Inclusive
Ministry
for
Children
with
ADHD
and
Autism
Spectrum
Disorders
Presented
to
the
Southeastern
MN
Synod
Convention,
May
5,
2012
By:
Susan
C.
Jenkins,
MD,
DFAPA
Child
and
Adolescent
Psychiatrist
[email protected]
Bluestem
Center
for
Child
and
Family
Development
124
Elton
Hills
Lane
NW,
Rochester,
MN
55901
Phone:
507/282‐1009
1.
Introduction
to
ADHD
and
Autism
Spectrum
Disorders
(ASD)
A.
Both
are
very
common
–
How
many
children
are
in
your
program?
ADHD
is
found
in
7%
of
school‐aged
population
of
Olmsted
County.
Autism
spectrum
disorders
–
1.1%
of
school‐aged
population
nationwide.
B.
Both
are
usually
inherited;
both
disorders
exist
on
a
spectrum.
C.
Some
definitions:
Look
at
the
parents:
apples
and
trees….
ADHD
=
attentiondeficit/hyperactivity
disorder.
It
exists
as
“Combined
type,”
“primarily
inattentive
type”
or
the
largely
theoretical
“Primarily
hyperactive‐ impulsive
type.”
ADD
=
attention
deficit
disorder,
and
many
people
mistakenly
think
that
it
refers
to
ADHD,
primarily
inattentive
type.
It
doesn’t.
Autism
spectrum
disorder
(ASD)
refers
to
“autism”
that
is
not
further
sub‐ typed.
Many
academic
careers
are
currently
being
made
and
broken
over
sub‐ typing
of
autism
spectrum
disorders.
D.
ADHD
and
ASDs
are
not
strictly
“mental
illnesses”
nor
are
they
brain
damage.
They
are
developmental
disorders
or
neurodevelopmental
disorders.
People
without
neurodevelopmental
disorders
are
known
as
“neurotypicals”
or
“ordinaries”
by
the
rest
of
us.
Unless
the
affected
person
also
has
a
major
mental
illness
or
developmental
delay
(intellectual
disability),
they
don’t
qualify
for
aid.
E.
These
are
real
entities
that
cause
genuine
suffering.
Children
and
adults
who
have
these
disorders
would
prefer
not
to
have
them.
The
majority
of
children
with
autism
spectrum
disorders
will
never
live
independently
as
adults.
Children
with
ADHD
have
a
1/3
chance
of
not
completing
high
school,
higher
medical
costs,
and
die
younger
than
their
peers.
Both
groups
of
kids
are
more
likely
to
be
abused
than
their
siblings
and
are
often
targeted
by
bullies.
F.
Most
persons
with
ADHD
and/or
autism
spectrum
disorders
have
co‐ occurring
(that
is,
comorbid)
psychiatric
disorders.
The
most
common
include:
anxiety,
learning
disabilities,
mood
disorders,
oppositional
defiant
disorder,
and
tics.
Obsessive‐compulsive
tendencies
are
common.
So
are
speech
and
language
difficulties.
ASD
kids
tend
to
be
clumsy
and
to
have
sensory
sensitivities.
G.
Both
disorders
occur
in
a
range
of
intellectual
abilities.
H.
The
developmental
trend
for
ADHD
is
generally
toward
more
normal
function;
the
developmental
trend
for
ASD
is
to
lag
behind
in
social
skills,
with
an
increasing
gap
through
teen
and
young
adult
years,
and
never
catching
up.
2.
Preschoolers:
Key
word:
INTERESTING
Infants
and
toddlers
with
neurodevelopmental
disorders
can
be
inconsolable
criers
and
unmanageable
in
the
church
nursery.
If
your
nursery
staff
expresses
concern,
go
watch.
ADHD
toddlers
are
climbers
and
escape
artists.
Some
are
aggressive.
Most
problems
can
be
solved
with
additional
staff.
Getting
expelled
from
Sunday
School
or
day
care
at
this
age
is
not
a
good
sign!
2.
The
young
Sunday
School
child
(ages
4
–
6)
Key
word:
FUN!
The
big
problems
at
this
age:
hyperactivity,
a‐social
play,
and
tantrums.
Preschoolers
with
ADHD
may
not
stand
out
from
the
crowd:
50%
of
three‐year‐old
kids
meet
diagnostic
criteria
for
ADHD.
Most
programming
for
this
age
group
is
geared
to
short
attention
spans
and
the
learning
is
hands‐on,
so
special
programming
isn’t
needed.
Keep
the
“busy”
ones
close
to
you
and
give
them
constant
physical
cues.
