MLM4164
No, I'm not a teacher but I am happily married to one who has taught the primary grades for almost 20 years. The stories she shares of her day to day experiences really makes me glad that she's in the classroom and not I.
Regarding your question. Checkout this specific site that CSMOMMY discovered. It has a letter to the teacher explaining about your child. More important is the class guide that is also included. This guide (according to my wife) really works and helps to reduce some of the issues you described. Let me know what ya think.
http://www.additudemag.com/ourkids.asp?DEPT_NO=302&SUB_N O=10
Paul
Paul,
are you a teacher? My 6 year old was knewly diagnosed about 2 months ago and has been on adderall xr since. We have a meeting on Thursday with my sons teacher, counselor, principal, nurse ( it's suppose to be a support group meeting on my sons progress). I ran into my son's teacher like 3 weeks after he started taking the medicine and she said how great he is doing and much improvement with his work. However at the same time with him started medicine apparently she was having problems with most of the class. The issue was having to repeat directions and if she had to repeat directions to the student they would have to move there bus which means losing part of recess(punishment). In turn my son was still getting in trouble several times a week because she would have to repeat herself. My concern is he was just starting his medicine and really feeling better about himself and feeling more in control yet being brought down verses supported by his teacher. I know that as a teacher she can not repeat directions several times to each of the 17 kids in the class however I feel this was a big moment in my sons life and a little bit of flexibility would of been great from her. What and how could I explain my opinion on thursday without the teacher taking offense? Opinions would be appreciated
Marcie
Paul
I just thought I would let you know how it turned out of thursday. I was so nervice. I even said prayers for God to help me find the right words to say to the teacher and he did! I started off by thanking them (the teacher, counselor, and principal) because without them I probably would never of gone to my doctor. And then we talked about how my sons behavior has improved since he has been on the medicine. I somehow found the right words to tell her how I felt about her coming down on the whole class when my son first started the medicine and how horrible he felt with still getting in trouble and really feeling like he was trying. And instead of bringing the "letter" and information about ADHD to the meeting I simply said at the end of the meeting, "you know I have found so much information out about adhd that has help us with out parenting and there is so much information out there that can be helpful to you with your class, would you like me to email you some information? Hopefully she wasn't just being polite but she said yeh that would be great! Anyway My husband and I felt pretty good about the meeting and I thought I would share.
Thanks for listening
Marcie
Scottish rite can take 9 months and must have refferal by a Dr. My sons eeg shows left posterial slowing not any fast things or frontal lobe like talked about here.I have a child diagnosed with ADHD, his taking Ritalin and he is in ESE (Exceptional Student education). His mayor problem is reading & comprehension. He has improved, but he is not in the level where he is supposed to be for his age & grade. I'm worry that this situation can lower (even more) his self-esteem, for not been able to get the same achievements as other. This is frustrating for students, for parents & even for teachers. Parents are blamed; Children are blamed or labeled. Schools are blamed. This is a neurobiological problem. This is nobody's fault. But, we all can do something, let put pressure in our political leaders so these kids can get more help. I think by preparing a special program/classes for this kind of disability (with psychologists, neurologists, teachers and parents input)Having these kids in a full time (separate) school with a fully trained personal in this matter & where they don't see themselves as “retarded” because the rest are doing great and they are getting D's or F's, will help so much! If the government has money for special schools & programs for "gifted" students, why not to invest in those who are in a "bigger" academic need. In my opinion everyone will benefit from this, even students who are not ADHD. Medication should not be the only solution, after all, they have side effects, too.
Just keeping this post on top for your reading
Paul, !Gina,
Welcome and keep us posted.
Paul
your post is very informative...
i am new here, my daughter has ADD along with Dyslexia.... tested by one of the best hospital in the country Texas Scottish Rite Hospital in Dallas.....
gina
Many of you have asked "what can I do to help my child's teacher be more successful dealing with my child's ADHD challenges?"
Thanks to Rae70's, Barb's and several other of you I've cut and pasted the following. The first part is meant to educate the teacher what ADHD is and the 2nd part is meant to give them some tools and techniques. I'm sure that there is much more out there, but this is a good beginning. Don't hesitate to edit, enhance, cut and paste to emphasis to the teacher those things you think are especially important. It will take about 20 minutes to read the whole thing but our kids are worth it.
Paul
WHAT IS ADHD? (PART 1)
“Johnny is very active! He never stops moving. He gets distracted by any little noise, and has the attention span of a flea. Often, he acts before he thinks. His sister, Jill, is often in a fog. Sometimes, she’s just so spaced!”
That is how we typically consider children with Attention Deficit Hyperactivity Disorder (ADHD). OK, not so bad. But that is often only the tip of the iceberg. Here is another likely description of the whole picture for a child with ADHD:
“I can’t take it any more!! We scream all morning to get out of the house. Homework takes hours. If I don’t help him with his work, he’s so disorganized that he’ll never do well. If I do help him, he screams at me. Since he never finishes anything, everyone thinks he doesn’t care. No matter how much we beg or punish, he keeps doing the same stupid things over and over again. He never considers the consequences of his actions, and doesn’t seem to care if they hurt me. It’s so easy for him to get overwhelmed. Sometimes, he just wants to ‘turn the noise off.’ He is so inflexible, and then blows up over anything. It gets me so angry that I scream back, which makes everything even worse. Now that he’s getting older, the lies and the cursing is getting worse, too. I know he has trouble paying attention, but why does he have all of these other problems as well?”
