Focus on the Family

ADHD

from The Complete Guide to Baby & Child Care

Managing a child with ADHD requires participation from the entire family. Each member — including Grandpa and Grandma — needs to become educated about this problem, just as they would if a child had diabetes, asthma, or any other significant chronic condition.

Input from the professional(s) involved and from books, tapes, and local support groups can be extremely helpful. The nonprofit organization CHADD provides a variety of services, including printed information (fact sheets, newsletters, educational materials for parents and teachers) and local chapters where parents — and adults with ADHD — can vent, support one another, and share ideas.

Parents of a child with ADHD must be unified and cooperative. The survival of your marriage will require your conscious decision to create a flexible team and firm support. If you are a single parent with an ADHD child, you will need to marshal all the support you can find — from relatives, friends, members of your church, even coworkers — to give yourself some breathing room. In all cases, prayers to God for wisdom and patience should be a vital part of each day.

The following can help restore and maintain order at home:

The ADHD child needs structure and consistency. A predictable routine every day, with specific times for meals, chores, homework, bathing, and bedtime, creates a stable framework for his life. The ADHD child most often wants to do what is right. External structure helps move him in the right direction.

House rules and expectations for behavior should be explicit, understandable, and achievable. It would be unrealistic to expect a child with ADHD to sit quietly through a full-length sermon, go on an extended shopping trip, or dine in a formal restaurant without some difficulty — or total disaster.

Give instructions simply and clearly; avoid giving a chain of directions. A half hour after making a seemingly simple statement such as "Put the LEGOs away, let the dog out, and get your coat," you may find the ADHD child playing with another toy he spotted while putting away the LEGOs. The dog and the coat will have been long forgotten. If you have more than one thing you want him to do, tell him one step at a time.

Enforce rules and limits consistently and predictably, with consequences appropriate for the violation. For example, if he charges into a busy street on his being warned not to do so, bike-riding privileges should be suspended for a day. If he knowingly mistreats a toy and it falls apart, don't repair or replace it right away. If he has become too excited or aggressive playing with other children, give him a time-out in an uninteresting spot.

Remember, the child with ADHD may not seem to "get the picture," and he may actually repeat the behavior for which you just punished him. It is important to make him suffer consistent consequences each time but not to yield to extremes: either giving up, which forfeits your right to be in charge, or reacting with increasingly harsh punishments.

As with all children, pick your battles carefully. Behaviors that put him or others at risk or are overtly destructive need your decisive response. But if you go to the mat with him over every minor annoyance, you'll be exhausted — and thoroughly depressed — every day.

Offer praise and encouragement. The child with ADHD needs to know he is loved and accepted as an important member of the family, especially because his disruptive behavior, difficulties with schoolwork, and lack of success in other areas such as games and sports will generate negative feedback from several directions. He needs to know that you and others are on his team and always will be.

When he does what he's told, accomplishes a task, plays well with another child, or makes progress at school, praise him. A special time of ten or fifteen minutes every day with one or both parents can allow some positive attention to be focused on him regularly.


Facts About ADHD

Unlocking the potential in your ADHD child will require some work on your part, but it will be well worth it.

by Dr. Walt Larimore

How Common Is ADHD?

Some studies estimate that 1.7 percent of children have ADHD; others claim the number is closer to 26 percent, depending upon where, when and how the studies were conducted.

The Journal of the American Medical Association states that ADHD "… is among the most common neurodevelopmental disorders in children." The British Medical Journal estimates that some 7 percent of school-aged children have ADHD — and that boys are affected three times as often as girls. A 1995 Virginia study showed that 8 to 10 percent of young schoolchildren were taking medication for ADHD.

According to the Centers for Disease Control and Prevention (CDC), in 2002, 7 percent of children in the U.S. ages 6 to 11 had ADHD. They also reported that half of children in whom a diagnosis of ADHD was made also have a learning disability. They calculated that at least one million children have a learning disability without ADHD. The total number of children with at least one of these disorders was 2.6 million.

