In one of NPR's upcoming How to Raise a Human reports Michaleen Doucleff travels to rural Mexico to discover a group of Mayan children with extraordinary abilities to pay attention.
SDPB is bringing How to Raise a Human home to South Dakota. Shane Hamilton, an Integrated Health Therapist with Sanford Health, expands on the subject. This conversation has been edited for web use, to listen to it in its entirety click here.
Lori Walsh:
Welcome to In the Moment. I'm Lori Walsh. Parents, take note. NPR brings you a new series on how to raise a human. You can follow the hashtag on social media or log into NPR.org to hear stories on everything from the language of babies to resilience to fifth graders to how the United States government first began to get involved in the health and well-being of children. In one of the upcoming stories, NPR's Michaeleen Doucleff travels to rural Mexico to discover a group of Mayan children with the extraordinary abilities to pay attention. SDPB is bringing How to Raise a Human home to South Dakota. Today, we welcome our guest, Shane Hamilton. He's an integrated health therapist at Sanford. Shane, thank you so much for being here with us. We appreciate your time.
Shane Hamilton:
You bet, and thank you for having me.
Lori Walsh:
Give me an idea of what an integrated health therapist is at first, why that word integrated?
Shane Hamilton:
The integrated aspect of it is I'm a behavioral health provider that's integrated right within the pediatric primary care clinic, so I work directly with the pediatricians, and we have others that do my role that are with family med providers as well.
Lori Walsh:
Okay, so you're physically located there, and then you work with other people in a collaborative fashion as well. Do I understand that correctly?
Shane Hamilton:
Yeah, a lot of that is when patients can come in and see the physician and they're talking about a cough, and all of a sudden there's more of a behavioral thing. Or we've got some attention concerns going on. They can bring me in, and I can be consulted immediately and meet with the patient and the families and figure out what we can do to help out.
Lori Walsh:
All right. I think we're gonna talk more about this program at Sanford in other ways in our next segment, but I'm hoping we can start out with you. Let's start with ... I'm sure you deal with all kinds of fascinating things, so we can go anywhere with this, but I want to start with this idea of attention and focus and distraction or attention deficit disorder. There are so many things as a parent that parents are wondering about in the technological age as kids go to school. Do you see parents asking about this and coming and saying to you, "My kid can't focus on one thing," or having questions about what's developmentally appropriate?
Shane Hamilton:
Yeah, we see a lot of that coming in, and the spectrum of it really varies. You have the parent coming in with their two, three year old of just them saying, "Hey, we're trying to work on letters, but we can't get him to sit down and to work on those different things," all the way ranging up to their concern for the ADHD, attention deficit hyperactivity disorder of, "Is that a true biological issue that's going on with my child, and if so, what do we need to do to be helping out?" On a weekly basis, I'd say I have that conversation, oh, probably a good five, ten times.
Lori Walsh:
Really? Okay, so let's start with some of the basics as far as, "Hey, I want to read my kid a book, but he just doesn't want to sit." What's developmentally appropriate? When should a child be able to focus on a task for an extended period of time?
Shane Hamilton:
It's something we want to introduce to them at a young age, even through infancy and early childhood of really reading to them and spending that time where they may not necessarily want to do those different things, but that's where we try to find ways to tailor it to their interests and what they're liking there of reading them the books and different types. You aren't gonna sit down and read a chapter book or even a longer book with a two year old. You do one that's fun, and you add some flair into it as you're reading it and working with them to adapt, and we want to set that expectation that, yes, we're going to be able to sit here and attend to this for an appropriate amount of time. A rule of thumb that I'll give parents is anywhere from ... You take their age and give it for every year old, two to four minutes for it. So, if you have a three year old, you're maybe gonna get anywhere from six to 12 minutes out of them during that time and having that expectation and making it, "This is a fun thing. We're gonna work on this for a little bit," and not necessarily just pushing them all the way to that 12 minutes. If we get done with it at six minutes, they're doing great. Okay, fantastic, now let's have a little bit of a break, and we can move on from it.
Lori Walsh:
Does the child know that there's a time limit? I mean, you're not setting a timer at this point. You're just in the moment with the kiddo, right?
Shane Hamilton:
Very much so. You don't have to. There's some times where maybe we will. You've got a kindergartner. "Okay, we've got to work on doing our letters here a little bit. Let's set this timer," because, sometimes kids can adhere well to that idea of there's a timer. They know it. They like. So, as adults, it seems to just make time drag on, but kids like it a little bit more, but is it something to where we need to set a timer for everything we do? Absolutely not. I think that's good for us as parents just to have that in the back of our mind and knowing those expectations and what's appropriate for them.
