James 1: ADHD Diagnosis

James 1

Listen or read the following transcript as Ed Welch speaks about an ADHD Diagnosis from James 1

The following unedited transcript is provided by Beluga AI.

I fell into attention deficit disorder in graduate school, actually. I did a major paper on what was then called minimal brain dysfunction. I didn’t know much about it personally or professionally, I hadn’t seen a lot of kids at that point. But since then, I have had some experiences with this particular diagnosis.

It’s not by way of my children. My children are, how can I put this in a way that’s not demeaning, they’re sort of your stereotypic females where they sit still and they can be quiet and they’re not real impulsive most of the time. Actually my experience comes from the classroom.

And eight years ago, I think, it was most obvious to me, I was teaching a course at Westminster Seminary. It was called scientific psychology. I think most people found it pretty boring. And people who are ADD loathe boredom. That is the worst thing that could happen to them.

And there were these two guys in the class and they loathe boredom. I didn’t, actually I didn’t realize I had this experience with ADD students until just this morning. But whenever the classroom got a little bit boring, these impulsive guys, they wouldn’t even raise their hand, they’d just belt something out and it would usually be a joke or something like that or some witty little comment. And they just loathe boredom and so they did everything they could to make the classroom interesting for them.

And as you can guess, they were Ted and Paul Tripp. I’ve since tried to get a hold of their mother, but I’m sure she could have lots of stories. But I don’t know if you could see that in Ted. He needs a certain environment for his ADD to really be appreciated. I’ve known Ted for long enough that I have seen him in those environments.

Since my graduate paper in minimal brain dysfunction, sort of a professional issue at that point. Since then, since the late 70s, this thing has gone crazy. In the last five years, this thing has gone crazy. Just for example, a book in the bestseller list now called Driven to Distraction. Probably a quarter of you have heard of it, some of you have read it, by a fellow named Ed Hollowell. A secular book, very practical book, maybe I’ll mention that a little bit later. Comes out almost immediately, it’s a bestseller.

People are begging for more and more information on this thing called ADD. Estimates go from, the estimates start around a million kids who are taking Ritalin these days in the public school system. That is a lot of kids, a lot of kids. ADD is trying to be an equal opportunity employer these days. It used to be, when I was in graduate school, the mystery was why is this all boys? It’s never girls, it’s always boys. Since that time, the diagnosis has expanded and now females are included as well. That’s broadened the girth of the thing.

I just entered CompuServe last month, the computer thing. I still don’t know what it is, but I know it costs money to get into, that’s about it. You get into CompuServe and you see these windows, and the windows are entertainment and newspapers and magazines and research. Then they have another window, and as far as I can tell, again, I’m a novice with this, but as far as I can tell, it’s the only real interactive bulletin board on a subject matter, and it’s the ADD bulletin board.

I went into the ADD bulletin board and they have two things. They have one area where you can dialogue with other parents who have ADD kids. They have another area where it’s a series of papers. You can download the papers into your computer and get access to them. These papers were pretty basic papers, and it showed how many people had logged in, and you’re talking about 1,000, 2,000 people who have logged in to these papers on CompuServe. It is, this thing has gone crazy.

Just in the last year, I have probably received five or six different calls for professional conferences asking to come. I’ve gone to one of them. It was a complete sellout, it was standing room only. People are begging for information on this thing. An immensely popular subject.

Now, as I try to think why it might be so popular, there are a couple things that come to mind. One is, I think it’s so popular because nobody wants to think of their kid as a bad kid. And ADD has finally been the breath of fresh air to lots of parents. My kid is not a bad kid. All these people who say, why is your kid such a bad kid hitting my kid? It’s not my kid, it’s ADD.

When you read the ADD literature, it seems like every other page is a self-esteem page. One of the most important things about this is this will increase the self-esteem of your child, and it will especially increase the self-esteem of you, the parents of ADD children. So, I think that’s one reason why it’s so popular. It reminds me in some ways of the alcoholism diagnosis. When people were saying it’s a moral problem, it was not too popular to say that you’re struggling with alcohol. But when it finally became popular to talk about this as an illness, it became much more commonplace for people to confess their alcoholism. I think we’re seeing a similar phenomenon with ADD.

So, I think that’s one reason why it’s so popular. People were begging for an explanation for their children to get it out of that category of “I have a bad kid,” and ADD provides that. Obviously, there’s another reason why it’s so popular as well, and that is that there are some very difficult kids out there. You can be a great parent, and one of your children can be similar to mine, where they tend to listen most of the time, they don’t tend to be real impulsive, they’ll hang out at the dinner table until you’re finished dessert, and then you can have another kid, but they seem like they are off the wall, and no matter what you do, it seems like your kid is out of control.

That’s the other reason why this is such a popular diagnosis, because there are parents these days, Christian and non-Christian, who truly do care about their children and how they’re doing. And they’re saying, we do not know what to do with these kids. I have an outline in your folder if you’d want to follow me, I’m going to try to follow it fairly closely.

Before I get into the outline proper, I just want to make a few initial observations about this thing that people are calling ADD. I’ll define it in a moment, but let me just make a few initial observations that I think most everybody would agree with, Christian and non-Christian.

Number one, let’s remember that ADD, like all psychiatric diagnoses, is a description, it’s not an explanation. Let me see if I can give you an illustration of what I mean. Let’s say you’re feeling sick today. I come up and ask you the question, why are you feeling sick? Now there are two different ways you could answer. If you wanted to give me an explanation for why you were sick, you would say, I went to the doctor and I have a virus, and the virus is going to take its course over the next week or so. That would be an explanation. That’s the cause of your sickness.

