From Distress to De-Stress: Strategies for kids with Learning Disabilities and ADHD

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Dr. Jerome Schultz was a recent guest of ours on Dr Radio,  About Our Kids, on Sirius 114 and XM 119 .  Dr Schultz is a clinical neuropsychologist and faculty member of the Harvard Medical School in the Department of Psychiatry. He specializes in the diagnosis and treatment of children and young adults with learning disabilities, ADHD and other special needs. Dr. Schultz has published many works including From Distress to De-Stress: helping anxious, worried kids. Here, Dr. Schultz describes activities and strategies that parents, teachers and other professionals can use to make learning a safer, more satisfying experience for students.

Ideas for teachers, parents and others helping anxious, worried kids with ADHD & LD.

 Kids who don’t know that they have ADHD or LD, or who don’t understand the nature of their condition, may “diagnose” themselves as stupid. Because they are faced daily with tasks that they cannot master, they are under a state of chronic stress. This causes the production of brain chemicals that actually change the way the brain functions, impairing learning and memory.

This article provides some strategies for dealing with the cycle of Fear, Avoidance, Stress and Escapism that we often see in these kids. I describe this phenomenon which I call “Saving F.A.S.E.”  and describe the DE-STRESS Model for building a child’s confidence and competence in my new book called “Nowhere to Hide: The Real Reason Kids with LD and ADHD Hate School,” to be published by Jossey-Bass in Spring/Summer 2011.

For now, let me offer you a sampling of the things that you can do now to alleviate the negative impact of chronic stress on kids with LD & ADHD.

 Teach kids how to relax.

 Consider this vignette:

 Roxanne: (agitated and loudly) “I can’t stand this freakin’ book!”

Teacher: “Roxanne, you need to take it easy. Just calm down! Try to relax.You need to finish your reading.

Roxanne: (to herself) “Right easy for you to say, teacher. But very hard for me to do. What do you mean calm down? I feel like my head is going to explode.”

Teacher: (seeing no response) “Well if you can’t settle down, maybe a trip to the office will help you!”

Some kids are so agitated that even if they know how to relax, they can’t. If you think about it, calming down when you’re upset is the hardest time to do it! Other kids can’t “calm down” or “relax” because they don’t know what that feels like. Teachers, occupational therapists, physical education teachers and parents need to actually teach children (of all ages) how to get themselves into a physical state of being relaxed. This doesn’t happen automatically. If it did, there wouldn’t be so many adult yoga classes!

Reduce the threat.

Many students live in a state of feeling psychologically unsafe in school. Students feel threatened by a perceived or real loss of status or control. A teacher who tells a class to “behave or you’ll lose your recess” is using a threat to manage behavior. Imagine that you are a child who is behaving and anxious. She wonders: “What do I need to do to make sure I get to go to recess? I am behaving. What more is expected of me? How can I make this unpleasant feeling go away? I can’t, and I’m getting more and more anxious.”

What if the teacher is “yelling” at another student? The anxious student worries about who’s going to be next. There is no easy escape from this threat. Heart rate goes up. Palms start to sweat. Breathing grows fast and shallow. Cortisol starts pouring into the blood and makes its way to the brain. Learning and memory suffer.

What about the child who is thinking “Nobody likes me. Soon it will be lunchtime. Where will I sit? Who will accept me? How can I avoid lunch? A trip to the bathroom or the nurse? My stomach hurts. I want to call my Mom. I am supposed to be doing math now. How can I do math? I’m scared about who’s going to shove food down my shirt.”

Teachers can reduce the threat by knowing which students are particularly vulnerable to stress and make the environment safe for them. Teachers can control their language and behavior so that it’s less threatening. Kneeling down to talk to a student can be less threatening that standing over her. Making requests quietly instead of calling across a room to ask is also tolerated better by a child who gets anxious when attention is paid to him.

Teachers need to find out when kids feel most confident and least anxious, and as often as possible try to replicate those conditions in the class. For example, a student may be relaxed and talkative when he’s with his family, but communicates very little in school, especially when he’s called on to read or answer a question in class. To give the reticent student more of a chance to interact, the teacher can alternate between small group activities with whole class discussions. She can ask the student to write an answer instead of saying it out loud, or to tell a study partner an answer and then the other student can share the answer to the group.

 Decrease reliance on reward/punishment systems.

 Kids know that the teacher who giveth can also taketh away. And is this knowledge stressful to some kids! Students who work to get the rewards or avoid the consequences are using valuable energy that could be fueling learning instead. You don’t want students to be working for the reward or to escape the penalty; you want them to be learning for the joy of learning. Think about it: Behavior modification is really not that hard to do. If reward and punishment systems were really so successful, wouldn’t there be fewer kids with troublesome behavior?