It is not a coincidence that children with ADHD often manifest so much more than the classic triad of inattention, impulsivity, and hyperactivity. When we focus merely on these typically defined symptoms, we fail to deal with the whole vista of difficult problems experienced by patients and their families. This spectrum includes a wide range of “executive dysfunction” (such as poor self-control and foresight), additional co-morbid disorders (such as anxiety, depression or conduct disorders), and family stresses. These are summarized in Figure 1.
Redefining ADHD as “Executive Dysfunction”
ADHD needs to be redefined to include a wide range of “executive dysfunction.” As Russell Barkley explains (see Resources), this dysfunction stems from an inability to inhibit behavior so that demands for the future can be met. In other words, people with ADHD are so drawn to the present that the future does not even “show up on their radar screen.” There is no future or past; only “NOW.”
So, what are Executive Functions?
When you step on a snake, it bites. No verbal discussion occurs within the snake’s brain. No recall of whether striking back worked in the past. No thought as to where this action will lead to in the future. No inhibition. Stepped on. Bite back. Humans, fortunately, have the option to modulate their behavior.
No single part of the human brain is solely in charge of this modulation. It does appear, however, that our frontal and pre-frontal lobes function largely as our “Chief Executive Officer (CEO).” Orchestrating language and memory functions from other parts of the brain, these frontal centers consider where we came from, where we want to go--and how to control ourselves in order to get there.
Most importantly, the ability to inhibit (“putting on the brakes”) is central to effective executive function. Successful execution of a plan largely involves putting brakes on distracting activities. These brakes--courtesy of our pre-frontal inhibitory centers--allow us the luxury of time during which we can consider our options before reacting.
This lack of inhibition is a double problem for people with ADHD. First, without these brakes, they will be viewed as unable to adequately inhibit distractions, inhibit impulsive reactions, or inhibit physically acting upon these stimuli (hyperactivity). Second, patients with ADHD do not inhibit their behavior long enough for the other executive functions below to adequately develop either. Executive functions identified by Barkley include:
Self-talk refers to the ability to talk to ourselves--a mechanism by which we work through our choices using words. Toddlers can be heard using self-talk out loud. Eventually, this ability becomes internalized and automatic. However, ADHD patients have not inhibited their reactions long enough for this skill to fully develop.
Working memory refers to those ideas that we can keep active in our minds at a given moment. For example, in order to learn from mistakes, you have to be able to juggle not just the present situation, but also keep in mind past times when certain strategies did or did not work. Working memory hopefully also includes keeping future goals in mind (such as remembering that we want to get into a good college, not just do the most intriguing activity currently available). Without the ability to inhibit, people with ADHD never get to develop good function of their working memory.
Foresight (predicting and planning for the future) will be deficient when inadequate working memory teams up with a poor ability to inhibit the present distractions. People with ADHD cannot keep the future in mind. They are prisoners of the present; the future catches them off guard. In fact, surprisingly poor foresight is perhaps the greatest difficulty in their lives.
Sense of time is an executive function that is usually extremely poor in ADHD.
Shifting from Agenda A to Agenda B is a difficult task requiring good executive function. Pulling yourself out of one activity and switching to another--transitioning--is innately difficult, and requires effort and control.
Separating emotion from fact requires time to reflect. Each event has an objective reality, and an additional “emotional tag” which we attach to it. For example, a traffic jam may occur, causing us to be late for work. That is the objective fact. How we react, though, is up to the emotional tag of significance that we place on it. Do we stay calm, and make plans to finish up a little later. Or, do our emotions cause us to see the traffic as a personal, unfair attack--causing us to seethe and curse. Without the gift of time, we never get to separate emotion from fact. This leads to poor ability to judge the significance of what is happening to us.
In short, then, the ability to modulate behavior comes largely from our pre-frontal lobes, which function primarily as inhibitory centers. Without the luxury of inhibitory brakes, ADHD patients do not get to fully utilize any of their frontal lobe “executive functions.”
What are the different kinds of problems in ADHD?
Redefining ADHD as inadequate inhibition explains a wide spectrum of difficulties experienced by people with the syndrome. This expanded spectrum of symptoms can create an environment of havoc. For more details, see the important works by Barkley, Greene, and Silver listed below under Resources.
1. Symptoms of Executive Dysfunction
a. Classical Symptoms of ADHD
ADHD is typically defined as a triad of inattention, impulsivity, and hyperactivity. Figure 2 is a simplified version of the DSM-IV criteria for ADHD. These are the symptoms that receive the most attention from doctors, and all come from an inability to inhibit.
· Distractible <=Inadequate inhibition of extraneous stimuli.
· Impulsive <=Inadequate inhibition of internal stimuli.
· Hyperactive <=Physically checking out those stimuli.
b. Other Symptoms of Executive Dysfunction
If we do not address the following additional executive function issues, we are only dealing with a small part of the problem. These are not just “incidental” symptoms. They are hard to live with—ask either the patient or his family.
· Lack of foresight!!! (“Johnny, you’ll never get into a good college if you all you do is play videogames. Why do you keep shooting yourself in the foot?”) Foresight--the ability to predict the results of our behaviors--is a major adaptive ability of humans. We can run imaginary simulations of the future on our brain’s computer. Lack of use of this ability can be the most devastating part of ADHD. Mothers--often endowed with great foresight-- are crushed as they watch their child repeatedly head down counter-productive paths.
