Monday, August 28, 2017

Start the School Year Right with The Teacher Letter and the Homework Station

guest blog by Beth A. Kaplanek, RN, and Linda Smith, BA

Summer is great—no schedule, fewer demands, and no homework! In August, however, it's time to start preparing to ensure a successful school year for your child. 

Schoolwork and the stress it brings can be difficult for families dealing with ADHD. But you can get the school year off to a good start by effectively communicating your child’s needs to his or her teachers and by setting up a home environment that facilitates homework completion.

A letter can be a great vehicle for getting pertinent information to your child's teachers, whether or not your child has a formalized educational plan. If a formalized plan has been created, don't assume that the teachers have been informed about its contents. Remember, it only takes a week to get behind in school, and then the stress for you and your child to play catch up never seems to end. 

Write your letter before the school year even begins—or as soon as possible if it already has begun. Information is provided below to assist you in writing your letter, and a sample letter is provided at the end of the blog. 

The purpose of the letter is to make your child's teacher(s) aware that your child has an educational program. Teachers may not have received those records from the school administration yet, and you want to make sure the information has been conveyed to them. Write the letter in the spirit of providing support to the teacher, while making sure your child's records have been made available.

Close the letter by saying you look forward to meeting the teacher(s) on back-to-school night, then be sure to attend it. If the school does not hold such an event, ask to meet before the parent-teacher conferences at the end of the grading period. Send the letter to all your child’s teachers, including physical education teachers and coaches, and share a copy with the school principal.

Important points to address in your letter 

  • Your name and relationship to (child’s name)
  • Your contact information
    • phone numbers
    • mailing address
    • email address
    • best times to reach you
  • Your aim to work as partners to ensure a successful year (for teacher and child)
    • establish positive, open communication between home and school
    • offer cooperation, collaboration, assistance, support
    • provide helpful information about your child
  • Information about your child’s disability and educational program (IEP or 504 Plan)
    • instructional needs, modifications, and/or accommodations in the plan
    • behavioral needs, modifications, and/or accommodations in the plan
  • System for home-school communication
    • daily homework and assignment sheet
    • daily/weekly behavior report
    • progress report, problem-solving, as needed


Next, think about setting up your home environment for homework sessions. Because many children with ADHD have problems with organizational impairment due to executive function deficits, proactive strategies can remove some of the stress from this process.

Organize a designated space in your home for doing homework. Choose an area that is away from distractions and has ample room. Depending on their age, some children do better working independently in a quiet place away from other family members and distractions. Younger children often need to be in an area close enough to mom or dad so that progress on homework can be monitored.

A large calendar on the wall can be helpful for keeping track of assignments, due dates, and for planning out the components of long-term assignments. You can also include the dates of other activities, such as soccer games, piano lessons, and so forth. This will help both you and your child see the big picture of what needs to be done each week. Post-It notes and a bulletin board can be helpful organization tools for older children.

Make sure all homework supplies are organized and accessible close to the designated homework area. Sort the supplies in containers or bins placed in a regular spot on a shelf. Students often need paper, pencils, pens, colored pencils, crayons, erasers, magic markers, a ruler, a calculator, a stapler and staples, scissors, glue sticks, and report folders. Different kinds of paper, such as lined, graph, computer, and construction paper, may be needed. It's wise to keep a supply of poster paper and maybe even a project board on hand for those moments when your child announces at 9 PM that he just remembered he has a project due for his science class tomorrow.

One tool that is essential for children with ADHD is a timer that can be set to break the homework session into manageable units. Setting the timer for fifteen minutes of on-task work followed by a five-minute break can give the fidgety or frustrated child an opportunity to get up, move about, and then refocus on the work. Repeat this process for as long as is necessary to complete that day’s assignments. Time limits will vary depending on the age of the child, ability to stay on task, and difficulty with or interest in the assignment. The timer can also be a tool for teaching time-management strategies.

Prepare a notebook for all handouts your child’s teacher sends home. This notebook will be for you. It's hard to remember classroom policies, course outlines, and grading scales for all teachers. When your children bring home correspondence during the school year, you will have a place to keep it. Another option is to create a section for each of your children in a three-ring binder, using notebook dividers with pockets. When you need to refer to the information, you will know right where to find it. 

Writing a letter to your child’s teachers and setting up your home environment so that you are ready to meet the challenges of homework completion can help your child and family get off to a good start in the coming school year. 

Dear Mr./Ms./Mrs. _____,                    

My husband and I are writing this letter to introduce ourselves and to open a door of communication. We are the parents of [child’s name], who will be a student in your class this year. We look forward to a successful school year for both you and [child’s name], and as parents, we want to work with you and the school as partners in [child’s name]’s education. We will be happy to help you and [child’s name] in any way we can.

In case you have not yet received the records, [child’s name] has an educational program [insert IEP/504 Plan as appropriate] to address needs related to ADHD, which affects [insert appropriate information here; for example: his ability to sit still, pay attention, and control his behavior. He has particular trouble getting organized, staying focused, completing and turning in assignments on time, and memorizing information, such as math facts.] We want to take this opportunity to share information about his educational services in a simplified format, including the modifications and accommodations he receives.

