WHY COUNSELING

SAMUEL R. CARON, Ph.D.

We all know that the treatment of choice for children with ADHD is a combination of medication and counseling. The medication increases brain activity and thus improves functioning. What I am going to discuss today are the purposes for the counseling component.

My first goal when I counsel ADHD families is to educate children and parents about ADHD. I use my 10 video lessons (http://www.adhd1.net/adhd-dvd.htm) to help me accomplish this. Understanding the disorder helps parents make informed decisions. It also aids them in better differentiating between misbehavior and ADHD related problems. It allows them to feel more comfortable with the medication when they understand the disorder and the purpose of the medication. It gives them the information they need to explain what is going on to skeptical relatives and friends.

Understanding ADHD

The children also need to understand the disorder. Understanding ADHD allows them to blame ADHD for historical inadequacies. This is probably better than their previous conclusions since so many children with ADHD decide that they are bad, stupid, crazy, lazy, uncontrollable, unlovable, etc. This education helps achieve a second counseling goal of improving the child’s self-esteem, which is so frequently damaged.

While encouraging the child to blame previous problem behaviors on ADHD, I simultaneously discourage them from continuing to use ADHD as an excuse. It is important that children take responsibility for their behaviors. On the other hand, we simultaneously want to make their environment more ADHD friendly so that they have a better chance of succeeding. Helping families develop ADHD friendly environments is a third goal of counseling.

Reward Programs

Setting up reward programs; improving family communication; constructing external reminders such as signs around the house; developing consistent family structures; reducing family arguing; practicing personal problem solving strategies; developing reasonable expectations; if necessary, reducing the amount of time spent daily on homework; having more family fun; helping parents to stop taking the problems personally; etc. are all ways to help make the environment more ADHD friendly.

Another counseling goal is to educate the children and parents about medication. It is easy to fall into the trap of thinking of the medication as a good pill or a smart pill. We discuss the fact that there is no medication that will make them smarter or keep them out of trouble. Although the medication does help improve concentration and reduce impulsivity, the children must try in order to improve. I want children to take responsibility for any improvements since this can also help improve self-esteem.

I think that some children resist the effects of the medication if they believe that we are trying to control them. That is why it is essential not to tap into their oppositionality with regards to medication.

Educate the Family

Another goal of the counseling is to educate siblings about ADHD. This can help them better understand the problems. We want the siblings to be our allies in treatment, and we do this by involving them in the treatment process.

A major counseling goal is to repair what is broken. ADHD can impair the relationships the child has with his parents, siblings, teachers, and peers. It is important to try to repair these. ADHD can also strain the relationship between the parents. It is essential that the parents are able to work together as a cooperative team in order to cope better with the problems.

Another goal of counseling is to determine whether other family members also need treatment. Every full sibling has a 40% chance of having the disorder. It is not unusual for the primary care taker to be depressed, and so this also needs to be explored. Parents might need marital therapy if the problems are affecting their marriage.

This article is not all-inclusive, but it does provide information about the importance of the counseling component.

Samuel R. Caron, Ph.D.
Dr. C & Elwood

I was thinking about the problems that parents have in public places managing children who have ADHD. The children easily can become overly stimulated and wild. They have a difficult time sitting still. They talk too loudly. The become bored easily. Many also have Oppositional Defiant Disorder in addition to ADHD. Before going out in public, it is important to :

1. Anticipate the problems so that you can develop a plan of action. It is always better to act rather than react.

2. Tell your child the ground rules in advance. Let your child know what the consequences will be both for compliance and non-compliance. Having a reward system in place is frequently helpful. Immediate consequences are very important.

3. When you arrive in the public place, identify a private place to which you can take your child, if needed, to deal with any problems. It can be embarrassing to discipline your child in front of lots of other people. A private place could be your car, the bathroom, or a corner away from everyone.

4. Plan a structure which will reduce the possibility that the problems will occur. For example, if you know that your children will fight with each other, keep them physically apart. At the Seder I recommended separating some siblings, and we even sat some of them with other families.

5. In a church or synagogue event, you should feel free enlisting the help of other adults. Don’t feel as if you are alone. Religious groups should function as extended families.

6. Don’t let one child’s problems interfere with everybody else’s enjoyment. If necessary, you can have a sitter on call, and entirely remove the child from the event without significantly interfering with your involvement.

