Medication can help the ADHD child in everyday life. He or she may
be better able to control some of the behavior problems that have led
to trouble with parents and siblings. But it takes time to undo the
frustration, blame, and anger that may have gone on for so long. Both
parents and children may need special help to develop techniques for
managing the patterns of behavior. In such cases, mental health
professionals can counsel the child and the family, helping them to
develop new skills, attitudes, and ways of relating to each other. In
individual counseling, the therapist helps children with ADHD learn to
feel better about themselves. The therapist can also help them to
identify and build on their strengths, cope with daily problems, and
control their attention and aggression. Sometimes only the child with
ADHD needs counseling support. But in many cases, because the problem
affects the family as a whole, the entire family may need help. The
therapist assists the family in finding better ways to handle the
disruptive behaviors and promote change. If the child is young, most of
the therapist’s work is with the parents, teaching them techniques for
coping with and improving their child’s behavior.
Several intervention approaches are available. Knowing something
about the various types of interventions makes it easier for families
to choose a therapist that is right for their needs.
Psychotherapy works to help people with ADHD to
like and accept themselves despite their disorder. It does not address
the symptoms or underlying causes of the disorder. In psychotherapy,
patients talk with the therapist about upsetting thoughts and feelings,
explore self-defeating patterns of behavior, and learn alternative ways
to handle their emotions. As they talk, the therapist tries to help
them understand how they can change or better cope with their disorder.
Behavioral therapy (BT) helps people develop more
effective ways to work on immediate issues. Rather than helping the
child understand his or her feelings and actions, it helps directly in
changing their thinking and coping and thus may lead to changes in
behavior. The support might be practical assistance, like help in
organizing tasks or schoolwork or dealing with emotionally charged
events. Or the support might be in self-monitoring one’s own behavior
and giving self-praise or rewards for acting in a desired way such as
controlling anger or thinking before acting.
Social skills training can also help children learn
new behaviors. In social skills training, the therapist discusses and
models appropriate behaviors important in developing and maintaining
social relationships, like waiting for a turn, sharing toys, asking for
help, or responding to teasing, then gives children a chance to
practice. For example, a child might learn to “read” other people’s
facial expression and tone of voice in order to respond appropriately.
Social skills training helps the child to develop better ways to play
and work with other children.
Support groups help parents connect with other
people who have similar problems and concerns with their ADHD children.
Members of support groups often meet on a regular basis (such as
monthly) to hear lectures from experts on ADHD, share frustrations and
successes, and obtain referrals to qualified specialists and
information about what works. There is strength in numbers, and sharing
experiences with others who have similar problems helps people know
that they aren’t alone. National organizations are listed at the end of
this document.
Parenting skills training, offered by therapists or
in special classes, gives parents tools and techniques for managing
their child’s behavior. One such technique is the use of token or point
systems for immediately rewarding good behavior or work. Another is the
use of “time-out” or isolation to a chair or bedroom when the child
becomes too unruly or out of control. During time-outs, the child is
removed from the agitating situation and sits alone quietly for a short
time to calm down. Parents may also be taught to give the child
“quality time” each day, in which they share a pleasurable or relaxing
activity. During this time together, the parent looks for opportunities
to notice and point out what the child does well, and praise his or her
strengths and abilities.
This system of rewards and penalties can be an effective way to
modify a child’s behavior. The parents (or teacher) identify a few
desirable behaviors that they want to encourage in the child—such as
asking for a toy instead of grabbing it, or completing a simple task.
The child is told exactly what is expected in order to earn the reward.
The child receives the reward when he performs the desired behavior and
a mild penalty when he doesn’t. A reward can be small, perhaps a token
that can be exchanged for special privileges, but it should be
something the child wants and is eager to earn. The penalty might be
removal of a token or a brief time-out. Make an effort to find your child being good.
The goal, over time, is to help children learn to control their own
behavior and to choose the more desired behavior. The technique works
well with all children, although children with ADHD may need more
frequent rewards.
In addition, parents may learn to structure situations in ways that
will allow their child to succeed. This may include allowing only one
or two playmates at a time, so that their child doesn’t get
overstimulated. Or if their child has trouble completing tasks, they
may learn to help the child divide a large task into small steps, then
praise the child as each step is completed. Regardless of the specific
technique parents may use to modify their child’s behavior, some
general principles appear to be useful for most children with ADHD.
These include providing more frequent and immediate feedback (including
rewards and punishment), setting up more structure in advance of
potential problem situations, and providing greater supervision and
encouragement to children with ADHD in relatively unrewarding or
tedious situations.
