The typical parent who reaches out to me at my practice, Center for ADHD often does so with a healthy amount of skepticism. Often, they bring up in our initial conversation that their child has been in and out of therapy multiple times and the felt that the therapy wasn’t a productive use of their time or financial resources. I wrote this article to help both parents and educators understand why traditional “talk therapy” is often ineffective for kids diagnosed with mild neurodevelopmental challenges such as ADHD, Asperger’s or higher-verbal autism. The primary reasons are as follows:
- Because ADHD, Asperger’s and higher-verbal ASD are learning issues, not mental health issues.
When a child is born with neurodevelopmental challenges their development is lagging in several areas. In the case of ADHD, Asperger’s and higher-verbal autism these areas can include: executive functioning, emotional regulation, expressive and receptive language, social cognitive skills (thinking in a social context), learning issues, fine and gross motor issues, etc. These areas of lagging skills need to be addressed through teaching skills and strategies that have not developed intuitively.
Talk therapy is often an ineffective treatment modality for kids with these profiles because therapeutic orientations are neither designed for individuals with neurodevelopmental challenges nor do they provide practical skills and strategies designed to help teach lagging skills. Kids who present with ADHD, Asperger’s, HFA do not improve their behavior or emotional regulation simply identifying or verbalizing emotions. They need to be taught how to put emotions in their proper context, understand if their emotional reaction was appropriate based on the context of the situation and to learn specific strategies, designed for their learning style to help them improve their ability to regulate their emotions. Most therapy does not teach these skills or strategies because most clinicians have no specific training in working with these diagnostic profiles.
While mental health certainly has a significant role in treating the anxiety, depression, obsessive behaviors that are common in kids with challenges it must be done with a comprehensive understanding of the neurodevelopmental profile being treated.
- The therapist mistakes the child/teen’s intelligence and articulateness as maturity.
Many kids with ADHD, Asperger’s and higher-verbal autism will often try to avoid anything that is outside of their comfort zone, particularly when it involves non-preferred tasks. This is particularly true for some kids diagnosed with ADHD and Asperger’s, who have a propensity to speak negatively of any new experience that doesn’t involve screen-based activities.
For many kids diagnosed with ADHD, Asperger’s or higher-verbal ASD there is a significant discrepancy between their intellectual ability (which may be well above their chronological age) and social/emotional maturity (which is often several years behind their chronological age).
Numerous times I have encountered therapists (who do not specialize in neurodevelopmental challenges) who supported their client in avoiding positive experiences because their client spoke negatively about the experience, made a compelling argument as to why they shouldn’t have to participate or articulated why the other kids were different from them. What many clinicians fail to realize is that a lack of perspective taking skills (understanding other’s thoughts, feelings and intentions and understanding how you come across to others) is prevalent in individuals who struggle socially. I often find that many kids with social learning challenges complain about kids who present exactly the same as them.
What the clinician did not realize in these cases is that being intelligent and articulate does not equate to mature judgement or social and emotional maturity. The amount of times I have seen kids talk their way out of doing things that would be very helpful to them because they convinced their therapist otherwise is very unfortunate as it denies them the opportunity to develop resiliency and a sense of accomplishment. Since parents will often defer to this clinician as the expert, they allow their child to miss out on opportunities that can help them grow socially and emotionally.
- The therapist doesn’t understand the depth of executive functioning deficits and misinterprets them as oppositional behavior.
Executive functioning is a topic widely misunderstood both by educators and mental health professionals. When a child or teen with ADHD is told to clean their room, but cannot conceptualize what the room should look like when it’s clean, where to start or understand how much time cleaning their room will take they often become frustrated and may become argumentative because they can’t complete what most people consider to be simple task. This expression of frustration and shame is often pathologized as being oppositional yet it is really stems from a lack of age-expected executive function skills.
- Because kids with ADHD, Asperger’s and higher-verbal autism lack perspective taking skills.
One of the primary reasons why people with social learning challenges such as ADHD, Asperger’s and higher-verbal ASD struggle socially is because they lack perspective taking skills (the ability to understand other’s thoughts, feelings and intentions) and the ability to understand how they’re being perceived by others. I have often seen clinicians mistake this lack of perspective taking ability as a lack of empathy or as symptoms of a personality disorder. Many kids with ADHD, Asperger’s and ASD are very empathetic despite their impaired perspective taking ability.
As you may imagine, traditional talk therapy that focuses on helping to develop insight into behaviors is not helpful to people who lack perspective taking skills. They need to be explicitly taught how to take the perspective of others and understand other’s thoughts about them.
- Few clinicians truly specialize in neurodevelopmental challenges (ADHD, Asperger’s, ASD)
Many parents select a therapist based on word of mouth or who is credentialed with their insurance company which is understandable, however, they often do not inquire as to the clinician’s depth of experience or training in working with children who present with ADHD, Asperger’s or higher-verbal autism. Many clinicians do not realize that treating ADHD, Asperger’s and ASD is a specialized field that requires extensive training and education. One family I worked with spent a year and a half taking their elementary school-age son diagnosed with Asperger’s to a therapist who specializes in substance abuse for adults. Why the therapist would not refer the family to an appropriate provider is beyond my comprehension.
The intention with this piece is not to bash the mental health field or mental health professionals, the vast majority of whom are ethical, well-meaning professionals. Rather, it is to encourage parents of kids diagnosed with ADHD, Asperger’s and higher-verbal autism to understand the limits of traditional talk therapy and to encourage them to do their due diligence when looking for a therapist who can work successfully with their child and their family.
Ryan Wexelblatt, LSW, CAS is the Director of Center for ADHD in Bryn Mawr, PA and Linwood, NJ. Learn more at www.centeradhd.com