Thursday, February 24, 2011

Helping Your Child Get Unstuck

by Joan Teach

http://adhdteacher.wordpress.com/


When we are doing something we like to do, we all have a difficult time stopping the activity and moving on to something new. It is as if the orchestra leader for our executive function loses his place. He appears to have a difficult time knowing when it is time to do something else, change the pace, the rhythm, or the tone. Smooth voluntary shifting and control seems impossible.

As teachers, we are often aware what activity we want to do next, and how we want to move our class onto our next teaching topic or experience. But somewhere along our way, we seem to leave some of our students behind. We don’t do it intentionally, and they do not linger because of belligerence or willfully defiant behavior. Their ADHD brains have mechanisms that interfere.

Students with ADHD have a difficult time sensing the passage of time, and once in focus, even if on the wrong thing, have an even more difficult time voluntarily putting activities aside and shifting gears. The more highly stimulating the activity, the better they are at keeping their focus, therefore, moving onto other activities and subject matter becomes difficult to impossible.

Many of us with ADHD have the compulsivity to do just one more thing before moving on. It makes us late for appointments, angry when distracted, and irritated with ourselves and others when forced to move on without finishing. Therefore, shifting gears is one of the hardest things for the ADHD brain to accomplish. Yes, neurological documentation exists to explain why this is true, but I’ll leave that to the neurologists at Johns Hopkins and Massachusetts General to explain.

HOW TO KEEP THE BALL ROLLING

So, what are we as teachers supposed to do to get the ball rolling, or maybe even to help it to stop? The first step is awareness. Knowing that all of your students are not on the same page and working at the same pace is a given. I don’t need to make you aware of that. Next, is to identify those who always seem to be lagging behind. But the most important key is to know what triggers these students to pay attention!

Let’s begin by analyzing how we can get students to shift out of one activity and be ready for the next. Many tricks we use will help the whole class to focus and know when to finish. A total class approach is the best strategy, as we do not want to single out the student that habitually is not ready for change.

AUDITORY PROMPTS

1. Call out: 5 minutes until math class, 3 minutes, 2 minutes, 1 minute.
2. Ring a bell at: 5 minutes until reading class, 3 minutes, 2 minutes, 1 minute.
3. Play soft music, preferably classical, to indicate a winding-down time. Increase the volume as time draws near. Stop the music abruptly as a final clue.
4. Use a metronome to denote time. Speed up at intervals, with a super blitz speed and stop at the end.

VISUAL PROMPTS

1. Blink the classroom lights at prescribed intervals.
2. Have a paper stop light that moves from green, through yellow at a 5 minute signal.
• The Yellow moves through 3, 2 minutes.
• Red comes on at the last minute signaling the student to put things away.
3. Note the time left on the board. Count down as time progresses to the final finish.
4. Post time-left-to-finish cards on an easel at the front of the room. Use time sequences that match the age of the students and complexity of the course.
5. Set up a large Time-timer that has a red wedge indicating the time remaining. The triangle reduces as time passes until no red is visible. The benefit of this timer is its silence.

MOTORIC PROMPTS

1. Stand next to the first student. Motion for the student to stand at his desk, but to keep working. This sequence begins about 3-4 minutes before transition.
a. Each student’s goal is to stand and finish the task they are working on, and then begin to put their material away.
b. Student 1 becomes the clue for Student 2 to do the same. As a chain reaction, each student stands and finishes.
c. When it is time to insist upon final completion, have Student 1 put his hands on his head, indicating he is ready for something new. As before, each student repeats the behavior.
d. This exercise takes a bit of rehearsal until the students know the routine, but is fun, nontraditional, and the kids love it.
2. A simpler form of the above activity is for a bell to ring, and all students stand, finish, and put away.
3. Another adaptation is to use one of the other verbal or visual prompts and have the finished students sit upon their desks or stand when their tasks are completed.
4. Assign a prompting partner. When a child is not focusing well enough to be aware of the many cues you are giving, help him to select a non-threatening partner. The partner must have guidelines, rules and limits, as the intensity coming from the bright, accomplished student may seem as bossy and maybe even intimidating. Selections must be made carefully.

