Attention Deficit Hyperactivity Disorder (ADHD)

1. Attention Deficit Hyperactivity Disorder (ADHD) Tips for Understanding and Managing ADHD in the Home Presented by: Brett L. Patterson, M.A.

2. Goals for This Presentation • Provide a basic understanding of what ADHD is, and what it is not. • Attempt to answer any questions and dispel any myths that many people have regarding ADHD. • Introduce some guiding principles for dealing with ADHD behaviors.

3. ADHD Exposed • ADHD is identifiable via behavioral, not physical characteristics, making it more likely to be misunderstood. • Misperceptions: • Behaviors that directly result from ADHD are not primarily attributable to poor parenting, lack of discipline, low motivation, or intentional “trouble making.” • Not everything that fidgets and/or behaves defiantly is ADHD.

4. What Is ADHD? • Neurobehavioral disorder marked by: • Inattention • Difficulties controlling impulses • Excessive motor activity (hyperactivity) • Be aware…the mere presence of these behaviors does not mean the child has ADHD.

5. Seen in early child development Behaviors clearly distinguish child from non-ADHD children Occurs across several situations (though not necessarily in all of them) Behaviors persistent over time Child not able to perform at age-appropriate levels Not accounted for by environment of social causes Related to brain function Associated with other biological factors that can affect brain function (i.e. head injuries, genetics) Indicators of ADHD as a Developmental Disorder (Barkley, 1995)

6. Things We Can See (aka, Common Complaints) • Difficulties sustaining attention • Daydreaming • Child doesn’t listen • Always losing things • Forgetful • Easily distracted • Needs constant supervision • Child doesn’t finish anything he/she starts

7. Common Complaints (cont’d) • Problems with impulse control • Impatient/Difficulties waiting for things • Always interrupting others • Blurts out answers • Doesn’t take turns • Tries to take shortcuts on many tasks (including chores, homework, etc.)

8. Common Complaints (cont’d) • Hyperactivity • Always on the go • Squirmy…can’t sit still • Talks too much • Frequently hums or makes odd noises • Unable to “put the brakes on” motor activity • Child has two speeds; asleep and awake

9. What Do These Behaviors Have in Common? • Problem isn’t as much sustaining attention as it is sustaining inhibition…this is the hallmark of ADHD • Inhibition: a mental process that restrains an action (behavior) or emotion • Problems of inhibition are not a matter of choice, but are instead a result of what is (or is not) going on in the child’s brain

10. ADHD and the Human Brain • Portions of brain’s frontal lobe are responsible for “Executive” functions: • Consolidating information from other areas of the brain • “Considers” potential consequences and implications of behaviors • Puts “brakes” on (inhibits) impulsive reactions • Initiates appropriate response to environment

11. ADHD and the Brain (cont’d) • Research suggests that in in children with ADHD, these “executive” areas of the brain are under-active • Increasing the activity level in these areas of the ADHD brain have been shown to decrease behavioral symptoms. This is the logic behind using Stimulant medications as a first line treatment for the disorder.

12. Common Stimulant Medications • Methylphenidate (Ritalin) • Dextroamphetamine (Dexedrine) • Amphetamine/ Dextroamphetamine (Adderall) • Pemoline (Cylert)

13. Depression Anxiety Hearing problems Visual problems Seizure disorder Oppositional defiant disorder Autism Learning disabilities Parenting problems Substance use Medication side-effects Lead poisoning Things That Look Like ADHD

14. Ten Guiding Principles for Raising a Child with ADHD (Barkley, 1995) • Give your child more immediate feedback and consequences • Give more frequent feedback • Use larger and more powerful consequences • Use incentives before punishment • Strive for consistency

15. Ten Guiding Principles for Raising a Child with ADHD (cont’d) • Act, don’t yak! • Plan ahead for problem situations • Keep a disability perspective • Don’t personalize your child’s problems or the disorder • Practice forgiveness

16. In Using These Principles, It Is Important That the Parent: • Pause before reacting to the child • Use the ensuing delay to remember all 10 guiding principles (post them around the house if necessary) • Choose a response that is consistent with the principles

17. Additional Tips for Managing ADHD Behaviors • Pay positive attention to your child…catch them being good • Give effective commands • Short, sweet, and straightforward • Limit the number of tasks to 1-2 per command • Maintain clear and consistent expectations • Communicate realistic consequences for inability to meet expectations

18. Tips for Managing ADHD (Cont’d) • Manage the child’s environment • Limit distracting influences during times when child is asked to be on task (i.e. homework) • Maintain a regular and predictable daily schedule • When eliciting child’s input, limit (but don’t eliminate) the number of choices available to him/her to 2-3 options

19. Tips for Managing ADHD (Cont’d) • Be patient • Be persistent • Be understanding • *Most importantly, remember to differentiate the behaviors from the child • Bad behaviors are not synonymous with a bad child

20. Resources Available to Parents • Children and Adults with ADD (CHADD): a family support organization that provides a variety of services. (www.chadd.org or the Central OK chapter phone number is 405-722-1233 • There is a plethora of readings available to those interested in obtaining more information on ADHD. One that I have found particularly useful in working with parents is Taking Charge of ADHD: The Complete Authoritative Guide for Parents, by Russell A. Barkley, Ph.D. (1995)