ADHD and Your ChildPresented by Dr. Kevin Metz

Lepage Associates, Solution-Based Psychological and Psychiatric Services

What this presentation will coverAn overview of ADHD Some facts about ADHDTips to cope with ADHDSome parenting coaching if your child has ADHD

Resources for more help

What is ADHD?A medical condition characterized by

inattention, hyperactivity, or occasionally bothThere are 3 Types:

Predominantly InattentivePredominantly HyperactiveCombined Type

ADHD NOS is the diagnosis for people who have some symptoms but not enough for a full diagnosis

What is ADHD?Inattentive Type: 6/9 Hyperactive Type: 6/9Fails to give close attention

to detailsDifficulty sustaining attentionDoesn’t seem to listenFails to finish tasksDifficulty organizingAvoids tasks that require

sustained effortLoses things necessary for

tasksEasily distracted by stimuliOften forgetful

FidgetsOften leaves seat when sitting

is expectedRuns or climbs in

inappropriate situationsDifficulty playing quietlyOften “on the go” or “driven by

motor”Talks excessivelyBlurts out responses before

questions have been completedHas difficulty awaiting turnOften interrupts or intrudes

PrevalenceA 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…

Worldwide PrevalenceCanada AustraliaNew ZealandGermanyIndiaChinaNetherlandsPuerto RicoJapanMexicoBrazil

3.8-9.4% of kids3.4% of kids6.7% of children4.2% of children5-29% of children6-9% of children1.3% of teens9.5% of child and teens7.7% of childrenApprox. 5% of children5.8% of 12-14 year-olds

Who is slipping through the cracks?Adult ADHD - Frequently undiagnosed

Diagnosed (15%)Undiagnosed (85%)

What is ADHD not?ADHD is NOT a problem of

Lack of willpowerPoor parentingLack of motivationLack of intelligenceLazinessDefiance

What else is ADHD not?Inattentive Type:

6/9Hyperactive Type:

6/9Fails to give close attention to details

Difficulty sustaining attentionDoesn’t seem to listenFails to finish tasksDifficulty organizingAvoids tasks that require

sustained effortLoses things necessary for

tasksEasily distracted by stimuliOften forgetful

FidgetsOften leaves seat when sitting

is expectedRuns or climbs in inappropriate

situationsDifficulty playing quietlyOften “on the go” or “driven by

motor”Talks excessivelyBlurts out responses before

questions have been completedHas difficulty awaiting turnOften interrupts or intrudes

How do you get ADHD?

Depression

IQ

Schizophrenia

ADHD

Height

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

Heritability

Heritability

You have the power!! (although it’s possible you have

forgotten)Long-term effects of ADHD on self-esteemHigh rates of anxiety and depressionADHD can impair decision-making skills

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?”

What needs to happen1. Recognize the condition. Impossible to

overcome a challenge unless it is recognized2. Accept the condition- both negative and

positive ramifications of the disability3. Understand the situation- the condition

and all its implications4. Act. The first three means little if you’re

not deciding to take action toward your goals (remember- you have the power!)

Strengths: What is the gift of ADHD?

Great imaginationUnusual intuitionHigh level of creativityCuriosity Lots of energyFlexibility

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?

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.

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.

What to do about: RoutinesWake-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.

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.

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.

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!

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.

Some other common problems…BoredomTime managementProcrastinationDifficulty with long-term projectsInterpersonal difficulties

What to do about: BoredomDo 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

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)

What to do about: ProcrastinationLook 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.

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

More Difficulty with Long-Term ProjectsReview 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?

What to do about: Interpersonal DifficultiesMonologuing- 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.