Tuesday, November 30, 2010

How do Parents Help their Child with ADHD if they do not Agree on the Methods to be Used?

I am sure that all parents want the best for their child. However, sometimes both parents do not agree on whether their child should take medicine, how much medicine to take, what type of therapist to see, how much computer time to give to their child, the time that their child should go to bed, when their child should do his homework, as well as whether or not exercise will diminish their child’s hyperactivity.

If both parents do not agree on how to manage their child with ADHD’s life, the child becomes very confused. Children with ADHD look for standards and structure. They need to have their schedule as predictable and planned as possible. Why? If they see how you schedule the time that they will do their homework, when they will exercise, the time that they will have their dinner, when they will go to sleep, etc., they will begin to realize how controlled they feel when they can depend on the fact that that the important things in their lives are predictable. This perception that everything is planned ahead of time and will not change, (barring emergencies, of course) will diminish their level of anxiety.

How would you set up your child’s schedule so that he will pay attention to it? You can either use a calendar from Outlook or use an Excel chart. But remember that children with ADHD look for stimulation, so always use colored markers to designate each activity or homework assignment as well as the time of the activity. For example, you could use the same color for all of your child’s homework assignments, a different color for bedtime and a different color for exercise. In that way, your child begins to learn how to categorize. An alternate way is to have a separate chart for homework and to use a different color marker for each subject with a different color for when the assignment is due.

Give it a try and let me know if you need any more suggestions.

Monday, November 29, 2010

Holidays Bring About Many Emotions

Thanksgiving is now over, whether you celebrated it on Thursday or on Saturday, as we did because our son had to work in Detroit. Holidays are times that are characterized by so many emotions. Family members are enclosed in one or two rooms for hours who observe but may not understand the interests and well as the behavior of your child with ADHD. For example, each time that one of the children with whom I used to work saw his grandfather on a holiday, his grandfather would say, “Jimmy, let’s go through a football around,” or “Let’s have a catch.” Jimmy’s grandfather played football in college and was an active spectator. Jimmy not only disliked sports but also felt that “I suck at sports.”

I often talked to him about this perception that he performed poorly at sports. I asked him whether or not he had ever been taught how to play football or baseball. He said that he had never had any lessons of any kind in any sport. So, therefore, I asked him, “How can you say that you suck at a sport when you have never been taught how to play it?” He agreed with my point. However, because he FELT that he was terrible at playing sports, he did not have any interest in playing them for fear that he would embarrass himself in front of other children.

His grandfather certainly did not mean any harm, but to Jimmy, his grandfather’s constant requests to play football or baseball made him feel anxious. Additionally, he did not even want to see his grandfather, because as he said, ”He keeps asking me over and over again to go outside with him to play a sport, so I just feel like running away from him.”

The relationship between a grandparent and a grandchild is indeed a special one, especially if the child has ADHD, because one would assume that grandparents would be all-accepting. Jimmy’s story was a sad one because no one helped his grandfather to understand what was happening to the dynamics of his relationship with his grandson and more importantly, why it was happening.

It is very important, especially concerning children with ADHD, who oftentimes do not excel at sports, to find out in what areas they do excel so that everyone, parents, grandparents and siblings can enjoy spending time together doing an activity in which they are all interested.

Monday, November 22, 2010

How to Successfully Gain Services for your Child with ADHD

The buzz lately has been about research studies that found that one in ten children have ADHD. These results are really not a surprise, because we had been hearing about an increase in the percentage of children who have ADHD for a few years. However, in light of the results of this research, the vital issue now is how to get services for all of our children with ADHD more easily.

It has seemingly become harder for parents of children with ADHD to obtain services either under 504 or IDEIA 2004. So, what can you do? Parents with more anecdotal evidence of their child’s difficulties have a much better chance of obtaining services. Additionally, if those records show a long history of issues, you are more likely to gain services for your child. Here are some data that you should begin to collect that hopefully, will make an impact upon the Committee on Special Education, etc. with whom you meet.

 Hard copies of your child’s work

 Videotapes or DVDs of your child having difficulty completing his homework within a certain amount of time (For example, if your child has a difficult time writing by hand.)