There’s another way you could answer. Why are you sick? Well, I’m sick because I have a headache, I feel nauseous, my body feels really achy, and I haven’t been able to sleep very well. That’s a description of the sickness. You’re not explaining why you’re sick. It’s simply describing the symptoms of the sickness. You’re being a little bit more specific in saying how you feel. Sick equals a headache, a stomach ache, sort of an achy feeling and a hard time getting to sleep.

Please recognize that when people use the term ADD, they’re not explaining anything. They’re just trying to specify a little bit more of the symptoms. I guess the practical point there is you have to ask the question, okay, why? Why is the kid struggling with these things? Now I think I understand a little bit more of the nuances of the child’s behavior, but why? ADD cannot be the final word. ADD is just sort of highlighting a few different symptoms. I think everybody would agree with that particular observation.

The second observation. The line separating ADD, which I’ll use as shorthand for attention deficit disorder or attention deficit hyperactivity disorder, the line separating ADD and non-ADD is an arbitrary line. Sometimes when you read the literature, there will be a large chapter in a book saying you have to have the diagnosis, and they’ll talk about all these different tests that you can use making sure you go to the physician, on and on and on. They give you the sense that it is a very precise diagnosis. It is not a precise diagnosis.

Perhaps the analogy would be, thinking in an academic realm, the difference between an A and a B. Some teachers, you have to have a 94 or above to get an A. Why? Why do they say a 94 instead of a 90? Well, it’s arbitrary. Other teachers, if you have a 90 and above, will give you an A. Other teachers, if you were awake during most of the classes, they will give you an A. Academically, the line between an A and a B or an A and an F is really an arbitrary line. Somebody made it up at some point, and it’s pretty arbitrary.

Likewise, that is the way it is with ADD. Think of ADD, if you will, as something that exists on a line rather than a point or a distinct circle. The line, I guess on this end of the line, you would have, I don’t know, comatose. Next to that, you would have, you know, you’re awake but you haven’t had coffee yet. Next to that, you would have, I really wish the preacher would keep his sermons to 20 minutes. Okay? I mean, let’s say you’re getting a little bit more distracted, I get a little restless when I get bored, and out farther than that, you have, I don’t know, you have Ted and Paul Strip, you have people who, well, let me give you the first illustration I ever had with an ADD kid. I was probably 12 years old, and some people were coming to my parents’ house. At that time, my parents lived on a very severe hill, a very severe hill. I never saw a person actually ride a one-speed bike up the hill without stopping and taking a break.

There were some missionary friends who were going to be coming to our house, and they had a child. The child was, I guess, around eight or so. They pulled up in a station wagon, and they got out of the car. This eight-year-old got out of the car, and he ran up and down this hill for a good 45 minutes until they finally called him for dinner. It was the most amazing thing I had ever witnessed.

So when I think of the extremes of ADD, he’s the guy I have in my mind. And when he came in the house, everything was very predictable. He was disruptive at dinner, he spilled something at dinner, and you’d think he was a horrible kid, but he wasn’t a malicious kid. Just things were in his way when he was trying to talk with his arms, and then the parents were trying to have a conversation. He would always be interrupting with some story, and he was always loud when he spoke.

As soon as he was done dinner, his parents made sure that he left the table. They weren’t even going to try to have him wait for dessert. They were going to let him run his laps again and have him come back up.

So think of ADD not as a distinct line that separates ADD from not ADD. It’s really a fairly arbitrary distinction between the two. I say that for a couple of reasons. One is I want to debunk sort of the real technical language that surrounds ADD. The second reason is the things that we’ll talk about today are going to be relevant to most of your kids, even if they wouldn’t fall into that technical ADD category.

So I don’t want you to exclude yourself from some of the good practical parental advice that comes from people who have thought long and hard about children who are at this far end of the continuum. The third observation that, again, I think most everybody would agree with, they might couch it a little bit differently, is ADD sits at an intersection of two biblical categories.

The first thing I say is brain-based strengths and weaknesses. Another way you could talk about that would be creaturely limitations. That’s one road. The other road is the orientation of the heart, which you have been studying about the entire day so far.

Let me see if I can explain what I mean by that. By brain-based categories or creaturely limitations, I’m thinking of categories that can change with brain damage. I’m thinking of what we would call abilities or talents. I’m thinking of functions that we would call strong or weak rather than right or wrong.

Explosive anger would be a heart category. It reveals to you the object of your worship. Who is it that you’re worshiping? Doing poorly in an arithmetic exam would probably be more of a creaturely limitation, brain-based, body-oriented category.

Sexual lust would be an issue of the heart. It would expose the orientation of our worship. Are we worshiping the true God or are we worshiping our own desires? A child who has a very difficult time reading up to his grade level, most of us would think of that as being a brain-based creaturely limitation. There’s nothing wrong with not reading up to grade level. We would call that perhaps a weakness.

The task of the parent, of the teacher, of the counselor is going to be a student with both of those. You forsake either one and you are in trouble. If you purely think in terms of creaturely limitations, these are brain-based problems that the child has, then you never give the child the privilege of being able to repent, of seeing the things that motivate them in their own heart. You never give them the opportunity to apply faith to some of the skills that you’re seeking to teach them.

If you focus solely on the child as a worshiper and forget about the potential unique creaturely limitations, strengths and weaknesses that the child might have, you’re going to constantly mistaken childishness or weaknesses for sin. You’re going to have a child who is frustrated. You’re going to have a child who is confused. You’re going to have a child who’s asking forgiveness when the child has no sense at all that they’ve sinned.

They’re just going to be robotic and say, “Mommy, forgive me, I know I was such a bad boy when I did that,” when it might have just been an accident, or they might not have had the intellectual abilities to understand the situation and respond accordingly. That is going to be perhaps our major task over the next 40 minutes or so.