The child is thinking: “Why is she getting that sticker? I want a sticker, too. I’ll sit here and do absolutely nothing wrong. I will be good. I am trying so very hard to get that sticker. Ooh! Ooh! She’s coming over here. She’s going to give me a sticker!! Um…The answer? The ANSWER!?! Er, could you please repeat the question? I didn’t hear you.” (Laughter from the class; teacher frowns and walks away.) Cortisol up, self-esteem down.

Set the mental and emotional stage for success.

 Teachers who want to reduce stress and increase learning know that getting kids into a positive mindset will do both. They say things and do things that connect kids to the security of past positive experiences. A boat in the harbor is not likely to be tossed onto a rocky shore if it is tethered to an anchor set firmly into the sandy ocean floor. Similarly, kids whose minds are re-united with the feelings associated with previous successes will be less likely to flounder in an anxious or distracted state.

Consider this interaction:

The teacher says to the class “Do you remember this? (holds up test tube filled with red fluid; a visual prop). Turn to your study partner and tell each other one thing we learned about this liquid yesterday.” Paired sharing has the following benefits:

  • enhances social interactions that the teacher can monitor and guide
  • increases information trading which promotes mutual interdependence
  • allows the anxious child a chance to rehearse a response before “going public”

“Now raise your hand if you want to say what your partner just told you.”

Telling about someone else’s idea reduces the possibility of public shame and decreases stress. Having the choice to do it reduces the stress even more.

Capitalize on the relationship between learning and feelings.

 It is clear that emotions and learning are linked. Why is it that most of us remember where we were when the space shuttle Challenger blew up, or where you were on 9/11? Why does the smell or texture of certain foods make us remember certain places or events in our lives?  Research tells us that positive thoughts enhance learning and memory; negative thoughts get in the way.

Here’s a scene from a classroom in which the teacher understands the connection between state of mind and learning. “Kids, I would like you to close your eyes (thereby reducing stimuli and putting children out of public view) and think of a time when you learned something very well and felt proud about it. This could be something academic, like fractions, or it can be something you learned to do, like a hobby or a sport. When you get that thought in your head, simply raise your index finger a bit and I’ll know you’re connected to that time and the feeling you had when you learned to do that particular thing.”

Now, open your eyes and tell us (solo or in sharing pairs) what it was that you learned and how it made you feel.” The teacher asks the kids what was going on (place, people, timing) that made this such a positive experience. Kids can also be asked to write this, or draw a picture of the event as the first step in the new assignment.

The teacher continues: “Today we’re going to learn something new” (anxiety rises). “We’re going to learn about ________. I want you to tell me, based on that positive experience you just recalled and/or talked about, what would make learning this new material successful for you?” She gives the students the choice of saying the answer, telling a classmate, or writing a paragraph about it.

By building the new activity on this foundation of comfort, the teacher hopes to lessen the stress that can be generated when taking kids into new territories.

Humor enhances learning and memory

Talented teachers know that students hang on to words in a joke because they want to hear the punch line. They also know that humor, in the form of funny stories, puns, limericks or cartoons can increase a student’s enjoyment of the activity. Students who enjoy learning are less anxious, less threatened and more likely to retain and apply what they learn. Teachers who spend time putting the lid on a funny student’s comments or antics may be missing the opportunity to use that jester as a collaborator. Teachers need to remember that sarcasm and ridicule have no place in the safe classroom. It may appear that at student can “take” the barbs tossed at him or her in class, but that’s often an erroneous assumption. That student is using up psychological energy coping with the tension created in such interchanges. Teachers also need to think about the “collateral damage” they do to the kids (especially the anxious kids) who are watching and hoping that they’re not the next “target” of this teacher’s verbal pot-shots. That student may not want to come to class, and certainly won’t want to come to see that teacher for extra help after school, where there’s no chance of escape if the teacher starts to “tease.”

Food, Water and Exercise help to decrease anxiety and stress in kids.

A study reported in the New England Journal of Medicine (Jenkins, 1989) called “Nibbling versus Gorging,” showed that students who had 17 snacks over the course of a school day did better on several measures than a matched group who ate the same quantity of food in three meals. They had had lower cortisol levels, better glucose tolerance, exhibited fewer discipline problems and had an enhanced sense of well being. Many kids don’t get enough water during the day to keep their cells functional. When kids get thirsty, they are already dehydrated. Having water available for active learners is extremely important. A brisk 10 minute walk around a college quadrangle has been shown to elevate exam scores in college students. You can build in physical activity more often during the school day. You can also teach students how to take active breaks from homework to keep their brains energized?

