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How Is ADHD Treated?

Monday, July 30, 2012 - 17:52

Contributing Author: Guy Slowik FRCS

Each child with ADHD is different and needs a different approach to treatment. An accurate diagnosis — one that describes your child’s problem precisely and also reveals any associated problems — is crucial to designing your child’s treatment.

 

Need To Know:

Make sure all adults who deal with your child know about ADHD. That includes teachers, scout leaders, and sports coaches. Keep lines of communication open so that if your child is having a hard time, you’ll know about it.

 

There are several research-proven and accepted treatments for ADHD. Most children do best with a combination of treatments.

 

Treatments for ADHD include:

 

Educational Strategies To Treat ADHD

 

Much of the treatment of ADHD needs to take place at school. Unless they receive appropriate support, many children with ADHD will struggle in school. This is not because they lack intelligence, but because their early years of failure affect their self-esteem and their ability to learn.

 

When children with ADHD are interested in the tasks in front of them, they can avoid distractions as well as any other child.

 

Need To Know:

There are two simple yet very good ways that teachers can help children with ADHD to avoid distractions:

  1. Make classroom tasks as interesting and stimulating as possible.

  2. Provide a system of rewards that children can earn for completing tasks.

 

Fortunately, most teachers are trained to understand and work with children with ADHD. And teachers are generally eager to communicate with parents. You should not hesitate to contact your child’s teachers when difficulties arise.

 

There are also many other ways in which a teacher can help by providing structure, and using behavior management techniques, to improve school performance.

 

Need To Know:

In The Classroom

 

When you talk to the teacher, here are some points you may want to discuss:

 

  • How is the class run? Children with ADHD often do best in structured classrooms, rather than in open classrooms where a lot of different things are going on at the same time. If your child’s class is very unstructured, you might want to discuss with your child’s teacher (or perhaps the school psychologist) whether such an arrangement is suitable. It may even be better to move your child to a different class.

  • Where does your child sit? Ideally, your child should sit near the front, as far away as possible from distractions such as the door or the pencil sharpener, or in other parts of the room where there is a lot of coming and going. Seating him or her near a good role model can also be helpful.

  • Can your child communicate easily with the teacher? It’s important for your child to feel that the teacher is on his or her side. For example, the teacher and your child can set up a system of signals, so the teacher can secretly cue your child to calm down or to focus. The child can even tell or signal the teacher that pressure is building, and there’s a need for “time out.”

  • Can you or the teacher improve your child’s listening skills? Encourage all teachers to speak slowly to your child, make eye contact, break down complicated instructions and, most important, check the child’s understanding of what he or she is meant to do.

  • How can you and the teacher help with organizational skills? Teachers can write instructions for school and homework clearly on the board. It’s helpful to have a special basket in the class for turning in completed homework. And the child should keep a good daily homework organizer.

  • What can the teacher do when the work seems “too much”? Allow the child to complete work in small segments. For example, have the child do four math problems at a time, then take a one-minute break before continuing, instead of expecting him or her to complete 30 problems all at once.

 

Most often, you will find your teacher to be your child’s biggest ally. If an outside psychologist has been working with your child, he or she can often help you make a case for the type of attention, or the type of schooling, that your child needs.

  • If you feel your child isn’t getting the support he or she needs at school, talk to the teacher.

  • If that doesn’t work, talk to the school administrators.

  • If that doesn’t work, talk to the school superintendent or school district officials.

 

Your child has a right to a free public education that’s appropriate for him or her.

Behavioral Strategies (How Parents Can Help)

 

Parents can do many things for children at home, including improving organizational skills and teaching social skills.

 

How-To Information

Practical Suggestions for Working with Your Child at Home

  • Make tasks as interesting and enjoyable as possible.

  • Adjust your expectations. Be consistent, but don't expect perfection in a hurry.

  • Use rewards and punishments that are meaningful to the child.

  • Give the child plenty of opportunity to talk and question what is going on.

  • Give the child time to succeed. Children with ADHD need more practice than others in learning tasks such as keeping track of their books or remembering to brush their teeth.

  • It is very important to build your child’s self-confidence. You can do this by encouraging and complimenting the child when he or she does well.

 

 

 

Helping Your Child Get Organized

A common desire of parents who have children with ADHD is to get their child organized. Here are some practical steps you can take to help provide structure:

 

  1. Establish a routine. Children with ADHD do better if their lives at home follow a routine.

    • Keep a schedule, with set times for meals, homework, TV watching, and so on.

