Understanding Temperament: Tolerance

image via flickr by David Dodge

image via flickr by David Dodge

A key goal in effective treatment for Attention Deficit Disorder should be to understand our temperament and the temperament of the children we live and work with. 

Understanding the concept of temperament and applying that knowledge to ourselves as parents and teachers and to those around us helps us to better understand behavior…struggles, failures, and successes.

Understanding FRUSTRATION TOLERANCE

Frustration Tolerance refers to the level of difficulty we are able to experience before we become frustrated. Frustration tolerance ranges from high to low.

Those of us who have a high frustration tolerance are able experience an awful lot of difficulty before we feel frustration.

Others of us who have a low frustration tolerance become frustrated very easily.

The child with a high frustration tolerance may be able to deal with repeated struggles and failures in the classroom without experiencing significant frustration.

The child with a very low frustration tolerance, however, can be quick to experience frustration when asked to perform tasks of only moderate difficulty. This, in turn, sets him up for repeated struggles and can turn into negativity towards school and other learning situations.


Temperament Traits and ADHD | The Being Well Center | Free PrintableUpcoming blog posts will discuss the other 9 Temperamental Traits that make you and your child unique.  Follow along with this Being Well Center | Temperament Worksheet designed to help you pinpoint where your or your child’s temperament trait falls on the continuum. Catch up on previous posts about Activity LevelRhythmicity, and Threshold.


Don’t forget to follow us on Facebook and join a community of people interested in getting the facts straight with compassionate support for ADD/ADHD!

Rule for Effective ADHD Treatment: Know Thy Temperament

Know Temperament for ADHD Treatment | The Being Well CenterTemperament refers to our in-born (not learned) behavioral style. We all come into the world with a unique set of temperamental characteristics that remain stable throughout our lifetime. These characteristics modulate how we respond to every situation in our lives.

Understanding our own temperament as parents and teachers and the temperament of our children is incredibly helpful in being the best we can be and in bringing out the best in our children.

In our experience, understanding the concept of temperament and applying that knowledge to ourselves as parents and teachers and to those around us helps us to better understand behavior…struggles, failures, and successes.

In fact, failure to understand a child’s temperament and the role it plays in his behavior and performance can be a major source of frustration for parents and teachers.  In our model, there are nine dimensions of temperament and we all fall somewhere along a continuum for each one. The ranges for these continuums are presented in upcoming blog posts for each temperamental trait. It is important to know that where an individual falls along this continuum for any given temperamental trait is neither good nor bad…it just is!

In fact, the same temperamental trait (e.g., being very intense) that is helpful to us in one situation may interfere with our behavior or performance in another.

A key goal should be to understand our temperament and the temperament of the children we live and work with. We need to critically consider how any extreme temperamental traits might be contributing to problems in performance, behavior, or social interaction. When temperamental extremes do interfere with performance, behavior or social interaction, we need to learn how best to work around or control these extremes.

Therefore, when we suspect that an ADD/ADHD child’s temperamental characteristics play a role in his failure to meet an expectation at school, we know we must develop some type of accommodation to address this contribution.


Keep following along this week as we delve in deeper detail into the 9 Temperament Traits recognized at The Being Well Center.

For greater detail and worksheets to guide you in discovering your child’s (and your own!) temperament and how to make those traits work positively for you, purchase Dr. Liden’s book, Accommodations for Success.

ADD/ADHD Behavior Management Help for Parents and Teachers

image via Flickr, Rober Arévalo

image via Flickr, Rober Arévalo

How can parents, teachers, and childcare providers best manage behavior in children with ADD?

There is no simple technique that is effective in managing all children with ADD. Each child is unique and requires an individualized approach to promoting positive behavior change.

It begins with first really knowing who the child is and then setting realistic expectations.