Listed here are the main provisions of his [insert IEP/504 Plan and list specifics below]: 
  • Preferential seating
  • Extra time on tests (time and a half)
  • Test answers recorded in an alternate manner, as needed—especially for short-answer and discussion items (oral, audiotaped, dictated, or typed responses)
  • Second set of books at home
  • Use of a calculator for math
  • Shortened homework assignments for math and writing
  • Homework, long-range assignments, and tests recorded in planner, signed by teacher, and sent home every day
  • Resource room, 45 minutes 4 times per week for math
  • Foreign language exemption
  • Home-school reward system for homework completion and turning in assignments on time
We would also like to take this opportunity to set up a system of communication between home and school. You may already have such a system for your class that we will be happy to adapt and use. If not, then we will send a planner to school with [child’s name] everyday. It will always be in his backpack. He is to use it to write down his daily homework assignments, as well as any long-range assignments, such as upcoming tests, so that we can help to monitor his schoolwork at home. I will also use the planner to communicate with you on a weekly basis. Would you please assist us by reviewing and signing his planner before he leaves school each day and sending a note home in the planner on Fridays, so that we can help [child’s name] come to school prepared and reward him for his weekly school progress? 

We would like to thank you in advance for taking the time to read our letter and helping with this important program. Having a system of support in place at the beginning of school will help to get the year off to a good start. My husband and I look forward to meeting you on Back-to-School Night, [insert date if known].

Please do not hesitate to contact us about problems or call on us for assistance at any time. We have included our phone numbers and email addresses below.

Best regards,
Parent(s) Full Name(s)
Street Address
Town, State, Zip Code
Home Phone, Cell phone
Mother’s email, Father’s email

CC:  Principal
Resource Room Teacher, Music Teacher, Art Teacher, Coach [all that apply]


Beth A. Kaplanek, RN, and Linda Smith, BA, are two of the founders of CHADD's Parent to Parent: Family Training on ADHD. A previous version of this blog appeared in Attention magazine.


Tuesday, December 22, 2015

From Hyper to Happy II: Your Holiday Home

guest blog by Karen Sampson Hoffman

The holidays are here. Questions like, “Which traditions does our family want to celebrate and continue?” have been answered. It’s the little things that are snowballing that need to be addressed now. Such as cleaning the house.

Getting ready for the holidays at home can test anyone’s patience. With ADHD in the mix, you may get overwhelmed quickly. You may find it difficult to start or stay on task. Can you offer to co-host holiday events with another family member, perhaps even at that person’s home? If that's not going to happen, we've got some tried-and-true suggestions to offer you.

Develop routines
Maintaining a home is such a big project that a few generations ago, nearly every family had a full-time home manager. Today, it is more common that single and partnered adults work outside the home. The challenge can still be met, even with ADHD in the mix.

FlyLady ( is the best-kept secret of many CHADD members, according to what they tell us. So named for her love of fly fishing, FlyLady is all about “baby steps” and routines. She explains how to develop a routine to tackle the holiday season and the rest of the year, and her plans and control journals work well for anyone affected by ADHD. Since you design your own routine with her guidance, it will fit the needs of your life.

Make a plan
Scout your dwelling and note what needs the most work, what needs the least work, and the best hiding places for stuff. That includes cramming things under the bed, but only for quick cleanings during the holidays.

Set a timer
Once you have a plan, set the kitchen timer for 5, 10 or 15 minutes. Then attack the first room. Pick up, stuff away, clear out of sight. When the timer dings, reset it for the next room, whether the first is done or not. Repeat the picking up in the second room. Ding; same for the third. Set the timer again, grab something to drink or nibble and sit. Rest for the fourth round. Ding, and you’re back to the first room. Do this until each room is picked up, dusted, and vacuumed and any additional scrubbing is completed. Repeat the process for as much time as you have available. Breaking it up over a couple days or a week is a good thing, too.

Follow these handy tips

  • Leave a second garbage bag at the bottom of the pail, underneath the current one. That way you have one handy in a pinch without having to hunt for it.
  • Keep one extra of each household product — soap, can of soup, paper towels, etc. — on hand. Don’t fill your cupboards with more than you need, but make sure you have a back-up at the ready so you don’t lose your stride.
  • Keep all cleaning supplies together — a mop bucket makes a great container to stick everything in so you can move from room to room quickly.
  • A good rule of thumb: If you use it in that room, find a place for it to live in that room. That goes for brooms (kitchen pantry), vacuums (living room closet), laptop computers and accessories (family room entertainment center), and tablecloths (dining room china cabinet). This works well with cleaning supplies, too (perhaps high up in a cabinet if there are small children in your life).

Heed the voice of experience

The best ideas often come from those who walk the same walk. Here are some strategies submitted to us by CHADD members.

Make running lists. Notebooks and smartphones are great for this. Make a list for everything from groceries to library books, and keep your lists in one place for easy reference.