Again, boys were three times as likely as girls to have a diagnosis of ADHD alone, and twice as likely to have ADHD with a learning disability. Rates of diagnosis of ADHD are twice as high in Caucasian children as in Latinos and African Americans. Interestingly, children with a diagnosis of a learning disability alone were more likely to live in a low-income or single-mother household. Children from families with health insurance were more likely to have a diagnosis of ADHD without a learning disability.

It may be that Caucasian children, especially boys, are overdiagnosed. Another example is found in a study of fifth graders. Eighteen to 20 percent of Caucasian boys were being treated for ADHD with medication. African American children with ADHD are less than half as likely to receive treatment.

Whether or not you believe ADHD is real, it is not at all uncommon. Those looking for help in dealing with ADHD are not alone. Many parents are trying to discover the attention deficit dividends of their child. There is hope. To unlock the potential in your child will require some work on your part, but it will be well worth it.

Undoubtedly, ADHD treatment is a controversial topic — but in my opinion it should not be. In fact, more and more the medical studies are confirming that treatments work and they help — and they should not be kept from children who need them.

I would be the first to admit that ADHD is occasionally overdiagnosed. Obviously, not everybody who is called ADHD really is. But overall, it appears that physicians and mental-health professionals are doing a fair job.

In fact, Journal of the American Medical Association (JAMA) concludes: "Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread over-prescription of methylphenidate (Ritalin and others) by physicians."

What Are Some Traits Seen With ADHD?

Hallowell and Ratey, authors of Driven to Distraction, list 20 symptoms that are often evident in a person with ADHD:

  1. A sense of underachievement, of not meeting one's goals (regardless of how much one has accomplished)
  2. Difficulty getting organized
  3. Chronic procrastination or trouble getting started
  4. Many projects going simultaneously; trouble with follow-through
  5. Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark
  6. An ongoing search for high stimulation
  7. A tendency to be easily bored
  8. Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled with an ability to focus at times
  9. Often creative, intuitive, highly intelligent
  10. Trouble going through established channels, following proper procedure
  11. Impatient; low tolerance for frustration
  12. Impulsive, either verbally or in action, as in impulsive spending, changing plans, enacting new schemes or career plans
  13. Tendency to worry needlessly, endlessly; tendency to scan the horizon looking for something to worry about alternating with inattention to or disregard for actual dangers
  14. Sense of impending doom, insecurity, alternating with high risk-taking
  15. Depression, especially when disengaged from a project
  16. Restlessness
  17. Tendency toward active behavior
  18. Chronic problems with self-esteem
  19. Inaccurate self-observation
  20. Family history of manic-depressive illness, depression, substance abuse or other disorders of impulse control or mood

Are the Brains of People With ADHD Different?

Although the cause of ADHD is unknown, the theories abound. Some believe it is associated with subtle differences in brain structure. Brain scans reveal a number of subtle changes in the brains of those diagnosed with ADHD. In fact, one of the former names used for ADHD was "minimal brain disorder."

Others say it's related to neural pathways, neurotransmitters or brain chemistry — particularly abnormalities in the brain chemical dopamine. Still other researchers believe ADHD is related to the brain's blood supply or electrical system. Recent research has raised the question of whether frequent exposure in early childhood to rapid electronic stimuli (such as television and computers) might contribute to this problem.

Richard Degrandpre, in his book Ritalin Nation: Rapid-Fire Culture and The Transformation of Human Consciousness, theorizes about what he calls a "sensory addiction phenomenon." He feels that many of the behaviors seen in ADHD people stem from a sensory bombardment from TV programs, movies, computers and so on. He feels that early exposure to this sensory bombardment, especially at a time when the brain is just forming connections and synapses, may result in biological or neurological effects, including, but not limited to, ADHD.

Degrandpre believes that these effects can be exaggerated in the absence of parental structure. We live in a world that is incredibly stimulating; there are constant stimuli in the life of even a young child. I don't know that we can get rid of all that, but I know that I can encourage parents to provide a loving, warm, structured environment so children can learn to deal with all the stimuli.