How do we bring those two together? How do we recognize that the children, especially in the extreme end of the continuum, may have a unique, called brain, if you will, and they may have unique strengths and weaknesses as a result of that, but how can we understand that without ever sacrificing all the things you’ve heard throughout the day about our children as being like ourselves, as being worshipers? I think most people would agree with those three initial observations. Now, let me get into a definition of what this thing called ADD is. Let me do it in three ways, as you can see in your outline.

Let me give you the core triad of people who are on the extreme end of this spectrum. Again, it leaks all through the spectrum to the point where hopefully the things we say, you’ll start saying, “That’s me, I didn’t know that.” We’ll start with the three core symptoms, which are impulsivity, restlessness, and distractibility. We’ll walk very briefly through the more technical definitions as you find them in DSM 3-4, and then we’ll just throw out some descriptions of what does this actually look like.

These three core symptoms, impulsivity, restlessness, and distractibility. Impulsivity. The child in the Sunday school class who, as soon as the thing is on his brain, he’s blurting it out. Sometimes he might actually raise his hand why he’s doing it, but he’s impulsive. As soon as it’s there in his mind, it comes out his mouth. That would be one example of impulsivity.

Sin, weakness, what is it here? Let me give you a couple of illustrations just to muddy the waters. I have a brother-in-law. Actually, my wife comes from a family of six children. The big event was monthly they would go and they would get their nickel ice cream cones. That was the major event in the home. When they would get their nickel ice cream cones, here are these kids who have been waiting a month for ice cream. Five of the kids would take that ice cream and literally within 15 seconds the ice cream would be gone.

There was one child, however, who nursed his ice cream cone. He would make that thing last for an hour. Sometimes I think it was his own sin because he just wanted to get on his sibling’s case and say, “Look, I still have my ice cream and you don’t.” I think another part of it is this kid had a real strength in not being impulsive. It wasn’t wrong that all the children ate their ice cream very quickly, and it wasn’t right that he ate his very slowly. It was just differences between the children.

And it’s very curious that my one brother-in-law is exactly the same way today. He will get a slow start on everything that he does, but he will keep going and going and going and going. And none of you could ever say, “What a man of great faith who has perseverance,” because it has nothing to do with faith. My brother-in-law is a Christian, but he would be perseverant whether he was a pagan or a Christian. It’s just a particular strength that he has.

So what I’m suggesting is, if it’s somebody who would have the opposite of that strength, who would be a bit more impulsive, who would have a tendency to blurt things out, it may not necessarily be a sin problem. It may sort of be a creaturely limitation that the child has.

Or let me put it this way. Let’s say, notice how we travel in a number of different places. There are rules, think of our children. There are rules that our children have for home. There are rules that our children have on the playground. There are rules that our children have at church. There are rules that our children have in the classroom. And all the rules are a little bit different.

And at home, sometimes if the kids are real loud, that’s okay. You don’t mind them just sort of blurting things out when it’s on their mind at home. And on the playground, that’s a good thing to do. But then all of a sudden, you go to the classroom and you gotta change the rules. Now, that can be a very, very challenging task. All of a sudden, they’re blurting things out in the classroom and the teacher’s yelling at them and their conscience does not say, “Hey, I’ve been doing something horribly wrong here.” Because they were just doing it on the playground and it was fine. Or they’ve been doing it at home and it has just been fine.

Can you see how it may not always be a moral issue? The emphasis may at times be on, this is a particular style that the child has. Impulsivity, maybe an even more common example of this would be, I only have two children, it’s a good thing. Because I can’t even get their names straight. I don’t even try to call them by their names anymore. I just make up names for them and hope they respond. Lindsay, Lisa, Leah, whoever you are.

Now, what is that? My brain is not sort of catching up to what’s coming out of my mouth. I’m not sitting down and thinking, “Okay, now which one is she? She’s the older one, I call her Lindsay.” No, that’s not the way it goes. Now, that mistake in messing up my daughter’s names, you wouldn’t consider that to be a simple problem on my part. But see, that’s a more normal version of impulsivity. I’m calling out to them before I have all the data at hand to work with, before I’m thinking about what I’m going to say in a sense.

Impulsivity, one of the symptoms that people talk about is a core symptom of people who move out to the extreme ends of the spectrum. Second thing, restlessness. This would be the classic hyperactivity. All the ADD people here have left, okay? I don’t see a whole lot of, you know, feet going like that. Of course, I can’t see everybody’s feet. But I’m sure, it’s true, the ADD people here, the people who have gone on that end of the spectrum, they left at lunch, okay? So they’re not here anymore.

You know, the kids who are always in motion, the kids who are always in motion, the kids who, again, they’re never gonna make it to dessert with the rest of the family. They drive people nuts while you’re methodically going through dinner, and you want this grand dinner time, and this kid constantly messes it up. Is it sinful? It may be.

Don’t forget, you’re entertaining both of these themes. Issues of the heart and issues of the body, creaturely limitations and the orientations of our worship. But recognize that fidgeting may not be necessarily sinful.

This is a bad illustration, but Easter, I went to visit my parents, and we’re sitting in church, and behind us, there was a person who had a hearing aid, and he had to turn the hearing aid up real high to hear the sermon, and it was buzzing. Mew, mew, mew. It was driving me nuts, just driving me nuts. And here I am, sitting in this Easter service, and I didn’t stop the whole time. And looking back, trying to find out who it was. I was gonna get up in the middle of this Easter service, and I was gonna, who’s got that crazy hearing aid?

And my wife, she didn’t move a muscle. I mean, she would have bed sores if the sermon was much longer. And then after the sermon, I said, Sherry, I tried so hard to stay with that sermon. I got some things, but this hearing aid was driving me nuts. And she said, what hearing aid? You know, what are you talking about? I’m further out in the spectrum than she is, okay?

