ADHD: The Parent's Challenge

Your child's teacher calls and says, "Tim's not doing well in school. I think he might have ADHD."

Your pediatrician suggests Tim be evaluated.

Although usually parents are already quite aware of their child's high activity level and impulsivity, this is often a parent's first introduction to the term "ADHD."

ADHD (Attention Deficit Hyperactivity Disorder) describes a set of symptoms. People often apply it to children whose behavior is difficult to manage. The causes of ADHD remain unclear. There can be many different reasons your child's behavior differs from that of other children's.

It's just like when your child has a high temperature. You know the fever is a symptom of some ailment, but you need to investigate further to find out what the underlying cause of the fever is. Once you know more about what's causing the fever, you can treat the illness more effectively.

Therefore, the ADHD-parents' first task is to learn as much as possible about why their child's behavior differs from that of other children's.

Diagnosing and treating ADHD should be "multi-modal." This means that professionals from different fields-such as mental health, medicine, and education-can all contribute to understanding and treating ADHD. Psychologists can measure your child's attention and impulse control and determine why the symptoms exist. Medications such as Ritalin can help decrease the child's activity level. Mental health professionals can evaluate and treat the emotional distress often present in the child or family. School personnel can provide structure and support for any special learning needs that exist. Rarely can one modality successfully diagnose and treat ADHD symptoms.

The most important professionals to help children with symptoms of ADHD are their parents. Parents have the greatest personal investment and the most chances to intervene. Here are some suggestions and guidelines to help parents challenged by the symptoms of ADHD in one or more of their children.

Behavior Management
General principles of assertive discipline work well for all children, including those with symptoms of ADHD. A home environment that is predictable, with consistent rules and consequences, will provide the best situation.

Spell out rules and consequences clearly so everyone in the family knows what you expect of them and what will happen if they don't follow the rules.

For example, "getting ready for school" may mean a list of several different behaviors from "getting dressed" to "making the bus." Create a checklist of the behaviors, as well as the consequences that follow should the child get off task and start fighting with a sibling, for example.

At first, this may seem like a lot of work, but parents find consistency helps children predict the consequences of their behavioral choices. This results in children obeying rules more often to avoid the consequences and earn their parents' praise.

Firm discipline means parents apply consequences consistently, every time the misbehavior occurs. Remember, firm does not mean cruel or harsh. This is particularly important for the ADHD child who usually needs redirection and discipline more frequently.

Using criticism or shameful remarks has a negative effect on children's self-esteem. Research shows that these remarks actually increase misbehaviors in children. They begin to feel it is impossible to please others, and they may decide they are failures and no one could ever like them.

One positive tool parents can use is praise. One of the most effective rewards for children is parental affection and attention. Therefore, if you praise children for appropriate behaviors every chance you get, you'll cause them to do those positive behaviors more often.

Of course, all parents sometimes feel frustrated and angry toward their children for repeated misbehavior. For the parents of a child with symptoms of ADHD, this may be very common. Because the risk of venting this frustration is higher due to the challenges of ADHD, parents must prepare themselves for these feelings.

Expect that frustration will occur. Plan for it. When it happens, label it. Remind yourself why it happens. Then actively avoid expressing it in ways that may harm your child's self-esteem or start a power struggle.

For example, state your dislike of the behavior calmly. Next, apply firm, consistent limits and follow through on them. As often as possible, make time each day for positive sharing and relationship-building with your child. This balances the tense and frustrating times you may have in disciplining your child.

Medication
Many children showing ADHD symptoms get help by using a stimulant medication. A common one prescribed for children is Ritalin, although others exist. You and your physicians should choose which medication to use after trying different ones to decide which has the greatest effectiveness with the fewest side effects.

Many people are not aware that stimulant medication will decrease activity levels in most children, regardless of whether they have been diagnosed with ADHD. Therefore, medication does not cure ADHD. It helps slow children down and increases their attention so other parts in the multi-modal approach can be successful. Although some professionals who work with children often believe it, medication alone will not treat ADHD.

It is equally important not to link your child's behavior directly to the medication-be it appropriate or inappropriate behavior. If children hear, "Your behavior is bad. Did you forget your Ritalin?" they assume the only way to be good is to take medication. This reduces the level of control and responsibility children believe they have over their behavior. Clearly, this is not a message we want to give.

The reverse is equally undermining. Comments like "You are behaving well. You must have taken your pill" deprive children of the opportunity to feel success. These comments also limit the degree of control and responsibility they feel for their behavioral choices.

These kinds of comments are more frequent than you might think. Children especially hear them from teachers or other authority figures in their life who may not yet understand the importance of the multi-modal approach.

Some child professionals continue to believe a trial of Ritalin will verify the presence of ADHD. If Ritalin slows him down, he must have ADHD. Educate teacher and others who interact with your child about the importance of their enhancing the child's control and responsibility for behavior by giving positive reinforcement and chances for success, not by limiting the treatment to medication alone.

Self-Esteem
This is one of the most important, yet challenging, areas of concern for the child with symptoms of ADHD. Our feelings of self-esteem begin early in life. The temperament with which we are born can affect how others feel and behave toward us.