 Photographs of your child’s work and/or your child at work

 Videotapes and/or DVDs of your child’s behavior at home, i.e., when he tries to sit still for extended periods of time, etc.

 Reports from teachers concerning how your child works in school, i.e., when he becomes distracted, how long he remains distracted, what strategies that have been tried and failed in order to keep him focused, how he behaves in unstructured activities such as recess as well as how he behaves in structured situations

 Reports from individuals who are in charge of extracurricular activities in which your child is enrolled in regard to his behavior, i.e., how he interacts with his peers, how he interacts with adults, etc.

 Reports from the bus driver who takes him to and from school, in terms of his behavior on the bus

If you come to the CSE meeting armed with all of this data, you will hopefully, have more success securing accommodations for your child. Please let me know the results of your journey…

Friday, November 19, 2010

Does your child seem to become more hyperactive on the holidays?

I think that many of us become very excited and a little overwhelmed on a holiday such as Thanksgiving. How do you help your child with ADHD to settle down? Keep him busy by getting him involved in the preparation of the food and the setting of the table. If your child is on the periphery of all of the preparations, he is more likely to behave in a more hyperactive manner. On the other hand, if he is involved in a specific job, such as helping you to cook, he will be stimulated, which will keep him focused and calm. Children with ADHD look for stimulation, and when they find it, they are less hyperactive and less distractible.

Children with ADHD also are able to control their behavior more effectively when there is some structure. If you have a chart of the jobs that he will be doing throughout the day, he will remain calmer, more attentive and less hyperactive. The best thing to do is to make a list of jobs that he will be doing and break each job down into small parts. In that way, he can complete a specific job component, check it off on the list and feel successful. You can use an Excel chart or just write the list out by hand. Use different colored markers so that he will be stimulated by the colors, and be able to pay attention to the specific jobs that you have assigned to him. It sounds like this is a lot of work for you, especially on Thanksgiving, but trust me, everything that you are trying to do yourself will take much longer if you spend your time constantly telling him to settle down, stop running around and relax.

Wednesday, November 17, 2010

Teaching Responsibility and Accountability to Young Children: Should I Clean Up my Child's Room for him?

Your seven-year-old child was playing with Legos and made an intricate structure. He also was playing with other toys and left them all over the floor. You also have a one-year-old child and are afraid that if those toys are left on the floor, it could be dangerous for your baby, in terms of him putting those toys in his mouth. Should you clean up after your seven-year-old?

If your seven-year-old becomes upset when he comes home from school and sees that the structure that he built is no longer there, that is your answer. If your seven-year-old is used to you putting away his toys and does not become upset, should you continue cleaning up after him?

NO! Why? First of all, even a seven-year-old child should receive the respect from his parent that he well deserves. His things are his private things. Despite the fact that his parent might be worried that his one-year-old brother might out those toys in his mouth, the one-year-old should be kept away from his things.

Second of all, the seven-year-old has been an only child for a long time and you want to discourage any possible jealousy and resentment.

Third, and perhaps most important is the fact that each person must learn responsibility and accountability. It is vital for children to learn to be responsible for their belongings at a young age so that being accountable simply becomes a part of their lives that begins in childhood and continues on into adulthood. When an individual works and his boss wants to see a certain report that he has completed, his boss will certainly not wait for him to locate it. It must be found and delivered immediately.

When a child is taught that he should put away one toy before playing with another, that is really the easiest way to be organized and responsible for his things. However, many children with ADHD seem to like many toys around them at the same time with which to play. The problem soon arises, however, is that they become overwhelmed by the accumulation of toys, books, etc. Hopefully, that overwhelming feeling can be used to teach them to take out fewer toys the next time they play.

