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Book Review: Overcoming ADHD by Stanley I. Greenspan, M.D., with Jacob Greenspan

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"If you take your eye off of him for a second, he'll be up on the roof!" I will always remember these words from my Grandma Mary in her charming German-Hungarian accent spoken after she babysat my son, who was two years old at the time. While her words were an apt description, they came as no surprise. My son has Attention Deficit Hyperactivity Disorder (ADHD). Later his two sisters, 16 months and six years younger respectively, were also diagnosed with ADHD. All three are now happy and healthy, self-supporting young adults in their 20s.

Overcoming ADHD: Helping Your Child Become Calm, Engaged, and Focused — WITHOUT A PILL by Stanley I. Greenspan, M.D., with Jacob Greenspan is a short, to the point, easy to read book promoting behavioral strategies to consider before seeking medication for ADHD. This book will be helpful to parents of young children who have been diagnosed with ADHD (or ADD) and to parents of undiagnosed children who display some degree of what I call 'ADD-ishness'. Kids with 'ADD-ishness' can be highly self-directed or independent (what some people call stubborn or self-willed), forgetful, very active, and have difficulty following direction and paying attention. (Sound like ADHD?) These types of children also require a higher level of parenting skill as do children formally diagnosed with ADD or ADHD.

With about '80 years' in the parenting trenches with my three kids and as a Licensed Marriage and Family Therapist, I sought out information early and often on Attention Deficit Disorder. I have read dozens of books and attended well over 100 hours of continuing education (CEU's) on the subject of ADD and ADHD. I agree with Dr. Greenspan that the first line approach to working with most children with ADD is not medication. (My three each began medication in their teens, when academic demands became overwhelming.)

In my professional work for over 20 years with couples, families, and parenting, I encourage a very careful and thought out approach to the use of medication for children to address ADHD and similar issues. At the same time, I understand there are broad differences in family structures, parenting strengths, school systems, community and family support systems, and the individual children — all factors which combine to influence medication decisions.

That being said, the author presents a basic description of ADHD and examples, along with behavioral strategies and activities that can be practiced to help build strengths and reduce the impact of ADHD on the child and his family, often without the use of medication. Greenspan encourages parents to consider how these strategies might be effective for them before making a medication determination.

Millions of children and adults have been diagnosed with ADD, with estimates that from 1 to 20% of children have this disorder. The author proposes that there are two ways to think about the disorder — as a feature of the human nervous system and as a learned process.

"The way that I and many of my colleagues who work with children prefer to think about attention is that it's a dynamic, active process involving many parts of the nervous system at the same time. Attention involves taking in sights and sounds in touch; it involves processing information; it involves planning and executing actions." (Page 5)

Greenspan identifies seven key goals to address ADHD:

1. Strengthening motor functioning
2. Helping the child plan and sequence actions and thoughts
3. Modulating a child's response to sensation

4. Reflective thinking
5. Building self-confidence
6. Improving family dynamics
7. A healthy environment

As a family therapist, my favorite section is Chapter 9 — Family Patterns (of course). In understanding family patterns, Greenspan notes that the skill and patience of parents and the way they interact with their children plays a huge role in how the child learns to pay attention.

In this chapter, the author points out fundamental ways in which parenting shapes the direction of a child with ADHD. (And certainly, parenting direction is shaped by the child's behavior.) Here are four major points from Greenspan's book which parallel my experience, either professionally or personally.

• Raising a child with attention problems can be very frustrating. Yet there is much that parents can do to create the kind of common supportive atmosphere that helps children engage and focus. (Page 119)• When parents' response to the child's behavior is to put their feelings directly into action without a lot of forethought and counter the child's impulse of actions with their own impulsive actions, this can only escalate the situation. (Page 120)
• Parents of children with special needs have a hard time hanging in there together and working out their problems. (Page 124)
• … parents and other caregivers (must) work together as a team. For parents, this means having regular time with each other in the evening not just to discuss the child but also to nurture one another. If they feel unappreciated and unloved, they will have a hard time summoning the patience and energy to meet the child's needs. (Page 128)

The book outlines a series of specific activities to address each one of the seven key goals to deal with ADHD. The activities are all very doable and may be familiar as common play activities, but can be shaped to address facets of attention difficulties. Throughout the book the author provides sidebar boxes of tip summaries such as the General Principles for Improving Self-Esteem on a page 115. Chapter 10 is dedicated to The Role of the Physical Environment.

At the end in Chapter 12, How to Identify When Additional Therapy and Medication Are Needed, Greenspan proposes a steady family effort over a six-month period of time using his behavioral strategies. After the family has worked with the approaches outlined in his book for six months and the child does not show gradual improvement in progress, he recommends seeking professional help.

Greenspan suggests consulting professionals who specialize in particular areas and identifies a number of specialties. I would add the specialty of Licensed Marriage and Family Therapists familiar with ADHD to the list of professionals to consult for work with strengthening the parents' (or other caregivers') bond and to identify family dynamics — work crucial to shaping family interaction to support ADHD progress. Families can find qualified family therapy professionals in their area through The American Association for Marriage and Family Therapy, and other professional organizations will have similar websites for information and referrals.

Lastly, a special section of this book offers a 17-item Sensory Processing and Motor Abilities Questionnaire. This instrument is useful along with sections for Further Reading and Resources. The Index also will help readers locate specific topics of interest.

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