When we discipline ourselves to do these two things, we minimize the likelihood that difficulties arise in the first place. Furthermore, when we reflect upon the child’s unique characteristics and set realistic expectations based upon these characteristics we equip ourselves with information essential to managing problems when they do occur:

STEP 1. Knowing who the child is

To understand the child’s unique pattern of individual characteristics, we must reflect on the answers to the following questions:

  • What are his strong and weak skills?
  • What are his attentional characteristics?
  • What are his physical abilities and limitations?
  • What stresses is he facing in his life?
  • What are his basic attitudes and beliefs?
  • How does he feel about himself?
  • Who are the significant people in his life?

STEP 2. Setting realistic expectations

Based upon the child’s unique pattern of individual characteristics, we must identify the appropriate expectations for academic achievement, social interaction, and independent functioning.

Encourage Independent Functioning

Only when these two steps have occurred can we effectively manage behavior, promote responsibility, and encourage independent functioning.

image via Flickr, Brad Flickinger

image via Flickr, Brad Flickinger

When problems emerge, we should take the actions described below (steps 3, 4, and 5) to ensure that individualized, effective management occurs.

These steps include determining the factors which are contributing to the problem, developing a plan which takes these factors into consideration, putting the plan into action, seeing what happens, and making changes in the plan as necessary:

 STEP 3. Determining the factors that are contributing to the problem behavior

To do this, we use our knowledge about the child’s unique characteristics to determine the following:

  • What specific expectation did the child fail to meet?
  • What characteristics of the child contributed to this failure/the problem?
  • What aspects of the child’s life circumstances contributed to the problem?

STEP 4. Developing a plan and putting it into action

In order to develop an action plan, we must reflect and act on the answers to the following questions:

  • Given who the child is and the factors contributing to the problem, does the expectation need to be modified? If yes, then how?
  • How is the expectation(s) best communicated to the child so that he understands it?
  • What can the child do, think, or say to increase the likelihood he will be successful in meeting the expectation?
  • What should happen if the child fails to meet the expectation; that is, should there be a consequence and what should it be?

STEP 5. Seeing what happens and making changes in the plan when necessary

image via Flickr, Simply CVR

image via Flickr, Simply CVR

We must reflect on the success of the plan; that is, we must determine whether or not the child is now behaving more appropriately. If he is not, we must identify what went wrong by answering the following questions and revising the action plan accordingly:

  • Were the expectations unrealistic?
  • Was the identified set of contributing factors inaccurate or incomplete?
  • Was the action plan–the method of communicating expectations, the structuring the environment, the child’s strategy, and the use of consequences–ineffective?

You’re not alone in struggling to identify and cope with the behavior challenges of ADD/ADHD!  Parenting and teaching children with Attention Deficit Disorder requires extra reserves of patience, reflection, and determination.  If you found hope in these questions, Dr. Liden provides more detailed guidance in his book, Accommodations for Success: A Guide and Workbook for Creating 504 Agreements and IEP’s for Children with ADD/ADHD.

Do We Need Special Classes for Kids with ADD?

image via Flickr, Jirka Matousek

image via Flickr, Jirka Matousek

The benefits of special classes or tutoring for kids with ADD…

All children, particularly those who are distractible, can benefit from the low teacher to student ratios that are characteristic of special classes and tutoring services.

Furthermore, some children with ADD require tutoring or special education services when their skill deficiencies in reading, spelling, writing, or math interfere with satisfactory academic progress.

…On the flip side, how special services can harm rather than help…

However, associated learning problems seen in children with ADD are often the result of inattention rather than basic skill deficits. When this is the case, academic performance improves as attentional weaknesses are appropriately treated.

Therefore, quickly jumping to tutoring or special education services when academic problems arise can temporarily cover-up the underlying attention problem.

When this band-aid approach is used, the problem inevitably resurfaces in a magnified form later.


Have you found special classes or tutoring have helped or hindered your child?

Looking for a comprehensive, action-oriented guide to navigating the confusing and often frustrating IEP or 504 Agreement process?  Dr. Liden’s Accommodation for Success is the answer you’ve been hoping to find!  Get a copy for yourself or a friend.  No better gift you can give than a guide to school success!

