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 (flylady.net) 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!

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.

HOLIDAY BEHAVIOR

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.

HOLIDAY TRAVEL

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!

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  http://pediatrics.aappublications.org/content/early/2013/10/24/peds.2013-2656.full.pdf+htm.

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 www.FamilySafeMedia.com for specifics.


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

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!

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. 

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.

Redefine Perfect: Handle Homework Hassles IV

by Meghan S. Leahy, MS, NCC

Homework can be very stressful for both adults and students. The best approach is to find a system that works for everyone and make it a habit. Discovering the system that works best can be tricky. It takes experimentation, creativity, and patience. Also, the system needs to be flexible, re-examined, and tweaked over time.

For students with ADHD, the key is flexible structure. Adults have to remember that it is their job to implement this structure for students in a positive manner. It is the student’s job to engage in the homework process and complete the work. This is an important relationship. Adults need to find a balance and model productive behaviors while allowing responsibility for quality homework completion to remain with the student. Students are empowered by adults who can honestly and enthusiastically help them discover success in small, continuous steps.

Here are a few helpful tips:

•    Make a plan. Know what is required; awareness is key. Each night, have the student make a list of all the work that needs to be done, for that night and for the week. Discuss a plan of attack for completion. How will the work be broken down?

•    Use your words and laugh a lot. Research has proven that positive reinforcement is the most successful way to motivate students with ADHD. Avoid negative language and always ask open-ended questions—remember to wait for a reply. Realistically, not too many students enjoy homework. Don’t judge. Address the fact that it is a reality that must be accepted and talk it through. Some students need to vent. Let them discuss how hard life can be—as long as they are talking while they work.

•    Redefine “perfect.” There is no such thing as perfect, so help your students to set reasonable goals that will make them (and you) “perfectly” happy. At the end of each marking period, reward progress, examine setbacks and set new goals.

Meghan S. Leahy, MS, NCC, is the founder and director of Leahy Learning and coauthored the medical textbook Attention Deficit Hyperactivity Disorders Throughout the Lifespan (Western Schools, 2014). As a clinical associate at the Penn Adult ADHD Treatment and Research Program at the University of Pennsylvania, she worked with college students and adults. She has also been a clinic director at Lindamood-Bell Learning Processes.

Get Support & Communicate: Handle Homework Hassles III

GET SUPPORT WITH HOMEWORK

by Thomas J. Power, PhD

Debate continues about the value of homework and whether homework should be assigned to students, particularly in the elementary grades. Although many arguments have been made in favor of homework, three are especially important.

First, family involvement in education clearly has been shown to have a positive effect on children’s performance in school. Homework provides an opportunity for families to be involved in their children’s education and to help their children to do well in school. Second, the quality of the family-school relationship is critical for school success. Homework is a natural means of family-school collaboration and provides ongoing opportunities for parents and teachers to connect with each other. Third, when students transition into high school and college, they generally need good work habits to be able to work effectively on their own. Homework provides an opportunity for students to develop independent study skills.

The most important question is not whether to assign homework but how to support families with homework. The following are a few points to consider:

• It is critical for homework assignments to be adjusted so that students experience high rates of success. Parents have an important role in negotiating with teachers the right amount and type of homework.

• Homework can be a battleground that has negative effects on student motivation to learn and the quality of the parent-child relationship. Many parents need training to design a homework routine and use positive reinforcement strategies that will be effective. School guidance counselors and your child’s doctor may be able to offer referrals to a professional who can offer this service.

• Homework assignments can be overwhelming to children and their parents. It is usually a good idea to break up homework into manageable chunks or units and to set goals for completion and accuracy for each unit. Subsequently, children can earn positive reinforcement for being able to achieve established goals.


Thomas J. Power, PhD, is professor of pediatrics and education at the University of Pennsylvania and director of the Center for Management of ADHD at The Children's Hospital of Philadelphia. He is a former member of CHADD's professional advisory board. He is one of the coauthors of Homework Success for Children with ADHD: A Family-School Intervention Program (Guilford Press, 2001).





COMMUNICATE ABOUT STRUGGLES 

by Courtney Calio, MSEd

Students with ADHD feel overwhelmed with the idea of homework. Work outside of the school day requires time management, focus, and self-regulation—all skills that do not come easily for those fighting ADHD. Not to mention that the required task could be difficult, in a content area of little interest, or seen by the child as pointless. These possible culprits are at the core of the all-too-familiar scene: fighting and crying over homework with your child at the kitchen table, plugging through one spelling word or math fact at a time.