Parents must explain to a child as to why it is so important to be organized and accountable as well as how to do so. One cannot expect a seven-year-old to clean up his room the first time by himself. Sit down on the floor with your child and discuss with him how to make a plan so that each toy lives in its own little place in his room, and that that place does not change. Children with ADHD need as much structure as possible. They respond positively to predictably and consistency. Then, so that this task does not become overwhelming, for about 15 minutes or so, after deciding which toy lives in which place, help him to put some of the toys away. (You can place clear boxes with different colored tops or stickers on the boxes to designate which toy should be placed in which location. This must be a collaborative effort, so that the child feels ownership of his toys, books, games, etc.) Come back with him later and put away the rest of the toys for no more than 15 minutes at a time. Continue doing this activity until all of the toys are put away.

Each day, help him put his toys away for just a few minutes, and begin to fade away after a week or so. In this way, at some point, your child will take responsibility over his own things and feel very proud of his effort. From then on, the responsibility of putting away his own toys should be his own, with a reminder, perhaps from time to time. If you feel that your child needs an incentive, I would incorporate that incentive, i.e., stickers, playing a computer game, going out with you alone without his sibling, etc., but I would also fade that out after a short time, as well. Being responsible and accountable should be its own incentive, after awhile!

Tuesday, November 16, 2010

How can you help children with ADHD deal with disappointment?

Unfortunately, disappointment is a part of each child with ADHD’s life in one way or another. These disappointments could manifest themselves as a child who has divorced parents looking forward to spending time with one of them and that person not showing up. It could manifest itself in hoping that he would be chosen in a game at recess and being rebuffed, instead. It also could manifest itself in not being invited to a birthday party.

It is crucial in terms of helping a child diminish his disappointment that he understands that these things happen to everyone and not just to him, as he thinks. In order to help him to deal with disappointment more easily, it sometimes helps to share some of your disappointments with him, either if you are his teacher or his parent. I am not telling you that you should tell him intimate details of your life, but it will help him to know that someone whom he respects has experienced disappointments as well.

For example, you could talk about a time when you looked forward to going to baseball game with a friend, and your friend became ill and could not go. You could discuss a time when you were looking forward to seeing your child who lives far away and was scheduled to come to visit you, and then found out that he had to work instead.

All disappointment is the same. We are all left feeling frustrated and sad that the event that was supposed to happen, to which we had looked so forward, did not happen. The most important thing that you can do to help a child who has experienced disappointment is to have a conversation about what disappointed him, when it happened, why does he think that it happened and how it happened. It is vital to discuss with him as to why it happened because in all likelihood the reason why it happened might have had nothing to do with what he imagined is the reason that it happened.

It is also important, however, to help him to have a reality check. If his behavior (and it should be emphasized that the reason might have been his behavior and not the person who he is!) caused someone to reject him, for example, then it is important to examine and to evaluate that behavior so that he can try to behave in a different way. More tomorrow….

Sunday, November 14, 2010

ADHD and Coexisting Disorders

This is a link to a good article explaining that ADHD may be paired with another disorder in some children. Let me know if you have worked with children with ADHD who have comorbidities, or paired disorders. Here is the link from the National Resource Center on ADHD.


Saturday, November 13, 2010

How does Anxiety Affect Children with ADHD?

Here you are trying to convince the child with ADHD to try to make friends. You suggest to him that he should go up to another child at school to ask him to come over for a playdate, perhaps someone with whom he worked on a project. You think to yourself that that would be easy because they already know each other having worked on a project together. Well, it may not be so easy. Why? Sometimes children with ADHD have a paired disorder of anxiety that can interfere with their ability to fluently interact with peers. 

As he begins to approach that child, he may have thoughts such as “I can’t talk to him before he talks to me.” “What would I say?”“ I can’t go up to that child. What if he rejects me?” “I can’t do that. I don’t even know if he likes me.” Anxiety can be paralyzing and interfere with a child’s ability to interact. Teachers and parents need to be aware of the child’s anxiety and make him feel that they really understand that it is an obstacle to making friends. In that way, the child feels that he has someone on his side who is going to support him, someone who believes that anxiety is real and is ready to help him to diminish it.

Friday, November 12, 2010

Children with ADHD hyperfocus. What is it? Is it positive or not?

