Is there a difference in ADD and ADHD?
No. ADD was the name given in the third edition of the DSM-IV. It is still widely used and interchangeable with the more current ADHD.
How do I know if my child has ADHD?
There is no scientific diagnostic test for ADHD. It is most often diagnosed in consultation with parents, teachers, counselors and others who know the child or adult well. There is a specific set of 18 symptoms for children and adolescents and a child must meet a minimum number of symptoms to be diagnosed.
How do I diagnose ADHD?
Getting a correct diagnosis is critical. One problem is that there is not a diagnostic test currently available. It is not uncommon for the problem to be suggested to a parent by a teacher. A trip to the doctor is next and he might say “let’s try this medication to see if it works.”
There is a better way. Find someone who is experienced and an expert. Many psychologists and counselors treat a wide variety of clients with a wide variety of presenting problems. That might not be your best option. Get a complete evaluation. It should take more than 30 minutes and should involve both quantitative and qualitative measures, using the most up to date methods available that are scientifically valid. These measures should be done by a variety of people involved in the child’s life. The assessment should consider a whole range of co-morbid conditions. Assessments should be complete and presented in writing to the parent. Suggested treatments should encompass more than one approach.
Treatments for ADHD vary tremendously in terms of approaches, effectiveness and costs. What works for some people may not work for others. Most practitioners would now consider a combination of approaches to be the most effective.
How many people actually have ADHD?
For the last few years it was reported that approximately 3-5% of children and adolescents had ADHD. More recent results by the Centers for Disease Control indicate that 7.8 % of children and adolescents have enough symptoms to qualify for a diagnosis. In addition, many adults carry significant symptoms into adulthood. ADHD Wichita Falls estimates somewhere between 12-18 million Americans have the disorder.
Doesn’t everybody out grow it?
No. More than half of the children diagnosed in childhood will carry significant symptoms that will interfere with their lives into adulthood.
Can’t I just ignore it?
You can, but that puts your child and your family at risk. Look at the following:
- 35% never finish high school & 25% repeat at least one grade.
- 52% of untreated teens abuse drugs or alcohol.
- 19% smoke (compared to 10%).
- 43% of untreated hyperactive males will be arrested for a felony by age 16.
- 50-75% of inmates have been found to have ADHD.
- Parents of ADHD children divorce three times more than the general population.
Isn’t medication the only thing that helps?
No. There are a variety of approaches that may offer some help. See types of treatment available below.
What about counseling?
There is no evidence that traditional cognitive behavioral therapy works very well with the disorder. Experienced and honest therapists will admit that results under the best of circumstances with highly motivated clients yield meager results.
Why does a stimulant calm my child down?
That would be the opposite of what we would expect. What we believe is that the areas responsible for self control and inhibition of impulses are under activated. Stimulant medications may stimulate those areas and get them to work at their proper level, increasing the person’s ability to exhibit self control.
Can girls get ADHD?
Yes. Females have ADHD in almost the same percentage as males yet are diagnosed four to five times less often. Some recent studies indicate that girls are diagnosed as nine times less often.
My child seems to have problems other than just paying attention. What about that?
It is VERY common for other problems to be associated with ADHD. If the brain is not working well we would EXPECT a broad range of behavioral and emotional problems.
Co Morbid Disorders and ADHD
Co-morbid disorders is a clinical term for conditions that often accompany ADHD or look like ADHD. The range of current estimates suggest that 50-90% of children diagnosed will have at least one other diagnosable mental health issue. While the range is large it does suggest that very few have “simple ADHD.”
Disruptive behavior disorders like Conduct Disorder and Oppositional Defiant Disorder are probably the most common. These disorders often lead to significant family disruption and parenting challenges as well as behavioral difficulty in school and relationship problems with both peers and siblings. We often see learning disorders like dyslexia and problems with depression with ADHD children. When you look at the list of symptoms for anxiety and ADHD there are several common symptoms. There are likely higher rates of bi-polar disorder as well as obsessive-compulsive disorders. The list also includes language difficulties and problems with reading and writing, auditory processing problems, and tics.