How a Teacher makes a difference with an ADD Student

image via Flickr, Ilmicrofono Oggiono

image via Flickr, Ilmicrofono Oggiono

The educator’s role is similar to the role parents assume in treating ADD.

It begins by learning to understand and accept the problem, rather than making superficial judgments about the child such as “bad,” “lazy,” or “underachieving.”

A primary responsibility of school personnel and childcare workers is to function as team members in treating ADD. This involves setting appropriate expectations, clearly stating limits for behavior, giving feedback, providing effective consequences, reinforcing self-awareness and self-control, and communicating regularly with parents.

In addition, professionals in schools and childcare settings can help to develop and implement compensatory strategies and to identify and remediate associated learning problems.

As team members situated in the structured school environment, teachers and other educational personnel are in an ideal position to monitor the effectiveness of the other treatments (e.g., medical therapy, counseling, etc).

It is also possible for professionals in a childcare setting to provide help with the monitoring of various treatments.

While educators are essential team members, it is never appropriate for them to diagnose ADD or to recommend or modify medical therapies. These are medical decisions that must be made by an experienced physician in consultation with others.


Dr. Liden examines the vital roles parents and teachers play in his book, Accommodations for Success.  The 10-Step book gives parents power to create a highly personalized, effective IEP or 504 Plan.

Get Help for ADD in School

School Success for ADD | The Being Well Center

image via Flickr, Jekino Educatie

There are two ways that students with ADD may receive support and accommodations in school. When ADD severely impacts upon learning and academic performance, the child may be eligible for Special Educational services through IEP law.

When a parent believes a child is struggling academically, the first step is to express his concerns to the building principal or guidance counselor. I always recommend that the parent put his concerns and a formal request for a thorough evaluation in writing addressed to the principal. In my experience, it is important that the parent keep a copy of all written documents for himself; creating a paper trail may be critical in insuring future educational accommodations for the child.

After a formal evaluation by qualified school personnel, the child with ADD may meet the criteria for being identified as learning disabled, emotionally disturbed or “other health impaired” and therefore qualify for special education services. At that point, parents and school personnel work together to define in writing an Individualized Educational Plan (IEP) to meet the unique educational needs of the child.

Section 504 of the Rehabilitation Act of 1973 states that any institution receiving federal fund must make accommodations for people with recognized disabilities. Because ADD is such a recognized disability, children with ADD are eligible for accommodations in any federally funded school.

Accommodations in school include allotment of extra time to complete tasks and tests, use of teacher signed assignment book, preferential seating and increased frequency of feedback to parents.

The first step in pursuing accommodations under Section 504 is for the parent to express his concerns and accommodations request verbally and in writing to the principal, guidance counselor, or, in college, the disabilities services office. As the appropriate accommodations are defined, it is important that they be formalized in writing; this ensures compliance, accountability, and future accommodations.

Are there other services available for the ADD child who experiences difficulties despite the usual interventions?

image via Flickr, Bart Everson

image via Flickr, Bart Everson

When ADD severely compromises the child’s functioning at home and school despite intervention, he may be eligible for Wrap-Around or Therapeutic Staff Support (TSS) services through the county or state mental health department.

These services assume different names and forms across the country and are dependent upon the unique needs of the child. For some children, the service involves access to a trained support person in the home to help with behavior management and independent functioning. For others, it involves having a support person accompany the child to each of his classes to facilitate his meeting school expectations.

While it varies from state to state, access to these kinds of services generally require the child be assigned a mental health or medical assistance case manager and to participate in additional comprehensive testing. I recommend to parents whose child can benefit from these services to begin the process by contacting the county or state mental health office.


Accommodations for Success | Dr. LidenIf you’re ready to secure educational support for your child, you will find Dr. Liden’s book, Accommodations for Success, invaluable.  Dr. Liden walks you through every step necessary to get the customized support you need for your child to achieve and succeed.

Friends Should Tell Friends About ADD/ADHD

While scientific research has only begun to demonstrate it, my observation and experience suggest that ADD may be everywhere in contemporary society. My bet is that ADD is an important biological contributor that interacts with life circumstances to cause some of the more significant health, educational, social, and economic dilemmas that we face.