Limit the number of guests. Make it a small party; a dinner party of six is more manageable than 26. Since this is a holiday season, make use of the time by having two small dinner parties with different guests. Another possibility would be to host a small, intimate party at home, and then make reservations for the larger group at a favorite restaurant.

Call your favorite grocery store and find out about its holiday meals. Many stores now prepare the entire meal at a reasonable cost. Order ahead, pick it up the morning of your holiday meal, and follow the store's reheating instructions. Serve in your own dishes — and who would know?!

Online shopping is good. If the online store includes gift-wrapping, go for it! Have gifts sent to their recipients rather than to you. One wise member pointed out that wrapping gifts as soon as you get them helps to avoid the 3 AM crunch before the big day.

As another wise member wrote to us, “Change the expectations so the holiday works for you, not the other way around.”

If all else fails…

Humor and spontaneity go a long way during the stress of the holiday season. Allow yourself to be creative when faced with a domestic challenge.

Perhaps one of the most creative solutions we’ve heard came from a CHADD member who wrote that he once had a stack of newspapers piling up in the dining room for a couple of years. As company was coming rather soon, he struck upon a plan: He placed a board across the tops of the piles and draped a holiday tablecloth over it. The piles were successfully hidden, and the set-up “didn’t look bad, really.”

With a touch of irony, he added that his newspaper/holiday table stayed in place for a few more holidays before finally making its way to the recycling bin.

Karen Sampson Hoffman, MA, is the coordinator of the NRC's Ask the Expert series. She writes from St. Denis, Maryland. This post is cross-posted on CHADD's Life with Adult ADHD blog.

Another version of this post appeared in 
Attention magazine. Join CHADD and receive every issue!

Tuesday, December 15, 2015

From Hyper to Happy Holidays

Seasonal Tips for Anyone Affected by ADHD, Part One

guest blog by Karen Sampson Hoffman, MA

The run-up to the holidays is in full force, offering everything from excitement to frenzy. For anyone affected by ADHD, it's often a time of both excitement and frenzy. No doubt about it, the holidays require additional thought and planning — and a healthy dose of humor.

Each of us has an image of the perfect holiday in our minds. Many of us create undue stress in our lives by trying to achieve this image. We end up missing out on the joy of the season. Instead, with a pad of paper, calendar and a realistic set of goals, we can plan and enjoy the holidays by following the advice of one CHADD member who wrote to us: “Change the expectations so the holiday works for you, not the other way around.”

So we dug into our archives in search of more gems like that. We found many ideas to make this holiday season flow more smoothly and become a pleasant experience in your home.


The amount of stimulation brought by holiday events — especially those that include crowds and seldom-seen family members — can easily become too much for adults and children affected by ADHD. Parents and relatives can help children with ADHD by understanding that the frenzy of the holiday season affects their kids’ daily lives and by showing empathy. Adults can be equally kind to themselves or their spouses and partners by allowing them time to regroup, setting up quiet rooms, or facilitating graceful exits from parties.

Think ahead to social situations that might be difficult. Plan a variety of cooling-off activities that can help you or your loved one gain control during stressful times and help make holiday events enjoyable for everyone.

For Young Children Turn on holiday music and encourage children to dance to get their “wiggles” out.
Provide a special treat that your child needs to sit down to enjoy.
Roll up your little one’s sleeves and let him splash in a sink with a bar of floating soap or bath toys.
Use a special CD or book for the holiday season as a distraction when behavior starts to escalate.

For Older Kids Make busy-time packets with stickers, coloring books, writing paper, crayons, pens and stickers.
Let children pack sack lunches and find different spots in the house or the neighborhood to have lunch.
Try art: Bring out the crayons, markers, and colored pencils, and let your child color in a special coloring book or use butcher paper to make a mural. Other possibilities include using modeling clay, gluing cotton balls together or on paper, or making chalk drawings on the sidewalk.
Record a favorite family TV show or find a special movie to play when quiet time is needed.

For Adults
Plan how long you would like to remain at an event.
Offer to help out in areas that are more suited to your abilities, whether it’s the excitement of watching the kids or the calm of helping to do dishes.
Talk with the host or hostess ahead of time, and ask if there is a room available if you need a little bit of time away from the hubbub.
Be willing to politely intervene when you see your companion becoming stressed in the situation. You may realize it before he or she does.


Be sure to make your travel arrangements ahead of time so you can take advantage of lower fares for advanced booking. Consider what is the best time of day for you or your family members to travel. Traveling with ADHD takes some planning beyond air flights and hotels.

