What Every Parent of a Kid with ADHD Needs to Know
It was 7 p.m. and my 11-year-old son, Charlie, was lying across two dining room chairs playing with the cat. “If you don’t start your homework right this second,” I warned him, “your Xbox is next.” I’d already taken away his skateboard and pitched his new Matchbox cars, still in their packages, into the trash. Yet the books remained untouched. I felt guilty about the cars, so I offered to fish them out if he would at least do his math. He didn’t flinch. I was near tears—and pretty sure I could strip his room bare and he would lie there, blowing newly exposed dust bunnies across the floor.
If your child, like mine, has been diagnosed with attention deficit hyperactivity disorder (ADHD), you can probably relate. Sometimes it feels overwhelmingly hard to keep our kids on the path to success. But experts agree that addressing the disorder from all angles—not just medically, but behaviorally and emotionally as well—yields the greatest improvement. Try the following advice for a 360-degree approach to setting your child up for his happiest life.
STEPS TO SCHOOL SUCCESS
Academic woes tend to be two-pronged: classroom behavior and homework. You’ve probably read your share of notes from the teacher describing disorganization and daydreaming. Homework challenges can range from forgetting the assignment (or needed books) at school to endless procrastination.
• Refuse to excuse. Don’t try to make things easier or rationalize low grades because he has ADHD. Remind your child, as well as those who might enable him, that the diagnosis is not a free pass to lower standards. “At times, family members would try to justify Chase’s poor choices by claiming that his ADHD made it close to impossible for him to behave otherwise,” says Cheryl Lynn Foster-Gerton, of Thornton, CO, whose son is 13. “Chase began to mimic that thought pattern. We made it clear that having ADHD meant he might have to work a bit harder, but that we expected him to do so.”
• Exercise a.m. options. Early-elementary-school kids with ADHD who got some kind of workout before class showed reduced symptoms in one study. Experts believe physical activity could have the same impact on older kids. Depending on their ages, consider letting your child take the dog for a morning run, walk or bike to school or ride a skateboard to the bus stop and play around on it while waiting.
• Switch things up. Does your kid do better early in the school year, when the teacher and the classwork are still novelties? Introducing fresh twists—like a new location or way to study—can keep kids on task, says Elaine Taylor-Klaus, cofounder of ImpactADHD.com, an online training, coaching and support resource for parents. Have your child read on the porch, or turn studying for a spelling test into a game by tossing a ball as you quiz her.
• Play to your child’s interests. Speak with the teacher about incorporating his favorite topics (as much as is practical, of course) into homework. For example, can he read a book on dirt biking or do a biography on LeBron James, even though those aren’t on the list?
• Think outside the desk. If being free to move helps your child pay attention, ask the teacher if she can listen to the lesson while standing by her chair or at the back of the room, suggests Taylor-Klaus. Leave Post-it pads on her desk for jotting down questions so she doesn’t forget them or interrupt the speaker.
• Encourage fidgeting. Small sensory items can help a child focus and avoid touching or distracting others, says Taylor-Klaus, who also wrote Parenting ADHD Now! It could be sandpaper taped under the desk to run fingers over, a keychain attached to a belt loop or a rubber necklace. Find other options at Autismshop.com under “Sensory Items.”
Making (and holding on to) friends may not be easy. By third grade, disruptive behavior irritates more than it amuses classmates. What used to elicit giggles—say, dropping erasers into the classroom fish tank—soon becomes isolating. Charlie’s MO was throwing pencils at classmates to get their attention. It worked, but not in the way he’d hoped.
• Sign on for a social-skills group. Some YMCAs and public schools offer these meet-ups, as do private organizations. “Look for groups whose leaders are active, gentle and direct,” says Gayani DeSilva, MD, child psychiatrist and learning disorder specialist at St. Joseph Hospital in Orange, CA. Leaders should consult with every kid before sessions begin to get a sense of each child’s individual needs and establish rapport.
• Allow online friends. Kids with ADHD can struggle with interpreting nonverbal cues, like facial expressions. Online interaction levels that playing field. Plus, talking to buddies all over the world takes the sting out of having few friends at school. You’ll need to use commonsense caution, of course. Start by seeking out groups that draw kids with similar interests, like book review clubs. Roblox, the top gaming site for kids and teens, lets users win prizes and gain “assets” while interacting.
• Promote extracurriculars. Many children with ADHD shine in settings where they can be physically active or creative. A kid who feels isolated in school may easily make a good pal in karate class or chess club. Groups that emphasize acceptance (like church youth circles) and trying new things (like scouts) are a perfect fit, says DeSilva.
