ADHD and Your Child

1. ADHD and Your Child Presented by Dr. Kevin Metz Lepage Associates, Solution-Based Psychological and Psychiatric Services

2. What this presentation will cover • An overview of ADHD • Some facts about ADHD • Tips to cope with ADHD • Some parenting coaching if your child has ADHD • Resources for more help

3. What is ADHD? • A medical condition characterized by inattention, hyperactivity, or occasionally both • There are 3 Types: • Predominantly Inattentive • Predominantly Hyperactive • Combined Type ADHD NOS is the diagnosis for people who have some symptoms but not enough for a full diagnosis

4. What is ADHD? Inattentive Type: 6/9 Hyperactive Type: 6/9 • Fails to give close attention to details • Difficulty sustaining attention • Doesn’t seem to listen • Fails to finish tasks • Difficulty organizing • Avoids tasks that require sustained effort • Loses things necessary for tasks • Easily distracted by stimuli • Often forgetful • Fidgets • Often leaves seat when sitting is expected • Runs or climbs in inappropriate situations • Difficulty playing quietly • Often “on the go” or “driven by motor” • Talks excessively • Blurts out responses before questions have been completed • Has difficulty awaiting turn • Often interrupts or intrudes

5. Prevalence • A common disorder among children, affecting approximately 5-7% of school-aged population. And about 2% of adults. This equates to about 5 million adults and 2 million children in the United States…

6. Worldwide Prevalence • Canada • Australia • New Zealand • Germany • India • China • Netherlands • Puerto Rico • Japan • Mexico • Brazil • 3.8-9.4% of kids • 3.4% of kids • 6.7% of children • 4.2% of children • 5-29% of children • 6-9% of children • 1.3% of teens • 9.5% of child and teens • 7.7% of children • Approx. 5% of children • 5.8% of 12-14 year-olds

7. Who is slipping through the cracks?

8. What is ADHD not? • ADHD is NOT a problem of • Lack of willpower • Poor parenting • Lack of motivation • Lack of intelligence • Laziness • Defiance

9. What else is ADHD not? • Inattentive Type: 6/9 • Hyperactive Type: 6/9 • Fails to give close attention to details • Difficulty sustaining attention • Doesn’t seem to listen • Fails to finish tasks • Difficulty organizing • Avoids tasks that require sustained effort • Loses things necessary for tasks • Easily distracted by stimuli • Often forgetful • Fidgets • Often leaves seat when sitting is expected • Runs or climbs in inappropriate situations • Difficulty playing quietly • Often “on the go” or “driven by motor” • Talks excessively • Blurts out responses before questions have been completed • Has difficulty awaiting turn • Often interrupts or intrudes

10. How do you get ADHD?

11. You have the power!! (although it’s possible you have forgotten) • Long-term effects of ADHD on self-esteem • High rates of anxiety and depression • ADHD can impair decision-making skills

12. Be on the lookout for self-statements that aren’t acknowledging your power! • “I’m sure to screw this job up too” instead try: “Let me take a look at what I can do to do a better job this time” • For example, when hearing of possible layoffs: “Well, who’s going to hire me now?!” instead try: “What can I do to make myself more valuable in this company?”

13. What needs to happen • 1. Recognize the condition. Impossible to overcome a challenge unless it is recognized • 2. Accept the condition- both negative and positive ramifications of the disability • 3. Understand the situation- the condition and all its implications • 4. Act. The first three means little if you’re not deciding to take action toward your goals (remember- you have the power!)

14. Strengths: What is the gift of ADHD? • Great imagination • Unusual intuition • High level of creativity • Curiosity • Lots of energy • Flexibility

15. How do my symptoms cause problems for me? • Problems organizing or forgetfulness may result in late homework or missing assignments • Avoiding tasks because they would take a long time is a form of procrastination which results in high levels of stress leading to a deadline • Hyperactivity may lead to annoying classmates/family members around you with noise and movement • Impulsivity may lead to poor relationships with others because of frequent interrupting in conversations • Any others that you notice in yourself or your loved ones?

16. What do to about: Organization (adapted from Beyond Ritalin by Garber et al) • Place important items for school or work on hooks or racks by the door the night before. Have the most organized family member monitor this. • Designate places for important items at home, school, and work. Place items in their proper location as soon as they are not needed: keys, glasses, purses, lunch boxes, uniforms, bookbags, or briefcases. • Buy furniture and containers with lots of drawers, shelves, and hooks. Label places for things and keep surfaces uncluttered. Over-organization is important! • Create file drawers and folders for important papers and schoolwork. Throw out items that are no longer needed.

17. More about Organization • Put medications in weekly pill keepers. This makes it easier for others to monitor if medications have been taken until it is a routine. • Have a weekend box for anything left out of place. Everything in the box must be put away before weekend free time begins. Place a bag of things that need to be put away in front of the TV. • Do not let messes pile up. Clean up one activity before starting another. ADD people can create chaos. • Avoid “to do” piles. Whenever possible handle paperwork only once. Throw it away, file it, or take whatever action is needed as soon as possible.

