What keeps kids with ADHD out of church?

shutterstock_148715915_2Since 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.

shutterstock_155968427_2If 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 be judged 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.”

shutterstock_55828720_2Another 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?

shutterstock_46864729_2Kids 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!

shutterstock_68372575_2Here’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!

shutterstock_173700593One 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.


KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

Posted in ADHD, Families, Hidden Disabilities, Inclusion, Key Ministry | Tagged , , , , , , , , , , | 1 Comment

Doing Ministry Like a Missionary…Mike Woods

Heidi_Baker_BabyhouseI think that we’re going to have to think differently about special-needs ministry in order to reach the special needs population with the Gospel. Statistics may vary, but many report that approximately 80% of the disability community are unchurched. And though there are several factors that may account for this, I would like to focus on one important factor called “cultural distance.”

The concept of “cultural distance” is one paradigm that will help us to understand the reason why special-needs ministry outreach is an essential activity in bringing the gospel to the disability community.

Cultural distance is a simple concept that was initially developed by Alan Hirsch. Alan is a South African-born missiologist, author, and an acknowledged leader in the missional church movement.

What is cultural distance? According to Hirsch:

Cultural distance is…“a conceptual tool that we can use to discern just how far a person or a people group is from meaningful engagement with the gospel.”

Let’s say that you take a continuum that is a line. And on that line you indicate cultural barriers from left to right, evenly spaced. Each cultural barrier needs to represent a real significant barrier to meaningful communication of the Gospel.

What are some significant cultural barriers to the Gospel? Try thinking of cultural barriers in terms of missionaries who go to foreign countries to plant a church. What are some of the significant cultural barriers that missionaries have to cross in order to effectively share the Gospel with people of other cultures? Here’s a few of the primary ones:

  • Language
  • Values and beliefs.
  • Current cultural practices.
  • Past history.
  • Stereotypes
  • ________ ?

Here’s what it would look like visually depicted:

Missionaries and Cultural Barriers

Make no mistake about this: missionaries go through a course of training to overcome the obstacles to reach a people group. To be a successful missionary you must be willing to learn the language, the cultural practices, the history, and the values & beliefs of the people you are going to in order to reach them with the Gospel.

The problem that I see happening now in many churches and church-based special-needs ministries is that we’re not the ones crossing the cultural barriers anymore.

Many church-based special needs ministries (and churches) have sunk a lot of time and energy and effort into developing a great special-needs ministry located within the walls of the church building. And there is nothing wrong with that…in fact, it is a good thing. I spent my first two years working hard to create a welcoming special needs ministry at First Baptist Orlando.

But realistically, this type of “come and see” special needs ministry only shares meaningful communication of the Gospel with people who are within the walls of your church building.

In other words, the Gospel is only shared with those differently-abled individuals who attend your church and participate in your special needs ministry. The problem with that, as I have mentioned earlier, is that the larger percentage of the disability community is nowhere to be found within the church building.

In essence, by operating only in the “come and see” mode we place the burden of crossing cultural barriers on the disability community. In other words, they now have to become the missionaries and take the initiative to cross significant barriers to get to the church. The more barriers that someone has to overcome the less likely they will be to cross them.

Here’s what it would look like visually depicted:

Come and See Ministries

That’s crazy! Each barrier presents a potential reason for someone to say, “Forget it.” That would be like a missionary going to Botswana, building a church building, and waiting for the Gciriku people to come to church after having made no effort to engage and relate to them. The “If you build it, they will come” philosophy isn’t a sure bet.

Whether you want to call it “outeach,” “missional,” or “go and tell,” I think it’s important for church-based special needs ministries (and churches without special needs ministries) to start operating again like missionaries.

We need to be the ones to shoulder the responsibility of being missionaries and take the initiative to cross cultural barriers in order to reach the people that we’re passionate about to meaningfully communicate the Gospel.

What’s one thing you could do this week to begin to do ministry like a missionary?

Mike-Woods-Joy-Prom-@-1024x615In addition to serving as a Church Consultant with Key Ministry, Mike Woods currently works as the Director for the Special Friends Ministry at First Baptist Orlando. Prior to joining First Baptist Orlando, Mike worked for nine years as the autism and inclusion specialist for a large school district in metropolitan St. Louis. Mike regularly blogs for Key Ministry on topics related to “missional” Special Needs Ministry…how churches can “leave the building” to share the love of Christ with families impacted by disabilities in their local communities.

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The chasm is bigger than I ever imagined…

shutterstock_110076620Some of our readers have picked up on my recent frustration in discussing topics related to mental illness and church. Since this is Mental Illness Awareness Week, it seems an appropriate time to espouse on the topic.

In our very first post on this blog, I discussed the chasm that exists separating many of the families I serve in my workplace as a child and adolescent psychiatrist and the people who compose the social network my family experiences through our involvement at church.

Once my church friends get a handle on the families in their communities who come to practices like mine, we can problem-solve together how to welcome them into our environments and  include them in the stuff we do so they can come to know Jesus, accept him as Lord, and grow to be more like him. Just like we do.