    • Write out or draw the morning routine, from waking up to breakfast time. You might want to ask your child to check off each activity with a sticker or magnet as it is completed.

    • Decide the night before on what clothing to wear, so it is ready and laid out.

    • Together with your child, create a large monthly calendar with important activities and dates clearly marked.

    • Schedule family meetings at least once a month to discuss coming events, jobs, and schedules.

 

  1. Have your child help with household duties. This will make the child feel useful, like a member of a team. It will also give the child practice in organization and follow-through.

    • Share household jobs among all your children. Have each child do at least one every day. Use a chart, so that no one complains that it’s unfair. You could attach the chart to the refrigerator with a magnet, using pictures for a child who can’t yet read.

    • Have a set routine at mealtimes, with each child helping. Again, make a chart, so everyone takes turns.

 

  1. Have set times for homework.

    • Make sure the whole house is quiet at homework time, with no music, radio, computer games, or TV.

    • Be available to help your child. Children will study better if a parent interacts with them and assists them.

    • Set up a mini-schedule so that your child can work for brief periods, with short rest periods in between.

    • Have a quiet time for the whole family even when there is no homework to be done or the homework is finished. As a bonus, you’ll find that the adults benefit from this quiet time too — while also serving as role models for the child.

 

  1. Limit TV. Don’t allow unlimited TV. Teach your children to be discriminating. Sit down with them and let them pick out one or two shows a day. Do it ahead of time, and write down the times of those shows on the monthly calendar. Watch the shows with your children if you have the time.

 

  1. Help your child control his or her belongings. Children, especially those with ADHD, are not naturally tidy. Help them keep their possessions under control and learn self-discipline at the same time.

    • Label shelves in clothes closets with pictures or words.

    • Have one color for each child’s “tools,” such as backpacks, lunch boxes, toothbrushes, and so on.

    • Make sure backpacks are packed and ready for school the night before.

    • Have regular clean-out days when children empty out their backpacks and make sure they have enough supplies for the next week.

    • Have a laundry container in each room for dirty clothes. Insist that clean clothes be put away.

    • When children are old enough, show them how to use an organizational planner to keep track of homework and upcoming events.

 

 

Improving Your Child’s Behavior

Managing the behavior of a child with ADHD can be exhausting — but it can also be rewarding as you see progress. There is a lot you can do to help your child stay more or less in control:

  • Encourage specific positive behaviors. This works much better than trying to get rid of “bad” or difficult behavior.

  • Identify a behavior that you want to change and then be specific about the positive skill that should replace it. In that way, you can help your child replace a negative behavior with a positive skill.

  • Work on one behavior at a time — and make sure you identify the behavior accurately.

  • Encourage specific behaviors. This works much better than trying to get rid of "bad" or difficult behavior.

 

Changing Negative Behaviors To Positive Skills

 

NOT:

BUT:

Stop fighting with your brother.

Learn how to share.

Don’t interrupt me when I’m on the phone

Learn how to wait until I’m off the

Don’t leave your clothes on the bathroom floor.

Leave the bathroom tidy.

Stop being so difficult when getting dressed.

Learn how to tie your shoes.

Don’t yell.

Use a quiet indoor voice.

Don’t ignore your parents.

Pay attention to your parents’

requests.

 

Finish your homework or you will be punished.

You’ll get a reward for completing

With each success, your child’s sense of self-worth and self-confidence will increase.

 

 

Helping Your Child Get Along With Others

With patience, parents can teach their child to understand and follow the “rules” for getting along with others. When there is a problem:

  • Define it (determine what the problem is).

  • Consider strategies to deal with it.

  • Then put them into practice.

 

Here’s an example:

Scott’s friends ignore him. They say he always interrupts.

 

  1. Define the problem

Scott often interrupts his friends.

  1. Discuss the consequences

Friends are annoyed. They think Scott is rude, and they stop listening to him.

  1. Consider alternatives

Scott and his parents think of possible solutions. Scott says, “I could wait till it’s quiet before I talk” or “I could raise my hand” or “Sometimes it’s fun to be a listener.”

  1. Choose the best alternative

Scott says, “I’ll wait till it’s quiet, so I won’t interrupt, and everyone can hear what I have to say.”

  1. Discuss how to put that alternative into action

Scott says, “I’ll listen until whoever’s talking has finished.”

  1. Put the alternative into action and evaluate it

Scott tries out his new strategy and tells his parents how well it worked.

