Do You Want To . . . Hey, Look Over There! Strategies for Working with Children Who Have Attention Deficits

by Christopher Thurber, Ph.D., A.B.P.P.

There are opportunities to teach every child better self-control. Of course, being spontaneous — even a little out of control — is fun. It’s just that learning to listen, concentrate, and sustain attention are also important life skills. Camp is an ideal setting for cultivating self-control and controlled chaos. It offers both energetic, physical activities — such as water basketball or capture the flag — as well as restrained, contemplative activities — such as listening quietly to a story during rest hour.

As frontline staff, you need not know anything about a child's formal psychiatric diagnoses to manage attention deficits effectively. Indeed, if you focus narrowly on only those children with diagnosed attention deficits, you may miss the opportunity to teach other children better self-control . . . and better controlled chaos. What you need are practical strategies that engender motivation and help children focus. In this article, such strategies are peppered among some theoretical points that will support your understanding of attention and distraction.

What to Expect

You can expect that the children you work with this summer will vary in their ability to focus. You can also expect this ability to vary by setting. Almost every child can sustain attention while playing a video game. Indeed, that observation teaches us a lot about attention. If an activity offers early success experiences, we humans work hard to get better. If we have control over an activity's outcomes, we humans feel motivated. And if an activity is motivating, we humans tend to stay engaged, which is the opposite of becoming distracted.

Strategy #1: Design activities for all of your campers that provide small successes early on, give them a measure of control, and are intrinsically motivating. Experiencing failure is fine, but when activities are terribly difficult, right from the start, motivation and attention quickly wane. For that same reason, avoid activities that are completely directed by adults. (For more on including youth as partners in programming, see my article in the September/October 2009 Camping Magazine, "Youth as Objects or Partners? Advancing Opportunities for Camper Leadership and Decision Making.")

What about Diagnoses?

Attention Deficit Hyperactivity Disorder (ADHD) is a real diagnosis with neurologically-based symptoms. When brain structures that regulate mood, control behavior, and sustain attention do not have enough of certain helpful neurotransmitters (the chemical messengers that transmit a signal from one brain cell to another), problems result. Specifically, when a person's frontal lobes (that part of your brain just behind your forehead) do not have enough dopamine and norepinephrine circulating along key neural pathways, it results in problems with attention and concentration. When other brain centers involved in motor control do not have sufficient dopamine, hyperactivity results.

Every person's brain is a bit different. As a result, some people have a harder time sitting still and paying attention than others. Sometimes, these difficulties are so pronounced that they affect a child's functioning in multiple domains, such as home, school, with friends, and in sports. In such cases, and after careful and systematic assessment, a psychologist, psychiatrist, or physician may make the diagnosis of ADHD. The diagnosis has three subtypes: Primarily Inattentive Type; Primarily Hyperactive Type; and Combined Type (with symptoms of both inattention and hyperactivity). The good news is that behavior therapy and certain medications — ones that increase the availability of these helpful neurotransmitters — effectively treat all three kinds of ADHD, in most cases.

Strategy #2: Although you'll never have to conduct a complex diagnostic assessment for ADHD, you can collaborate with a child's treatment providers by ensuring that the young people in your care take prescription medications as directed. Be sure your campers go to the camp health center as required. In addition, do your best to continue at camp whatever helpful behavioral strategies therapists and parents have put in place at home.

So, Medications Are the Answer?

Not completely, and not for all children. Some who should be on medication are not; some take medication who shouldn't; some don't respond well to medication; and some respond well but are unadvisedly taken off medication before arriving at camp. Moreover, there is considerable evidence that behavior therapy and study skills coaching are essential complements to drug therapies.

As if this treatment picture weren't complicated enough, remember that some of your best-behaved campers will be those who have received or are receiving treatment for ADHD. In contrast to their untreated peers, these children have had practice and therapy aimed at better behavioral, emotional, and cognitive control. So rather than wishing to have no campers with ADHD this summer, remember that all children have trouble focusing, sitting still, and paying attention some of the time. And remember that treated children may be some of your most helpful, calm, and reliable.

