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ADHD- Attention Deficit Hyperactivity Disorder
By:
Audra Boxma (Life Skills Counseling Center) &
James Mahoney (Center of Hope And Healing)
What You Need to Know About ADHD
Parents often say they don’t believe in ADHD anymore because it has become such a cliché. As adults we tend to see children use ADHD as an excuse to justify not fulfilling responsibilities and perhaps that is why we reject the idea. I frequently talk to adults who do not know enough about it to know where to set an appropriate limit. They struggle with not wanting to enable the child, but also do not want to set expectations beyond the scope of the child’s ability. This course will give you the basic information you need to know to help your child or student be the best he or she can be.
It is important that all adults are aware that it is not a cliché, ADHD is as serious a disorder as Autism or Asperger’s , the kids just don’t look it. There are areas of the brain that are specifically responsible for the symptoms associated with ADHD. It is a true disorder that impairs one’s ability to function. However, the key is that we have to teach them the skills they are lacking, devise systems for daily life, and create motivation for them. It is unfair to have the same expectations that you would have for a non-ADHD child, without having these interventions in place. In most cases it is unrealistic, and sets a child up to fail and lowers self-esteem. I realize this is not what most adults are intending to do, but that may be what is happening.
Understanding ADHD
To begin, it is important to identify that ADHD is a developmental disorder. This means there is a delay in the rate of development. It does not mean the brain is defective, it means it is developing more slowly than the norm.
I would like to share with you my understanding of the views of an expert on the topic of ADHD, psychologist Russell Barkley, Ph.D. Dr. Barkley reports that ADHD is not really a problem with attention. In fact, ADHD kids pay attention to everything. He believes it is a disorder of inhibition. Inhibition is the ability to wait and not respond to an event. You inhibit the urge to get out of your seat, to blurt out the answer, to wait your turn, etc. These are all things you may think of, but your inhibitory system doesn’t let you do it. So, if this area is not functioning properly, this inability to inhibit behaviors will manifest itself in many different ways.
Many people understand the symptoms, but not many people understand the neurological reasons behind the behaviors. Dr. Barkley reports there are 3 specific areas in the brain associated with ADHD behaviors. These specific parts of the brain are responsible for “executive functions”. These executive functions contribute to self control and self-regulation, how we manage ourselves. Think of the inhibition system as the base and the executive functions are built on that base. If the base is faulty, then the executive functions will also be faulty. These executive functions are directly related to the 3 brain structures that are shown to be smaller, less active, and less developed in individuals born with ADHD. The following functions may be impaired:
#1. Nonverbal Working Memory
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Cooperative reciprocal interaction- (social skills problems)
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Imitation and vicarious learning (problem learning from others mistakes)
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Hindsight, foresight, the future- (living in the now)
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Sense of time (no sense of time)
#2. Verbal Working Memory (self-speech)
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Reading comprehension
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Self-description, reflection, questioning
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Self-instruction: following rules
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Stagnated moral development (looks immature)
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Telling your self to do things, self-talk
#3. Internal Motivation and Emotion
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Motivation WITHOUT CONSEQUENCES
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Ability to manage (and express) emotions in a socially acceptable manner
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Includes willpower and persistence (in the absence of rewards)
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The ability to defer gratification to achieve goals
#4. Planning, Problem-Solving, & Mental Manipulation (play to self)
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Planning
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Nonverbal and verbal fluency
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Complex, goal-directed actions
This may look like difficulty explaining, thinking, and organizing thoughts, especially on the spot. Usually this is accompanied with poor penmanship. Freeform writing can be a devastating task. A “write a paragraph” assignment can be very overwhelming as it requires all of the skills in which they are weak.
What can I do?
There are a plethora of interventions that a parent or teacher can implement to help an ADHD child. The purpose is to compensate for the executive functions in the brain that are not functioning to capacity. If we utilize a few interventions that compensate executive functions, we will improve the child’s ability to meet the expectation (and improve self-esteem, as a result). Here are a few of my suggestions:
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Take note of changes on your “bad days”
Question what was different that day- big or little (It can be that the jeans he was counting on wearing were dirty. That is a change of his plan). Do your very best to maintain a routine and to be prepared.
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Intervene on the front end, not the back end
Decrease the stimuli. Turn down the TV, turn down the radio, sit down when talking to your child, decrease the distractions to prevent information overload. Understand that rushing also makes things worse. Try to have a good plan to help the kids be ready 5 minutes early. For example, in the evening they can pack backpacks and place them by the door or pick clothes out. Also, use your weekend wisely. Pick out clothes for the week or get homework done on Saturdays rather than Sundays. Being prepared can prevent a lot of those hurried, frantic moments that can precipitate tantrums or conflict.
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Watch your child and learn what it looks like when (s)he is in information overload
Note the behaviors and use them as warning signs. Teach your child to see these behaviors in himself/herself and have a plan of action already devised. This plan can include using some coping skills to decrease stress.
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Focus on solutions, not problems
Practice saying, “So that’s the problem, what solutions can we think of?” or “You want X and I want Y, what is in between?” If you do this enough your child will start thinking this way with friends, at his job, in his relationships then, talk about how to prevent problem situations from occurring in the first place. Children with ADHD have difficulty learning from their mistakes and thinking ahead. Help them to devise the solution in advance. Identify and create a plan for problem situations and transitions. Focusing on the solutions helps you to avoid the blame game. It’s a great life lesson for us all.
