Should you Negotiate with your Child who has ADHD?

Let me give you an example:

You are walking your dog with your child with ADHD. As you are walking, you stop from time to time to chat with your neighbors. As you are conversing, your child swings from a branch on your next door neighbor’s property. You are ready to begin walking home, and you say to your child “Okay, let’s go. We need to get home.” He says, “Can I swing a little more?” You say “Yes” but then you also say, “We really have to leave in a minute.” The next time you tell your child that both of you have to leave, he refuses.

You should never negotiate with your child with ADHD because you will end up battling with a child who is trying to manipulate you.  You cannot get your child to move off of that branch. What could you have done?

You will not get the results that you want from your child with ADHD unless you give them a choice. What you could have said, depending on how close you were to your home, the age of your child and his related independence was to say, “You can either come with me right now or come back by yourself in five minutes.” (This strategy depends, however, upon whether your child has a watch with an alarm that can be set or if he can tell time.)

You could also have said “We can leave now or in five minutes.” Have the child make a choice as to when he wants to leave within your parameters. If he says five minutes, then time him and in five minutes say, “Okay, the five minutes is up. Let’s go.”

This strategy typically works. The most important thing is to give your child a choice according to your own parameters of when you need something done. Please let me know if you tried this technique, if it worked and the degree to which it worked.

How should you Talk to Young Children with ADHD about the Bombings in Boston?

Young children with ADHD in most cases will not understand the nuances and the ramifications of the bombings in Boston. However, they will feel a sense of anxiety and fear based upon what they have heard from others, as well as what they have viewed on television.  What might we do to calm these children’s fears and anxieties?

The first thing to do is to sit down and listen to what the children are saying about the bombing. What do they think happened? What do they know that are facts? What do they know that are rumors? Answer their questions while reassuring them. You will be able to generalize some but not all of the details of the Boston bombings, depending on the age and maturity of the child with ADHD. Remember, do not only make general statements. Upon discussing the details, however, do not talk about any specifics that might make them more fearful and anxious. However, tell these children the truth so that what you are telling them is valid.

The second thing you want to tell young children with ADHD is that you were afraid as well. In that way, you will be able to validate the fact that other people were fearful in addition to them. In fact, they will see that it was acceptable to be fearful. Go over and over the fact that the bombing suspect is in custody and since what he did was illegal, the authorities will keep him in jail. You should also explain to these young children with ADHD that events of this type, i.e., bombings of cities in the United States, are very, very rare.

How do you Talk to your Child with ADHD about the Bombing in Boston?

It is vital to talk to your child with ADHD who is either of elementary school age or an adolescent as soon as possible about the bombing and terror in Boston. (I will address how to talk to younger children about the bombing of Boston tomorrow.)

Parents oftentimes think that they should wait until their child asks questions about sad or horrific events. That is not a good idea. Why? One never knows what the child with ADHD is thinking, and what are his anxieties and misperceptions.

Here are a list of steps to which you may adhere or modify in your discussions of the bombing of Boston with your child with ADHD:

1.     Ask your child what he thinks happened.

2.     Confirm and/or modify his perception of the events that occurred.

3.     If he is anxious about a similar horrific event happening to him.

a.      Ask him to delineate each and every fear/anxiety that he feels

b.     Systematically discuss each and every one of his fears

4.     Explain to him the low probability of that dreadful event happening where he lives. Also, explain to him that the adults with whom he interacts will make sure that he is safe.  

5.     Tell the child with ADHD the positive stories of those individuals who ran into danger protecting and helped the injured.

6.     Discuss what his family could and would do to help if they were in a similar situation, reiterating again, however, the rarity of this type of event happening to him.

7.     Talk about what positive steps he could take to help people to whom these events happened.

a.     He and his friends could raise money for a charity that is helping victims of the Boston bombing, such as onefundboston.org or the Red Cross. Unfortunately, in 2013, we have to be aware of charities that are scams. Please talk to your child about this before he or his friends send any contributions.

b.     Those children can write and send condolence letter to the Red Cross who will send the letters to the family members who were injured in the Boston bombing.

 

Are you Trying to Decide if a Child with ADHD you know has Social Skills Problems?

Perhaps some examples of social skills deficits/problems might be helpful. Read and see if the child in question in your classroom or home exhibits any of these behaviors.

