Repost: The Critic

contemplationAs much as I think I have “accepted” my children’s learning challenges, I forget that I still have The Critic living in me as well. The voice of acceptance is calm and even soothing at times. It has been cultivated and reflects flexibility and surrender to what is in me and my children, rather than rigid ideas of what “should” be true. “The Critic”, on the other hand, is loud and harsh and, at vulnerable times, unrelenting. Three kids with ADD? Yeah, right! You’re just a bad mother. ADD? Not! Rather, it must be LMS (lazy mother syndrome). Maybe you are imagining all this because you are in the mental health field. Maybe you jumped the gun in terms of assessment and intervention and maybe all this HELP has actually created the problem. Maybe it is your hyper-vigilance with the oldest, the Sudafed you took for a bad sinus infection when pregnant with the second child, or the way the youngest baby turned blue as she left the birth canal and needed oxygen… Or, most benignly, maybe it is just your screwed up DNA.

It does not matter that we have consulted with experts in the field many times over the years to see if the ADD and related learning problems are our imagination, the validation we desperately need to avoid self blame. It doesn’t matter that we have been told that this is genetic or simply how they are wired. I still find myself living with chronic doubt. I don’t like to admit that The Critic is always nearby, but it is.

This week my 16 year old son endured his second full neuropsychology testing. The last time was in seventh grade when he came to me saying “something is wrong with me. I don’t learn like other people.” Well three years later with puberty completed and after a head injury 18 months ago, my son has a very different perspective. “I just don’t believe in all that stuff and I think those tests are stupid.” After my son was first diagnosed by his pediatrician with ADD at age 11, in 6th grade, we tried a stimulant medication but before we could get to a therapeutic dose, the side effects were overpowering. He couldn’t even go to school because he felt so sick. Definitely counterproductive. We didn’t try any other medications for the next year because part of me wondered if he really did have ADD or if, perhaps, he could “grow out of it.” It was a year later that we had him fully tested and felt better knowing that the ADD diagnosis was confirmed in this way. Over the next couple of years we would try Concerta, Methylphenadate XR, Adderal, Focalin, Stratera, and the Daytrana patch. My son is sensitive to medication and could not tolerate any of them.

Over time The Critic would sneak in thoughts like “Maybe it’s just adolescence” or “I grew out of my ADD like behavior and learned to compensate and so will he” or “It’s just brain development and will go away as he gets older.” The Critic also slipped in judgements about how my early parenting actually could have created the ADD behavior and eventually led to his giving up any attempts to do well in school. Then Jake had a mild traumatic brain injury just days before he was to start high school. The effects of the head injury? Lots of symptoms at first such as a tremor, scars on his face, headaches, trouble sleeping, depression and anxiety, but most of these went away. What is left, however, is a magnified version of his ADD, or so we think. When something is invisible it is really hard to feel certain. So, Jake’s neurologist ordered the neuropsych testing that he endured on two separate days of his spring break. First thing in the morning.

After the first day my son said “Mom I was so sleepy during the testing that I seriously think it should be invalidated and just thrown out. I did so bad.” I explained that most teen brains are sleepy in the morning. It’s just how it is. And I encouraged him to tell his thoughts to the neuropsychologist. For the second day of testing Jake did seem more awake as we left for the appointment. And at the end of that testing session we were called in to the office together for some preliminary impressions. Jake had shared his thoughts about the first day of testing. The neuropsychologist assured him that while his scores were lower than last time, each IQ test result was a snapshot in time. Not very reassuring to a teenager. Also, she said, what she was mainly seeing were significant problems with attention and learning, with input and encoding. Processing speed was so-so, just mildly an issue. Also not very reassuring. “It’s too bad that you haven’t been able to use medicine,” she said. “There are lots of other things that can help, but medicine can make such a difference for people like you.” Jake just stared in her direction. He is a polite boy, but I could feel the hostility in his silence. Embarrassment rose up through my body. I could tell that she could tell that Jake was not happy and it was awkward. Maybe if she had said something, anything, about his strengths Jake would have been more receptive, but no. She was not at all mean, but direct and to the point about his weaknesses. Hard for anyone to hear. She then said “I also saw evidence of some anxiety Jake” and went on to explain that at times when he asked to do something it seems he is overwhelmed and “freezes.” “No. I don’t think I have a problem with that at all” was Jake’s quick response, quietly maintaining eye contact. Soon after this we left. It turned out that during one test, the neuropsychologist had said to Jake “Boy, you’re really bad at this.”

I felt terrible that Jake had been subjected to such insensitive feedback, that the neuropsychologist did not seem to have the clinical skills to know that this information needed to be carefully given. Instead, somehow I felt that Jake had been wounded and that I had allowed that to happen. However, driving to work later that day, I realized that I also (once again) felt relieved because, based on the testing, Jake’s ADD is very real, a very real hinderance to his accessing traditional learning. Unfortunately, this is the type of learning that is expected of him now in high school and I want him to be able to go to college. My mind then starts going crazy with thoughts of the possible consequences of his not being able to do these things, such as depression, anxiety, drug addiction, and so on. What do you do when your big teenage son refuses to accept his diagnosis and take it as an opportunity to get help?

And it is in this moment that I realize the motivating force behind The Critic. It is fear. I am so afraid for my boy that I turn to blame and the easiest target? Myself.

 Rachel Penn Hannah is a clinical psychologist living in the San Francisco Bay Area with her wonderful husband and three kids, ages 12, 15, and 17. When not mothering, working, driving, cleaning or losing her mind, Rachel tries desperately to find time to write and do yoga. 

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One thought on “Repost: The Critic

  1. Unfortunately, you can’t do much with your big teenage son who refuses to accept his diagnosis and help — you’ve not choice but to let him fail and hope he’ll be willing to accept help afterwards. Neither mom nor dad can do the accepting of help/the diagnosis for him.

    It probably wouldn’t hurt to point out that something like 15% of the population has ADHD/ADD, so he’s far from alone. That taking meds for it is no different than taking meds for, say, diabetes or depression, i.e. when a body can’t make an essential chemical, getting it via medication is the next best thing.

    Just keep telling him that help is available, and you’d be thrilled to assist him in getting it whenever he’s ready to do so.

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