People often describe children diagnosed with ADHD as "difficult to soothe" or "colicky" as infants. As children get older, adults say they are "a whirlwind of activity" needing constant monitoring and supervision to prevent harm to themselves or other children.

We can see how these children are more likely to cause frustration and exasperation than the infant who cuddles affectionately when held or sleeps through the night, giving parents a much-needed rest. So, the child with ADHD symptoms is doubly-affected by the symptoms themselves and by the negative feedback the symptoms cause from even the most patient of caregivers.

Children's self-esteem and feelings of worth can be severely diminished when feedback from people around them confirms what they experience anyway. That is, they often disappoint their caregivers. And worse, they often feel powerless to change without help from the very people they challenge and frustrate. This can be a complicated cycle that is difficult to break.

As we might expect, the earlier in a child's life we can interrupt this negative feedback cycle, the less his/her self-esteem will be affected negatively. It's important for children to receive periodic, ongoing therapeutic support as both they and their parents struggle with the emotional distress often present in ADHD.

Consistent, assertive discipline and outside support helps keep emotional reactions in check. This also helps limit the negative impact the symptoms of ADHD have on the child's self-esteem. And it gives the parents a feeling of mastery in their important-and challenging-role.

Stress Management
Parents should use support systems to avoid the burnout associated with the challenges of parenting. Many communities have organized parent groups for ADHD. Some offer respite services that give parents a needed break. Frequent conferences with school personnel enhance consistency between home and school and head off major problems before they emerge.

Periodic, ongoing therapy for the parents and child can provide the insight and support they need. Support group meetings or parenting classes offer this, too.

Routinely review books on stress management and parenting. This keeps you fresh and expands your arsenal of techniques and strategies. Reread books you found helpful in the past.

Some creative parents have formed babysitting cooperatives so when they need time away from their child, the child receives supervision from a caregiver who is familiar with the special needs and challenges of ADHD. For the sitter, there is the incentive of knowing the favor will be returned in kind. This arrangement provides parents a sense of relief and security they lost when previous babysitters threw up their hands in exhaustion and refused to sit for their child again.

Other considerations include educating siblings about the special needs the ADHD child may have. Couples must set up a schedule that allows each parent some "time-off" so neither becomes overburdened or resentful.

Similarly, couples need to nurture their marital relationship by periodically spending time together away from their parenting duties. This break is good for the child, as well, but most important, it allows parents a chance to replenish their resources and manage more effectively.

It would be unrealistic to suggest that simply following these guidelines will make parenting your child-or any child-an easy process with few challenges. Remember that consistency and predictability help all family members function to their greatest potential. Nurturing self-esteem in your child is essential.

The presence of ADHD symptoms is not the only factor that affects how a family functions. However, families sometimes blame ADHD for more than its share of the emotional tension and conflict in the home. You'll have a more realistic perspective on parenting when you recognize other sources of stress.

For example, marital conflict, physical illness, loss of a grandparent or other relative, sibling rivalry, and job changes or relocations are all normal events for a family. And they all contribute to the level of tension or conflict present in families.

The stress of normal transitions and events that accompany family life can sometimes tax the family to the point that outside professional assistance helps reestablish a sense of control and predictability in the home. This reduces stress and conflict. An objective third party can often identify stumbling blocks that interfere in the family's functioning. These are often hidden from view because those living "within the family" cannot take the perspective an outsider can. It's like the old saying, "You can't see the forest for the trees."

In keeping with this adage, the guidelines presented here provide a kind of map. Families can use them to chart their course through the "forest" of family life. The map helps families avoid as many pitfalls as possible along the way and insures all family members-children and parents alike-arrive with as few bumps and scrapes as possible.

Resources for Parents or Individuals with ADHD

Support and Information Groups

Children and Adults with Attention Deficit Disorders (CH.A.D.D.)

. National Headquarters (for referral to local chapters): (305) 587-3700

. Grand Rapids Chapter: (616) 248-2423

. National Headquarters: (508) 462-0495

. Support Group Information: (800) 487-2282

. National Headquarters: (412) 341-1515

. L.D.A. of Michigan: (517) 485-8160

. Gordon, Michael. I Would If I Could: A Teenager's Guide to ADHD/Hyperactivity. GSI Publications, 1993.

. Greenberg, Gregory and Wade Horn. Attention Deficit Hyperactivity Disorder: Questions and Answers for Parents. Research Press, 1991.

. Ingersoll, Barbara. Your Hyperactive Child. Doubleday, 1988.

. Ingersoll, Barbara and Sam Goldstein. Attention Deficit Disorder and Learning Disabilities: Realities, Myths, and Controversial Treatments. Doubleday, 1993.

. Parker, Harvey. The ADD Hyperactivity Workbook for Parents, Teachers and Kids. Impact Publications, 1988.

. Silver, Larry. Dr. Larry Silver's Advice to Parents on Attention-Deficit Hyperactivity Disorder. American Psychiatric Press, 1993.