Use
as
few
words
as
possible
–
touch
works
better
for
many
kids
with
ADHD.
Structure
a
user‐friendly
environment.
Tantrums:
For
the
immediate
event,
remove
the
audience,
stay
calm
and
wait
it
out.
Whenever
possible,
do
a
post‐tantrum
“autopsy.”
What
went
wrong?
Where
and
when
did
it
happen?
Who
got
involved?
How
was
it
handled?
How
long
did
it
last?
What
happened
next?
Would
you
do
anything
different
next
time?
Write
the
plan!
Churches
tend
to
be
forgiving
environments,
but
a
Sunday
School
teacher
who
has
just
weathered
a
storm
may
have
strong
opinions
about
how
the
child
has
(or
has
not
been)
brought
up.
Call
the
parents.
Most
of
the
parents
I
meet
tell
me
they
suspected
there
was
something
different
about
the
child
from
birth,
so
you
probably
won’t
surprise
them,
and
the
parents
are
in
the
best
position
to
help
you
plan.
Problems
usually
occur
during
times
of
transition
from
one
area
or
activity
to
another,
or
during
“free”
play.
Structure
and
routine
are
your
friends!
Use
a
buddy
system.
On
walks,
use
a
knotted
rope.
Some
kids
are
not
developmentally
ready
to
play
well
with
others
at
this
age.
That’s
OK.
Assist
volunteers
in
accepting
and
planning
for
the
“special”
child.
3.
The
grade
school
child
(2nd
–
5th
graders,
ages
711)
Key
Word:
PLAN!
Grade‐school
boys
with
ADHD
show
the
triad
of
hyperactivity,
impulsivity,
and
inattention.
Girls
with
ADHD
may
not
be
as
obvious.
Seat
the
ADHD
kid
near
the
front
and
keep
him
directed
at
all
times.
Touch
cues
still
work.
Send
him
on
errands.
Have
him
help
you
find
things
(they
are
excellent
losers
and,
since
they
notice
everything,
also
excellent
finders).
Seat
them
on
the
floor,
on
a
cushion,
or
have
them
stand
during
lessons
–
they
fall
off
chairs.
Put
them
next
to
model
citizens.
Occasionally,
a
couple
of
ADHD
boys
will
be
better
together
–
especially
if
they
are
both
hands‐on
learners.
Point
systems
and
“Magic
Marbles”
work
at
this
age.
Some
teen
volunteers
may
not
be
able
to
handle
an
ADHD
grade‐schooler;
some
teens
are
superior
to
adults
with
“specials.”
ADHD
done
well
=
creativity,
energy,
and
optimism.
Exploit
those
traits.
On
field
trips,
get
help.
Plan
the
number
of
chaperones
you
need
for
your
group
and
add
one
adult
for
each
ADHD
kid.
The
parents
of
ADHD
kids
are
not
surprised
to
be
asked
to
go
along
–
just
don’t
ask
them
to
manage
their
child
–
have
another
parent
do
that
and
everyone
will
have
a
better
time.
If
the
parents
supply
medication,
give
it!
Be
honest
with
the
parents
about
your
observations;
they
can’t
help
you
if
they
don’t
know
the
truth.
(Some
parents
are
in
denial,
so
if
you’re
not
confident
of
how
your
message
will
be
received,
bring
a
silent
witness
for
moral
support.)
Kids
with
ASDs
at
this
age
seem
immature
one
moment
and
precocious
the
next.
Most
are
rejected
by
peers
and
relate
better
to
adults.
Some
are
non‐talkers
and
avoid
eye
contact;
others
will
monopolize
your
attention
and
stare.
Most
ASD
kids
at
this
age
have
an
area
of
intense
fascination.
Tell
them
how
much
God
loves
trains
or
dinosaurs
and
you
will
have
a
friend
for
life.
Don’t
corner
them
–
they
will
panic
or
fight.
Many
can
look
after
themselves
if
you
give
them
wiggle
room.
Be
clear
about
expectations
and
speak
literally.
Tell
them
“the
rule
is…”
OK
to
be
direct.
4.
The
middle
school
child
with
ADHD
or
ASD
Key
Word:
SORRY
Middle
school
girls
with
ADHD
usually
present
to
our
offices
with
depression
due
to
peer
rejection.
Middle
school
boys
with
ADHD
are
likely
failing
one
or
more
classes.
Middle
school
kids
with
ASDs
have
been
referred
to
special
education
and
spend
hours
on
video
and
computer
games.
