A Unique Perspective on the “Orange” Movement

I’ll return tomorrow to our series on ADHD and Spiritual Development, but I wanted to share some thoughts on a movement that’s dominating the children’s and student ministry blogosphere for the next week.

Setting aside for a moment my volunteer position as President of Key Ministry, I’m a husband, father of two girls of whom I’m very proud, a member of the Board of Elders in my local church and a physician specializing in child and adolescent psychiatry in an upper middle class “exurb” of Cleveland. My job affords me a view of the kids and families in our community that most people, including our children’s and student ministry leaders never get to see. And I can’t accept what I’m seeing.

I’ve had this burden for several years that the kids and families in our community won’t get healthy until and unless our churches take the lead in becoming the catalysts for change. Chagrin Falls, Ohio is the type of place parents move to with the interests of their kids in mind. We have outstanding public and private schools and a rich array of athletic, artistic and intellectual opportunities for kids. It’s a place where parents don’t want to deny their kids any experiences that could help them grow. The problem is that far too many of our kids live lives that are experience-rich and relationship-poor with parents who have no idea of how to teach their kids about the things that matter most.

I became familiar with Reggie Joiner about five or six years ago when I used a video series he developed with Andy Stanley (“Parental Guidance Required”) with a small group I led. I came across his book “Think Orange” the summer before last while poking around the local Christian bookstore and knocked it off in two days.  The principles that Reggie articulated in the book have led to a movement among church leaders to reconsider the strategies used to help kids grow spiritually, emphasizing the importance of partnering with parents and merging the heart of a caring family (red) with the light of a faith community (yellow), resulting in a combined influence (orange) that will have greater impact than either influence alone.

Here’s my source of frustration. We know that there are lots of things that parents can do to significantly enhance the likelihood that their kids will grow up to be passionate followers of Christ who are actively engaged in a faith community with fellow Christians and intentional in using their gifts and talents to serve others. Most parents would want that for their kids. They just need someone to show them what to do. Apologies to the ministry staff at my church, but I get very impatient that that we’re not doing enough to help the families in our community fast enough because of the volume of kids and parents who show up in my office crashing and burning.

My first thought after reading the book was to question whether our church staff would also need someone to show them what to do. I’ve found from personal experience that my entire style of communication has to change when I’m speaking in a church as opposed to doing a lecture for 200 physicians. There’s an entirely different skill set involved in communicating with high school kids at a worship service compared to the skills involved in first building credibility with parents and then equipping them. I know how difficult change can be from working in the medical field. As a leader in my church, I want our staff to have the best support we can provide to help them navigate the change.

Last Spring, I had the opportunity to attend the Orange Conference with our Senior Pastor, Executive Pastor, Elementary and Middle School Pastors, along with the person now serving as our Small Groups coordinator. I left with the impression that, like our work with Key Ministry, leaders in the Orange movement are still sorting out the “best practices” those serving in the ministry trenches need to know. The value of the conversations occurring across the blogosphere and at conferences like Orange is in increasing the slope of the learning curve for leaders in children’s, student and family ministry who need to implement the change. I’d anticipate the content of next year’s conference will represent a vast increase in collective ministry wisdom that’s resulted from the Orange movement.

I’ll be devoting the first two weeks of November to a series of blog posts discussing the importance of the Orange principles and strategies for churches seeking to serve families of kids with disabilities. The role of parents in guiding the spiritual development of their children is even more vital in families where one or more kids have conditions that may impact their style of learning and social interaction while the challenges to staff and volunteers in overcoming the barriers that exist between church and family are more imposing.

Keep up the good work, guys! The kids who cross my path have great need  for what parents can offer in partnership with their church.


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The Taboo Topic: Medication at Church for Kids With ADHD (Part Two)

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This is the eighth post in our Fall Series: ADHD and Spiritual Development: Strategies for Parents and Church Leaders

Last Sunday, we looked at the issues connected with the use (or lack thereof) of medication for kids with ADHD during church activities. Today, we’re going to discuss the issue from the perspective of the children’s/student ministry pastor or key volunteer.

Allow me to digress for a moment and spell out why the issue of medication is such a big deal at church. Because medication is the single most effective stand-alone treatment for ADHD and the therapeutic effects of the medications used to treat ADHD are very short-lived, the child’s experience in church on a day to day or week to week basis may be highly contingent upon their medication status.