ADHD Wichita Falls screens for Scotopic Sensitivity Syndrome as well as absence seizures. Previously known as petit mal seizures, an absence seizure is a brief episode of staring. They usually appear from age 4 to 14 and about 70% outgrow them. They are characterized by a distinct “spike and slow wave” activity on an EEG. During the seizure, awareness and responsiveness are impaired. They may last for 5 to 30 seconds and the person isn’t usually aware that they have had one. A person can have may of these types of seizures a day. We are finding that a significant number of our clients with ADHD have some of these types of seizures. Having these types of seizures can lead to significant problems with attention.
Additional health risk behaviors include higher rates of smoking, increased risk taking behaviors, more injuries, and more substance abuse. Higher rates of teen pregnancy are often associated with ADHD.
It is critical than any assessment consider a wide variety of associated conditions. Failing to recognize these puts any treatment at risk for not being successful. ADHD and these co-morbid associated conditions makes treatments more complex but also more important to achieve normalization of behaviors and symptoms.
Should I tell my child’s teachers?
That’s a decision every parent should make carefully. Chances are your child’s teacher has already seen some signs and may be relieved that you begin to discuss it with them. One concern is that your child might get “labeled.” A possible advantage is that you can begin to discuss ways to cope and that everyone works together for the benefit of your child.
ADHD impacts school more than any other aspect of a child’s life.
ADHD children do worse on objective measures of achievement such as grades, group tests, and individual achievement tests (large effect size, 1-2 standard deviations). ADHD predicts other school-related impairments, such as special education placements, retention, and suspension. Up to 50% are suspended, 15% have math/reading disabilities, 80-90% are significantly behind in school by fourth, fifth, or sixth grade.
Most classrooms are not structured to help a child with ADHD succeed. The challenges vary and change depending on where your child is in school.
As a parent of an ADHD child, you have legal rights as well. Section 504 of the 1973 Rehabilitation Act states that in order to qualify for services a child must have “an impairment that substantially limits a major life activity.” Given the limitations that ADHD places on a child it is likely that your child qualifies. But there is room for interpretation and guess who gets to make the call? Your school. In order to be evaluated under 504 a formal request in writing must be made. Your school has a specific set of guidelines and must proceed. They will notify you and you can appeal if the decision is that your child does not qualify. If he qualifies under 504 the school should develop a specific learning plan for him. 504 can help with getting your child a more structured learning environment, modified testing and homework, additional learning aids, visual study aids, modified class schedules, modified tests. These can be of great benefit to your ADHD student. Educate yourself about your rights.
You may also have the right to request specific teachers for your child when they change grades. If you have that right you might want to go interview teachers for next year. Some teachers don’t believe in the reality of ADHD. Choose one that does. A teacher who uses multi-sensory learning strategies will help. Is your child a auditory, visual or kinesthetic learner? If you don’t know then learn about learning. Ask your teacher what they’ve read about ADHD. Once your child is in their class, determine how often you will meet with them. Communication with the teacher is critical. Sometimes daily or at a minimum weekly communication is necessary. Let the teacher know you support her efforts to help and discipline your child. Monitor grades and homework. Over the course of several years you will have lots of interaction with the school. Document everything, both positive and negative.
Lunchtime and recess are opportunities, for both good and bad. They give time and allow your child to burn off some needed energy but can be noisy, chaotic, and overwhelming. Kids often get picked on during those times. Transitions back to working in the classroom may take longer for ADHD children after a break.
How do you deal with homework? This is perhaps the toughest challenge for parents. I know of one parent who battled his child for hours every night. The child would not finish it. Finally, after bedtime, the father would do the homework. This dad, rewarded his child for not doing their own homework. Here are some suggestions:
1) Provide a distraction free place to study.
2) Work in small time frames and take frequent breaks.
3) Find ways to make sure they turn in what is done. ADHD children will often do the homework but not turn it in.
4) Set a time limit on homework and stick to it. Even if they don’t get all the homework done.