Parents may also learn to use stress management methods, such as
meditation, relaxation techniques, and exercise, to increase their own
tolerance for frustration so that they can respond more calmly to their
child’s behavior.
Some Simple Behavioral Interventions
Children with ADHD may need help in organizing. Therefore:
- Schedule. Have the same routine every day,
from wake-up time to bedtime. The schedule should include homework time
and playtime (including outdoor recreation and indoor activities such
as computer games). Have the schedule on the refrigerator or a bulletin
board in the kitchen. If a schedule change must be made, make it as far
in advance as possible.
- Organize needed everyday items. Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies.
- Use homework and notebook organizers. Stress the importance of writing down assignments and bringing home needed books.
Children with ADHD need consistent rules that they can understand
and follow. If rules are followed, give small rewards. Children with
ADHD often receive, and expect, criticism. Look for good behavior and
praise it.
Your ADHD Child and School
You are your child’s best advocate. To
be a good advocate for your child, learn as much as you can about ADHD
and how it affects your child at home, in school, and in social
situations.
If your child has shown symptoms of ADHD from an early age and has
been evaluated, diagnosed, and treated with either behavior
modification or medication or a combination of both, when your child
enters the school system, let his or her teachers know. They will be
better prepared to help the child come into this new world away from
home.
If your child enters school and experiences difficulties that lead
you to suspect that he or she has ADHD, you can either seek the
services of an outside professional or you can ask the local school
district to conduct an evaluation. Some parents prefer to go to a
professional of their own choice. But it is the school’s obligation to
evaluate children that they suspect have ADHD or some other disability
that is affecting not only their academic work but their interactions
with classmates and teachers.
If you feel that your child has ADHD and isn’t learning in school as
he or she should, you should find out just who in the school system you
should contact. Your child’s teacher should be able to help you with
this information. Then you can request—in writing—that the school
system evaluate your child. The letter should include the date, your
and your child’s names, and the reason for requesting an evaluation.
Keep a copy of the letter in your own files.
Until the last few years, many school systems were reluctant to
evaluate a child with ADHD. But recent laws have made clear the
school’s obligation to the child suspected of having ADHD that is
affecting adversely his or her performance in school. If the school
persists in refusing to evaluate your child, you can either get a
private evaluation or enlist some help in negotiating with the school.
Help is often as close as a local parent group. Each state has a Parent
Training and Information (PTI) center as well as a Protection and
Advocacy (P&A) agency. (For information on the law and on the PTI
and P&A, see the section on support groups and organizations at the
end of this document.)
Once your child has been diagnosed with ADHD and qualifies for
special education services, the school, working with you, must assess
the child’s strengths and weaknesses and design an Individualized
Educational Program (IEP). You should be able periodically to review
and approve your child’s IEP. Each school year brings a new teacher and
new schoolwork, a transition that can be quite difficult for the child
with ADHD. Your child needs lots of support and encouragement at this
time.
Never forget the cardinal rule—you are your child’s best advocate.
Your Teenager with ADHD
Your child with ADHD has successfully navigated the early school
years and is beginning his or her journey through middle school and
high school. Although your child has been periodically evaluated
through the years, this is a good time to have a complete re-evaluation
of your child’s health.
The teen years are challenging for most children; for the child with
ADHD these years are doubly hard. All the adolescent problems—peer
pressure, the fear of failure in both school and socially, low
self-esteem—are harder for the ADHD child to handle. The desire to be
independent, to try new and forbidden things—alcohol, drugs, and sexual
activity—can lead to unforeseen consequences. The rules that once were,
for the most part, followed, are often now flaunted. Parents may not
agree with each other on how the teenager’s behavior should be handled.
Now, more than ever, rules should be straightforward and easy to
understand. Communication between the adolescent and parents can help
the teenager to know the reasons for each rule. When a rule is set, it
should be clear why the rule is set. Sometimes it helps to
have a chart, posted usually in the kitchen, that lists all household
rules and all rules for outside the home (social and school). Another
chart could list household chores with space to check off a chore once
it is done.
When rules are broken—and they will be—respond to this inappropriate
behavior as calmly and matter-of-factly as possible. Use punishment
sparingly. Even with teens, a time-out can work. Impulsivity and hot
temper often accompany ADHD. A short time alone can help.
As the teenager spends more time away from home, there will be
demands for a later curfew and the use of the car. Listen to your
child’s request, give reasons for your opinion and listen to his or her
opinion, and negotiate. Communication, negotiation, and compromise will prove helpful.
Your Teenager and the Car.