The reality is that all children of this generation are required to sustain a daily routine that requires intense academic rigor. Eligible content and high-stakes standardized testing leave little room in the school day to release extra energy or engage in self-selected learning activities. Unfortunately, there is little reprieve from this routine for many children at dismissal time. The transition from school to home, usually with well-deserved extracurricular activities jammed in between, creates a difficult dilemma. How do you explain to your child who has ADHD that he or she must be focused all day at school to do his or her best work, but then must also refocus at home to do more schoolwork?

As an elementary educator, I have come to realize that only so much can be expected at home from all children, that the smallest modifications can reap huge rewards, and that without communication (from teacher, parent and child) the battle is never won. My advice to parents of children with ADHD:

• You must communicate with your child's teacher about homework. Determine the exact purpose of the homework. Is the teacher open to differentiating the assignment to meet the strengths of your student? Your child's teacher will not understand any struggles going on at home unless you communicate them and work together to develop possible alternatives.

• Consider your child's learning style. Is your child a great artist, musician, or athlete? Does your child love technology? Seek out ways to complete a reading log or memorize spelling words and math facts that involve your child's natural strengths, known as multiple intelligences in the world of education.  Find activities that are enjoyable but meaningful and produce the same results.

• Stay positive and involve your child in open dialogue. Involve your child in discussions with the teacher and demonstrate how to communicate and voice struggles. Your child knows he or she has ADHD and it will always present challenges in life. There will be many times when modifications can't be made and when one just has to get the job done. Explain this, each and every time. Show your child that you are advocating for him or her, that you understand, and that learning how to cope and overcome will make him or her stronger.

Courtney Calio, MSEd, teaches fifth grade in the Kennett Consolidated School District in Pennsylvania.


Earlier versions appeared in Attention magazine. Join CHADD and receive every issue!

Establish the Homework Ritual: Handle Homework Hassles, Part II

by Jim Karustis, PhD

Many years ago I discovered that homework problems can truly rip families apart, and that is no exaggeration. Common complaints include:

• “My kid will argue for six hours about doing homework that would take her fifteen minutes!”
• “He says he does his homework at school, then I get hit with surprises at teacher conference time.”
• “My child really does try, but homework seems to take up all of her time every night.”

Homework can be a silent problem. Many students struggle while doing their homework at home, but as long as they finally complete the work and submit it, the teacher may not even realize that there is a problem. Many well-meaning parents gradually find themselves taking over the lion’s share of homework responsibilities, out of fear that their children will be penalized for incomplete work.

If your child is experiencing significant homework problems, review the basics of what we call the homework ritual. Get clear on the rules yourself, then review them with your child and post them prominently in your home.

As much as possible, homework should begin at the same time each day. There should be a designated, distraction-minimized location. Don’t believe it when your child says he can pay attention better when the television is on — turn it off. Some children do fare better, however, when there is some subdued music in the background — mainly for rote tasks. The homework location should be virtually a sacred spot, set aside only for homework, so that your child can keep materials there and not confuse the location with other activities.

If these elements of the homework ritual have been problematic, then I suggest that you implement an incentive system that targets the troublesome homework-related behaviors — for example, fifteen minutes earned for her favorite video game for beginning homework with one reminder.

The next issue is to keep separate and distinct your roles as homework manager and homework tutor. Managerial duties include the structure of homework time and making sure you know what your child has to do for homework. Once you are confident your child understands the directions, then leave the homework station. Inform your child that you will check back later, but that you expect that he will have completed X number of problems. The assistance with the actual instructional material can come later.

All students should use homework assignment books. Most schools now have websites where teachers can post assignments. While these may greatly reduce the importance of pen-and-paper assignment books, they have variable reliability for some students. If compliance with consistently using an assignment book has been a problem for your child, you may wish to ask the teachers to sign the book on a daily basis. On days when there is no assignment, teachers would write "no homework" and sign off on it. If your child is one of those who says she has completed her homework at school, then make it clear that privileges at home are contingent upon her bringing the work home for you to compare against what is in the assignment book.

If you have these elements in place and still experience significant problems, it may be time to request a meeting of the school’s Instructional Support Team (private schools have equivalent teams with varying names). The IST can assist with basic interventions regarding homework and related issues, and can also begin the process of exploring the possibility of whether your child is receiving instruction consistent with her current level of functioning. For students with ADHD, requesting reduced homework demands is a common and reasonable intervention.

Homework can be put in its place for what it is meant to be, which is a reinforcement of classroom instruction. If it is dominating home life, then try the modifications outlined above, and consider seeking assistance from the IST or a qualified psychologist with expertise in school issues.

