SHOULD YOU PERMIT YOUR PRESCHOOL CHILD WITH ADHD TO ENGAGE IN SCREEN TIME?

You have probably observed that your preschool child with ADHD needs stimulation and is always looking for something to do, which in many cases involves a screen. Therefore, it may be your cell phone, an iPad, a tablet, a computer, or a television. Do parents (including me!) employ

these screens as a respite from the behavior that our children exhibit that is negative or socially inappropriate? Absolutely! Who could blame you? No one! What is the influence of screens on preschool children with ADHD?

Screens offer preschool children with ADHD the opportunity to hyperfocus, or to lock in with intense concentration. These children need stimulation, and rewards and screens satisfy these needs. Preschool children with ADHD may become what I call “zoned out,” whether they are

watching a television show or playing a game on an iPad. You may be confused by the term “hyperfocus” and ask yourself, “What is she talking about? My child has difficulty focusing so how can she be talking about an intense focus?”

Hyperfocus is the ability to zero in intensely on an interesting project or activity for hours at a time . . . the tendency for children and adults with attention deficit hyperactivity disorder (ADHD or ADD) to focus very intently on things that interest them. At times, the focus is so strong that they become oblivious to the world around them (Flippin, 2005, np).

Have you called your preschool child with ADHD to a meal, or asked him a question when he just stares ahead and does not answer you? Children and adults with ADHD have difficulty shifting attention from one thing to another. If they are doing something they enjoy or find

psychologically rewarding, they will tend to persist in this behavior after others would normally move on to other things. The brains of people with ADHD are drawn to activities that give instant feedback (Barkley, 2005, np). Preschool children with ADHD appear to exhibit less hyperactivity and/or inattentiveness during a period of hyperfocus, which typically occurs when they watch a television show, play a computer game, or a game on their iPads.

Is hyperfocus a good thing? It is advantageous to intensely focus on completing a puzzle or building an intricate Lego structure. Many young children play iPad games or watch television. However, there may be damaging effects of these screen-involved activities depending on the

length of time that they are engaging in them. There is much research that indicates that there may be some negative side effects as related to your children using screen time.

As your child grows, keep in mind that too much screen time or screen time that is of poor quality has been linked to

• obesity

• irregular sleep schedules and shorter duration of sleep

• behavioral problems

• loss of social skills

• violence

• less time for play (www.mayoclinic.org, 2017, np)

A better goal for the parents of preschool children with ADHD for their child is to build their child’s creativity and independent play, which they are not going to do while he is concentrated on a screen. If your child is sitting on the couch staring at the television watching a show, or playing a game on an iPad, is he using his mind for creative play? My opinion is probably not, though there is room for some imagination when a child is accessing apps. I am not advising you to never permit your child to have screen time. Instead, I am saying that it would

be smart on your part to limit the time that your child spends on screens, as well as make sure that he independently plays.

Should you permit your child to use a screen during a meal? Just to return to your desire to keep your child seated at meals once again, please do not permit him to use any device with a screen that might zone him out during meal time. Meals should be a social time of finding out about your child’s day and simply conversing about everything. If your child is using an iPad or a mobile device during a meal, he will only be paying attention to exactly what he is doing in a hyperfocused way. In other words, your child may not be accessible to you during these meals if he is viewing anything with a screen.

That being said, why would you introduce your preschool child with ADHD to apps? Why would you not just have your child play with typical toys? As I have said before, preschool children with ADHD, especially those who are hyperactive, need stimulating materials and

activities to grab their attention. Therefore, apps for preschool children with ADHD are worth trying if you think that these children will be successful at them. They should be colorful and interesting to your child, however, accompanied by pleasing sounds and positive reinforcement.

More later… questions??

The ABC Chart

ABC CHART

Date/Start & end time	A=Antecedent: Location, activity, people, etc.	B=Behavior What did the child do?	C=Consequence What happened after the behavior

Retrieved from http://schools.nyc.gov/NR/rdonlyres/3CBEB620-5B0B-4824-B79A=
6.09F0731B2C/166366/ABCChartAllinOneVersion1Instructions.docx

Does your Preschool Child with ADHD Stay in his Seat at Meals?

Save yourself some stress by not expecting your preschool child with ADHD to sit still during a meal. In fact, one of the most aggravating behaviors that occurs with preschool children with ADHD is their reluctance to stay in their seats at meals. Why does this behavior occur? Well,

some reasons might be that they are not hungry or that they see something else that interests them. Additionally, they may be copying their sibling. The reason that they are not staying in their seat at meals does matter, however.