Strategy #3: Rather than focusing on diagnoses, focus on children — all children — and have your repertoire of supportive strategies ready to go. Let the professionals in the health center worry about ongoing medical treatments. Concentrate your energies on implementing recommended behavioral strategies and responding to each of your campers' idiosyncratic needs.

Okay, I'll Look at Everyone . . . But What Am I Looking For?

Let's break it down:

  • Inattention may be manifest as messy, careless work (e.g., setting the table haphazardly), or difficulty sustaining attention in mundane tasks (e.g., camp duties) or in play activities (e.g., tennis instruction), or difficulty completing tasks (e.g., a crafts project).
  • Children with attention deficits may often appear as if their mind is elsewhere or as if they are not listening or did not hear what has just been said (e.g., rules of capture the flag).
  • Children with attention deficits may have difficulty organizing tasks (e.g., a group skit for the talent show) or following through on directions (e.g., "Go to the equipment shed, grab two soccer balls, and bring them back to the field").
  • Children with attention deficits may dislike or avoid tasks that require sustained self-application (e.g., practicing a new swimming stroke or basketball drill).
  • Children with attention deficits may shift conversation topics quickly, get taken in by extraneous noises or stimuli that others can ignore, and forget responsibilities. They may also lose things necessary for an activity (e.g., pen, paper, and envelope to write a letter home).

As a result, children with attention deficits sometimes have trouble making and keeping friends. Their behavior may become the object of negative attention from others, leading the child to become a kind of "cabin clown" or an outcast. Beware of relational aggression directed toward children with attention deficits.

  • Impulsivity may be manifest as impatience, difficulty in delaying responses, blurting out answers before questions have been completed, difficulty awaiting one's turn, and frequently interrupting or intruding on others.
  • Children with attention deficits may grab things from others without asking (e.g., taking the kickball from the pitcher), initiate conversations at inappropriate times (e.g., talking during announcements), or take unsafe risks (e.g., jumping down from a tall tree).

As a result, children with attention deficits often have accidents, get into trouble, or set a poor example for other children. Be especially vigilant about the physical safety of children with attention deficits.

  • Hyperactivity may be manifest as fidgetiness or squirming in one's seat, excessive running or climbing, or difficulty engaging quietly in leisure activities (e.g., writing).
  • Children with attention deficits may run or climb excessively in situations where it is inappropriate.
  • Children with attention deficits may be excessively talkative, appear "on the go" or "as if driven by a motor" more so than is typical for a child that age.

As a result, children with attention deficits may have more physical accidents, bowl over peers in games, and break equipment accidentally. Carefully monitor program activities in which hyperactive children are engaged.

Now That I Know What to Look for, What Can I Do?

Besides medication, psychotherapy, and the broad Strategies 1–3 above, there are a variety of additional specific strategies you can use to help all children be in control and behave well while still having fun.

