This past Sunday, I introduced you to the concept of kids with ADHD having a disability involving executive functioning: cognitive abilities involved in controlling and regulating other abilities and behaviors. Today, we’ll take a look at how delays in development of specific executive functions contribute to challenges for kids with ADHD in growing spiritually.

For review, the executive functions we discussed include behavioral inhibition, non-verbal working memory, verbal working memory, emotional self-regulation and reconstitution.

For kids who struggle with behavioral inhibition, parents are often reluctant to consider taking them to church or participating in church-related activities. Problems often start when the parent asks the child to start getting ready to leave the house. A request to shut off the X-box and get dressed may result in the game controller being flung across the room. Minor provocations from another child at church like an accidental push or a trip can result in a kid with ADHD responding impulsively or aggressively.

My favorite story to illustrate the challenge behavioral inhibition can pose to church participation involved a patient of mine with ADHD…we’ll call him Nick. Nick’s parents are very involved in their local church-they’re really going above and beyond in shepherding their kids. In any event, they’re in for a follow-up visit and Nick’s mom mentioned that they did a family mission trip over Christmas break. Here’s what came next:

Me: “How’d it go?”

Mom: “Pretty good, except for one little incident. We got a letter from the Mayor who was apologizing because his son hit Nick.”

Me (to Nick): “Why did the mayor’s son hit you?”

Nick: “It probably had something to do with me calling him an a**hole.”

Kids with weaknesses in nonverbal working memory will evoke great frustration from parents when they make the family late for church by forgetting where they put their Bible as Dad backs out of the garage. They may have a harder time remembering where they’re supposed to go or what they’re supposed to do when they get to church. They might get angry or frustrated when they have a hard time learning the hand movements and gestures that accompany the music at worship time. Kids with ADHD may also have a harder time accessing and remembering experiences of others demonstrating essential Christian attitudes and virtues, and more difficulty modeling such behavior in their daily interactions.

A child with delays in development of verbal working memory will have a harder time than other kids their age memorizing and repeating Scripture (a great opportunity for Awana leaders to demonstrate the concept of grace), recalling the most important theme of the message at Children’s Church and applying Bible verses they’ve been taught in day-to-day situations. One observable sign of delayed verbal working memory would be a child who is unable to pray silently when their same-age peers can.

Kids who struggle with emotional self-regulation will often demonstrate patterns of behavior that represent direct violations of Biblical teaching. They are likely to have a more difficult time maintaining an attitude of respect toward parents and leaders in the church. They’ll want to stay home and watch their favorite TV show instead of going to Sunday School, or have great difficulty ignoring the urge to send Facebook messages when they’re pretending to use the You Version Bible on their cell phones at youth group. In a later post, we’ll go into some depth about the impact of ADHD on spiritual growth, but a lack of capacity for emotional self-regulation will likely have an enormous impact on a person’s ability to make use of spiritual disciplines as well as their capacity to avoid temptation.

Kids who struggle with reconstitution will have a much harder time than their peers figuring out how to apply their faith in daily life. They might tend to procrastinate when given a task involving planning and organization…following through on asking a friend to the retreat, or not scheduling time to complete a school project due on Monday when they have youth group on Sunday night.

I believe it’s a sin to bore kids with the Gospel, and kids with ADHD are especially vulnerable to boredom when the content of a presentation lacks relevance or the presenters lack an engaging style. The experience of church becomes associated with unpleasant thoughts and feelings, resulting in kids who become turned off by the experience and stop coming when parents can no longer compel them to attend. At the same time, too much stimulation at church results in kids with more difficulty maintaining self-control and less retention of the spiritual principles we’re trying to teach. We’ll devote an entire post next month to the importance of environments as determinants of the quality of the church experience for families of kids with ADHD.

Finally, I’ll share a not so pleasant episode from my practice reflecting a total and complete lack of understanding of kids with ADHD in a local church. A number of years ago, a physician in another state called me to request a consult for the kindergarten-age son of his former pastor. The boy’s father was the pastor of a small-town Baptist church, and he and his wife had felt led, after considerable time and prayer, to adopt a child (my patient). As is often the case in kids available for adoption, this boy met diagnostic criteria for ADHD. Unfortunately, the dad was the physician’s FORMER pastor because his son punched a boy at a church event whose father was chairman of the Elder board. The father was dismissed from his position after the church board arrived at an extremely literal interpretation of Titus 1:6.

After a couple of medication trials, we were able to identify a treatment that was very helpful in improving the boy’s capacity for self-control. Sadly, I put their last prescription in the mail to the address in another state where the family was staying while the pastor looked for work.

Updated March 22, 2016

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