ADHD Help

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.

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.

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.

A child does not have to have all of the symptoms of ADHD in order to be diagnosed. Only 6 hyperactive/impulsive symptoms are needed to diagnose ADHD primarily hyperactive/impulsive.  The child needs 6 of the inattentive symptoms to be diagnosed with ADHD primarily inattentive.

If the child has six in each category, the combined ADHD can be diagnosed.  However, 3 year olds probably need to have 7 or 8 of the symptoms since more of the symptoms are normal at that age.  It is also important that the child be compared with his/her peers when deciding whether the symptoms are present.  Finally a child must also meet the impairment requirements in DSM IV in order to be diagnosed.  If the child is not significantly impaired, the diagnosis should not be given.

If you have concerns, I recommend that you take your child to be evaluated by a child psychologist or by his/her pediatrician.

~Dr. C

Today I am going to discuss some of the advantages of joining a support group. Support groups can help you in several ways. To begin with they offer you a group of peers with whom you can swap frustrations, successes, and strategies. Frequently talking to peers is less threatening than talking to professionals. Sometimes peers have practical insights which we professionals might overlook.

Next, peer groups offer you a place where you can learn which local professionals work well with ADHD. Other parents know which professionals have been able to help them. They also know which school teachers and counselors are sensitive to ADHD.

Peer groups are able to recommend or even provide advocates and help you to better understand your rights. They are also able to set up professional presentations so that you can learn more about ADHD. There are regional and national conventions at which you can learn from many different experts. ChADD, http://www.chadd.org, for example, will be having their national convention this November in Anaheim. I will be there with Elwood and lots of other fun surprises. I hope that I will be able to meet those of you who attend.

Finally, sometimes you can meet parents at support groups who are willing to swap baby sitting with you. As you all know, it is not always easy to find people you trust who are willing to stay with your children while you have a well needed, relaxing night away from responsibilities.

Peer support groups can be a very worthwhile investment in time, energy, and money.

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When you put your hand up, you can block out the sun. One little hand can stop you from seeing the biggest object in our solar system. This phenomenon is truly amazing.

ADHD, just like your hand, can block out your ability to see and enjoy your child. There is a tendency to find ones self focusing entirely on ADHD related problems and losing sight of the child as a whole. It is easy to fall into this trap when every night you spend four hours helping your child do homework, when every time the phone rings during a school day you begin to feel anxious that your child is again in trouble, when you feel unable to take your child into stores or to other children’s homes to visit, and when you spend considerable time in counseling sessions because of the ADHD.

DON’T LET ADHD STOP YOU FROM ENJOYING AND APPRECIATING YOUR CHILD!

Find fun activities which you can enjoy doing with your child on a regular basis.
Limit the amount of nightly homework time.
Reduce the amount of energy you spend on ADHD related problems.
Appreciate your child’s assets instead of only focusing on the deficits.
Don’t take the problems personally or too seriously.
Create an ADHD friendly home environment to increase success to reduce the stress.

Remember that your children will only be children for a short time period. If you spend all of your time on the problems, you will miss out on all the fun. Don’t let ADHD block out your son or daughter. If you don’t start enjoying them now, they’ll be grown up before you know it.

To oversimplify, there are two types of solutions: ideal ones and practical ones. If your children fight frequently, the ideal solution is to teach them to get along better. This is often quite difficult to accomplish. Some practical solutions are to separate them (just yesterday I recommended separate bedrooms for two siblings) or pay them for getting along. It doesn’t feel right to most of us to pay our children to treat each other appropriately, but sometimes even this technique can help reduce family stress and break the pattern.

It is important to remember that one size does not fit all for ADHD. Some children, if you let them run around a great deal prior to bed, will settle down and go to sleep. Other children might become over stimulated. The goal is to when in doubt try something. If it works, great. If it doesn’t, alter your plan or try something else.

~Dr. C