In fact, by putting ADD into the mix and addressing its role, we may find that some of these perplexing problems are far more solvable than we thought.

Friends Should Tell Friends

image via Flickr, coolio-claire

image via Flickr, coolio-claire

It is imperative in addressing these perplexing societal problems that we increase society’s awareness of this important, but hidden, biological difference. All of us need to be more aware of the critical role that paying attention plays. We need to recognize that difference of weakness in attention places an individual at risk for problems in almost every area of life — problems which, at first glance, hardly seem to be related to a difference in brain chemistry.

Responsibly written and produced articles, books, and media presentations can play a significant role in enhancing awareness about ADD. Too often, ADD is presented in a cursory, negative, and sensational way in the media. Such a simplistic approach to a complex problem like ADD only confuses the picture and heightens parents’ and teachers’ fears.

Professionals Need Informed Training

Another key step in increasing awareness of ADD involves improving and expanding the training that professionals who work with ADD receive.

Too often professionals who are in the position to work with ADD individuals have a poor understanding of ADD. In fact, many professionals continue to be unaware of the fact that ADD is not just a school problem. It is a life problem whose basis is biological. Effective assessment and treatment is impossible without a comprehensive team approach.

Professionals who lack appropriate training and experience with ADD have an obligation to make a concerted effort to match up the ADD individual and his family with the best resources available.

Schools Should Put Some Muscle Behind ADD/ADHD Support

image via Flickr, alamosbasement

image via Flickr, alamosbasement

We also need to break down the barriers that limit access to appropriate comprehensive services. Schools should do more than pay lip service to providing multidisciplinary services to ADD children. The team cannot consist solely of a school psychologist and teachers and other educational personnel.

Since ADD is a biologically-based problem, the team must include a physician who is knowledgeable in this area.

And, because the impact of ADD goes beyond the schoolyard, dedicated school personnel need to feel comfortable encouraging parents to seek appropriate help from other nonschool professionals for management of the problem in other life arenas.

ADD is NOT a “Mental” Problem

To make this possible, insurance companies and government health financing systems need to evaluate critically policies and reimbursement mechanisms that unfairly discriminate against individuals with ADD. At a most basic level, they need to accept that ADD is not a “mental problem,” but that its physical basis is as real as diabetes and coronary artery disease. These health care financiers would be wise to consider the cost efficiency of early intervention, health education, and comprehensive team treatment of ADD.

Give ADD the Middle Ground

Finally, as a society, we need to find the middle ground. We need to strike a balance between emphasis on skill acquisition and on learning how to live, between permissiveness and firm discipline, between reliance on technology and humanistic intuition, and between manipulation of the brain and counseling the mind.

It is in this middle ground that true quality of life is found.

Structuring the ADD environment

Treating ADD: What works, what doesn’t, and why…

How far should parents and teachers go in structuring the environment?

Structuring is a method of managing behavior, promoting responsibility, encouraging independent functioning by changing the physical surroundings or by providing the organization necessary for completion of a task. It is a valuable tool for increasing the likelihood that the individual with ADD will achieve success.

ADD ADHD structure teacher parentParents, teachers, and others need to find the balance between too little and too much structure. Too little structuring generally guarantees failure. Too much structuring can actually be detrimental to the individual with ADD. If the environment is too controlled or a task is too tightly organized, it actually takes away, from the individual with ADD, his need to control his inattention and to organize himself.

When over-structuring occurs, parents and teachers are actually allowing the individual with ADD to become overly dependent. They make it possible for the individual with ADD to avoid facing his weakness, accepting it, and developing appropriate compensatory strategies.

As a rule of thumb, to avoid over-structuring, parents, teachers, and childcare providers should only use structuring that is practical and applicable to the real world. Individuals with ADD need to learn to cope with the demands of a world where parents and teachers are not always present.