ALLOWING THEM TO FINISH

What if you really want the student to finish the task before changing to another activity? Sometimes it is so difficult to get students started on a task, you want to take advantage of the momentum.

1. Make special arrangements with the student to let him know he can continue.
2. Give some students the option to continue on if they feel they need more time. Students raise their hand requesting more time when the count down begins.
3. Give the child something tangible, like a post-it-note with OK written on it to let the child know he or she can continue. The drifting mind may forget he has been given the extra time. Or, the insecurity developed over time makes him sure you didn’t respond.
4. Use other similar responses to connect and communicate, “go ahead and finish” to your students.

INITIATING OTHER ACTIVITIES

What if the follow-up activity is to move or leave the room?

1. Tap on the first desk in a row, to line up.
2. Whisper to a student by name—this is made easy by having each student’s name on a card, and you can shuffle these so the order is always random.
3. When students enter the room, give them a number written on an index card, shuffled again to make them random. This number can be used as line placement, indicating who answers first, a way to jumble partners and many other events. As the student’s number changes daily, everyone gets a chance.

If the end of the activity includes turning in material remember that:
1. Systems of passing in papers should be routine and predictable.
2. Often inattention to details and lack of focus in the ADHD brain also includes being physically present, but completely unaware that it is time to turn in papers.
a. By the time the student becomes aware it is “paper time”, or “homework return” time, the moment is gone.
b. Shuffling into the desk, book, backpack becomes a scramble of anxiety. Papers that become wadded as they are shoved into desks, pants, backpacks are impossible to tell one from another.
c. Anxiety raises, and the ADHD mind shuts down, retreats into safe territory and decides the paper can’t be found.
d. Again a partner can be a great asset.
e. Standing up to hunt, having help hunting, having a silent partner that gives out positive vibes, instills confidence that the paper can be found and reverses the negativity of the situation.
3. Teachers each have their own strategies for turning in papers. The more organized the better for all.
a. Bins at their certain place in the room can be sorted by subject, child, or even down to the level of assignment.
b. Some teachers have students initial a chart when they turn in papers such as homework.

Sometimes, mini movement breaks help youngsters to keep focus. Scheduled activities are programmed to help students sift gears positively. When organizing this approach, it is important to have a built in list of rules and requirements as to how to return to task.

HOMEWORK THE HORIBLE

Homework—have we done it or not?

1. It is hard to believe that someone can actually spend two hours on an assignment, have two or three meltdowns, and finally finish the work, get it into the backpack—only to forget to turn it in.
a. First of all you have to understand that once an assignment is completed, or even stopped, it has been addressed and moves completely out of the ADHD line of focus and is stored in Neverland!
b. It isn’t that the student doesn’t care, but when the assignment has been thought about, if even briefly, it is often “considered” done.
c. If this action has created pain, and the situation is especially emotional, it is removed off radar. Therefore, with the fleeting attention it has been given, the impulsivity to move on to greater and better, more stimulating activities, the original task is long forgotten.
2. Oh, I’m not making excuses, the work needs to be done and turned in to prove its existence. However, knowing how the neurological system works, gives us a clue as to how we must proceed. Knowing the system, we need to analyze how to repair these nonproductive behaviors.
• Organizational skills are abominable.
• Sense of timing is offbeat.
• Inattention supports lack of focus on detail and a seeming lack of concern about performance.
• Impulsivity interferes with the ability to carry through to completion.
• Social skills and the focus on responsibility is delayed. Often students with ADHD are a third behind their peers in maturity.
3. Okay, how do we repair the system? The earlier in the day a homework assignment is requested, the higher the possibility it will be turned in. As a rule, homework must be turned in at the same time, in the same way, at the same place each day.
• All of this helps—think consistency + consistency + consistency.
Consider other ways to turn in assignments:
• Via email
• Faxed to the school office
• Filled in online
4. Is this too much handholding? The object is to create a support system, but at the same time to encourage the student to be responsible for turning in his own homework assignments. A certain amount of points are given for physically turning in the assignment; 10 points, for example. Lesser points are given for backup material emailed, faxed etc.; say, 5 points. Or, start with faxed in material and add points if the paper gets to school. You need to play “let’s make a deal” with the parents. Points can then be used for rewards. Rewards are given at home, partnering home and school. Remember, punishment for trying, stops trying. Reinforcement, especially when unexpected makes the student feel better and work harder.
5. Have parents monitor the time it takes the student to do homework.
a. When did they sit down to the task?
b. When did the student actually begin?
c. How long did the student work before stopping or “hitting a wall?”
d. What emotional responses happened?
e. How long a break did the student take?
f. How much was accomplished?