· Poor hindsight/Trouble learning from mistakes (“Johnny, how many times do you have to be punished for the same thing.”) Unable to inhibit the present, Johnny cannot stop to consider lessons from the past.
· Live at the “mercy of the moment.” (“Johnny is always swept away by whatever is happening to him right then and there.”) ADHD behaviors make sense once we realize that they are based on reactions taking only the present moment into account. It is not that Johnny doesn’t care about the future; it is that the future and the past don’t even exist. Such is the nature of the disability. By way of analogy, imagine riding down a river with a leaking canoe. You would be so overwhelmed by the need to bail out water that you would not see the upcoming cliff. It's not that you don't "care" about falling over a cliff--it's that you don't even get to consider it.
· Life in the next 4 seconds. If you want to make sense out of inexplicable behaviors by someone with ADHD, just ask yourself: “What behavior makes sense if you only had 4 seconds left to live?” For example, if you only had 4 seconds to live, it would make sense to lie in order to expediently get out of a problem…After all, who cares about a future reputation when there is no future?!”
· Poor organization (“Johnny, you never told me that there is a paper due tomorrow! And, why do we have to fight over getting out of the house every morning!”)
· Trouble returning to task (“Johnny, you never complete anything. You just don’t care.”)
· Poor sense of time (“Johnny, what have you been doing all afternoon? You can’t spend one hour on the first paragraph!”)
· Time moves too slowly (“Mommy, you are taking forever to go shopping!”)
· Poor ability to utilize “self-talk” to work through a problem (“Johnny, what were you thinking?! Did you ever think this through?”)
· Poor sense of self awareness (Johnny’s true answer to the above question is probably “I don’t have a clue. I guess I wasn’t actually thinking.”)
· Poor internalization and generalization of rules (“Johnny, why do I need to keep reminding you that playing videogames comes after you finish your homework.)
· Poor reading of social clues (“Johnny, you’re such a social klutz. Can’t you see that the other children think that’s weird.”)
· Inconsistent work and behavior. (“Johnny, if you could do it well yesterday, why is today so horrible.) With 100% of their energy, they may be able to control the task that most of us can do with 50% of our focus. But who can continually muster 100% effort? As the joke goes: ADHD children do something right once, and we hold it against them for the rest of their lives.
· Trouble with transitions (“Johnny, why do you curse at me when I’m just calling you for dinner?”)
· Hyper-focused at times (“When Johnny is on the computer, I can’t get him off. And once his father gets his mind on something, off he goes!”)
· Poor frustration tolerance (“Johnny, why can’t you even let me help you get over this?”)
· Frequently overwhelmed (“Mommy, just stop. I can’t stand it. Just stop. Please!”)
· Gets angry frequently and quickly (“Johnny, you get flooded with emotion so quickly. Why are you always angry with me? Even though you usually apologize, it still hurts me.”)
· Push away those whose help they need the most (“Mommy, stop checking my assignment pad. Get out!”).
· “Hyper-responsiveness” (“Mommy, you know I hate sprinkles on my donuts! You never do anything for me! I hate you!”) Barkley uses the term hyper-responsiveness to indicate that people with ADHD have excessive emotions. Their responses, however, are appropriate to what they are actually feeling. So next time you see someone “over-reacting,” realize that they are actually “over-feeling,” and must feel really awful at that moment.
· Inflexible/explosive reactions (“Johnny, you’re stuck on this. No, I can’t just leave you alone. Johnny, now you’re incoherent. Johnny, just stay away. I can’t stand it when you break things!”) Greene (see Resources) goes into extensive explanation about the inflexible/explosive child.
· Feels calm only when in motion (“He always seems happiest when he is busy. Is that why he stays at work so late?”)
· Thrill seeking behavior (“He seems to crave stimulation at any cost. In fact, he feels most ‘on top of his game’ during an emergency.”)
· Trouble paying attention to others (“My husband never seems to listen when I talk to him. He just cannot tolerate sitting around with me and the kids. He doesn’t “pay attention” to his family any more than he “paid attention” in school.”) As the patient gets older, people in his life will increasingly expect more time and empathy to be directed their way. Yet, the behaviors above of ADHDers may interfere with their demonstration of these traits, despite their passions.
· Trouble with mutual exchange of favors with friends. Without establishing a reliable “bank account” of kept promises, friendships can be hard to make.
· Sense of failure to achieve goals (“Somehow, I never accomplished all that I thought I could or should have.”) This deep disappointment is commonly what brings adults with ADHD to seek help.
· Lying, cursing, stealing, and blaming others become frequent components of ADHD; especially as the child gets older. According to some particularly depressing data by Russell Barkley, here is how ADHD children compare to ty
· In short, the symptoms of ADHD become less “cute” as the children switch from elementary to secondary schools. The “good” news comes from understanding that these problems are commonly part of the syndrome we call ADHD. They are nobody’s fault--not yours, and not your child’s. This understanding points the way towards coping with these issues.
a. Learning Disabilities (LD)
Twenty to thirty percent of patients with ADHD have LD. A review of the diagnostic criteria for ADHD (figure 2) will show that an Organizational Disability is virtually built into the syndrome of ADHD by definition. Following directions, sequencing problems and dysgraphia are also particularly common. Learning disabilities should be suspected whenever a student does not “live up to his/her potential.” They are identified with history, exam and psycho-educational testing. As well explained by Larry Silver (see Resources), learning disabilities can either exacerbate or mimic ADHD. After all, how long can someone focus on something that she does not understand?
b. Disruptive Behavioral Disorders
50% of ADHD children have Disruptive Behavioral Disorders. Even in the absence of a full diagnosis, the lives of many (if not most) children with ADHD are afflicted by lying, cursing, taking things that do not belong to them, blaming others, and being easily angered.This frequency is not surprising given the executive dysfunction hypothesis. Full definitions can be found in the Diagnostic and Statistical Manual-IV. Medications such as mood stabilizers (eg. Depakote), Catapress, and Risperdal can sometimes help with impulsivity and aggression.