The point is that it is very hard to have an enjoyable family meal with a preschool child with ADHD jumping in and out of his seat. All you find yourself doing is reprimanding your child, which ends up stirring up more negativity between the two of you. Your end goal is for your child to stay in his seat at meals. Before you begin to implement any intervention, design an ABC chart. (I will copy the chart for you send it to you via this social media.) Your data from the chart will show you what happened before your child behaved in a certain way, what was the behavior that he exhibited, and what happened to maintain the behavior such as a reinforcement, a reprimand, or praise. Also included, is the date that the behavior started and ended. This data is invaluable in trying to get your child to stay in his seat at meals. Hopefully, you will gain an answer as to how to get him to stay in his seat at meals successively and over time.

 Additionally, try using a bit of self-talk. Say to yourself, for example, “I am not going to get annoyed. I will not show him that he is driving me crazy! I will remain calm and figure out a way to maintain my composure and keep my sense of humor.” Of course, as I have said before, the real trick to not allowing yourself to become annoyed and aggravated, and showing your child that you are disgusted and upset is to think ahead of time about what you will say. Fewer mistakes are made when you decide ahead of time exactly what to say to your child. Try to turn each and every negative situation into a positive one. I clearly realize that whether you have been working all day or staying at home with your child, you have a right to sit down to a calm and

relaxing dinner. That being said, find something that your child is doing that is positive and praise that behavior. It could even be, “I like the way you are spearing your pasta with your fork. You are being so neat when you handle your pasta in that way.” Praise goes a long way when it is used with preschool children with ADHD. Additionally, try to get your child to move before he sits down for a meal. Put on music, so that he will naturally move and/or dance. The

more movement that he does before meals, the longer that he will be able to sit in his seat at meals.

I have found a really great book that is literally titled, It’s Time to Sit Still in your Own Chair by Lawrence E. Shapiro. The author suggests an intervention that just might work with preschool children with ADHD, so I would suggest that you obtain that book and see what the author suggests to do. In fact, this book along with other similar books written by the same author is available on Amazon.

Okay, so what should you do now to try to help your preschool child with ADHD to sit in his chair for a meal? Instead of looking for a long-term yield of having him stay in his seat for thirty minutes at a time, set up a regimen where the goal of how long he sits at the table is shorter, for

example, two minutes This time, use a kitchen timer instead of the Time Timer. Even though your preschool child with ADHD can undoubtedly not tell time, he will be able to at least see the two-minute mark on the timer.

If you really want to be creative, buy an Amazon Echo and set a timer on it. Your preschool child with ADHD will think it is fun, which will make your entire experience a more positive event. You can set the Amazon Echo’s timer for any increment of time. You can set the timer by

using your voice. You can also ask how much time is left on the timer and cancel the timer. For example, you can say, “Alexa, set the timer for three minutes.” In fact, if you are wondering how much time is left, you can ask Alexa. When the time is up, an alarm will sound.

Some type of reinforcement is in order here, so think of something small that is in your preschool child with ADHD’s interest area. If you decide to use stickers, for example, do not just give him a sticker that he puts on his body or on the table. Buy him a blank sticker book so that your preschool child with ADHD can see the stickers accumulate that he received when he behaved in a socially appropriate way. Remember, in addition to these short-term goals, you always want to keep in mind the longest-term goal of all, which is, as I have said previously, positive self-esteem.

What would you do if your preschool child with ADHD does not really care about stickers? Find out what he really cares about, whether it is playing on an iPad for five minutes, watching a few minutes extra of his favorite show, drawing with a new marker, eating a snack after dinner such as fruit snacks, drawing outside with sidewalk chalk, blowing bubbles, or counting all of the change that you have collected in a cup in your room! In fact, you can give him one fruit snack (to be eaten after dinner), for each minute he remains in his seat at a meal! The only thing that

matters here in terms of the value of the reinforcement is whether or not he has a real interest in that reinforcer or reward. Oh, and you may have to change the reward frequently so that it does not lose its value.

You may also have to frequently change the schedule of the reinforcement. For example, you may begin this intervention by giving your preschool child with ADHD a sticker each time he stays in his seat for two minutes. Then, you can give him a sticker for every other time he stays in his seat for three minutes. When you switch to four minutes and then five minutes, follow the same plan.