Together, God will help us figure out how we as church can welcome and include families of kids with real, but invisible disabilities.

facebook-miaw-badgeI’m not necessarily the most patient person when I see something that needs to change. Progress has been slow. I’ve wondered what we need to do to get folks in the church to notice the resources offered by Key Ministry. I probably came down way too hard on Focus on the Family and Lifeway here and here over their surveys looking at mental illness and the church. The truth be told, I think the Lord was giving me a little taste of what it feels like to be left out of something at church I wanted to be part of. Not at all dissimilar to the experience of the families served by the churches we support.

One thing the guys at FOTF and Lifeway did well in their executive summary of their surveys was include comments and observations from a panel of experts in the church on mental illness in adults. A number of their comments provide excellent insights into the challenges facing the church in addressing these issues. I’ll share some of them here..

  • People with mental illness or their families deal with a large amount of social shame and stigma around the illnesses.
  • Conversations about mental illness need to change in frequency and tone.
  • Labeling a mental illness as only a “spiritual issue” is not helpful and can be detrimental. 
  • Strong faith does not make a mental illness go away. People who deal with mental illness tend to be more honest about their relationship with God.

I’m not sure I agreed with what the folks on the panel had to say about kids and families. I sensed that the space needing to be bridged separating the church from the kids and families we serve was more like a chasm, especially when the folks who church leaders rely upon for education didn’t seem to know the questions that needed to be asked. The experts seemed a lot less hopeful than I am about kids overcoming the conditions for which their families seek treatment.   In any event, here’s what I would’ve said had I been invited to participate on behalf of Key Ministry…

  • shutterstock_104938268_2Including kids with mental illness at church is incredibly important, given the evidence that suggests most people who come to faith in Christ do so before they reach adulthood.
  • While the church is appropriately becoming concerned about adults with mental illness leaving church through the “back door,” very few pastors or ministry leaders appreciate the size and scope of the mission field awaiting outside their “front door” composed of families impacted by mental illness who have little or no experience of church.
  • Parents of kids with mental health conditions are especially prone to be stigmatized at church because of the lingering belief among many in the Christian community that mental illness is a byproduct of sin, kids who struggle with managing emotions and maintaining self-control are the product of parents who are ineffective or indifferent and much of the mental health profession can’t be trusted.
  • shutterstock_162382229The conditions that produce the greatest obstacle to church participation and spiritual growth for the greatest number of families impacted by mental illness are anxiety disorders.
  • Because the “apple often doesn’t fall far from the tree,” a family-based ministry approach will likely be required for the majority of kids and teens with mental illness to be assimilated into the church.

Here are three resources I’d suggest for Mental Illness Awareness Week…

Our friends at SNAPPIN’ Ministries have put together a Facebook event site for Mental Illness Awareness Week. I’d encourage you to check it out.

An excellent place to go for information about mental illness in kids and teens are the resource centers developed by the American Academy of Child and Adolescent Psychiatry.

Kay Warren and the crew at Saddleback Church are hosting 24 Hours of Hope beginning at 3:00 AM Eastern time on Friday, October 10th.

If you need more resources, you might find a few useful links from Key Ministry under “Past Blog Series” in the sidebar of this page.


KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

Posted in Advocacy, Families, Hidden Disabilities, Mental Health, Resources | Tagged , , , , , , , , , , , , , , | 3 Comments

A special little church in Chicago…

Christian Fellowship ChicagoThis past Sunday, my wife and I were in Chicago for Parents’ Weekend at Loyola University. It’s our habit to find a place to worship on Sunday when we’re out of town and we were looking forward to doing church and breakfast with our oldest daughter (Leah), studying hard in pursuit of her goal to be a research physician.

I’d heard great things about Christian Fellowship Church, located on the North Side of Chicago in a lovely neighborhood (Roscoe Village) about a mile or so west of Wrigley Field.

Seven years ago, Sergei Marchenko moved into the neighborhood with his wife Gillian and their four daughters to become pastor of the church. Gillian is a well-known author and national speaker who writes and speaks about parenting kids with Down Syndrome, faith, depression, imperfection, and adoption. Gillian was a faculty member for our Inclusion Fusion Web Summit in 2012. Her video, Loss and Grief in Parenting Children With Special Needs was the most viewed video from the Web Summit that year.

Marchenko girlsOur family arrived a little bit early…I was pleasantly surprised by how plentiful parking was on the street in front of the church. I’d messaged Gillian to let her know we might be coming by…we were welcomed by Gillian and given a brief tour of the facilities.

On the morning we attended, the preponderance of kids attending church would have an identified disability or special need. Christian Fellowship is truly an inclusive church…a church where typical families and families affected by disability can worship together. The children’s area was designed to be sensory-friendly and includes a sensory wall along with a quiet area for kids who need a little break from overstimulation. Kids with significant special needs have 1:1 buddies on Sunday morning. Christian Fellowship also offers a free respite program on Thursday evenings for parents of kids with disabilities (families served DON’T need to belong to the church) staffed in part by students from the Moody Bible Institute a few miles away.