· Oppositional Defiant Disorder (ODD). Whereas ADHD children do not comply because of inattention or impulsivity, ODD children are unwilling to conform (even with an intriguing task). They may be negative, deliberately annoying or argumentative, angry and spiteful.
· Conduct Disorder (CD). Children with CD are more frequently overtly hostile and law breaking, with lack of remorse, not seen in ADHD alone. These people violate the rights of others, such as with physical cruelty to others or animals, stealing, etc.
· Antisocial Personality Disorder. People with Antisocial Personality Disorder have a pervasive pattern of severe violation of the rights of others, typically severe enough to merit arrest.
c. Anxiety Disorder
Anxiety Disorder occurs in up to 30% of children with ADHD, but half of the children never tell their parents! Patients are beset most days by painful worries not due to any imminent stressor. Children may appear edgy, stressed out, tense, or sleepless. There may be panic attacks or an incomplete (or negative) response to stimulants.
Treatments include:
· Change of environment; behavioral approaches; exercise; meditation.
· buspirone (Buspar)—helps anxiety but not panic attacks.
· SSRIs (Prozac, etc.)
· Klonopin, Xanax—helps anxiety.
· Tricyclics—helps some with anxiety; great for panic attacks.
· Stimulants may help if anxiety is a secondary problem, but may also worsen anxiety.
d. Obsessive Compulsive Disorder (OCD)
Obsessive thoughts and compulsive actions may occur in up to one third of ADHD patients. If ADHD is living in the present, then OCD is living in the future. Although difficult to live with, the future goal directed behavior of OCD may help overcome the organizational problems of ADHD. SSRI’s are the current mainstay of medical treatment.
e. Major Depression
Depression occurs in 10-30% of ADHD children and in 47% of ADHD adults. Although pure ADHD patients get depressed briefly, they flow with the environment (changing within minutes). In contrast, depressed children stay depressed for long periods. The symptoms include loss of joy, sadness, pervasive irritability (not just response to specific frustrations), withdrawal, self-critical outlook, and vegetative symptoms (abnormal sleep or appetite).
Treatment:
· Counseling; adjusting environment.
· Selective Serotonin Uptake Inhibitors (SSRIs) such as Luvox, Paxil, Prozac, and Zoloft.
· bupropion (Wellbutrin)—helps depression and ADHD.
· venlafaxine (Effexor)—helps depression and maybe ADHD.
· Tricyclics (Tofranil, Pamelor) do not appear to work in children for depression.
f. Bipolar Depression
Bipolar depression occurs in up to 20% of ADHD children. These children show depression cycling with abnormally elevated, expansive, grandiose, and pressured moods. Children may cycle within hours. Other hallmarks include severe separation anxiety and often precociousness as children; extreme irritability; extreme rages that last for hours; very goal directed behavior; and little sleep requirement. They may demonstrate hypersexuality; gory dreams; extreme fear of death; extreme sensitivity to stimuli; often oppositional or obsessive traits; heat intolerance; craving for sweets; bedwetting; hallucinations; possible suicidal tendencies or substance abuse. Often symptoms are shown only at home. See The Bipolar Child by Papolos (under Resources). Also see the article ADHD vs. Bipolar.
Consider bipolar when a diagnosis of “ADHD” is accompanied by above symptoms or:
· strong family history of bipolar disorder or substance abuse.
· prolonged temper tantrums and mood swings. Sometimes the angry, violent, sadistic, and disorganized outbursts last for hours (vs. less then 30 minutes in ADHD).
· bipolar rages are typically from parental limit setting; in ADHD, rages are from overstimulation.
· oppositional/defiant behaviors.
· explosive and “intentionally” aggressive or risk seeking behavior.
· substance abuse.
· separation anxiety, bad dreams, disturbed sleep; or fascination with gore.
· morning irritability which lasts hours (vs. minutes in ADHD).
· symptoms worsen with stimulants.
Medical treatment:
· valproate (Depakote).
· carbamazepine (Tegretol) clearly helps bipolar and aggressive symptoms at least in adults (no controlled studies in children).
· lithium (not clear that it works in children who cycle so rapidly; does not help ADHD).
· Plus cautious use of stimulants or antidepressants for ADHD symptoms.
· Stimulants and antidepressants may trigger mania.
· Plus risperidone for psychotic symptoms and aggression.
g. Tics and Tourette’s (motor & vocal tics, ADHD, OCD, LD)
Seven percent of ADHD children have tics; but 60% of Tourette’s patients have ADHD.
Medical treatments include:
· clonidine (Catapress) / guanfacine (Tenex)—help impulsivity & tics.
· bupropion —helps ADHD but might worsen tics.
· stimulants—helps ADHD but often worsen (or improve) tics.
· tricyclics—mild ADHD help but tic “neutral.” Cardiac concerns.
h. Asperger’s Syndrome
ADHD and Asperger’s syndrome can cluster together. Symptoms include impaired ability to utilize social cues such as body language, irony, or other “subtext” of communication; restricted eye contact and socialization; limited range of encyclopedic interests; perseverative, odd behaviors; didactic, monotone voice; “concrete” thinking; over-sensitivity to certain stimuli; and unusual movements.
