Steve relates our current understanding of brain functioning in kids and teens with ADHD with strategies to help them have a great Awana experience and overcome unique obstacles to spiritual growth.

1. Stephen Grcevich, MD!
Director of Strategic Initiatives, Key Ministry!
Awana 2014 Ministry Conference!
First Baptist Church, Oxford, MS!
August 23, 2014!
Helping Kids With ADHD to Grow Spiritually

2. Learning objectives:
¨ Review our current medical understanding of the
causes of functional impairment seen in persons with
ADHD
¨ Explore how our ministry environments represent
obstacles to church participation and spiritual growth
in children and adults with ADHD
¨ Discuss strategies for promoting spiritual growth in
persons with ADHD
¨ Identify gifts and talents often associated with ADHD
that may be channeled for Kingdom purposes

3. What is ADHD?:
¨ ADHD is a neurodevelopmental disorder
characterized by an age-inappropriate degree of
inattentiveness and disorganization, and in some, but
not all instances, impulsivity and hyperactivity

4. What causes ADHD?:
¨ Genetics is primary factor…many genes appear to
make minor contributions
¨ Environmental toxins (lead)
¨ In-utero environmental toxins (drugs, alcohol,
cigarettes)
¨ Trauma
¨ Prematurity
¨ Technology?

5. ADHD facts and figures:"
¨ 11% of U.S. kids ages 4-17 have been diagnosed
with ADHD…88% continue to carry the diagnosis"
¨ 14% of kids in Mississippi have ever been
diagnosed with ADHD, 10.9% currently diagnosed"
¨ Highest prevalence in southeastern U.S."
¨ 69% are currently being prescribed medication
but…the majority do not take medication on a daily
basis"
¨ 42% increase in parent-reported prevalence since
2003"
¨ Many have “comorbid” mental health conditions"
U.S. Centers for Disease Control

6. Executive functioning as the fundamental
difference in persons with ADHD?
¨ Executive functions…cognitive abilities involved in
controlling and regulating other abilities and behaviors
¨ Necessary in initiating goal-directed behavior, regulating
emotions, delaying gratification, planning future
behavior
¨ Children with weaknesses in executive functioning have
more difficulty foreseeing outcomes of behavior,
adapting to new situations.
Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

7. Key executive functions:
¨ Behavioral inhibition
¨ Verbal working memory
¨ Non-verbal working memory
¨ Emotional self-regulation
¨ Reconstitution
Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

8. How might ADHD affect one’s spiritual life?"
¨ Behavioral inhibition: sitting through a
worship service"
¨ Nonverbal working memory:
remembering my Bible when it’s time
to leave for church"
¨ Verbal working memory: the ability to
pray silently"
¨ Emotional self-regulation:
immediately react negatively to
demands from authority"
¨ Reconstitution: Managing time,
priorities… Skipping AWANA
because homework’s not done."
¨ Can I use the computer without
viewing pornography?"
¨ Forgetting to register my kids for
the weekend retreat"
¨ The ability to memorize and
meditate quietly upon Scripture"
¨ I scream and yell at my spouse
and my kids, overreact when
imposing discipline"
¨ Difficulty applying Biblical truths,
wisdom in daily life"
Children/teens: !! Adults:!

9. Problems with internalization of
faith arising from ADHD:
¨ Kids struggle to maintain a spiritually disciplined life
¨ More difficulty meditating quietly upon God
¨ May give up on Bible study when it becomes tedious
¨ Difficulty delaying immediate gratification for long-term
spiritual outcomes
Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

10. Problems with stability of spiritual
growth arising from ADHD:
¨ Poor self-regulation increases vulnerability to negative
environmental influences
¨ Tend to have intense spiritual experiences at VBS, camp,
mission trips that fade when spiritual context is gone
¨ More prone to “roller-coaster” spirituality
¨ Shunned for volunteer, leadership opportunities if perceived
as undisciplined, disorganized
¨ Drawn to religious contexts that are more participatory,
action-oriented, relational (better doing than talking)
Hathaway WL, Barkley RA. J Psychol Christianity 2003, 22(2) 101-114