One piece of data that may support Degrandpre's theory is the experience of the Amish, who are known to forego computers and television. This keeps their children from this type of stimulation; ADHD appears to be uncommon among the Amish. Researchers have reported that among 200 Amish children followed prospectively and compared with the non-Amish population, symptoms of ADHD were unusual.


More Facts About ADHD

Unlocking the potential in your ADHD child will require some work on your part, but it will be well worth it.

by Dr. Walt Larimore

Is ADHD Different in Boys and Girls?

It's important to realize that while ADHD is usually associated with hyperactivity, there is a form that is not associated with hyperactivity. This form is especially common in girls. Girls with predominately inattentive type ADHD will usually be seen as dreamy or detached. Unfortunately, some will be called "airheads" or "space cadets." Such a young lady can look at a book for 30 minutes without reading a word.

One parent told me that their daughter would lose every article of clothing that wasn't hooked to her body. Nearly every day, this child's teacher would have to send her back to the playground to retrieve her sweater or coat, only to have her return 15 minutes later without it, having forgotten what she went after.

A girl with that kind of distractibility would find it extremely difficult, if not impossible, to get home night after night with books and assignments written down, and then to complete the work and turn it in the next morning.

Dr. James Dobson has written, "The 'far away' child worries me more than the one who is excessively active. She may be seen as a good little girl, who just isn't very bright, while the troublemaker is more likely to get the help he needs. He's too irritating to ignore."

What Is the Genetic Link With ADHD?

There is increasing evidence from medical studies that genetic factors play a role in ADHD. Jacquelyn Gillis and her team, then at the University of Colorado, reported in 1992 that the risk of ADHD in a child whose identical twin has the disorder is between 11 and 18 times greater than that of a non-twin sibling of a child with ADHD. She showed that between 55 and 92 percent of the identical twins of children with ADHD eventually develop the condition.

A large study of twins in Norway, involving 526 identical twins (who inherit exactly the same genes) and 389 fraternal twins (who are no more alike genetically than siblings born years apart) found that ADHD had nearly an 80 percent chance of being inherited. They concluded that up to 80 percent of the differences in attention, hyperactivity and impulsivity between people with ADHD and those without the disorder can be explained by genetic factors.

In addition, scientists are telling us that there are genetic mechanisms that regulate hyperactivity, especially as they relate to dopamine. For example, a significant percentage of people with ADHD have been found to have an abnormality of the dopamine D4 receptor gene, which is associated with abnormal risk-taking behavior and hyperactivity.

What does this mean for your family? Simply that one or both of the parents of your ADHD child are likely to have ADHD. If so, dealing with your child may remind you of some painful memories from your childhood or teenage years. This can make it even more difficult and emotional to deal with your child.

Furthermore, the unaffected siblings may be more likely to have children of their own with ADHD. These are just a few of the reasons that many ADHD therapists will recommend that parents and siblings also be tested for ADHD and consider education and counseling for the entire family.

Is ADHD Associated With Risk-Taking Behaviors?

There are studies indicating that there is an association between ADHD and the abuse of alcohol and drugs, as well as criminal activity. When it comes to tobacco abuse, a study from the University of California, Berkley, reported "a significant difference in rates of daily smoking and tobacco dependence for those with ADHD who had used stimulant medication in childhood in contrast to controls." These researchers felt there was a possible link between ADHD treatment histories and levels of tobacco dependence in adulthood.

However, most experts believe these anti-social behaviors are much more likely in those who have ADHD and another disorder, such as conduct disorders and mental health disorders. They believe those with ADHD alone do not appear to be at increased risk for these problems. For example, they point to a study that showed that medication for children with ADHD reduced the probability of substance use disorder (SUD) by 85 percent when compared with the risk among unmedicated kids with ADHD.

The general danger of the typical characteristics of ADHD — particularly in adolescence and adulthood — is a desire for high-risk activity. Dr. Dobson points out, "Even as children they can be accident-prone. But, as they get older, rock climbing, bungee jumping, car racing, motorcycle riding, white-water rafting and other high-risk activities are among their favorite activities."

