Zachary Marsh has been an ADHD Coach and Behavioral Specialist for over 12 years. He customizes his programs for children, adolescents and adults through unique exercises, to help them foster skills to help them attain executive control over their behavioral and emotional states in response to external stimuli. Through these practices, clients guide their own actions and understand the consequences.
Momstamp sat down with Zac to understand more….
Tell us about your journey
Throughout my childhood and adolescence, my parents noticed an impulsive nature to my behavior, an inability to inhibit my initial emotional responses to particular situations, and difficulties in certain executive functioning areas in multiple domains of my life. It would not be until my later years that I would be assessed and formally diagnosed, thus suffering from not having the appropriate treatment and support systems in place during my childhood and adolescence. The theory and practice of current treatment modalities address the neuro-biological, psychosocial, environmental inter-relatedness between symptoms, impairments, and treatment. Fundamentally, as a result of the times, this was not available when I was a child. As I have got older, and as the field has made incredible advances in the research and practice of ADHD treatment, I have benefited tremendously in all areas of my life. For 12 years along this continuum I have dedicated myself to contributing to the field of ADHD assessment, treatment, and research in any way that I can. Specifically, I have been able to create this ADHD Coaching and Behavioral practice devoted to helping those whose children, adolescent, or adult may be suffering from the symptoms of ADHD and need access to the treatment modalities that I did not have available when I was younger.
I think my child might have ADD or ADHD– what am I looking for?
The assessment, diagnosis, and treatment models of Attention Deficit Hyperactivity Disorder are all multi-dimensional in nature as is the disorder itself. Parents can begin to suspect that their child may have ADHD when consistent difficulties arise with inattention and or hyperactivity/impulsivity in more than one area of their child’s life and functioning. The effect ADHD has on executive skills is evident in the difficulties children have in regulating their behavior and emotional expression, particularly in situations that enforce rules, time constraints and delayed gratification on the child. Furthermore, characteristic symptoms are seen particularly in situations requiring focused attention over a duration of time, following rules during social interactions, and situations wherein performance of a particular task may not have an immediate reward associated to it. Early in the child’s life the parent will begin to note these characteristic difficulties that are beyond the threshold of what is age appropriate for that child.
So, what should I do next?
A successful, accurate, and comprehensive assessment by a professional who has extensive experience in the field of ADHD research, practice and the assessment processes is critical to the long term success of those children thought to have ADHD. For the parents’ that I work with, for example, who on the first session tell me that their child has ADHD, I assess if the situation requires formalized testing. After discovering that impairments in executive skills as well as hyperactive/impulsive or inattentive behaviors are occurring across multiple domains, then I will refer my client to a colleague who only does evaluations and assessments. Specifically, I will refer the client to a child neuropsychologist with the caveat that they administer an executive functioning scale, which when compared to executive functioning tests are not only cheaper but more accurate in the assessment of predicting the impairments in life activities. After the assessment and now with the diagnosis treatment resumes with my client. Although not recommended for the evaluation itself, general internists and pediatricians are great sources for those parents who are looking for possible referral sources in the hopes of maybe having their child assessed for ADHD. They will be able to notice the more obvious indications that a child may have ADHD and that it is worth further assessment. The key is to find someone who is extremely knowledgeable in the field of ADHD and executive functions and have them do a general assessment. Then, parents can either continue with that person or allow them to refer you to their colleague, this often begins a process whereby after diagnosis treatment could begin with the person who performed the initial assessment. Otherwise they can ask for another referral source and they can now know that they are within a circle of individuals all extremely knowledgeable, well-practiced, and researched in ADHD and Executive function assessment and evaluation.
My child has a playdate with a friend with ADHD– how do I best prepare?
I tell parents’ of children with ADHD who are concertedly working on good social skills to look for four major social skill difficulties that may arise during playdates. Firstly, parents should note the manner in which their child initiates play with their friend, paying particular attention to his/her ability for rule following, taking turns, and displaying point of performance listening to the needs of their friend relative to the activity. Secondly, because of the difficulties with self-control, this often prevent children with ADHD from being able to see the long term benefit of listening to their peers during conversations as well as inquiring about how they feel, why they feel that way, and reflecting upon their own feelings and interest in these conversations. Parent’s need to look at the conversational dynamics during playdates for the long term benefit of building lasting friendships between their child and his/her friend. The effective application of the social skills that children with ADHD are aware of can be particularly taxing during conflict-resolution scenarios. Specifically, although they are able to interpret the intent behind a playmate’s actions who is upset, social-cognitive deficits make it difficult for them to be able to find and effectively communicate the social response most appropriate to making their playmate feel heard and resolving the situation. Parent’s need to be particularly aware of these conflict situations and intervene when they pass the threshold of talking and enter aggressive modes of communication. Lastly, with the idea of fostering positive peer interactions and social skills, I tell my client’s to pay particular attention to the capacity of their children to share their toys and objects of affections with their friends.
Transitions between emotional states can be a difficult task for children with ADHD, however, delay of gratification for the purpose of building lasting friendships is why this is an area of both concern and interest. The construction of the playdate is extremely important for the ability to foster a dyadic friendship between a child with ADHD and a non-ADHD child (or another ADHD child with positive peer regard) that is lasting and meaningful can protect, long term, against some of the social difficulties over time. Consequently if your son or daughter is having a friend over who might have ADHD it is very important to speak with his or her parent before the two children even see each other. In that conversation it is prudent to ask if there is any structure to the playdate that they might prefer and if so, are there any restrictions or allowances that you should be made aware. For the parents’ of an ADHD child, they may ask you to make written notes of the aforementioned four areas of potential social skill problems that may arise during the playdate. Additionally, they may ask about the social behaviors and play style of the non-ADHD child in order to both prevent conflict and increase the probability that the playdate will be the start of a potential friendship. For, example if the social behaviors of the non-ADHD child are naturally aggressive, then this is not going to be the ideal candidate for a child with ADHD who already has difficulty inhibiting primary emotional responses to events as well as refraining from aggressive behaviors. This necessary question from parents of children with ADHD is vital for the continued progression of the social skills training that the child may be working on at home as well as avoiding negative peer regard in the community.
For the initial playdate, it is best to structure purposeful play activities that either involve parent assistance or direct supervision i.e. going to a movie, building a model car to test at a park, or going swimming in the pool. Either way, for the initial playdate, to decrease the probability of conflict and to have someone the ADHD child can model their behavior after, parental supervision/participation should be present at all times. Creative play, within the guidelines of the structured playdate, is beneficial for both children so long as there is not an exponential increase in goofiness, physical play, and loud conversations. Whereas the non-ADHD child will be able to inhibit the impulse to continue this style of play and contemplate the likely outcome, the child with ADHD will unfortunately may not be unable to utilize his working memory and foresight to predict such an outcome. Ultimately, so long as the play activities are structured and purposeful, a parental figure is participating or present at all times then the playdate should be an exciting and fruitful occasion for both children.