Well, that’s a bad illustration, because some of you could say, well, that’s just sinful on your part. You should have been more attentive. But it repeats itself all over the place. My wife really does have an ability to, she is not restless in situations where she’s called to attend for a long period of time. She is not distractible. And I am more trippish in my style, where when things get boring, I wanna stir things up a little bit more. At least I’m feeling restless.

I would like to encourage you to think that that might not solely be a sinful problem, okay? It might be sort of a constitutional weakness that some people may actually have.

And third category, this category of distractibility. Be careful with this one. A better word for it would be inconsistent attention. That’s what people like to say. For example, here’s this kid who seems to be way out on the right-hand part of that, or my right-hand part of that spectrum. And they sit down and they watch TV, and they watch it for four hours straight, and they don’t even blink. How could that possibly be? And you’re telling me that my kid has problems with attention? There’s no way.

Well, be careful. Because you can’t say that I’ve just measured my child’s attention span. It’s four hours and five minutes. That’s how long they can sit in front of their cartoons. It’s an inconsistent attention span. They may be able to sit in front of a cartoon with rapidly changing features and lots of colors coming at them, with commercials that are very lively. But if they are a bit less interested in the topic, they are gonna be distracted by all kinds of things that come at them.

If they are a bit less interested in the topic, okay, you have a noise like that. Okay, you hear it? The air conditioning system? That’s distracting. The person in front of you who just maybe moves a little bit. All of a sudden, that’s distracting. And then you go back and you try to listen, but what happens? You miss part of it, okay? Now it’s even less interesting. And so you’re even more prone to being distracted. And by the end of it, you don’t have a clue as to what the person said.

And it’s possible, it may not simply be an arrogance on the kid’s part that says, I don’t care what this person has to say. Some people have a longer attention span than others. All the ADD people have left. Again, normally I’d be able to point out those people who have the shorter attention span. But most of you look like you have a fairly long attention span.

Those are the three core symptoms of this thing called ADD. By the way, you see, put some of these things together, you see how homework could be a life and death battle? Because here’s a kid who tends to be restless, tends to be distractible, especially when things aren’t intrinsically fascinating, and tends to be a bit impulsive. And you’re trying to get them to sit down for 10 minutes and go through their math homework.

Boy, I mean, try to picture what it would be like to be in this kind of a family. It could be very, very difficult. There are some suggestions we can have, certainly, though. They’re the core symptoms. The DSM definition just sort of spells it out a little bit more. Again, recognize that these are descriptions. They’re not saying what causes it. The cause resides in this intersection of the orientation of the heart and creaturely limitations. But why don’t you take a look at that briefly? It spells, they’re the three categories: the inattention, the hyperactivity, and the impulsivity. And they’re trying to specify a little bit more what those things look like.

Just since some of you may not go over these outlines, again, I’ll go over it very quickly. Under inattention, they’d like you to have six of the following. Notice how these are a spectrum rather than a clearly demarcated point. Often, how often is often? Often means enough until it drives you nuts. Okay, that’s what often means.

Often makes careless mistakes in schoolwork, work, or other activities. By the way, by the time we’re done this, most of you will be able to locate yourself on the farther end of this. Often has difficulty sustaining attention in tasks or play activities. By the way, you recognize that if you really want to see your ADD in action, spend time in quiet prayer.

Now maybe, thank you for some of you chuckling at that because I was gonna say, all of a sudden, I’m making myself very vulnerable here. But, well, I’ll say something about myself. When I say, okay, I wanna pray for 15 minutes right now. Inevitably, what happens is I start to pray, and then I start thinking about the person, and I start thinking of things we used to do, and then I start praying for my children, and I start thinking about their day tomorrow, and I had to get this ready for them tomorrow. And it gets me so frustrated.

You know what a lot of us do as a result of that? Because we do not have that attention that can last more than 15 seconds or a minute in prayer. We pray with other people, okay? That’s one thing that we do. We allow other people to provide for us a certain structure. And so many of us can pray for hours at a time, perhaps, if we’re praying with a group of people. ADD people can have similar struggles.

Often has difficulty sustaining attention in tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions or fails to finish schoolwork. All of these have a component of both of those two themes. Typically not all one, not all the other, some sort of combination of the two.

Has difficulty organizing tasks and activities. Strength, weakness, sin. Most of us, I think, would see that as a weakness rather than a problem of immorality. Often avoids dislikes or is reluctant to engage in tasks that require sustained mental effort. How many people do I know whose watchword in life is procrastinate? Same sort of thing. Things that require sustained mental effort, where you can’t see the result immediately. You have a tendency to put those things off until the very last moment.

Often loses things necessary for tasks or activities. Is often distracted by extraneous stimuli. Often forgetful in daily activities.

The hyperactivity part. Often fidgets with hands or feet or squirms in your seat. Often leaves seat in classroom or in other situations which remaining seated is expected. C, often runs about or climbs excessively in situations in which it’s inappropriate.

A family where their child came home from school so hurt one day, just felt beaten. And what happened was it was lunchtime and they couldn’t go out for recess right away and he started running on all the cafeteria tables and making these running jumps from one cafeteria table to another cafeteria table. And the proctor came, and this is I guess a fourth grader, came and just took him aside, took him in another room and started rebuking this child, yelling at the child. And the child just broke down in tears. The child didn’t do anything wrong.

Now it’s interesting. Lot of things are going into that. Number one, nobody had ever said in the cafeteria you can’t get on the tables and run and jump from one to the other. However, everybody in the cafeteria got that message except for this kid. Now that’s an interesting one. He just didn’t have the self-awareness to translate that unwritten code. Also, he jumps around on the furniture at home. How could it be? Why does mom let me go crazy in this one room in the house, but now the teacher is yelling at me for doing this? Can you see how it could be confusing for some children?

Often has difficulty playing or engaging in leisure activities quietly. Is often on the go or acts as if driven by a motor. Often talks excessively.