The children’s/student ministry leadership will generally be “flying blind” when it comes to serving kids with ADHD. For reasons of stigma that we’ve discussed in earlier posts, parents of kids with ADHD probably won’t disclose their child’s condition to the ministry team and are even less likely to discuss their child’s medication status. As we discussed on Sunday, it’s simply not appropriate for church staff or volunteers to jump to conclusions about a child’s diagnosis or treatment needs without the proper professional training and credentials and absent a complete evaluation. The willingness of the church to welcome and serve all of these kids and their families regardless of their medication status should be unconditional.

The bottom line is that there’s a big pool of kids out there for whom their needs for support in church will vary greatly from week to week, or from activity to activity. The parent who gives their kid his medicine two hours before leaving for church may not send medication along for a weekend retreat. The kid who does well at 11 AM may not have the same self control at 8:00 PM.

So what’s a children’s/student ministry leader to do? We want the kids and their families to have a great experience without placing too great a burden on outstanding volunteers and group leaders. After all, excellent volunteers are almost as hard to find as victory parades through downtown Cleveland. We also want the other kids in a ministry environment to have a great experience without their ability to learn compromised by a kid exhibiting lots of disruptive behavior.

One strategy to consider involves training a small group of floating “buddies” who are available to provide some 1:1 attention to kids who may not need a regular support person but are disrupting a class or a small group on an infrequent basis.  Having a few extra volunteers available on an “as-needed” basis who can spend 1:1 time with any kids who have “issues” and lend an extra pair of hands for your volunteer teachers leaves you prepared to serve guests and visitors who may have a kid with special needs or issues with self-control.

Coming Friday: The Taboo Topic: Talking About Medication at Church for Kids With ADHD…The physician’s perspective

Coming Sunday: Discipleship Strategies for Kids and Teens With ADHD



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The Taboo Topic: Medication at Church for Kids With ADHD (Part One)

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This is the seventh post in our Fall Series: ADHD and Spiritual Development: Strategies for Parents and Church Leaders

We’re going to plunge headfirst into a topic this week that I’ve never seen addressed anywhere in books, articles or seminars on working with families of kids with ADHD…the use of medication for the specific purpose of helping kids function better during church-based programs and activities.

There are several reasons why I referred to today’s discussion as “the taboo topic.” Parents of kids with ADHD who do make their way to church are often very uncomfortable sharing any information about their child’s diagnosis or treatment. Church staff and volunteers should appropriately avoid speculation about a child’s diagnosis or judgments regarding a child’s treatment needs. Physicians and other professionals involved with treating kids with ADHD are likely too uncomfortable broaching the need for medication at church or too oblivious to the reality that some parents would desire treatment in support of their child’s spiritual development.

Today, I’d like to look at the issue of medication for church from the perspective of parents and kids. Wednesday, we’ll take the perspective of church staff and volunteers. Friday, we’ll take the physician’s perspective and offer a resource to help parents discuss the need for treatment during church activities with their child’s doctor.

First, my two cents: If your child’s experience at church is as important as their experience at school, the need for effective treatment at church is as great as their need for treatment at school.

Why would a parent not give their child medication on the weekend that would help them have a better experience at church? One reason involves the side effects many kids experience from the commonly prescribed ADHD medications.

Here’s data from a study I presented several years ago at the American Academy of Child and Adolescent Psychiatry Meeting looking at prescription fill rates for children and adults with ADHD:

Parents of the “average” kid with ADHD fill between four and five 30 day prescriptions per year…the number for adults is 3.1. 27% fill seven or more 30 day prescriptions per year. As a result, the “average” kid with ADHD who has been prescribed medication isn’t on their medication on any given day.  My interpretation is that people take this stuff when they really need it and avoid medication whenever they can get away without it. Appetite suppression is the most common side effect in kids. Some kids have more difficulty sleeping on medication. Kids with ADHD who also have anxiety disorders (30%) often experience worsening of anxiety symptoms accompanied by moodiness and irritability on stimulants. Parents administer medicine because, in many instances, their kids just wouldn’t make it through school without it or their behavior would just be too disruptive to family life and peer relationships.

