Based upon the experiences shared by fathers of kids treated in our practice, here are four thoughts as to why they may be more vulnerable to depression…
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Since we’re filming a training this weekend on the impact of ADHD on spiritual development, I thought today might be a good time to review some of the impediments to kids and adults with ADHD becoming involved and staying involved 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 parents of kids with ADHD are very 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 bejudged 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 church a number of years ago 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.
Finally, 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.
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.
What about 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.
For 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 (6:00 AM in the case of our tenth grader) 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 the leadership made at the church our daughter attends was moving 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!
Here’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. 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 ministry 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!
One 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…
We’ll call my friend Jake. Jake has ADHD along with auditory processing difficulties. 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
Jake: 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 finish directing traffic about the time his large group worship was winding down and the kids were getting ready for their breakout groups.
Consider the stories of the five people described in these passages…
I’ve lost twenty pounds in two months because of your accusation. My bones are brittle as dry sticks because of my sin. I’m swamped by my bad behavior, collapsed under gunnysacks of guilt. The cuts in my flesh stink and grow maggots because I’ve lived so badly. And now I’m flat on my face feeling sorry for myself morning to night. All my insides are on fire, my body is a wreck. I’m on my last legs; I’ve had it—my life is a vomit of groans.
Psalms 38:3-8 (MSG)
He ran for dear life to Beersheba, far in the south of Judah. He left his young servant there and then went on into the desert another day’s journey. He came to a lone broom bush and collapsed in its shade, wanting in the worst way to be done with it all—to just die: “Enough of this, God! Take my life—I’m ready to join my ancestors in the grave!” Exhausted, he fell asleep under the lone broom bush.
1 Kings 19:3-5 (MSG)
Curse the day I was born! The day my mother bore me—a curse on it, I say! And curse the man who delivered the news to my father: you’ve got a new baby—a boy baby!” (How happy it made him.) Let that birth notice is blacked out, deleted from the records, and the man who brought it haunted to his death with the bad news he brought. He should have killed me before I was born, with that womb as my tomb, my mother pregnant for the rest of her life with a baby dead in her womb. Why, oh why, did I ever leave that womb? Life’s been nothing but trouble and tears, and what’s coming is more of the same.
Jeremiah 20:14-18 (MSG)
We do not want you to be uninformed, brothers and sisters, about the troubles we experienced in the province of Asia. We were under great pressure, far beyond our ability to endure, so that we despaired of life itself.
2 Corinthians 1:8 (NIV)
He was despised and rejected—a man of sorrows, acquainted with deepest grief. We turned our backs on him and looked the other way. He was despised, and we did not care.
Isaiah 53:3 (NLT)
King David, Elijah, Jeremiah, the Apostle Paul, and Jesus (as described in Isaiah’s prophesy). Hardly a collection of guys lacking in faith. Yet, many in the church persist in the view that depression is a consequence of a lack of faith.
While it’s possible that a lack of faith can contribute to symptoms of depression (Elijah in fear for his life from Jezebel) or sin (David), or life stresses (Jeremiah, Paul) it’s difficult to conclude from the number of Biblical illustrations in which giants of the faith struggled with hopelessness and despair that a primary cause of depression is a lack of faith or trust in God. Aren’t we making presumptions about God’s purposes in our suffering? Isn’t it possible, perhaps likely that God might use our suffering to strengthen our faith and to draw us into closer relationship with Him? I’m struck by the number of ministry leaders I’ve met who have struggled personally with depression. Just the other day, our colleague Shannon Dingle shared a wonderful post in which she described how being broken is not bad when God breaks us.
Churches that welcome kids with disabilities and their families will encounter many parents who struggle with depression…in my nearly thirty years in psychiatry I can attest that depression is a frequent complication of having a child with significant disability,especially among mothers. If we’re using family-based ministry models as a strategy to help all kids grow in faith, we need to consider how we’re going to care for parents with depression if they’re responsible for shepherding their kids.
As a psychiatrist, I can’t ever say for sure why any individual kid I’m treating is depressed, other than to say that some combination of biological predisposition, patterns of thinking and perception, environmental influences, situational stressors and sometimes, spiritual factors are involved. From where I sit, churches are most helpful when demonstrating the unconditional love of Christ to all kids and adults struggling with depression, offering biblical counsel if desired, recognizing that depression is a manifestation of our broken world and that God (at times) may use medication and evidence-based psychotherapies as instruments of healing in response to prayer, and acknowledging that like all of us, persons with depression are broken people in need of a Savior.
Updated July 15, 2015