 

 

If the plan doesn’t seem to work the first time, it may need to be adapted. Or just keep working with the plan patiently, day after day. Your child can learn to problem-solve more effectively – one situation at a time.

 

 

Involving Your Child

Consider your child to be a partner in the treatment of the ADHD:

  • Children will do best when they know what is expected of them and are rewarded for doing what is asked of them.

  • Children need to learn to read their own signals and impulses, so that they know when they need to let off steam and when they need time out.

  • Children will often have suggestions and insights about which problems should be tackled next — and how. You just have to ask!

 

 

Rewarding Your Child

Rewards can help change behavior. They can be used to reinforce the specific positive skills or behaviors that you want to see more often. When a child gets a reward for doing something, he or she is much more likely to do it again.

 

Rewards need not be expensive — in fact, they don’t have to cost anything.

 

Rewards are useful in two sizes:

  • Small rewards that you give each time the child does a certain behavior.

  • Large rewards to be given after the child has kept up this behavior for a while or met a goal for improvement over a period of days or weeks.

 

Small rewards can vary according to the age of the child. For example:

  • A young child may be happy with a gold star to stick on a special sheet that shows progress.

  • An older child would do better with points or tokens that can be exchanged for a larger “prize.” This prize could be a toy or a special treat.

  • Money can work – a penny a time for a small child, a nickel for older ones. It adds up!

 

 

Need To Know:

Some Hints About Rewards

  • Don’t give rewards before the behavior has been done. That’s a bribe, rather than a reward.

  • Remember that hugs, smiles, or praise are also rewards, and will help encourage the child to repeat the type of behavior you are aiming for.

  • If the child is getting closer to the behavior you want, but isn’t quite there, give plenty of praise. This technique is called “shaping” — you are helping to shape behavior.

  • Give sincere reinforcement for specific behaviors. “Bogus” or general “good job” compliments are not helpful.

  • Don’t overdo the talking. Your actions (giving rewards) send the message.

  • Extra nagging, coaxing, and reminding about your goals can confuse the issue. Nonverbal messages work well.

  • Compliments are much more effective than criticism.

Is Punishment Appropriate?

Harsh punishments don’t work. Spanking only teaches your child that violence is a good way to express anger.

 

It’s often much more effective to “punish” children by ignoring them. This sends the message that if they want your approval, they need to earn it by doing “positive” things.

 

Sometimes, though, you may need to punish your child for breaking important rules. It is especially important for children with ADHD to know exactly what type of punishment to expect. If you tell them what to expect, you will seem fair.

 

  • Discuss punishments ahead of time. For example, tell your child “if you leave your bicycle out, you can’t ride it the next day.” Be as specific as you can.

  • Make the punishment appropriate. For example, don’t take away biking privileges because your child took food into the living room and made a mess of the couch.

  • Always follow through. For example, don’t ground your child for three days, then relent after one day.

  • Make the punishment right for the age. For example, a five-minute “time out” in the bedroom may work for a 5-year-old, but not for a teenager.

 

 

Keeping Track Of Your Child’s Improvement

You should measure how much you have succeeded in helping your child, and how much your child is improving. Here is a four-step approach:

 

  1. Keep a record. Track the number of times your child performs unacceptable behavior, such as ignoring you when you ask him or her to do something. In a notebook or diary, separate part of the day into one-hour blocks, and in each block, record how many times the behavior happened.

 

For example: “Ignoring me when I ask him to pay attention - How often?”

Tuesday 3 pm - 4 pm XXX

4 pm – 5 pm XXXXX

 

  1. Decide on a goal. Decide how much improvement you hope to see a month from now. Don’t ask for too much. Aim for partial improvement, just at one time of day. At first, plan to work on this one piece of behavior for a specific time — say, a week. Later you can aim for more improvement, more often during the day.

 

For example, if your child has been failing to pay attention about ten times between dinner and bedtime, you might want to cut the behavior down to two or three times during that time slot.

 

  1. Talk to the child about your plan. You might tell your child that he or she will get a reward each time he or she stops what he or she is doing, listens to what you are saying, and answers. Explain that at first you’ll only be keeping track at a certain time of day — for example, between 5 pm and 6 pm.

 

  1. Do it! Make sure you really can give your child a reward every single time that he or she stops, listens, and answers (it could just be a hug). Also, keep records, so you can see for yourself and show your child exactly how much improvement there has been.

 

ADD AND ADHD