See Attwood’s book (Resources).
i. Sensory Integration (SI) Dysfunction
SI dysfunction is the inability to process information received through the senses. The child may be either oversensitive or undersensitive to stimuli. Or, the child may not be able to execute a coordinated response to the stimuli. SI may mimic or co-exist with ADHD. SI is typically evaluated by an occupational therapist. See Kranowitz’s book (Resources). Some types of SI include:
· Hypersensitive to touch: sensitive to clothes or getting dirty; withdraw to light kiss.
· Hyposensitive to touch: wallow in mud; rub against things; unaware of pain.
· Hypersensitive to movement: avoid running, climbing, or swinging.
· Hyposensitive to movement: rocking; twirling; unusual positions.
· May also respond abnormally to sights, sounds, smells, tastes or textures.
· May be clumsy; have trouble coordinating (bilateral) movements; or have poor fine motor skills.
3. Familial Issues.
This can be of two categories:
a. Family members with their own neuro-psychiatric problems
Family members may have their own ADHD, OCD, depression, anxiety, etc. In fact, a child with ADHD has a forty percent chance that one of his parents have ADHD. Such difficulties affect the family’s ability to cope with the ADHD child, and may need to be addressed independently.
b. Stress--created by the child--cycling back to further challenge the patient.
Children or adults with ADHD can create chaos throughout the entire family, stressing everyone in the process. The morning routine and homework are frequent (and lengthy!) sources of dissension. Other siblings are often resentful of the time and special treatment given to the ADHD child. Mothers, who frequently consider their child’s homework to be their own, find it stressful that “their” homework never seems to get completed. Fathers come home to discover a family in distress, and that they are expected to deal not only with a child who is out of control, but also with the mother who is understandably now losing it, too. Parents may argue over the “best strategy,” a difficult problem since no strategies are even close to perfect. The unpleasantness of life around someone with ADHD leads to a pattern of avoidance which only furthers the cycle of anger. In turn, all of this family turmoil creates a new source of pressures and problems for the already stressed ADHD patient to deal with.
Non-Medical Treatments for ADHD
First, we need to identify and treat any of the above symptoms. We need to recognize that “ADHD” is short-hand for this entire biologically based spectrum. Otherwise, parents will think that they have a child with ADHD who just also happens to be difficult and/or appear mean spirited.
Non-medical treatment usually requires academic and organizational support. Learning disabilities need to be identified and treated. Computers can help with handwriting and spelling difficulties, graph paper can help with the spacing of math problems, and clip-art can help with art projects. Organizational support includes close supervision of all tasks by parents; checking assignment pads by teachers; small, structured settings; one to one attention when possible; good eye contact; having the child repeat directions ;and possibly two sets of school books (one for school, one for home).
Behavioral reward approaches can also ameliorate symptoms. Children with ADHD are like moths: they are drawn to the brightest light. Unfortunately, sometimes the brightest light is a bug zapper. Our goal is to make sure that the brightest light is a productive one. If the light is bright enough, they will go there. It is fortunate--but not an accident--that children with ADHD can be easily enticed by quick rewards. Afterall, they are creatures of the moment. No doubt, it would be better if the children were adequately motivated by their own internal “high ideals.” But for those ADHD children who do not see how doing thirty math problems right now will lead to a better world, external rewards may be needed.
Reward systems rely on children's natural desire to please their parents. If a child's basic relationships with her parents are so full of anger and resentment that she no longer finds pride in pleasing her parents, then those basic relationships need some healing first, before behavioral modification programs are likely to be successful. Set aside a period of special time (up to 30 minutes) where the goal is simply to exist together pleasantly in the same room. The child gets to choose the (reasonable) activity, and the parent gets to enjoy being near their child without provoking a world war. Avoid saying anything critical--even if it would be helpful. Keep questions and comments (even positive ones) to a minimal level. After all, interruptions are still annoying. The goal here is to put your account of good/bad interactions into a positive balance, making it more likely for the child to want to please you. That sets the stage for smoother discipline in the future. Dr. David Rabiner (see http://www.helpforadd.com/behtreat.htm) and Dr. Russell Barkley (see Resources) provide a full explanation of this technique.
Typical behavioral plans are token systems which motivate via strongly enticing rewards; and if needed, by punishments. Such programs are explained in detail by both Barkley and Silver (see Resources). Barkley’s guiding principles for behavioral approaches include:
· Feedback and consequences that are:
· Immediate
· Frequent
· Powerful
· Consistent
· Preferably positive
· Clearly defined and reviewed before difficulty arises
· Acted upon without extensive moralizing
· Recognition that the ADHD person has a disability.
· Do not personalize the ADHD person’s actions.
· Be forgiving to the child and yourself.
· Use tangible, physical methods to externalize problem areas.
· Explicitly state out loud the problem and consequences at the time of the event.
· Use timers and planners to break down time into manageable, concrete tasks.
· Brainstorm ideas on index cards or word processor. Then, physically sort through and order thoughts.
Just STOP!