I am repeating this information for emphasis: you may have to change the reward as well as the reinforcement schedule. You will carry out this intervention in an easier way if you design a chart similar to the ABC chart that I have included here in appendix B, that includes the start and

the end time of the task; the antecedent, or what happens before the preschool child with ADHD exhibits the behavior; the behavior; and the consequence, or what happens that maintains the behavior. Then you can complete each element of the intervention and see if he is improving in

the amount of time that he is sitting in his chair at meals. You can use the chart for two meals per day. In that way, you will be able to look at your data and try to determine if your preschool child with ADHD sits longer at one meal than another. Additionally, you will have data-driven proof, so that you can try to ascertain as to why he sits longer at one meal than another. Also, collect information such as the following: Are his siblings at one meal and not another? Do you and your spouse actually eat at one meal and not another? Does your preschool child with ADHD eat with his siblings? Does your preschool child with ADHD eat by himself? Are you on the phone when he is eating during one meal and not another? Are you rushing out with your preschool child with ADHD in the morning meal to get him to school and are more relaxed at dinner?

If your preschool child with ADHD attends school, ask his teacher if he stays in his seat at the meals that he eats there. How long does he stay in his seat while eating at school? Ask his teacher to write down the length of time that your preschool child with ADHD sits in his seat at

school when he eats. In that way, you can compare the time period that he sits at his seat at a meal at school to the time period that he sits in his seat for a meal at home. If you can answer these questions, then you can try to figure out which variables might possibly influence how long your preschool child with ADHD sits at a table at meals.

DO PRESCHOOL CHILDREN WITH ADHD LEARN SOCIAL SKILLS?

Typically, preschool children learn how to interpret social cues from their parents, and therefore,

behave appropriately by observing them. Their parents teach them how to behave in a social situation and specifically how to learn the meaning of what another child is saying to them.

However, preschool children with ADHD cannot pay attention to their parent’s words or actions because they are paying attention to something else. Their focus is also inconsistent, so they may hear only a part of what their parent is saying to them. The result of this inconsistent focus is that

these children behave in a socially inappropriate way, leaving the other children to look at them in a strange way, not understanding their peer’s inappropriate behavior. Children may look at the preschool child with ADHD as different. They may ask themselves why their peer does not understand how to behave. These children appear vulnerable, which may lead to them bullying others and to be bullied themselves even at a preschool age! (We will talk about bullying in another blog post.) They may misunderstand other children’s social cues as well.

THE DEFINITION OF SOCIAL SKILLS

What are social skills? “Social skills may be defined as socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses” (Elliott and Gresham, 1993, p. 287).

THE IMPORTANCE OF PARENTAL KNOWLEDGE OF THEIR PRESCHOOL CHILD WITH ADHD’S SOCIAL SKILLS

Why do parents of preschool children with ADHD need to know the importance of learning social skills? Typically, preschool children with ADHD have poorly developed social skills. They have difficulty following instructions, they do not listen well, and therefore interrupt others, among other negative behaviors. When a child appears to be vulnerable as these preschool children with ADHD often appear to be, they are at risk for negative and difficult social experiences. Social situations which typical children find easy to manage may be treacherous for preschool children with ADHD. They may have difficulty making friends and even their families may find them annoying, which is very sad! Here is what one mom told me about her son:

“He has this behavior that really pisses people off. Some ADD or ADHD is either manageable or they’re so charming or sometimes it passes. We have one. His personality

makes people really upset. And that was pretty evident early on.”

I was troubled by her statement about her son because I knew that his life and his parent’s life had to be very difficult. I was especially heartbroken hearing any mother talk about her child in such negative terms. How do preschool children with ADHD who have social skills deficits

behave? They either talk excessively without realizing that they are doing so, or they may talk so infrequently that their parents hardly know that they are in the same room. Additionally, they may not understand social cues that other children are expressing in conversations. Social cues are signals, either verbal or nonverbal, that help to communicate behavior. Some of these social cues may be facial expressions or body language. Preschool children with ADHD typically misinterpret social cues, which we will discuss in a later blog.

There are many other examples of poor social skills, including touching another child, pushing, hitting, etc. I am sure that we all know the definition of social skills. However, in terms of

accuracy, Elliott and Gresham (1993) stated that “social skills may be defined as socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses” (p. 287).  Preschool children with ADHD need to learn and exhibit positive social skills in order to make friends, get along with their family, and build positive self-esteem. These children have experienced rejection and criticism constantly because of their inappropriate behavior and their lack of social skills. If

they live in the same house as their siblings, why do they do not learn the same social skills as them?

DO PRESCHOOL CHILDREN WITH ADHD LEARN THE

SAME SOCIAL SKILLS AS THEIR SIBLINGS?

If you look at the previously stated definition, preschool children with ADHD have difficulty learning social skills. How can that be? Aren’t they being brought up in the same house as their siblings who exhibit positive social skills? If you are a parent of one of these children, you know very well that your child has immature social skills. In fact, due to the point that they do not have a complete repertoire of intact, positive social skills, they are not only difficult to manage but sadly, annoy many people (as I have said before, but will emphasize again here), due to their excessive verbiage and socially inappropriate behavior.

