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What Is ADHD?
ADHD, or attention deficit hyperactivity disorder, is a behavioral condition characterized by inattention, impulsiveness, and/or hyperactivity. It has been estimated that approximately 5% of U.S. children have ADHD, according to established diagnostic criteria.
What Are the Symptoms of ADHD?
The three key symptoms of ADHD are hyperactivity, impulsivity, and inattention. These symptoms typically interfere with the child's functioning in social and academic settings, such as paying attention to tasks at home or school, making careless errors, being easily distracted, not following through with tasks or completing instructions, being easily bored, losing things, being forgetful, having difficulty organizing tasks, being fidgety, having difficulty remaining seated, and talking excessively, to name a few.
Many children with ADHD will have symptoms that persist into adulthood. Effective treatments for ADHD include both medications and behavioral therapies. Not surprisingly, parenting a child with ADHD can pose special challenges.
How Do I Know if My Child Has ADHD?
Many of the symptoms of ADHD are also symptoms seen during normal childhood and development, and exhibiting one or more of the symptoms does not mean that a child has ADHD. It is also important to note that for a health-care professional to make a diagnosis of ADHD, the symptoms must have been present for at least six months in more than one setting (for example, home, school, and in the community), usually beginning before 7 years of age, and the symptoms must be inconsistent with the developmental level of the child and severe enough to interfere with the child's social or academic functioning.
What Should I Do if I Am Concerned That My Child Might Have ADHD?
If you are concerned about your child's behavior, it is appropriate to communicate this to your child's primary health-care provider. He or she can help you determine whether further evaluation may be necessary and whether your child's behavioral symptoms are suggestive of ADHD. If a formal evaluation is indicated, this evaluation will involve professionals from various disciplines to provide a comprehensive medical, developmental, educational, and psychosocial evaluation.
While ADHD can certainly present unique and sometimes what can seem to be daunting challenges, being able to sincerely know and have confidence in your child's strengths can go a long way toward helping him or her be the very best person he or she can be. Many famous, accomplished, and indeed brilliant people of the past and present have ADHD. An outstanding example of learning to have a positive outlook about ADHD is demonstrated in the children's book and movie called, Percy Jackson and the Olympians: The Lightning Thief.
Another benefit to thinking positively about your child with ADHD is its infectious nature. It is much easier for the child's teacher, coaches, peers, and in fact, the child him- or herself to accept and harness strengths when the parent communicates and emphasizes those strengths. The challenge for parenting a child with ADHD is to be able to use the child's unique gifts and address his or her challenges to work toward achieving the child's fullest potential.
Define Schedules and Routines
Clearly defined schedules and routines are essential for children (as well as for teens and adults) with ADHD. Having an established, while not inflexible, pattern for getting ready in the mornings, preparing for bedtime, and managing after-school homework and activities provides a sense of consistency and allows the child to know what to expect. It can be helpful for older children to have plenty of conspicuous clocks to use as cues for time management. Some parents find that the use of timers (for homework time, time to finish up play, etc.) helps for younger children.
To make the process more enjoyable or easier to remember, charts and checklists can be used that list the steps or tasks required for each time of day. For example, the "morning checklist" can include items like making the bed, brushing their teeth, and helping to prepare school lunch. Hang the checklists in a conspicuous place and allow your child to check off completed items as they are done, if he/she wishes.
Set Clear Rules and Expectations
As with clearly defined schedules, attainable, clearly defined rules and expectations are also essential for kids with ADHD. In both school and at home, children with ADHD need a consistent and clearly defined set of rules. It can be helpful to create a list of rules for the home and post them in a place where the child can easily see them. It's very important to stick to the rules and provide fair and consistent rewards and consequences when the household rules are not followed.
Give Clear Instructions
Avoid vague or open-ended instructions such as "clean up your mess" or "play nicely" that do not accurately convey the specific tasks that you want to be done. Instead, use clear language and specific instructions such as "please put all the dirty clothes in the hamper," "please put all the toys back on the shelves," or "let's allow your friend to have a turn playing with the toy." Speak in a calm and clear voice, and be sure to establish kind eye contact with your child when you give instructions so it is more likely he or she is focused on what you are saying. It can be helpful to have your child repeat the instructions back to you. Breaking down instructions for larger tasks into simple steps can also be helpful.
