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eJOURNAL OF THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net) Ė ISSN 1605-7406

ISSUE 126 AUGUST 2009 ē  CONTENTS ē  HOME PAGE

PRACTICE 

ADHD: Remembering the Skinner box

John Stein

I remember getting my lab rat and Skinner box in my first psychology lab in 1964. The Skinner box was a marvelous gadget. I liked gadgets in those days and still do. It had a bar the rat could operate. It had a food dispensing magazine, a device to produce an audible clicking sound, a light, and a floor that could be electrified. The experimenter (me) could operate all of these things. And I could hook up any or all of these things to the bar such that the rat could turn them on or off. With this box, we could replicate many of Skinnerís experiments to study the effects of different schedules of reinforcement, of punishment, and of cues that reinforcement or punishment were or were not available. What a marvelous gadget it was.

We deprived our rat of food for 22 hours before placing it in the Skinner box for a one-hour session. Then we returned it to its cage and allowed it to eat its fill for an hour before removing its food to repeat the cycle.

Our professor explained that we did not deprive the rat of food so that it ďWill work for food.Ē Rather, we deprived the rat of food so that it would be active when we placed it in the Skinner box. The more active our rat, the more likely it was to exhibit behavior that we wanted to study.

Rats who are satiated, who have no unmet needs, tend to be inactive. They are likely to curl up in a corner and take a nap. Rats who have unmet needs are in what our professor called a ďheightened drive state.Ē They are very active. We can expect them to exhibit their full repertoire of behaviors in such a state. Food, of course, makes a convenient reinforcement when rats are hungry.

With our rats so active, we could then begin to shape their behavior, dispensing pellets of food when they went near the bar, then when they stood on their hind legs near the bar, then when they touched the bar. Finally they pressed the bar and dispensed the food themselves.

So I put my hungry rat in the Skinner box, and indeed it was very active. It ran all around the box, going from one corner to another. It stood on its hind legs. It sniffed everything. It was behaving all over the place. It even checked out the bar and the empty food tray. So I dispensed a pellet of food. But it just kept going and going, as if it were ďdriven by a motor.Ē It did not sit still for even a moment. Eventually, it discovered the pellet I had dispensed and started hanging out by the food tray. With a little more dispensing by me, it pressed the bar. From then on, the rat seemed to concentrate fully on pressing the bar and eating. Until it had enough. Then it ambled around for a bit and settled down in a corner looking very content.

We didnít do much diagnosing of children in those days. The original DSM in 1952 didnít have a diagnosis of ADHD, so the thought didnít occur to me at the time, but as I look back now, my hungry rat behaved very much like an ADHD child.

So when I see a child with symptoms associated with a diagnosis of ADHD, I canít help but wonder ó is this a child with a disability? Or is this a relatively normal child in a heightened state of activity because of some unsatisfied need?

But what unmet needs could children possibly have in this day and age? With all of our wealth and knowledge and science, donít we provide everything our children need?

Several things come to mind. Time outside. Exercise. Being able to see outside. Natural light. Play. Competition. Challenge. Status, recognition, acceptance. A break, time out. Knowing their environment. Freedom from constant programming and adult supervision. A break. Time for free play. Attention. Sleep. Nutrition. Feeling safe and secure.

Some children feel some of these needs more than other needs, or more than other children. It might not be a conscious thing. Just some feeling of discomfort or dissatisfaction. Children might not even recognize consciously what they are missing. But it seems natural that their activity levels will increase, perhaps with random behaviors, until their drive state is reduced.

Time outside, exercise. I think children have a fundamental need to spend time outside, and I think children need exercise. Here in Louisiana, I donít think they get enough of either. Most children ride to and from school by bus or car. We have eliminated recess to increase instructional time. By the time children get home, itís dark. I donít see many children playing after school, on weekends, or in the summer. Most of our schools are now fenced. The gates are locked after school so that children cannot use the play areas. Many children are enrolled in organized sports from an early age, which means a select few spend a lot of time sitting on the bench (at least they are outside). Those who are not enrolled in organized sports cannot access the athletic fields.

