ADHD Resources

by Emily Suggs, LPC

In conclusion of this month’s blog on ADHD, the following books and websites have been provided as resources for families and professionals.

Books

Taking Charge of ADHD by Russell Barkley

ADHD and the Nature of Self-Control by Russell Barkley

Simon Says Pay Attention: Help for Children with ADHD by Daniel Yeager

ADHD: What Every Parent Needs to Know by Michael Reiff

Websites

www.ADHDSupport.com

www.chadd.org

www.add.org

www.addwarehouse.com (list of books and videos)

www.freeprintablebehaviorcharts.com (behavior management, behavior charts, and chore charts)

www.myadhd.com

OTHER HELPFUL RESOURCES:

• To help your child with homework organization, go to www.ADHDSupport.com/homework and download the Homework Planner PDF.
• Looking for a support program, go to www.ADHDSupport.com/join to enroll in free ADHD email support program.
• Do you think your child may have ADHD? Schedule an appointment with your doctor or a therapist. To help clarify concerns, complete the Child Symptom Checklist at www.ADHDSupport.com/child and share with your doctor/therapist.

Discipline and ADHD

by Emily Suggs, LPC

“Fathers, do not exasperate, but bring them up in the training and teaching of the Lord.” Eph. 6:4

Last week I shared the roles parents play in the life of their child with ADHD. This week let’s discuss discipline. There are different viewpoints on how children should be disciplined.  This blog is not a debate regarding which form of discipline is correct; rather, it is focused on understanding how to distinguish normal childhood misbehavior from ADHD symptoms.

When working with parents whose child has been diagnosed with ADHD, the most common questions I receive have to do with discipline. Discipline is a true balancing act when it comes to children with ADHD. It is often difficult for parents to know the best means of discipline as well as what behaviors to discipline. To help distinguish misbehavior from ADHD symptoms, I am going to take a moment to share about misbehavior. Rudolph Dreikurs, a child psychiatrist, proposed that children misbehave for four reasons: 1) to gain attention, 2) to gain power and control, 3) to gain revenge, and 4) to display feelings of inadequacy.  Misbehavior is a normal part of childhood development. Children are learning which behaviors are acceptable and which behaviors are not.

When thinking about what behaviors to discipline, it is important to distinguish between ADHD symptoms and misbehavior.  Often parents feel guilty when they discipline their child for behaviors that are truly connected to ADHD, such as hyperactivity, poor attention span, and impulsive behavior. Misbehaviors that generally fall outside the realm of ADHD symptoms are behaviors such as defiance towards authority, disrespect, anger outburst, and manipulative/testing tactics. Although these behaviors can be a result of a child’s emotions or frustrations in dealing with the symptoms of ADHD, sometimes their misbehavior is trying to accomplish one of the four goals mentioned previously.  Often it is next to impossible to determine ADHD behaviors from misbehavior. When trying to determine what is taking place, analyze the goal your child was trying to accomplish. Was he trying to get revenge on his brother or was it an impulsive decision, or was it both? Once the purpose of the misbehavior is determined, then parents will know better how to discipline.

If the purpose of your child’s behavior is due to one of the goals of misbehavior, then it is important to address how you can teach them better ways to accomplish these goals.  Setting limits and following through with discipline is essential. Children with ADHD quickly learn what they can and cannot get by with when it comes to misbehavior.  John’s mom tells him to go to his room, put on his pajamas, and get in bed. Thirty minutes later John has done none of these three. John’s mom is furious….but what is John’s misbehavior due to? The more John’s mom understands about misbehavior and the symptoms of ADHD then she will be able to determine a solution to such a problem.  Children usually cannot communicate the purpose or goal of their behavior. However the more you learn about how ADHD affects your child’s behavior, the more effectively you will be able to discipline. Children with ADHD have difficulty following multiple tasks (go to room, put on pajamas, and get in bed), staying on task, not getting side-tracked, and completing more than one task at a time. But if John shares his purpose was because he did not want to go to bed then you are dealing with misbehavior (power/control). It is also important to know the personality of your child. If your child is strong-willed then you may have a harder time distinguishing between ADHD symptoms and misbehavior. But if your child is normally cooperative but easily gets side tracked or has trouble completing task, then you know his true intention is not to misbehave.