5) Keep track of projects and start early.
Consider alternative schools including charter schools, private schools, and home schooling.
School will be a challenge, but ADHD impacts school performance more significantly than any other area of life. Your efforts will make the difference.
Isn’t ADHD a new disorder?
No. It was first described in 1902 by British physician George Still. It was called by various names over the years including Minimal Brain Damage, Minimal Brain Dysfunction, Hyperactivity of Childhood, Hyperkinetic Reaction of childhood, ADD and now ADHD. Various theories for it’s causes included bad parenting, defiance, moral defectiveness, poor diet, allergies, brain damage, toxic exposure and traumatic brain injury.
History of ADHD
It was 1902 when a British doctor named George Still identified a cluster of symptoms found mostly in boys. He called it minimal brain damage and that explanation made perfect sense at the time. It was called by various names over the years including Minimal Brain Dysfunction, Hyperactivity of Childhood, Hyperkinetic Reaction of childhood, ADD and now ADHD.
It was thought that there may have been a number of causes of the disorder. Perhaps the most logical “sounding” explanation is that ADHD is caused by bad parenting. This misconception is still believed by many people. It’s not true. Others suggested that it could be that ADHD is just an explanation for a defiant kid who wants his own way at home and at school. Perhaps there is some moral deficit. Poor diet, allergies, toxic exposure, traumatic brain injury and brain damage are other suggested causes. None of these explanations over the last 100 years explains this very complex disorder.
Since the publication of the Diagnostic and Statistical Manual-IV in 1994 by the American Psychiatric Association, ADHD has been thought of with two primary aspects of the disorder. One set of symptoms is grouped around aspects of being inattentive and distractible. A second set of symptoms is grouped around aspects of hyperactivity and impulsivity. Some people have characteristics of both groups of symptoms.
It has been assumed for years that many people “outgrow” it and that adults don’t have symptoms. That’s simply not correct.
ADHD is perhaps the most researched mental health disorder. Current and future thinking and the explosion of research into brain function that is occurring will bring changes in the way we think about ADHD. Some are suggesting future classifications of at least five and perhaps seven different disorders or sub types of the disorder.
One new but controversial theory by a neuropsychiatrist from California named Daniel Amen has emerged
He says there are SIX types of ADHD, not the traditional two or three suggested by most mental health experts. Dr. Amen has done SPECT scans on 15,000 patients over the last several years which measures blood flow in the brain.
Based on that research, he has clearly identified six different patterns of blood flow which emerge, and the results have been fascinating. Dr. Amen says that some traditionally prescribed and effective medications make some types of ADHD worse. Because that’s true, getting the correct diagnosis is critical.
Shouldn’t my child be able to control his behavior?
Yes and No, and it’s the frustrating part of parenting a child with attention problems. They often seem to be able to pay attention to things they are interested in and can sometimes pay attention very well and then not at all at other times. For many of these children there are times when it is “I won’t” and at other times it may be “I can’t.” Being able to tell the difference is difficult but also critical.
Child Self Control
One of the most frustrating concerns for the parent of a child with attention problems is the fact that they can SOMETIMES control their behavior and attention. Parents often comment that they can play video games for hours but can’t do math or reading homework for “five minutes.” They believe that if he can pay attention with one thing, he ought to be able to pay attention for everything.
But that’s not the way it is. Why?
First let’s consider why the child has ADHD in the first place. Simply put, for most it’s caused by an underactived prefrontal cortex. That prefrontal cortex NEEDS stimulation and it feeds off of high stimulation environments, like video games, or music, or sports or even just noise. When they are in medium to low stimulation environments their brains just don’t get enough “stuff” to rise to the level that keeps them interested and engaged. In the thinking part of the brain blood flow and electricity determine much about how it works. Some studies have shown that for the ADHD child, blood flow to the thinking part of the brain is actually reduced when given a concentration task, making them less able to focus and think. It’s at precisely the time they need more blood that they get less.
