Kids Awareness Series

Archive for the ‘ADHD’ Category

The question as a parent of a child with ADHD is often, “should I give my child medication or not?” Parents are often at odds with themself and with their spouse on the decision of whether or not to give their child medications because of the potential side effects. In addition, they often hear other parents saying negative things about the medications. As a therapist, what I often hear from parents is, “I don’t want anything that will make my child like a zombie.” To make the decision to medicate your child is often a difficult one and you and your doctor will have to consider many factors in making this important decision.
As a parent, if you decide to medicate your ADHD child then you need to monitor your child’s reactions to the medications and if their are adverse effects then the trial of medication should be stopped immediately.

Stimulant medications are the most popular medications used with children with ADHD, especially when your child’s inattention or impulsivity/hyperactivity is interfering with their school work or in their ability to get along with other children due to behavioral problems. Also to consider as a parent are alternative treatments such as individual counseling for your child as well as holistic treatments such as Attend, Focus or Omega 3 with Fish Oil, which are considered alternative treatments. Your child’s dietary intake should also be considered as well as if they are getting enough exercise. The food your child eats really does make a difference in their behaviors.

There is no way to predict which children will respond well to ADHD medications and which children will not, which is unfortunate because children often have to be tried on a number of treatments before something finally works for them. The most helpful criterion to date in predicting which children will respond to medications is the degree or severity of the child’s hyperactivity or inattention. The more severe these symptoms, the better a child will respond to the medications. However, a diagnosis of ADHD does NOT mean that a child should automatically receive ADHD medications. There are other things to consider before medications are used and these need to be discussed with your child’s doctor. For example, the age of the child should be considered, have other approaches been used, have all physical or developmental disorders been ruled out, can the medications be properly supervised by you as a parent, is the child’s behavior severe enough to warrant the use of medications, and lastly how does your child typically respond to medications.

If all of these things have been taken into account and have been discussed with your child’s doctor, then medication for ADHD can be considered. ADHD medications should never be used as a first resort but as a last resort when all other treatment approaches and factors have been looked at. If a parent makes the decision to medicate their ADHD child, then medications should be monitored regularly by their child’s physician. The decision to medicate your child is a difficult one and all factors need to be considered before making the choice to give your child ADHD medications.

The most important component at arriving at an accurate diagnosis of ADHD is to complete a thorough and comprehensive evaluation.  Many times, I have seen children and they have have been brought in by their parents and diagnosed by their pediatrician after being seen for five to ten minutes.  In addition, parents will often tell me that either their child’s pediatrician or a child psychiatrist, prescribed their child medication after being seen and the parent is uncertain as to whether or not their child received an accurate diagnosis.  Unfortunately, this happens all too often and the steps to arrive at a diagnosis of ADHD should take more than 5-10 minutes in a doctor’s office. 

First and foremost,  a clinical interview should be completed with the parents to obtain a thorough background history.  This should include developmental history, medical problems or complications, school and home issues, any behavioral problems, social/interpersonal skills, etc… In other words, everything else should be ruled out before a diagnosis of ADHD is given.  ADHD is a diagnosis of exclusion.  We need to rule out that their is not another issue or problem before we arrive at a diagnosis of ADHD.  A medical evaluation may also be needed to determine that the behavior or symptoms are not caused by a medical issue.

Both a child’s parents and the child’s teacher should complete a behavior rating scale in order to determine the child’s behavior in both settings.  In addition, this is a good method to compare if their are any discrepancies between the parent’s report of behavior and the child’s teacher’s report.  If there is a huge difference between what the parents are saying and what the teacher is saying, this might strictly be a behavioral issue in one of the settings and we should be looking at a discipline problem and not an attentional issue.

The child should also be interviewed and behavioral observations should be made by the psychiatrist, psychologist, or a mental health professional that is conducting the evaluation.  Direct behavioral observation of the child are often very helpful, however this is not a necessary component to reach a diagnosis of ADHD. 

Also, intelligence and/or achievement testing is also beneficial to determine if their is a learning difficulty.  Children who are struggling in school, often act out or are inattentive as a result of extreme frustration with their school work.  A learning disability evaluation is often beneficial to rule out that the child is not struggling academically, which affects their behavior at school.  Before any child can be diagnosed as having ADHD, a complete and thorough evaluation needs to be completed and all information obtained should be scrutinized carefully and all issues/problems ruled out that may be causing attentional difficulties.  Most evaluations completed by a psychologist or psychiatrist to diagnosis ADHD last at least 2-3 hours in order to obtain the necessary clinical information.  If your child has been diagnosed with ADHD after a 5-10 minute session with your child’s pediatrician than a comprehensive evaluation should now be completed.

