By Stanley I. Greenspan Da Capo, 2009 Review by Dr. Anthony R Dickinson and Lucillal Lau on Mar 30th 2010
Right from the book's outset, Greenspan presents what the current reviewers' hope and believe will be for its readers, a new way forward in helping children with ADHD and ADD diagnoses. Prior to the prescription and establishment of any psychoactive medicine regime, Greenspan argues for, and illustrates with successful case studies, the exploration of Piagetian-like activities set in a developmental-intervention program. Similar to those found in multi-month PII Brain Spa Programs, Greenspan introduces several customisabletask/activity options to suit any child's target-set of strengths and weaknesses,for any family coping with an ADHD/ADD-diagnosed child. Parents are encouraged here to initially focus upon the identification, skill-development and monitoring of core indicators of developmental-behavioural anomaly, including age-normative motor planning, sequential coordination(s), and visual-spatial processing skills.
Once such core behavioural differences have been clearly identified, Greenspan's proposed 'cognitive-scaffolding' activities/interventions may be introduced to the child's routine to assist with the generation of more context-appropriate behaviors, rather than immediately opting for managing the largely unwanted behaviors typically associated with ADHD/ADD by the uncritical use of psychoactive drugs following diagnosis. The author's propose in waiting to see the results of at least six months of continuous intervention/activity practice, before agreeing to offer their child pharmaceutical treatments (which may be proposed by some practitioners as a way to treat a child's behavioural symptomology, but not the cause(s), of undesired behaviours identified at initial clinical presentation).In this sense, we hope that Greenspan's work provides both a welcome and fascinating resource (i.e., good news !) for the increasing numbers of parents whose child(ren) is/are diagnosed with ADHD/ADD. Indeed, to those who have been wondering if medication might be the only way of offering help to their hyperactive child, the 'hands-on' knowledge being made available here as the basis of the interventional program will enlighten, whilst proactively enabling them to assist their child to deal with everyday situations with increasing flexibility and appropriacy amidst the increasing demands of a variety of environmental challenges.
Greenspan's comprehensive approach outlines seven key goals, including reflective thinking, building self-confidence, improving family dynamics and provision of a healthy environment. These goals struck a chord with the reviewers as professional training consultants with the daily responsibility for monitoring children's developing progress from 1st-person (e.g. self esteem, spatial and sensory awareness skills), to social (e.g. communication and interpersonal logical construct) perspectives. More commentary with regards the maintenance of cooperation between trainers/councillors and parents would provide a further critical addition, however, so ensuring that all parties remain regularly updated as each child's intervention task/activity sets' progress over time, whilst parents also be advised to independently keep records of their observed daily behaviour patterns for comparative purposes.
Chapters 4 through 7 discuss the core measures and activity recommendations regarding children's motor systems and sensory processing skill developments. As with PII Brain Spa Program, trainers and/or parents may modulate particular activity/game details to suit the individual child's identified strengths and weaknesses in order to maintain the optimal developmental progress pace.The games/activitiesthat Greenspan recommends are designed to allow individual children to build up their concentration levels as their 'attentional deficits' begin to come under their own conscious control towards personal mastery. Example game progressions might include a simple crawling to walking routine, followed by running and skipping, only then introducing increasingly complex syncopated rhythmic patterns. Introducing increasingly complex sequencing tasks, adjusting the rhythm by speed, and/or volume parameters further practices extremity, and later, whole body-part control. 'Simon Says' and obstacle-course games are also suggested according to age-related and ability-determined dispositional states of readiness. Music and sounds (including use of varied tones of voice) are recommended in providing further opportunities for children to experience and locate the origin of different sound sources. As with other sensory modalities, helping every child to make 'sense' of the auditory components (for example) 'hidden' amongst the mass of sensory stimuli as may be occurring in their surroundings,will assist in their coming to know where different stimuli are coming from, and to master/assign their significance more appropriately. By so doing, Greenspan's program focuses (correctly we believe) upon strengthening each of the separate abilities that support attention, focus and concentration – the latter three skills being the most frequently identified as criteria diagnostic of ADHD/ADD conditions.
In reading this volume, parents can be helped in coming to better understand the most up-to-date behavioural patterns their child may develop as they continue to monitor progress, and analyse the changes in previously identified strengths and weaknesses that may underlie their hyperactivity. With the inclusion of frequently cited supportive references, the'Sensory Processing and Motor Abilities Questionnaire' allows both parents and professionals to keep track of an individual child's behavioural profile (or overt behavioural pattern). However, the reviewers also must point out some shortcomings of the way in which this tool was presented in the version received for review: It was unclear how exactly the resulting profile might best be interpreted and used for activity generation and scheduling. Indeed it is possible that some readers/parents may even take the questionnaire as providing a diagnostic aid for ADHD/ADD (which is NOT its purpose), and some readers would clearly benefit from guided consultancy with a supervising clinical or educational psychologist sympathetic to Greenspan's ideology (as are the current reviewers). Whatever interpretation one may result in accepting the profile generated following use of Greenspan's 'Sensory Processing and Motor Abilities Questionnaire', we agree with him that, respecting each child's uniqueness and treating them in a 'student-centred' way is the most valuable approach in treating children diagnosed with ADHD/ADD.
With the inclusion of several regularly updating website addresses to continue checking in the Resources section at the end of the book, Greenspan has offered here a great opportunity for both parents and educational/psychological professionals work with suspected ADHD/ADD cases without immediate resort to psychotropic drugs and/or medical specialists (at least if occurring in the absence of any clear psychopathology or neuropathy). Intervention programs are always time-consuming however, but if affordable, persistent monitoring and assessment of sensory, motor and sequencing skills can, and often will result in happier, more self-motivated success stories, and, a lasting outcome rewarded by enhanced levels of personal control and responsibility,.... all possibly quite readily achievable without administering any mind-altering drugs !