Monday, November 26, 2012

ADHD - self control , CPS and mindfulness

I recently read an article on ADHD interventions which can be described as mindfulness in action. 

This is a lot different from the traditional Barkley interventions of rewards, consequences etc which are supposed to compensate for the lack of intrinsic motivation, but essentially don't teach any skills and in the long run they  ( rewards ) undermine intrinsic motivation.

Barkely sees ADHD as ' self-control or self inhibition disorder. If I understand him correctly the ability to inhibit response enables the 4 executive functions ,- nonverbal working memory , verbal working memory= privatization of speech, privatization of emotion which is the source of intrinsic motivation , and playing with ideas-problem solving. 

ADHD kids lack the ability to privatize emotion , the source of intrinsic emotion and need to be compensated by extrinsic motivation. He says cognitive therapy does not work because it assumes the presence of verbal working memory=privatization of speech. 

Others disagree with Barkley. Dr Ross Greene shows that how engaging kids in the collaboration problem solving process many of the kids lagging skills such as executive functions, social skills, language processing skills, cognitive flexibility and emotional regulation skills are taught in an indirect way in a dynamic environment and in the context of real problems.

Attention and self talk skills can be taught in a more direct way by teaching ' mindfulness for children'. In this way kids become more reflective rather than impulsive.

In an article by Dr Ofer Timna , a kid with ADHD is taught to eat chocolate in a mindful way , taking his time by reflecting on taste, texture, smell etc and delay swallowing the piece of chocolate.

Blowing up balloons helps a kid learn to be attentive and monitor his actions and avoid popping the balloon. The balloon could be used to animate how his friends react to his irritating behaviors.

We see from here that self control and inhibition has less to do about self discipline and delaying gratification but more about activating the prefrontal lobe and get the kid into a thinking, reflecting  and problem solving mode.
This is also what Walter Mischel found about kids who participated in his famous "Marshmellow experiment.
Four decades ago, in the Stanford University laboratory of Walter Mischel, preschool-age children were left alone in a room after having been told they could get a small treat (say, a marshmallow) by ringing a bell at any time to summon the experimenter -- or, if they held out until he returned on his own, they could have a bigger treat (two marshmallows).  As the results of this experiment are usually summarized, the children who were able to wait and exert good old fashioned self control , scored better on measures of cognitive and social skills about a decade later and also had higher SAT scores. 

What mostly interested Mischel wasn’t whether children could wait for a bigger treat – which, by the way, most of them could – and whether waiters fared better in life than non-waiters, but how children go about trying to wait and which strategies help.  It turned out that kids waited longer when they were distracted by a toy.  What worked best wasn’t “self-denial and grim determination” but doing something enjoyable while waiting so that self-control wasn’t needed at all.     - mindfulness for children

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