Children that have been diagnosed with ADHD often have severe problems getting along with other children.  The child with ADHD tends to be very impulsive, has problems sharing, and they tend to be overactive.  Other children may find this child’s behaviors aversive and they often will not want to play with the ADHD child.  Other children may not like when the ADHD child blurts out whatever they are thinking, as ADHD children often have problems showing restraint in what they do or in what they say to others.  In addition, ADHD children often fail to consider how their behaviors or actions will affect those around them and they usually do not consider that there are consequences to all of their actions. 

These children often do not see an immediate reward for playing well with other children, with sharing, cooperating, or taking turns with other children and other children usually perceive the child to be very selfish and self-centered.  As a result of their poor social skills, children with ADHD often have few friends and the school year can be a very harrowing and difficult one as a result of poor peer relationships.  How often has it been said by the ADHD child, “I have no friends, no one wants to play with me.”  Another common comment is, “everyone seems to make fun of me” and parents will often hear, “I don’t want your son playing over at our house, he misbehaves and hits my son.”  How can we as parents teach our children better social skills in order to improve their relationships.  There are a number of steps that can be taken in order to improve social skills:

1.) First and foremost, establish a reward or behavior management program in which tokens or a chip program are used in order to improve social behaviors.  Choose only one or two social behaviors that you would like to see improved such as sharing or say your child keeping their hands to themselves and not hitting or touching another child.  Only pick one or two behaviors, more than that and your child will most likely not be successful.  Choose the unwanted behaviors that you see your child doing the most and work on these such as being bossy, not speak loudly, or taking turns.

2.) Post the social behaviors that you want to see changed in a prominent place that you want your child to see.  I usually advise parents to post a chart on the refrigerator, in the child’s bathroom, and possibly on the mirror in your child’s bedroom.  The chart does not have to be too detailed, simply post the unwanted social behaviors that you want to see changed in your child.  If your child’s friends are coming over take the charts down, they will probably embarrass your child otherwise.

3.) When you observe your child playing with other children and your child is displaying appropriate social behaviors, make sure to tell them they are acting appropriately.  This should be done in a discrete manner and not to embarrass your child or take them away from an activity with their friends that they are enjoying.  When you see your child acting in an inappropriate fashion (ie… bossing their friends around or not taking turns) remind them that they lose tokens for their behavior.  Also, before your child has friends over or goes over to play with friends or at the beginning of a school day, remind them of the unwanted social behaviors that you want them to change.  Observe your child more frequently when they are playing with their friends to ensure that that their social skills are appropriate.  Reward or punish according to the behaviors that they are displaying.

4.) A few times each week, you and your child should set aside time to go over the positive behaviors that you have observed and the negative behaviors that you have observed while they were with their friends.  Make sure to point out the positive aspects so your child does not become discouraged. 

5.) Role playing appropriate social behaviors can also be a very useful tool.  As a parent, you pretend to be your child and model the negative behavior you see them displaying and then model the appropriate more positive social skill such as taking turns and then have your child try the positive new skill.  Encourage your child to display this new, more appropriate skill the next time they are playing with their friends and they will more likely get a more positive result from their friends.  Remind your child every time they go off to play with friends or if friends come over to the house, that they need to use their new social skills when they are playing with them. 

The main areas of concern that children with ADHD may have problems with are: starting or maintaining a conversation with another child, listening to other children when they are speaking and not interrupting, resolving conflicts when everything is not going their way, and sharing and taking turns with other children.  Be patient with your child when trying to teach them these new skills and focus on only one or two behaviors at a time in order to improve their social skills.  Peer relationships are such an important part of a child’s life, whereby teaching them these skills will make them alot more comfortable in their social interactions.

Are you saying, does a stigma still exist for kids that have ADHD?  Absolutely!  Many kids are still ashamed to tell anyone that they have ADHD and even more embarrassed if they have to take medications at school!  Older children and teenagers that I have seen in therapy often quit taking medications for ADHD because they do not want their friends to find out that they have ADHD or even worse that they have to take medications for it.  How can we help our children overcome the stigma that still exists among adults and kids alike when a child or teenager has ADHD.  Of course for children, parents, caregivers, and teachers, the best way to cope with the symptoms of ADHD are often a struggle, however a good starting point is how to overcome the stigma of a label or diagnosis of ADHD.  There are several steps that can be taken to combat the stigma:

1.) As a parent, the first thing you need to do to reduce the stigma of ADHD, is to not make a big deal about it.  Watch and control your reaction about the symptoms of ADHD when they rear their ugly head.  You making a big deal about having ADHD or that they have to take medications or an alternative treatment (natural vitamins or therapy) will only increase the challenge that they are already fighting.

2.) Don’t tell your child not to tell anyone!  This definitely sends the message that having ADHD is something to be embarrassed or ashamed of.

3.) If your child is embarrassed to take medications for ADHD at school then work with your child’s pediatrician or psychiatrist on finding a way for your child to take medicines before or right after school.  Many children and especially older children and teenagers are embarrassed in front of their friends no matter what you say to them about taking medication.