Some people’s brains are too inflexible and explosive to respond consistently to such systems. This occurs more commonly in the pre-teen and teen years. Nothing good can come from a “discussion” held by out of control people. Once that fact is recognized, some families may be ready for Plan B: try to prevent incoherent “meltdowns” before they occur--by allowing a cooling off period at the first sign of their appearance. Sometimes this involves being coached or cajoled through the difficult situation. Other times, we need to be left alone to regain composure. Once cool heads prevail all around, calm discussion of the issue can productively ensue. An attitude of negotiation must prevail on all sides. Sometimes, we are better off just “picking our fights.” These approaches are empathically explained in Ross W. Greene’s excellent book, The Explosive Child.
In summary, STOP!!! Remember, the hallmark of ADHD is trouble stopping--trouble putting on the brakes. Thus, it is not surprising that the first step in dealing with ADHD is to STOP. You will notice that the sections on anger management, problem solving skills, and general behavior techniques all begin with the need to STOP. Only then does executive function to resurface. Typically, when calm and unthreatened, even the ADHD brain will make the correct choice. The need to first STOP applies to both the child and ourselves! See sections on Anger and Problem Solving.
In addition, regular exercise is also frequently reported as useful.
Medical Treatments for ADHD
When behavioral approaches are insufficient, medication is frequently warranted; and in fact, often gives the patient the tools to successfully follow behavioral plans. Medications for ADHD usually involve the stimulation of frontal lobe function. Specifically, they increase firing of noradrenergic pathways. Remember, the frontal lobes function primarily by way of inhibition. Thus, to use an analogy, stimulants “slow you down” by equipping the bicycle with adequate brakes. Importantly, they do not work by “gumming up the gears.” ADHD patients bump into less trouble because they are now a high performance bike capable of appropriate braking, not because they are too tired to get going. Stimulants allow putting on the brakes against distractions, impulsivity, over-reactions, and frustrations. They give the executive functions a fighting chance.
Top Principles
1. Keep a sense of humor. Seek to enjoy, not to scream.
2. Celebrate the ADHD person’s humor, creativity, and passion.
3. Hate ADHD, not the person with it.
4. You do not have a standard child. You can view the issue as a disability. Or, you can view it as wonderful uniqueness. Or, you can view it as both. The perspective of “standard,” though, is not an option. This "disability outlook" will help because it eliminates blame; sets reasonable expectations thereby minimizing anger; and points the way for parents/teachers to see themselves as "therapists" not victims.
5. Recognize that attention issues in the child are only the tip of the iceberg that the whole family must address.
6. The “patient” in ADHD is the whole family.
7. Remember that children with ADHD have two time frames: “Now,” and “Huh.” There is no future. There is no past. There is only now.
8. Do you want to understand the ADHDers actions? Just ask yourself: “What behavior would make sense if you only had 4 seconds to live?”
9. Instead of punishing wrong behavior, set a reward for the correct behavior you would rather replace it with. Rewards should be immediate, frequent, powerful, clearly defined, and consistent.
10. Plan ahead. Give warnings before transitions. Discuss in advance what is expected. Have the child repeat out loud the terms he just agreed to.
11. Don’t argue; nag; or attempt unsolicited and spontaneous transplants of your wisdom to your child. Instead, either a) decide that the issue is aggravating but not significant enough to warrant intervention; or b) make an appointment with your child to discuss the issue.
12. Head off big fights before they begin. Seek to diffuse, not to inflame. When tempers flare, allow everyone to cool off. Serious discussion can only occur during times of composure.
13. Especially with teens, negotiate, negotiate, and negotiate. Parents need to model negotiation, not inflexibility. Don’t worry about losing control: the parent always gets to decide when negotiation is over and which compromise is accepted. Remember: negative behaviors usually occur because the ADHDer is spinning out of control, not because he is evil. While evil behavior would need to be aggressively squelched, the much more common overwhelmed behavior needs to calmly defused.
14. Pick your fights. Is the issue at hand worth chipping away at your relationship with your child? Can your child really control the offending behavior at this moment?
15. Although it is not the child’s “fault,” he will still ultimately be the one to take the consequences of his behavior.
16. This is hard work.
17. You will make it through this; you have no choice.
18. “The children who need love the most will always ask for it in the most unloving ways.” [Words of a teacher quoted by Russell Barkley.]
19. If it is working, keep doing it. If not, do something else.
20. Barkley implores you to forgive your child and yourself nightly. You didn’t ask to live with the effects of ADHD any more than did your child.
21. Review this text, and others, periodically. You are going to forget this stuff, and different principles will likely be needed at different stages. A good way to remember to review is by subscription to some of the free monthly newsletters on ADHD (see resources).
22. Steven Covey (The Seven Habits of Highly Effective People) suggests imagining your child delivering your eulogy. What do you want him to say about you? Keep those bigger goals in mind as you choose your interactions/reactions to your child.
23. This is not a contest with your child. The winner is not the one with more points. The winner is the one whose child still loves them when they graduate from high school.
50 Tips on the Classroom Management
of Attention Deficit Disorder (PART 2)
by Edward M. Hallowell, MD and John J. Ratey MD (c) 1992
Teachers know what many professionals do not: that there is no onesyndrome of ADD, but many; that ADD rarely occurs in "pure" form byitself, but rather it usually shows up entangled with several otherproblems such as learning disabilities or mood problems; that the faceof ADD changes with the weather, inconstant and unpredictable; andthat the treatment for ADD, despite what may be serenely elucidated invarious texts, remains a task of hard work and devotion.There is no easy solution for the management of ADD in the classroom,or at home for that matter. After all is said and done, theeffectiveness of any treatment for this disorder at school dependsupon the knowledge and the persistence fo the school and theindividual teacher.