  • Always gather information from each child's parents, either in-person, on a paper form that the camp sends to parents, or electronically via the camp's online registration. Ask your camp's director to share with you whatever helpful information the parents have authorized him or her to share. Some medical information may remain confidential, but other information is intentionally provided to put you in the best possible position to support the camper in question.
  • Be sure children take all medications exactly as prescribed. No changes should ever be made without consulting the prescribing physician. Yes, this is so important that I've mentioned it twice. Most severe behavioral and emotional problems related to ADHD can be avoided if campers stay on the same helpful medication during the summer that they take during the school year. This is the published guideline of the American Academy of Pediatrics.
  • Ensure that children get protein at every meal. For emotional and behavioral stability — rooted in a balance of helpful neurotransmitters — protein is essential. Eggs, meats, milk, cheeses, beans (including soy), and nuts are excellent sources of protein. Consider particular children's allergies, of course.
  • Provide plenty of safe, engaging, physical activities. Not only is physical activity fun and essential for good mental and physical health, it can also offload some of the extra energy all children possess. At the end of the day, provide some low-key activities (e.g., reading) that help children wind down.
  • Keep directions short and simple. (Like in this bullet point.)
  • Give sequential directions one step at a time. (Like in this bullet point.)
  • Give frequent feedback. Offer specific praise (e.g., "I like how you asked before you borrowed that . . .") balanced with constructive criticism (e.g., "It's not okay to take my racquet without asking . . .") to help children internalize the appropriateness of their behavior. In the interest of promoting positive social connections, help all children gain insight into how their behavior is perceived by others (e.g., "She seemed unhappy that you cut in front of her in line . . .").
  • Use diagrams (e.g., a job wheel for camp duties) to help visual learners understand their responsibilities and to help you avoid repeating the same requests. Provide reinforcement or incentives (e.g., additional free play if camp duties are completed early and well).
  • Be patient and willing to say the same thing in different ways. Try: "I'm not sure I was clear. What I meant was . . . ."
  • Stay in close physical proximity to hyperactive and impulsive children in order to contain and protect them. For example, a counselor or cabin leader might sit next to a child at a meal if that child has a history of poking other campers or getting up from the table without asking.
  • As much as possible, stick to a predictable, familiar schedule, even though the activities will, of course, vary within that schedule. All children like structure because it helps them regulate their emotions and behaviors.
  • Give two- to five-minute warnings before transitions. Try: "We'll be ending this game and heading to the pool in three minutes!" Give children extra time to get from one activity to another, especially if it involves changing clothes or equipment.
  • Help children organize their belongings ahead of time. For example, you might help a child with an attention deficit lay out his bathing suit and towel before breakfast if he's going to need it right after breakfast. • Expect some misbehavior. No child behaves well all the time.
  • Give yourself a break. No adult behaves well all the time either. If you feel your temper boiling, ask a colleague to take over. And if you do lose your temper with a camper, offer a sincere apology. Children know that adults are not perfect and they respect the ones who take responsibility for minor lapses in good leadership.
  • Always provide limits and consequences. All children must learn that they alone are responsible for their own behavior and that their behavior affects others in different ways.
  • Help children find a safe place to cool off. Whereas many younger children respond well to "time-outs," you may need to tell older children to "take a break" or design a "chill spot" where they can calm down.
  • Get in the habit of assessing needs, especially in response to misbehavior or conf lict. Ask: "What do you need right now?" and "What do you feel you want in this moment?" Answers to these unexpected questions help impulsive children self-soothe and give you the advantage of knowing what you can do to help, right then and there. As long as the child isn't asking for something that's illegal or harmful, there is probably a way you can meet their needs (e.g., fair teams), as well as yours (e.g., good sportsmanship).

Um . . . I Don't Want to Work at Camp Anymore

If every camper you had the privilege of serving this summer was ultra-highmaintenance because of enormous attention deficits and outrageous hyperactivity, you'd probably quit. Who wouldn't? It would be overwhelming. The truth is that children's behaviors vary along a spectrum. At some point this summer, you'll be applying a selection of the strategies in this article to different children. But take heart. About 93 percent of children have no major problems paying attention, following directions, and staying calm.

Think flexibly about your approach to individual children this summer and be sure that each of your campers gets a fair measure of your time. It's fine to have some favorite campers, in your own mind. After all, developing preferences is human nature. But a youth development professional knows the difference between having favorites and playing favorites. Be sure that any attention problems that emerge this summer are not the byproduct of children having to work hard to get your attention. That's a kind of attention deficit that no high quality youth program should ever possess.

Christopher Thurber, Ph.D., is a board certified clinical psychologist and the co-founder of ExpertOnlineTraining.com, which hosts educational content for youth development professionals. He designed The Secret Ingredients of Summer Camp Success, ACA's homesickness prevention DVD. Contact: chris@campspirit.com or visit CampSpirit.com.

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