For Yourself
Consider your daily needs and how they can be met while you’re on the road. How much do you rely on your smartphone or daily planner? What about computers and email? Do you use medication to control your ADHD symptoms? Do you crave a particular morning coffee or evening snack? Take account of all of these things and plan in advance, packing anything necessary for your day to run smoothly.
Check with your airline, hotel or travel agent to see if they can assist in meeting your needs. Ask for aisle seats if you know you’ll need to stand or walk a short distance for comfort. If you're carrying medication for ADHD or other health concerns, check ahead of time for the proper way to pack them. Make sure you have any necessary documentation or prescriptions with you, and always pack your medication in your carry-on bag. If you're traveling internationally, find out the proper way to carry your medications between countries.
When packing your carry-on bag, keep in mind your level of tolerance for inactivity. Bring appropriate diversions, including books, laptops, tablets, and so forth.

For Your Partner
If you're traveling with someone with ADHD, you might need to be proactive in making your travel arrangements and packing. Many of the previous suggestions can apply, but also step back and offer guidance rather than doing it for your companion. Casual reminders rather than demands often go further in creating a pleasant experience. Plan ahead if you think a particular task or item will be missed and help to avoid problems.

For Your Children
Forethought goes into just about everything when you travel with children with ADHD, whether you're their parent, grandparent, aunt, uncle, or guardian. 
Just as you need to check on medication concerns for yourself, you need to do the same for children in your care, along with any necessary documentation of their disabilities. Talk with the agent booking your travel, and ask about special accommodations or recommendations to make the trip more pleasant for all involved. 
Always make sure medications are carried in their original containers and that you bring your medical insurance cards and documentation or consent forms. If necessary, ask your child's doctor for suggestions about medication during the holidays.
When packing carry-on bags, make sure you have activities for the kids. Coloring and activity books are great for all ages; older children and teens may need a variety of books or magazines. Tablets, iPods or MP3 players, or small game systems can be useful, too. The idea is to keep children occupied, especially when their attention can shift quickly. 

Karen Sampson Hoffman, MA, is the coordinator of the NRC's Ask the Expert series. She writes from St. Denis, Maryland.

Another version of this post appeared in
Attention magazine. Join CHADD and receive every issue!

Tuesday, December 1, 2015

Too Much Screen Time?

When Your Child with ADHD Over-Connects
 guest blog by Martin L. Kutscher, MD, and Natalie Rosin, CASAMHC

Do you worry about the amount of time your child with ADHD spends playing videogames? Does your son scream when you try to get him off the computer?  Is your daughter honest about her online activities? Does trying to limit your child’s screen time bring about World War III? Just how much screen time is too much? What effect is all of this technology having on your child?

The rapid explosion of digital technology in the past fifteen years has led to unprecedented opportunities and challenges for us all. This is particularly true for people with ADHD, who tend to be attracted to the Internet, digital media, and videogames like moths to a bright light.

According to a 2013 policy statement from the American Academy of Pediatrics,
•    Children aged eight to ten spend nearly eight hours a day on media.
•    Older children and teens spend more than eleven hours a day on media.
•    Seventy-one percent of children have a TV or Internet device in their room.
•    One-third of teens send more than a hundred texts per day (largely replacing phone use).
•    Our children spend more time with media than in school.
•    Yet, two-thirds of children and teens say that their parents have no media rules.

This technology attraction spills over into the classroom, where 62 percent of iGeneration students state that while in class they check their digital devices more frequently than every fifteen minutes. And it’s not just children who are so hooked on their screens: One out of three adults say that they check their mobile device before getting out of bed in the morning.

Children with ADHD seem to be particularly prone to excessive screen time use. After all, it’s not that people with ADHD cannot pay attention—they do that just fine with videogames and Legos. It’s more that they have difficulty sustaining attention to anything that isn’t fascinating. What could be more fascinating than videogames, with their visual graphics, sound effects, action, constant change, immediate feedback, and incentive to get to the next level? What could be a more addicting setup than ready access in your own room to the Internet, with its endless content of information or services for just about any question or desire?

People with ADHD tend to require frequent and immediate rewards, which are needs quickly fed by screen-time activities. Each stimulus instantly drops a small bolus of the neurotransmitter dopamine right into the brain’s reward center. No wonder it is such a fight to get our kids off of the computer or console.

The effects of screen-time usage
People with ADHD run a much higher risk of Internet addiction than neurotypicals—estimates run as high as twenty-five percent of the ADHD population. Such excessive screen-time use is associated with a multitude of problems. These include troubled relationships with families and friends, poor school/work performance, fatigue, and poor sleep (even the light emanating from a laptop interferes with sleep onset). There may be monetary losses from gaming, shopping, gambling, pornography, etc. There is considerable evidence that a TV in the child’s bedroom increases the risk for obesity, substance abuse, and exposure to sexual content.

Technology is also changing the way our students learn, and not always for the better. According to one teacher survey, nearly 90 percent of teachers felt technology has created a distracted generation with short attention spans. Further, constantly turning to digital distractions means that there is no downtime, which interferes with problem solving and creativity. Excessive media use also cuts into free time that could have been utilized for other productive activities.