The impulsivity often blurts out answers before questions have been completed. Often has difficulty awaiting turn. Often interrupts or intrudes on other people.

Now some of those you can see more of the issues of the heart. Some of them you can see, hey, it’s not a right or wrong issue. It’s probably a little bit more in this situation. It’s a little bit more of a strength or a weakness that the child might have.

Now let me just spend a few minutes describing this. Just a little bit more ifI could. I’ve given you the three core symptoms. Here’s the DSM-IV. Let me just take a few illustrations across the ages.

Start with young children. When I think of young children, I’m thinking of preschool children. Always running, always climbing. The family I know, when they talk about their son, they will say, “My son does not sleep. He simply recharges.” And then when I go and spend time with that family, I know exactly what they mean. One time, one time, the child has sat down and listened to somebody read through a whole child’s book. One time. And I can’t remember what it was, but it was this monumental bribe that the parents used to have the child do it. Always running, always climbing. It seems like if they stop, they’re just recharging for the next go around.

Going to supermarkets is like those people you see on television who try to spin the 20 plates. You, okay, you’re trying to figure out, you’re gonna choose this or this. And meanwhile, your child is over here at this display, taking something out from the bottom of the display. He’s picking up something that’s made of glass and you know that when he puts it back on the shelf, it’s not gonna be on a sturdy place and the glass is gonna fall and it’s gonna break. Pretty soon, you’re gonna be excommunicated from Pathmark and you’re never gonna be allowed back in there again. I mean, going to a supermarket with a child on the more extreme end of the spectrum can be immensely, immensely hazardous.

Now, very briefly there, I mean, perhaps there’s some practical suggestions we can have for that parent. But one, this might not be your favorite, but one may be for somebody else in the Body of Christ to say, “When you go shopping, you drop your kid off over here, okay?” Frankly, I think that would probably be the best suggestion in those situations. Otherwise, the mother is gonna be spending hours and hours trying to do her shopping.

Young children. Child who is starting to get in trouble because he hits other people. I think that’s wrong. But there could be a certain constitutional impulsivity in the child as well. Where some of us, when we’re a little bit frustrated with our friend, we don’t immediately just push them or hit them. But an ADD kid, as soon as they’re frustrated with somebody, they’re gonna push the kid out of the way. Again, is that wrong? There’s no question that that’s wrong. But do we have to take into account that this child may be a little bit more constitutionally impulsive than my brother-in-law who can spend an hour eating an ice cream cone? I think that that would probably be the case.

One of the things you should be alert to here, and this is why some parents love the ADD label, is because if you’ve had a son like this for the early preschool years, you’re gonna feel like a horrible parent and you are gonna be defensive in all kinds of situations. You are not gonna wanna pick up your kid from Sunday school because you know, if you say anything to the Sunday school teacher, the Sunday school teacher is gonna say, “And he did this today, and he did this today, and he did this today, and if this keeps happening, we can’t have him in our Sunday school class.” Now, most Sunday school teachers won’t quite go that far, even though they’re gonna be thinking it most of the time.

And so it’s not uncommon for parents to become very defensive at this point, which is unfortunate because what they need is they need to become absolute experts in parenting. And to become an expert in parenting, you need the Body of Christ to gather around you and to offer you counsel, especially from their own experiences.

That’s what it might be for young children. With elementary age children, just take it to the next level. The fidgeting, the distractibility, the getting up out of their seats, their interrupting, their tendency to engage in things that can be physically dangerous. Here’s one, their tendency to, in some ways, enjoy getting mom angry. Here they are, they’re sitting at home, it’s raining, there’s nothing to do. And boredom is the worst curse in the entire world. So, what do you do? You do some things that you know will get mom a little riled up. And when mom gets riled up, you might get spanked, but that’s better than what you already have, so you’re gonna do it.

So, I’m saying there’s an intersection between both, both themes, there’s a certain constitutional uniqueness with this kid, but there are also certainly issues of the heart that had to be dealt with.

The adult, we don’t want to spend too much of our time talking about adults, but just in passing, there are probably a couple of things you should know. This is where it comes closer to home. This is very popular in the research these days. A sense of great promise, but always underachieving, okay? I had the highest IQ in school, but I never could keep the job, I never quite had the job that everybody thought I should have. The first adult I saw who was clearly like this was a counselee. He was everything, jittery, he was talking, impulsive, when he had something to say, he would blurt it out, and it was fun initially becauseI didn’t have to guess what was going on with him. I mean, it was all written all over the place. Went home, they went to His house one time, interesting. His house was a complete wreck. It must have been 10 projects that were started, none of them were completed. And that was 13 years ago, and they’re not completed today.

That would be characteristic of this in adults, where lots of projects, but nothing is completed. This intolerance of boredom, tendency to tune out in the middle of conversations, tendency to be impatient. Some people call their style of thinking lily pad thinking rather than linear thinking, where instead of this logical step by step by step thinking through issues, it’s more this, some people might think about it as artistic or creative. You see things from this way, then from this way, and the leaps from one place to the other may seem illogical to some, but they make some sort of sense to you.

One other thing I probably should mention with adults, and this is relevant throughout the spectrum, with younger children and school aged children, is they tend not to be very self aware. They can be doing things that are pretty weird, okay, the impulsivity, oh, Ed, could you repeat that again? Okay, if one of you did that, I mean, maybe it was something that would be very unclear, but some of you, if you said it, you’d probably say that was a little bit weird, I mean, nobody else does that here, but somebody on that end of the spectrum, they wouldn’t be thinking, oh, hey, that was sort of a strange thing for me to do, why did I do that? I mean, that might have been distracting to other people, might have been a little disruptive.