One of the parents with whom I worked described her child’s behavior this way:

I can remember when he was four and he talked back to his grandfather.

I said nothing, because it was like, you know what the situation

was with the grandfather. I don’t want to say he asked for it, but the

tone and attitude and the behavior was such that Aaron was “back at

ya,” you know. I did correct him. I told him, Aaron that was not right,

even though my thinking was, I’d have done the same thing as an

adult. You’re a child, you don’t behave that way. So, it’s always been a

very tricky situation. I talked to him at that point. I did say to him,

Aaron, you know, you need to apologize; that was wrong. To let him

know that it was unacceptable, but at that same point in time I knew

that what he said was something that anyone, any adult would have

said in the same situation. But the problem was that he wasn’t an adult.

He was a child. He didn’t know he wasn’t supposed to say that. That

was how he felt, so that’s how he handled it (Rapoport, 2009, p. 23).

Another parent described her son’s inability to control his own behavior:

As far as social skills go, I do think that kids with ADHD have significant

issues with this. Sometimes it seems to be a matter of the fact that

they do not notice their own behavior as being unusual or inappropriate

in any way. Thus, they make no effort to control it. But, even when

pointed out, they often seem unable to control odd or inappropriate

behavior. (Rapoport, 2009, p. 24).

Okay, so let’s get to the bottom of these children’s social skills difficulties. Preschool children with ADHD of all types may have social skills problems, even though their behavior may be varied. Why? They have social skills deficits. These deficits typically have been described as either “can’t do” or “won’t do” (Gresham, Sugai, and Horner, 2001, p. 33). They either do not have the knowledge to behave in a socially appropriate manner or they know how to behave in a socially appropriate manner but do not do so (p. 33). Social skills deficits prevent these children from learning positive social skills. They typically do not pick up and internalize positive social skills that are modeled by their parents at home in the same way as preschool children without ADHD do.

  

So, why don’t preschool children with ADHD learn the same social skills as their siblings who live in the same house? Check out my next blog!

HOW DO THE SYMPTOMS OF ADHD PRESENT THEMSELVES IN PRESCHOOL CHILDREN?

The Diagnostic and Statistical Manual for Mental Disorders- (DSM-5) states that “In preschool, the main manifestation (of ADHD) is hyperactivity” (American Psychiatric Association, 2013, p. 62). The CDC also found that the most typical and paramount symptom of ADHD in preschool is hyperactivity (www.CDC.gov, np). It does not mean that preschool children with ADHD are not inattentive and unfocused because many are characterized by these symptoms as well. I will concentrate on young children who are four- or five-years old specifically, because these are the ages that it is possible to differentiate their behavior from the more variable behaviors they exhibit before they are four-years-old. As the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states, “Many parents first observe excessive motor activity when the child is a toddler, but symptoms are difficult to distinguish from highly variable normative behaviors before age 4 years” (APA, 2013, p. 62). However, if your child is younger than four-years- old, my interventions will definitely help your child anyway!

The Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) states that preschoolers with ADHD are more likely to have difficulty in daycare, including problems with peer relationships, and learning, as well as a higher risk of injuries than preschool children without ADHD. Frequently, these children are suspended or expelled from preschool for their behavior, which I know sounds extreme, but it does happen. Preschool children with ADHD experience difficulty in their relationships with their parents, as well as struggles in their social interactions.

Why do these things happen? These children do not have intact positive social skills. They either do not have knowledge of effective social skills or they have knowledge of the appropriate social skills, yet do not perform them. Wait! You KNOW that you have taught social skills to all of your children? Why and how did your preschool child with ADHD not learn positive social skills? Tune into my next blog post!

The Definition of Attention-Deficit/Hyperactivity Disorder (ADHD)

THE DEFINITION OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Even though as parents, you are acutely aware of your child’s behavior, it is imperative to know the accepted definition of ADHD, as stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here is the well-accepted and current definition:

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by (1) and/or (2):

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities:

Often fails to give close attention to details or makes careless mistakes in

            schoolwork, at work, or during other activities                          

often has difficulty sustaining attention in tasks or play activities

often does not seem to listen when spoken to directly

often does not follow through on instructions and fails to finish

schoolwork, chores, or duties in the workplace

often has difficulty organizing tasks and activities

often avoids, dislikes, or is reluctant to engage in tasks that require

sustained mental effort

often loses things necessary for tasks or activities

is often easily distracted by extraneous stimuli

is often forgetful in daily activities

Hyperactivity and impulsivity: Six (or more) of the following symptoms

have persisted for at least 6 months to a degree that is inconsistent

with and that negatively impacts directly on social and academic/

occupational activities

often fidgets with or taps hands or feet or squirms in seat

often leaves seat in situations when remaining seated is expected

often runs about or climbs in situations where it is inappropriate

often unable to play or engage in leisure activities quietly

is often “on the go,” as if “driven by a motor”

often talks excessively

often blurts out an answer before a question has been completed

often has difficulty waiting his or her turn

often interrupts or intrudes on others

Several inattentive or hyperactive-impulsive symptoms were present

prior to age 12 years.