"Adults with ADHD are sometimes called 'adrenaline junkies,' because they are hooked on the 'high' produced by the adrenaline rush associated with dangerous behavior. Others are more susceptible to drug use, alcoholism and other addictive behaviors." Because of this, about 40 percent of adolescents living with ADHD have been arrested by their eighteenth birthday.

Dr. Dobson warns those with ADHD: "Some adults who have ADHD are at higher risk for marital conflict, too. It can be very irritating to a compulsive, highly ordered husband or wife to be married to a 'messie' — someone whose life is chaotic and one who forgets to pay the bills, fix the car or keep records for income-tax reports. Such a couple usually needs professional counseling to help them learn to work together and capitalize on each other's strengths."

Nevertheless, for many that live with ADHD, the symptoms will diminish with neurological social maturing. Nevertheless, it is helpful for all of us to realize that many of those living with ADHD can, with instruction, skill and mentoring, demonstrate in remarkable ways their outstanding giftedness — which can include creativity, energy, enterprising thinking and leadership skills.


How to Help an ADHD Child

Unlocking the potential in your ADHD child will require some work on your part, but it will be well worth it.

by Dr. Walt Larimore

What Is My Child Feeling?

At Focus on the Family, we receive letters from children, adolescents and young adults who live with ADHD. One of the most heartrending came from a boy in the seventh grade. Here is some of what he wrote:

When I began the second grade, I went from having a good teacher to a hard one. I did not feel ready for second grade, and felt different from the other kids. Writing words were hard, like writing the Korean numbers. No letters or numbers made sense, and I had trouble remembering everything I learned. I did not understand and remember the directions, and everyone seemed mad at me all the time.

When you're in second grade, you feel pressure to wear cool clothes and hang out with cool friends and do well in school. I began to feel like I was a failure and heard my teacher tell my mom I was at the bottom of my class. What did that mean? I did not know, really, what that meant until the other kids made fun of me and called me "stupid." I felt stupid. I told my mom I was stupid. My pride was hurt because I didn't feel like the other kids, or I didn't feel like I belonged. Everyone seemed to have fun and school stuff was easy for them.

I had one friend like me, and we started a club only for kids like me. My teacher told my parents that I might have a learning disease, and should have some tests. I had a tutor everyday after school, and I learned the stuff real good at night, but at school I could not remember what I'd learned or the right way to do problems.

In fifth grade I still had trouble learning, and people, especially my teachers, were getting more and more mad at me for forgetting. Sometimes, I would forget all the stuff and have fun. Sometimes I would not. Mostly, not.

My mom tried really hard to help me remember things, and she was starting to get mad at me, too. They told me I was not trying. The teacher told my mom I was lying about not remembering and that I was lazy. I'm not lazy. I'm just so tired of people telling me to try harder. I did not blame them for my disease, so why does everybody blame me?

He goes on and describes a terrible thing that happened at school when he was forced by a teacher to pick up trash because he wouldn't do his homework. Kids started calling him the "Trash Man" and the name stuck.

I wish I could say that this is the only letter like this we have received at Focus on the Family. Unfortunately, it is not. These young people, without proper parental and medical care, can easily become defeated — first academically, then emotionally, socially and spiritually. With prayer and proper care, these specially gifted kids can have academic success. They can discover who God created them to be and find what He has in store for them.

Support Groups

Successful management of ADHD involves a range of options. The first and foremost, after diagnosis, is education. The person living with ADHD is usually greatly relieved to learn that he has an identifiable, treatable condition. They are gratified (as are their parents) to learn that they've done nothing wrong. This condition is not caused, but you are born with it. It's part of your design and make-up. Best of all, God can and does use ADHD in His particular and peculiar plan for your life.

One organization that may be able to help is CHADD (www.chadd.org*), which provides an incredible amount of evidence-based and trustworthy information. They can offer the seeds, at least, for parent support groups. This organization, and others, can help you gather information.