JOIN RANKS AND UNDERSTAND

Parent-teacher communication on homework and similar issues often means that teachers and parents view the task in completely different ways, including the amount of struggle, the ability to perform, the student’s ability to work independently on his or her own, and the ability to understand the material. Communicate, communicate—remember that some of the adults involved may be having some of the same trouble shifting gears as the students.

The Homework Autopsy chart is easy for a parent to fill out and reveals information to share between parent, student and teacher. Fill in a Homework Autopsy to determine what is really going on during homework.

NOW, HOW TO GET STUDENTS TO START!

The next issue becomes how to get a student started on an assignment during class.

Frequently we introduce an assignment, give clear instructions, note the page, which parts to read, the questions to answer, the time the assignment should take and when it will be due.

Feeling confident we were as clear as could be, we gaze over our class watching the eager beavers dig in and begin.

Oh, but alas, there is one, maybe two or three, whose eyes glaze over like a deer’s in the headlights, not ready or able to begin. How do we get them to simply start.? Some strategies I’ve found helpful include:

1. Clustering slow starters in an area where you can move easily from one to the other.
2. Leaning close, note where the child is stalled. Many times they haven’t even put their name on the paper.
a. Start with a whisper – “Put your name on the paper.”
b. “Read the first part of the instruction.”
c. “In your own words, what does it tell you?”
d. Many times a few seconds of prompting gets through the stall, allows the fog to lift and facilitates the initiation to understand the directions.
3. Taping an index card on the student’s desk with a list of steps is helpful. In order to encourage activity, put a paper clip on the card that can be slid down the list. The student has a constant reminder as each step is passed. The list should be specific to the area of instruction. Short simple key words should prompt action.
4. If the instructions are quite lengthy, give the child your list. Even a two-step sequence is difficult for some students.
5. Instructions may be written on the board, but this still creates difficulties for some. Many youngsters with organizational difficulties also have shifting problems when looking from the board to the paper. They become lost and often have to reread the material over again each time they look up. They often forget what they have done, or what they are to do next. This is a result of their poor short-term memory. A list beside them brings the focus closer and makes success more easily attained
6. Verbal rehearsal helps many youngsters. Being able to hear the directions reinforces them into their short-term memory. Listing the steps as 1, 2, 3 helps to distinguish and differentiate the steps. Speaking aloud and describing his performance reinforces the action in the student’s mind and helps him maintain focus.

Well, this might not be all there is to it, but I hope you’ve at least remembered some of the techniques you have let slide, or you believe may need to be retried. So, get into your old Model T, crank that shaft and get it going. You’ll feel so much better, your relationship with your students will soar, your communication with parents will become solid and meaningful, and everyone’s attitude about learning will change as success comes within reach.

Here’s to success,
Joan

http://adhdteacher.wordpress.com/

Friday, February 18, 2011

How You Can Be a Friendship Coach for Your Child with ADHD


Imageby Amori Yee Mikami, PhD

MADISON HAS ADHD and her parents expend great efforts helping her to focus during homework time, to keep her backpack organized, and to remember to transport her materials to and from school. However, they are beginning to notice that while other children in their daughter’s third-grade class get together for playdates and birthday parties, these invitations don’t arrive for Madison. More concerning is the fact that Madison herself is suddenly realizing that she is left out. Madison’s mother says the child recently told her that she “wished she didn’t have to go to school anymore so that her best friends could just be her family.”