11. Challenges presented to the
church by persons with ADHD:
¨ Balancing worship that’s engaging, but not overstimulating
¨ Pastors, ministry leaders lack training, experience in
working with kids with ADHD
¨ Church environments less structured than school
¨ Parents choose not to use, or physicians discourage use
of effective medication on weekends
¨ Many activities occur when medication has worn off or
rebound is occurring

12. Ministry strategies for persons with ADHD:
ADHD-friendly environments"
¨ Registration/sign-in needs to be
orderly"
¨ Staffing for transition times
before/after services"
¨ Use of color, lighting"
¨ Engaging, not overwhelming"
¨ Communication strategies…
reinforce key point(s)"
¨ Use of touch, nonverbal cues"
¨ Family worship experiences
geared to kids? ""
¨ Is signage, direction clear?"
¨ Use of music, technology"
¨ Physical environment shouldn’t
become a distraction"
¨ Flexibility in dress code"
¨ Simplicity in communication"
Children/teens: !! Adults:!

13. http://drgrcevich.wordpress.com/2010/10/22/harmony-hensley-welcoming-
ministry-environments-for-kids-with-adhd-part-two/"
ADHD-Friendly Ministry Environments"

14. http://drgrcevich.wordpress.com/2010/10/22/harmony-hensley-welcoming-
ministry-environments-for-kids-with-adhd-part-two/"
ADHD-Friendly Ministry Environments"

15. ADHD-UNFRIENDLY ministry environments!"

16. ADHD-UNFRIENDLY ministry environments!"

17. Ministry strategies for persons with ADHD:
Discipleship"
¨ Church and parents as
partners in teaching kids
about God"
¨ They’ll learn and retain more
in 1:1, small group situations"
¨ Ministry resources need to be
sent directly to parents…role
for technology?"
¨ Where can they be involved
in meaningful service?"
¨ Connecting them with others in
the church especially important"
¨ Break Scripture into smaller,
manageable parts"
¨ Study guide format for sermon
notes"
¨ Small groups offer multiple
accountability partners"
¨ Where can they be involved in
meaningful service?"
¨ You have to remind them if you
want them to come"
"
Children/teens: ! !! Adults:!

18. What can I do to help someone I love
with ADHD come to faith, grow in faith?"
¨ Spend time with your child
one on one or as a family
praying together, studying the
Bible together"
¨ Make Jesus, Scripture
interesting by sharing from
your experiences"
¨ Seek opportunities for your
child to serve in ways that fit
their talents, gifts"
¨ Attend church regularly"
"
¨ Invite them to church (or
remind them to come)"
¨ Go with them to a church
where they’re more likely to
have a positive experience"
¨ Pray, study the Bible, serve
with them"
¨ Connect them to others in the
church who will accept them,
follow up with them"
My child:! My spouse, sibling, friend:!

19. What advantages might ADHD provide
a follower of Christ?
¨ Willingness to take chances for God
¨ May be very energized by topics or ministry
activities that capture the imagination
¨ May be very effective in ministry teams when others
have complimentary organizational skills
¨ Ability to engage others useful in sharing the Gospel
¨ Good at scanning environment for trends
¨ Is ADHD overrepresented among senior pastors?

20. Conclusions:
¨ Churches may promote spiritual growth in kids with
ADHD by…
1. designing ADHD-friendly ministry environments
2. resourcing parents for 1:1 discipleship
3. providing opportunities for meaningful service
4. demonstrating intentionality in promoting relationships
with others in the church

21. Questions?"

22. Key Ministry provides knowledge,
innovation and experience to the
worldwide church as it ministers to
and with families of children
impacted by mental illness, trauma
and developmental disabilities. !