Because a child with ADHD already struggles with low self-esteem, it is important to handle discipline in a respectful manner.  Embarrassing your child by disciplining them in a public sector only increases the internal struggle they face. It is also hurtful to discuss your child’s misbehavior in front of them with others like teachers, therapists, doctors, or family. Children have reported they feel shamed and embarrassed when parents communicate in this manner.  However it is necessary to be consistent with discipline and to follow through with discipline strategies. Otherwise it is only an empty threat and behaviors will usually increase.  Establish a routine of what is expected when in public situations, such as the grocery store or a restaurant and the consequences following if misbehavior becomes a problem.  Be realistic about what to expect when in specific situations. Children with ADHD can become over stimulated by loud noises, bright colors, upbeat music, and large crowds. When taking your child to an environment that includes one or all of these, be realistic about what you can expect from your child. The same is true with environments that require your child’s undivided attention.  When at home, establish rules and guidelines regarding your expectations. Use strategies to like discussed in week 2 to help your child complete tasks in a timely manner as well as to hold them accountable for staying on task. Bedtime is a difficult time. Allow extra time to help your child wind down and relax at bedtime. Use books, music, or talk time to help them slow down their little brains.

Addressing Misbehavior:

1. Gaining Attention: Ignore attention seeking behaviors and direct your child to alternative ways of gaining positive attention. Children with ADHD sometimes struggle with social situations. They have trouble reading social cues and respecting personal boundaries/space. In social situations, your child might resort to misbehavior (also known as “the class clown”) to get attention and acceptance from peers. Equip your child with positive ways to make friends and get accepted by peers.
2. Gaining Power and Control: Avoid power struggles! We have all heard the statement “pick your battles wisely.” When addressing power and control issues, be very wise, especially since conflict can easily escalate and in the end who usually ends up angry and agitated- the parent! There are multiple reasons children attempt to gain power and control, but in the end, the key is to not allow them to pull you in a power struggle.
   
3. Revenge: At the root of revenge is hurt. Like power and control, do not engage in a battle that will end only end in anger and frustration. Even though children with ADHD tend to get in trouble over and over for the same behaviors, it does not change the fact that they are very sensitive to criticism. This hurt can lead to them acting out to get revenge.
4. Inadequacy or Helplessness: Children with ADHD have shared with me that they feel different than their peers because the symptoms keep them in trouble. They know when teachers and parents are frustrated because they cannot complete their school work or stop talking during class. Due to these feelings, children feel discouraged or helpless. Children with ADHD need lots of encouragement and empowering to accomplish tasks.

The best way to discipline is to be proactive. If you establish guidelines and communicate these clearly, it will address not only the misbehavior but also the ADHD symptoms that often frustrate parents. Unfortunately there is not a magic solution to solving the discipline dilemma when it comes to ADHD. It takes patience, understanding, and consistency to help alleviate behaviors that can easily get out of control. The following are some guidelines to establish in your home.

1. Provide Consistency and Structure: Keep things simple and do not over explain. Children with ADHD find arguing stimulating therefore they will thrive when you try to engage in an argument or to explain reasoning.  A great discipline approach for children with ADHD is 1-2-3 Magic by Thomas Phelan. He addresses this very issue and gives clear approaches to addressing misbehavior.
2. Establish Clear Standards and Rules: Parents who have children with ADHD often let them get away with misbehavior because they think they cannot control it. This is not true. Let your “No” mean no and your “Yes” mean yes.  If they think they can persuade you otherwise, they will continue to badger you.
3. Have High Expectations: This means you as the parent have to work harder to equip your child to be prepared for whatever challenge comes their way. This does not mean you give up on what your child can accomplish because they have been diagnosed ADHD.
4. Teach Your Child to Behave: Positive reinforcement teaches positive behaviors. Children with ADHD have to worker harder to learn impulse and self control. It will not happen overnight, but if they are taught right from wrong then as they mature they will learn to be successful in life.

ADHD: What Every Parent Needs to Know by Michael Reiff, MD

“Making Child Therapy Work” by Robin Walker, MFT

“Training Lions and Tigers: Discipline and Children with Disabilities” by Pete Wright, Esq.