Many parents of children with ADHD are used to investing hard work into helping their children succeed academically. This is not surprising, given that most treatments focus on these children’s (very real) academic difficulties. Parents are less accustomed to handling their children’s social challenges, however, and there are fewer instructions available to them about how to help their children make friends. As in Madison’s family, many parents are not aware of the significance of their child’s social problems until some time after their child is diagnosed with ADHD. Yet, as is also illustrated by Madison’s situation, difficulties with peers can be hurtful and can reduce a child’s engagement in school, which ultimately hampers academic learning.

Common friendship problems in children with ADHD

Research suggests that the majority of elementary school-aged children with ADHD have nobody, or at most one other child, in their classroom who they would call a friend and who would similarly refer to the child with ADHD as a friend. Even when children with ADHD do have friends, the friendships tend to be less supportive and more conflict-filled than those of children without ADHD. Also, the friendships of children with ADHD are more likely to be “on again, off again” and marked by frequent declarations of “I’m not your friend anymore.”

Why do children with ADHD struggle with friendships? One reason is because the core symptoms of ADHD can interfere with these relationships. For example, what if the child with ADHD wants to play with toy cars but the peer is bored and would prefer to play something else? Because of inattention, a child with ADHD may not pick up on this social cue (the peer looks unenthused, starts looking around the room). A child with ADHD may also be unable to inhibit the overriding desire to play with the cars, even if he or she is aware that the peer is becoming bored.

As another example, what happens when the child with ADHD wins or loses a game? Because of poor impulse control, some children with ADHD will gloat with happiness upon winning or throw a tantrum out of frustration when losing. It can be difficult for children with ADHD to regulate their emotions and calm themselves down during times like these, but such behaviors can be extremely off-putting to peers.

Even if friendship difficulties begin with the behavior of the child with ADHD, the way peers respond can further the problem. The child with ADHD may develop a negative reputation among his or her classmates. Once this occurs, peers become disinclined to judge the child with ADHD objectively, so that even when he or she is behaving well, peers may never change their impressions. Children new to the classroom may hear negative things about the child with ADHD from peers, and this can make it tough for the child with ADHD ever to make friends.

Being excluded from social events such as playdates or birthday parties is also a common occurrence. Unfortunately, this can deprive the child with ADHD of opportunities to practice (and to get better at) social skills and to build friendships. The lack of social opportunities can compound the social-skill problems the child with ADHD had to begin with, which leads to the child with ADHD falling further behind peers in the friendship domain.

Become a friendship coach for your child

Does your elementary school-aged child with ADHD have social issues? Just as you can help your child succeed academically, you can help your child to make and keep friends. Here are some guidelines.

Build on a positive parent-child relationship. Children will be more likely to listen to constructive feedback and guidance about their friendship problems if they feel their parent is on their side. Think about the parallel with your own life: Do you want to improve your performance for a caring, positive boss, or for a critical boss who you can never please? In order to do this:
Image Spend special time with just you and your child alone, doing a fun activity without you directing, teaching, or criticizing your child.
Image Pick your battles wisely. If your child is doing ten things wrong, focus on the most crucial one or two first. Most adults and children can only handle working on one or two things at a time before they feel overwhelmed.
Image If your child is upset, try to be empathetic and listen to your child’s feelings first for ten minutes before you jump in and suggest what your child could do differently next time. If the problem is already in the past, then delaying ten minutes before you give constructive suggestions will not hurt anything.

Give friendship feedback. Try to keep the ratio of positive to negative feedback at about 4:1. Research has shown that this is a ratio that keeps adults happy with their marriages and jobs; children are no different. It is exceptionally hard to maintain this high ratio when parenting children with ADHD because of children’s behavior problems; most parents report they are nowhere near this ratio. In order to get there:
Image Start by praising for twenty-five percent correct. This actually encourages your child to try harder than if you wait around for your child to do something a hundred percent correct before you praise and your child never or rarely manages to do it.
Image Don’t spoil the praise by putting in a backhanded criticism, such as “You did a good job today, but why can’t you do this all the time?”
When your child has behaved badly and you do need to address the problem behavior:
Image Keep it specific to the behavior that needs to be changed and not about character.
Image Try to talk about the behavior that just occurred and not about what may have happened in the past.
Image If you feel yourself getting angry, it is okay to say to your child, “I am getting upset and I don’t want to say something I don’t mean. Let’s take a break to calm down.”
See the sidebar titled "Giving Your Child Friendship Feedback" for more tips about giving good friendship feedback.

