The most important thing for which we can prepare a child is the experience of freedom, at the right moment in life, through the understanding of one's own being.

 

Rudolf Steiner (1861-1925)

Foundations
Premature birth, nerve-sense system, sensory hypersensitivity, dyslexia, dyscalculia, failure to thrive, physical deficits, absent father, depression, poverty, excessive demands, rhythm, orientation, safety, attention and concentration problems, early education
By: Georg Soldner, March 2020, Medizinisch Pädagogische Konferenz" Issue 73, May 2015, shortened

Three types of attention and activity disorders


We can distinguish three types of children who challenge our social system for very different reasons. It is possible, however, that several categories overlap and combine, for example, premature birth disorders of the nerve-sense system with a pronounced disruption of social relationships in the family and a volitional temperament. The following consideration (part 2) supplements and does not replace pediatric and pediatric-psychiatric diagnostics. However, it can facilitate a meaningful classification, a pathogenetic understanding of the symptoms, and be therapeutically helpful.

Children with hypersensitivity and disorders of the nerve-sense system

We can recognize and understand this group when we focus our attention on the child’s head pole, which is already largely formed during embryonic and early childhood development. The nerve-sense system, including the bodily senses, the autonomic nervous system of the abdominal cavity including the large nervous system of the digestive tract (enteric nervous system, ENS), shows acquired or congenital developmental disorders in these children. Characteristic are resulting perceptive disorders, such as disturbances of the tactile sense, visceral hypersensitivity with corresponding abnormal sensations, disturbances of intestinal function and often colicky pain, proprioception and disorders in the sense of balance, but also disorders in speech comprehension, hearing, and other higher sensory performance (1) up to severe visual and hearing disorders. Sensory hypersensitivity to food and odors is common, for example, in the mouth and digestive tract; as is hypersensitivity to sounds and groups of people. These children often strike us as having "wounded souls”, being easily outraged by external stimuli and occasions; but they can improve when enveloped with peacefulness. A graceful physique predominates in such children.

 

Functionally, it is often possible to diagnose described "partial performance disorders" (dyslexia, dyscalculia, etc.) and developmental delays, as when the concentration span is short, motor skills, including graphomotor skills, are often limited, and an overall slow pace of work is common. Intelligence may or may not be limited. Learning progress is often slow and strongly dependent on an optimized, low-stimulus, patiently guided learning situation with sufficient opportunity for repetition.

 

The child's problem usually has its origin in past events or congenital disorders:

  • (Extreme) premature birth and extremely low birth weight are associated with an approximately two to fivefold increased risk of attention and activity disorders (2). The risk of dyscalculia is increased many times over, especially in premature infants born before the 28th week of pregnancy. Today, premature babies are considered to be the largest risk group for partial performance disorders.
  • Early traumatized children, especially when the trauma has directly damaged the nerve-sense system.
  • In early childhood, malnutrition not only damages the immune system but also the sensory nervous system, and is a major cause of lifelong persistent damage to the development of the nerve-sense system in children worldwide.
  • Children with constitutional sensory hypersensitivity, are thin-skinned, have low birth weight, and can "quickly fly off the handle".
  • Children with vegetative hypersensitivity, frequent nausea, abdominal pain and weak vitality
  • Children with circumscribed sensory deficits, e.g. hearing-impaired children
  • Children with genetic disorders concerning the development of the sensory nervous system with resulting attention and activity disorders.

According to the genesis of their problems, these children primarily have disorders in the in the development of the physical body. The etheric body is disturbed in its internalization process during the first seven years of life. Many of these children are often ill during this period, and recover only slowly. At the beginning of school, these children often have few life forces for thinking and concentration; the result, among other things, is a short concentration span.

 

The children in this group, however, often improve therapeutically through:

  • Contact, rhythmical body oilings, oilings and oil dispersion baths. Training the basal senses (sense of touch, movement, and balance and perception of visceral life processes) is of central importance. Early support, physiotherapy on a neurophysiological basis, ergotherapy, and eurythmy therapy are just a few examples of many other possible therapy methods. Music therapy can have a profound calming effect; therapy in rhythmic groups and later choral singing can significantly strengthen the child's social integration and ability to concentrate in the group.
  • An osteopathic/craniosacral treatment can help many of these children relax their autonomic nervous system and improve their eating and sleeping habits. Here the region of craniocervical transition is of particular importance.
  • A long breastfeeding period, possibly enhanced with mare's milk in the absence of breast milk, is important for immunological as well as neurological development and mental stabilization. The great importance of nutrition for the nerve-sense system has already been mentioned. (3) The same applies to physical deficits, e.g. iron (4) and vitamin B12 deficiency, which may be associated with an increase in ADHD problems. On drug treatment, consult the reference material in "Individual Pediatrics" (3).