Everyone we met at Christian Fellowship was very friendly without being the least bit pushy. Sergei comes across as the polar opposite of the self-promoting pastor. He was teaching on the parable of the unforgiving servant from Matthew 18…his was the most thought-provoking (and challenging) teaching I’d heard on that passage from the Bible. A sign of a pretty good sermon is a message that continues to provoke thought six days after attending church.

Christian Fellowship RespiteMy biggest surprise was to find that the church wasn’t completely full. I can’t get over the irony that on the morning our family visited Christian Fellowship, we shared this story from an anonymous reader that became our most-viewed guest post ever. At the same time that many of our followers share their experiences of rejection at church, there’s a friendly place with good teaching in a cool neighborhood offering a great experience for families impacted by disability with free respite care in the middle of a city with millions of people and they still have space? I don’t get it.

I asked Gillian if it was OK to share our family’s experience with our readers and she agreed. I’m a little afraid after posting this that they’ll be overwhelmed with visitors. I would ask families planning to visit on a Sunday bringing children with disabilities or Pulling to Standseeking to take advantage of the high quality, free respite care they provide to contact Christian Fellowship in advance to let them know you’re coming so they might be prepared to welcome you in advance.

God’s clearly at work through Christian Fellowship. You’ll be blessed if you check it out.

Editor’s note: In celebration of Down Syndrome Awareness Month, Gillian is giving away the electronic version of her new book, Pulling to Stand: Glimpses of Parenting Two Children With Down Syndrome on Very Different Paths to readers who sign up for her monthly newsletter. Click here to learn more.


KM Logo UpdatedKey Ministry is pleased to make available our FREE consultation service to pastors, church leaders and ministry volunteers. Got questions about launching a ministry that you can’t answer…here we are! Have a kid you’re struggling to serve? Contact us! Want to kick around a problem with someone who’s “been there and done that?” Click here to submit a request!

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Looking at the Lifeway/Focus on the Family mental illness study as a peer reviewer would…

AACAP ProceedingsIf I could pick the one experience in my medical career that contributed the most to my development as a physician, it would be the three terms I served on the Program Committee and New Research subcommittees of the American Academy of Child and Adolescent Psychiatry.

The Academy hosts the largest (and most prestigious) scientific meeting in the world every October in the field of children’s mental health, attracting 5,000+ professionals from fifty or more countries. The Academy members who serve on the Committee are responsible for peer reviewing all of the research proposals submitted for the scientific program at the meeting, based upon the quality and importance of the work.

In a typical year, we’d literally receive hundreds upon hundreds of submissions, and the committee would break up into teams to review each study/project submitted. Five members would review each study individually, with one member assigned as the “principal reviewer.” The “fun” began when the full committee assembled for a two-day meeting each Spring, where the principal reviewer would present their analysis of the studies they reviewed in front of everyone, and anyone on the committee could comment on each study reviewed.

BmKJR3EIEAAcytc.jpg-mediumI wasn’t a “typical” committee member in that my role was to represent the perspective of the mental health professionals practicing in the community. Most committee members were in the upper echelon of the elite in our field. Several worked full-time for the National Institute of Mental Health. A couple were future presidents of the Academy. Nearly all were tenured professors at elite institutions who were instrumental in the pivotal studies that drive the treatment in our field. It was fascinating to observe them critically analyze data and question the methods used in conducting a study. The first year was like drinking out of a firehose! I recognized how little I learned in med school, residency and fellowship in terms of evaluating research. I took great pride by the end of my tenure on the committee in the ability to hold my own with some very prestigious colleagues in the room. Our Committee leaders spoke often about setting a standard for excellence in research in our field that might be a model for the rest of the mental health profession.

The thing that is gnawing at me about the Focus/Lifeway mental illness study is this…As Christians, part of our witness is to reflect excellence wherever we’ve been placed by God. I see that as a part of our worship, because excellence is a true reflection of the Savior we as Christians claim to represent. Because of my past experiences, I think I can recognize excellence in research when I see it, and my gut is telling me this study doesn’t reflect excellence.

In examining and interpreting the study for our readers, I thought it would be most helpful going forward to put on my “old hat” as a reviewer and offer insight into how the folks who sit where I sat might think about the Focus/Lifeway study…

First question…What were the hypotheses/objectives about mental illness, the church and faith that the study designers sought to examine?

In this case, the project objectives were 1) to equip family members and churches to care for loved ones suffering from acute mental illness, by expanding the understanding of what these persons experience, applying what Scripture says about the essentials of faith, and sharing positive contributions that can be made in these individuals’ spiritual lives; 2) to help family members and churches discern the spiritual state of loved ones suffering from mental illness.

The first take on the objectives is they’re extremely broad. Understanding of what aspect of their experience with mental illness? How will they discern the spiritual state of persons with mental illness? What do we know about this topic? How will this study build upon what we know?

shutterstock_167550659_2Next question…Is the study population appropriate for the study objectives?