• Plan one-on-one hangouts. Usually, more isn’t merrier; it’s all too easy for kids with ADHD to be odd man out. “They’re often saddened by a perceived rejection, especially since they did nothing wrong to deserve it,” says DeSilva.
• Forget about age. Don’t discourage friendships with kids a year or two younger. “The younger the child, the more the energy and impulsiveness of a kid with ADHD is fun rather than annoying,” says DeSilva. Charlie built confidence and social skills by hanging with younger kids. Years ago, I worried it might not be good for him. But now I’m thrilled. He’s 16 and his best bud is 14.
HARMONY AT HOME
You’re having constant battles to get chores done, stick to a household routine or make it out the door on time. This can be extra frustrating during the school week: Kids, having held it together as best they can during the day, let loose when they return, so it’s enough of a feat to get homework done, never mind anything else.
• Break it down. Beat long-term procrastination by setting frequent, small deadlines and writing them on a calendar. This works well with school projects, but it can also help with big home projects, like straightening up a disaster of a room. Make jobs manageable by setting intermediate goals that can be accomplished in short bursts of effort, like cleaning out a closet. Then move on to putting away what’s on the floor or tidying up the desk.
• Look into PCIT. Parent-child interaction therapy is unique because it involves live coaching of the parents and child. Goals are set and “homework” is assigned. Although this treatment is relatively short-term (about 15 one-hour weekly sessions), positive results happen quickly and last for years, says Robin H. Gurwitch, PhD, a psychologist at Duke University Medical Center.
• Incentivize. “I had a distraught parent who removed everything but the mattress from her child’s room as punishment, and still the child’s behavior did not change,” recalls Scott Kollins, PhD, director of the ADHD program in the department of psychiatry and behavioral sciences at Duke University. Why does punishment rarely succeed? “The brain system responsible for mustering motivation, especially for less-preferred activities, doesn’t work the same way for individuals with ADHD as it does for others,” explains Kollins. An incentive is better than threats of lost privileges or possessions. “They stay so focused on the present moment that they don’t think much about how they’ll feel when they’ve lost whatever it is,” says Thomas E. Brown, PhD, associate clinical professor of psychiatry and behavioral sciences at the Keck Medical School of the University of Southern California. Time the reward so it’s given close to completion of the task. “Typically, these kids won’t continue to work for rewards that come later rather than sooner,” says Brown. In fact, focusing on the carrot instead of the stick could improve both your moods.
THE MEDICATION QUESTION
Deciding whether to put your child on ADHD meds is rarely easy. Yet experts agree that often the most effective treatment is a combination of medicine and occupational therapy to improve organizational and execution skills. “Many children with ADHD are treated as though they aren’t listening or trying hard enough to finish a task,” notes Gayani DeSilva, MD, child psychiatrist and learning disorder specialist at St. Joseph Hospital in Orange, CA. “Actually, they are trying harder than their peers. The biggest plus to meds is that when ADHD is managed well, kids can perform to their potential.”
Today’s meds are longer-acting formulations of older go-tos, such as Concerta (a 10-hour form of Ritalin) and Vyvanse (a 10- to 12-hour version of Adderall). Other options your doctor may mention are Clonidine, Tenex and Intuniv (antihypertensives that also control impulsivity). Ask doctors these three questions when discussing your child’s treatment plan:
→ “How can I make sure my child gets the nutrition she needs daily?” Stimulants can suppress your child’s appetite, so you’ll need to ask about and watch out for vitamin deficiencies.
→ “Will this medication cause tics?” Kids who are prone to them may have more pronounced tics on ADHD medications.
→ “How long will my child need to be on medication?” The typical treatment course for a stimulant is one year before reassessing the child’s needs.
TIPS FROM THE TRENCHES
"When we started waking Charlotte up to her favorite music, she jumped out of bed and practiced dance routines. She now comes down to breakfast singing. It was a total turnaround to our mornings." —Terri Johnson, Eden Prairie, MN
"When he gets to that uncontrollable and intolerable point, speaking softly while making eye contact and pulling him in for a hug usually does the trick." —Dawn Rossetti, Long Beach, NY
"We do homework in 10- or 15-minute blocks throughout the afternoon and evening." —Patti Barnes, Vancouver, BC
"I hired a tutor specializing in kids with ADHD for 90 minutes twice a week. I save the long-term projects and studying for her. This has saved my life." —Kristina Godfrey, Orange, CA
"I focus on what it’s like for him. He doesn’t want to be like this. It’s simply how his brain is working. Remember that and it’s easier not to get frustrated." —Matthew Becker, Portsmouth, NH
"A picture schedule on his bedroom door reminds him what he’s supposed to be doing and when. We direct him back to it when he’s off track. It also has pictures of what he can do after completing each task." —Amanda Morin, Portland, ME