Parents haven’t been conditioned to think about the impact of ADHD on their child or family’s church participation because I suspect most clinicians don’t ask. In the last fifteen years, I can count on the fingers of one hand the number of times I can recall a parent spontaneously volunteering that they were concerned about their family’s inability to do church because of their child’s ADHD before I raised the question. Talk about don’t ask, don’t tell!

Tweens and teens frequently take themselves off medication between the ages of 10-14. I hear kids tell me their medicine results in friends telling them they’re too “serious,” or that they don’t feel like themselves or become more self-conscious in social situations. The middle schooler on a retreat may be more concerned about having fun with their friends than being able to absorb the content of the group discussions on the trip. For that matter, parents may choose not to provide medication for overnight retreats or mission trips because of concerns the knowledge their child takes medication may not remain confidential.

Finally, some church activities are scheduled at times of day when administration of ADHD medication is inconvenient or becomes problematic because of side effects. For example, if your church offers AWANA and has a relatively high population of kids with ADHD, starting your AWANA program at 7:00 PM on a weeknight probably isn’t all that great an idea.  The three most commonly prescribed ADHD medications, Adderall XR (pictured right), Concerta and Vyvanse (pictured left) typically last around 10-13 hours max. If kids are getting their medication around 7:00 AM, the effects of medication will typically be wearing off around dinnertime. The only time I’ve ever had to have a parent sign a release of information to talk to my wife involved a situation when she was serving as AWANA group leader and one of my patients with ADHD got into a fight with another kid who probably should have been one of my patients. Having an understanding of this boy’s issues at a time of night when we wouldn’t have ordinarily considered his need for treatment led to a medication adjustment and a successful year in AWANA.

My hope would be that parents would become as comfortable addressing the need for medication at church with their child’s physician as they would discussing the impact of their child’s ADHD in school or at home, and physicians would routinely ask about the impact of ADHD on the child’s church participation and spiritual development. We’ve got a long way to go before those conversations become routine.

Coming Wednesday: The Taboo Topic: Talking About Medication at Church for Kids With ADHD…The perspective of church staff and volunteers

Coming Friday: The Taboo Topic: Talking About Medication at Church for Kids With ADHD…The physician’s perspective



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ADHD and Spiritual Disciplines

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This is the sixth post in our Fall Series: ADHD and Spiritual Development: Strategies for Parents and Church Leaders

All good Christians get up early in the morning to pray, read the Bible and quietly reflect upon God, don’t they? On the other hand, is it possible that there are kids and adults out there who truly have a heart for God even though they don’t necessarily engage in the central spiritual practices of the Christian faith as frequently or consistently as some in the church would deem optimal?

Persons with ADHD will have more difficulty maintaining a spiritually disciplined life, even when they desire to do so to honor God. Last week, we discussed some of the difficulties kids and adults with ADHD have with maintaining focus, delaying gratification, setting priorities, managing time and exhibiting self-control because of their weaknesses in executive functioning. Let’s consider how those weaknesses might come into play when attempting to use some of the disciplines:

Prayer: Kids and adults with ADHD are more likely to struggle in setting aside time to pray consistently. They may have difficulty remembering what they wanted or needed to pray about when they make time to pray. Prayer logs and journals may be as important for the Christian with ADHD as daily planners and organizers are for the kid in school with ADHD. More importantly, persons with ADHD may have a more difficult time listening for God’s responses to prayer. The ability to “Be still and know that I am God” is a challenge for all of us in our modern society, but even more so for kids and adults with brains wired to notice the trivial and mundane.

Bible Study: Kids and adults with ADHD are more prone to give up on studying the Bible when it becomes tedious. Many of us start off each year with good intentions and do OK through Genesis and Exodus, but the person with ADHD is going to struggle with Leviticus and has probably abandoned their resolve by the time they get to Numbers or Deuteronomy. Many kids with ADHD tell me they get distracted while reading by the words on the page. I know lots of folks with ADHD who have to use highlighters while reading to focus on the main points. I don’t think God minds the Bible being all marked up if it helps the reader absorb more content. I think it’s important to remember (to paraphrase Reggie Joiner) that while all Scripture may be equally true, not all Scripture is equally important. One place where the church can help is by presenting the most important truths of Christianity in ways that are relevant, engaging and interesting. If kids with ADHD and their parents can’t stay focused long enough to get all the way through the Bible, let’s make sure they get the most important parts.