I would have MAJOR concerns here, given the information available to us by the study authors. The study authors chose adults with what was labeled as moderate to severe depression, bipolar disorder and schizophrenia. Why those three conditions? Would the experience of an adult with schizophrenia be in any way comparable to the experience of a person in the midst of a major depressive episode? Some people with bipolar disorder who have been stabilized on medication may be relatively symptom-free for extended periods of time…how might their experience be different?

Quoting from the report:

The focus of the theological research was on those in a state of psychosis, people with a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.

How does this work with a sample in which 79% of subjects describe themselves as “very stable” or “somewhat stable?”

One of the imperatives that led to the creation of our current diagnostic classification is the need for common definitions and common terminology in order to conduct meaningful research. Looking at the study objectives, one would need a sample that reflects the breadth of conditions characterized as mental illness that result in significant functional impairment. Collectively, anxiety disorders are our most common mental illnesses in adults, followed by depression. Next comes ADHD, followed by PTSD. Where do they fall in the sample? The authors lumped together three conditions to represent “mental illness”…two of which are closely related, while one isn’t.

BIG PROBLEM: The authors are exceptionally vague as to how the individuals surveyed for the study were selected. The lack of transparency as to precisely how the sample was obtained would be utterly unacceptable if this work were submitted as a paper. How do we know that the subjects selected for this study actually had the conditions described in the study? How were they prescreened? Who diagnosed them with depression? Who was the “large, national panel” doing the prescreening? 200 of 355 sample participants attended Christian churches once a month or more as adults? Isn’t that percentage significantly higher than the rates of church attendance reported in the general population?

I can’t tell from the information disclosed by the authors that their sample is valid. How do we know their data is valid? Would someone seeking to test or replicate FOTF/Lifeway’s findings have enough information to do it?

Next question…Who are we comparing them to? If we’re going to look at measures of spiritual practices…Do they (or their family members) attend church? How frequently do they pray? Attend small groups? Serve? How do they stack up compared against others selected from the same population who don’t have mental illness? There is no comparison population here. That’s not necessarily a fatal flaw…but data that is significantly divergent from norms for the general population is a big red flag without a comparison (control) group selected from the same pool. Lifeway may have data on spiritual practices from the same sample pool. If so, it’s not presented here.

shutterstock_113814862-2_2Are there confounding variables that might impact the data that are unaccounted  for by the study methodology? Here’s one…we know from research out of the Barna group that the vast majority of Christians make their initial profession of faith by their early teen years. I’d speculate that mental illnesses that impact children and teens would have a more profound impact on faith or spiritual maturity than the postpartum depression that lands a 30 year old mother in the hospital who has been active with church or campus ministry for the last fifteen years. The age of onset of the conditions selected here typically occurs after the time most Christians have professed their faith. How do the results look different if you selected Asperger’s Disorder, ADHD and adults treated for depression prior to the age of 18? I can think of others…lots of adults with schizophrenia are homeless or in assisted living situations. Their family’s church experiences might be very different than those families caring for a son or daughter or parent with schizophrenia who is still living at home. We don’t know that from looking at the information presented.

Baylor Religion Study 3What instruments are used to measure the variables the authors seek to study? When we’re involved with a study in our practice, our outcome measures are typically normed and validated rating instruments. For example, we used the ADHD Rating Scale as an outcome measure in comparing long-acting ADHD medications, or the Brief Psychiatric Rating Scale in a study of kids with early onset schizophrenia. If I were reviewing a drug-company sponsored study of XYZ medication and their primary outcome measure is something I’ve never seen used in a paper before, my index of suspicion goes way up. What instrument or interview was used here? It’s not clear. Investigators at Baylor have developed standardized questionnaires to examine spiritual practices. Were they used? How did the authors decide on the questions they asked and why?

Looking at the study objectives, I’d expect to see questions about how often one attends church, prays, reads the Bible, participates in a small group or Bible study or serves in a ministry associated with a church. Did the authors intentionally oversample for church attenders? How many of the non-attenders became non-attenders because of their mental illness or a family member’s mental illness? When was the onset of their illness, and is there an association between the onset of illness and a decrease/discontinuation in church attendance? Are there specific church activities that are more difficult for the person with mental illness or their family members? Then again, nearly 80% of their sample was self characterized as “very stable” or “somewhat stable.” Why would one expect to see much of a difference at all in studying a group that may not be all that different from the other people attending church?

Next…we look at the data and data analysis. Is the analysis clear? Are the statistical measures appropriate? Is there any data that appears grossly inconsistent with our understanding of the topic? If some very unusual results exist, it doesn’t mean they’re not valid, but they’ll draw closer scrutiny.

In the FOTF/Lifeway study, here are some of the findings that made me look carefully…

  • 37% of evangelical pastors and 55% of mainline pastors have taken seminary courses on care for the mentally ill. They may have taken a course in pastoral counseling, but the conversations I’ve had (and members of our Key Ministry team) had with pastors and seminary staff suggests this type of training is very uncommon. The percentages of pastors who claim to have taken continuing education classes on counseling or psychology seem very high also.
  • 94% of individuals with acute mental illness say they have been prescribed medication to treat their mental illness. It’s very difficult to know what to make of this claim without a knowledge of how the sample was obtained. Most persons who received a formal diagnosis of bipolar disorder or schizophrenia have likely been treated with medication. This figure seems far above what one would expect for the general population of adults with depression, given the availability of non-medical treatments (cognitive-behavioral therapy) for depression.
  • 85% of participants reported medication was very effective or somewhat effective. Given that the majority (94%) of the sample was identified as moderately to severely depressed at one time (depression is also common among persons with schizophrenia and bipolar disorder), this number appears wildly optimistic given the research on the effectiveness of antidepressants.