I have read articles suggesting that the constant national news coverage of missing children has raised fears about safety, so that parents do not allow their children out to play on their own until they are older ó much older. And then, of course, we have video games. And air conditioning.

Being able to see outside. I think some people have a fundamental need to know whatís happening outside, perhaps to help them keep track of the progress of time throughout the day as the sun moves across the sky, perhaps to know what the weather is like. I think our schools need windows. Big ones. With the blinds open.

Daylight. Many years ago, I was driving alone on a long trip late at night on a brightly lit section of highway. I passed into a section of road where the lighting was different. I became instantly more alert. It was if someone had thrown a switch in my brain. I thought to myself, ďHow clever of them to change the lighting every so often to make drivers more alert.Ē

Later, in the 1970's, I read an article by John Ott, who studied children in windowless class rooms in an elementary school. Initially, with the standard fluorescent lighting, some of the children exhibited symptoms of ADHD. They were all over the place, even climbing on the tables. Their teachers couldnít get them to do their lessons. After a few weeks, he replaced the standard fluorescent lighting with fluorescent tubes that provided lighting in the natural daylight spectrum. Almost immediately, the children settled down and began to do their work.

The study had some flaws and lacked controls and things necessary for drawing scientific conclusions, but it made sense to me. It seems that the standard soft white fluorescent tubes have a different spectrum from natural daylight. The soft white tubes are high on both ends of the visible spectrum but low in the middle of the spectrum ó the blue range. The full spectrum daylight tubes approximate natural daylight across the whole spectrum.

On two occasions since then, I was able to convince administrators in programs I managed to allow me to convert the fluorescent lighting in activity areas from standard to daylight. It wasnít cheap. Daylight tubes cost about 2Ĺ times more than standard tubes. I was not able to determine whether this produced any changes in behavior because I made other changes at the same time. What is remarkable, however, is that on both occasions, office staff made such a fuss about getting the new lighting in their offices and corridors that the administrator asked me to change their lighting, too. The difference between the two types of lighting is quite dramatic, especially when the two occur in adjacent areas.

A number of other studies over the years have found evidence of benefits of full spectrum fluorescent lighting in schools and businesses over standard fluorescent tubes in addition to reduction in symptoms of hyperactivity, including improved test scores, better attendance, and reduction in symptoms of Seasonal Affective Disorder. Other studies have found similar benefits in schools and businesses that have natural lighting from windows or skylights. Yet other studies question these conclusions.

One explanation suggests that daylight stimulates a portion of the brain that increases alertness. (Is that what we now try to do with medication?) I thought back to my experience on my road trip and wondered ó was it just the change in the lighting that made me more alert, or was there something special about that one particular type of lighting?

Could it simply be that some children need daylight? Or at least light in the daylight spectrum?

Why are we building schools with such tiny, heavily tinted windows? ? Is it to save energy? Some of our schools almost look like prisons. Why are teachers keeping the blinds closed? Is it to keep children from being distracted by something outside?

Play. Normally, children will play when given the opportunity and there is nothing to distract them or prevent them. Itís important to their development, physical, social, and every other phase. They try out different behaviors, try on different social roles, try out new ideas, explore relationships, develop their creativity, and so much more. When things slow down in the classroom, or when children lose interest in what is happening, we should expect them to begin to play.

I see too many children who do not seem to be able to play when left on their own. I canít help but wonder whatís wrong. And I wonder what happens to children who do not have sufficient opportunities for free play.

Competition. I think children have a need to compete, to test themselves against others. Some children can meet this need successfully through academics and thrive in school. Others cannot. They need other opportunities for competition and success. We seem to be eliminating more and more of these opportunities in our schools. I have read articles about games such as dodge ball and tag being eliminated, either because of the liability should someone get injured, or because of self-esteem issues for the children who cannot compete physically. And we are eliminating more and more non academic activities, such as recess, art, and music.

Challenge. I think some children need challenges, to test themselves against the world as it were. One of my favorite things when I was a kid was the high sliding board. I think it was twelve feet high. It was a thrill just to climb up there. Sometimes we slid down the poles instead of the sliding board. Another was the 3 meter (10 foot) high diving board. What thrill to master a dive from that height! I donít see those things anymore. They have taken them away. Why? Is it liability again? Protecting our children from danger?