Finally, trying to multitask media with work is inefficient. Current thinking is that what most people call “multi-tasking” is actually “multi-switching.” We switch back and forth between tasks so frequently that we think we are doing more than one thing at once, but we rarely are. You can’t type a text into your smartphone and read a school book at the same time! It actually takes anywhere from one to twenty additional minutes just to get back to where you were when interrupted. Of course, texting while driving should be explicitly forbidden. Even texting while walking (TWW) is dangerous: It results in more injuries (albeit milder ones) per mile than distracted driving.

The problems are on a spectrum

Screen-time problems run along a spectrum of severity. At the mildest end are the problems we perceive among typical, well-functioning children and teens, such as texting multiple times an hour or ignoring friends and family at get-togethers in favor of communicating elsewhere with their smartphone. Then there are the kids whose screen-time activities result in modest family discord and inefficient work, but who are still able to get good grades and participate in other activities such as sports. At the most severe end, there are those who suffer from what can be called a true Internet addiction: an inability to control one’s digital or Internet behavior despite significant resultant problems such as falling grades, withdrawal from friends and activities, and significant family turmoil.

So what distinguishes enthusiasm for an activity from a true addiction? The simplest answer is that healthy enthusiasm adds to life, whereas an addiction detracts from it. It’s not the excessiveness time-wise of the behavior. Rather, it is (a) the individual’s inability to control behavior (b) despite its having negative consequences. Additional features of addiction are withdrawal (including anger/tension/depression when trying to stop); and tolerance (including need for more and better software/hardware/time).

Preference for socializing online with “virtual friends” as opposed to direct human interaction is a strong predictor for Internet addiction. Other risk factors include other addictions such as to drugs, family dysfunction, spending more than twenty hours online/week, and strong reactions to parental attempts at limiting access.

Estimates of the prevalence of Internet addiction vary widely, based on the criteria used and nationality studied, but the following rates appear to be reasonable estimates:
•    Adolescents:  4.6 to 4.7 percent
•    College Students:  13-18.4 percent
•    General Population:  6-15 percent
•    ADHD:  up to 25 percent

Dealing with screen-time problems

A family meeting to create a technology plan is an excellent tool to use with children aged eight and up. For some families, ensuring a casual and relaxed environment may require a professional.

The meeting is a means of improving family cohesiveness. Never come in anger; this is not a forum for discipline. Set content and total screen-time limits, including TV. Schedule times and choices in advance. Address fairness issues with all those involved. Seek a solution where everyone feels their needs are met, if possible. Develop and follow up on consequences. Finally, develop a list of fun activities that don’t use technology.

Parents are role models, and must examine and address their own technology habits. Although this doesn’t mean the same rules apply to everyone in the family, all rules need to operate from a similar philosophy. Be sensitive to the message you give your child when you place answering your own text messages or phone calls above paying attention to your child. This can affect his or her sense of self-worth.

See below for additional strategies for preventing screen-time problems.

Treatment for screen-time addiction

Total abstinence from technology is not possible in our current society (unlike addictive substances). With those who have a true addiction, therefore, it’s necessary to identify the specific applications that are triggering addiction, and exercise total abstinence from those applications.

Severe problems may require formal therapy, which can be individual or group. Cognitive behavioral therapy (CBT) is widely used for substance, depression, anxiety, OCD and other behavioral disorders. Dialectic behavioral therapy (DBT) is a form of CBT with emphasis on validation; that is, accepting uncomfortable thoughts, feelings, and behaviors (versus struggling with them). DBT seeks to establish a balance between acceptance and change, and thus helps reach the goal of gradual transformation. DBT also focuses on coping skills, relaxation techniques, and mindfulness.

Therapy also aims to promote the individual’s recovery by repairing the damaged relationship, and bringing the family back as a supportive resource. Unfortunately, research has not yet shown any particular therapy to be more effective or useful than any other.

Strategies for preventing media overuse

The American Academy of Pediatrics makes the following preventive recommendations:

•    Discourage electronic media use by children under two years old.
•    Limit entertainment screen time to less than one to two hours per day.
•    Keep TV and Internet devices out of the child’s bedroom.
•    Monitor media use for duration and content.
•    Co-view media. This also gives rise to the opportunity to discuss issues.
•    Establish and enforce a family media plan, including technology use at meal time and bedtime “curfew.”

Paraphrased from the AAP Policy Statement, “Children, Adolescents, and the Media,” published in Pediatrics, November 2013, vol. 132 no. 5; available online at

Additional simple preventive interventions include:

•    Take a technology break every fifteen minutes, turning off websites and phone for one to two minutes.  Make dinner and homework time screen-free as well, unless an assignment specifically calls for online research.  Just knowing that a technology break is coming up soon may help soothe the pain of transient abstinence.
•    Alternatively, partition the day into different activities: Work/study, social networking, and email sessions.
•    Close computer windows that are not needed for work.
•    Turn off phone’s message alert sounds/vibration. Research shows “Out of sight, out of mind,” or more importantly, “In sight, in mind.”
•    Use an alarm clock or TimeTimer to monitor duration of technology usage.
•    Teach the skill of “practicing the opposite.” If you want to stay off the computer/smartphone, then do something different!
•    Set up site filtering and time control software or apps on hardware including desktops, laptops, iPads, and smartphones. Some WiFi routers allow different settings for different users and cover all Internet connections from one central location. See for specifics.