Identify good potential friends. These should be same-age peers who seem already inclined to like your child (or at the least don’t dislike your child), share common interests with your child, and won’t be a bad or destructive influence. It’s more important to choose the right match for your child than to choose the most popular child in the class. Ideally you also want a peer who has a parent who can provide the supervision your child needs, and who will understand your child’s behavior.

Children with ADHD can be poor judges of who likes and does not like them. This may be because they miss social cues about liking from peers, or it may be because they want to have more friends than they truly do. You can help your child sort out who is a good potential friend by getting involved in your child’s activities to observe for yourself which peers seem to get along with your child or not. In order to identify good potential friends:
Image Ask your child who he or she likes to play with and why, and what they do together.
Image Ask the teacher (or group leader of an extracurricular activity) who in the class might be a good potential friend for your child.
Image Volunteer to help out in the classroom and in your child’s activities. Observe the children there to see who would be a good potential friend.
Image Hang out during activities and network with other parents. You will get to know them and they will be more likely to invite your child places.
Image If your child consistently wants to play with one peer who you think is a bad influence, make a pact with your child that the two of you will invite over someone else for two playdates first, and then if your child still wants to, you can invite over the peer that your child wants.

Arrange fun playdates. Playdates are the cornerstones to deepening friendships among elementary schoolchildren. Aim for one to two good, high-quality, supervised playdates per week for your child. If right now your child is having zero good playdates, however, it is more important to have one good playdate every month than to pack in two playdates per week where the quality suffers. See the sidebar below titled "Tips for Playdates" for tips on playdates.

Tips for supporting your teen socially

These friendship-coaching tips are best geared to parents of children with ADHD who are ages five through eleven. However, it is common for social problems to persist in adolescence. If you are the parent of a teenager, you can still help your son or daughter to make friends, but you must remember that it is normal for teenagers to not want their parents to be as involved in their social lives. So, as parents, you will have to find a nonintrusive way to remain helpful.

Try to develop a supportive relationship so that your teenager is willing to come to you for social advice. You can still foster social opportunities where your teenager can meet friends. This might not be through playdates, but rather through helping your teen to get involved in extracurricular activities or clubs.

As a parent, you can still give a teenager feedback about social skills, but it is important to include the teenager in this discussion collaboratively instead of just telling the teenager what needs to be changed. For example, you might ask in a nonjudgmental way how the teenager would like to be seen by his or her peers, and how the teenager thinks he or she is currently seen by peers. If there is a discrepancy between these two descriptions, you might state that you would like to help him or her to be perceived by peers in the way that he or she would like.

Take-home messages

Remind yourself that your child will have better and worse days as he or she is working on being a better friend. We all have ups and downs ourselves. Try not to get too discouraged with yourself or with your child when there are minor setbacks, so long your child’s friendship-making skills are improving overall.

Also, remember that your child does not need to be the most popular boy or girl in the class. In fact, sometimes children who are the most popular develop other problems. The goal is for your child to maintain a small group of close friends who truly like one another and can turn to each other for support. If you can invest in helping your child develop a few strong friendships, then this will set the stage for your child to become a happy and well-adjusted adult.



Giving Your Child Friendship Feedback

Here are some tips and examples of helpful and not-so-helpful comments from parents to children.

1. Keep it brief. It will be easier for your child to follow what you say.
Image Poor: In this last playdate you talked with your friend early on about who should go first, which your friend wanted to do, and I think that was helpful to lead to your friend feeling welcomed by you as a guest here.
Image Better: Nice job letting your friend go first.

2. Be specific. Your child needs to know exactly what behavior is expected.
Image Poor: Nobody likes it if you are a bad sport when you lose.
Image Better: If you lose you can say “good game” to the winner.

3. Stay in the present. This is especially important when you are giving negative feedback; the child can’t do anything about the past.
Image Poor: You always have to move your guest’s pieces in games. You did that today with your guest, you did it the last time we had a playdate too, and your teacher says this is a problem at school too.
Image Better: I think that your guest today wanted to move his own pieces in the game. Next time, you move your own when it’s your turn and let your guest move his own when it’s his turn.

