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!