Parenting Your ADHD Child

by Emily Suggs, LPC

Your role as the parent to a child with ADHD

1. Advocate: Every child needs an advocate! A child’s best advocates are the people who know him best, his  parents.  If your child had a physical disability, I imagine you would do everything possible to let teachers, school counselor, and other school personnel know your child’s specific needs and desired accommodations. When it comes to ADHD, there are needs and accommodations that need to be considered. As your child’s advocate, it is important to understand the rights and laws that are in place to help your child. Since ADHD is a spectrum disorder where the symptoms range from mild to severe, parents have to communicate the specific needs of their child to the school, and many times parents have to fight in order to get the accommodations their child needs. For more information about the rights for children with ADHD, go to www.help4adhd.org. This website represents the National Resource Center on ADHD and provides educational resources to ensure your child gets the educational help needed.
2. Coach: Rather than viewing your role as a punitive disciplinarian, think of yourself as your child’s coach. A coach’s role is to equip and encourage. During practice a coach spends his energy equipping or teaching the player strategies, skills, and techniques so that when game day approaches, the players know how to play the game. Then during the game the coach’s role shifts to that of an encourager or a motivator. The coach cannot play the game for his players. His role is to remind them of what they have learned and to encourage them to do their best. At home you are equipping your child with ADHD with the skills and strategies to succeed when he is at school. You cannot go to school for your child, but you can encourage him to remember what you have equipped him with and encourage him to do his best.
3. Empower: If you are a nurturer, then empowering your child may take practice. Nurturing personalities tend to attempt to “help” or “fix” problems when they arise for their children. For a child with ADHD, unfortunately you cannot “fix” the struggles he will face. You can advocate and coach but many of the challenges are lifelong obstacles that individuals with ADHD have to learn to address. By empowering your child, you are communicating that you BELIEVE in them. Empowerment places the responsibility and power back on the child to solve the problem while also recognizing the child’s ability to learn and grow. Statements such as, “You did it! You worked hard to clean your room all by yourself.” Or “I noticed you stayed on green today. That took a lot of hard work and self-control. I bet you are proud of yourself.” When you empower, it focuses on what the child accomplished and what the child is feeling.  Children with ADHD have reported to me feeling different and not accepted by the outside world. They struggle with meeting the expectations of others. When empowered, they learn to look within for strength and acceptance.

Parenting is a difficult task whether you are parenting a child with ADHD or not.  Every child is created differently and what works for one child may not work for another. As a parent, it is your responsibility to think outside the box of tradition to search for what is best for your child to succeed and prosper spiritually, mentally, and emotionally.

The Importance of Executive Function with ADHD

by Emily Suggs, LPC

When thinking about ADHD, it is essential to recognize the importance executive function plays in our day-to-day functioning. First you may be wondering what is executive function?

“Executive Function is a set of mental processes that helps connect past experiences with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details and managing time and space”  (CHADD ATTENTION magazine, February 2002).

As adults we use executive function all day long to help remember tasks and responsibilities. We make list to carry to the grocery store (planning/strategic thinking). We don’t answer a phone call when we are trying to get kids out the door to school because we don’t want them to be late to school (interference control). After working all day we come home and cook supper (initiating task). We make list of things we need to remember to accomplish during the day (planning). We set three alarm clocks so we don’t oversleep (sense of time).

These are examples of how the different mental processes guide us through our day-to-day functions. These mental processes are believed to be based in the pre-frontal region of the brain. For many individuals, these processes occur naturally and allow one to move through day-to-day tasks easily; however, for an individual with ADHD, there is an impairment or deficit in executive function. An example of what this might look like is:

Emma’s mother tells her to start her homework (initiating task). Five minutes passes and Emma still has not started her homework (lack of motivation). When she finally sits down to start her homework, she cannot find where she wrote down her assignments (lack of planning and strategic thinking). She calls a friend to get her assignment but gets distracted by talking to her friend about her new toy (no sense of time/interference control).  Emma looks at her assignments and is overwhelmed by all the work she has to accomplish (lack of initiating task). Not sure where to begin she begins watching television (interference control/lack of motivation). Her mom redirects her to start her homework. She picks up her pencil and notices it is dull. She wonders where her sharpener could be. This leads Emma to dumping out her backpack looking for a pencil sharpener (interference control). By this time an hour has passed and Emma has not completed any of her homework (no sense of time).

Because these deficits exist for individuals with ADHD, it is important for individuals to exercise skills that will improve their executive function.  The following are suggestions and tools that may help improve these mental processes:

• Planning/strategic functioning/working memory: planners, checklists, calendars, charts, reminders
• Regulating emotions: talking, drawing, writing, exercising
• Internalized language: positive self-talk, post or memorize sayings, proverbs, and Bible verses,      meditating/reflecting
• Interference control: turn off television, limit distractions, silence cell phones, and prioritize tasks
• Self-motivation/initiating action: small/easy tasks first, set deadlines/due dates, evaluate reward/consequence

Here is how the above story might be different when focus is placed on improving executive functions. (Notice the mother’s role is to equip and empower her child to improve her executive function.)

Emma’s mother tells her to start her homework (initiating task). Emma, with her mother’s help, unpacks and organizes her books and assignment notebook/folder from her backpack. She decides what assignments she will do first (strategic thinking/planning.) Emma notices her favorite show is coming on later that night and her mother reminds her that if she plans to watch television later, she must complete her homework.(sense of time). Emma’s mom decides to turn off the television so she does not get distracted (interference control). To help her stay on task with each assignment, Emma’s mom sets a timer that allows Emma to know when it is time to move to the next assignment (shifting between task/sense of time). While working on her math, Emma’s pencil lead breaks. But Emma knows her sharpener is located in her pencil bag because she organized her backpack and zipper binder before starting homework (strategic thinking/planning). An hour passes and Emma is about to check off her last homework assignment.