Here are a few tips on the school management of the child with ADD.The following suggestions are intended for teachers in the classroom,teachers of children of all ages. Some suggestions will be obviouslymore appropriate for younger children, others for older, but theunifying themes of structure, education, and encouragement pertain toall.
1. First of all, make sure what you are dealing with really is ADD.It is definitely not up to the teacher to diagnose ADD, but you canand should raise questions. Specifically, make sure someone hastested the child's hearing and vision recently, and make sure othermedical problems have been ruled out. Make sure an adequateevaluation has been done. Keep questioning until you are convinced.The responsibility for seeing to all of this is the parents', not theteacher's, but the teacher can support the process.
2. Second, build your support. Being a teacher in a classroom wherethere are two or three kids with ADD can be extremely tiring. Makesure you have the support of the school and the parents. Make surethere is a knowledgeable person with whom you can consult when youyhave a problem (learning specialist, child psychiatrist, social worker,school psychologist, pediatrician -- the person's degree doesn'treally matter. What matters is that he or she knows lots about ADD, hasseen lots of kids with ADD, knows his or her way around a classroom,and can speak plainly.) Make sure the parents are working with you.Make sure your colleagues can help you out.
3. Third, know your limits. Don't be afraid to ask for help. You, asa teacher, cannot be expected to be an expert on ADD. You should feelcomfortable in asking for help when you feel you need it.
4. ASK THE CHILD WHAT WILL HELP. These kids are often very intuitive.They can tell you how they can learn best if you ask them. They areoften too embarrassed to volunteer the information because it can berather eccentric. But try to sit down with the child individually andask how he or she learns best. By far the best "expert" on how thechild learns is the child himself or herself. It is amazing how oftentheir opinions are ignored or not asked for. In addition, especiallywith older kids, make sure the child understands what ADD is. Thiswill help both of you a lot.
5. Remember that ADD kids need structure. They need their environmentto structure externally what they can't structure internally on theirown. Make lists. Children with ADD benefit greatly from having atable or list to refer back to when they get lost in what they'redoing. They need reminders. They need previews. They needrepetition. They need direction. They need limits. They needstructure.
6. REMEMBER THE EMOTIONAL PART OF LEARNING. These children needspecial help in finding enjoyment in the classroom, mastery instead offailure and frustration, excitement instead of boredom or fear. It isessential to pay attention to the emotions involved in the learningprocess.
7. Post rules. Have them written down and in full view. The childrenwill be reassured by knowing what is expected of them.
8. Repeat directions. Write down directions. Speak directions. Repeatdirections. People with ADD need to hear things more than once.
9. Make frequent eye contact. You can "bring back" an ADD child witheye contact. Do it often. A glance can retrieve a child from adaydream or give permission to ask a question of just give silentreassurance.
10. Seat the ADD child near your desk or wherever you are most of thetime. This helps stave off the drifting away that so bedevils thesechildren.
11. Set limits, boundaries. This is containing and soothing, notpunitive. Do it consistently, predictably, promptly, and plainly.DON'T get into complicated, lawyer-like discussions of fairness.These long discussions are just a diversion. Take charge.
12. Have as predictable a schedule as possible. Post it on theblackboard or the child's desk. Refer to it often. If you are goingto vary it, as most interesting teachers do, give lots of warning andpreparation. Transitions and unannounced changes are very difficultfor these children. They become discombobulated around them. Takespecial care to prepare for transitions well in advance. Announcewhat is going to happen, then give repeat warnings as the timeapproaches.
13. Try to help the kids make their own schedules for after school inan effort to avoid one of the hallmarks of ADD: procrastination.
14. Eliminate or reduce frequency of timed tests. There is no greateducational value to timed tests, and they definitely do not allowmany children with ADD to show what they know.
15. Allow for escape valve outlets such as leaving class for a moment.If this can be built into the rules of the classroom, it will allowthe child to leave the room rather than "lose it," and in so doingbegin to learn important tools of self-observation andself-modulation.
16. Go for quality rather than quantity of homework. Children withADD often need a reduced load. As long as they are learning theconcepts, they should be allowed this. They will put in the sameamount of study time, just not get buried under more than they canhandle.
17. Monitor progress often. Children with ADD benefit greatly fromfrequent feedback. It helps keep them on track, lets them know whatis expected of them and if they are meeting their goals, and can bevery encouraging.
18. Break down large tasks into small tasks. This is one of the mostcrucial of all teaching techniques for children with ADD. Large tasksquickly overwhelm the child and he recoils with an emotional"I'll-NEVER-be-able-to-do-THAT" kind of response. By breaking thetask down into manageable parts, each component looking small enoughto be do-able, the child can sidestep the emotion of beingoverwhelmed. In general, these kids can do a lot more than they thinkthey can. By breaking tasks down, the teacher can let the child provethis to himself or herself. WIth small chidlren this can be extremelyhelpful in avoiding tantrums born of anticipatory frustration. Andwith older children it can help them avoid the defeatist attitude thatso often gets in their way. And it helps in many other ways, too.You should do it all the time.
19. Let yourself be playful, have fun, be unconventional, beflamboyant. Introduce novelty into the day. People with ADD lovenovelty. They respond to it with enthusiasm. It helps keep attention-- the kids' attention and yours as well. These children are full oflife -- they love to play. And above all they hate being bored. Somuch of their "treatment" involves boring stuff like structure,schedules, lists, and rules, you want to show them that those thingsdo not have to go hand in hand with being a boring person, a boringteacher, or running a boring classroom. Every once in a while, if youcan let yourself be a little bit silly, that will help a lot.