23. Stay in Touch!"
Key Ministry Website: http://www.keyministry.org"
Church4EveryChild…Key Ministry Blog: http://drgrcevich.wordpress.com"
Key Ministry Training Channel: http://go.mediasocial.tv/keyministry"
Front Door (Online Church Campus): http://go.mediasocial.tv/cbcfrontdoor"
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http://www.facebook.com/keyministry
http://www.pinterest.com/keyministry/
http://twitter.com/#!/drgrcevich
http://twitter.com/#!/KeyMinistry

24. Additional Resources on ADHD:"
Church4EveryChild…Steve’s Key Ministry Blog:"
http://drgrcevich.wordpress.com"
"
ADHD and Spiritual Development Blog Series (including Barkley video):"
"
Blog post:"
http://drgrcevich.wordpress.com/2010/09/12/how-are-kids-and-teens-with-adhd-different/"
"
Key Ministry"
http://www.keyministry.org"
"
AACAP Resource Center-ADHD"
http://www.aacap.org/cs/ADHD.ResourceCenter"
"
"

25. ADHD: DSM-5 Criteria for Predominantly
Hyperactive-Impulsive Type"
Six or more of the following manifested often:
Impulsivity/Hyperactivity
Impulsivity!
¨ Blurts out answer before
question is finished"
¨ Difficulty awaiting turn"
¨ Interrupts or intrudes on
others"
Hyperactivity!
¨ Fidgets"
¨ Unable to stay seated"
¨ Inappropriate running, climbing
(restlessness)"
¨ Difficulty in engaging in leisure
activities quietly"
¨ “On the go”"
¨ Talks excessively"
American Psychiatric Association. DSM-5, 2013.

26. ADHD: DSM-5 Criteria for
Predominantly Inattentive Type"
¨ Inattention to details/
makes careless mistakes"
¨ Difficulty sustaining
attention"
¨ Seems not to listen"
¨ Fails to finish tasks"
¨ Difficulty organizing"
¨ Avoids tasks requiring
sustained attention"
¨ Loses things"
¨ Easily distracted"
¨ Forgetful "
Six or more of the following manifested often:
Inattention
American Psychiatric Association. DSM-5, 2013.

27.
ADHD in Preschoolers (Ages 3–5):!
¨ Motor restlessness (as if “driven by a motor”)"
¨ Difficulty completing developmental tasks (e.g., toilet training)"
¨ Decreased and/or restless sleep"
¨ Insatiable curiosity"
¨ Family difficulties (e.g., obtaining and keeping babysitters)"
¨ Vigorous and often destructive play "
¨ Demanding of parental attention, argumentative"
¨ Delays in motor or language development"
¨ Excessive temper tantrums (more severe and frequent)"
¨ Low levels of compliance (especially in boys)"
Campbell et al. JAACAP 1984;23:243.
Greenhill. J Clin Psychiatry 1998;59(suppl 7):31.
Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.

28. ¨ Easily distracted"
¨ Unable to sustain attention"
¨ Homework is disorganized, incomplete, contains careless
errors"
¨ Blurts out answers before question completed (often
disruptive in class)"
¨ Often interrupts or intrudes on others"
¨ Often out of seat, acts like the “class clown”"
¨ Perception of “immaturity” (unwilling or unable to complete
chores at home)"
ADHD in School-Age Children (6-12):!
Greenhill. J Clin Psychiatry 1998;59(suppl 7):31.
Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.

29.
ADHD in Adolescence (Ages 13–18):"
¨ Excessive motor activity tends to decrease"
¨ May have a sense of inner restlessness (rather than
hyperactivity)"
¨ School work disorganized and shows poor follow-through;
fails to work independently"
¨ Engaging in “risky” behaviors (speeding and driving mishaps)"
¨ Difficulty with authority figures"
¨ Poor self-esteem"
¨ Poor peer relationships"
¨ Anger, emotional lability"
Greenhill. J Clin Psychiatry 1998;59(suppl 7):31.
Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.

30. ¨ Disorganized, fails to plan ahead"
¨ Forgetful, loses things"
¨ Difficulty in initiating and finishing projects or
tasks"
¨ Misjudges available time"
¨ Makes impulsive decisions related to spending
money, travel, jobs, or social plans"
¨ Inattention/concentration problems"
¨ Poor anger control"
¨ May have job instability and marital difficulties"
ADHD symptoms in adulthood:"
Greenhill. J Clin Psychiatry 1998;59(suppl 7):31.
Conners and Jett. ADHD in Adults and Children. Compact Clinicals;1999.