Case Study - Jenna

This case study is a composite of several real children I have treated in the past 7 years. Names have been changed, but the story is based on real events that actually happened with different children and parents I have worked with.

A 7-year old with ADHD symptoms such as lack of focus, and poor school performance.

Jenna was a delightful 7 year old second grade girl with a cute, brown ponytail. Her mother, Julie, brought her to Play Therapy because Jenna was having great difficulty concentrating on her schoolwork, she was easily distracted, unfocused, and would get quite upset while doing homework, which took them 2 hours daily and only could be completed with great difficulty. Jenna’s teacher reported that she was also very distracted in class, and her efforts to get her to focus were not successful. Julie was clear, however, that she did not want to medicate her and was seeking another solution.

Gradually over the first few sessions, I got to know Jenna and also I familiarized myself with Julie’s Parenting style. It was extremely important to Julie that Jenna be successful in school and life, and she was somewhat concerned as Jenna had been testing below grade level, and now with her difficulty focusing she was falling further behind, to her mother’s alarm. Julie admitted that as a result she tended to put pressure on Jenna to do her work correctly and completely, and homework times had gotten extremely stressful and unpleasant. Julie was not sure if Jenna maybe could be working harder than she was. She was very frustrated with her daughter’s lack of focus and tended to get upset with her and reprimand her frequently, and even raise her voice sometimes. Her father was generally sweet and gentle, and left Jenna’s education up to her mother.

Otherwise Jenna’s behavior was generally good, except she would be sensitive and cry sometimes.

I began to meet every week with Jenna for Play Therapy, and twice per month with Julie for Parenting Counseling at a time when Jenna’s father was unable to make it because of his work.

In Parenting Counseling I helped Julie to herself recognize how she might be interacting with Jenna in a way that might be unhelpful. She noticed that Jenna would get very upset when reprimanded or criticized, and that it never seemed to result in improvement. That was why Julie was so frustrated, nothing she seemed to do ever seemed to work. I helped her see that whatever academic benefit Jenna was getting out of completing her homework, it was offset by the stress, unpleasantness and bad feelings that went along with it. Julie began to realize that something needed to change but was afraid that if Jenna didn’t complete her homework she would fall further behind and would end up being uneducated! I Then presented to Julie the voluminous evidence laid out by Alfie Kohn in The Homework Myth which showed how excessive homework actually doesn’t bring any academic benefit, that it just frustrates and makes parents and children alike miserable, and can teach them to actually hate school. See my blog post Is homework helpful or harmful, for more information on this. Therefore with Julie’s consent I offered to reach out to Jenna’s teacher and see what I could do about it. I had been a teacher for many years, so I knew what she was going through with a student with ADHD symptoms and behaviors. I explained to her that I appreciated her heroic efforts to educate Jenna, and that it was my sincere and dedicated desire to help her. I told her that I was a medical professional, and that for the benefit of Jenna’s emotional health I needed to make a medical prescription of a reduction in the homework assigned. Not only would this benefit her and her mother emotionally, and reduce stress in their relationship, but I believed it would actually improve her academic performance, as I had seen it happen before! Approached in this respectful way, Jenna’s teacher understood and agreed to cut her homework load in half. Since Jenna needed more work in math, she decided to leave most of the math work and to cut out more of the other subjects where she was a bit stronger anyway.

Over a couple more sessions, I helped Julie to understand that the quality of the parent-child relationship was the most important factor in her daughter’s life, and her academic success would flow from and improvement in that relationship. Therefore Julie agreed to adopt a very patient, gentle approach to Jenna’s homework time, and to avoid criticism, reprimands and conflict at all costs. In addition I explained to Julie that the most important indicator of academic success is the extent to which the child actually enjoys her learning, and that making learning pleasant was the key to a good result. See my blog post, Joy in learning, for more information about this. At the same time the reduced homework load was of great relief to both of them. Jenna no longer felt hopeless and overwhelmed and was able to muster the concentration to finish all her work in only 45 minutes. This left much more time over for badly needed play time, and Julie began to realize how important it is for every child to have 3-4 hours of intensely pleasurable play every day, that it is a deep and fundamental need, not a frivolous desire. Julie loved the idea of giving he daughter a pleasant treat during homework, which created a positive association and made the work go much more smoothly. After 3 months of less homework combined with a much more pleasant, positive and pressure-free time with her mother, Jenna’s homework performance improved greatly. Her fear of poor performance was also significantly reduced, and her classwork began to brighten up as well.

Before beginning therapy Jenna had been feeling very badly about herself, feeling like a failure in school and like she was a disappointment to her mother, and her self-esteem and self-confidence had suffered. She had bouts of crying and being very upset.

Therefore during Child-Centered Play Therapy sessions, I completely let her be the boss, and I followed her, letting her realize how important all of her chosen activities were. This was incredibly exhilarating to Jenna, as she was the complete director of her own institution, her weekly Play Therapy session. I showed so much respect for the activities she chose to do, that she began to learn to respect herself more. One time a toy she was playing with broke, and I empowered her by allowing her to struggle with it, as I reflected back to her verbally each step of her attempt to fix it, giving her insight into her own capabilities. After finally fixing it, she proudly exclaimed, “I know how to fix things!” That is the actual creation of true self-esteem! Over time, all this made her feel so good about herself, that she was able to find the strength to persevere in improving her school performance.

Children with ADHD symptoms tend to lack executive functioning, and therefore can’t muster the concentration power to choose to focus on their work. Therefore in the playroom I was careful to support, validate and celebrate each and every decision Jenna made, giving her intense pleasure upon making her decisions, which created a positive association and encouraged her to make more! This exercising of her decision-making muscles actually helped her develop the power to choose to focus on her work in the classroom and during homework!

Desires are very closely related to feelings, and by helping Jenna honor so much her own desires in the playroom, she began to become more aware of her own feelings, and to respect them. She began speaking up and expressing her feelings, wants and needs, in and out of the playroom, and her bouts of crying and being upset were greatly reduced.

Her mother’s great change to a more gentle, patient parenting style, and the healthy expression of her needs, desires and feelings in Play Therapy, resulted after 6 months of treatment in a much happier and relaxed child, great improvement in academic performance, and a much healthier parent-child relationship.