ADHD Help

What does the Norway Spiral have to do with ADHD?

As I was looking at the video of the giant blue and white spiral lights in the sky over Norway, my thoughts turned to children who have ADHD. What, you may ask, does the Norway Spiral have to do with ADHD? Those spiral lights are a phenomena to which many ADHD children could successfully attend. People who have ADHD are able to attend to things which really grab their attention. Things that are new, different, exciting, or rewarding, can hold their attention. Even though one of the three main symptoms is getting distracted easily, there are exceptions.

Parents often come to see me after being referred by a teacher who believes that their child has ADHD. Many immediately tell me that their child can’t have the disorder because the child is able to pay attention for long periods of time to video games or attractive cartoons. They only seem to have problems with schoolwork.

I explain to the parents that people with ADHD have their biggest attending problems with boring and redundant tasks such as school work. These problems are so severe that they really are unable to stay on task unless someone continually supervises them one on one.
I am writing this short article to remind you that just because your child can play a video game for long periods of time or can complete work when you closely supervise, that doesn’t rule out the possibility that he or she has ADHD.

If you think your child might have ADHD, get an evaluation and find out. The proper diagnosis and treatment can really help.

There are many who believe that there is a positive relationship between ADHD and creativity and ADHD and high intelligence. Unfortunately, research does not support this belief. There are brilliant people with ADHD and also retarded ones. Some are artistically or creatively gifted, and others are not. ADHD is a disorder and not an advantage. The good news is that we are becoming progressively more successful treating ADHD. With good treatment, ADHD does not need to interfere with relationships, occupational success, or overall life quality.

As a child psychologist, I find that it is much easier to suggest
strategies to others than to successfully manage your own family. When
dealing with others, you can be much more objective and dispassionate.
Your emotions don’t interfere nearly as much. With your own children,
however, it’s an entirely different ballgame.

I also believe that the tricky part of being a therapist isn’t coming up
with suggestions but rather helping the parents figure out what to do
after your initial recommendations don’t work. Children with ADHD are
quite good at playing adults against each other. They also appear to be
good at learning your plan and figuring out how to work it to their
advantage in ways you probably never imagined. That is why you need to
be flexible, able to change the strategy as needed. Raising
psychologically healthy children is still an art rather than a science.

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A high percentage of children with ADHD , particularly boys, also have Oppositional Defiant Disorder (ODD). ADHD alone can create friction within the family. ADHD, when combined with ODD, can make family life much more challenging. I have known parents who did not want to go home after work and face the frequent conflicts. Some were also concerned that if they did not go home, the problems might escalate even more. Family life with ADHD and ODD can become quite unhealthy for children and parents alike.

It is better to act than to react. In order to improve the situation it is a good idea to have a plan in place to improve family communication and cooperation. Consequences need to be clearly stated, and parents must follow through. I also want families to have fun together and accomplish goals as a team. I want people in families to treat each other with respect.

I have created a program specifically designed to encourage more peaceful families. The program takes into account the special needs of children with ADHD. I will be presenting the program in the near future in a series of teleconferences. I hope you will be able to attend.

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Behaviors tend to be cyclical. We deal with the same problems over and
over again.  This means that we don’t necessarily need to have good
skills thinking on our feet.  If we don’t get it right the first time,
we can plan how to handle the problem the next time around.

A general principal is that it is better to act than to react. If a
problem occurs and you are unhappy with your response, sit down with
your spouse or some other trusted adult, discuss what happened, and come
up with a plan regarding how to respond if and when the problem recurs.

Look at management of problem behaviors as problem solving. If a
particular response is not effective, come up with another one.
Eventually you will get the problem under control.

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The majority of medications used to treat children with ADHD are stimulants. Most mental health providers prefer sustained release preparations rather than short acting ones. With the short acting ones, you have to take them every 4 hours. Sometimes there are symptoms rebounds when the medication wears off. A symptom rebound is when the symptoms return, possibly even worse than normal.

The sustained release medications do not appear to have significant problems with symptom rebounds. Because you have to take them every 4 hours, more energy is put into the act of taking the short acting medication. I like to deemphasize the medication if at all possible. It is also more likely that you might forget to give some of the doses if you need to give the medication 3 times a day. Finally, the child will have to take the medication at school, thus increasing the child’s stigma or possible embarrassment. As you can see, there are many advantages to the sustained release preparations.

Sometimes less is more.

This is a counterintuitive statement (goes against intuition) which is often true when dealing with misbehavior in children. Conventional wisdom is that the more you yell at your child for a wrong deed, the better. However, I usually do not find this to be true. What you do when you yell is give your child lots of negative
attention. Sometimes this rewards the behavior instead of punishing it.
The more you yell the more powerful your child might feel.

It is better to deal calmly and efficiently. Tell your child the
consequence and move on.

We define a punishment as anything which follows a behavior and
decreases the probability for recurrence.
A reward is anything which follows a behavior and increases the
probability for recurrence. If you are yelling over and over regarding
the same type of misdeed, you are probably not punishing the problem.

Regarding less is more, shorter consequences tend to work better than
longer ones. When we use long consequences we have a difficult time
following through and can easily end up burying our child in
punishments. Better to use shorter punishments and follow through.
That way children also learn that we mean what we say.

If you overemphasize to your child the importance of the medication, you very well might tap into his/her oppositionality. A high percentage of children with ADHD are oppositional. They do not want to do what you tell them to do.

If they think that you are trying to control them with medication, they might try their best to do the opposite. It is very important that you avoid falling into this potential trap. That is why you emphasize that the child is doing better because (s)he is trying.

When medication helps, the effects can often be remarkable. It is easy to fall into the trap of putting all of the responsibility for the improvements on the medication and forgetting that the child is responsible for her/his own behavior.

Obviously the medication is an important part of the treatment. However you have to remember that children improve because they try to change. The medication does not make them act appropriately. It just makes it easier for them to improve if they try.

When we put all of the emphasis on the medication, the child can stop taking responsibility. Remember to emphasize that your child is doing better because he or she is trying rather than just focusing on the importance of the medication.

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.