  Help kids get with the flow.

Csikszentmihalyi (1990) wrote a book called Flow: The Psychology of Optimal Experience (New York: Harper & Row) in which he described the following optimal mind-body states for learning.

  • Students are appropriately challenged by a personally relevant, intrinsically motivating task.
  • They are operating under a state of low stress (not no stress), in a state of general relaxation
  • They are immersed in a “flow” state in which their attention is on learning and doing.

He defines flow as a state in which skills, attention, environment and will are all matched up with the task. A teacher concerned about helping kids feel successful, not stress-full must ask: How do I create a learning environment that meets these criteria?

 Teachers can help students reduce stress by having them focus on the importance and the relevance of a task.

 This three part question can be at the heart of all learning: Why is what we’re learning important to me? to you? and to the world we live in? Activities that require students to answer these questions will build interest and lead to meaningful (and less stressful) learning. For example, students could be asked to go home and ask their parents why they think it’s important to learn about the civil war. As a way to weave humor into the task and to put this war into a historic context, kids may be instructed to ask their parents how old they were during this war. Reporting the answers can be the opening activity at the next class.

Teachers can help student overcome stress by teaching them to identify the impediments they might encounter in doing a certain task.

The teacher can ask:

What’s going to get in the way of you doing this work?

He or she may have to jump-start the students’ thinking by suggesting such things as:

competing events (family activities, friends call, IM-ing, new video game, etc.)

lack of adequate place to study

inadequate prior preparation or skills

a negative attitude (this is not necessary, I can’t do math, I’ll never need to know this, etc).

health factors (I’m sick; I’m tired)

Conversely, teachers have to teach students to identify the enhancers; What’s going to make it more likely that you will do this, and do this well?

(examples)

I have confidence in my ability

I feel competent in this skill

I am committed to learning this because:

I have the necessary resources to complete this task, such as materials, sources of information, people supports; parents, tutor, other kids

Teachers can turn distress into de-stress by using the Language of Success

 The key is to de-emphasize PRAISE and emphasize SELF-APPRAISAL

Teachers can encourage self-evaluation by asking:

How do you think you did?

Are you satisfied with this?

What goal were you working on?

Did you achieve your goal?

Consider use of simple rating scales for students who lack language of self-appraisal (and then provide the language to go with their number rating, as in:

1 = not the best work you can do

2 = work that’s OK, but not great

3 = about the best you can do

For younger kids, smiley faces might replace the numerical rating system.

When a student turns in work that is substandard (for him/her) and says: “I think this is great,

you say: “I have seen great work from you, and I have to disagree with you–this is not great work.” (the focus is on comparisons with self; personal best is the standard.)

If a student turns in work that is acceptable and devalues it, (“This stinks!)

You say: “I’m sorry that you feel this way Sean; I’ve been teaching for a long time, and what you did here definitely does not stink–I can show you some examples of lousy work if you want, but this is not it…”

This communication establishes the teacher as an impartial judge, giver of honest feedback.

Teachers should encourage students to keep an electronic or paper portfolio of work samples.

Having this “evidence” allows the teacher to say: “Here’s what you did in October. Now compare that with what you just did. (And here, resist the temptation to evaluate). Instead ask: “How would you say these are different?”

 Focus on the process more than the product:

When a child turns in work, you say:

This looks good (it’s still OK to praise — kids expect it), but also ask:

How did you do this? What did you do to make/write/construct this?

If the student can’t say, give her suggestions:

Ex: “I see that you used a word processor. Did that help you get your words down on paper without having to worry about handwriting?”

Or: “You folded your paper into fourths; it looks like the sections helped you organize your work—and helped to keep this math problem from running into this one.”

 

And get confirmation: “Would you agree?”

The goal here is to get the student to self-appraise and be able to identify the behaviors or strategies that have allowed him/her to be successful. This leads to a feeling of competence and confidence that helps keep stress in check.

Buddy Checks can reduce performance anxiety and build confidence.

 When you ask a question of the class, announce: “I don’t want anyone to answer. First I want you to turn to a study partner (buddy) and tell them what you heard me ask (helps both students to focus on the question or tasks). Then I want you to find out what your Buddy thinks the answer is. (This encourages positive social communication and mutual interdependence, and gives each student a chance to hear or verify an answer.)

Then you ask the students to “Tell the class what your buddy just said.

This allows the reticent student the opportunity to offer an answer when he/she might otherwise be silent. If the answer is wrong, the buddy shares the “blame”; if the answer is right, the anxious student shares the success.

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