Archive for May, 2009
A common complaint from parents with ADHD kids and teachers that teach ADHD kids is, “I can’t seem to keep his attention no matter what I do.” As most people are aware, the brain functioning of a child with ADHD is different than that of a child who has not been diagnosed with ADHD. Sustaining attention for any task for any length of time usually takes monumental effort. Your child’s teacher is crucial as is the role of the parent in improving or increasing level of attention. Here are some tricks to increasing level of attentiveness in a child with ADHD. First of all, when you ask a question either as a parent or as a teacher, pause before you ask for an answer. For a teacher, they should look at all of the students and then call on someone to answer a specific question. This slows the pace down and gives the ADHD child time to regroup and get back on track with the discussion at hand if their mind has been wandering. If you see the ADHD child is clearly not paying attention, call out their name or work out a nonverbal way to cue them back in. For example, I suggest that you tap the child on the shoulder or walk by their desk to get their attention. When other students in the class answer a question, a good practice would be to have all of the other students look at the child who is answering the question. In school, keep your students guessing, this makes the material alot more interesting and we know that interesting material keeps everyone’s attention. For example, when telling a story or when instructing, say to the class, “you will never guess what happened next”. Liven things up a bit. For older children, make them keep a timer or some form of record-keeping instrument for self-monitoring purposes. If a test is given, make them monitor how long it takes them to do it. This will enable them to stay on track much easier! A very good trick for teachers to use is to have the ADHD child repeat back the instructions given or homework assignments, this ensures that the information was processed and the ADHD child was not tuning you out. Remember a child does not learn if they are not listening to the teacher and are in their own “little world.”
Although there is no such thing as the perfect teacher or the perfect classroom or the perfect anything, there are a few suggestions for the classroom setting for the ADHD child. As most of us are aware, the ADHD child struggles with becoming easily distracted, inattentiveness, difficulty sitting still, getting up out of his/her seat, and numerous other symptoms. ADHD symptoms affect each child differently and your child may have some of these symptoms but not all of these symptoms. However, one thing that is almost consistent across the board with children with ADHD is the fact that they are highly distractible and the more confusion in the classroom and lunchroom, the more acting out behaviors you are going to see at school. Here are a few suggestions to optimize their learning environment:
Seat the child in the front of the room, there are less distractions from other students this way.
Do not be afraid during test times or on assignments that require sustained effort to have the ADHD child work with a resource assistance or a para-professional at school. Additional services from the school may be warranted here and will need to be discussed with your child’s school.
The classroom should be minimally distracting. What I mean is the classroom should not have every available surface covered with art, posters, classroom materials. The more “stuff” that is on the walls, the more the ADHD child will be distracted by them.
Look at where your child is seated. If your child is sitting next to the door, the air conditioner, a computer making noises while it runs, or the window, they will most likely be distracted by the noises or movements that they see outside. Placement of their desk is really that important!!
The rules of the classroom should absolutely be posted (ie.. no hitting, always be respectful, take your turn, raise your hand when you have a question). Clear expectations of behavior should be conveyed.
The children sitting next to the ADHD children are also very important. If you sit another child with ADHD or a child that gets up constantly from their chair, this will not help your child. The children sitting next to a child with ADHD should be good role models for behavior. Children learn through modeling behaviors!!
When the ADHD child participates in activities that are overstimulating such as P.E., the lunchroom, activities that involve the entire class, give him/her time to calm down and engage him/her in relaxing activities. I often make the children I see in therapy stand up and take deep breaths in and out ten times and then close their eyes and pretend they at the beach listening to the sounds of the ocean.
Above all, praise ADHD children for behaviors that are appropriate and encourage them to ask questions when they need classroom help. I hear too often from parents of ADHD children that everyone seems to point out the “bad stuff” about their child but they never hear anything positive!! All positive and appropriate behaviors should be praised and a reward system at home should also be implemented. No classroom environment will be perfect, however by implementing some of these suggestions, your child will have much more success in his/her classroom.