The real cause is a disregulated brain. It’s a brain that can “sometimes” pay attention and sometimes can not. Sometimes it’s a child who is choosing to not do his homework because he doesn’t “want” to. Knowing the difference between CAN’T and WON’T is among the most difficult but also the most important task for the parent of an ADHD child.
So then each parent must decide how they are going to respond to that after they determine if it’s CAN’T or WON’T. One choice is to blame and pressure the child. Usually that doesn’t work. We can punish him or reward him. ADHD kids often won’t respond to those very well either. Make him stay until it gets done? If your child has ADHD you know that can take hours. Here are some suggestions.
1) Take a break from the tasks and come back to it in a few minutes.
2) Break the task into smaller sections so it doesn’t seem so overwhelming. 15 minutes may be the most ADHD kids can handle.
3) Remove distractions of music, TV or other visual and auditory nature.
4) Go for a walk or do some exercise. Exercise increases blood flow to the brain.
5) Plan early so there is enough time to complete the projects. Last minute usually doesn’t work.
6) Don’t tell them to “try harder.” It will often make things worse.
My child has trouble sleeping in addition to having trouble with attention. Are those two problems related?
Absolutely. The scientific evidence is clear that they often go together. Your child’s brain can either be stuck in an “underaroused” or “overaroused” state and sometimes both. Their brain may not slow down enough to get adequate sleep. Very few of our ADHD clients are getting an adequate amount or an adequate quality of sleep.
I don’t know of a single ADHD client that doesn’t have some trouble with sleep. Mornings can be particularly difficult for the person with ADHD. Children often have trouble “waking up” and parents often get increasingly frustrated, finally resorting to yelling and threats. The morning starts off with hostility and anger making everyone feel bad and starting the day off focusing on the problem rather than things that are more important.
To start with, evaluate how much sleep your child needs. Most parents underestimate the amount significantly. According to the National Sleep Foundation, the numbers below represent the average sleep requirements based on age and the average amount children get.
|Age||Sleep Needs in 24 hours||Average Amount of Sleep|
|Newborns (0-2 months)||10-18 hours|
|Infants (3-11 months)||14-15 hours||12.7|
|Toddlers (1-3 yrs)||12-15 hours||11.7|
|Preschool (3-5 years||11-13 hours||10.4|
|School children (5-12 years)||10-11 hours||9.5|
A study published in the March 15, 2002 issue of SLEEP suggests there is a strong link between sleep problems in children and ADHD. The study of 866 children between ages 2-23 found that children who frequently snore or have sleep disorders are almost TWICE as likely to suffer from ADHD as those who sleep well.
Children with ADHD often have trouble getting to sleep, staying asleep, and waking up well. Below are some basic suggestions for helping your child with sleep.
1) Get to bed at a reasonable hour. That’s likely going to be earlier than what you child wants.
2) Set an alarm clock to a type of music your child likes.
3) Give your child his medication 30 minutes before his get up time, let him snooze and then get him up.
4) Have a quiet time beginning at least one hour before bedtime.
5) Consider “brainwaive entrainment” music. These tapes send out pulses that are the same brainwave frequency as sleep frequencies. Many of our clients have had some success using these. They are inexpensive and readily available in music stores or on the internet.
6) Talk to your doctor about melatonin. The research hasn’t clearly demonstrated it’s effectiveness but many ADHD Wichita Falls clients use it to their benefit.
7) Take the television and computer out of the bedroom. Make the bedroom for sleep only.
8) Use sleep medications only in the short term. The tend to lose their effectiveness after a few weeks.
What type of treatments are available?
There are basically three types of treatments. The first of those are biological treatments. They may include medication, changes in diet and exercise, vitamin supplements, neurofeedback, rhythmic entrainment intervention, auditory integration training, and vision therapy.
The second type of treatment is psychological treatments. They include counseling coaching, training, and behavior management techniques.
The third type is social treatments. Social treatments would look at the home environment, school situations, and even work settings.
Most professionals would recommend a combination of approaches.
What works? What doesn’t?
