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.

Start the School Year Right II: Homework and the Home Environment

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

Last week, in part one, we discussed how parents can effectively communicate their child’s needs through a letter to his or her teacher(s). This week, we'll address how you can set up the home environment to effectively organize and plan for those dreaded-by-parents-and-kids-alike homework sessions.

When your child has ADHD, it is important to set up a home environment that facilitates homework completion. Because many children with ADHD have problems with organizational impairment due to executive functioning deficits, the following proactive strategies will help take some of the stress out of the homework process.

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

A large calendar on the wall can be helpful for keeping track of your child’s assignments, when they are due, and when your child will be working on parts of long-term assignments. It can also be beneficial to include the dates of other activities such as soccer games, piano lessons, and so forth. This will help you and your child see the big picture of what needs to be done each week. Post-it notes and a bulletin board to put them on can also be a helpful organizational tool for older children.

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

One essential tool to have in the homework work area is a timer that can be set to break the homework session into manageable units. Setting the timer for fifteen minutes of on-task work followed by a five-minute break can give the fidgety or frustrated child an opportunity to get up, move about, and then refocus on the work. Repeat this process for as long as is necessary to complete the evening’s homework.

Time limits will vary depending on the age of the child, his/her ability to stay on task, and the child’s difficulty with and/or interest in the assignment. The timer can also be a tool for teaching the child time-management strategies. Parents can make the child aware of the importance of using strategies, such as a timer, when they model using it to break homework completion into manageable parts.

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

Schoolwork and the stress that it brings can be difficult for families dealing with ADHD. Help get the new school year off to a good start by setting up your home environment so that your child — and you — are ready to meet the challenges of homework completion.


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



Beth A. Kaplanek, RN, and Linda Smith are two of the founders of CHADD's Parent to Parent: Family Training on ADHD.