Discipline, Rewards, and Consequences
Children with ADHD respond very well to a defined and predictable system of rewards and consequences to manage behavior and discipline. Reward positive behaviors with praise or with small rewards that cost little or no money, such as special time with a parent or participating in an outing or favorite activity. Focus on praise or privileges as rewards rather than offering foods or toys as prizes.
It's always best to give more rewards and positive praise than negative comments or consequences. For example, smile and say, "I like the way you're working on your homework" or "you're doing a great job clearing the table." Ask your child to say what he or she did well during an activity and help him or her to come up with something if he or she cannot.
Discipline, Rewards, and Consequences (continued)
Likewise, consequences for negative behaviors should be fair, appropriate, consistent, predictable, and swiftly implemented and completed. Major events like holidays or the child's birthday should never be completely withdrawn or uncelebrated because of something the child did. Consequences ideally should be explained in advance and should occur immediately following the negative behavior. Delayed consequences (such as not participating in an event or outing in the following week) are not as effective as immediate consequences. Consequences can include time-outs, removal from the situation or setting, or restriction of privileges. It is very important that the consequence occur after every instance of negative behavior.
Use Time-Out Effectively
Particularly for younger children, time-outs can be an effective consequence for negative behaviors that serve the additional purpose of removing the child from an overstimulating or stressful environment. A time-out is also an immediate consequence that is likely to be more effective than a delayed consequence. Many experts recommend that time-outs not last longer in minutes than the child's age in years (for example, a five-minute time out for a 5-year-old). Longer than that may be too difficult for the child to complete, leading him or her to be more likely to defy doing the time-out at all.
Ignore Within Reason
In some situations, ignoring an undesired behavior may be an effective behavior-modification technique for children with ADHD. Obviously, behavior that is risky or injurious to the child or to others cannot be ignored, but behaviors such as whining, nagging, and arguing sometimes can be ignored until the behaviors stop. Many children with ADHD crave attention from others, even if it is negative attention in the form of yelling, shouting, or scolding. Refusing to provide any attention to the child who is behaving inappropriately can be effective if done consistently. For the child who gets increasingly loud or disruptive (escalates) when ignored, another way to respond may involve calmly and quietly telling the child that when they are calm and quiet the conversation can resume.
Develop Organizational Aids
Children with ADHD have poor executive functioning skills, which means, among other difficulties, that they have trouble organizing their belongings and tasks. Some parents (in cooperation with teachers) have found it helpful to provide color-coded binders and notebooks for each school subject, as well as a homework sheet in the front of the binder that lists homework for each school day. Others may find that purchasing a second set of textbooks for the home is useful for the child who frequently forgets to bring the proper materials home. Help your child develop an organizational system for his/her room and belongings and stick to it.
While this sounds obvious, many home environments are simply chaotic and full of distractions for the child with ADHD. Be sure that your child has plenty of quiet time and space to complete homework and other tasks. A homework space that is free of external distractions like television and video games, and is not located in rooms in the home where most people congregate is key to successful completion of assignments.
Set Small, Attainable Goals
Think of changing your child's less positive behaviors like training for a marathon. Just like no one would expect you or anyone else to go from never running at all to completing 26-plus miles, it is unfair and unrealistic to expect your child to change 15, or 10, or even five behaviors immediately. Don't expect dramatic changes overnight. If your goal is to have your child sit still politely through a restaurant meal or family outing, break the process down into small and attainable goals like not interrupting a conversation for five minutes, remaining seated for 10 minutes, etc. Be sure to offer plenty of praise and rewards when these small goals are met.
Focus on One or Two Challenging Behaviors at a Time
Changing all of a child's negative behaviors at once is never possible, and attempting to do so can create unbearable stress for both parent and child, setting up both for failure. Instead, pick one or two challenging behaviors that you'd like to improve and focus on those. Examples might be interrupting, not remaining seated, forgetting to put toys away, or arguing about bedtime. Whichever behaviors you choose to modify, understand the behavior changes must be gradual to be successful over time.