ADHD Wichita Falls is interested in improving how our clients function. Our motto is to “do whatever works.” What works with your child may not work with others. Below is what we have seen as the “best evidence” for efficacy of treatments.
Medication: The research indicates 75% of patients get some benefit from a carefully chosen and monitored medication strategy. Almost 250 studies have verified this over the last 20 years. Choices are usually either stimulant medication, anti-convulsants, or medications used to treat depression. Side effects do exist but are usually manageable for most patients. One significant problem with medication is compliance. The majority of patients do not tend to take their medication correctly or for a long period. Medication only works while it is in the patients system. It tends to wear off and exit the body quickly. It can be misused.
On April 6, 2006, the FDA approved the newest approach for treating Attention Deficit Hyperactivity Disorder. Children ages 6-12 can now get a “patch” to administer their medication.
Daytrana is a once daily patch applied by the parents on alternating hips and worn for nine hours. Parents will be required to track and chart the application and removal of the patch each day. Side effects if the patch is worn too long may include insomnia, blurred vision, slower weight gain and height growth, skin irritation and allergic reactions. Doesn’t sound all that appealing does it?
Medications used to treat ADHD are nothing new. Dr. Charles Bradley directed the first study of the effects of amphetamine on children with conditions that we now call ADHD in 1937. Since then more than 250 clinical studies have expanded on those findings. There are basically two types of medications used to treat ADHD – amphetamines (Adderall, Concerta, Cylert and Dexedrine) and methylphenidate, typically known as Ritalin.
What we believe is that these medications increase the dopamine output and increase the activity in the prefrontal cortex and temporal lobes of the brain. Research suggests that these are very safe medications when administered correctly. In late 2002, the FDA also approved the first non-stimulant medications for ADHD. These include anti-depressants, drugs initially used to treat hypertension, and some anti-convulsants.
Several important questions remain. Will it help? What are the side effects? Does my child need to be on the medication long term? Can the medication be misused? Is it being over prescribed?
First, studies clearly show that children and adolescents do benefit from medication when combined with counseling. The problem is that not a single study followed children beyond a 14-month period after beginning medication, so we don’t know about long- term effectiveness or health risks.
Given that ADHD is a chronic condition and is likely to persist into adolescence and even adulthood, a long-term approach to treatment and medication is a key to getting the long-term benefits most parents and children need.
Adverse side effects can occur, but these problems can often be eliminated completely or significantly reduced by adjusting the amount or type of medication. Typical side effects include loss of appetite, insomnia, stomach upset, headaches, rebound symptoms where moodiness or irritability is severe when the medication is wearing off in the afternoon or evenings. It is critical that parents work with their doctors to do manage those side effects.
Can the medication be misused? Absolutely. Many children are approached at school to give away or sell their medication because of the “buzz” that it gives other kids. Some ADHD kids misuse their own medication.
Are we “overprescribing” the medication. One study identified 159 children with ADHD in a southeastern city and determined that only 42% of those children were taking medication of any kind. Twelve months later, only 64% of the ones started on medication were still taking it. The result was that only 27 % of those diagnosed were medicated for the condition.
Yet, use of the medication is growing enormously. Global use of medication rose 300% from 1993 to 2003 and costs rose 900% (adjusted for inflation) during the same period.
So should I medicate my child? No one can answer that for you, nor should they. The long-term side effects of having untreated ADHD are immeasurably worse than any side effects caused by the medication.
Diet and Exercise
Many clients report improved attention and stamina with proper diet and exercise. This would be true even if the client didn’t have ADHD. There is no research evidence that suggests that this is a cure, but it may be a very effective way to help cope with the problems typically associated with ADHD. ADHD Wichita Falls recommends 30 minutes of aerobic exercise every day for our clients.
Here’s a basic premise. Every bodily system works better with proper nutrition and exercise. Many children get too much sugar and not enough physical exercise. The question is whether a change to a specific diet will help with the symptoms of ADHD. Most professionals recommend a low carb/ high protein diet. Starting the day with muffins, donuts, and sugary cereals almost guarantee lack of attention at school within two hours after they arrive. Here are some basic recommendations:
1) Get enough water. Nutritionists recommend at least 8 eight ounce glasses of water per day. Soft drinks don’t count. Avoid caffeine.