In summary, we can clearly see that the past dominates the present here, and that it is important for the child and its parents to accept and patiently overcome the consequences of an "acquired" (suffered) or genetically congenital disorder. Patience is perhaps the most important attitude for this process. Patience also applies to addressing issues such as the right age to enter kindergarten and school. There is a not inconsiderable social risk of "bullying" on the part of children of the same age, which in turn has a traumatizing effect and makes learning even more difficult. Learning to read and write, and especially learning the basics of arithmetic, often progresses slowly and laboriously. At the same time, such children frequently demonstrate a high degree of distraction and their mental powers are quickly exhausted. Helpful factors are:

  • Small groups and class sizes with trained teachers (5)
  • Avoidance of electronic media as long and as consistently as possible.
  • Delayed age for school enrollment

Children who grow up in disturbed social relationships
With this group of children, the disturbance of relations in the child's family and environment is often the prominent factor. The attachment to the mother is often uncertain or ambivalent, and the relationship to the father is often disturbed or insufficiently developed due to his absence. The relationship with siblings can be disturbed or overshadowed by rivalry or close age differences; in short the child experiences "too little sunshine" in the family scene. Repeated childhood stress experiences due to lack of availability or serious conflicts between the parents/relatives of the child are often not sufficiently realized by the parents and are not reported to the doctor, but are apparent, for example, in the child's drawings. In many cases, these children are sadly depressive, but this can manifest itself in boys in particular in aggressive, hurtful and oppositional behavior, and in girls during puberty in self-harming behavior.

 

The parents of such children are often very preoccupied with themselves. In this group, the absent father is a common theme, but also maternal depression, poverty, and feeling overwhelmed along with the neglect of a child's needs for rhythm, orientation, and security. The child here is often also an index patient on many levels (6). In the author's experience and that of many other colleagues, these children represent the most common group presented in medical practice today, which gives the diagnosis ADS-ADHS a certain reason for doubt, especially if it is mainly seen from a genetic-neurobiological point of view.

 

In contrast to the first group, the cause of the problem here lies more in the present. Mutual trust in the family is often deeply disappointed. The child's astral body and "I" cannot develop in a stable parent-child triad. The imitation of the primary reference persons remains problematic, and the internalization of the child's four members is often disturbed. This may also be associated with sleep disorders, which are common in this group. Parental conflicts are a central cause. (7) The etheric body does not experience the stimuli necessary for the development of the organs, since the activity of the astral body is confused and misdirected under the influence of disturbed emotional attachments and bonding. The rhythmic system, the center of the organism, which is formed in the second seven years and enables us inwardly to mediate between the head and limbs, and to keep them in balance, is disturbed in its development. The child is spiritually undernourished or malnourished.

 

The children improve especially when the whole family is treated or involved in the therapy. All those involved need a clear orientation to guide them out of their self-absorption in misfortune to enable an appreciation of the child and mutual appreciation of the parents.

 

In my practice it is always moving to see fathers "wake up" when assured they would be more effective than any medicine, if they take time for their child and especially if they do something with him or her that promises sunshine, play and adventure (and don't exhaust themselves alone in front of the screen or in the car to the soccer club). Talking to a benevolent, neutral therapist, and arranging for an artistic therapy can effectively strengthen the child's middle realm, especially in affected girls. The central therapeutic goal is the positive development of the rhythmic system and emotionally the development of the child’s ability to build relationships. Attention, motivation and concentration depend crucially on the strengthening of the middle, the ability to build up trusting relationships.

 

The second seven-year period is particularly important with respect to therapeutic efforts for this group of children, when the astral body gradually detaches itself from the parents and is "born", the rhythmic system takes shape (up to the pulse-breath quotient), and in which art and the experience and creation of beauty are of central importance for giving final shape to the organism. If the treatment is successful, then in adolescence the 'I'-organization can become increasingly stable, the adolescent increasingly tolerates frustration, develops sustainable relationships, and sustains learning processes.

 

Children with a "difficult temperament"
This third group of children we have to deal with demonstrates a strong will. This group is strongly bound to the limbs and its own metabolic organization, which matures only in adolescence and only then can often realize a great potential of will. This one-sidedness of the child's constitution can manifest itself "propulsively", and the child is often considered to be particularly challenging, or even "retarded". The latter is not uncommon, but attention disorders without hyperactivity tend to predominate in this group.