Most people with ADHD typically hyperfocus. What is hyperfocus? It is when someone focuses on something so intensely that they seemingly do not even hear another person when they speak to them. Have you witnessed your child playing a video game and zoning in on the game yet zoning out regarding what is going on around them? That is hyperfocus. Is it a positive or a negative? It depends…

In the movie with Kevin Costner, “For the Love of the Game,” there is a moment at the end of the movie where Kevin Costner is trying to concentrate and pitch to win a big baseball game. He is distracted so visualizes and says to himself “Clear the mechanism.” All of a sudden, the crowd is blurred out and all he sees is the catcher and himself. He then throws the winning pitch to strike out the batter. That is an example of a hypefocus that is productive. If you can get your child to hyperfocus on homework, that clearly would be productive. How could you do this?

Start him out with an assignment that he considers interesting and fun. After he completes it, praise him in a mild but meaningfully way, such as a pat on the back or by saying “Good job.” Then get him to do a few minutes of exercise, say on an indoor bike or using Wii Fit for just a few minutes. Give him some incentive for getting off of the Wii fit if playing it turns out to be a moment of hyperfocus!

Immediately, get him to do another assignment that is not so interesting to him and give him intermittent reinforcements, such as a snack that he likes. It is important to give him intermittent reinforcements so that he is never sure when he will receive them. If you do not want to give him a snack or if he is not hungry, you can arrange a different reinforcement adjusted to his interest. The reinforcement could be playing with Legos after he finishes the assignment.

If you notice that he is hyperfocusing, walk away and let him do his work independently. Later, you can praise for doing his work independently as well as completing it and he will feel so proud of himself. This intervention is not a guarantee of helping your child to achieve a hyperfocus in a productive way, but it is certainly worth a try.

Thursday, November 11, 2010

Is getting your child to sit down at dinner and stay at the table an arduous task?

I would say that the most important part day is the family dinner. Why? Because that time is a precious and rare time for each and every family member to touch base and share what they have been doing, where they have been, people with whom they have met and with whom they have made friends, their struggles at school, at work and socially as well as their successful experiences.
 Now, if one of the parents comes home at 9:00 P.M. and your children are very young, it is difficult for them to wait for dinner. The goal in my mind is to have a family dinner as many nights of the week as possible.  The alternative is to have a family breakfast or lunch, if those are more applicable. 

That being said, how do you get your child with ADHD to stay in his seat for more than a second? Here is a way to teach a young child to remain quietly in his seat at dinner. Place a colored clock at his seat at the table that counts down the time by color that he is sitting quietly. (You can buy this timer, called a Time Timer, from timetimer.com.) They come in a three-inch, an eight-inch, or a twelve-inch size. If the child is older or can tell time, you can use a timer or a regular clock. (I would not use a kitchen timer, because it is just too noisy and distracting.)You can start out with the child staying in his seat for five seconds if that is the longest time that he can sit.

Find a reinforcement or reward that really interests him. You need to give the child the reinforcement intermittently so that the child does not know when he is receiving it. The idea is that if he is not sure when he is receiving the reward, he will sit and sit and sit. Rewards do not typically work if the child is not interested in what he is receiving, however. Therefore, before instituting this reinforcement schedule ask the child to tell you about his interests, so that you can collaboratively decide on a reward. You can increase the time required to receive the reward. Eventually, you will fade out the reward so that the child is sitting for longer periods of time.

Wednesday, November 10, 2010

I cannot get my child to do his homework independently. We do it together and after three hours of arguing, it is finally completed and I am completely frustrated and exhausted. What should I do?

Many parents who have children with ADHD go through this kind of dilemma. If they help their child to do his homework, every night is torture and they worry that their relationship with their child will be damaged. If they do not help their child with his homework, they worry that the teacher will be angry at their child and he will have to suffer the consequences of staying in for recess to complete it and/or be stigmatized as the “one” who never completes his homework.

What can you do? First of all, try to have your child do some form of exercise before he does his homework. Exercise has been shown to diminish hyperactivity and distractibility and will help your child to focus better. Second, when your child sits down to do his homework, if you see any resistance at all in terms of a specific subject, tell him to complete the homework first that he finds interesting or easier for him. Third, place a limit on the time that you spend trying to help your child. If you begin to feel frustrated yourself, stop and take a break.