Martin L. Kutscher, MD, is a board certified pediatric neurologist in Westchester, New York, who specializes in neurobehavioral problems. His website is
Natalie Rosin, CASAMHC, is a credentialed substance abuse counselor and mental health specialist in Rye, New York. Her website is

Tuesday, November 24, 2015

ADHD & Extended Family Ties

How to increase understanding and move forward

guest blog by Janette Patterson, MSW, LCMFT, and Larry Maltin, MA

As awareness grows, we are better able to address the challenges people with ADHD face at school, at home, and in the workplace. Self-help strategies abound, but the focus is usually on help for the immediate family — the child, mom, dad, and siblings. The impact of ADHD symptoms does not stop with the immediate family, however.

What about the concerns and reactions of grandparents or uncles and aunts? Research is lacking on the role and dynamics of the extended family when one or more members have ADHD.

In Taking Charge of ADHD, RussellA. Barkley, PhD, writes: “Parents of children with ADHD also may be deprived of the encouragement, warmth, and assistance of a supportive family. They tell us that they have fewer contacts with their extended family members than in families without children with ADHD, and that these contacts are less helpful to them as parents and more aversive or unpleasant.”

As parents, we want to help our children to become well-functioning and socially successful people. Our own anxieties are sometimes triggered when our children with ADHD act out and misbehave. We desperately want them to behave appropriately and to be accepted.

“Emotional dysregulation” is a term used to describe the struggles that some children with ADHD experience with their feelings. When a situation becomes frustrating, the child's emotional reaction is so intense that he or she feels overwhelmed and reacts with behavior that can range from crying to hysterical sobbing, from whining to screaming, from shutting down to destroying property and harming others. These struggles are debilitating to the child and everyone around.

We all know those painful and awkward moments when everyone at family gatherings is affected. We feel embarrassed and defensive for our child when he gets reprimanded or described as “spoiled” by a relative, and we feel guilty for being unable to prevent these stressful occurrences.

It is painfully clear that misunderstandings, social expectations, unspoken rules, and unresolved family dramas keep us stuck in uncomfortable, maybe even dysfunctional interaction patterns within the extended family.

How do we respond to grandparents, aunts, uncles, and cousins when our child becomes symptomatic at family functions? How can we advocate for our children, but also validate our extended family members’ experience while respecting their opinions and decisions?

Strategies for coping and healing

Much of the research and literature on dealing with ADHD can be helpful for educating our extended family. What strategies make the most sense in managing a family gathering so that our child (and everyone else) can participate and feel comfortable?

1. Educate the family about ADHD. Remember when you first learned about ADHD? What it was like when you were finally able to understand why your son was unable to finish his homework assignments, or why your daughter couldn’t make it through birthday parties without fighting with everyone?

The more you learned about how ADHD affects emotional reactions and behavior patterns, the more you were able to reach out to your child and support him or her in finding workable coping strategies to make things better. It’s the same with extended family. The more we can speak openly with them about how ADHD affects our child (and us) in a way that is understandable, the more we can have meaningful conversations and explore problem solving skills.

2. Develop self-awareness. Find a way to slow down so that you can take a moment to check in with yourself. Practicing mindfulness, for example, helps us become aware of how we feel in the moment, and is a key element for emotional healing and building of coping strategies and skills. For some, this means finding a word or phrase to help them remember to check in with themselves. For others, it might be deep breathing exercises to facilitate the process of self-awareness.

3. Practice self-advocacy. While advocating for our child, we are also aware of our own struggles and experiences. We are aware of our child’s vulnerability to being judged, and that our child is not able to self-advocate. So we need to speak for our family member who has ADHD: “Please remember that it is really hard for [fill in child's name] to sit still—especially when the energy in the room is high. He gets really hyper when people around him are excited.”

In addition to reminding our extended family members, we also need to address our own struggles: “I get so nervous when I see [child's name] become all revved up. It’s really helpful when you can reassure me that you won’t overreact when he gets loud.”

In order to be effective in advocating for our child, we must check in with our family member and make sure that he or she is able to listen. How many times have you experienced rejection and rebuffing from an angry family member? “I don’t care that your son has ADHD! He just broke my flower vase. You have to control him better!”

4. Explore alternative or new ways of communication. We need to explain to our family members that our child’s behavior is not about them, but is directly related to our child’s inability to regulate his or her emotions in the moment. It takes practice, patience and flexibility to work with these highly charged, emotional situations.
Be proactive. Prepare for the next event by having conversations with your relatives before the family gathering.
Brainstorm with your relatives. Include them in the process of exploring how potential stressors can be avoided or addressed before an incident happens.
Be aware of your relatives’ concerns and feelings.
Stay positive!