Another observation about the data…the authors point out item by item where findings are deemed “significant” statistically, but never indicate whether some findings were more robust (statistically significant) than others.

Conclusions…When I’m looking at a paper, I’m interested in how the authors interpret the data in light of their findings and what we previously knew about their area of research. In this case, the authors didn’t include any such summary in the download of the study results. We’re given lots of information without context. If I’m a pastor or a church board member, what should I do with this information? To me, the survey felt like a big data dump without any attempt to make sense of the data for the reader.

So…If I were given this study as the lead reviewer, it would have been turned down. It’s possible that portions of the study could be salvaged. The pastor survey had very large numbers with lots of statistical strength, even though I suspect a survey bias in which pastors tended to give the “right” answers when questioned. My sense from the remainder of the study is that the authors didn’t fully understand their subject material, and that’s too bad. There are critically important questions we as the church need to answer if we’re going to more effectively minister with a large segment of the population.


KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

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Fitting in at church…by Anonymous

shutterstock_170018114Editor’s Note:  “Sydney” sent me this e-mail last week and gave me permission to share with our readers. Her e-mail is a wonderful, first-person description of attending church as a person with Asperger’s Disorder.

Church is one place where there ought to be a place for everyone. We’ve had two very similar conversations in the last few weeks…one with a man who, like “Sydney” has autism, the other with a woman with bipolar disorder and PTSD. We share in the hope that the church will listen and learn from “Sydney’s” perspective…

I have aspergers, ADD, depression, and anxiety. I am a student who recently moved to do more studies. I am very nervous about joining a new church because of the experiences I have had in church before. I so find the loud rock concert type services completely overwhelming. However, the social aspects at the quieter services are just as overwhelming as some very perky person pounces in on me. Although I typically like structure and routine, I do enjoy contemporary (less high services) for connecting with god. In addition, there is all that small talk around swarms of people wearing all sorts of perfume who do not understand when I talk loudly, change topics, or suddenly get distracted.

Coordinating getting myself to church and then balancing a cup while talking to people is a challenge. When I finally do get the courage to introduce myself to someone, it turns out that I met the person the week before but did not remember his or her face. I am never on time for church and it is a good day when I remembered both my money and kindle bible. (Real bibles are too distracting as the smooth pages are too much fun to feel!) I feel left out as others display their feelings and get emotional during worship. I never know where to sit and always leave belongings behind after church.

I have managed to alienate everyone at my old church–apparently through breaking countless social rules (though I am not sure which ones). It is hard to know what I do wrong since no one communicates with me and I cannot read body language. Even when I try to send update emails, I get no response. It is so is hard for me to initiate conversations. Therefore, I even sent an email with pictures from Corinth and Ephesus to initiate a conversation. However, no one from church ever emailed me back. Many people when dealing with me say, “There’s Samantha. And I hadn’t even asked god for patience when I met her.” I have taken all of these “find your spiritual gifts” and “find your ministry” quizzes. All of them say that since I care about social issues and kids that I must want to do all these social activities. I like people as an abstract concept and I like helping them indirectly. I would rather hang out with the kids since I feel as immature as they are. In addition, my attention span matches theirs.

I do not want to join a small group in a new church because I am so afraid of belong alienated again. My old pastor told me I just needed to get more antidepressants and more friends–if only it was that easy. In my old church, I tried doing alpha at the church but I never felt like I was part of the fellowship. I enjoyed watching the alpha videos online more. I am currently learning from Christian courses.com and biblicaltraining.com in the meantime. When I have autistic meltdowns, worries, or compulsions, I am just admonished for not giving things to god and that I have not asked for enough healing. If I speak about issues such as modesty, they admonish me for being too shy introverted or antisocial. In discussions in admonished for always being too off topic. Do not even get me started sitting still for quiet time with god. Clear sermons with pictures and outlines are such a blessing (though church with so much socializing can be tiring!)

I do not even know how to approach joining a church now since it is so evident that no one at my old church in my old city wants anything to do with me. For all the talk on forgiveness, I am apparently too eccentric and egocentric to be forgiven and to be accepted. Moreover, if not even loving Christians can put up with me, the rest of the world seems scary. I once volunteered at a Christian youth centre, but I was told I had to leave after a few days for being too clumsy. I applied to several Christian schools, but I have found them to be the least accepting of my disabilities. I have this vision that if I ever get married, it will be an empty church (not that I want to be the centre of attention making small talk and hugging others). I was told once during a healing session that I was to remember that I was a princess in God’s kingdom; however, what I also remember is the person who described me as the “pre-princess” from The Princess Diaries.