Find Areas in Which the Child Excels or Succeeds
No one enjoys being subjected to constant criticism or complaints about their behavior. As every individual needs to feel good at something, constant criticizing can result in the child unwittingly working more at perfecting negative behaviors they get attention for rather than the positive behaviors if he or she is not praised. Help your child find an area or interest in which he or she is successful. This can be a sport, musical instrument, academic subject, art form, or other hobby. Being successful or having a strong interest in a hobby can greatly improve your child's self-esteem and well-being. There is no single "best" activity for children with ADHD. Let their interests and enthusiasm be your guide.
Promote a Healthy Lifestyle - Nutrition
A healthy lifestyle will help not only your child but the entire family to preserve both physical and emotional health. Stick to a nutrition plan and avoid giving your child junk foods and "empty" calories on more than an occasional basis. While sugary foods are not a cause of ADHD, some parents find that lots of sugary foods may worsen their child's symptoms. Sometimes older children with ADHD are so distracted and disorganized that they may skip meals or eat irregularly. Decreased appetite can be a side effect of some medications that treat ADHD. Try to ensure that your child is eating regularly, and small meals every few hours may be most effective for some children with ADHD. While allowing your child to enjoy childhood by allowing for an occasional treat, it is important to teach your child to make good food choices by modeling these choices yourself.
Promote a Healthy Lifestyle - Exercise
Exercise can help excitable children "burn off" excess energy, and regular exercise promotes physical well-being and healthy sleep habits. Encouraging your child to participate in organized sports after school can provide both regular exercise and the benefits of a regular and predictable schedule. Many children with ADHD do well in martial arts or yoga classes that emphasize mental as well as physical control over their bodies. In general, it's important to pick a sport that suits your child and his or her abilities, but sports that involve constant activity or motion may be better choices for some kids than sports that have significant "down-time" like baseball or softball.
Promote a Healthy Lifestyle - Sleep
Sleep is the final factor in ensuring a healthy lifestyle for your child and family on a daily basis. If your child is not well-rested, he/she will have even more difficulty staying focused and on-task. Falling asleep can be difficult for children with ADHD who may be overstimulated and have an increased activity level. As part of your regular and predictable schedule, it's important to have a set bedtime and bedtime routine. You can use a checklist or timer if you like to help your child make the transition to bedtime. Eliminating caffeine in your child's diet as well as providing a calming nighttime ritual (such as cuddling or sharing a book or story) can help your child wind down at the end of an active day. For older children and teens, turning off the computer and storing cell phones and other electronic devices outside the child's room for the night serve to prevent their interfering with sleep.
Show Your Unconditional Love
Be sure your child is aware of your unconditional love and support, no matter how he or she behaves. Withdrawal of love or affection is never an appropriate consequence for undesired behavior. It's OK to let your child know that you are angry or frustrated with his/her behavior at times, but remember to say "I love you" every day and be sure your child knows that he or she is an accepted and valued member of the family.
Take Care of Yourself
Finally, don't forget to take care of the caregiver. In addition to the joy of accomplishment, parenting a child with ADHD can bring on a variety of upsetting emotions, including embarrassment, anger, anxiety, worry, and frustration. In fact, you may feel any or all of these on a given day. Try to keep a sense of perspective and understand that your child's behaviors are due to a disorder and may not always be under his or her full control.
If you need a break, you shouldn't feel guilty. Parenting is a stressful job, and it's OK to accept help from family and friends in caring for your child. Take time off from parenting to spend time on activities you enjoy or even spend time alone in order to recharge yourself. You won't be an effective parent or role model if you have no energy to devote to the process.
Take advantage of all the resources that are at your disposal. If you don't know where to look, talk with your child's teacher, school counselor, or health-care provider. School systems vary in the level of support they may be able to provide for parents and students with ADHD, but in all cases, parents and educators should work as a team to address the whole needs of the child.
You may find that a therapist or support group may be helpful, for either you or your child. Many health-care practitioners offer social skills and positive behavior workshops and classes for children that are geared toward having fun while learning to manage their condition. Your health-care provider can also be a valuable resource and may have information about parent support groups or community resources.