Caroline Deacon - ADHD – what parents can do.

Caroline Deacon
Journalist and author based in Scotland, UK

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ADHD – what parents can do.

Your child may not be hyperactive, but could still be diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD). Caroline Deacon investigates exactly what this label means, and what you as a parent can do if you suspect your child has ADHD.

There are many misconceptions about ADHD. A child who is “bouncing off the walls” may not have it, while a dreamy child, who isn’t progressing at school, may in fact have ADD (Attention Deficit Disorder without hyperactivity).

The typical ADD or ADHD child is impulsive, easily bored or distracted, disorganised, has difficult following a set of directions, and yet can concentrate intensely on something that grabs their interest. They usually have poor social skills and so have problems making or keeping friends.

ADHD is not an illness; it’s a description of a group of behaviours. Many children show some signs of ADHD sometimes; children who are formally diagnosed simply have more of the signs, more often. Diagnosis is usually sought when the child’s behaviour is having a negative effect on their life.

To be sure that your child has ADHD or ADD, you need a detailed assessment from an educational psychologist. However, even if your child hasn’t been formally assessed, ADHD children need behaviour management strategies first and foremost, and these are just as effective with difficult to manage, non-ADHD children.

Tackling ADHD with behaviour strategies

All children respond well to boundaries, and an ADHD child needs structure more than most. However, the ADHD child will take boundaries as a personal challenge, and will constantly push at them, past the point where most other children would back off. Parents need to be really strong – often a well run house with an ADHD child will look like some sort of rehabilitation centre – apart from the chaos, there will be star charts and house rules pinned up everywhere.

As a parent of an ADHD child, you will need to invest time in discussing and agreeing rules and structure with your partner and children, but your child will thrive. It is better to start by targeting the biggest problem areas – don’t attempt to sort everything out at once. Bedtimes, leaving the house – whichever time of day is worst is the one to start with. See if you can figure out what triggers your child’s behaviour – often transitions are problematic; for instance going from home to school.

The ADHD child loves attention, but most of the attention they get is negative; shouts, screams, “don’t do that!” You need to starve him of attention when he misbehaves, and go mad with positive attention when he gets something right.

He also enjoys the stimulation of an argument; as arguing involves far more attention than complying. The “broken record” response is really useful – in a flat monotone, keep repeating yourself, “no, you are not allowed the Playstation until you have packed your school bag.” Remember the ADHD loathes boredom, and if you are responding in a boring voice, he will quickly lose interest.

The “1,2,3 Magic” technique works really well all children, especially those with ADHD. It involves counting out, in a firm but unemotional tone, when you want your child to stop doing something. Having told them to stop, if they haven’t, you say, “That’s one.” If the behaviour continues, you proceed to, “That’s two.” If they get to three, then there are negative consequences – usually time out in their room. The most important part of this technique is that there is no extra communication; no argument, just the counting.

Star charts also work well with ADHD children as they are very goal orientated. A working star chart will have up to five clear, specific, “more of…” behaviours as well as up to five “less of…” behaviours, with the balance weighted so they can win more than lose, so the system is not demoralising. Start by tackling the biggest problem areas. For example two pluses for a more of (getting ready for school on time) and one minus for a less of (swearing). Rewards should be meaningful and attainable; for example, ten pluses = a trip to the swimming pool.

One recent piece of research in London found that young adults are more likely to have grown out of ADHD if their families were accepting and they did not experience too much hostility from other people. The researchers also found that in families with ADHD children, reducing hostility lead to less hyperactivity.

The ADHD child gets so much negative feedback, their self-esteem can be really low. Friends shun him because he is too in their face. His siblings have him labelled as the problem of the family. Parents and teachers are always nagging at him to do something, and although this attention is welcome, the ADHD child also needs some unconditional positive attention, from you and your family. Try to find something your ADHD child is doing well, and find one positive thing to comment on every day.

A big step in reducing ADHD behaviour is in creating some unconditional positive time. It makes a huge difference; your child’s self-esteem will rise, and once this happens, his motivation to improve also increases.

Tell your child he will have ten minutes per day to spend just with you however he wants. It is useful to call the time something specific, e.g. “Our Time”. If all he wants at first is for you to simply sit and watch him playing – that’s fine. He’ll come up with more things in time, but what you should avoid doing is organising the activity yourself; it must be his to control.

If you have more than one child, you are probably finding that it’s difficult to give enough time to them; your ADHD child takes so much time and effort. The “me” time can and should be offered to the others too – they will equally benefit from it.

What causes ADHD?

No one is really sure what causes ADHD. There is some evidence that it runs in families; you may well have other family members who fit the description. There has also been a suggestion that ADHD may be due to oxygen deprivation at birth. Brain scans have indicated that the ADHD brain may differ, and recent evidence suggests that the ADHD child may lack certain essential fatty acids.

Other things to try

At one point food additives were blamed for hyperactivity in children, and many parents of ADHD children looked to diet for a cure. While many children do become hyper when they consume certain food additives, this is not the full story, and ADHD cannot usually be resolved just through diet.

Many processed foods are high in sugar, and a child whose blood sugar levels are fluctuating during the day is likely to respond by being irritable or hyperactive. Make sure your child gets a balanced diet, avoiding highly refined or sugary foods, and keep his blood sugar level constant by avoiding large gaps between meals. You may want to avoid certain food colourings (particularly Tartrazine – E102) if they affect your child’s behaviour.

There have been some promising results using LCP vitamin supplements– such as Efalex, which contains fish oil and primrose oil. In a recent study, Efalex was given to a group of eight to 12 year olds attending a special school in Northern Ireland. Another group at the same school was given a placebo. There were no improvements in the placebo group after 12 weeks, but the researchers found significant improvements in the behaviour and cognitive abilities of the group using the supplement. Nutricia, the manufacturers of Efalex, warn that if your child is already taking Ritalin, you should consult your doctor before taking Efalex as well.

Drugs

Although ADHD is not an illness, drugs like Ritalin are often prescribed. These drugs are closely related to amphetamines, and have been found to calm ADHD children. However as with any strong drug which alters behaviour, there are side effects too, ranging from sleep disruption, appetite suppression and growth retardation through to more ghastly side effects like Tourette’s Syndrome, where the child can develop a permanent twitch.

Drugs should be seen as the last resort. Ritalin is often claimed to create a “window of opportunity” – allowing the child to calm down and concentrate for long enough to absorb facts, but research has not found any improvements in long-term memory in ADHD children taking Ritalin. Even if your child is on Ritalin he still needs to work at changing his behaviour with learnt strategies.

Is ADHD a disability?

It is interesting to note that some countries have far higher rates of ADHD diagnosis than others – the USA and UK for instance having high levels, while in countries like Italy, where excitable behaviour is perhaps more acceptable, there are practically no diagnosed cases of ADHD.

Thom Hartmann, an American psychotherapist whose son has ADHD, challenges the idea that ADHD is a disability. He thinks people with ADHD are invaluable to society, being at the forefront of social and intellectual progress. The problem, he says, is that our schools value children who can sit still and absorb facts, not those who are up and at ’em, like the typical ADHD personality.