 

From early childhood on, these children are characterized by slow development, in which the educational efforts of their environment are largely ineffective. Physically, they demonstrate completely opposite characteristics to those depicted in the first group, with a rather stable to somewhat sluggish constitution. The appetite is mostly robust, limb activity develops slowly, the attachment to the parents, especially the mother, is close, even if for her the self-will of her child is not always easy to bear. They are slow, but not mentally weak, in their senses. Sensory impressions have a long-lasting effect, depictions of violence on children's TV shows can have a very irritating effect, and the need for social contacts is limited. The etheric body, the life organization, develops overwhelmingly, the awakening process of consciousness is accordingly slow, and the children need a long time in their development in order to in order to emotionally, mentally and spiritually penetrate their intensive life processes so that they can orient themselves towards goals brought in from the outside.

 

Early enrollment in school is bad for these children. They tend to dream, to digress from the subject, to cramp up when learning to write, to feel overwhelmed and try to submerge themselves in the world of their inner fantasy. But the long-term prognosis is usually excellent, they often develop into stable, down-to-earth, reliable and popular people in their environment after the 9th year of life, with increasing internalization of the soul and spirit. Here it is important to effectively field and counteract feelings of disappointment from parents and teachers.

 

In pediatric terms, we often find the following characteristics in such children:

·       Strong impulsiveness

·       Often claim leadership, display charisma at an early stage

·       Enthusiastic warriors, active outdoors, fearless in dangerous situations

·       Reject rules "for wimps"

·       Often have powerful oral needs: sweets, later alcohol

·       No inclination to develop a normal rhythm on their own - on the other hand also very resilient!

 

These children call for "masculine" educators (which today can sometimes be embodied more convincingly by women) and improve when exposed to

·       Clear guidance

·       Recognition whenever possible

·       Humor!

·       Rhythmic daily activities, in particular nutrition

·       Vigorous and sufficient exercise

·       Eurythmy therapy, which they often practice with surprising pleasure, especially when taught by a male eurythmist (see above).

·       Challenges

·       Strong groups that can offer them a counterpart

·       Medication that helps to regulate the metabolism, for which potentised sulfur is a primary substance. (3)

 

Translated by Margy Walter, Edited by Rozanne Hartmann

 

 

Georg Soldner, Deputy head of the Medical Section of the School of Spiritual Science at the Goetheanum, Switzerland; Head of the Academy of Anthroposophic Medicine in Germany (GÄAD); established paediatrician and youth physician in Munich/ Germany with focus on integrative treatment of children with chronic diseases; editor-in-chief of the Vademecum of Anthroposophic Medicines

 

References

(1)   Kutik, C., Entscheidende Kinderjahre, Verlag Freies Geistesleben, Stuttgart, 2nd edition 2012.

(2)   Saigal S. et al: School-age outcomes in children who were extremely low birth weight from four international population-based cohorts. Pediatrics 112 (2003), 943–950.

(3)   G. Soldner, H. M. Stellmann, Individuelle Pädiatrie, Wissenschaftliche Verlagsgesellschaft Stuttgart, 5th Edition, 2018, Chap. 2, 4, 7; specifically on ADHS Chap.7.5.

(4)   Konofal E. et al., Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 158: 1113–1115.

(5)   K. Jäkel: Frühgeborene und Schule – Ermutigt oder ausgebremst? Erfahrungen, Hilfen, Tipps, www.fruehgeborene-rlp.de/121downloads_buch.php

(6)   Schneider/Eisenberg: ADHS-Kinder als Symptomträger eines gestörten sozialen Umfeldes? A. Jenke, Pädiatrie hautnah (3) 2005 – cf. also Note 19.

(7)   Palmstierna P. et al: Parent perceptions of child sleep: a study of 10,000 Swedish children. Acta paediatrica 97, 1631–1639 (2008): “It turned out that the greatest determining factor of sleep disturbance was the child´s perception of parental conflict”.

 

Further literature

H. Köhler, War Michel aus Lönneberga aufmerksamkeitsgestört? Verlag Freies Geistesleben, Stuttgart

 

The article presents an expanded version of the author's presentation of a lecture given on October 26, 2014 at the Goetheanum in Dornach during an anthroposophical medical further training session for school doctors, pediatricians, and child and adolescent psychiatrists on the subject of attention disorders. The explanatory panel drawings are missing. First published in "Medizinisch Pädagogische Konferenz" Booklet 73, May 2015, abridged by Katharina Stemann.

 



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