A by-product often seen in ADHD children is difficult behavioral problems. This particular disorder causes difficulty with hyperactivity, impulsivity, and self-control. It is issues with their self-control that often get them into trouble at home and at school as a result of their inability to restrain their behaviors. Often times, their behaviors make others upset and I have heard repeatedly from parents, “I swear my child is trying to tick me off on purpose.” This may actually be the case, it often seems that their primary objective is to get a rise out of their parents as a means to stimulate their brain. Children of course will deny this over and over, however turmoil often surrounds the ADHD child due to their lack of self-control and inability to censor what they often say and do. To reshape these behaviors or in Psychology world we call this Behavior Modification, there are several steps that must be taken in order to retrain the behavioral problems of an ADHD child. First, you must define the particular behavior you want to change. Only pick one behavior at a time, otherwise it becomes too overwhelming both for the parent and the child. For example-hitting classmates or a younger sibling. Secondly, establish a baseline period of time. In other words, log how long you plan on monitoring this behavior and how many times the behavior occurs. Thirdly, communicate the rules and your expectations of your child CLEARLY to them. Children have to know how they are expected to act in order for a behavioral plan to work. Fourthly, reward their behavior consistently when the desired behavior is observed. Lastly, if they engage in the undesired or unwanted behavior, then you dispassionately provide negative consequences for the behavior. No yelling, no screaming, just pass out punishment for negative behaviors. Screaming never works, they learn to tune you out!!
There seems to be alot of confusion and misinformation as to exactly what an eating disorder is and misconceptions about the reasons why a person would engage in these types of self-damaging behaviors. The three main and most common eating disorders are anorexia, bulimia, and binge-eating disorder. Stated simply, anorexia is when a person starves themselves as a result of the intense fear of becoming fat. Bulimia involves the destructive cycle of binging and purging and then following out of contorl eating and these individuals usually take laxatives or some type of diuretic. Binge-eating disorder is simply when a person overeats a large amount of food in a very short period of time and are unable to control this compulsive eating.
Eating disorders involve extreme disturbances in eating behaviors followed by rigid diets, throwing up, counting calories, weighing themselves, and gorging on food. People with eating disorders use FOOD as a way to deal with uncomfortable emotions and a way to control what is going on around them. At its very core root, people with eating disorders have very self-critical attitudes, are perfectionistic in nature, and are striving to deal with negative emotions and feelings that they have about themselves.
What eating disorders are NOT: I recently had a patient that was referred to me after she was diagnosed a few months ago with anorexia after seeing a psychologist in town. Prior to coming to see me, she had seen her pediatrician for a physical examination and he stated to her, “gee, I thought you would be thinner.” This is the last thing you want to say to someone with an eating disorder. You do not have to be underweight to have an eating disorder. In fact, most of the individuals I have seen are of average weight and many are even overweight. Eating disorders also affect men and boys, this diagnosis is not given only to girls and women. People often think that people that have eating disorders are consumed with their physical appearance, in essence they think they are very vain and self-absorbed. This is very untrue. They engage in these behaviors as a way to control their feelings of anxiety, guilt and they have a very self-distorted self-image. Lastly, individuals with eating disorders are engaging in very self-injurious and damaging behaviors and these types of behaviors should be handled very carefully and seriously. That is not to say that you should start waving materials and information about eating disorders at them and telling them if they don’t stop they are going to die. The best thing you can do for someone with an eating disorder is to encourage them and often support, but at the same time strongly encouraging them to get professional help. Forcing them to get help or to change the way they think will only exacerbate the problem.
The number one thing I hear from children and adults with ADHD in counseling is-”I can’t get along with others at home or work” or “I can’t seem to keep friends.” As a result of the impulsivity, distractibility, and hyperactivity that accompanies ADHD (not necessarily all at the same time folks), individuals with ADHD often have difficulty maintaining relationships. Many children with ADHD are teased because they appear to be different especially when they are hyperactive and seem to be “all over the place” as one parent recently told me. Children and adults with ADHD often are in arguments with those around them as a result of the impulsivity. Our words often get us in trouble and when you do not think before you say something, problems usually ensue. Children with ADHD often have difficulty waiting their turn and this is not popular with other children and causes problems in keeping friends. In addition, ADHD children and adults are sensitive to noises and to being touched and this will often cause social isolation in an ADHD’r trying to isolate themselves from others in order to cope. Also, in children and in adults they often have low self-esteem as a result of the problems that ADHD can cause in their relationships. When you do not feel good about yourself you certainly do not want to be around other people alot of the time and you isolate yourself. These are only some of the issues that are encountered in psychotherapy with ADHD children and adults and through effective medical and psychological treatment, these issues that affect relationships can be overcome.