Status. I think children need to be good at something, to get recognition, acceptance, to have success, a feeling of accomplishment. Some children are successful at academics. Others, not so good. The more activities we have for them, the more opportunities they have for success and accomplishment. But we are eliminating more and more of those activities, perhaps to focus more on academics, perhaps to save money.

The Louisiana Legislature has been considering a bill to require student athletes to maintain a C average. In a recent letter to the editor, a local businessman wrote that he was a D student and could do no better. But he stayed in school because of football (the American type, of course) and got an education that contributed to his later success. If he had been denied football because of his grades, he would not have finished school. (And I wonder how much of that education he got from football rather than from the classroom ó the challenges and the confidence that comes from setting goals and applying oneself and achieving those goals in spite of opposition.)

The fewer activities we allow children in our schools, the fewer opportunities we give children to meet their needs for accomplishment and acceptance and status. These are basic needs for most people.

A break, a time out. It takes more effort for some children than for others to keep it together and concentrate. After a time, they may need a break to regroup. When this need is not met, they may become more active and unable to continue to control themselves and concentrate. Perhaps the request to go to the bathroom is not so much the need to toilet as it is a need for a break.

We have known since the 1920's that factory workers produce more in 7Ĺ hours with 15-minute breaks in the morning and afternoon than they do working the full 8 hours. What about our children?

Knowing their immediate environment. I believe that some children become very uncomfortable when they do not know what is happening around them in the classroom ó namely, what the children behind them are doing. It may be some sense of insecurity, needing to know that others are not watching them. It may be some sort of paranoia. It may just be curiosity. And it may be some vestige of a survival instinct, needing to know that one is safe, that there is no danger lurking.

There are those people who seem to be uncomfortable sitting in the front of the bus, the front of the church, the front of an auditorium, the front row of a workshop. They prefer to sit in the rear. Just as there are others who seem to prefer the front, to be more comfortable in the front.

The temptation to put the fidgety kid who has trouble concentrating in the front of the room or next to the teacherís desk may be the worst possible thing for some children.

Attention. I have heard psychologists opine that children misbehave to get attention because attention from adults is so reinforcing to children that even negative attention is reinforcing. When they canít get the attention they crave through positive behaviors, they resort to negative behaviors to get negative attention.

I just donít believe that this is what happens. When children need attention or recognition or acceptance and cannot get it for whatever reason, we should expect them to become more active, to begin to exhibit increasing behaviors from their repertoire. Itís not a conscious decision to misbehave, a conscious effort to get attention. Rather, itís an urge or perhaps a drive that is difficult to control. Perhaps a simple need to interact with the teacher when they are unable to interact in ways that are academically or socially acceptable. Or perhaps they feel a need to retaliate against the teacher who is ignoring them.

Sleep. Anyone who has been around young children who have missed their nap or are up well past their bed time knows that they are not likely to become lethargic. Rather, they are likely to become so hyper that it is difficult to settle them down when we are ready to put them to bed. It is as if they are driven by a motor, running from one thing to another.

There have been studies that suggest that, while younger children tend to thrive with early bedtimes, popping out of bed and ready to go at the break of day, teenagers tend to thrive with later bedtimes and sleeping later in the morning. Nevertheless, here in Louisiana, our school schedules seem to depend more on things other than the needs of our children, things such as the bus schedule. Our high school students start school first at 7:30 am, getting up in the dark to catch their buses. After completing the high school runs, the buses pick up elementary and middle school children.

The high school students complete their school day at 2:30, get home a little after 3, then have lots of free time because they stay up late. The elementary and middle school children complete their school day at 3:30, but sometimes their buses donít arrive until close to 4:00, so itís close to 5:00 until some of them get home, leaving them with little or no free time before dark. And with homework, perhaps not much free time before bed.

Nutrition. So going back to my hungry rat, how about food and nutrition? Surely we feed our children well. Except that when I volunteered at a local school a few years ago, I happened to see the little kids coming in for breakfast. They were served a glazed donut and a box of juice. I love glazed donuts, but never with a sugary drink. I like juice, but not with sugary foods. And the lunches our schools have been Ďservingí in efforts to cut costs. They are no longer cooked in our schools but in a central kitchen and transported to the schools, or worse, prepackaged in a factory. Really.

