Stephen Grcevich, MD!

Director of Strategic Initiatives, Key Ministry!Awana 2014 Ministry Conference!First Baptist Church, Oxford, MS!

August 23, 2014!

Helping Kids With ADHD to Grow Spiritually

Learning objectives:

¨  Review our current medical understanding of the causes of functional impairment seen in persons with ADHD

¨  Explore how our ministry environments represent obstacles to church participation and spiritual growth in children and adults with ADHD

¨  Discuss strategies for promoting spiritual growth in persons with ADHD

¨  Identify gifts and talents often associated with ADHD that may be channeled for Kingdom purposes

What is ADHD?:

¨  ADHD is a neurodevelopmental disorder characterized by an age-inappropriate degree of inattentiveness and disorganization, and in some, but not all instances, impulsivity and hyperactivity

What causes ADHD?:

¨  Genetics is primary factor…many genes appear to make minor contributions

¨  Environmental toxins (lead) ¨  In-utero environmental toxins (drugs, alcohol,

cigarettes) ¨  Trauma ¨  Prematurity ¨  Technology?

ADHD facts and figures:"

¨  11% of U.S. kids ages 4-17 have been diagnosed with ADHD…88% continue to carry the diagnosis"

¨  14% of kids in Mississippi have ever been diagnosed with ADHD, 10.9% currently diagnosed"

¨  Highest prevalence in southeastern U.S."¨  69% are currently being prescribed medication

but…the majority do not take medication on a daily basis"

¨  42% increase in parent-reported prevalence since 2003"

¨  Many have “comorbid” mental health conditions" U.S. Centers for Disease Control

Executive functioning as the fundamental difference in persons with ADHD?

¨  Executive functions…cognitive abilities involved in controlling and regulating other abilities and behaviors

¨  Necessary in initiating goal-directed behavior, regulating emotions, delaying gratification, planning future behavior

¨  Children with weaknesses in executive functioning have more difficulty foreseeing outcomes of behavior, adapting to new situations.

Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

Key executive functions:

¨  Behavioral inhibition ¨  Verbal working memory ¨  Non-verbal working memory ¨  Emotional self-regulation ¨  Reconstitution

Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

How might ADHD affect one’s spiritual life?"

¨  Behavioral inhibition: sitting through a worship service"

¨  Nonverbal working memory: remembering my Bible when it’s time to leave for church"

¨  Verbal working memory: the ability to pray silently"

¨  Emotional self-regulation: immediately react negatively to demands from authority"

¨  Reconstitution: Managing time, priorities… Skipping AWANA because homework’s not done."

¨  Can I use the computer without viewing pornography?"

¨  Forgetting to register my kids for the weekend retreat"

¨  The ability to memorize and meditate quietly upon Scripture"

¨  I scream and yell at my spouse and my kids, overreact when imposing discipline"

¨  Difficulty applying Biblical truths, wisdom in daily life"

Children/teens: !! Adults:!

Problems with internalization of faith arising from ADHD: ¨  Kids struggle to maintain a spiritually disciplined life ¨  More difficulty meditating quietly upon God ¨  May give up on Bible study when it becomes tedious ¨  Difficulty delaying immediate gratification for long-term

spiritual outcomes

Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

Problems with stability of spiritual growth arising from ADHD:

¨  Poor self-regulation increases vulnerability to negative environmental influences

¨  Tend to have intense spiritual experiences at VBS, camp, mission trips that fade when spiritual context is gone

¨  More prone to “roller-coaster” spirituality ¨  Shunned for volunteer, leadership opportunities if perceived

as undisciplined, disorganized ¨  Drawn to religious contexts that are more participatory,

action-oriented, relational (better doing than talking)

Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

Challenges presented to the church by persons with ADHD:

¨  Balancing worship that’s engaging, but not overstimulating ¨  Pastors, ministry leaders lack training, experience in

working with kids with ADHD

¨  Church environments less structured than school

¨  Parents choose not to use, or physicians discourage use of effective medication on weekends

¨  Many activities occur when medication has worn off or rebound is occurring

Ministry strategies for persons with ADHD: ADHD-friendly environments"

¨  Registration/sign-in needs to be orderly"

¨  Staffing for transition times before/after services"

¨  Use of color, lighting"¨  Engaging, not overwhelming"¨  Communication strategies…

reinforce key point(s)"¨  Use of touch, nonverbal cues"¨  Family worship experiences

geared to kids? ""

¨  Is signage, direction clear?"¨  Use of music, technology"¨  Physical environment shouldn’t

become a distraction"¨  Flexibility in dress code"¨  Simplicity in communication"

Children/teens: !! Adults:!

http://drgrcevich.wordpress.com/2010/10/22/harmony-hensley-welcoming-ministry-environments-for-kids-with-adhd-part-two/"

ADHD-Friendly Ministry Environments"

http://drgrcevich.wordpress.com/2010/10/22/harmony-hensley-welcoming-ministry-environments-for-kids-with-adhd-part-two/"

ADHD-Friendly Ministry Environments"

ADHD-UNFRIENDLY ministry environments!"

ADHD-UNFRIENDLY ministry environments!"

Ministry strategies for persons with ADHD: Discipleship"

¨  Church and parents as partners in teaching kids about God"

¨  They’ll learn and retain more in 1:1, small group situations"

¨  Ministry resources need to be sent directly to parents…role for technology?"

¨  Where can they be involved in meaningful service?"

¨  Connecting them with others in the church especially important"

¨  Break Scripture into smaller, manageable parts"

¨  Study guide format for sermon notes"

¨  Small groups offer multiple accountability partners"

¨  Where can they be involved in meaningful service?"

¨  You have to remind them if you want them to come"

"

Children/teens: ! !! Adults:!