Did you know The Being Well Center is a team of experts who are here to support parents and teachers?  In addition to doctors and PAs, we are counselors, nurses, dietitians, and behavioral therapists.  We support the whole person through all of life’s demands.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

 

Early Diagnosis of ADD/ADHD

add in school children | the being well center

Can ADD be diagnosed before a child enters school?

Yes, but it is often difficult. The reason is that some of the behaviors that are red flags or indicators of ADD can be normal in the preschool-age child. This means that interpretation of behavior and test results is complicated. Interestingly enough, however, experienced preschool teachers can be amazingly accurate in identifying the child with ADD. They have the advantages of making observations over time and being in a position to compare a given child’s behavior to that of his peer group. This makes it possible to identify the child with ADD whose behavior is consistently more extreme.

add in school children | the being well centerEarly identification of ADD should be a goal for parents and teachers. This makes it possible to begin treatment before the child enters a destructive cycle of failure that can interfere with successful growth and development. Sometimes parents and teachers hesitate to identify and investigate an extreme behavior for fear of creating a problem where there really is not one. While this is an understandable concern, over the years I have learned that parents know their kids better than anyone (and teachers aren’t far behind).  Their difficulty, more commonly, is being honest about what they see and holding back, as opposed to inaccurately observing and jumping the gun.

Therefore, my advice to parents and teachers is: “If you think there is a problem, then there is.”

It may not necessarily be ADD, but something is out of sync. All developmental, learning, and behavioral concerns in children deserve some type of comprehensive assessment. The “worst thing” that can happen by taking the step to investigate a concern is that parents and teachers can be reassured that they are handling things in the right way!

And even more importantly, when we evaluate a problem, identify the factors–including ADD–that are contributing to the problem, and implement a specific treatment plan, we are likely to prevent the development of more significant problem.


How can you be sure your ADD/ADHD diagnosis is accurate?  One sure-fire way is to book a Discovery Session with Dr. Liden at The Being Well Center!  Another great way is to download Dr. Liden’s book, ADD Basics 101, currently offered as a free ebook.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

How does ADD affect learning?

Check out Lisa Ling‘s frank admissions of her struggles in the classroom.  Sound familiar?

Attention plays a major role in learning since all information coming into and out of a person’s brain is filtered by attention. That is, in order to acquire a new piece of information or a skill, we must first pay attention to it. In order to show that we have mastered the information or skill, we must control our impulses, monitor our behavior, filter distractions, and concentrate for a sustained period of time on the “tests” that occur in the classroom and in the real world.

Poor attention affects both incidental and “school” learning. A person who has a weakness in attention is less able to receive all of the input from the environment–structured or unstructured–that is necessary for learning. For example, he neither sees nor hears all the steps that Mom and Dad show and tell him about cleaning his room; he misses the fact that there are actually road signs that tell where to go; and he fails to get the coach’s instructions about game strategies during practice. At school, he doesn’t listen to the teacher’s instructions; he doesn’t see the assignment written on the blackboard; he doesn’t get the meaning of the stories he reads; and he doesn’t remember the steps in long division.

ADD can also interfere with a person’s ability to demonstrate what he has learned. People with ADD may have messy rooms, dirty dishes, and poor hygiene even though they know how to clean, to do the dishes, and to care for their bodies. In school, people with ADD may fail to complete all the problems or daily worksheets, add instead of subtract on achievement tests, make careless errors on intelligence tests, reverse letters when reading or writing, and forget to capitalize and punctuate in written language tasks.

Apparent difficulties in seeing, hearing, remembering, and understanding often lead to the false conclusion that individuals with ADD have auditory or visual perceptual problems or are just less intelligent. In reality, however, they are simply not alert and not reflecting, focusing, filtering, persisting, or monitoring their behavior and their schoolwork.  Brain power only goes so far.

ADD negatively affects learning. But, it never does so alone. A person’s temperament, intellectual, and learning abilities, and language skills, among other things, interact to influence how attention affects learning. It is important to remember that ADD, as a biologically based individual difference, can occur in anyone–an individual who is gifted, learning disabled, retarded, and one who has average learning ability.

Catch up on previous posts in the Pay Attention series.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.