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

A psychologist in private practice, James Lorenzo Karustis, PhD, is a member of the professional advisory board for Chester County/Main Line CHADD. He coauthored Homework Success for Children with ADHD: A Family-School Intervention Program (Guilford Press, 2001).

Handle Homework Hassles, Part I

With schools back in session, we know you want to prepare for the homework blues before they become nightly battles. For the next few weeks, we'll share advice from experts, many of whom are first and foremost parents of children with ADHD. Some have additional expertise as educators, psychologists, social workers, or pediatricians. Let us know what other topics you'd like to read about!


INTERVENTIONS THAT BUILD LIFELONG HABITS
by Maureen A. McQuiggan, EdD

Tips and tricks for surviving the homework wars fill volumes. Strategies intended to “help” with homework often leave both parent and child feeling like they are just adding to the workload. The real key to success with homework rests in identifying strategies that work for all homework all the time. Here are three basic interventions that get the job done and build valuable lifelong habits:

• Process is more important than product. In recent years, educators have perfected the art of outlining explicitly the product they expect from students. Rubrics and assignment contracts spell out clearly what teachers expect to see handed in. The missing link often rests with the process. Help your child get from “I haven’t even thought about the assignment” to handing in a quality product by creating process cards. Together with your child, outline clear and simple steps to completing the task. Cards for tasks such as learning new vocabulary and outlining reading materials can be used repeatedly to build both confidence and good work habits. Start each step with a motivational check box that can be ticked off for a sense of accomplishment.
• All reading assignments must be active. Asking a child with ADHD to simply read a chapter for homework is like asking him or her to watch grass grow — many will comply, but in the end the grass and child remain unchanged. If reading assignments are not active, the brain is not engaged, attention wanders, and learning does not take place. Active reading strategies can involve asking students to locate key ideas in the reading, color coding answers to the end-of-chapter questions, or creating questions based on the reading. 
• Build basic skills. Basic skills are the gifts that keep on giving. Devoting a chunk of time in the summer to targeted basic skills practice such as increasing reading fluency, improving written language skills, or committing math facts to memory will help build your child’s automaticity. Students who read more fluently, compute with speed and accuracy, and write with ease will realize the benefits across all academic tasks.

HIRE HOMEWORK HELPERS
by Sheila Grant, MS, RN

As a parent, I have experienced the stress and tension of trying to get my kids to complete their homework. When you break it down, the steps required to complete homework can be especially challenging for a student with ADHD:

1. Figure out the assignment. (Big problem, because it is not always written down.)
2. Do you have the right materials to complete assignment? (Is the book at home?)
3. Do you have an understanding of what is required? (Your child may have the assignment, but does not really know what is required.)
4. Complete the assignment. (This is the hard part.)
5. Hand in the assignment. (How many times does your child finally complete homework, only to leave it on kitchen table?)

After many stressful nights, tears, and fights, hiring a homework helper was the best thing I ever did for my family when my kids were in elementary and middle school. I hired many wonderful college students and graduate students over the years. Some were studying to be special education teachers.

Once or twice a week, the homework helper sat in the kitchen with my child and supervised homework. The job included going through the backpack to find all of the errant papers, checking assignment books, working on organization, and making sure the assignments were complete and put away in the backpack. I was able to prepare dinner quietly; there were no fights, and my children felt a sense of accomplishment and confidence in their ability to do the work.

Homework helpers do not cost nearly as much as a tutor; figure on paying between $8 and $15 per hour. Here are my tips:

• If you have a university near you, try posting an ad. There are always students who need jobs and are perfect for elementary age through high school. Mature high school students would work well for elementary-age children.
• Be prepared to change homework helpers if they do not work out. Look for one that is very organized, very kind, and comfortable setting limits with your child. For example, if you asked my son if he had any homework, he would frequently say no because he simply forgot. The effective homework helper did not stop there, but went through the backpack and the assignment book and almost always found something that needed to be done, even if it was simply organizing school materials or reviewing material. 
• Ask for an extra set of books to be kept at home. This accommodation should be a part of the child’s IEP or 504 Plan to ensure you get that extra set of books.

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


Maureen A. McQuiggan, EdD, is director of curriculum and professional development for the Radnor Township School District in Radnor, Pennsylvania, and an adjunct professor in special education at Immaculata University. She is a member of the professional advisory board for Chester County/Main Line CHADD and the parent of two children affected by ADHD.

Sheila Grant, MS, RN, is the coordinator of Chester County/Main Line CHADD, where she facilitates the parent support groups. She is a psychiatric nurse on the adjunct faculty of Immaculata University.