2) Proteins are essential. They get broken down to amino acids in the body and are either used or stored for later use. Typical basic proteins would include chicken, turkey, very lean cuts of beef and fish.
3) Carbs. There are three types of carbohydrates: sugar, simple and complex carbohydrates. Families with ADHD should select more complex carbohydrates for their diet which would include more fruits, vegetables, peas, beans and whole grain products.
4) Fats. Should we eliminate all fat in our diet? Absolutely not! Nearly half of the brain is composed of fat. Nearly one third of that is composed of a long chain fatty acid called DHA. Diets high in DHA increase essential neurotransmitters in the prefrontal cortex of the brain. Healthy DHA foods include olive oil, canola oil, grapseed oil, avocados, nuts, and fish oil.
Here are some principals for your diet:
1) Eat three meals per day and one or two snacks.
2) Eat a protein at each meal
3) Increase complex carbs and reduce simple carbs.
4) Less fruit juices and more fish and nuts.
Vitamins and Supplements
A multivitamin providing 100 % of your daily allowance is good advice for all of us. Very few of us eat a balanced diet these days. There are many supplements which may increase specific amino acids and neurotransmitters which may be lacking in ADHD brains. Research them well. Use them only under the direction and supervision of your physician. Remember that anything that we put in our bodies impacts how our brain functions.
A “balanced” diet may be a thing of the past in our fast food society. Families where ADHD exists usually have problems planning and may eat out more often than those who don’t. Providing everyone in the family with vitamins and supplements that provide 100% of your daily allowances is a good strategy.
Never take supplements without the advice and close supervision of the supplements by your physician. Some ADHD clients have deficiencies in the neurotransmitter dopamine. L-tyronsine is the amino acid building block for dopamine. Other types of ADHD clients have lower levels of serotonin as well. St. Johns Wort is thought to increase the level of serotonin in the brain. It may also decrease prefrontal cortex activity. 5-HTP may also increase cerebral serotonin. GABA is an essential amino acid in the brain that can be taken as a supplement. DLPA, SAMe, and ginko biloba should be researched and considered as supplements. If you want to consider these then do your research carefully. Consult with your doctor. Monitor the impact of the supplements carefully. Try one at a time so you can evaluate their effectiveness. Remember that anything you put in your body will impact it in some way.
Neurofeedback: Research into NFB started in the 1960’s. Think of this treatment option as brain exercise. The purpose of the training is to be able to change your brain wave patters when you want to, giving you a new ability to regulate your own brain. This new found ability should translate into improved behavior. The process is usually a slow and gradual one but there is significant scientific evidence that suggests that the changes may last long term. One limitation is that it usually takes many sessions to begin to see some real benefit.
Research into NFB started in the 1960’s. Think of this treatment option as brain exercise. The purpose of the training is to be able to change your brain wave patters when you want to, giving you a new ability to regulate your own brain. This new found ability should translate into improved behavior. The process is usually a slow and gradual one but there is significant scientific evidence that suggests that the changes may last long term. One limitation is that it usually takes many sessions to begin to see some real benefit. Neurofeedback therapists use sensors placed on the head to monitor, measure, and adjust brain wave activity. What we know is that the left side of the brain is responsible for focused, selective attention and that the key chemical in that task is dopamine. The left side is also responsible for carrying out routine and repetitive tasks.
We believe that people with attention difficulties produce too little dopamine. The reduced dopamine slows the brain wave activity and the result is that the ability to stay focused drops significantly.
The right side of the brain is tasked with processing vision, spatial location, and the ability to shift attention. Norepenephrine is the critical chemical. We believe that the right side may produce too much of this resulting in the need for novelty and change.
Research done over the last 30 years shows that people with attention problems have decreased blood flow and metabolic activity in the frontal/prefrontal areas of the brain. Stimulant medication works to improve function in those areas and with those changes the brain is able to work more effectively.
