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Introduction
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The winner is
the parent whose child
still loves them when they turn 18.
The purpose of this concise book is to be useful.
After all, there is a lot of work to be done. This thing we call "Attention Deficit Hyperactivity Disorder (ADHD)" is not just about cute, unfocused kids running around. If that was the only problem in your life, you would not be reading this. ADHD is about overwhelmed kids who yell at their mother when she tries to help them. It is about mothers who fear that their relationship with their child is slipping away. It is about fathers who come home to find everyone at wit’s end. It is about the threat to the most important things in life.
As I hear these stories over and over again in my practice in pediatric neurology, there are so many things I want to explain to families. I want to explain that the problems they are experiencing--the over-reactions, the disorganization, the lack of planning, the screaming, the lying, the blaming others etc.-- are usually caused biologically as part of the condition we summarize with the letters ADHD. I want to explain behavioral approaches for home and school, and the role of medications.
I wanted a book that would concisely re-inforce it all. I made many recommendations for the truly excellent books that exist. However, most times, the parent’s response at the next visit was, "No, Dr. Kutscher, I didn’t read that yet. If I had time in my life to read all of those 300 page books you recommended, I wouldn’t have needed them in the first place." Yet the need existed. So I scoured through the top books, condensed the best insights of brilliant thinkers, added some of my own, and wrote this text. The idea was to be brief but not "dumbed down." Realistic, yet optimistic.
We begin with a discussion of the problems that we face: the full spectrum of ADHD and co-morbid symptoms. The chief difficulty is that people with ADHD cannot inhibit the present moment long enough to consider the future. ADHD behaviors make sense once we realize that they are based on reactions taking only the present moment into account. It is not that Johnny doesn’t care about the future; it is that the future and the past don’t even exist. Such is the nature of the disability. If you want to make sense out of inexplicable behaviors by someone with ADHD, just ask yourself: “What behavior makes sense if you only had 4 seconds left to live?” For example, if you only had 4 seconds to live, it would make sense to play a videogame rather than do homework. After all, why do homework if college doesn't exist?
The rest of the book deals with solutions. First, behavioral approaches for home and school are discussed. The key to therapy is recognition that ADHD is a true disability, which requires continuous “enabling” by parents and teachers—caregivers who need to constantly diffuse (not inflame) an already overwhelming situation. Then, we move on to the role of medications. We end with a summary re-cap, which can be read as a complete freestanding text. The summary chapter could be usefully provided to spouses, teachers, etc. Finally, further readings are provided.
I am indebted to the original thinkers who have added so much to this field. I have cited their works when possible. I am further indebted to those in my life who have added to my understanding of the full spectrum of ADHD. I hope that you find this book useful. I hope that it is brief enough for you to actually read and use. The stakes are high: nothing less than our children’s success, and our relationship with our children.
Good luck to your family. It will take time, but it can turn out great!
Departments of Pediatrics and Neurology
New York Medical College
Valhalla, New York
(c) 2002 Martin L. Kutscher, MD
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