Several inattentive or hyperactive-impulsive symptoms are present in

two or more settings.

There is clear evidence that the symptoms interfere with, or reduce the

quality of, social, academic, or occupational functioning.

Specify whether:

314.01 (F90.2) Combined presentation: If both Criterion A1 (inattention)

and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.

314.00 (F90.0) Predominantly inattentive presentation: If Criterion

A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity)

is not met for the past 6 months.

314.01 (F90.1) Predominantly hyperactive/impulsive presentation:

If Criterion A2 (hyperactivity-impulsivity is met and Criterion

A1 (inattention) is not met for the past 6 months (American

Psychiatric Association, 2013, pp. 59–60).

THE DIAGNOSTIC FEATURES

According to the American Psychiatric Association (AAP),

The essential feature of attention-deficit/hyperactivity disorder

(ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity

that interferes with functioning or development. Inattention

manifests behaviorally in ADHD as wandering off task, lacking

persistence, having difficulty sustaining focus, and being disorganized

and is not due to defiance or lack of comprehension. Hyperactivity

refers to excessive motor activity (such as a child running about) when

it is not appropriate, or excessive fidgeting, tapping, or talkativeness.

. . . Impulsivity refers to hasty actions that occur in the moment

without forethought and that have high potential for harm to the individual

. . . Impulsivity may reflect a desire for immediate rewards or an

inability to delay gratification. Impulsive behaviors may manifest as

social intrusiveness (e.g., interrupting others excessively) and/or as

making important decisions without consideration of long-term consequences

(American Psychiatric Association, 2013, p. 61).

How do the symptoms of ADHD present themselves in preschool children? Check out my next blog post!

I am Back! Let Us Learn about Preschool ADHD

For the past several years, I have been writing my new book. It is entitled, Positive Behavior, Social Skills, and Self-Esteem: A Parent's Guide to Preschool ADHD, published by Rowman and Littlefield.

It is available at https://smile.amazon.com/Positive-Behavior-Social-Skills-Self-Esteem/dp/1475850409/ref=sxts_sxwds-bia?keywords=preschool+adhd&pd_rd_i=1475850409&pd_rd_r=c682dcd5-ba39-45cb-a611-d331566748f4&pd_rd_w=BQY1R&pd_rd_wg=R3rNa&pf_rd_p=a5491838-6a74-484e-8787-eb44c8f3b7ff&pf_rd_r=THWJQ6CS87WTY2S7VVPH&psc=1&qid=1571770958 

I am back now, and am ready to help parents who have preschool children with ADHD and educators who teach them to learn how to encourage positive behavior, social skills and positive self-esteem, as my title states!  First of all, how do parents know if their preschool child has a diagnosis of ADHD?

HOW DO I KNOW IF MY PRESCHOOL CHILD HAS A DIAGNOSIS OF ADHD?

Parents who have a child of the preschool age who suspect that he has ADHD typically know from a young age that their child’s behavior looks different from another child’s behavior of the same age. Even though we try not to label a child and try to look at his behavioral symptoms instead of a diagnosis, many preschool children exhibit behaviors that resemble the symptoms of ADHD. The difference in these children’s behavior is the degree to which they exhibit hyperactive or inattentive behaviors. I have seen many children who are jumping off of the couch one minute seemingly out of control, who are sitting looking at a book with focus and concentration the next minute.

This inconsistency of behavior also makes it somewhat difficult to make a clear diagnosis of ADHD in preschool children. However, the correct diagnosis is based upon the intensity and the persistence of these symptoms, as well as how their behavior impacts their interactions with other people in their lives. In addition, a diagnosis of ADHD may not be determined unless the child exhibits socially inappropriate behavior in at least two settings.

What are the symptoms and/or the behavior that the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition, (DSM-5) states is present in a preschool child with ADHD, as is consistent with the accepted definition? Read on to my next blog post!

* For clarity purposes, I am referring to a preschool child with a diagnosis of ADHD as "he" instead of "she" in my blog, even though clearly there are many girls who have a diagnosis of preschool ADHD, as well.