20. Still again, watch out for overstimulation. Like a pot on thefire, ADD can boil over. You need to be able to reduce the heat in ahurry. The best way of dealing with chaos in the classroom is toprevent it in the first place.
21. Seek out and underscore success as much as possible. These kidslive with so much failure, they need all the positive handling theycan get. This point cannot be overemphasized: these children need andbenefit from praise. They love encouragement. They drink it up andgrow from it. And without it, they shrink and wither. Often the mostdevastating aspect of ADD is not the ADD itself, but the secondarydamage done to self-esteem. So water these children well withencouragement and praise.
22. Memory is often a problem with these kids. Teach them littletrick like mnemonics, flashcards, etc. They often have problems withwhat Mel Levine calls "active working memory," the space available onyour mind's table, so to speak. Any little tricks you can devise --cues, rhymes, code and the like -- can help a great deal to enhancememory.
23. Use outlines. Teach outlining. Teach underlining. Thesetechniques do not come easily to children with ADD, but once theylearn them the techniques can help a great deal in that they structureand shape what is being learned as it is being learned. This helpsgive the child a sense of mastery DURING THE LEARNING PROCESS, when heor she needs it most, rather than the dim sense of futility that isso often the defining emotion of these kids' learning process.
24. Announce what you are going to say before you say it. Say it. Thensay what you have said. Since many ADD children learn better visuallythan by voice, if you can write what you're going to say as well assay it, that can be most helpful. This kind of structuring glues theideas in place.
25. Simplify instructions. Simplify choices. Simplify scheduling.The simpler the verbiage the more likely it will be comprehended. Anduse colorful language. Like color coding, colorful language keepsattention.
26. Use feedback that helps the child become self-observant. Childrenwith ADD tend to be poor self-observers. They often have no idea howthey come across or how they have been behaving. Try to give themthis information in a constructive way. Ask questions like, "Do youknow what you just did?" or "How do you think you might have said thatdifferently?" or "Why do you think that other girl looked sad whenyou said what you said?" Ask questions that promote self-observation.
27. Make expectations explicit.
28. A point system is a possibility as part of a behavioralmodification or reward system for younger children. Children with ADDrespond well to rewards and incentives. Many are littleentrepreneurs.
29. If the child seems to have trouble reading social cues -- bodylanguage, tone of voice, timing and the like -- try discreetly tooffer specific and explicit advice as a sort of social coaching. Forexample, say "Before you tell your story, ask to hear the otherperson's first," or, "Look at the other person when he's talking."Many children with ADD are viewed as indifferent or selfish, when infact they just haven't learned how to interact. This skill does notcome naturally to all children, but it can be taught or coached.
30. Teach test-taking skills.
31. Make a game out of things. Motivation improves ADD.
32. Separate pairs and trios, whole clusters even, that don't do welltogether. You might have to try many arrangements.
33. Pay attention to connectedness. These kids need to feel engaged,connected. As long as they are engaged, they will feel motivated andbe less likely to tune out.
34. Give responsibility when possible back to the child.
35. Try a home-to-school-to-home notebook. This can really help withthe day-to-day parent-teacher communication and avoid the crisismeetings. It also helps with the frequent feedback these kids need.
36. Try to use daily progress reports.
37. Encourage a structure for self-reporting, self-monitoring. Briefexchanges at the end of class can help with this. Consider alsotimers, buzzers, etc.
38. Prepare for unstructured time. These kids need to know in advancewhat is going to happen so they can prepare for it internally. Ifthey suddenly are given unstructured time, it can be over-stimulating.
39. Praise, stroke, approve, encourage, nourish.
40. With older kids, have them write little notes to themselves toremind them of their questions. In essence, they take notes not onlyon what is being said to them, but what they are thinking as well.This will help them listen better.
41. Handwriting is difficult for many of these children. Considerdeveloping alternatives. Learn how to use a keyboard. Dictate. Givetests orally.
42. Be like the conductor of a symphony. Get the orchestra'sattention before beginning. (You may use silence, or the tapping ofyour baton, to do this.) Keep the class "in time," pointing todifferent parts of the room as you need their help.
43. When possible, arrange for each student to have a "study buddy" ineach subject, with phone number. (Adapted from Gary Smith.)
44. Explain and normalize the treatment the child receives to avoidstigma.
45. Meet with parents often. Avoid the pattern of just meeting aroundproblems or crises.
46. Encourage reading aloud at home. Read aloud in class as much aspossible. Use story-telling. Help the child build the skill ofstaying on one topic.
47. Repeat, repeat, repeat.
48. Exercise. One of the best treatments for ADD, in both childrenand adults, is exercise, preferably vigorous exercise. Exercise helpswork off excess energy, it helps focus attention, it stimulatescertain hormones and neurochemicals that are beneficial, and it isfun. Make sure the exercise IS fun, so the child will continue to doit for the rest of his or her life.
49. With older children, stress preparation prior to coming intoclass. The better idea the child has of what will be discussed on anygiven day, the more likely the material will be mastered in class.
50. Always be on the lookout for sparkling moments. These kids arefar more talented and gifted than they often seem. They are full ofcreativity, play, spontaneity and good cheer. They tend to beresilient, always bouncing back. They tend to be generous of spirit,and glad to help out. They usually have a "special something" thatenhances whatever setting they're in. Remember, there is a melodyinside that cacophony, a symphony yet to be written.