Meditation: Reflecting quietly upon a passage of Scripture or upon some attribute of God is going to be more challenging for kids and adults who have more difficulty holding words or images in their minds. The shorter the time spent in meditation and the more direction given to the meditation, the more likely the exercise will be in facilitating spiritual growth.

Service: Kids with ADHD may have a difficult time remembering and getting started on uninteresting tasks. Just ask one to take the garbage out or clean his room if you need an illustration. On the other hand, serving can be a powerful experience if the act is meaningful and the skill set required fits within the giftedness of the person with ADHD. Here’s a great example:  I used to participate in an annual event, ADHD Experts on Call, that was hosted by Ty Pennington from Extreme Makeover Home Edition, who was serving at the time as a national spokesperson for ADHD. The kid or adult who has to be dragged to a Bible Study kicking and screaming may be all charged up about working on a Habitat crew, renovating houses for single moms in the city, or digging wells for villages in Africa.

Worship: Many kids and adults with ADHD may do better with worship events as participants as opposed to spectators. One of the churches we were working with through Key Ministry offers monthly family worship experiences that parents attend with their elementary-age kids emphasizing Biblical virtues. The director told me every kid who performed on stage in their family worship was being treated for ADHD.

Evangelism: Evangelism is one spiritual discipline in which having some ADHD traits might actually be advantageous. Kids and adults with ADHD may have an easier time acting on the impulse to share their faith with others instead of pondering all the reasons why saying nothing might be a good idea. We’ll talk more in a future post about the ways in which ADHD might be of benefit to Christians, but one observation I’ve made in working with lots of churches through Key Ministry is that a disproportionate number of senior pastors probably have ADHD, in part for the reason described above.

Today’s take-home: If God wanted cookie-cutter Christians, that’s what He would have made. We have different spiritual disciplines because we won’t all grow closer to God in exactly the same way. The key for church leaders, parents and those who care for kids with ADHD is helping them identify those disciplines that excite them about God and help them grow closer to Him!

Coming Sunday: The Taboo Topic: Talking About Medication at Church for Kids With ADHD

Coming Wednesday: TBA


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What Keeps Kids With ADHD Out of Church? Part Two

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This past Sunday, we looked at some of the obstacles that deter families of kids with ADHD from participating in church activities from the perspective of the parent.  After all, the kids aren’t coming to church if the parent doesn’t bring them to church. Today, we’re going to look at the experience of church from the perspective of the child or teen with ADHD.

Kids with ADHD are often capable of intense focus when they’re engaged in activities they find interesting. In fact, the vast preponderance of the time kids come into my office with a history of wetting themselves during the daytime, their “accidents” occurred while playing a video game or outside in the middle of play with their friends. In many ways, ADHD should be thought of as an attention dysregulation as opposed to an attention deficit…kids with ADHD pay attention to too much stuff, much of which is unimportant, at the expense of what they need to pay attention to.

Kids with ADHD don’t do well in situations when they perceive the activity or the topic as boring or irrelevant, and unfortunately that’s the case in too many churches. I’ve said on many occasions that I believe it’s a sin to bore kids with the Gospel. And that’s exactly what happens when kids are required to sit through worship services designed for adults, especially kids with ADHD.

shutterstock_59907679For many kids with ADHD, especially those with the “H” component, the mental energy required to maintain self-control for an extended period of time takes away from their ability to get the desired “take away” from their church experience. They don’t like sitting for extended periods of time. Many educators are starting to catch on to the importance of movement and exercise on learning.

As kids with ADHD get older, rates of insomnia increase. Many of these kids are “night owls”…they stay up very late because they have a hard time slowing down their brains to settle enough to fall asleep. The problem is compounded when they have to get up very early (6:21 AM in the case of my ninth and sixth grade girls) on school days. By the weekend, getting up and out of bed may be more of a challenge for the teen with ADHD than their friends. One of the wiser moves our church leadership made was moving our high school worship service from 9:00 AM to 6:06 PM on Sundays. Let’s just say there weren’t a whole lot of kids with ADHD responding to invites from their friends to check out 9:00 AM church.

