Survival Strategies with Parenting Children with ADHD

• Be Available During Homework Time. Be present and talk through what assignments need to be completed. Once your child begins to work on his assignments, you then can complete the tasks you may have to complete. If your child asks you to leave, consider going to another part of the home, as long as he or she is working on their assignments.

• Increase Physical Activity. Studies suggest a connection between physical activity and increased levels of alertness, mental function and learning. Physical activity increases blood flow to the brain, allowing for increased levels of glucose (brain food) to the brain, while releasing endorphin's, which are shown to improve mood. Encourage your child to bounce a ball or walk around the house while reading aloud from a book. Your child will eventually settle down and be able to focus on their work more easily.

• Use medication. Most children with ADHD are mentally exhausted upon returning home from school. This often poses significant challenge for completing homework. Discuss with your doctor additional options such as, prescribing a medication that is short acting/ quickly absorbed. Children are able to remain focused, complete assignments and recall the material they studied when prescribed medication.

• Arrange the environment. Although the end of the day may be approaching, homework still has to be completed. Getting your child comfortable and reducing interruptions/distractions improves his or her ability to complete homework. Create an inviting work-space free of the TV and cellphone. Have your child sit away from anything that could distract him from completing homework.

• Make it more fun and it will get done. Homework can be difficult and exhausting. The idea of coming home from a long day of school, only to begin the process all over again can be dreadful. Develop a reward system for homework assignments. You can reward your child with additional privileges such as increased television time or a later bedtime on weekends after homework is completed. If your child is studying for a test, turn it into a game of jeopardy or allow him to also ask you questions. Math, Science and English are some of the subjects that tend to tedious for children. Spice it up a bit.

• Periodically take a break. Allow your child a few minutes to rest in between subjects. Don’t expect your child to complete each assignment one right after the other. Consider also working for 20 minutes then allowing for a short break before moving to the next 20 minute segment.    

• Find a tutor. Depending on your schedule, you may find it hard to help your child with assignments. Consider hiring a tutor or locate an after school program where your child has a teacher available for assistance.

• Organize assignments in their appropriate folders.  Have your child place their homework in the designated folder and place it in his schoolbag the night prior. Develop a system with his teacher to ensure that his assignments are being turned in daily. 

Disciplining Teens - A Skill That Takes Practice and Refining

     Teens need rules and they need the rules to be enforced. Sounds simple doesn't it? But giving teens rules and enforcing those rules is one of the more difficult parenting tasks parents face. First off, teens resent rules and they can argue endlessly for a life with no parental controls. Often, parents' first mistake is to engage in the argument about the need for rules. A better approach is to explain that having rules is a given. What can be negotiable are the kinds of rules and the consequences for rules not followed. Many parents readily dismiss the idea of involving their child in the process of making rules and setting consequences without even trying that method. When a child is fairly emotionally healthy and the parent/child relationship is, for the most part, stable and friendly, the rule/consequence negotiation meeting can be a a valuable starting point.Surprisingly, teens on their own often come up with consequences more harsh than the parents are considering. The critical piece when planning the consequence is that enforcing the consequence isn't going to make life more difficult for the parents than the teen. Inconsistent enforcing of the consequences is what usually weakens the whole system.    Grounding the teen seems to be the most ineffective method of discipline because parents usually set up a grounding consequences right after an unexpected misbehavior. The parents are at the height of their anger at the teen and suggest grounding for a period of time that requires they, themselves having to stay at home much longer that is feasible. The teen learns very little from this process other than their parent usually doesn't follow through on the month or six weeks of grounding.The most effective response when an unexpected misbehavior occurs is for the parent to tell the teen, " I am so angry with you that I don't know what I want the consequence to be. I will tell you in a few hours. "  This approach allows the parent come up with an appropriate consequence that the parent will enforce. Allowing the teen to worry about the consequence for a few hours is a plus. But the parent MUST follow as quickly as possible. The closer the consequence is set up following the misbehavior the better. Also important in the disciplining process is the parents' view of the reason for setting up the consequences. The reason is not punishment. The reason is to teach teens that, for the most part, making poor choices results in unwanted consequences. The other reason for disciplining is to help the teen learn self- control. When done right, when the teen accuses the parent of being mean, the parent doesn't crumble but reminds him/herself that setting reasonable consequences is being a good parent. Not setting consequences is poor parenting.Parents often report that their teen says, "I don't care" when the parent removes a privilege.  Usually, THEY DO CARE. That's why they are telling you they don't care. But it doesn't help for the parent to say, " I know that you really do care. " There are times when a teen really doesn't care. When that happens it can be that the teen is depressed. And sometimes when a teen is depressed it is because the parent has taken away all of the teen's privileges without providing any plan for earning them back.Parents also often say "giving my teens consequences for misbehavior doesn't work; I've tried it." This usually means the parent thinks that letting the teen know in advance what the consequence is will automatically stop the behavior. When the unwanted consequence for misbehavior is first established, the teen will test it at least three times to see if the parent is truly going to follow through with the enforcement of the consequence. Once the teen sees the parent is being consistent in enforcing consequences the unwanted behavior usually stops. Occasionally, the teen may weigh the benefits to him/herself of the misbehavior and then choose the misbehavior. Parents may then have to find a new consequence. Another important tip is to start small with consequences so you can add or intensify as needed. For instance, take away the cell phone for one night in response to one instance of a minor unwanted behavior.  Then when a more serious misbehavior occurs you have the option of taking the phone away for a week or more. Food, shelter, clothing and health care are some of the basics parents are expected to give their child. Most of the other things parents are currently providing for their children are privileges that can be taken away for short periods of time as consequences for misbehavior. It helps when both parents and teens start with this premise in mind.  
      

