how they will learn, and how they'll interact with others. Even newborn infants have
personalities: intelligence, humor, and all the other elements that make up a personality are largely determined in the womb. But that is by no means the whole story.
A child's personality development is
affected, sometimes verry strongly affected, by the environment in which he grows up. A child who is naturally cheerfull and optimistic will not remain upbeat for long if the world is constantly giving him
downbeat messages. Neglected and abused children find it more than a little difficult to maintain the sunny dispositions they were born with. In the same way, having a brain disorder has crucial and
sometimes long-lasting effects on a child's personality development.
When Mario, an eight-year-old boy, came to see me, I asked him what he thought his problem was. "I'm a bad boy," he answered.
,,What do you mean you're a bad boy?" I asked. "I get into trouble all of the time," he explained. ,,Do you want to get into trouble all the time?" I asked. "I dont know if I want
to, but I do. Im just bad," Mario replied. At the ripe old age of eight, Mario is already convinced that he is a failure. Traveling through life surrounded by people who are forever impatient or enraged
is bound to have an impact on a child's personality
Mario is by no means the only child I've encountered with low self-esteem. I see kids every day who think they're bad or stupid or incompetent, who are.
convinced that they're a thorn in the side of their teachers and a severe disappointment to their parents. ,,My dad thinks I'rn a real screw-up," ten-year-old Ross told me. ,,He's right. I am
always screwing up." lt's easy to understand what has brought Ross to this sad conclusion. His short life has consisted of one negative experience after another. He's know little else....
VINCENT - Teacher’s pest
Another study I was involved in illustrates just how hard it can be for a teacher to deal with a problem child. This time we were interested in finding out
how teachers react to the behavior of their students. Our first challenge was to track down the very best teacher we could find - someone conscientious, caring, patient, creative, and skillful at getting the
best out of children. We ended up in a grammar school in the Bronx with Ms. Leonard, a veteran first-grade teacher evervone said was the best in the business... [Ms. Leonard] agreed to leave her own class
for a day and teach another group of first-graders... We asked her to conduct theclass as she usually did, but with two provisions: she was to ignore any negative behavior on the part of the children and
praise all positive behavior.
Unbeknownst to Ms. Leonard, one of the kids in her temporarv classroom was six-year-old Vincent, who had been diagnosed with AD/HD but had not yet started taking medication
for the disorder. Also in the classroom...was a blind observer - someone who monitors behavior without knowing why. We asked our blind observer to monitor Ms. Leonard's reactions to four children in
class, one of whom was Vincent. Every time any of the four children did or said anything, either positive or negative, the observer was to make a note of the child's behavior and describe the teacher's
reaction to it in one of three ways: ignore, criticize, or praise.
Vincent hit the ground running that morning. Before class had even begun, he pulled the hair of the gil in front of him.... Then he
tripped one of his classmates... When Ms. Leonard gave instructions, he ignored most of them. Ms. Leonard...was flawless in her almost impossible mission. All day long she ignored all the bad things that
Vincent did - shouting out, getting up from his seat, and so on. The behavior of the rest of the dass was fine for the most part, and she praised and thanked each child who did something positive.
the school day was just about over, Ms. Leonard handed out some papers to the first person in each row and asked the children to take one and pass the rest back. For the first time that day, Vincent did as
he was asked, but Ms. Leonard did not praise him for his positive behavior. The blind observer made a note of the action - and the reaction of the teacher....
After class we reviewed the events of the day
with Ms. Leonard and congratulated her for her overall handling of the class and for her patience and restraint in the face of Vincent's impossible behavior. Then we asked her about her slip at the end of
,,At about two o'clock, when you asked the kids to pass the papers back, did you notice that Vincent followed instructions?" the interviewer asked her. ,,Yes, I noticed,"
said Ms. Leonard. ,,Oh, we were thinking you might have missed it," said the interviewer. ,,No, I definitely saw him do it." ,,But you didn't praise the behavior," the interviewer said.
,,Remember? You were supposed to praise the kids whenever they did something positive. ,,Yes, I remember," Ms. Leonard replied. ,,But after the terrible way that child behaved all day long, there was no
way I was going to say anything nice to him!"
My colleagues and I could do a hundred more studies and dozens more tests, but one thing is already crystal clear: brain disorders affect a child's
behavior in many ways, directly and indirectly, and a child's behavior affects the way he is regarded and treated by the outside world.
The longer a child goes without treatment; the more damage
will be done to his self-esteem and his prospects for success.
If Ms. Leonard, superteacher, can't say anything nice to poor little Vincent, nobody can.
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