What Is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder seen in childhood. Symptoms include inability to focus on tasks or pay attention, impulsiveness, and/or hyperactivity. The American Psychiatric Association estimates 5% of children have ADHD, though some studies believe the incidence may be higher.
What Are the Symptoms of ADHD?
Children with ADHD are usually hyperactive, impulsive, and inattentive. While these behaviors are normal in children at times, those with ADHD have symptoms that are more frequent and severe.
Symptoms of hyperactivity include:
- Difficulty waiting their turn
- Saying inappropriate things
- Interrupting others
- Acting without regard for consequences
Symptoms of inattention include:
- Being easily distracted
- Difficulty focusing on tasks
- Difficulty staying organized
- Trouble completing homework or other activities
- Struggle to follow instructions
How Do I Know if My Child Has ADHD?
Most children show signs of inattention, hyperactivity, and impulsiveness as part of normal behavior and development. In children with ADHD these behaviors are more severe and frequent. In order to be diagnosed with ADHD, these behaviors must persist for six months or more, and be observed in multiple settings (such as home, school, and other places), and interfere with the child's schoolwork or relationships. The average age of onset for ADHD is 7 years old.
What Should I Do If I Am Concerned That My Child Might Have ADHD?
The first step in determining if a child has ADHD is to talk to the child's pediatrician about the behaviors observed and concerns you have. Often you will be referred to a mental health specialist who has experience in childhood disorders such as ADHD. There is no single test for ADHD, and the first step is to try to rule out other conditions that may have similar symptoms such as seizures, hearing or vision problems, learning disabilities, or anxiety or depression.
An important part of helping a child with ADHD to overcome their challenges is to provide positive support and encouragement. Many children with ADHD are bright and creative, and can use those strengths to their advantage. When parents, teachers, and coaches find something the child is good at, it is important to praise them and encourage those positive traits. Remember your child is not behaving badly on purpose, and know that your child can learn and grow.
Define Schedules and Routines
Children with ADHD often benefit from well-defined schedules and routines. Knowing what to expect helps the child manage daily tasks. Set schedules for getting ready for school, doing homework, and chores around the house so the child can complete them in a timely manner. Time management skills and cues can help them, such as timers for homework or play time.
Charts and checklists can also be used to help the child know what has been done and what tasks need to be completed. As the child finishes each task, he or she can check them off the list.
Set Clear Rules and Expectations
Clear-cut rules with reasonable expectations are important for children with ADHD. Write down the rules and post them if this is helpful. Children with ADHD often respond well to rewards and consequences. Make sure your child understands the rules that are set, and stick to them. When the child follows the rules, provide positive feedback and rewards. If the rules are not followed, there needs to be fair and consistent consequences.
Give Clear Instructions
Make sure instructions are clear. Children with ADHD may have difficulty following vague requests. Instead of telling your child to "clean the mess," tell him to "make the bed and put your clothes in the closet." Instead of saying, "play nicely," ask your child to "give your friend a turn to play with the video game." Give step-by-step instructions for larger tasks. Stay calm and speak clearly, and make eye contact to keep your child focused on you. Ask your child to repeat instructions back to you to make sure they are understood.
Discipline, Rewards, and Consequences
A clear-cut system of rewards and consequences helps children with ADHD to manage behavior. Use positive rewards such as praise or privileges when the child behaves well. Avoid rewards such as food or toys. Consequences for negative behaviors may include time-outs or removal from activities.
Try to praise your child with ADHD, even for small things. Children with ADHD often hear a lot of criticism and it is important for them to know they can do things well.
Discipline, Rewards, and Consequences (Continued)
Consequences must be consistent and fair. A child with ADHD should know in advance what the consequences of negative behaviors are, and those consequences must be predictable and acted upon immediately. Delayed consequences are less effective. Consequences may include time-outs, withdrawing the child from the situation where they are acting inappropriately, or restricting privileges. Every time the child exhibits negative behaviors, consequences should be implemented.
Use Time-Out Effectively
One type of effective consequence can be time-outs. These can be particularly useful for younger children, and can remove the child with ADHD from the situation that may be stressful or over-stimulating. Time outs should be immediate (at the time of the behavior) and should last no longer in minutes than the child's age in years (for example, a 6-year-old should get a time out for no longer than 6 minutes).