5. Utilize the best ways to “defuse” behavioral disruptions at family gatherings. Even the best intentions are not always enough. Accidents happen — our child with ADHD can get triggered and disaster unfolds. For example, what could have been done differently in preparing for grandma’s birthday party?
Do “prep work.” Talk with your child before the party and come up with a game plan if things get out of hand: “[child's name], if you start getting all riled up, I will give you a sign that we need to step out of the room so that we can calm down. What sign is better for you? Should I just call your name or should I walk up to you and tap you on the shoulder?” For some kids and for some occasions, it might make sense to negotiate a “deal.” For example, “It’s really important for grandma that everybody shows their best behavior when we celebrate her birthday. If you can stay at the dining room table until we have eaten the cake, then you can get some computer time when we get home.”
Find allies. Before the party you could find some benevolent family member(s) who could jump in to support you in a time of need. For example, grandpa could come to the rescue when your child is unraveling: “Hey [child's name], let’s go in the living room. I want to show you something.”
Be prepared. Keep an eye on your child to check when the behavior is beginning to escalate so that you can step in before it gets out of control. Sometimes you might just need to give a quick reminder: “Hey [child's name], indoor voice, please!” Or you might offer him a distraction: “Hey [child's name], let’s go outside and shoot some basketball hoops!”
Advocate for your child and yourself. Speak up and explain to your family members what is happening and how they can help when your child is in crisis. If your child is in a full-blown temper tantrum, you could say: “Sorry, folks, when the party gets noisy, [child's name] gets overwhelmed. We will see if we can get ourselves calmed down in the other room. Thanks for being understanding.”

Moving forward

As parents of children affected by ADHD, it is our responsibility to develop understanding and mutually acceptable support within the extended family. It is up to you to initiate the conversation. You know your child and yourself. When you reach out to your family members and invite them to explore how you can have a more satisfying family experience, you are creating an opportunity for change.

As James L. Karustis, PhD, coauthor of Homework Success for Children with ADHD, told us: “Extended family members can be a surprisingly excellent source of support. Be clear in communicating what you need from the family member, and remember what you need is likely to change over time. You may need logistical support, such as a family member pitching in to help with babysitting and homework. You may need a person to vent to from time to time.”

Advocating for and supporting your family member with ADHD is an ongoing process. With practice, patience, understanding, and consistency, we can better help our child with ADHD, our immediate family, and ourselves. We can also strengthen the ties to the loved ones in our extended circles of family and friends.

Janette Patterson, MSW, LCMFT, is the co-coordinator of the Montgomery County, Maryland, chapter of CHADD, and a family therapist.
Larry Maltin, MA, is program coordinator for Elkins Park Pennsylvania CHADD. 
This blog is adapted from their June 2014 Attention magazine article. See also their articles in the current October 2015 issue of Attention. Join CHADD and receive every issue!

Tuesday, October 20, 2015

More Wit & Wisdom for Naysayer Encounters

guest blog by Marie S. Paxson

When children are younger, it is somewhat easier to disclose that they have ADHD. Some experts feel that keeping a child's ADHD secret contributes to stigma. I’ve heard a special education attorney assert that children may think they have something shameful if during school meetings they hear their parents ask whether information is kept confidential or if the IEP is kept in a locked file cabinet.

The way their peers reacted to my children’s ADHD surprised me a few times. Once a group of boys let my son use a dictionary during a Scrabble game because they knew that spelling was difficult for him. Who would have thought of that — an accommodation for a board game!

When my children became teenagers, I felt they were entitled to confidentiality, and they could choose whom to tell and whom not to tell. Some teens are more comfortable about their ADHD diagnosis than others — I’ve heard psychologists say that during a treatment session a teen will answer a cell phone with "Dude, I'm in therapy. Can I call you right back?"

When you disclose, you may be surprised at how many other people also have the disorder and would like to talk to you about it. But if you are holding back, then your instinct may be telling you that you are dealing with some potentially judgmental people.

Last week I wrote about typical scenarios people with ADHD face when they are put in a position to defend the disorder and how they manage it. Here are some additional examples.

Doubts about adult diagnosis: "You didn't have a problem as a kid, why do you have this now?"

Depending on how old an adult is now, the diagnosis may not have been very common back when he or she was a child or adolescent. Baby boomers certainly had the symptoms, but didn't receive accurate diagnosis and treatment. But regardless of a person’s generation, many supports were in place during their childhood years. Because they had fewer responsibilities and managed fewer details, their childhood ADHD was easier to manage.

Assertions like: “If more kids played outside, there would be fewer diagnoses of ADHD, which is caused because kids watch TV too much.”

There have been some studies indicating that children with ADHD see improvement when they participate in outdoor activities. John Ratey’s book Spark looks at the effects of exercise on the brain, and Last Child in the Woods by Richard Louv makes a strong case for the importance of unstructured outdoor activities for child development.

You could respond, “There have been headlines about too much TV causing trouble with attention span and distraction, but they were talking about the distractibility we all struggle with. A diagnosis of ADHD means that symptoms of inattention and inability to tune out distraction are severe enough to be an impairment and occur in a variety of settings. That’s very different from the effects of too much technology.”