7. Many problems recur. If you don’t figure out how to manage the problem properly the first time around, go “back to the drawing board” and come up with a better plan for any recurrence.

8. If your child takes medication, remember that medication is not just for school. It can also make it easier for your child to succeed in public places.

I hope these suggestions are helpful.

Imagine my surprise when yesterday I learned that Amazon.jp was down to their last copy of the Japanese version of my ADHD DVD book. Of course I really don’t understand what that means because I don’t know if they started out with five copies or 500 copies. However, I was quite heartened to also discover that more copies are on the way.

A little bit of personal history might help you to better understand how in the world I ever ended up on Amazon.jp. Besides being a psychologist, I am also a ventriloquist. I started ventriloquism when my Aunt Sally gave me a Jerry Mahoney puppet for my seventh birthday. At that time I was recovering from rheumatic fever, and she thought that the puppet could hel p the process. Aunt Sally was absolutely right, and ventriloquism became my lifelong hobby.

When I grew up and became an elementary school guidance counselor, I continued to use my Jerry Mahoney puppet to help me establish rapport with the students at my schools. Next I used Jerry when I worked at a residential hospital for severely developmentally disabled people. In fact, while I was at the hospital, I almost got to entertain on the same bill with Bo Diddley, but that’s another story.

In private practice I became even more involved with puppets, having the money to acquire a small collection for myself and for my young patients to use. Therefore, I indulged myself. It was good both for me and the children. The puppets made my work and their treatment more successful and enjoyable.

About 15 years ago I commissioned Jerry Baum, a puppet maker, to create Elwood for me. It was the first time that I ever had a professional puppet. By the way, we used to call them dummies. Currently, the politically correct term is vent figures. We wouldn’t want to hurt the little puppets’ feelings!

Anyway, once I had invested in Elwood, I decided that it would be beneficial to utilize ventriloquism to educate children and families about various topics. Since than I have produced PSAs on child abuse, molestation, stranger danger, domestic violence, 9/11, and, most recently on combat PTSD. I also produced 3 programs about ADHD. I combine ventriloquism, humor, magic, animation, and original songs to educate children and families in an entertaining fashion.

My puppet, Elwood, has already taken me to Japan three times. One of my Japanese sponsors, Dr. Michiko Hara, is a pediatric neurologist. She likes my videos so much that she had them translated into Japanese and published a version with subtitles and a script book. That, in a nutshell, is how I ended up on Amazon.jp.

I am including with this first entry a short segment from the Japanese version. In this segment Elwood learns what the letters ADHD mean.

My newest puppet arrived today. Honestly, I have no idea why I ordered another figure. Maybe it’s just because I like them. The puppet is a soft figure, quite different from the rest of my collection. It is a big monster. Here is a picture of him:

Maybe he will represent the “oppositional defiant monster” which is often associated with ADHD.

My son suggested that today I include my list of the seven most destructive ADHD myths. I decided to list them in reversed order.

7. You have to be hyperactive to have ADHD.

Children with inattentive ADHD are not hyperactive. Many are hypoactive (less active). They are daydreamers who are distracted by their own thoughts.

6. A child who can play a video game for long periods of time can’t possibly have ADHD

Children with ADHD are better able to stay on task when the task is highly attractive, with built in rewards and punishments. Video games meet these criteria. Children with ADHD also do better one on one and in new situations.

5. Too much sugar and food additives cause ADHD.

Not only has the myth never been proved, but research has also not proved that special diets reduce symptoms.

4. Medication should only be used at times when the children are in school.

We used to use the medication only for school, deemphasizing the fact that the children have problems with ADHD throughout the entire day. By only medicating for school, we made home management much more difficult.

3. Children magically outgrow ADHD when they reach adolescence.

We now know that many people continue to have problems with ADHD throughout their lives. Often the hyperactivity decreases as people age, but the problems with inattention and impulsivity remain. However, some people with ADHD do have a significant decrease in their symptoms as they age.

2. Using stimulant medications leads to drug addiction.

Children with ADHD are at a greater risk for drug and alcohol problems than children who don’t have the disorder. Treatment actually reduces that risk.

1. ADHD isn’t a neurological disorder. It is just an example of poor parenting.

ADHD is a real neurological disorder which is usually inherited. Since many of these children are difficult to parent, it is easy to incorrectly conclude that ADHD is due to poor parenting. Lot of parents are still being unfairly blamed for this neurological condition.