Ignore Within Reason
Often, children with ADHD may whine, nag, yell, or argue for attention. Ignoring these undesirable behaviors may be an effective consequence when done consistently. Another way to respond to these attention-seeking behaviors is telling the child in a calm and quiet tone that they will be listened to when they are calm and quiet themselves. If a child is doing something where they or others could be injured this should not be ignored.
Develop Organizational Aids
Children with ADHD often have difficulty organizing tasks and belongings (also referred to as executive functioning skills). Doing homework and performing in a classroom may be stressful for these children. Parents and teachers often find using color-coded binders and notebooks for each subject along with a checklist of homework for the day to be helpful. Having a second set of textbooks at home may help the child who forgets to bring books home. Create an organizing system for your child and help him follow it.
Children with ADHD can easily become over-stimulated and quiet spaces are important. There are many distractions at home from televisions, computers, video games, and siblings. If your child has ADHD make sure to have a space free of distractions so they can complete homework assignments or other tasks.
Set Small, Attainable Goals
Set small, gradual, and attainable goals. It is unrealistic and stressful for a child to be expected to change overnight. Just as with losing weight you cannot expect to lose 25 pounds overnight and need small increments along the way, your child needs small steps to accomplish behaviors that are important. If you want your child to sit still when you go out to dinner, break up the meal into small attainable segments such as not interrupting conversations for five minutes, then remaining seated for ten minutes. Offer praise and rewards for each goal met.
Focus on One or Two Challenging Behaviors at a Time
Take it one step at a time as far as attempting to change challenging behaviors. Remember your child is not behaving this way purposefully and changing will take time and patience. Expecting change all at once is stressful and frustrating for the child. Pick just one or two things to change such as not interrupting, or putting toys away, or not arguing about homework. Changes may be gradual and it is important to praise your child for every positive accomplishment along the way.
Find Areas in Which the Child Excels or Succeeds
All children are good at something. Children with ADHD are often criticized for their negative behaviors and as a consequence their positive behaviors and accomplishments are overlooked. Help your child find out what they are good at, whether it's a sport, a musical instrument, a class at school, art, or any other activity. It doesn't matter what the hobby is – having something they can be successful at and receive praise for will improve self-esteem.
Promote a Healthy Lifestyle - Nutrition
Physical and emotional health is also important. Many children with ADHD are so distracted or disorganized they neglect to eat proper balanced meals. Limit sugary and junk foods, as many parents find they worsen ADHD symptoms. In addition, many of the medications used to treat ADHD can cause decreased appetite so it is important to make sure your child eats regularly. Make healthy choices for yourself and your children will follow your example.
Promote a Healthy Lifestyle - Exercise
Children with ADHD often have a lot of excess energy and regular exercise can help them release their pent-up energy in healthy and constructive ways. Organized sports can provide regular exercise, a predictable schedule, and an area for your child to receive positive rewards and praise. Activities such as martial arts or yoga can be beneficial as these emphasize the mental and physical aspects of activity. For some children, highly active sports where there is more constant motion such as running track may be better than sports with a lot of 'down time' such as baseball.
Promote a Healthy Lifestyle - Sleep
Lack of sleep can make it more difficult for children with ADHD to focus and pay attention. Falling asleep is often a challenge for children with ADHD who are frequently over-stimulated to begin with. A scheduled and consistent bedtime should be part of your child's schedule. Also coming up with a bedtime routine where the child is calm and quiet before bed can help them relax. Children with ADHD should avoid caffeine, and the television, computer, and cell phones should be turned off well before bed time so they don't interfere with the child's sleep.
Show Your Unconditional Love
Like all children, kids with ADHD need to know they have their parent's unconditional love and support. Even if you are angry or frustrated at your child's behaviors remember to tell them you love them no matter what.
Take Care of Yourself
It can also be stressful and frustrating as the parent or caregiver of a child with ADHD. Remember to take care of yourself. It can help to remember your child cannot control his behaviors and they are due to a disorder. Take a break if you need one, and don't be afraid to ask for help. You will be a more effective parent if you take care of yourself.
There are numerous resources for families of children with ADHD. Your child's pediatrician, teachers, and school counselors can help direct you to resources in your community. Therapists, support groups, behavioral workshops and other resources may be available.