Before the Diagnosis: Reframing Behaviour and Reducing the Stress Load

By Laura Newell

Last week, I had an email from my son’s senior kindergarten teacher informing me that he’s been having a tough time in school. This led to a phone call, where we discussed some of the challenges happening both at school and at home. His teacher mentioned that some of what she’s been observing aligns with

characteristic ADHD behaviours. This was no surprise to me, as I see what we consider typical ADHD behaviours at home, too. She also made sure to note that she’s not a doctor and is by no means trying to diagnose anything, but wanted to give me the most comprehensive idea of what was being observed as possible.


I was happy that she brought these issues to my attention, as it lays the

groundwork for us to work together to support him, and to support each other.

She shared some of the strategies she and her ECE teaching partner have been

using to try to help him reduce his stress in the classroom, and I shared some of

the strategies we’ve been trying at home. I’m very thankful for their

understanding, compassion, and soft eyes.


But even as we work together, I can’t help but get caught up in the mention of a

potential ADHD diagnosis down the line. What would that mean for my son?

What effect would that have on his school and social experiences? How might it

impact our family? I decided it was time to re-read “The Self-Reg View On:

ADHD” by Dr. Stuart Shanker, to help me make sense of this idea and to help me

figure out where we go from here.


One of the main messages I took from this article is that ADHD, in many cases,

needs to be reframed. In my son’s case, regardless of whether or not he has true

ADHD, we need to keep working on helping him to reduce his stress. My husband

and I need to focus on ensuring our parenting is authoritative and consistent, and

we need to consider stressors in all 5 Domains as we work together to reduce

some of the stress that might be causing our son to feel overwhelmed. But after

studying Step 3 in more depth over the last few weeks, I also recognize that it’s

much more complex than simply ‘reducing’. We need to reduce, yes, but in some

areas, we also need to increase the positive stress. Sometimes I need to get him

outside to race around the block. Sometimes he needs to do an activity circuit.

Sometimes he needs to read a book that challenges him a little bit.


Another message that stood out for me was the idea of ‘over-diagnosis’, which

led me to think about the fact that over-diagnosis has likely been exacerbated as

a result of the pandemic. If symptoms we use to diagnose ADHD are also typical

behaviours seen in young children, and young children have been exceptionally

over-stressed as a result of COVID, with little to no social interaction with their

peers that would normally be typical for children this age – how does that impact

their behaviours?


For my son in particular, I’ve been reflecting on how in some instances, he doesn’t

appear to have much empathy. This is not always the case, and in some

situations, he actually shows an incredible amount of empathy – often even more

than most. I’ve learned however that a child who appears to have no empathy

might actually be so overstressed by someone else’s distress, that they shut

down. My son has been very worried about death and dying over the last year –

and his worry seems to elevate whenever there’s another lockdown, or when he’s

moved back to virtual learning, or when hockey is cancelled, or when he’s told he

can’t see his friends for a little while due to COVID restrictions. How has this

worry around COVID, and the knowledge of the eventual death of loved ones,

impacted his prosocial stress level? How has this high level of prosocial stress

impacted his stress load in the other 5 domains? It reminds me that in these

moments where he appears to have no empathy, we must focus on reducing his

stress load, and resist the urge to attempt to have any kind of ‘teachable

moment’.


To support my son in reducing his stress, I also need to be aware of my own

stress, and the impact it has on my ability to co-regulate. This is a big piece that

can easily be overlooked when trying to support children. We often focus on the

specific child, or the specific symptom, and we forget to look outward beyond

them, or inward within ourselves. We can’t remove all of their stress, and we

can’t remove all of our own stress – but we can chip away at some of the stress

that’s impacting us negatively.


This article has reminded me of the importance of trying to understand my son’s

behaviours, versus trying to suppress them. We know that behaviour is

communication, and we need to pay close attention to what his behaviour is

telling us. I have a creative, curious, delightful little guy who has been showing overt signs of frustration, anger, sadness, and fear. His stress load is too high, and

while there is no magic quick-fix for reducing his stress, I am committed to using

Self-Reg to try to help reduce the stress load where we can, and to offer him

opportunities to restore. I recognize that I must look for subtle signs of

improvement, and I need to commit to using the Self-Reg process long-term. This

is how I will help him reach his full potential as he grows, regardless of whether or

not an ADHD diagnosis pops up for him somewhere along the way.

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