And
now
you
have
them
for
confirmation!
In
group
activities:
structure
and
routine
are
still
your
best
friends.
ADHD
and
ASD
kids
both
fare
better
when
they
know
what
is
happening
and
what
to
expect.
Pre‐ teach.
Some
don’t
have
a
meaningful
concept
of
time
–
visual
schedules
are
helpful.
Others
need
to
be
paired
with
a
model
citizen
so
they
can
ask
for
directions
to
be
repeated
or
be
reminded
of
what’s
happening.
When
possible,
write
directions
on
the
board
and
have
tools
set
out
ahead
of
time.
Avoid
unstructured
time.
Avoid
“find
a
partner…”
Many
of
ASDs
have
rigid
morality
–
they
are
great
at
distributing
materials.
Some
won’t
be
able
to
complete
any
task
due
to
perfectionism.
Get
to
know
your
“special”
and
accept
what
you
find
as
the
way
he/she
is
–
you’re
not
likely
to
change
them,
but
you
may
be
able
to
help
them
feel
better
about
who
they
are
and
get
through
a
difficult
stage
of
life.
When
possible,
1:1
or
small
group
confirmation
can
work
well.
Many
kids
with
ASD
have
wonderful
singing
voices,
but
may
need
to
be
strongly
encouraged
to
participate.
Watch
out
for
them
on
overnights
–
they
are
targeted
for
teasing
and
bullying
and
may
put
up
with
it
because
they
want
so
badly
to
be
accepted.
Girls
with
ASD
get
used.
Give
them
photos
with
names
of
other
kids
to
study.
Be
sure
they
know
what’s
happening
and
give
their
parents
notice,
too.
5.
High
School
Students
with
ADHD
and
ASD
Key
Word:
SPLITS
By
this
age,
the
teen
with
only
ADHD
is
beginning
to
adapt.
Hyperactivity
fades
to
fidgets
and
impulsivity
is
confined
to
odd
remarks.
The
kids
with
more
severe
ADHD
are
on
medications
or
(sadly)
have
gone
to
juvenile
detention
centers
or
dropped
out.
Those
who
have
ADHD
and
are
still
participating
in
church
activities
will
not
cause
major
problems,
but
many
continue
to
have
annoying
traits.
Most
will
struggle
with
being
late,
losing
things,
forgetting
commitments,
looking
disheveled,
and
disorganization
for
life.
Many
are
so
bruised
by
negative
social
encounters
that
they
have
become
withdrawn
and
shy.
The
teen
with
ASD
is
now
clearly
“different”
and
obviously
disabled.
Most
are
so
odd
that
the
neurotypical
teens
no
longer
tease
them.
The
teen
with
ASD
may
need
help
to
find
their
identity
and
usefulness
in
a
group.
Sometimes
ordinary
girls
can
be
enlisted
to
coach
an
ASD
girl
on
hygiene
and
dress
–
this
is
a
great
service
when
done
well!
We
counsel
parents
of
ASD
kids
get
them
into
part‐time
jobs
and
a
driver’s
license.
These
two
factors
seem
to
mark
the
difference
between
the
ASD
kids
who
go
on
to
work
for
a
living
and
those
who
don’t.
Feeling
accepted
and
finding
a
role
within
a
church
community
can
also
mean
the
difference
between
a
life
lived
in
a
parent’s
basement
or
in
a
group
home
and
one
with
semi‐
or
full
independence.
Experiences
as
church
greeter
or
assistant
custodian
can
generalize
to
the
workplace.
If
you
can
pair
a
teen
with
an
ASD
to
an
adult
mentor,
you
will
do
both
the
teen
and
the
family
a
world
of
good.
Many
teens
with
ASD
have
an
affinity
for
very
young
children.
Don’t
give
them
responsibility
they
aren’t
ready
for;
they
are
unreliable
in
a
crisis
and
may
not
do
well
with
a
demanding
child.
Sexual
offenses
are
a
risk
because
this
group
combines
teen
hormones,
social
skills
deficits,
and
exceptionally
poor
judgment.
Fortunately,
most
teens
with
ASDs
avoid
drugs
and
alcohol
unless
recruited
as
a
stooge
by
another
teen.
Suicidal
crises
occur,
but
these
kids
usually
bounce
back
if
given
the
chance
at
a
real
relationship
with
a
caring
adult
or
peer.
More:
addwarehouse.com
chadd.org
cdc.gov/ncbddd/adhd/
pacer.org
ninds.nih.gov/disorders
aspergersyndrome.org
ncbi.nim.nih.gov