What can I do to help someone I love with ADHD come to faith, grow in faith?"

¨  Spend time with your child one on one or as a family praying together, studying the Bible together"

¨  Make Jesus, Scripture interesting by sharing from your experiences"

¨  Seek opportunities for your child to serve in ways that fit their talents, gifts"

¨  Attend church regularly" "

¨  Invite them to church (or remind them to come)"

¨  Go with them to a church where they’re more likely to have a positive experience"

¨  Pray, study the Bible, serve with them"

¨  Connect them to others in the church who will accept them, follow up with them"

My child:! My spouse, sibling, friend:!

What advantages might ADHD provide a follower of Christ?

¨  Willingness to take chances for God ¨  May be very energized by topics or ministry

activities that capture the imagination ¨  May be very effective in ministry teams when others

have complimentary organizational skills ¨  Ability to engage others useful in sharing the Gospel ¨  Good at scanning environment for trends ¨  Is ADHD overrepresented among senior pastors?

Conclusions:

¨  Churches may promote spiritual growth in kids with ADHD by…

1.  designing ADHD-friendly ministry environments 2.  resourcing parents for 1:1 discipleship 3.  providing opportunities for meaningful service 4.  demonstrating intentionality in promoting relationships

with others in the church

Questions?"

Key Ministry provides knowledge, innovation and experience to the worldwide church as it ministers to and with families of children impacted by mental illness, trauma and developmental disabilities. !

Stay in Touch!"Key Ministry Website: http://www.keyministry.org"Church4EveryChild…Key Ministry Blog: http://drgrcevich.wordpress.com"Key Ministry Training Channel: http://go.mediasocial.tv/keyministry"Front Door (Online Church Campus): http://go.mediasocial.tv/cbcfrontdoor""""""www"

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http://www.facebook.com/keyministry http://www.pinterest.com/keyministry/

http://twitter.com/#!/drgrcevich http://twitter.com/#!/KeyMinistry

Additional Resources on ADHD:"Church4EveryChild…Steve’s Key Ministry Blog:"http://drgrcevich.wordpress.com""ADHD and Spiritual Development Blog Series (including Barkley video):""Blog post:" http://drgrcevich.wordpress.com/2010/09/12/how-are-kids-and-teens-with-adhd-different/"

"Key Ministry"http://www.keyministry.org""AACAP Resource Center-ADHD"http://www.aacap.org/cs/ADHD.ResourceCenter""""

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ADHD: DSM-5 Criteria for Predominantly Hyperactive-Impulsive Type"

Six or more of the following manifested often:

Impulsivity/Hyperactivity

Impulsivity!¨  Blurts out answer before

question is finished"¨  Difficulty awaiting turn"¨  Interrupts or intrudes on

others"

Hyperactivity!¨  Fidgets"¨  Unable to stay seated"¨  Inappropriate running, climbing

(restlessness)"¨  Difficulty in engaging in leisure

activities quietly"¨  “On the go”"¨  Talks excessively"

American Psychiatric Association. DSM-5, 2013.

ADHD: DSM-5 Criteria for Predominantly Inattentive Type"

¨  Inattention to details/ makes careless mistakes"

¨  Difficulty sustaining attention"

¨  Seems not to listen"¨  Fails to finish tasks"

¨  Difficulty organizing"¨  Avoids tasks requiring

sustained attention"¨  Loses things"¨  Easily distracted"¨  Forgetful "

Six or more of the following manifested often:

Inattention

American Psychiatric Association. DSM-5, 2013.

ADHD in Preschoolers (Ages 3–5):!

¨  Motor restlessness (as if “driven by a motor”)"¨  Difficulty completing developmental tasks (e.g., toilet training)"¨  Decreased and/or restless sleep"¨  Insatiable curiosity"¨  Family difficulties (e.g., obtaining and keeping babysitters)"¨  Vigorous and often destructive play "¨  Demanding of parental attention, argumentative"¨  Delays in motor or language development"¨  Excessive temper tantrums (more severe and frequent)"¨  Low levels of compliance (especially in boys)"

Campbell et al. JAACAP 1984;23:243. Greenhill. J Clin Psychiatry 1998;59(suppl 7):31. Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.

¨  Easily distracted"¨  Unable to sustain attention"¨  Homework is disorganized, incomplete, contains careless

errors"¨  Blurts out answers before question completed (often

disruptive in class)"¨  Often interrupts or intrudes on others"¨  Often out of seat, acts like the “class clown”"¨  Perception of “immaturity” (unwilling or unable to complete

chores at home)"

ADHD in School-Age Children (6-12):!

Greenhill. J Clin Psychiatry 1998;59(suppl 7):31. Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.

ADHD in Adolescence (Ages 13–18):"

¨  Excessive motor activity tends to decrease"¨  May have a sense of inner restlessness (rather than

hyperactivity)"¨  School work disorganized and shows poor follow-through;

fails to work independently"¨  Engaging in “risky” behaviors (speeding and driving mishaps)"¨  Difficulty with authority figures"¨  Poor self-esteem"¨  Poor peer relationships"¨  Anger, emotional lability"

Greenhill. J Clin Psychiatry 1998;59(suppl 7):31. Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.

¨  Disorganized, fails to plan ahead"¨  Forgetful, loses things"¨  Difficulty in initiating and finishing projects or

tasks"¨  Misjudges available time"¨  Makes impulsive decisions related to spending

money, travel, jobs, or social plans"¨  Inattention/concentration problems"¨  Poor anger control"¨  May have job instability and marital difficulties"

ADHD symptoms in adulthood:"

Greenhill. J Clin Psychiatry 1998;59(suppl 7):31. Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.