IMG_0905Here’s another consideration…there are a lot of kids with ADHD who need to take medication to have a successful school experience during the week who don’t have that option available to them on the weekend because of concerns their treating physician or parents have about the effects of medication on appetite and growth. You’ll see more on this topic later in the series, but think about this: If many kids with ADHD require medication for school during the week despite accommodation plans and assistance from teachers with special training, how do you think they’re going to do at church on the weekend without medication and a volunteer leader who lacks a teaching degree?

One of the main points my former colleague Katie Wetherbee makes when training church staff and volunteers is that kids want to be successful. My kids with ADHD often get very frustrated and discouraged and start to see themselves as a disappointment to parents and teachers. Put that kid in an environment in which the behaviors resulting from their inability to maintain self-control may be labeled as sin and see how excited they’ll be about coming back next week.

f77fc902f0ffff8a9dc080bff842bdddOne final word on the issue of environments…there is such a thing as too much stimulation for kids with ADHD. When kids are struggling with sensory overload…too noisy, too many kids talking, lighting is too bright-they don’t learn and may experience the environment as unpleasant or aversive. Let me share an example from a nearby church we occasionally attend.

We’ll call my friend Jake. Jake has ADHD along with an auditory processing disorder. When several people are talking at once, Jake’s experience is like listening to a radio with lots of static. Because of his ADHD, he notices all the different sounds in his environment. One day, I was hanging around in the lobby of the church about five minutes after the start of our second service and Jake comes up to say hello:

Jake: Hi, Dr. Steve

SG: Hi Jake. How you doing?

Jake: Just great

SG: How’s school?

Jake: Really good this year. (Hesitation) Dr. Steve, Can I ask you a question?

SG: Of course

shutterstock_140497306Jake: When I go into my church service, there are too many kids yelling and screaming and talking and pushing…I can’t concentrate on what’s going on. Do you have any suggestions for what I can do?

Jake just had too much trouble tolerating the level of stimulation in the large group worship area that was present at the time. He liked the discussions when he broke out into his small group, so his parents and leaders came up with a great solution. Jake was given an orange vest and made a part of the parking team between services. We had people who drove around the lot looking for Jake on Sunday morning because of his friendly demeanor. He’d get done directing traffic about the time large group worship for his age group was winding down and the kids were getting ready for their breakout groups.

Updated March 22, 2016

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shutterstock_24510829Key Ministry is pleased to make available our FREE consultation service to pastors, church leaders and ministry volunteers. Got questions about launching a ministry that you can’t answer…here we are! Have a kid you’re struggling to serve? Contact us! Want to kick around a problem with someone who’s “been there and done that?” Click here to submit a request!

Posted in ADHD, Key Ministry, Ministry Environments, Spiritual Development, Strategies | Tagged , , , , , , , , , , | 2 Comments

What Keeps Kids With ADHD Out of Church? Part One

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Now that we have a better understanding of why people with ADHD are different than others and considered some of the challenges they might face in growing spiritually, let’s look at some of the impediments to their active involvement at church.

Let’s start by looking at this issue from the perspective of the parent. In all probability, the kids aren’t coming to church if the parent doesn’t bring them to church.

By the weekend, many of these folks are really tired. Kids with ADHD often have a very difficult time getting through their morning routine. They need constant reminders to get out of bed, get dressed, eat breakfast and are easily distracted by the TV, the dog, just about anything. If kids are taking medication, the stuff does take a little while to kick in, so that mornings often become a great source of frustration to parents.

If the parent(s) can get their child up and ready in a reasonable time, the next challenge is the car ride to church. Compared to kids without ADHD, the child with ADHD is more likely to be angry about going to church, more likely to be screaming, yelling or crying because of some perceived grievance about their sibling’s behavior, and the family as a whole is less likely to arrive in a worshipful mood.

A major obstacle is the perception of many parents that they’ll be placed in a situation where they’ll be expected to explain their child’s behavior to others, or where they’ll be judged by others. Like it or not, there’s a stigma associated with many of the hidden disabilities (while this study from the American Journal of Psychiatry doesn’t address ADHD, it does reinforce the point). I was at a worship service in our old church for Disability Sunday at which a couple got up to share their story of what it was like looking for a church with two young boys with ADHD. The mother’s words illustrated the expectations parents of kids with ADHD and other hidden disabilities bring to church:

“People in the church believe they can tell when a disability ends and bad parenting begins.”