So Just What is Normal Adolescent Behavior?

"I just want my sweet, kind, respectful kid back. I don't even know the person she has become."  Counselors hear countless parents complain about their pre-adolescent or adolescent child in that manner. The good news is that the child you knew before WILL return but the bad news is that it may not be for several years. The other good news is that I could give you some tips to help you, survive your child's teen years. Generally, if followed, things could get better in a reasonable amount of time. The first step in making your life with your adolescent less turbulent is defining what is normal adolescent behavior. Most parent's have been warned about the " terrible two's, so when your child goes through this stage you may easily recognize that the behaviors are normal and come to an end. So when teens don't want to be seen walking with their parents in the mall that is NORMAL. Parents' of course, are hurt by this  because they don't remember that this has less to do with being embarrassed by the parent but more about that the child worrying that a friend or classmate will view them as being a "baby" and not being allowed to shop on their own. When a parents' own self-confidence is not solid, their teen's changing interactions with them are a constant source of pain. Nature plays a dirty trick on many parents' because they are experiencing their own "mid life crisis" at the same time their children are going through adolescence. Often, parents' are asking ask themselves the same questions that their teens are asking themselves--Who am I? What do I believe in? What do I do with the rest of my life? Teens question their parents' values because they want their parents' to convince them to accept the parents' values. This whole process is NORMAL but many times can be very threatening to parents'. Many parents' worst fear is that their adolescent has turned into a selfish, self-centered and self absorbed person. This total self- focus is NORMAL. It is what the adolescent must do to achieve the final formation of their personality to help them become self - confident enough to leave the comfort of their parents' home. What most parents' don't realize is that the way they respond to their teens temporary unpleasant behavior often factors greatly in their future parent/child relationship. Sadly, many adults do not remember all the wonderful things their parents' did for them when they were one through six years of age. What adults often remember most vividly is either their parents' tolerance of them as they passed through the difficult teen years or the terrible battles or hurtful things their parents said to them. Some simple rules for you' to follow and try to remember as you walk with their teens through adolescence is:  


1.  Pick Your Battles. What many parent's often forget is that all of the changes that are taking place with their adolescence are an essential part of healthy human development. All the pulling away, oppositional, critical behaviors is what a child must do to better survive in the real world. Just as little birds are programmed to leave the nest, so are adolescent humans, programmed to begin to separate from their parents at a certain stage of their development. At the very same time, the teens begin to make fun of the music their parents' listen to, the TV shows they watch, the movies they enjoy, the clothes they wear and even the way their parents' talk. Of course, it's no surprise that some parents' may begin to wonder if it was such a good idea to have children. Yes, all of the aforementioned behaviors are NORMAL but for the most part temporary behaviors. One of the hardest struggles parents' also have is watching their adolescent experiment with radical hair, piercings and clothing styles as they put the finishing touches on the image they want to present to the world.  Parents don't have like the external changes. They just need to tolerate them, remember that what they are seeing is NOT the finished product. It is helpful if you can avoid power struggles and try to convince your adolescent to modify their new look.


2.  Replace Lectures With Consequences for Unwanted Behaviors (The teens already know all of your lectures, word for word.)

3.  Set Reasonable Limits.

4.  Expect Grumbling and Testing of Those Limits. 

5.  Be Flexible, Give Freedom Gradually to See What Your Child Can Handle.  

Is Summer Vacation the Time for ADHD Medication?

Only seven weeks left!  Once again school will be out and summer break will be upon us.  This is the time of year when most students jump for joy!  Desks are emptied; backpacks are stashed in the closet.  Families begin to think about sun and fun, lazy afternoons, swimming lessons, BBQ’s, summer camp and family vacations.  When you’re the parent of an ADHD child, there is often another issue that begs attention. Parents frequently ask whether their child really needs to take his/her ADHD medications during the summer.  Parents often feel that because there is no need to manage an academic setting and everything that goes with it, there is no need for medication.  Not necessarily so.

In order to make an informed decision about your child’s summer medication needs, there are several factors to consider.  The best place to begin this process is to have a conversation with the doctor who prescribes medication and works with your child.  He or she will have the information necessary to help the family make an informed decision that is appropriate for their child. 