 

Among some examples of social skills deficits are the following, accompanied by the specific behaviors characterizing these deficits below, so please keep reading:

 

✱ Deficits in social perception and social cognition that inhibit students’ abilities to interact with others

✱ Lack of consequential thinking

✱ Difficulty expressing feelings

✱ Difficulty in feeling empathy for others

✱ Difficulty delaying gratification (impulsive)

✱ Inappropriate grooming and hygiene

✱ Failure to understand and fulfill the role of listener

✱ Inability to take the perspective of another

✱ Less time spent looking and smiling at a conversational partner

✱ Unwilling to act in a social situation to influence the outcome

✱ Less likely to request clarification when given ambiguous or incomplete information

✱ Tendency to talk more or less

✱ More likely to approach teacher and ask inappropriate questions

✱ Less proficient in interpersonal problem solving. (Vaughn, Bos, & Schumm, 2007, p. 255)

 

Before you check to see if the children in question have social skills deficits, let me give you some specific behaviors that may occur if a child has these deficits:

 

✱ Difficulties in social perception: A child walks up to two children who are disagreeing and asks “Can I play?” Even though the child clearly sees the ongoing argument between the two children, he seemingly is unaware that they may be so involved with disagreeing that they may not consider including him at that moment. Additionally, they may become annoyed with him if he intercedes.

 

✱ Lack of consequential thinking: A child walks up to another and pulls the chair out from under him. The child who pulled the chair out does not realize that the child who was sitting on the chair will fall down on the floor, possibly hurting himself.

 

✱ Difficulty expressing feelings: A child pushes another one down and cannot say he was sorry.

 

✱ Difficulty delaying gratification: A child walks up to another who is using a shovel at a sand table. Instead of asking to use the shovel, he grabs it and knocks the child down. The child did not have the patience to wait until the other child finished with the shovel. Instead, he acted on impulse.

 

✱ Inappropriate grooming and hygiene: A child arrives at school with dirty hands wearing the same soiled clothes he wore the day before. He may not pay attention to how others view his physical appearance.

 

✱ Failure to understand and fulfill the role of listener: In conversations

with peers or adults, the child talks incessantly and continuously interrupts. He does not understand that when one person talks the other person listens.

✱ Inability to take the perspective of another: One child is upset because the other children did not permit him to play. The child with ADHD does not understand why that child is upset.

✱ Less time spent looking and smiling at a conversational partner: As a child is playing with another, the child with ADHD does not look or smile frequently at the other.

✱ Unwilling to act in a social situation to influence the outcome:

A child is playing by himself on the playground while watching the others play together. He is unwilling to go over to those children to ask them to play.

 

✱ Less likely to request clarification when given ambiguous or incomplete information: A teacher hands out permission slips and tells the children to return them to school signed by their parents. She does not tell the children when they

have to return it. The child with social skills deficits does not ask the teacher when to return the permission slip and, typically, forgets to hand it in to the teacher.

 

✱ Tendency to talk more or less: A child either talks too little or excessively to peers and adults.

 

✱ More likely to approach teacher and ask inappropriate questions: A teacher gives instructions on speaking out in class. She instructs the children to raise their hands when they have something important to ask her or to tell to the class.

The child with ADHD raises his hand and asks “Can we stand up in our seats and shout out our questions?”

 

✱ Less proficient in interpersonal problem solving: A child feels rejected by another child. He has not actually been rejected but does not understand how to go about trying to be friends. (Vaughn et al., 2007, p. 255)

How do you know if your Child has ADHD?

 

Typically, parents do not seemingly realize when certain symptoms are present in their child or adolescent. How can that be? We often see what we want to see, because to see the child or adolescent’s negative or inappropriate behavior is often too difficult to accept, nonetheless manage.

There has been so much talk lately about the overdiagnosis of ADHD. The fact that a child has a diagnosis or does not have a diagnosis does not matter to me. Instead, I look for persistent symptoms that interfere with (or as the new DSM states, impacts) the life of a child or adolescent with ADHD.

The operational word here is persistent. I am not talking about behaviors that the child exhibits once in a while, but rather, those that occur consistently over time. Some of the behaviors that parents should notice, as I state in my book[1] are the following, as adapted from the Conners Rating Scale:

✱ Restless in the “squirmy” sense

✱ Excitable, impulsive

✱ Fails to give close attention to details or makes careless

     mistakes in schoolwork, work, or other activities

✱ Is an emotional child

✱ Restless or overactive

✱ Does not appear to listen to what is being said to him

✱ Leaves seat in classroom or in other situations in which

     remaining seated is expected

✱ Inattentive, easily distracted

✱ Has difficulty waiting his turn

✱ Does not know how to make friends

✱ Fidgeting

✱ Disturbs other children

✱ Talks excessively

✱ Runs about in situations where it is inappropriate

✱ Has poor social skills

✱ Fidgets with hands or feet

 ✱ Demands must be met immediately—easily frustrated

✱ Blurts out answers to questions before the questions have

     been completed

✱ Interrupts or intrudes on others

✱ Easily distracted by extraneous stimuli

✱ Restless, always up and on the go

If you have noticed any of these behaviors, please feel free to send me your questions about how to manage those behaviors.

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[1] Rapoport, E. (2009). ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents. Maryland: Rowman and Littlefield Publishers.