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Give frequent feedback and kudos
Use this questions for all of our communication with your child: “Would you like it if your Boss (or Spouse) spoke that way to me?” You can be upset, but express it well. Think of yourself as a mirror. You are teaching your child how to express anger, so rather than only talking out when things are bad, remember to notice things that are good. Think about how you feel when your boss gives you kudos. It improves self-esteem and provides confidence about your abilities and the person that you are. Children are still trying to figure those things out. Help them identify what they do right and what they are good at. A child can feel so special just from one comment from you. Also, frequent feedback can help keep your child on task and act as a reminder that you are involved and available for guidance (if requested). Allowing your child to take out 27 toys and then wondering why (s)he’s upset when its time to clean up can be prevented.
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Use empathy and focus on your child’s feelings, not the details of the precipitating incident
Say, “It looks like that made you angry, how are you going to deal with that anger right now? For a young child you can use the verbiage, “What are you going to do with all that mad?” Want to go play basketball for a while?” Making suggestions for coping enables children to develop a mental list of coping skills. The ultimate hope is that they will use them when you are not there to guide them.
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Ask for your child’s opinion and offer 2 choices
Asking for an opinion helps you to learn about your child and to identify if he has learned any wrong life lessons. With choices, the more decisions he makes, the better he will become at making good choices. You are creating an opportunity for independence and control. If you don’t offer structured choices, your child will create his own options. Ask what he wants to make for dinner on his night to cook. Ask if he wants to go at 1p.m. or 4 p.m. to buy the groceries. Ask if he wants to shower now or at 7 p.m. when his favorite TV show comes on.
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Use lists and visual (not verbal) reminders
Write it down. Kids with ADHD forget things. They will be able to look it up, if it is written down. You can get creative. Use a note card that your child has to give you each morning or a dry erase board where he places checkmarks after each activity is completed. For instance:
PM Checklist
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Pick up all items in the living room
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Pick up all items in the kitchen
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Put pajamas in the bathroom
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Take a shower
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Brush teeth
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Hang up the wet towel on the hook
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Put dirty clothes in the hamper
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Put on pajamas
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Lay out clothes and shoes for the next day
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Organize your backpack
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Place backpack by the door
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Take medicine
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Be in bed by 9 p.m.- then you can read for 20 minutes (reward)
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Externalize time- use timers and alarm clocks that
As time is a difficult concept, you can make time tangible to the child. Buy him a wrist watch that beeps or vibrates to remind him to write in his planner or to start his chores. Set an extra alarm in the morning that rings 10 minutes before it is time to leave. This will remind him he should be ready and has to hurry. Use an egg timer to help younger children stay on task. Be aware, however that studies show when a child is timed to complete academic tasks, thief performance decreases significantly. Use the timer to alert them, not so much to time them.
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Provide Clear, Consistent rules and Consequences
Clearly identify what is expected. Kids with ADHD do not perform well with ambiguous directions or unstructured time. The rules should not change, so write them down carefully. Once the rule is understood it becomes the child’s responsibility, not yours. If a consequence is earned, it is not about you being a mean parent, it is about the choice your child made. Remind your child that he chose to violate the rule, it was his decision, and now he has to just deal with the consequence. If you don’t allow your child to experience the consequence, he will not learn the lesson.
Nutritional Recommendation
The primary treatment of behavioral problems starts with diet and behavior journaling. Journaling helps to identify aggravating foods and patterns of eating that suggest underlying hypoglycemia and systemic fungus (sugar and carbohydrate craving) as well as allergy and other biochemical causes of intolerance (eg. lactose intolerance). Most behaviors can be improved to some extent by removing irritant foods. The top foods that cause symptoms of ADHD can be removed from the diet and added back in at intervals to evaluate their effect. This list of foods is likely to look a lot like your shopping list:
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Cow’s milk and cow’s milk products (cheese, butter, ice cream)
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Eggs (from chickens)
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Cane sugar and high fructose corn syrup (read labels)
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Wheat
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Corn
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Soy
Starting with cow’s milk, remove a food from the diet once weekly. Reintroduce foods one at a time and pay attention to behavior during the next few days. Though some studies have shown minimal impact of foods on behavior, we have found that this approach can be very helpful.
A qualified health professional can do laboratory investigations to pinpoint which foods create allergic responses or other biochemical irritation. Hard evidence in the form of lab studies and clinical testing can frequently sway those that would otherwise refuse to modify their typical diet. Some of the techniques and treatments that can be helpful in reducing the impact of allergic response include:
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Homeopathic drops
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Allergy Elimination technique (Nambudripad and others)
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Allergen extract injection
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Rotation diets
Nutrients that can be helpful in ADHD are numerous because the typical American diet is low in so many critical vitamins, minerals and fats. Individual nutrient needs can vary widely from one person to another. Studies have demonstrated benefits from doses of nutrients at many times the values established in the Recommended Daily Allowance (RDA). Simply adding a good high-potency vitamin and mineral complex can often create dramatic positive changes in a period of days or weeks. The following nutrients can be helpful in reducing hyperactivity:
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Taurine 500 -3000mg
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Magnesium Malate 500-1000mg at bedtime
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L-theanine 100mg 3-4 times daily
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GABA 500 to 750 mg 2-3 times daily
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Valerian Root 250 to 500 mg 2-3 times daily
Additional ADHD Resources
Dr. Barkley’s books for parents:
Adhd Websites
www.chadd.org
www.add.org
www.addwarehouse.com -- Full of great books and devices for parents.
www.help4adhd.org
(www.featofnc.org/chat.html)
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