When you get to a point that you and your child begin to argue, tell your child to do as much as he can and let the teacher handle the rest. It is vital for him to feel some accountability and responsibility. Not that you want your child to feel pressure and stress as a result of your comment that he should bring the homework that he cannot complete to his teacher, but it is her job to help your child with things that he simply cannot understand.

One of the problems with children with ADHD doing their homework independently is that they do not pay attention to the details of the instructions of how to do a particular assignment. If you have gone over the directions and have helped him for a short period of time, you must step away and let him handle whatever he can manage by himself. If he cannot finish the homework because he cannot understand it, then it is HIS responsibility to go o speak with the teacher.

This procedure may be a learning curve for you, but you certainly want to return to having a good relationship with your child instead of spending each and every night arguing with him.

Tuesday, November 9, 2010

To my Readers

To my readers:

I would like to ask my readers to please either add yourself as followers of my blog so that I will know who you are or comment on my blog entries. I really would love to know to whom I am helping, or hopefully helping. Thank you to all those who have been reading my blog. I now have over 2,000 pageviews, which is just awesome!!

Dr. Rapoport

How do you feel when your child has a “meltdown” in public?

Well, the first thing that you are thinking to yourself is, “What must that woman be thinking who is observing my child’s behavior? They must think that I am a terrible mother!” Well, perhaps, if that woman is a terrible person! More likely, she will glance at the situation and say to herself, “I hope that that child feels better later,” and continue on wherever they were going. Do you remember when you were in a class and asked or answered a question and felt so ignorant and was sure that everyone was staring at you? Also remember when that happened to someone else? You did not think twice about it or paid little attention to their comments, right?

It is very important for you to think that no one is judging you. Why? If you think in this way, then you will not judge your child, but instead, realize that he cannot control his behavior at that moment. Our children with ADHD feel frustrations much of the time. If they somehow force themselves to hold every emotion together as they are trudging through the school day when they are required to complete their academic work amidst many distractions that occur in schools, they are likely to have some sort of “meltdown” at some point or another at home. These “meltdowns” can take many forms, from temper tantrums, to noncompliance, to falling asleep on the kitchen table as they are completing their homework.

If you learn what possibly can cause these “meltdowns” then you will be able to handle them better, which will decrease the likelihood of their occurrence as well as diminishing the time that each one lasts. Try talking to your child at a time of relaxation, such as watching a television show or playing catch as to what gets him so upset. Do not ask him closed-ended questions, such as, “When the teacher is getting ready to send everyone home, do you get upset?” That is a yes or a no question. You want to ask an open-ended question so that the child has to answer in some detail. An example is, “How do you feel at the end of the school day when everyone is rushing around trying to get ready to go home?” Remember that it is imperative for you to remain calm. Trust me in that your child does not want to lose control of his emotions any more that you want to observe him doing so.

Monday, November 8, 2010

How to prepare your child for Monday morning after a relaxed weekend

During the weekend you typically may relax many of your rules for your children.That being said, after doing so, how do you get your child out the door on a Monday morning in an easy and prompt manner while reverting back to the weekday rules?

This is not an easy task, which is why it may be important to use the same or similar rules on the weekend as on the weekdays. Children with ADHD need consistency. Why? They need to know what to expect during as much a part of the day as is possible. If they have a fairly set schedule as well as rules of behavior, then there will be no surprises for them. They will know what to expect and then behave accordingly. If they are fully aware of what the consequences of their actions will be, then they will not be surprised when they have to live with the consequences of their actions.

That is why it is critical for you to hang up a list of the acceptable behaviors that they are to exhibit in one of the major thoroughfares of your house, perhaps, the kitchen, for example. As far as drawing up a list of the consequences that will be associated with them exhibiting unacceptable behavior, the best idea might be to collaborate with your child and come up with consequences that match up fairly with the unacceptable behaviors that your child exhibits.