Things at home. When children have serious needs that are not being met at home, we should not always expect them to be calm and focused at school. Things such as the need for safety and security and having a predictable environment. And so many other needs. Some such children may thrive in school settings that provide for some of these needs or respite from things at home. Others may not.

Many of my observations are from my experiences here in Louisiana. But I travel enough and read enough to know that what I see in Louisiana is not unique.

There are certainly families, teachers, and schools who are excellent at meeting the needs of children. But I think I am seeing a drift. I think we have been drifting away from strategies to meet the needs of our children to strategies to get our children to meet our needs for them ó especially for their education and safety. And other needs, such as cutting school budgets to keep from raising taxes, or minimizing exposure to litigation should someone get hurt on a playground or swimming pool. (But I still donít understand why we eliminated big windows in classrooms, even replacing the big windows in older schools with smaller heavily tinted windows.).

When some children are not good enough at doing what we want, we look to behavior plans to motivate them or to make them comply. When that doesnít work, we wonder what is wrong with them and look for diagnoses and medication.

We donít look at their needs. What children in elementary school, or even middle school, really feel a real need to get a great education? Even when they recognize and understand the importance, do they really feel it as strongly as they feel some of their other needs?

When I was a lad, before the age of behaviorism and diagnoses and medication, parents and teachers were more likely to see kids as Ďnormal.í Some of us were different, but our differences didnít require diagnoses (we didnít have diagnoses then except for kids who were really, really disturbed), behavior plans (we didnít have them then, behaviorism was still in the laboratories of psychology), or medication (we didnít have many meds then nor market them so aggressively.)

Parents and teachers had to find ways to manage the kids who were different without behavior plans and medications.

I think I was one of those Ďdifferentí kids. I could not sit still. I was always in motion. I hated to sit through a long meal. And I talked constantly. People said I had Ďants in my pants.í But I could and did work very hard at meeting expectations. I expected myself to do so. I was a good kid.

I look at schools today and wonder how I would have survived. But I had help. I didnít have more than I could handle. My mother sent me out to play on my own when I was four years old, as did other mothers of children my age. We played all day.

Everyone walked to school (sometimes we ran) in my town and we were allowed to play when we got there, so I got some exercise before school started. In elementary school, we always had morning and afternoon recess, so I didnít have to keep it together too long. When the weather permitted, our teachers took us outside for activities like dodge ball and tag and races. When we couldnít go outside, our teachers had us push our desks out of the way and organized games to play. It got pretty rowdy at times. It was fun. And we had 90 minutes for lunch. We would often run home to eat our lunch as quickly as possible, then return to play for as long as possible before the afternoon session.

All of my schools had huge windows, a whole wall of them. They reached all the way to the high ceilings. Teachers only closed the blinds if the morning or afternoon sun was in our eyes, or to show a movie. They only turned on the lights on the dreariest of days. Somehow, I always managed to sit in the rear of the classroom. I could squirm as much as I wanted or look out the window without bothering anyone else. And I could always watch the other kids. To this day, you wonít find me sitting in the front of an auditorium or movie theater or bus or workshop.

I felt for the kids who struggled academically. And I struggled to match their speed and agility on the playground, or their abilities in other activities. We had lots of opportunities for success.

Now, we demand that kids comply and employ behavior plans to make them do so. Teachers have behavior plans for their class rooms. They send behavior reports home, sometimes it seems for every little problem, apparently hoping parents will make their kids behave better. Individual children who have trouble complying eventually get put on individualized behavior plans. For children who still cannot comply, teachers sometimes send them home and tell parents they canít return until they are on medication. (OK. I know teachers canít do this. But I also still hear of those who do.)

I just think that itís becoming less and less about the needs of our children, more and more about the needs of teachers, schools, budgets, and yes, even of parents. I think we move too quickly to behavior plans, then to diagnoses and medication. They are just kids. We should be able to manage them without these things. If we meet their needs.

Just some of my thoughts.