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.