Another common complaint I hear from parents whose experience of church has been in denominations or traditions in which children and parents are expected to attend worship services together is that they can’t get anything out of the experience if their primary focus is monitoring their child’s behavior during the service. We’re seeing a growing trend among Catholic churches we serve to offer (at least periodically) separate worship experiences for kids and adults as a strategy for addressing this problem. I’m admittedly apprehensive about the well-intentioned efforts of some in the family ministry movement to discontinue separate worship experiences for kids because I suspect we’d lose many of the families of kids with ADHD who have difficulty with self-control.

shutterstock_255913471Finally, we have the issue of parents who themselves have ADHD. They’re more likely to have difficulty following through on good intentions. They may want to come to church, they may know it’s important for their kids to be involved at church, but they have a hard time pulling things together to make it to church. They’re more likely to suffer from insomnia, or be “night owls” themselves, and struggle to get themselves up in the morning, much less their kids. They have more difficulty with establishing priorities and managing time. I can spot the families affected by ADHD in our church parking lot ten minutes after the start of the last service with Mom hopping across the parking lot putting her shoes on with three kids in tow.

We’re going to discuss environments at length in a future post, but for parents who themselves may have ADHD, the ease and clarity with which a church communicates where to go and what to do when you arrive is especially important. They tend to be easily frustrated looking for parking. They have a very difficult time remembering directions, resulting in the need for signage that is highly visible and processes for checking in and checking out kids that are as simple as possible.

Here’s one more issue to consider: Unlike families in which a child has an autism spectrum disorder, in which divorce rates are no higher than in the general population, the divorce rate nearly doubles in marriages where there’s a child under the age of eight with ADHD. Kids with ADHD are more likely to be alternating from household to household on the weekend, making establishment of a consistent routine of church attendance more difficult.

Updated March 22, 2016

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shutterstock_24510829Key Ministry is pleased to make available our FREE consultation service to pastors, church leaders and ministry volunteers. Got questions about launching a ministry that you can’t answer…here we are! Have a kid you’re struggling to serve? Contact us! Want to kick around a problem with someone who’s “been there and done that?” Click here to submit a request!

Posted in ADHD, Families, Hidden Disabilities, Key Ministry, Parents, Spiritual Development | Tagged , , , , , , , , , , | 8 Comments

The Apple Doesn’t Fall Far From the Tree…ADHD in Families

shutterstock_149729270In Wednesday’s post, we discussed spiritual challenges that kids with ADHD encounter, related to core deficits in executive functioning. Today, we’re going to take another angle on the topic of spiritual challenges to look at the obstacles to growth that result (in some, but certainly not all cases) from the families of kids with ADHD.

The first issue we need to consider is that kids with ADHD often have parents with ADHD. If a parent has ADHD, the odds that any one of their children will have ADHD is around 50%. Around 75% of cases of ADHD in kids can be attributed to genetic influences, but that doesn’t necessarily mean that environmental influences aren’t important, because some of that 75% includes the interaction of environment and genetics. Other cases are caused by developmental or environmental insults…premature birth, exposure in-utero to alcohol or tobacco, lead exposure, early physical or sexual abuse, and possibly, excessive exposure to video games or media.

Dr. Steve Faraone is one of the top researchers and statisticians in the child mental health field. He co-authored a editorial in last month’s JAACAP reviewing studies on the genetics of ADHD. I included this excerpt because the understandings we’re reaching about ADHD are likely to be what we’ll find with autism and other “hidden disabilities”…

“While twin studies report that ADHD is influenced 60% to 90% by genes, at best, only 5% of that influence can be traced to specific candidate genes. In some ways, this discovery was also an important one because it motivates us to think of genes in a different light. Rather than think of genes as disease genes, which they almost certainly are not, it is perhaps better to embrace the concept of susceptibility genes, i.e., that some DNA variants increase the risk for the brain variations underlying a disorder but are not necessary and specific causes of the disorder. In this way, each DNA risk variant can be seen as being responsible for influencing a trait, expressed as a variation in brain functioning, and the combination of these traits may be what puts one child at risk for a disorder, and yet a different combination may be protective.”

Sorry about digressing, but here’s the bottom line: We’re often relying upon parents who have difficulty setting priorities, following through on tasks and maintaining focus to be the primary faith trainers of kids with a condition that already poses obstacles to their spiritual growth.