There seems to be a certain lack of self awareness, as a result, one of the practical suggestions we’re going to have is they should have a mentor, they should have a discipler who sticks close by, somebody who really, really loves them, who is willing to say, that’s a good point, it’s hard to stick with these people, but somebody who’s willing to say, that was really weird, okay, most of us don’t have a tendency to say that to people, let’s see, the trips, they’re probably around a handful of people I know who are ADD, that’s right.

Moving on to the next part of the outline, Roman numeral two, what do we know from the research, go through this quickly, letter A, there are some medical problems that can imitate ADD, the obvious consequence of this, when we get to thinking how to get a medical evaluation, thyroid problems are the ones that are most notorious, hearing impairment would be one, kid’s going to be distractible if they can’t hear very well, they don’t have a clue as to what’s going on around them, visual problems, just some very basic things like that, so there may be medical problems that imitate ADD,

Letter B, there may be educational problems that can incite ADD, a very poor reader, and here is a class that has read through this book and they’re talking about this book, and the child is going to seem like they’re distracted and impulsive and restless, I mean, they just don’t know what’s going on in the class, they may be poor at linear thinking, they may have that more chaotic style of thinking, so the practical how-to here would be, get an educational assessment, and we’ll talk about that in just a moment,

Letter C, what do we know from the research, presently you can’t find ADD in the brain, you can’t find how the ADD child’s brain is significantly different at the level of the brain, I can say more about that perhaps after this if we can talk about it some more, there are things we know, fourth thing, and this is probably what a lot of you have questions about and interest in, what about this medication, what we know about the medication is the medication may suppress some of the symptoms in some of the children and some of the adults, and I’ve given you according to their popularity a list of those different medications,

Let me be more specific now, what else do we know about the medications, medication has side effects, nervousness, inability to sleep, loss of appetite, weight loss in some people, sometimes a little bit of a change in mood, however, most of those side effects, if the child has the side effects at all, tend to leave after a week or two, within a month those side effects tend to be gone, the vast majority of children do not experience really any noticeable side effects after they’ve accustomed themselves to the medication,

Number two, medication helps, but it helps everyone, if on the way in we had a little dispenser of Ritalin, all of you would be a little bit more attentive, especially in a late afternoon session, if you went to a sermon, if you listened to a sermon and you got dusted off with a little Ritalin prior to coming to the sermon, all of you would listen just a little bit better to the sermon, that’s what stimulants have a tendency to do. So there’s nothing unusual with its effect when children at the more extreme end of the spectrum, it’s something that we would find in all of us, number three, it helps ADD children attend longer, and sometimes it helps them be a little less impulsive.

Sometimes they can stay in their seat a little bit longer. Sometimes they may not be quite as distracted by the air conditioner that might be going on. Number four, this might seem like a paradox in light of what I just said. Number four, the long-term benefits of medication are very limited. In other words, you have these pogo stick bouncing off the wall kids. You break them into two groups, you give one group Ritalin, you don’t give Ritalin to the other group. You follow and see what happens in three years. After three years, you can’t distinguish the two groups. Their academic problems are pretty similar, their social problems are pretty similar. The Ritalin doesn’t seem to have a whole lot of consequence over the long haul.

Now let me think in terms of a strategy for how to help. There’s some of the things that I think you should know. Room numeral three, what do we do to help these children? So obviously, you see that I’m not dealing with the question does it exist, does it not exist. I’m saying that attention, impulsivity, restlessness is distributed across the population and some people are going to be those more extreme ends and they are going to be a little bit more difficult to parent, a little bit more difficult to teach.

The first thing, become a parenting expert. I’ll break these down into two categories. One, creatively think how to address the heart of your child. I know Ted went through all these things and most ADD associations would love the things that Ted had done already today. Very practical, very relevant to people on this farther end of the continuum. But let me highlight just a few things that I think might be important. Structure is the password. Structure. If you are an unstructured person, if you tend to lead a fairly chaotic life and your home is fairly chaotic, it’s going to be tough. It’s going to be very tough. The child does best when they have certain guidelines for their behavior, when there’s a certain predictability in their lives, when they know expectations and those expectations have been carried out by the parent. That’s when the child does best.

A couple of strategies to keep in mind. Keep rules simple and perhaps even written. And written is just a way to force you to make them more concrete. So what may seem very clear and structured to you might not be to the child. You write them out and they are probably going to be a good bit more concrete. Keep rules simple and written. Treat other people the way you want to be treated. Don’t hit. Obey your parents. There are a handful of other things that we could talk about there. Ted, I’m sure, has already spoken about those. Keep rules simple and written.

Number two, I don’t have this in your outline but you can throw it in there, prioritize your agenda. Prioritize your agenda. You can’t do everything. If you wanted to get on the kid’s case for everything they were doing, you couldn’t do it and would frustrate the kid horribly. Have, okay this is the first thing I want to work on, then as we seem to master that then we are going to go to this. Now it doesn’t just have to be one thing, it could be one thing in a couple of different areas in the child’s life.

For example with children, okay Jimmy this is what we are working on, we are working on trying to understand what your friend would like to do. Okay, so when they come to the house one of the questions you can ask is Billy what would you like to do, do you want to play a game or do you want to go running or do you want to ride bikes, what would you like to do? Now that’s a very concrete application of loving your neighbor but your problem is you are going to have to be willing to stick with that for a long time until the child begins to get it and most of us in my experience are unwilling to stick with something that long. I am not talking about a couple of days, I am talking about weeks, I am talking about months until it is part of the child’s repertoire.

Okay that’s what we are working on with kids. Okay with, or here is another one, okay one thing we are working on with your sister, no hitting. Okay, no hitting. There is this, and by the way you are going to have to be very concrete, there is a little bubble around your sister. I don’t know the best way to make this like a picture for somebody, but there is this little bubble around your sister. Okay you see it, okay let’s say here is the sister, okay you can’t get through that bubble, you see. Okay every time you try to touch your sister, every time you try to push her you get stuck right there because there is this bubble that goes all around her.