Teenagers, especially boys, begin talking about driving by the time
they are 15. In some states, a learner’s permit is available at 15 and
a driver’s license at 16. Statistics show that 16-year-old drivers have
more accidents per driving mile than any other age. In the year 2000,
18 percent of those who died in speed-related crashes were youth ages
15 to 19. Sixty-six percent of these youth were not wearing safety
belts. Youth with ADHD, in their first 2 to 5 years of driving, have
nearly four times as many automobile accidents, are more likely to
cause bodily injury in accidents, and have three times as many
citations for speeding as the young drivers without ADHD.14
Most states, after looking at the statistics for automobile
accidents involving teenage drivers, have begun to use a graduated
driver licensing system (GDL). This system eases young drivers onto the
roads by a slow progression of exposure to more difficult driving
experiences. The program, as developed by the National Highway Traffic
Safety Administration and the American Association of Motor Vehicle
Administrators, consists of three stages: learner’s permit,
intermediate (provisional) license, and full licensure. Drivers must
demonstrate responsible driving behavior at each stage before advancing
to the next level. During the learner’s permit stage, a licensed adult
must be in the car at all times.15 This period of time will
give the learner a chance to practice, practice, practice. The more
your child drives, the more efficient he or she will become. The sense
of accomplishment the teenager with ADHD will feel when the coveted
license is finally in his or her hands will make all the time and
effort involved worthwhile.
Note: The State Legislative Fact Sheets—Graduated Driver Licensing System can be found at web site http://www.nhtsa.dot.gov/people/outreach/safesobr/21qp/html/fact_sheets/Graduated_Driver.html,
or it can be ordered from NHTSA Headquarters, Traffic Safety Programs,
ATTN: NTS-32, 400 Seventh Street, S.W., Washington, DC 20590; telephone
202-366-6948.
Thirteen Great Books on ADHD
-
Driven To Distraction : Recognizing and Coping with Attention Deficit
Disorder from Childhood Through Adulthood by Edward M. Hallowell and
John J. Ratey (Paperback - Mar 2, 1995)
-
Answers to Distraction by Edward M. Hallowell and John J. Ratey (Paperback - Mar 1, 1996)
-
Odd One Out: The Maverick's Guide to Adult ADD by Jennifer Koretsky (Paperback - Sep 24, 2007)
-
Survival Tips for Women with AD/HD: Beyond Piles, Palms, & Post-its by Terry Matlen (Paperback - Jan 1, 2005)
-
ADD-Friendly Ways to Organize Your Life by Judith Kolberg and Kathleen Nadeau (Paperback - Aug 2002)
-
Organizing Solutions for People With Attention Deficit Disorder: Tips
and Tools to Help You Take Charge of Your Life and Get Organized by
Susan C Pinsky (Paperback - Dec 1, 2006)
-
Making ADD Work: On-the-Job Strategies for Coping with Attention Deficit Disorder by Blythe Grossberg (Paperback - Sep 6, 2005)
-
Women with Attention Deficit Disorder: Embrace Your Differences and
Transform Your Life by Sari Solden, Edward T. Hallowell, and John J.
Ratey (Paperback - Nov 29, 2005)
-
Scattered Minds: Hope and Help for Adults with ADHD by Lenard Adler and Mari Florence (Hardcover - May 4, 2006) - Bargain Price
-
10
Simple Solutions to Adult ADD: How to Overcome Chronic Distraction
& Accomplish Your Goals (10 Simple Solutions) by Stephanie Sarkis
(Paperback - Jan 2, 2006)
-
You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book
for Adults with Attention Deficit Disorder by Kate Kelly, Peggy
Ramundo, and Edward M., M.D. Hallowell (Paperback - April 25, 2006)
-
Attention Deficit Disorder in Adults, 4th Edition: A Different Way of Thinking by Lynn Weiss (Paperback - Nov 25, 2005)
-
The
Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your
Time, Tasks, and Talents by Nancy A. Ratey (Hardcover - April 1, 2008)
Resource and Support Groups for ADHD
- Attention Deficit Disorder Association
- The Center
- Adders.org
- Daily Strength
- ADHD news.com
- Additude
- About.com ADD ADHD
- WebMD
- The Real Beauty of ADHD Support Groups
- Wegohealth
Additional Resources:
- For related articles on ADHD
and adults on the Web, click on: “Sphere: Related Content” located at the
bottom of this blog post.
- For related books or blog
posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to
“Psychiatric Disorders: ADHD: General” or type in the keyword “ADHD and
Adults” into “Google Search” located in the sidebar.
- For more books with related
content, click any hyperlinked keyword in the blog or type in the keyword,
“ADHD and Adults” into “Amazon Search” on the Amazon banner located in the
side bar.
Sources: National Institute of Mental Health, See also blogposts in: Psychiatric Disorders: ADHD: General
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