Lori Walsh:
When my child was little, one of the things I had to teach myself to do was to not interrupt her. I mean, obviously not never, but there are times where she would get involved with playing with some blocks or something. I would be sitting nearby, and I remember just freezing and saying, "Okay, she's totally in this space right now. I'm not going to interrupt her by getting up and moving around." How important is just when the child is looking at a book by themselves or playing with a toy or an object that they've found for parents to just back off and let that attention develop?
Shane Hamilton:
That's very much important. Sometimes our natural instinct is to want to come and say, "Hey, oh, you're doing a great job there looking at those books or building with the blocks," but then that just pulls them away from it, and so it's us managing our impulses there of just letting them play. Hey, this is a great thing. Whether they'll go on and play with it for five minutes or 20 minutes, you get some kids where they'll sit there, and they'll play with their Legos for 1/2 hour without any issues, and that's okay. That's helping them build that of creating that foundation so that when they get to be a little bit older, get into the school age, they've got some of that ability to do so.
Lori Walsh:
How old do they start developing, and I can't remember, is it called object permanence, that moment where they realize if they can't see her, she still does exist. What age does that start coming into kids? Do you know?
Shane Hamilton:
It varies a little bit, obviously, for each child. We expect to see some of that around that two year age range ... of knowing, and a lot of times then they'll get so engrossed in that and then they'll be okay. And then all of a sudden, they'll look around and, "Oh, Mom's not there," and then that's when you'll get some of those cries that come about there, but then all of a sudden, "Okay, yep, Mom is there," and attends to it and then just helps redirect. That reassures them. "Yep, everything's okay. You're fine playing there doing your thing, and Mom was still there to provide that reassurance or Dad, whoever happens to be there.
Lori Walsh:
How important is this? Because now that my child is 17, and I see what she goes through in school with homework and the amount of attention she has to pay something in the duration, she has to be able to stick with a test, for example. How important is it to build the ability to pay attention and to focus, and how much can it really get in a kid's way if they are struggling in this area?
Shane Hamilton:
I think it's definitely important for them to be able to build that, because expectations nowadays are a lot different than back when I was in school, and I like to think it wasn't that many years ago, but it's really changed. They have a lot of expectations. Even on the younger ones with kindergarten, first grade, second grade, they have that expectation, and we look at it as being executive functioning to where everybody has the ability to do so. We're not just born with it, so you have to foster that and help them learn to develop those different skills that are gonna benefit them for when they get later on in life and doing that. And we see some kids to where maybe they do have a biological issue, such as ADHD, that's going on, whether it's the inattentive component or the hyperactive and impulsive, or maybe there's another learning disorder that's going on. And if they're struggling to do that, it creates a lot of issues for them, not just for the child, but for parents and for teachers. I think sometimes they'll express it through different ways. You'll see some of the different acting out behaviors, and we contribute it to, really, just noncompliance type stuff, but we have to ask ourselves, "Okay, is there something else that's contributing to it?" I like to think that for a kid, there's always a reason for the behavior. It's just us as adults, we have to figure out what is that reason that it's going on, and then once we know it, the we can figure out how to best help them.
Lori Walsh:
How do we know when it's a problem, and what are the indications that we are looking at something that's biological, not just normal development?
Shane Hamilton:
I get asked that question a lot. A parent will come in with their three year old and say, "Boy, my kid's really energetic or can't tend to their letters like we're wanting them to. Do they have ADHD?" Not necessarily. Really, when we start to assess that is at kindergarten age, five, six years old to where we can look to see, because that's where they start to separate some of the age-expected type behavior and distraction that's going on there. And we'll really start to see it stand out as far as we give them a task to do, and they can't do it, or there's different things in school to where the teacher is able to compare to other peers. They're able to sit and attend and do these different things and remember these concepts, and this child's really not. I look at it as, really, when we get into that school age frame to where if it's starting to impact them academically, that's when we know we need to look a little bit further into seeing if there's some more issues going on.
Lori Walsh:
Are there gender differences? I know that mothers of boys often will say, "He's a boy. He's not gonna sit down." Is that an expectation difference, or is there really something going on there with the difference between boys and girls when they're little?
Shane Hamilton:
We do hear that a lot of that aspect of it's just a boy type of thing, and then we tend to see boys as being a little bit more of the hyperactive, impulsive type things, and girls are a little bit quieter. And there's a lot of times where females are not diagnosed or misdiagnosed with an inattention type component because, "Well, they're just a girl. They're being quiet. They're shy," type of thing, so we do see that a little bit more predominantly in boys with it being diagnosed, but that doesn't mean that's not occurring there with girls.