However, let me share a caution here. Parent support groups, if not carefully done, can turn into gripe and whine sessions. That is not helpful and is sometimes harmful. All of us need someone to gripe to on occasion, no doubt, but unless there's some direction to the group, such as, "Okay, now we've heard everyone's complaints, what can we do about it?" it just stays at the complaining level. Then the kids pay the price. I've seen parents come home from such a group and get all over their child because of what they talked about at the support group. That's not helpful for the parent or the child.

Discipline and Structure for the ADHD Child

One of our constituents wrote to Focus on the Family saying, "We have a 5-year-old son who has been diagnosed with ADHD. He is difficult to handle, and I have no idea how to manage him. I know he has a neurological problem; I don't feel right about making him obey like we do our other children. It is a big problem for us. What do you suggest?"

Dr. Dobson responded to this mother: "I understand your dilemma, but I urge you to discipline your son. Every youngster needs the security of defined limits, and the ADHD child is no exception. Such a child should be held responsible for his behavior, although the approach may be a little different."

According to Dr. Dobson, "most children can be required to sit on a chair for disciplinary reasons. However, the ADHD child would probably not be able to remain there. In the same way, spanking may actually be ineffective with highly excitable children. As with every aspect of parenthood, disciplinary measures for the ADHD child must be suited to his or her unique characteristics and needs."

Here are 18 suggestions from a book by Dr. Domeena Renshaw entitled The Hyperactive Child. Though her book is now out of print, Dr. Renshaw's advice is still valid:

  1. Be consistent in rules and discipline.
  2. Keep your own voice quiet and slow. Anger is normal. Anger can be controlled. Anger does not mean you do not love your child.
  3. Try to keep your emotions cool by bracing for expected turmoil. Recognize and respond to any positive behavior, however small. If you search for good things, you will find them.
  4. Avoid a ceaselessly negative approach: "Stop." "Don't." "No."
  5. Separate behavior, which you may not like, from the child's person (e.g., "I like you. I don't like your tracking mud through the house.").
  6. Establish a clear routine. Construct a timetable for waking, eating, play, television, study, chores and bedtime. Follow it flexibly when he disrupts it. Slowly your structure will reassure him until he develops his own.
  7. Demonstrate new or difficult tasks, using action accompanied by short, clear, quiet explanations. Repeat the demonstration until learned, using audiovisual-sensory perceptions to reinforce the learning. The memory traces of a hyperactive child take longer to form. Be patient and repeat.
  8. Designate a separate room or a part of a room that is his special area. Avoid brilliant colors or complex patterns in decor. Simplicity, solid colors, minimal clutter and a worktable facing a blank wall away from distractions help concentration. A hyperactive child cannot filter overstimulation.
  9. Do one thing at a time: Give him one toy from a closed box; clear the table of everything else when coloring; turn off the radio/television when he is doing homework. Multiple stimuli prevent his concentration from focusing on his primary task.
  10. Give him responsibility, which is essential for growth. The task should be within his capacity, although the assignment may need much supervision. Acceptance and recognition of his efforts (even when imperfect) should not be forgotten.
  11. Read his pre-explosive warning signals. Quietly intervene to avoid explosions by distracting him or discussing the conflict calmly. Removal from the battle zone to the sanctuary of his room for a few minutes can help.
  12. Restrict playmates to one or two at a time because he is so excitable. Your home is more suitable so you can provide structure and supervision. Explain your rules to the playmate and briefly tell the other parent your reasons.
  13. Do not pity, tease, be frightened by or overindulge your child. He has a special condition of the nervous system that is manageable.
  14. Know the name and dose of his medication. Give it regularly. Watch and remember the effects to report back to your physician.
  15. Openly discuss with your physician any fears you have about the use of medications.
  16. Lock up all medications to avoid accidental misuse.
  17. Always supervise the taking of medication, even if it is routine over a long period of years. Responsibility remains with the parents! One day's supply at a time can be put in a regular place and checked routinely as he becomes older and more self-reliant.
  18. Share your successful tips with his teacher. The outlined ways to help your hyperactive child are as important to him as diet and insulin are to a diabetic child.

Next Steps and Related Information

Additional resources on ADHD

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