Of course it is never quite this easy, however the goal is to equip the child with these skills so as the brain continues to develop, so will the executive function. Just like a young baseball player does not start out knowing all the skills and techniques of baseball but begins learning the basic skills and techniques. As he grows and develops, it becomes a natural part of playing baseball.

Dendy, Chris A. Zeigler M.S. “Executive Function: What Is This Anyway?” CHADD ATTENTION magazine: February 2002.

Yeager, Marcia LCSW, RPT-S. “Executive Function: A Key to Understanding the ADHD Mind.” Play Therapy Magazine: June 2009.

The Myths and Misconceptions of ADHD

by Emily Suggs, LPC

For the month of August, the UDT blog is going to focus on helping families better understand one of the most prevalent chronic childhood disorders, Attention Deficit Hyperactivity Disorder, also known as ADHD.  During this month, several aspects of ADHD will be addressed and hopefully the information will equip parents, empower teachers, and encourage readers to see ADHD in a new light. In order to accomplish such a task, one must first be aware of the myths and misconceptions that exist regarding ADHD.

• Lazy and undisciplined. One misconception that often exists prior to a child being diagnosed with ADHD is that the child is lazy and undisciplined. Parents may find themselves frustrated with their child’s forgetfulness and lack of motivation. They may accuse the child of being lazy because they cannot complete what is considered a simple task, when in actuality it is the child’s inability to focus and pay attention.
• Poor parenting. Some people are quick to blame parents for ADHD, thinking that problems would not exist if the parents were only more consistent, harsher, or better at disciplining their      children. However, ADHD is not a result of poor parenting. ADHD does make parenting difficult. Parents of children with ADHD often struggle with finding the correct balance when faced with discipline. Often before a child is diagnosed with ADHD parents may use harsh punishment. They may feel their child’s behavior is due to something they are not doing; therefore they over-discipline and punish. Yet once their child is suggested to have ADHD, they may stop disciplining altogether due to guilt and shame from punishing their child for behaviors that were a result of a biochemical disorder. Since behavior issues tend to be a part of ADHD, it is important for parents use effective parenting skills.
• Medication is the cure. There has been much debate over the years regarding medications for ADHD. Although research has indicated that medication helps children with ADHD function better day-to-day, it is not a cure all. Since ADHD is a chronic disorder, many may need to take medication well into adolescence and adulthood in order to function daily. The medication does not “cure” all the symptoms. Many children on medication greatly benefit from individual, group, and family therapy. The medication may improve attention span and decrease impulsive      behaviors, but does not address social skills, self-esteem, communication, and coping skills. Therapy, along with medication, has proven to ensure the best chances of success.
• Need for structure. Some believe that children with ADHD need structure, structure, and more structure. Although children with ADHD tend to succeed best with structured classroom environments, clear rules and boundaries, and limited auditory, visual, and tactile stimulation, students with ADHD need some freedom to let their minds take a break. Studies have shown that children with ADHD perform better when allowed breaks and recesses throughout the day. Extracurricular activities and sports that require a high degree of focus and concentration along with long periods of waiting, listening, and sitting still tend to be problematic for children with ADHD. Activities and sports such as running, swimming, and free play allow children with ADHD both freedom and structure.
• Outgrowing ADHD. There was a time when it was thought that children would outgrow ADHD. As research has progressed, it is evident that children do not necessarily outgrow ADHD but instead learn to cope with and manage the symptoms of ADHD. Since ADHD is a spectrum-type disorder, one may face more intense symptoms that may require lifelong treatment while another may learn to cope with mild symptoms of ADHD by adolescence.
• Low IQ.  It is very common when parents first address the ADHD needs of their child for them to say, “But he is very smart” or “She is so bright and talented.” For years there has been a misconception that children with ADHD are not smart or have a lower IQ than other children.  Often the ADHD symptoms mask the true abilities of many children by affecting their grades and ability to learn. Some children with ADHD do struggle with a learning disability; however many are extremely bright, creative, gifted, and intelligent individuals.

Understanding the truth about ADHD can ensure children succeed in life. Despite all the misconceptions that exist in society, the following verse provides encouragement and reassurance of the potential that lies beyond the diagnosis ADHD.  Individuals with ADHD are gifted and wired in such a way that can bring creative, new ideas to our world when we learn to embrace their strengths rather than being blinded by the disorder.

“For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.” (Psalm 139: 13-14)

ADHD: What Every Parent Needs to Know by Michael I Reiff, MD, FAAP