Many of these parents were the kids who were turned off by church trying to sit still as a 12 year old in a straight-backed pew through a boring sermon while wearing uncomfortable clothes. One can make an argument that our “seeker-sensitive” churches represent an attempt to create an environment welcoming to adults with ADHD through offering relevant messages with one main point, services incorporating rich media, contemporary music, stadium seating and holders for coffee cups or other caffeinated beverages. (I told my last pastor that the least I could do after he spent 20 hours on the sermon was to show up with my Diet Mountain Dew Code Red prepared to listen.)

To illustrate the challenge at hand for the parent with ADHD raising the child with ADHD, let’s look at a summary slide below examining the executive functions we discussed in recent posts and consider the impact on spiritual growth in adults with ADHD:

I’m a big fan of the family ministry philosophy espoused by the guys at Orange Leaders, especially for families of kids with disabilities. That’s a teaching series for later in the fall or early in the winter. Here’s where there’s a parallel between what a children’s or family ministry pastor does and what I do in my day job…in many instances, we won’t be able to help the child until we first help the parents. Having a church community that can come around these families becomes a really important piece of the solution for kids with ADHD.

One more thought about how this plays out…last Fall, our team had the pleasure of doing some training at Northland Church in Orlando, where Debbie Blahnik is doing great things with the Children’s Ministry and Laura Lee Wright heads up the Access Ministry for persons with all types of disabilities. Debbie asked us to do a presentation on serving families of kids who are “irregular attenders,” because her team had theorized that their kids with hidden disabilities like ADHD have some relationship with the church, but the relationship is inconsistent. I had one of those moments when the light bulb went off over my head and our ministry team gets really scared. Most kids can’t get up and drive themselves to church! We can talk about ministry environments and curriculum all we want, but we’re not going to be able to help kids with ADHD to grow spiritually unless we can connect with and build influence with their parents.

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KM greenKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

Posted in ADHD, Families, Hidden Disabilities, Key Ministry, Parents, Spiritual Development | Tagged , , , , , , , , , , | 6 Comments

Spiritual Challenges for Kids With ADHD

shutterstock_343101839This 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 inhibitionnon-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.”

shutterstock_212282236Kids 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.

shutterstock_366339971Kids 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.

shutterstock_234024676Finally, 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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shutterstock_24510829Key Ministry is pleased to make available our FREE consultation service to pastors, church leaders and ministry volunteers. Got questions about launching a ministry that you can’t answer…here we are! Have a kid you’re struggling to serve? Contact us! Want to kick around a problem with someone who’s “been there and done that?” Click here to submit a request!

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Can we use your story to help churches?

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We’re looking for some families willing to share their stories to help Key Ministry help churches.

Our current teaching series on the impact of ADHD on spiritual development is part of Key Ministry’s ongoing efforts to help churches serve, welcome and include families of kids with hidden disabilities. We’re confident the information to be shared will be helpful, but we won’t have the impact we hope for without a little help from some friends.

We’re looking for parents of kids with ADHD (and/or other hidden disabilities) who would be willing to share from their experiences in trying to “do” church. Because Jesus often used stories to teach, many of the leaders in “church world” we’re trying to influence will find stories from parents far more compelling than my data or our ministry team’s training resources.

Answers to the following questions would be very helpful. Please feel free to respond in writing in the comments section below, or better yet, if you have a video camera and would like to respond, post your video to a publicly accessible site (you Tube, Vimeo etc.) we can link to. If you’d prefer anonymity, we can post comments without identifying information.

If you or your child have ADHD or some other “hidden disability,”

What experiences have you had of a church helping you to grow in faith, helping your child or family to grow in faith, or helping to meet an immediate need?

What experiences have you had with churches that weren’t helpful, reflecting negatively upon Christianity?

What would you like to share with Senior Pastors, Children’s/Youth Pastors or church leaders to help them other families affected by ADHD?

If you’d prefer to E-mail your posts, feel free to send them to steve@keyministry.org or rebecca@keyministry.org.


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How are Kids and Teens with ADHD Different?

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ADHD is among the most commonly identified mental disorders in children and teens in the U.S. According to a 2011 study, 11% of youth between the ages of 4-17 have received a diagnosis of ADHD, and over 6% are actively being for the condition with prescription medication. Given the sheer number of  kids affected by the disorder, the need for the local church to serve, welcome and include them (and their  families) has become too great a problem to ignore.