What should you call these behaviors? I like to call them acceptable and unacceptable behaviors, because sometimes if you call them inappropriate behaviors, the child looks upon those words as so negative and thinks that he is the only one who exhibits these behaviors. Either way is fine. It all depends on your child’s level of self-esteem and how it is connected to his misbehavior. Just a little clarification here: You are clearly the one who has the final decision on the consequences of your child’s unacceptable behavior. However, if he has some part in collaborating in some way with that decision he will more likely feel that he owns his acceptable and his unacceptable behavior. Therefore, when he exhibits positive behavior, he will have ownership of it which will affect his self-esteem in a positive way.

Sunday, November 7, 2010

Why do our children with ADHD become so frustrated by their performance in video games?

Yesterday, I talked about what to do when your child is frustrated with not getting to a certain level in a video game or because he lost the game. At issue as well, is why our children become so frustrated with what I alluded to, or as my son stated, “is just a game.” Children with ADHD often have a poor self-esteem. Despite the fact that they do not always have an accurate world view of how others see them and their behavior, they certainly know that they have few if any friends. They observe other children playing during recess while they walk around alone. They do not get invited to birthday parties. They have few if any play dates. Therefore, they know that something is not the same for them as compared to other children.

Because of their low self-esteem they look for any way to feel “cool,” and to feel good about themselves for achieving at something. I know that the older children with whom I work as well as those to whom I have interviewed during my doctoral research have said to me that they have difficulty focusing in school which prevents them from getting good grades and they see that others are rejecting them due to their annoying (their words) behavior. Therefore, if they are not excelling in school and they are not able to make friends, then certainly succeeding at playing video games becomes paramount. First of all, it builds their self-confidence when they become good at anything. Second of all, when a child is good at video games, he is somehow looked at as “cool” by the other children.

Our job as parents and teachers is to help our children to become experts at whatever we can in which they have an interest as well as something at which they excel. It does not matter if that “something” is music, art, sports, chess, debating, etc. What does matter is that you help them to find something that they can do so that when they walk into middle school and/or high school they have immediate friends as well as a social niche. Since our children with ADHD have difficulties making and keeping friends, it is vital that they somehow create an immediate social group that will accept and need them as an important member of their group. If they find that niche, their self-esteem and self-confidence will grow.

Saturday, November 6, 2010

What do you do if video game frustration causes your child to have a temper tantrum?

What do you do if video game frustration causes your child to have a temper tantrum?
I have heard parents, even of young children, talk about how frustrated their children become when they cannot reach a certain level in a video game that they had been playing. As the child realizes that he cannot reach that level, they typically begin to cry and/or scream and whine, which may be accompanied by body language that matches his emotional state. No one wants to see their child disintegrate emotionally because of a video game. Parents may feel that it is ridiculous that their child has become so upset by a game. Being successful at video games may be just as important as being successful at school or sports to children. It is important to respect your child’s need to succeed at video games, even though you may feel they are totally unimportant.
That being said, it is one thing to respect your child’s passion for video games and another thing to permit him to behave inappropriately when he loses. Some parents have told me that when they see that their child is becoming frustrated, they tell them that they will turn the video game off in five minutes if they do not stop their whining, crying, etc. What does this ultimatum do? It sets up a power struggle that will definitely result in a temper tantrum. What else can you do?
Your goal here is twofold. First, you want to diffuse his misbehavior. Second, you want him to learn to manage his own behavior so that he can control his own frustration. By having a conversation with him explaining that, as my son, a long-time video game player has told me, “It’s really just getting himself to stop and think about his actions and making him realize that it’s just a game.” Therefore, by pausing the game instead of the shocking action of shutting it off, and talking to him about the fact a game can be played over and over again, he may not have had a temper tantrum.
Also, he must be taught self-talk on task cards so that he has steps to follow when he feels that he is getting frustrated that will teach him to exhibit appropriate behavior instead of inappropriate behavior. These task cards will get him to stop, as my son says and think about behaviors that he can exhibit that will lead to productive behavior. In the end, when he learns to self-regulate his misbehavior he will feel a new sense of positive self-esteem. Try these strategies and let me know.
Check back tomorrow to hear me talk about how children gain self-esteem by feeling successful at video games.