18. What to do about: Routines • Wake-up routines may include extra alarm clocks, water sprays, rambunctious pets, ice cubes, or ammonia swabs. • Bedtime routines are important for both children and adults: bathing, watching (nonstimulating) TV, reading, calming music, and relaxation exercises. • Be dressed and ready for school or work before eating breakfast or watching TV. There are many instant, nutritious foods that can be eaten on the way to work or school. Prized privileges can be withheld until a child is ready on time for school. • Set clocks and watches ahead to decrease chances of being late. • Make lists for routines and put them on white boards or Post-it Notes placed in strategic locations (refrigerator, TV, video control box): feed pets, have snack, put dishes away, do homework, make bed, put belongings away, free time.

19. More routines… • Monitor tasks that require a sequence of actions until it is independently mastered: “What do you need to do next? Next? Next?” • Use a stopwatch to time how long it takes to complete (part of) a task. Then make a game of gradually decreasing time. Similarly, time how long a person can sit still in the car or at dinner and gradually work on increasing time. • Break large tasks into smaller units and provide immediate rewards or breaks after each one is complete. Physical activity and stretching may be especially important. • Make eye contact, announce instructions, say them and have them repeated—“I’m going to tell you what still needs to be done. You need to . . . What did I say?” Use many gestures or sign language if it helps focus attention.

20. Even more routines… • When something has been left out of place or a step is out of sequence, interrupt what you or your child is doing before returning to the desired activity. This reinforces neural links in the mind. • Do not start a new task before completing a current one. • Link undesirable tasks with high-priority activities: Domestic chores must be completed before using the computer. Place pill keepers in front of toothbrushes. • Train organized family members to remind instead of nag—“I know you meant to . . . Would you do it . . . ?” “How about if the TV goes off after this show until . . . gets done.” Keeping expectations realistic will go a long way to increase patience. • Reinforce routines with rewards. Pick one routine on which to concentrate and keep track of the number of days in a row it is done. Identify a reward and use it each time a record is broken. Once something is done 14 days in a row, it is a habit.

21. What to do about: Forgetfulness… • Keep a “day list” by the door with everything you or your child might need: keys, glasses, notebook, lunch, snack, medicine, retainer, wallet, or sweater. Make a habit of scanning the list before you leave. • Have a What-have-I-forgotten? list in your car or on a key chain, or have it memorized: hat, gloves, glasses, assignment book. Make children repeat their list five times as a consequence for forgetting items not brought home. Build the habit of asking the above question every time you leave a place. • Use a “must remember” bag for non-routine items that need to come home by placing high-priority items (car keys or snacks) in the bag. • Call your voicemail and record reminder messages of things you need to do as soon as you think of them. • Use alarm watches for reminders to take medication, start chores, or leave a friend’s house. Set other timers for five-minute warnings before it’s time to leave for school or other activities. People with ADD lose track of time!

22. More forgetfulness… • Use assignment books that list homework, tests, and other important dates. Coordinate with teachers and monitor tasks until children establish a routine. • Buy spiral notebooks with pockets in which to place assignments due the next day, or designate a special homework pocket in bookbags. • Keep a calendar or planner for all important dates and events. • Keep notepads and pens in the car, by the bed, or in your purse to write down ideas and things you need to remember to do. Read with a pen in hand for the same reason. • Schedule weekly errands at the same time so they won’t be forgotten.

23. Some other common problems… • Boredom • Time management • Procrastination • Difficulty with long-term projects • Interpersonal difficulties

24. What to do about: Boredom • Do the boring stuff at high energy times of the day. Don’t wait until you are tired. • Delegate boring tasks whenever possible. What is intolerable to you may seem like an easy task to someone else. • Break boring tasks up into small bites. • Recognize your need for change and stimulation and actively work to introduce more change or challenge into your life

25. What to do about: Time Management Problems • Hyper-focusing: If you get caught up in what you’re doing and lose track of time, develop the habit of setting a beeper to go off when you should leave • Running late: aka “just-one-more-thing-itis” Plan to be early and take something with you (book, paperwork) to battle “i-hate-to-wait-itis” Catch yourself answering the phone or doing one last little task and remind yourself- “It’s time to leave. I’ll do it later.” • Over-commitment: Try to consciously under-commit your time (you’ll do things more effectively because you’re not always rushed)

26. What to do about: Procrastination • Look for tasks that require more immediate responses by their very nature. This eliminates the possibility of procrastination. • Build in rewards for completing undesirable tasks. • Request closer supervision . Procrastination flourishes in secrecy! • Accept/work with your procrastination: if you know you work better under a time crunch, make sure you have time carved out just prior to deadline.

27. What to do about: Difficulty with Long-Term Projects • Team up with others to work in close-connection. Weekly or even daily team meetings can help you stay on track • Break the project down into stages, estimate the time required by each stage • In planning, start the due-date and then work backwards in your calendar, setting dates for the completion of each part of the project

28. More Difficulty with Long-Term Projects • Review progress regularly with your supervisor/teacher • Identify parts of the project that you are having trouble with and actively identify a solution. Ask yourself- Do I have the knowledge or resources for this portion? Do I need the help of a classmate?

29. What to do about: Interpersonal Difficulties • Monologuing- Try thinking to yourself- do they seem interested in what I’m saying? Or are they giving signs that they would like to shift the topic or leave the interaction? • Interrupting- In class write your comment down if you’re afraid you’ll forget. In conversation, monitor yourself, and apologize and stop talking if you catch yourself interrupting. • Being Blunt- Ask for a little feedback about how your comments are taken.