Square Peg Round HoleKey Ministry has assembled a helpful resource on the topic of Asperger’s Disorder and Spiritual Development. This page includes the blog series Dr. Grcevich and Mike Woods developed for Key Ministry, links to lots of helpful resources from other like-minded organizations, and Dr. Grcevich’s presentation on the topic from the 2012 Children’s Ministry Web Summit. Click here to access the page!

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My Weekly Reader…September 27, 2014

Tennessee High School CheerleadersThe big story this week in our world was the survey released by Focus on the Family and Lifeway Research related to the perspectives of pastors and the experience of adults with mental illness and the church. I’d encourage anyone with an interest in disability ministry to download and read the survey…in our blog posts next week, we’ll be digging into the survey in great depth while sharing a little teaching on the topic of interpreting research studies.


Here’s an interesting study that helps explain why kids with ADHD struggle to make good decisions…altered functioning in the medial prefrontal cortex, a part of the brain involved with choosing between multiple alternatives and learning from one’s mistakes.

Disability Ministry:

Jeff Davidson keeps sharing high quality content. Here, he answers the question Don’t you feel cheated about the life you imagined you and your son would have?

Brad Hambrick is a leader in the Biblical Counseling field. Earlier this week, he shared a very solid list of six steps to wise decision-making about psychotropic medication.


MelissaEdge-nowcircleMelissa Edge shares an incredible story of how God was unmistakably at work through her suffering in the aftermath of losing her husband. What do we do with our lives In the Meantime as we’re experiencing grief.


In my line of work, I tend to see lots of kids who struggle in the face of negative influences in the culture. Here’s a look at some very impressive kids in Tennessee who aren’t ashamed to live out their faith in public…especially when the American Civil Liberties Union sent their school a threatening letter because of their school’s tradition of a pre game prayer before home football games.

Coffee Break ChurchThis coming week, we’re continuing our preparation for Inclusion Fusion, and launching “Coffee Break Church” a weekday worship experience at The Front Door for parents of kids with disabilities who are unable to attend church on the weekend. Join us this coming Monday at 10:00 AM for church, chat and online community.

Tomorrow, we’re sharing an incredibly powerful guest post from a blogger who has requested to remain anonymous. She’ll share a first-person account, Fitting in at Church, about her experiences in trying to attend church as a person with Asperger’s Disorder. Help her share her story!

Finally, while I had some issues with the FOTF/Lifeway study, the crew at Focus on the Family put together an excellent, free book for pastors, Serving Those With Mental Illness. Here’s a link to the page from FOTF where the book can be downloaded.

Have a great week!


KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

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Focus on the Family, Lifeway avoid the tough questions about mental illness…

FOTF InterviewWith much fanfare, the folks from Lifeway Research and Focus on the Family released a report yesterday containing data collected from three separate surveys of Protestant pastors, Protestant adults identified with mental illness, and family members of Protestants with mental illness in what’s been titled the Study of Acute Mental Illness and Christian Faith.

I spent the last two evenings pouring through their report. Given the emphasis that our ministry places upon supporting churches as they minister to families impacted by mental illness and the prominence the studies are likely to receive throughout the evangelical church as a result of the people and organizations behind them, the release of the report is something we need to speak into. Nevertheless, I found the design of two of the surveys to be profoundly disappointing and the results of the survey not nearly as useful as they could’ve been.

We’re going to examine the results of each of the three surveys

The most useful of the three surveys was a telephone survey of 1,000 U.S. senior pastors in Protestant churches conducted last May. Responses were weighted to reflect size and geographic distribution of the churches surveyed. Here are some key findings…

  • 74% of pastors personally know one or more people diagnosed with depression.
  • 76% know one or more people diagnosed with bipolar disorder.
  • 50% don’t know anyone who has been diagnosed with schizophrenia.
  • 59% have counseled one or more people eventually diagnosed with an “acute” mental illness…defined here as schizophrenia, “clinical depression” or bipolar disorder, but only 13% had counseled more than ten. 31% answered “none.” Pastors were more likely to answer “none” as the size of the church they serve became smaller. Pastors in the South were significantly more likely to answer “none.” Note: Schizophrenia is not an “acute mental illness,” nor is depression in many instances.
  • 38% of pastors reported feeling equipped to identify a person dealing with acute mental illness that may require referral to a medical professional.
  • 23% indicate they have personally struggled with mental illness of some kind, but only 12% of pastors surveyed were ever formally diagnosed. Pastors in the Midwest were significantly more likely to report undiagnosed mental illness.
  • Only 35% strongly agreed with the statement that a Christian with an acute mental illness can thrive spiritually, regardless of whether or not the illness has been stabilized, although 41% answered they “somewhat agree” with that statement.
  • 40% agreed with the statement that medications should be used anytime they can ease symptoms of an acute mental illness.
  • 51% agreed with the statement that psychological therapy should be used before sharing spiritual principles, while 20% agreed that psychological therapy should be used before sharing spiritual principles.
  • 56% strongly agree that local churches have a responsibility to provide resources and support to individuals with mental illness and their families.
  • 68% of pastors indicate their church provides care for the mentally ill or their families by maintaining lists of experts to refer people to…but only 28% of family members of persons with mental illness reported such lists were available.
  • 49% of pastors rarely or never speak to their church in sermons or large group messages about acute mental illness.