Lori Walsh:
So, we're looking at some cultural differences, no doubt.
Shane Hamilton:
I feel like you could say that.
Lori Walsh:
How about nutrition and environment? Do we worry about or do we think? How much do we think about the connection between what we're putting in front of our kids, even our teenagers, and how they can focus? Does nutrition affection attention?
Shane Hamilton:
There's a lot of different opinions out there with it. I think you need to make sure the child's basic needs in regards to nutrition are being met. You say, "Let's try to limit some of the different sugars and different things that are going on instead of just eating candy all the time and drinking pop." That's going to amp them up there, that little bit. But as far as other environmental type things, it very much plays into it. I think that one thing that often gets overlooked is sleep. In that aspect, we get a lot of kids of kids that are coming in, they're not sleeping well, and when kids aren't getting adequate sleep, then we tend to see it to where they'll have more of those energetic, distracted type behaviors. Some come in that really seem like they have ADHD-based symptoms going on, but we get a good sleep hygiene down, and those behaviors calm down. Doing some of those things, and then there's always that question of electronics, of, "How much time should my child be spending on electronics?" The struggle is that in today's age, electronics are all over the place. When a kid goes to school, they're using computers and iPads, so we're not going to completely get away from those. I think we want to make sure that it's purposeful, and we're gonna have those times of doing maybe a learning app on the iPad, but then having some of that other unplugged time to go out and play. You go outside. You do different free play type activities there.
Lori Walsh:
How does it, focus and attention issues, surface? How do they surface with teenagers and adolescents?
Shane Hamilton:
A lot of times, we'll start to see more of a dip and decline in the academics. Sometimes it's that aspect of, "Boy, we're really just not comprehending the math, and we're trying all these different things. We sit down, and we work on homework for three hours a night, but it's still not getting done," or "We're doing poorly on the test," so it comes out in some of those different things. You don't see it quite as much with the hyperactive component that's there, because they learn some of those self-regulation skills, but their ability to really fully attain that information becomes more prominent there.
Lori Walsh:
How do you work with kids, maybe in that middle school, high school area where maybe they're having to do more homework than they have before, and exactly what you said, they've got three hours and they're still not done, because they're having a hard time just prioritizing and focusing? Is that just learned behavior? Where do you begin?
Shane Hamilton:
I think you have to do the wrap around approach. Yes, the child is gonna need to do some different behavioral strategies to help them to be more attentive and things, but we also have to work with the parents and work with the school to make some of those different accommodations. And I think, sometimes, just helping the parents understand it's not a noncompliant based thing. This is legitimately a struggle there for your child to be able to pay attention and retain this information. So, sometimes it's that matter of, "We're gonna work on homework for 20 minutes, and then we're gonna purposely take a break, give you five, 10 minutes to reset." I look at attention as being a switch. Sometimes, we'll be able to flip our switch on, and it stays on, and our attention is there for as long as we need it. Other people, their switch goes on, and then it's like it's greased, and it slowly starts to come down. So, we have to recognize and know, okay, when are we starting some of that attention space, and then give it that purposeful break to reset with it. And then there's other strategies that they can do as far as understanding how that child learns best. Maybe it's writing different things out or using flash cards or making sure we're very purposeful about writing in a planner. I think that's where a lot of the middle schoolers start to struggle is they don't know what their homework assignments are. They're not writing them down, and so making sure that the teacher is checking in with them to, "Okay, did you get all the assignments wrote down for the day?" And then that goes home, and mom and dad make sure to look at it, so there's that communication, a little bit of accountability that's there as well.
Lori Walsh:
All right. Any tips for those of us who are adults and who need a good, healthy five to 10 minute break to reset our focus?
Shane Hamilton:
It's that self-awareness component. I think we all have a little bit of that intention at times. Particularly, it's we're doing something that we don't necessarily want to be doing, but being mindful and setting my goal of, "Okay, I'm gonna make sure that I do this and get my reports written," or all these different things for work. And then once I hit that goal, then I'm going to give myself a break. Then, when I'm working on everything, limit those distractions, putting the phone away, I'm not gonna respond to any different emails or things like that.
Lori Walsh:
Shane Hamilton is an integrated health therapist at Sanford Health. Hey, thanks so much. This has been fascinating. We'd love to have you back some time. And you can follow NPR.org for more conversations about how to raise a human. Just look for that hashtag.