What if the naysayer is your spouse? And doesn’t want your child labeled—or treated?

People are afraid of labels, sometimes with good reason. But the child has ADHD whether we acknowledge it or not. Often the best route is to have a third party try to educate your spouse; most likely he or she is tired of hearing it from you.

You could try to have your spouse talk it over with someone he or she respects or go to a well-regarded professional. Perhaps you could introduce some reading material on the subject. When I was a new mom and wanted my husband to read articles on parenting, someone told me to take all the sports magazines out of the bathroom and replace them with books about babies.

You could also bargain for open-mindedness on this topic in exchange for the same deal on the topic of your spouse’s choice. For instance, your spouse will read some literature or watch a video on ADHD for a specific amount of time and you will do the same on the topic of his or her choice.

I have found adults with ADHD to be a good source of insight about childhood issues. Often they inspire a sense of urgency to address ADHD symptoms in childhood because of the impact that the lack of a timely diagnosis had on their lives. There are several books and videos by adults with ADHD on the market, and adults with ADHD often speak at CHADD meetings and conferences.

 Marie Paxson, a past president of CHADD, is the mother of two grown children with ADHD. Over the years, she has been on the receiving end of many myths, misconceptions, and judgmental remarks. Sometimes these were handled with diplomacy, sometimes not. 

Tuesday, October 13, 2015

Dealing with Naysayers, Part 1

by Marie S. Paxson

It is really hard to deal with naysayers, isn't it? I often have to decide is if trying to convince them is worth my time and energy. We all know people who have strong political opinions and will not listen to any other points of view.

Would your time be better spent managing the ADHD instead of trying to convince someone who will never hear you? Can you limit the amount of time you have to spend with people like this? Shorten the duration of mandatory visits— stop in for dessert at holidays instead of the entire meal? If these are people you are required to spend a lot of time with, can you counterbalance by spending time with supportive people?

These are the questions I ask myself when I'm deciding whether to respond to naysayers. The trick is to balance whom to tell about your ADHD and how to say it in a way that gives them a better understanding. And you may want to tailor your responses to the specific remark made, as in the examples below.

In business circles, the rule of thumb is “praise in public; correct in private.” So if you need to let someone close to you know that their remarks are hurtful to you, it is best to do this in private, rather than as an angry reaction in front of others. At the very least you may be able to get the other person to agree to disagree and not make these remarks in your presence.

"ADD is just an excuse!" or "Everyone is ADD!"

I might say something like, “I probably would have said something similar BEFORE my child (or self, spouse, friend, etc.) was diagnosed with ADHD. I feel very differently now.” Or I might acknowledge their perspective by saying something like, "I know it sometimes seems that way. But look at the number of organizations that have determined that ADHD is real. Real science defines ADHD as real disorder.”

"ADHD is an explanation, but not an excuse" is a response that demonstrates that while there may be occasional slip-ups and glitches, the person is actively managing the disorder and doing the best he or she can.

And sometimes I say something along the lines of, "How fortunate that you aren't affected by the disease and have the luxury of disbelief."  You might ask them if they would have this reaction to a physical illness.

Perhaps you can use an analogy to help others display more sensitivity and compassion: “It is so hard when those with Alzheimer’s face memory and organization issues toward the end of their lives. Can you imagine if you had these struggles from day one?”

Rude comments about medication, such as: "Of course your house is quiet! You drug all your kids!"

Sometimes I like to use the word “compassion” in my response. No one likes to be thought of as uncompassionate. And being compassionate doesn’t necessarily mean that one agrees or approve of something, just that one is taking a nonjudgmental stance.

You could perhaps point out that the individual has a documented medical condition that is being helped by medication. You can point out that using the word "drugs" in that fashion is very stigmatizing. Not to mention that a true friend wouldn't want your life to be any more difficult. 

"Others have been successful with ADHD, why haven't you?"

The general public doesn't understand that ADHD has "severities." People tend to understand only the type of ADHD that they’ve been exposed to. Some people have mild ADHD and no co-occurring conditions while others have a severe case of ADHD and very limiting co-occurring conditions.

It can be helpful to point out that people with ADHD have the same rate of having successful lives as the rest of the population. And each individual defines success in his or her own unique way.

Analogies can show similar situations. If you know the person has been affected by any of these conditions, it can help to highlight the individual circumstances of those with ADHD. You might say:
•    Some people manage diabetes with diet and exercise; others need an insulin pump installed in their bodies.
•    Some people with asthma occasionally use an inhaler; others need to be hospitalized.
•    Some people with arthritis can do yoga and take nutritional supplements, while others are in a wheelchair.
•    Some cancers can be managed with watchful waiting, while others require aggressive treatment or surgery. 

These are just a few common scenarios and possible responses. I’ll share more next week.

 Marie Paxson, a past president of CHADD, is the mother of two grown children with ADHD. Over the years, she has been on the receiving end of many myths, misconceptions, and judgmental remarks. Sometimes these were handled with diplomacy, sometimes not.