For ADHD children in school, this seems to be an enormous problem and for parents it is often the biggest problem when they bring their children in for treatment. Often, I will hear a parent say, “Lord, you should see their agenda!” “Their backpack is just a mess of papers and they don’t even write their homework assignments down.” As a parent, you have likely said something similar about your ADHD child or teenager. If your child is completely disorganized, they are likely not doing well in school as the level of disorganization does not help keep them focused or improve attention. It is just one more thing to distract them. Here are some helpful hints on how to get some organization back into your child’s life. These will also work for ADHD adults by the way!!
Have a clear set of goals of what you want to accomplish for the day, week, month and write it down in one central location. An agenda for children is where everything needs to be written. Do not use post-it notes, they seem to get lost when you have hundreds of them in your room or around the house.
Figure out what you feel is your priority on your “to do list” and start with that one thing. Do NOT start something else until you have finished the first task. This goes for children trying to complete their homework and for adults trying to finish tasks at work or around the house.
When you have time to yourself, use your time wisely. The old saying, “work smarter, not harder” applies here. Be productive. If you are doing something currently and it seems to you that it is a waste of time with very little results, then change your priorities.
Write down how long in a folder or agenda, how long you think a particular task should take. If a task takes too long, with very little positive results, then rethink what you are doing.
Get organized. For homework or any type of work to be organized, you first have to think about how to get it organized. What I mean here is, look at your room or wherever you decide to work and if it is not organized, it will be really hard for you to focus on what you are supposed to be doing.
Write down ideas in a notebook or agenda and always keep your “to do” list with you. ADHD kids and adults often have a hard time concentrating during tasks and it will be difficult to remember what you have done and not done if you have not written it down and then checked it off when it is completed. (You know who you are!!)
Lastly, make deadlines for yourself. Do not say, “I will get it done”, and not put a time line on it. Procrastination always has to be fought here.
Often asked as a therapist, I hear from parents, “I don’t understand how my child can be depressed, what do they have to be depressed about?” It does not actually work like that. Children do not ask to be depressed and if they could control it, they most certainly would. The symptoms of depression in children/adolescents are similar to the symptoms of depression in adults, however as a therapist I often see children exhibiting acting out behaviors in addition to the usual symptoms of depression. Treatment of depression in children uses a variety of therapeutic techniques and cognitive-behavioral therapy and play therapy are used most often in treatment. Play therapy is used for very young children, who as of yet do not have the verbal skills and emotional resources to communicate what is going on with him/her. Cognitive-behavioral therapy will focus on changing the way they think in order to change their behaviors/actions that are contributing to their depression. The child’s family is a very important component in therapy and family therapy is often recommended in order for the family to recognize the signs/symptoms of depression as well as to follow the prescribed treatment plan. The child’s family is crucial in preventing relapse of symptoms, recognizing suicidal thoughts/behaviors, as well as in helping in reducing stressors in the child’s life. A combination of medication (Fluoxetine) and psychological treatment is most often the prescribed method of treatment for childhood depression.
Treatment of Anorexia, which is truly a treatable condition, involves several factors. The treatment is multi-disciplinary in nature and involves the individual, his/her parents, a mental health professional, a dietician or nutritionist, and a medical doctor. Treating Anorexia Nervosa first and foremost means restoring the individual to a normal or healthy weight. Secondly, treating the mental health issues that are directly related to anorexia and a reduction and the eventual extinguishing of the behaviors that led to the unhealthy eating habits. Lastly, preventing a relapse in the unhealthy habits of the person with anorexia. It is very easy to return to their “old habits” of doing things.
A person with anorexia often is often at a very unhealthy weight and is painfully thin. Any medical concerns or problems need to immediately be addressed by his/her physician. In these individuals that are painfully thin and that are at a critical point, outpatient mental health treatment is not recommended until they are medically stable.
Nutritional therapy/counseling is also needed to treat a person with anorexia. For an anorexic that is very thin, it will take some time to restore them to a healthy weight. A dietician will be able to work with the individual on proper nutrition, healthy eating habits, and how to eat balanced meals.
Lastly, counseling and therapy for a person with anorexia is of the utmost importance. Working through the issues that led the person to the anorexic behaviors in the first place is needed in order to identify their thoughts/feelings and to set goals for healthier eating habits. Often seen is individuals with anorexia is low self-esteem and a distorted perception of the self. Therapy usually focuses on and stresses the importance of effective and more positive coping skills to work through stressors in life. Therapy will also focus on family issues and how to work through problems in their relationships.