It is important for parents to consider just how much assistance their child derives from the prescribed medication.  What symptoms are being managed by medication?  How important is medication for the child’s ability to function in a healtlhy fashion.  For the child whose major ADHD symptom is inattentiveness it is possible that a “med vacation” could be well tolerated.  However, for the child who exhibits symptoms of hyperactivity and extreme impulsive behavior, year-round medication may be a better option.  This child frequently has difficulty appropriately managing social situations with peers.  Lack of medication can often result in poor social/peer relations thus having a negative impact on the child’s self-esteem. Again, in this situation, a medication break might not be the best option. 

Generally, summer is looser and less structured than the school year. The ADHD child, however, still needs structure and predictability in daily life in order to manage effectively.  Providing daily lists can help your child more efficiently manage the day. Keeping a calendar with daily and weekly activities clearly spelled out is helpful.   Provide daily activities like: planned events, enroll your child in swimming lessons/summer camps, play dates with friends, encourage reading for enjoyment (not classroom assigned reading) and family outings.  These types of activities can provide structure for your child thus avoiding boredom and the need for stimulation seeking behaviors.  Kids with ADHD have a more difficult time structuring their own lives.  They require some external support in the form of parental intervention. Planning lots of physical activities is a key to success.

When considering sending your child to sleep-away camp, it’s imperative to consider how well your child can stay on task, follow directions and relate to peers. In addition, it’s important to consider the skill level of the camp counselor who will be supervising your child.  Will these adults be familiar with ADHD and its impact on a child’s behavior?  These are questions that might help you decide whether your child can have a “medication vacation” while away at camp.  The last thing any parent (or child) wants to experience is a call from camp requesting an early pick-up.  Some ADHD children may be more able to manage a day-camp setting vs. a sleep-away camp. There is less stress and less for them to manage when they know they will be home at the end of the day.

It’s important to remember that there is no perfect solution to this dilemma.  But, there are options. You may choose to try a lower dose of the child’s prescribed medication during the summer months. You may choose to take short breaks from medication as seems appropriate. You can always medicate your child on days when you feel he may need a little extra help maintaining self-control.  Summer break should be a time for fun and relaxation for kids and their families.  If you begin with the premise that your child deserves to have a positive and successful summer experience, you will be on your way to making a healthy choice for your family.   

School Refusal

Written by: Angela Lacalamita, MA, LCPC


School anxiety, refusal and avoidance are increasingly becoming a problem with children/adolescents. Researchers estimate that 2-5% of school age children suffer from anxiety related school refusal. School refusal encompasses a broad spectrum of behaviors to include:

• prolonged absence from school

• sporadic attendance

• skipping classes

• emotional or behavioral difficulty in an attempt to refuse school

• physical complaints of illness without medical explanation (somatic) when faced with having to attend school

There are numerous factors that may influence school refusal. Generally, youth refuse school to avoid academic situations that cause distress (i.e. homework or other school related situations), escape social or evaluative situations (i.e. peer groups or tests), to gain attention from a person in which the child has an emotional attachment toward, to obtain rewards outside of the school setting (i.e. sleeping in, or video games). Many children that display school refusal also display other emotional or behavioral difficulty to avoid school settings i.e., running away, substance use, noncompliance, temper tantrums and aggression. If left untreated, school refusal can lead to significant difficulty with a child’s social, emotional and educational development.

The long-term outcome for children who refuse school is not well established, primarily due to an inconsistent definition.  Regardless of the terminology used, school refusal may be a precursor to disturbances later in life if left untreated. If your child is experiencing difficulty in attending school, a comprehensive evaluation from a mental health professional will reveal the reasons behind the school refusal.

The following are tips that can help your child manage school related anxiety or other stressful situations.

• Relaxation Training: a combination of progressive muscle relaxation and breathing exercises can be helpful. Diaphragm breathing is achieved by inhaling through the nose and exhaling through the mouth for a set number of times. Progressive muscle relaxation is a technique in which a muscle group is isolated and contracted for five seconds and then released. This technique can begin by starting with the feet and gradually work up to the head or vice versa.

• Gradually introduce school to your child in small degrees. Eventually this will help them realize there is nothing to fear and that nothing bad will happen (generally for younger children just beginning school).

• Have your child identify the positive aspects of going to school: being with friends or learning a favorite subject.

• Have your child identify any negative thoughts they may be having. Encourage your child to replace the anxious (negative thoughts) with supportive and calming statements, i.e., “I can handle this.”, “I have done this before.”

• Arrange a meeting with your child’s counselor for support and direction.

• Establish routines: Having a routine offers predictability, improves transitions to school and reduces anxiety. The morning routine prior to school should be the primary focus. It can be a benefit to have regular routines for all parts of the day to limit any behavioral difficulty.

• Learn about your child’s anxiety disorder and research the treatment options.