Talking about mental illness

So…what to make of all this?

After my first read through the survey, my initial reaction was to question the extent to which the folks who designed this project understand the concept of mental illness. Were they hoping to study the impact of severe mental illness and stumbled onto the concept of “acute” mental illness? How or why did the survey authors decide to ask specifically about schizophrenia, depression and bipolar disorder? 90% of patients with bipolar disorder experience recurrent mood episodes resulting in most instances in a need for lifelong treatment. Schizophrenia is certainly not an acute illness. Here’s the first sentence in the National Institute of Mental Health’s (NIMH) information page describing schizophrenia…

Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history.

The diagnosis doesn’t matter as much as the severity of functional impairment the person experiences from symptoms related to the diagnosis. Want to know what mental health condition results in severe impairment to the greatest number of adults according to NIMH? It’s anxiety! The authors never asked about it in the survey.

Here’s my most significant criticism of this survey…they didn’t ask the right questions!

If I had access to 1,000 pastors, here are some of the questions I’d ask…

To what extent do you believe mental illness is indicative of an individual lacking sufficient faith in Christ?

What percentage of the time do you believe that mental illness is a direct result of habitual sin in the life of the affected person?

How often is prayer likely to lead to remission/cure of the following conditions?

  • Depression?
  • Anxiety?
  • Autism?
  • Schizophrenia?
  • PTSD?
  • ADHD?

In the last year, have you referred a person attending your church who appears to be experiencing symptoms of mental illness to…

  • A fellow pastor (inside or outside your church) for counseling
  • A Nouthetic, Biblical or Christian counselor
  • Their primary care physician
  • A secular psychologist or counselor
  • A psychiatrist (MD/DO)

What challenges would you anticipate a person with mental illness or a family member with mental illness might experience if they sought to regularly attend worship services at your church and participate in other activities your leadership views as essential for spiritual growth (small groups, Christian education, missions/service, etc.)

Here are a few thoughts on this survey of pastors…

Why weren’t questions like those I suggested included in the survey, especially after Ed Stetzer from Lifeway noted in an earlier blog post that a high percentage of Americans views prayer and Bible Study alone as sufficient for overcoming serious mental illness. Where do those attitudes originate? I wonder if the folks at Focus on the Family didn’t want to ask tough questions that might embarrass some of their longtime friends and supporters?  Are they even aware of the experiences of shame or blame reported by faithful Christians when seeking comfort and support during episodes of mental illness? Are they so isolated from Christians with outstanding reputations for doing quality academic research on disability-related topics that they didn’t know where to go for help in tackling a project like this one?

It’s interesting that while nearly a quarter of pastors identify themselves as having personally experienced mental illness, roughly half never sought help. Why not? Is the stigma against seeking help that great among senior pastors? Do they have difficulty finding high quality mental health care that’s affordable under their health care benefit packages? Is it a lack of trust of mental health professionals? Somebody should’ve asked.

Lifeway 3Last…and this is one area where this data is consistent with surveys looking at other areas of disability…there’s an enormous disconnect between what pastors believe their church is offering in the way of supports and what families in the church experience in describing the availability of supports when it comes to mental illness. The graphic on the right illustrates this point nicely…the church may have resources to help support persons with mental illness and their families, but if we never talk about mental illness at church, how would those who might benefit know that the resources even exist?


KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

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How my daughter taught me about friendship…Jonathan Holmes

HolmesJonathanEditor’s note: We’re grateful to Jonathan Holmes for serving as our guest blogger today.

Jonathan serves at Parkside Church in Cleveland, Ohio as the Pastor of Counseling. He graduated with degrees in Biblical Counseling and History from The Master’s College and a master’s degree from Trinity Evangelical Divinity School. Jonathan and his wife, Jennifer, are parents of three beautiful daughters, Ava, Riley, and Ruby. Jonathan also serves on the Council Board of the Biblical Counseling Coalition. I’m grateful to Jonathan for his willingness to explain the world of Biblical Counseling to a child and adolescent psychiatrist with one foot in academia. Here’s his post…

I learned something valuable about friendship from my daughter.

A few weeks ago my two oldest daughters and I were at our local library. As any parent knows, going to the library with kids can be a bit stressful. As you juggle piles of Bernstein Bear and Fancy Nancy books, clean up dishelved copies of other books avoid judging stares from the librarians all while all while telling them to “shhhh…”

On this particular day near the activity area, there was a sweet little girl in full leg braces and a walker in the corner. As the she carefully placed animal puzzle pieces into their respective places, I hurriedly tried to strategize in my mind how to keep my two girls away from her as not to bother her or embarrass her. Truth be told, I realize in hindsight I was more afraid and embarrassed than I would venture she ever was.