4.) Remind your child regularly that ADHD is merely a different way of thinking about things and that their brain works differently.  Don’t treat ADHD as something awful, I have found that ADHD has many positive aspects and treat it as a gift.  Do not treat your child differently because they have ADHD and expect less of them, they will act accordingly and will lower their own expectations of themselves.

5.) Determine as a parent whether or not you plan to share a diagnosis of ADHD with your child or teen’s school.  Parents often differ in this regard on whether or not they want their child’s teacher and school to know of an ADHD diagnosis.  I highly recommend to parents that they share their child’s diagnosis of ADHD with the school and discuss strategies that need to be implemented for your child in the classroom.  Your teacher should also not lower his/her expectations for your child.  Yes, the ADHD child may have to have a modified curriculum, but it does not mean that they can not learn like everyone else.

6.) Talk openly with your child about an ADHD diagnosis in order to take away the stigma of the diagnosis.  Boost their self-confidence and explain how those around them may perceive their ADHD behaviors.  Unfortunately, many children at your child’s school will discriminate against a child that has ADHD and often because ADHD children struggle socially, they have difficulty making and keeping friends.  Encourage your child to particpate in activities that will raise their self-esteem and emphasize their positive attributes.  When you see your child doing something good or helpful, point it out.

7.)  Encourage your child to be around other children that have similar strengths and weaknesses.  ADHD is a common problem and your child may benefit from attending a social skills or an ADHD group with children that are experiencing similar struggles.  Psychological treatment is also another option, where your child can learn self-confidence, coping skills, social skills, and parents can learn about how to manage negative behaviors associated with ADHD.

8.) Children and parents need to surround themselves with individuals that are positive and supportive of  ADHD.  The last thing a child needs to hear is that, “ADHD is not a real diagnosis, it’s just an excuse to misbehave.”  This a very common misconception among the general public and many parents will experience this very thing as will their children. 

9.)  Lastly, use the resources that are available to you.  Discuss with other parents, teachers, family members, or a local or national support group about your child’s ADHD.  Information for parents and educating those around you about what ADHD is and how it affects your child and adults is the best weapon against the stigma of ADHD.  Get your child the help they need at school so that they are NOT discriminated against. 

Let’s start off this school year the right way and give your child every opportunity to learn and be successful!

A common misconception among parents, caregivers and the general public is that ADHD is caused by TV or by too much time playing video games.  When I see parents or family members in therapy that have brought their ADHD child in to see me, I commonly hear, “should we take away his video games, I hear that this can cause ADHD.”  I also have heard repeatedly as many other mental health professionals have that the more time a child watches TV or plays video games, the worse their ADHD symptoms will be.  This is definitely not true!  Yes, children that have been diagnosed with ADHD prefer to watch television or play video games, because these activities require very little effort and a shorter attention span than say reading a book or completing their homework. 

Up to this point in time, there has been no scientific study or any empirical research that has been completed that links TV or playing too many video games to a diagnosis of ADHD.  However, should a child that has ADHD or a child that does not have ADHD spend hours upon hours watching television or playing video games? Of course not!  Parents need to find a balance between TV time, video games and other leisure pursuits that is balanced with school, homework, and a social life.  Too much of anything is never a good thing!  Remember that moderation is king.

Parents often tell me that completing homework with their ADHD child is often a great challenge and causes a lot of frustration. Children usually by the time they get home are tired and simply want a “break” from their work and want to play or “chill out” and watch television. However, homework still has to be done and parents usually wait until late afternoon or night to complete homework. Inevitably, children procrastinate and “fight” their parents every inch of the way in completing their homework. By the time the homework is completed, everyone including the child are usually angry and frustrated and homework took a very long time as the parent tries to cajole their child to complete the work.

As a rule, children with ADHD seem to do better on schoolwork in the mornings, more often than children without ADHD. What this means exactly is that school work and/or homework should be completed earlier in the day or even some of the homework should be completed in the morning if possible. Tasks for children that are boring, repetitive, or that take sustained attention/concentration should be done earlier if possible. By the end of the day, children are usually tired; fatigued and if parents decide to complete homework late in the day, problems are sure to ensue and the work will most likely not be completed.

Therefore, a homework schedule should be implemented that includes part or the entire school work load to be completed in the morning.   Also, when homework is completed with your child, it should be done in a quiet setting with no distractions.  This means that the radio, television, and the noise from video games must be turned off.  Children with ADHD are easily distracted and the less distractors for them when they are trying to complete their schoolwork the better.  In addition, homework should be completed on a 1:1 basis.  Children with ADHD do not do well in group situations where they are able to become over-stimulated and if possible homework should be done alone, just you and your child where individualized attention can be given.

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!!

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.