Well that’s what it is going to be like, you can’t push, you can’t even touch your sister, that’s what we are going to try today. Now that’s a pretty extreme way to do it, but sometimes they have a difficult time. Well I can touch my sister in some situations, but I can’t touch her in others, that might be a little complex, so. I might just say, “Okay, what we are going to try to do is, we are not going to touch your sister at all today, except at night you are going to give your sister a nice big hug before she goes to bed.” That might be the one thing that you are working on with the child. There are ten other things you would like to work on, but that’s the one thing that you are going to focus on especially.

At the dinner table, we are going to try to sit, starting right now, we are going to try to sit at the dinner table for ten minutes, without saying, “Mommy, can I get up and play now?” Okay, we are going to try to do it for ten minutes. That would be the one thing that you are trying to focus on, but you get the idea. That’s the way that God certainly tends to work with me. I can’t keep two things in mind at one time, and there is no question children who are on this end of the spectrum cannot keep two things in mind at one time. So, you have simple rules and then you prioritize the things you especially want to focus on with the child.

The next thing I have, please don’t take this the wrong way, be careful about over-reliance on spanking. Over-reliance on spanking is probably unwise. Please don’t think I am succumbing to state pressures on this, that’s not what I am doing. I guess what I am thinking is that we can get so frustrated with these children that spanking ends up being a whole lot easier than the kind of concrete instruction that they typically need.

For example, with a kid who is absolutely out of control, now you use your judgment on this, but many times it seems to me spanking is the worst thing to do in that situation. I say that in part from my own experience. I know times when my own child has been out of control and we have tried to give directions to our child, “you don’t speak that way to your sister, you don’t speak that way to us,” the child would disregard them, would still be out of control, would spank the child and it just seemed to go from bad to worse.

Typically what we do now is we wait for the child to not be out of control anymore. “Go to your room, you are being cruel right now, you are saying things that are wrong, you go to your room and we will be up in 10 minutes and we will talk to you.” That would be one alternative to spanking immediately in a situation like that.

Another thing, over-reliance on spanking, sometimes I find parents spank when it would have been much wiser for them to just make sure they prepared the child long beforehand what was going to happen. “Okay, we are going to have dinner in 5 minutes, very soon we are going to have dinner. I know you are playing right now and having a lot of fun playing and it is going to be hard for you to stop playing but in 5 minutes we are going to have dinner.” That kind of preparation.

The child can be thrown by different things. Whatever the case, you study the child. If they are thrown by getting in the car and going somewhere, what you do is the night before you say, “We are going to get in the car and we are going to go to this place.” That day, again, you prepare them again and what you will find is you will probably preempt a lot of the things that were sinful in the child’s life as a result of that particular event.

Another thing, and I think Ted talks about this very nicely, consider, be at least as creative in thinking about the blessings for obedience as you do for the curses of disobedience. “How can I make obedience immensely attractive to this particular child?” That is hard work. At least it is hard work for me. It is a lot easier for me to think of consequences. “If my kid does this bad, this is what is going to happen.” It is much more difficult for me to think of trying to lead the child in the blessings of obedience. So be careful about over-relying on spanking.

Now for some children that might be very effective but if you find that you are spanking your child every single day, it would be a wise thing to consult with some other people in your church on that to see if there are some other ways that you could be addressing the child.

Some common problems, one other thing, give clear directions, give them once and have immediate consequences. Everybody in the world says that. Hard to do but everybody says it. The consequences must be swift. I talked to some friends about this the other day and I was told not to give this illustration but I will be impulsive on this one. I am not trying to demean children at all with this illustration.

If my dog does something wrong, my wife can’t say, “Dog, when daddy comes home, he is going to spank you.” I come home and I spank the dog, the dog is not going to have a clue as to what is going on. With an animal, obviously you have to couple the instruction very close to whatever the disobedience was. Please forgive that illustration but I am trying to make a point that there should be swift consequences.

By consequences, please don’t think just negatively. I am also thinking when the child stopped at that bubble and didn’t push his sister, Jimmy, do you see what happened? Do you see what God just did in your life? Do you see that we have been praying about this for weeks and weeks, and you were just about ready to push your sister, and you didn’t do it? We should stop everything. Let’s all get together, and we are just going to thank Jesus for the fact that He hears our prayers and helps us with those kinds of things that are so difficult to do.

I am also thinking about those kinds of consequences, swift consequences, very close to the behavior that you want to address. The farther you get from the behavior, the more difficult it is going to be. Some common issues that you are going to want to bring the scriptures directly to bear on the problem, I have three different things.

The triad in James 1:19 is probably going, common heart problems. The triad of poor listening, impulsivity, and anger are going to be something they struggle with for years and years. So what you do is you take something like James 1:19, here is that triad, everyone should be quick to listen, slow to speak, slow to become angry. If they can grow gradually in that over the next decade, that will be a dramatic work of sanctification.

19 Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; (James 1:19, ESV)

For them to do that, you are going to need to keep that in front of them, not in a punitive way, but here are the good things that God offers us. These are the things that God wants to do in our lives and these are the things we are going to be praying for. So chances are if you have a child who struggles with these things, that is going to be one of your theme songs that you are going to be talking about consistently.

Another common heart problem, this lack of self-awareness, this lack of understanding. The book of Proverbs, they are going to need counsel from other people. Proverbs 15:22 says,

22 Without counsel plans fail, but with many advisers they succeed. (Proverbs 15:22, ESV)

Proverbs 2 says,

2 My son, if you receive my words and treasure up my commandments with you, 2 making your ear attentive to wisdom and inclining your heart to understanding; 3 yes, if you call out for insight and raise your voice for understanding, 4 if you seek it like silver and search for it as for hidden treasures, 5 then you will understand the fear of the Lord and find the knowledge of God. (Proverbs 2:1-3, 5, ESV)

The book of Proverbs, the wisdom in the book of Proverbs, one of the main themes in that is we must have counsel from other people. People on that end of the spectrum tend to be a little bit less introspective, if you will, tend to be a little bit less self-aware and they are in a special need, all of us are in need of it, but they are in a special need of somebody coming close to them and being their counselor who beckons them to wisdom. So that is another theme that you are going to be using to address the child’s heart.