Getting the brain wave patterns in a normal range is critical to being able to focus, complete tasks, reducing distractibility and impulsive and aggressive behavior. Effective neurofeedback under the direction of a competent professional can do that.
Rhythmic Entrainment Intervention: This therapy uses auditory rhythm’s to stimulate the nervous system. Studied specifically since 1993, the scientific evidence is minimal at this writing. The idea is that the brain will change to match the rhythm of any stimuli around it. In this therapy an individually prepared CD is created based on an extensive interview of the client. The purpose of the CD is to stimulate the brain to a different state.
Auditory Integration Training: Developed in the 1950’s by French physician Dr. Alfred Tomatis, the method uses specific types of frequency that is intended to change the way you hear sound. The purpose of the treatment is to correct problems with auditory processing, which may be associated with attention problems. Most of the research with this method involved children with autism and involved very small numbers of subjects.
Vision therapy: Some problems related to attention may be related to Scotopic Sensitivity Syndrome. What may happen is that for some clients, letters move and shift and wiggle and change while reading. Also called Irlen’s Syndrome, clients find reading is easier with a series of color overlays that are placed on the page. Colored lenses may also be used.
Counseling: Cognitive behavioral therapies and behavior modification approaches are the standard of care and show some benefit to ADHD clients. These approaches require significant commitment of time, effort and energy by the client and their families and only last as long as the client is motivated. Most experienced therapists would admit that counseling ADHD children and adolescents is often difficult because they lack the insight, experience, and ability to make changes that are required by these approaches.
Several approaches for counseling and therapy for people with ADHD. Insight oriented therapy requires long and regular conversations with a therapist so that the client can understand “what makes them tick.” If a client understands that they have an opportunity to make changes. While it may have some value for adults, the value for children is clearly limited.
Cognitive-behavioral therapy is the therapy of choice for most mental health practitioners these days. Many studies have demonstrated it’s effectiveness across a wide range of mental health issues. It uses a systemic approach to help the client identify their thoughts and behaviors and establishing a connection between the two. The theory is that if you can change your thoughts then your behaviors will change as well. It also requires a good deal of self awareness that doesn’t usually exist in children and adolescents.
Behavior Modification approaches use a system of rewards and punishments to help the client change. It sets up a very structured system that rewards desired behavior and gives consequences to negative behaviors. The very detailed system is usually developed by therapists and parents together and implemented primarily by parents and teachers. It is a very demanding approach that usually requires significant changes in family structure and functioning. Some therapist recommend a token system in which the child earns tokens for positive behavior and is “fined” tokens for negative behavior. Token are then traded in for desired privileges. In addition, ADHD kids often don’t respond as well to rewards and punishments as do other children.
Experienced child and adolescent therapists will usually admit that benefits to ADHD children and adolescents using the traditional standard of care approaches have limited benefit to the client and their families.
No formal training is required to become “an ADHD coach.” Professional ADHD coaches use a variety of approaches to help a person become more successful. They will work on helping a person with ADHD get organized, set goals, stay motivated and develop management skills. While advocated by several national organizations, there are few standards in this field, no standard approaches and almost no research documenting it’s effectiveness. Coaches will vary with training, experience, and other qualifications. Contact between coaches and clients can range from daily to even monthly meetings. While advocated by several mainstream ADHD groups, there is little evidence to demonstrate how effective coaching can be.
Social Skills Training
ADHD children and adolescents have clear social skills problems. They are more aggressive and impulsive, break rules, complain more often and are viewed by peers in a negative fashion. This often leads to children internalizing problems resulting in loss of self esteem, motivation and increased frustration. Much research has clearly demonstrated that there is significant and negative social impact on children with ADHD. Much of this is due to the difficulties with mood and the impulsive and often aggressive behavior of the ADHD child. Recent research has reported that three basic skills can make a huge difference with these children. Learning to follow the rules of the games that are played, exhibiting pro-social behaviors and not whining or complaining are the three critical changes that kids with ADHD need to make in order to minimize the negative impact in social situations. Social skills training is time consuming and may be difficult to generalize to school situations.