We need to understand the nature of the disability associated with ADHD if we’re to appreciate the challenges the condition presents for the church and for parents invested in their child’s spiritual development.

According to the DSM-5 criteria, children, teens and adults with ADHD have a developmentally inappropriate degree of inattentiveness, poor impulse control and in some (but not all) instances, hyperactivity.

barkley_homeRussell Barkley, Ph.D. is one of the world’s foremost experts in researching brain mechanisms in children and adults associated with ADHD. I had the honor of being his co-presenter at a day-long symposium on ADHD a number of years ago and was surprised to discover that he’d co-authored a paper with Dr. William Hathaway from Regent University entitled Self-Regulation, ADHD and Child Religiousness (Journal of Psychology and Christianity, 2003; 22(2):101-114). Here’s a fascinating lecture on the nature, causes and treatment of ADHD that Dr. Barkley gave on February 13, 2008 at the U.C. Davis MIND Institute.

Dr. Barkley’s theories suggest that ADHD is a disorder not only of attention, but of executive functioning as well. Executive functioning describes a set of cognitive abilities involved in controlling and regulating other abilities and behaviors. Such functions are necessary in initiating goal-directed behavior, suppressing impulses arising from lower brain centers, and planning future behavior.

There are five key executive functions: Behavioral inhibition (critical to development of the other functions), non-verbal working memory, verbal working memory, emotional self-regulation and reconstitution. We’ll describe in more detail the consequences of delays in the development of these functions.

shutterstock_86980295Behavioral inhibition involves the ability to delay one’s response to an event (allowing time to think), interrupt a chain of responses to an event and the capacity to keep competing events from interfering with the initial response. Without this ability a person would be entirely focused on the immediate consequences of any action or behavior and would be unable to develop the capacity for self-control. Kids in whom the development of this capacity is delayed will be unable to suppress the publicly observable aspects of behavior.

Non-verbal working memory involves the capacity to maintain a picture of events in one’s mind. The ability to analyze situations for recurring patterns in order to predict future events is critical in anticipating consequences of behavior, managing relationships and planning complex, goal-directed behavior. Moral conduct and social cooperation are contingent upon this capacity as well the retention of events in sequence that allows one to estimate the time required to perform a task. Kids who experience delays in developing this capacity will have more difficulty remembering multi-step directions, more difficulty completing tasks (especially tasks that take a long time to complete), and will tend to underestimate the amount of time necessary to complete assigned tasks.

Verbal working memory involves the capacity to think in words. Internalization of speech allows kids to internalize social norms and rules, facilitating moral development. As kids develop this capacity, they’re able to hold a thought in their mind without having to actually say what they’re thinking. A classic example is the inability of little kids to pray silently. Kids with delays in development of verbal working memory would tend to talk excessively compared to peers, have more difficulty organizing and communicating thoughts, struggle more with use of proper grammar and experience more challenges in following rules and directions.

Emotional self-regulation involves the ability to keep private one’s initial emotional response to an event or situation. This allows a child to modify their response to an event as well as the emotions that accompany the response. Capacity to sustain motivation for future-directed behavior is contingent on this ability. Kids who experience delays in acquiring this capacity will likely appear to overreact in response to minor provocation, have more difficulty appreciating the impact of their actions upon others, and have more difficulty summoning the drive or emotional states to overcome obstacles or complete goal-directed behaviors. Their response to initial frustration is usually to quit the activity or task.

Reconstitution involves the ability to use private visual imagery and language to represent language and actions. This allows us to mentally rehearse possible solutions to problems when attempting to overcome obstacles in order to complete a task or achieve a goal without physically having to carry out each and every solution. Kids with delays in acquiring this capacity will experience much more difficulty generating solutions to problems when they get frustrated or stuck.

The theory described above applies only to kids with the classic, combined type ADHD in which kids have difficulty with impulse control and hyperactivity. In general, they know what they should do, but lack the self control to do what they know is right. They also are challenged to generate work product, be it schoolwork or completion of chores at home. Kids with the inattentive subtype of ADHD have problems with focus, concentration and information retrieval. They are more likely to complete their work, but make careless mistakes in doing so.

Posted in ADHD, Key Ministry, Spiritual Development | Tagged , , , , , | 10 Comments