A third one probably will be something like Romans 5, suffering and producing perseverance or the analogous passage in James chapter 1. Trials are a testing of your faith which develops perseverance. This stick-to-itiveness, this hard to go from one thing to the next. Letter B, become a parenting expert in knowing their particular strengths and weaknesses. You’re knowing their heart and you’re seeking to address their heart. Now you want to know their particular strengths and weaknesses. You want to offer them structure. You want to give them a predictable schedule, a routine. You want to prepare them for changes. Structure in the classroom, as all of you know. Eric, that’s one thing that people often encourage in classrooms.

You want to establish eye contact with a person and you want to say their name. If I would say, if you’re in a sermon and the pastor’s preaching and all of a sudden they say your name, the person says your name, what happens? Yes, I’m home. It’s one way to bring a certain structure, limits, guidelines for the person to live with them.

With adults, obviously, do three important things before you do something fun, dealing with the procrastination. Help somebody to organize the tasks that you have in front of you. Get somebody to help you to break that big task down into 20 smaller tasks and establish deadlines for when you’re going to complete it. When you start something, see it through all the way to the end as a way to practice this tendency to go against this tendency to be distractible.

Work with the concrete rather than the abstract. Give them pictures. Your sister has a bubble around her. Have them hear it, say it, and do it. That’s a good motto with those children. They must be able to repeat it back to you and then if you’re instructing them about hitting or not hitting, allow them to do it. Let’s play that again. Here’s your sister and she just got near your truck and she accidentally hit your truck. What are you going to do now? You’re a little frustrated and you want to, okay, good, you didn’t hit her that time. Hear it, say it, and do it.

Another good advice, tired brains and tired bodies at the end of every day. Sometimes that might mean sports, reading, whatever it might be. Do what you can to give them a tired body and a tired brain. Always be looking for their strengths. Always be looking for their strengths. I’m a parenting expert. That is the number one thing you’re going to do. I’m not telling you anything new, obviously, at this point. This is just sort of a follow-up of some of the things that Ted had said.

Two other things that might be unique, however, to this group. You find that the child is still having struggles and struggles that fall out into the school system. Well, ask your school district for help. There is federal law that says that school district must help, whether you’re home schooling, whether it’s in private school or in public school. The school district will offer a fairly aggressive educational assessment. It is federal law.

What does that educational assessment do? It helps you to know more specifically the things that your child is able to do, the strengths and weaknesses of your child. It’s not going to point out where your child is righteous and where your child is rebellious. It’s going to point out the strengths and weaknesses. That can be immensely, immensely helpful.

You are probably going to have to be an aggressive advocate for your child, because school districts are loaded with these kind of children, and they’re going to be very slow in getting around to it. But pursue your school district for some sort of educational assessment.

Last thing, obviously, is ask your physician for help to, one, rule out any other problems, and two, I haven’t laid out my cards on this at all yet with medication. Let me put it this way. I think we need to be charitable on this particular issue. We don’t have clear enough evidence in scripture that compels us to say medication, Ritalin, is wrong with these kids. The scripture does not compel us to say that. So I don’t think it should compel us to say that.

Pros for medication. It might make instruction, it might make it a little bit easier for the child to hear instruction in the classroom. It might make the child be a little bit more attentive at home, a little bit less prone to distraction. It can help some kids. Can help almost all kids, but it can help kids who seem to struggle at the more extreme end of the spectrum.

The myth, the medication is not addictive. Medication is not the answer. Children don’t tend to blame shift all their problems and say, well, the ADD made me do it. See, I have this problem, and I’m taking medication for it, and that’s what I’m doing. I don’t tend to see that very often at all. I have never seen that with children. I’ve seen it with adults sometimes, but I haven’t seen the children do those sorts of things.

It will label the child, good question. My experience is it tends to be a myth. Everybody has a label of ADD these days. Your child is not unique if somebody starts throwing that label around. And I don’t find school districts treating the child in an unusual or second class sort of way if somebody throws that label at them.

Medication will mask the problem. Medication will not mask the problem. You will have plenty of things to work on. The cons, the expense of the medication, the hassles of taking it, and the fact that over the long haul it doesn’t seem to help that many kids, it doesn’t seem to make a difference.

If it was my kid, would I ever consider medication with my kid, which is the way I want to think about your kids and the way I want to think about the children that I counsel. In some situations, I would consider it. Scripture does not prohibit it. My experience is that I’ve seen some children where it has been very helpful for the child, and the child has wanted to take it. Not because it’s an excuse for their behavior, but because they see that it does help them in the classroom. They do seem to be a bit more attentive. They don’t tend to pop around in their seats quite as much when they’re taking it.

So in some situations, I think that there is merit to considering it. You consult with your physician on it. You consult with other parents who have tried it and have liked it or have not liked it. But I don’t think we can rule it out right off the bat.

To summarize that, I guess I would follow the party line, which is you become expert parents first. You read what you can. You get counsel from as many people as you can. You get that more elaborate educational assessment that perhaps will help you to understand the nuances of your child’s strengths and weaknesses. Those are the first things that you do.

Most people, when they get through those stages, they will think that medication is not something they really want entertained. Some people might. If those people are in your church, I do not want those people to feel like they are doing something that is horribly sinful. I don’t think we can argue that biblically.

I’ve kept you a few minutes late. You have been a very attentive group and I do appreciate that.