No standard approach for social skills training is recognized at present.
Doesn’t having ADHD mean that my child can’t succeed?
Absolutley not. There are many accomplished and successful people who use this challenge as a way to be creative and energetic. There are many careers that are suited to adults with ADHD. Everyone has challenges based on their personalities. Everyone has strengths and weaknesses. The challenge is to use this and find a way to maximize their strengths and compensate for the weaknesses.
Successful People with ADHD
ADHD doesn’t guarantee your failure. Believe it or not, there are many successful people with ADHD. They have learned to cope with their weaknesses and capitalize on the creativity that often comes with ADHD. They choose careers that work well with the limitations that ADHD brings.
Below is a list of people who many believe have ADHD. They have achieved a great deal of success in spite of having ADHD. The list includes presidents and statesmen, athletes, entertainers, scientists, explorers, inventors, military leaders, writers, and artists. In short, successful people in every career field you can imagine who made incredible contributions in their fields.
Alexander Graham Bell.
Orville and Wilbur Wright
John F. Kennedy
These people were artistic, creative, intuitive, visionary, exuberant, and original. What makes anyone think they can’t be successful and still have ADHD?
My child is often frustrated, negative, and angry. How can I help his change the way he thinks about things?
It is not an uncommon response to a child who can’t seem to cope very well with the stresses normally associated with school, peers and home. They often sense that things aren’t quite right with them. We often see them hit themselves in the head as if to say “OK, Brain, start working like you should.” Our response as adults is to gently challenge mistaken beliefs about themselves and the world. It’s not easy to do but it is critical for their success.
Thinking Skills for ADHD
Everyone has an “internal working model of the world.” It’s their belief about how the world operates and how they fit into it. Having ADHD changes a person’s model. People with ADHD often develop mistaken beliefs and maladaptive thought patterns. Many believe they are destined to become a failure, are stupid and that they aren’t worthy of being loved. Teaching a child to “think about their thoughts” is a basic therapeutic technique.
Below are some patterns of thought and some mistaken beliefs that impact people with ADHD. Correcting them requires awareness, intervention, and patience.
1) Blaming and guilt. Perhaps the most problematic of thinking patterns. We blame either ourselves or others for problems. Neither is helpful. Working to find solutions is. If you hear blaming then it’s time to take a break and rethink what needs to be done. Guilt is rarely helpful. It often motivates us to do things that are usually bad, because we feel inappropriately responsible. There is a huge difference in feeling sad and feeling guilty about an event or an experience. Sort out which is which. If you do then you’ll respond better.
2) Labeling. Kids with ADHD often get labeled as problematic, angry, aggressive and unmanageable. While many do have behavioral problems and all have problems with self control, it isn’t helpful to label them as anything. Labels often tend to follow children. We should be more concerned about solutions than a diagnosis. Don’t let them label themselves and don’t let anyone else label them either.
3) Predicting the future. Can anyone possibly know the outcome of what will happen? Yet, ADHD kids will often do that, predicting a negative outcome because of past experiences. Help your family member stop that when it occurs.
4) Always and “all or nothing” thinking. Usually designed to avoid something that we are fearful about, when we hear “always” or “never” or black and white responses then we can assume some emotion associated with the future event we are trying to avoid. Talk about the emotion that exists rather than what might or might not occur.
5) Giving up. We once had a nine year old in our center who had a 138 IQ. He had already decided he wanted to be cowboy when he grew up “because Cowboys don’t have to go to college.” He had given up on school by age 9 in spite of being the smartest child in his class. Is having ADHD problematic? Yes! Is it challenging? Yes! Can we learn to cope and succeed? Yes!. Look at the list of incredibly successful people who did well in spite of the problems. Don’t ever let your child believe they can’t be successful because they have ADHD.
Identify other mistaken beliefs. Every ADHD person develops different ones as a result of their experiences. Help them believe. Instill hope. Exhibit confidence. Show love. Be patient.