Before words could come out of my mouth, my sweet and friendly daughter Ava had gone over to introduce herself. In the space of seconds, she had asked her what her name was (Hannah), what grade she was in (pre-K), and why she was in leg braces (unknown). As Hannah’s mother kindly looked on, I nervously re-ordered the pile of books I had accumulated.

As time went on and the girls happily became enveloped in their world of princesses, puzzles and giggles, I relaxed and took a deep breath. There was no awkwardness now, just the fun whispers of girl-to-girl chatter.

As we walked out of the library, Ava looked up excitedly saying, “I can’t believe I made a new friend!” In the coming weeks, she would tell me she had seen Hannah at her school (they’re a year apart) and had waved at her. Every once in a while, sweet Hannah will come into our conversation, and Ava will remind me of the friend she met at the library that summer day.

Reflecting back, I’m so thankful for my daughter’s kind heart and gracious outreach. Hannah’s mom told me that day not many kids reach out to her because she has disabilities. In that moment, I realized how simple, yet profound friendship can be in the life of a child. It can brighten one’s day, put a smile on one’s face and in the best of ways it can soften shame, alleviate stigma and lift spirits.

That day my daughter taught me to enter into other people’s worlds with love and care. You don’t need to have fancy words or a planned out monologue…sometimes the simplicity of “Hello, I’m Ava” is all you need to begin a friendship.

You see that is exactly what Christ does to us when he calls us into friendship with himself. In some of the most life-changing words ever spoken, Jesus says to the disciples in John 15:15, “No longer do I call you servants…but I have called you friends…” Think on that for a moment. The Son of God, Immanuel, comes to us and calls us friends. Could there be any sweeter message? Any kinder outreach?

With this new friendship comes great opportunity and responsibility. With each outreach of friendship we actually tell the story of the gospel to an unbelieving world. With each encouragement to pursue others in friendship we communicate the love of Christ to people in desperate need of such community and relationship. Even recently, the need for friendships in the church has been expounded here at this blog.

It was with these thoughts in mind that I wanted to write a book on the topic of friendship. The Company We Keep: In Search of Biblical Friendship, is a short, yet accessible book designed for parents, ministry leaders, small group participants—really anyone who desires a biblical theology and practice of friendship.

This is also why I love the work of Key Ministry. I know at the core of Key Ministry is a desire to see children loved, cared for and friended in Christ.


Adobe Photoshop PDFIs it possible friendship exists for a greater purpose than my enjoyment and comfort? Is friendship more than just having some people to hang out with on a weekend, participating in a book club, or hitting the golf course together?

These questions and more are answered in Jonathan Holmes’ new book, The Company We Keep: In Search of Biblical Friendship. Biblical friendship is first and foremost about a relationship with Jesus Christ. As you are brought into friendship and relationship with the Father, Jesus Christ calls you a friend! It is out of this friendship, that our human friendships find their beginning and their purpose.

Available through Cruciform Press.

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My Weekly Reader…September 19, 2014

BPCOverwhelmed by all the information coming at you?In this week’s Weekly Reader, I’ll share some features that caught my eye over the last week. The Weekly Reader is meant to be a two-way feature! See something that our team at Key Ministry missed? Something we should read? Post it in the “Comments” section below for all of our readers to enjoy!


Mental disorders are responsible for nearly a quarter of all years lived with disability worldwide. Despite the presence of cost-effective, evidence-based treatments, getting treatment to people who need it fails to be a high priority. A look at The Unconscionable Gap Between What We Know and What We Do

Disability Ministry:

Jeff Davidson from Rising Above Ministries has another excellent post…Top Ten Church Myths About Special Needs Ministry.

My colleague Barb Dittrich reminds us of the challenges faced by the families ministered to by churches we serve in 5 Ordinary Things That Aren’t So Ordinary for Families With Special Needs.

Ellen-casualI had the pleasure of brainstorming ministry ideas for a couple of hours in a videoconference earlier this week with Ellen Stumbo. I think all of us will want to meet Ellen’s daughter after reading My Daughter’s Disability Is Not a Tragedy.


The Adrian Peterson child abuse case has resulted in criticism of the church for encouraging corporal punishment. How should the church respond?


There continue to be arguments about what constitutes “settled science,” but the evidence that children do better when they’re raised by their biological father and mother in a married family is so compelling, an argument can be made that persisting in denial of the obvious is cruel and abusive.

Black_Cara_smallWe had a great response to this past week’s training with Dr. Cara Daily on spiritual development in kids with autism. Jolene Philo joins us at our Front Door Online Church platform this coming Thursday (September 25th) at 12:00 PM Eastern to discuss PTSD in kids with special needs. Colleen Swindoll- Thompson will be with us for our first Parent Chat on Thursday at 8:30 PM Eastern. We have online worship  this week on Sunday, Monday and Wednesday evenings. Cara’s videos remains available on Front Door daily through October 4th.

Thanks to all who prayed for our Google Grant application! We were approved this week. The $10,000/month in free online advertising that accompanies the grant will be invaluable in expanding the number of churches able to discover our training and participate in November’s Inclusion Fusion Web Summit!

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