4. Stay positive. Catch your child being good to encourage more of that behavior in the future.
Image Poor: You shared your dolls but then you really didn’t share your video games after that. You need to work harder on sharing the whole time.
Image Better: Awesome job sharing your dolls so well! Your friend really liked that.

Tips for Playdates

ImageBEFORE THE PLAYDATE
Image Choose the right friend to invite over (see the section on identifying good potential friends).
Image Have your child and the friend decide in advance what they would like to do during the playdate. Then, plan the activity with your child and don’t leave a lot of unstructured downtime.
Image Put away (with your child) any toys that your child doesn’t want the guest to touch.
Image Have snacks on hand in case there is a period of boredom. Then you can bring out snacks and revitalize the interaction.
Image If there are poor friendship behaviors that your child consistently shows, pick no more than one or two to talk to your child about in advance. Tell your child you’ll be watching out for him or her to do well in these areas and (if necessary) you will give your child a reward afterwards for behaving well. Remember to tell your child the positive behavior you would like to see and to pick a standard that is slightly above your child’s current performance, but not so far above that it is unattainable.
Image Make the first playdate last no longer than one hour. Make it a shorter amount of time if you are not sure your child can behave for one hour. The guest should leave on a good note.

DURING THE PLAYDATE
Image If your child is showing minor behavior problems, calmly whisper a reminder in his ear.
Image If the behavior problems are more severe or if the reminder doesn’t work, ask to see your child in the other room and tell your child what behaviors need to be changed. If you do it privately with your child, it won’t make the guest feel awkward. If your child is behaving that poorly, the guest will have already noticed that, and will be relieved that you are doing something about it.
Image Unless the problems are so severe that someone is in danger, don’t send the guest home. The guest shouldn’t be punished for your child’s misbehavior. Plus, your child loses the opportunity to socialize. Give your child a different punishment afterwards. Then, ask yourself what you could do differently next time before the playdate to reduce the likelihood that this will happen again.

AFTER THE PLAYDATE
Image If true, tell the other parent that the children had a good time and you hope they can get together again.
Image Use the principles of effective feedback to tell your child specifically what was and was not good friendship-making. Remember the 4:1 ratio and to praise for even twenty-five percent correct.
Image If you had a contract with your child about how to behave, then give your child the rewards that you promised if your child showed these target behaviors.

When ADHD Runs in Families

Sometimes parents of children with ADHD have ADHD symptoms, too. This can make being a friendship coach for the child easier in some ways and more challenging in others. Here are some tips to remember:

Image Empathize with your child.
Having ADHD yourself can make you more patient and understanding when dealing with your child’s friendship difficulties. This has the positive benefit of building a good parent-child relationship so that your child trusts you to be on his side and help him as a friendship coach. Also, having ADHD may help you better anticipate your child’s social behaviors and needs.

Image Take things one step at a time.
Some parents with ADHD struggle with providing the level of structured, organized playdate that is recommended here. Just pick one friendship-coaching tip from this article that is realistic to try with your child first, and focus on doing that one tip well. It might help to write on your calendar which friendship-coaching tip you have chosen so that you are reminded about your goal. Once you practice the tip it will get easier, and then you can work on adding another friendship coaching tip later.

Image Work together as a team.
Some parents with ADHD have difficulty networking with other parents, similar to the difficulties that their child with ADHD has in relating to the other children. You and your child might both set a goal that, during soccer practice, both of you will talk to other adults and children to each think about one potential friend to invite for a playdate. Remember to celebrate your successes as a team afterward, too.

http://www.chadd.org

Monday, February 14, 2011

Understanding Preschool Girls with AD/HD

Image

By Patricia Quinn, M.D., and Kathleen Nadeau, Ph.D.

