ADHD Help

I had a difficult day today at work. Working with young soldiers in crisis is seldom easy , and it takes a lot out of me. By the end of my day, I felt dazed and confused. I had a date for tennis after work and was concerned regarding whether I’d be able to focus well enough to avoid getting hurt out there on the courts. My other thought was that when I arrived home, I’d only be able to “veg out” on the couch in front of the television. I had absolutely no desire to come home and write anything for my webpage.

Luckily, the tennis revitalized me. It reminded me of the importance of taking care of yourself before you try to take care of others. If you don’t take care of yourself, you won’t be able to take care of your children!

When I was a child, (this is when Elwood would say, “Now we’re really talking ancient history!”), one parent, usually the mother, stayed home to take care of the children and the house. Families did not have as many consumer goods, but we also, in those days, didn’t have available all of the amazing technology to attract our dollars.

When I was in graduate school, we were told that we should be trained as leisure counselors since computers would give us all much more spare time. Of course most of us now have much less time.

Almost everybody works. At the end of the day both parents are exhausted. Neither has the energy to spend time with the children and cope with family business.

So, what’s the answer?

One answer is to give up some of the consumer goods and have one parent stay at home. By the way, I am not saying that being a stay at home parent is an easy choice. I think that being a stay at home parent is one of the most difficult, important, underrated, and undervalued jobs in society.

Ok, now I know that most of you won’t follow this suggestion. What’s next?

If you are a single parent, make sure that you have a little extra time for yourself before you return to your children after work. Give yourself a half hour to wind down from your day. That extra time could make all of the difference.

If you have a spouse or significant other, each parent should give the other parent the needed time, even if it is only 15 minutes. It is also important to have a date night once a week. Leave the children with a sitter and go out. Don’t feel guilty. You need and deserve the time to enjoy each other without all of the responsibility. If you can’t afford a sitter, see if you can find another family and swap baby sitting with them. If that is not an option, figure out a way to hire your older children to sit for your younger children while you have a special dinner or watch a movie with your significant other in another room at home. Single parents can try similar strategies/ Where there is a will, there is a way.

If you don’t take care of yourselves, you won’t be able to take care of your children!

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.

Help For ADHD

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ADHD can have a multitude of effects on the entire family. To begin
with, it is not unusual for a child who has ADHD to attract
significantly more of his or her parents’ attention than the other
children receive. Just remember the old saying, “The squeaky wheel gets
oiled.” The other children can become jealous because they do not get
as much attention. They also can take advantage of the situation
because their parents are not paying close attention to them. What I
mean is that they can get away with doing wrong things because their
parents are busy paying attention to their sibling who has ADHD.

Since so many children with ADHD also have ODD, the frequency and severity of
arguing and yelling can increase significantly. This can cause other
family members either to withdraw, become angry, or to become more
aggressive themselves. Parents of children who have ADHD frequently
feel frustrated, inadequate, guilty, exhausted, and depressed. Many of
these parents end up in psychotherapy themselves. Since children who
have ADHD are good at playing people against each other, they can cause
problems between their parents or between their siblings. Please write
to me to tell me more specific ways that a child with ADHD has affected
your family life.

drc@adhd1.net

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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ADHD Specialist / Child Psychologist, Dr. Sam Caron answers your questions about ADHD. Send them to: drc@adhd1.net

or leave him a message! Call toll-free 1-800-993-ADHD (2343)

Stephanie Deering from South Plains College writes:

I just received and viewed the first 2 Dr. C and Elwood videotapes. Planning to use them in an inservice for early childhood teachers! On that subject, would you like to comment on the use of medication with very young (preschool) children? We are seeing a drastic increase in the number of 3-5 year olds diagnosed as ADHD, with medication. Our concern in the early childhood field is that many behaviors interpreted as ADHD symptoms are actually developmentally appropriate for young children.

Dr. C’s response:

Dear Ms. Deering, First of all, thank you for ordering my videos. I hope that you find them to be helpful teaching devices. Your question is an excellent one. The DSM IV requires 6 hyperactive/impulsive symptoms prior to diagnosing ADHD, Primarily Hyperactive and Impulsive

The same is true for diagnosing ADHD Primarily Inattentive. Six symptoms in each area is required in order to diagnose ADHD Combined type. Even though it is not stated in the DSM, symptoms reduce in number as a person ages. Therefore it is prudent to require more symptoms be endorsed before diagnosing younger children

For example 8 to 10 symptoms instead of 6 should be endorsed when diagnosing a 3 year old. Additionally one should endorse a symptom only if it is in excess to the norm for the age group. Finally there must be some impairment in two or more settings and clinically significant impairment in social, academic, or occupational functioning.

I, personally, only diagnose ADHD in young children if the symptoms are extreme. If the symptoms are severe enough to be causing the needed clinically significant impairment, medication is, I believe, an important part of the treatment.In order to diagnose a child, the evaluator should obtain input from the child’s teacher; after all, who knows more regarding normal expectations for any specific age group than one who spends her/his day with members of that age group.

Teachers concerned that their students have been misdiagnosed should ask, I believe, to provide their input to the evaluator. Unfortunately children are often diagnosed without obtaining any of the necessary input from the teacher but rather entirely based upon a parents input. I hope this is helpful.

Sincerely,
Samuel R. Caron, Ph.D.

Dr. C & Elwood
adhd1.net

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.

It’s not unusual for children with ADHD to have problems getting up in
the morning. If your child is taking medication, you might check with
your physician to find out whether or not you can give him a dose of
the medication one half hour before he awakens. You do this by coming
into his room with the medication one half hour early, waking him up,
and then letting him go back to sleep for another half an hour.
Sometimes this early morning dose can help reduce oppositionality and
thus make getting up in the morning much easier.

Sometimes sleep problems are a side effect of ADHD medication. If the
child is having sleep problems, this will interfere with his/her ability
to get up in the morning. It is important to make sure that your child
is getting enough sleep every night. If your child is having a
difficult time falling asleep, there are different things that you can
try.

If it appears that the medication is interfering with sleep, you
can try to give the medication earlier and thus hopefully reduce the
sleep problems. If it does not appear that the ADHD medication is
interfering with sleep, but the child is having problems falling
asleep, you can check with the physician about the possibility of giving
a small dose of medication one half hour prior to sleep. Sometimes
children with ADHD have difficulty falling asleep because they cannot
stop their mind from thinking. Medication taken one half hour before
bedtime can help with this problem.

This information seems to conflict. On the one hand the medication can
interfere with falling asleep, and on the other hand the medication can
help the child to fall asleep. Working with your physician and trying
different options can help you figure out the best choice for your
child

A third possibility is to utilize a reward system for getting up
appropriately in the morning. Fixing a special breakfast treat for good
mornings is one way to reward appropriate behavior. Another way is to
allow your child time to watch a special television program in the
morning if he gets up without arguments.