Read my comments in the New York Journal News on April 2, 2013 on the arguable overdiagnosis of ADHD. Send me your thoughts.

ADHD may be overdiagnosed, Lower Hudson Valley experts fear

Study: 20% of H.S. boys classified with disorder

Apr 2, 2013 |

2Comments

 

Student in class / Getty Images/Comstock Images

Written by

Gary Stern

 

·         Filed Under

·         News

·         Westchester Medical Center In Valhalla

The decades-long debate over how many children have attention-deficit hyperactivity disorder — and whether those who do should be treated with medication — will only intensify with a new study that shows ADHD diagnoses soaring across the country.

Eleven percent of all school-age children have received a medical diagnosis of ADHD, including 20 percent of all high school boys, according to a New York Times analysis of a new national survey done by the U.S. Centers for Disease Control and Prevention.

Experts in the Lower Hudson Valley who deal with the diagnosis and resulting treatment needs say the figures may indicate too many children are being classified with the disorder.

“My impression is that it is definitely overdiagnosed,” said Eric Neblung, a Nyack-based psychologist and president of the New York State Psychological Association.

“A lot of times, the diagnosis is made by primary care physicians who aren’t trained to do it,” he said. “Parents may say that their son or daughter has trouble concentrating, and the physician will jump on it based on a quick screening. It could be typical adolescent behavior or other things like depression or anxiety.”

Neblung can’t see how one in five high school boys could have ADHD, a disorder characterized by inattentiveness and impulsiveness that is attributed to genetic and possibly environmental factors.

“The consensus traditionally is that it’s 1 to 10 percent, but even 10 percent is pushing it,” he said.

The Times report, based on a CDC telephone survey of more than 76,000 parents between February 2011 and June 2012, found that about 6.4 million children between 4 and 17 had received a diagnosis of ADHD at some point. This would represent a 16 percent increase from 2007, when the CDC did its last survey, and a 53 percent upsurge over the last decade.

The Times found that about two-thirds of all school-age children currently diagnosed with ADHD receive prescribed stimulants like Ritalin.

The CDC was not involved in the Times’ study, and a representative for the federal agency said it did not have enough information to assess the report. The CDC will have its own report analyzing the data later in the spring. The agency’s survey sought information on children’s overall health.

(Page 2 of 3)

 

Esta Rapoport of Chappaqua, the author of “ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents” (2009), said that many will be alarmed by the possible overdiagnosis of ADHD because they assume that children will be medicated. But this doesn’t have to be so.

“People become hysterical because of medication,” she said. “But we should be trying conservative methods first — teaching kids to self-regulate their behavior, to recognize when their behavior is inappropriate or when their academic work is ineffective. These kids struggle and need help, but they may not need medication.”

There is no simple test for ADHD, so it’s up to individual pediatricians, psychiatrists and psychologists to make the diagnosis.

A lot of factors have come into play to drive up the number of diagnoses, local experts said. Dr. Ronald Jacobson, chief of pediatric neurology at the Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, said that it can be simpler and cheaper to get a prescription for Ritalin than to seek ongoing counseling.

“We should insist that patients have a comprehensive evaluation, but you don’t always see that,” he said. “You may want to think about therapy and counseling and medication or all of those, but many families don’t have the resources or care to make use of all options.”

State rules governing prescriptions also have an impact, Jacobson said, and a new New York law that takes effect in August will create a “real time” online registry that tracks who prescribes drugs to whom.

“People may be more thoughtful about what gets prescribed,” he said.

Regardless of whether the growing number of diagnoses are accurate, the higher profile of ADHD should produce more public awareness of the challenges facing children, said Christine Reinhard, executive director of the Rockland County Association for Learning Disabilities.

“There are not enough support services,” she said. “We need more services like specialized tutoring and skills training to help them identify strategies that might reduce the need for medication.”

(Page 3 of 3)

 

Robert Fraum, a psychologist who provides counseling for attention deficit disorder and hyperactivity in White Plains and Manhattan, said that it’s very difficult to judge the numbers without having another survey for comparison.

“But if the numbers turned out to be true, I wouldn’t be surprised,” he said. “You would be talking about a wide range. Not everyone with attention-deficit disorder is hyperactive. There are a lot of daydreamers who are inattentive and try to keep their restlessness down as much as they can.”

Fraum said that while school districts may resist the diagnosis, suburban parents can be very aggressive in seeking services that come in the wake of an ADHD diagnosis and other accommodations such as “extra time on the SAT exam.”

Michael Schulman, assistant director of special services for Southern Westchester Board of Cooperative Educational Services, said that schools have to be careful about how they explain children’s behaviors to parents and doctors.

“What is the message we send to parents when a student may be behaving outside the norm?” he said. “We need to see if these behaviors can be ameliorated in a simpler fashion without a diagnosis. If a child isn’t sitting still, is it ADHD or is the child bored?”