We understand far too little about girls with AD/HD. How are they similar to boys? How do they differ? We know that a higher percentage of women than girls receive treatment, which strongly suggests that girl are being under-diagnosed. A critical question to ask is why this is the case? What prevents more girls from being identified and helped earlier in their lives? Most women with AD/HD were only able to seek help for their struggles after many years of feeling frustrated, inadequate and misunderstood. We don't want this to be the fate of girls withAD/HD growing up today. One very important issue is how AD/HD is diagnosed in children. We've come a long way in understanding AD/HD over the past 15 to 20 years, dispelling the myths that hyperactivity was the of AD/HD and that AD/HD is "outgrown." But we are still living with the myth that AD/HD is primarily a boys' disorder. We continue to diagnose children according to criteria that were developed by studying hyperactive boys. Until we develop gender-sensitive diagnostic criteria, we will continue to overlook most girls with AD/HD, only identifying those who are "just like the boys." Although there is much overlap between girls and boys with AD/HD, there are also important differences. What about the internalizing tendencies of girls? In this article, we address preschool girls with AD/HD — how we can identify them and begin to help them.

The Preschool Years

AD/HD in most cases is a congenital disorder meaning present from birth — but symptoms may not always be apparent from birth. Some girls with the hyperactive/ impulsive type of the disorder may display the more classic symptoms of increased motor activity and impulsivity: however, not all girls with AD/HD present this clear-cut picture. Some may be shy and withdrawn. Others are irritable and dysphoric, with mood swings and temper tantrums. No matter what type of AD/HD a girl demonstrates, the most important point is to recognize the condition early in order to obtain access to appropriate treatment. Early identification can prevent or greatly reduce problems with poor self-esteem, peer rejection and academic difficulties. But how do we recognize these girls as toddlers or preschoolers? To date, several subtypes of AD/HD have been identified in girls. These include the hyperactive/impulsive, the shy/withdrawn, or the dysphoric girls with temper tantrumsand mood swings.

Hyperactive Subtypes

"Tomboy Tara" is easy to spot. Like many boys her age, she is hyperactive and always on the go. She doesn't sleep through the night and gives up her naps early. She may crawl or fall out of her crib before she can walk and is always exploring or getting intothings. She frequently engages in dangerous activities involving climbing. "Chatty Cathy" is more hyper-verbal than hyperactive. She talks early and her language development is often precocious. However, she cannot stop talking and comments on everything. While this appears cute at first, it quickly becomes a problem for peers and family members, who are often overwhelmed just trying to keep up. This type of chatter is also very disjointed and frequently off the target of the conversation. While everyone else is discussing what he or she would like to order at the restaurant, Cathy is talking about why "Ronald McDonald has a red nose" or the present she wants you to buy her for her birthday!

Shy/Withdrawn Subtype

In the early 1970s, researchers at NIH studying a population of preschoolers found that some girls with AD/HD presented with behaviors that were the opposite of those expected and were actually shy and withdrawn. "Shy Samantha" is just such a preschooler. Very placid and adaptable as a baby, she does not make great demands on her world. When she becomes a toddler, she does not readily join in with the other children, but rather watches from the sidelines. She tends to have isolated play and to over-focus on one activity. She can play by herself for hours when engaged in a favorite or familiar activity. However, when presented with multiple stimuli, she seems overwhelmed and unable to focus on one thing. When given directions or tasks to perform, she tends to get distracted or "lost along the way," playing with something else that catches her eye. If sent on an errand, she may get to the destination but then "forget" what she was sent for. Too many directions at one time overwhelm her and she frequently looks like a "deer caught in the headlights."

Dysphoric/Mood Disordered Subtype

This subtype of AD/HD in girls is not as prevalent, but frequently causes the most distress for parents and teachers. "Crybaby Christine" is typical of this subtype. As an infant, she is extremely difficult. She has colic and cries a great deal, is not adaptable and sleeps in "fits" and "starts." Early feedings do not go smoothly andthis child seems insatiable and difficult to please. Her mother quickly becomes frustrated and depressed, often thinking that she is a failure as a mother. Many nights are spent walking Christine and trying to soothe her. In the toddler phase, she enters the "terrible twos" but they never seem to end. She can become very out of control and may have prolonged temper tantrums during which she falls on the floor or bangs her head. Her parents become desperate and admit that at times they wish they never had a child. Marital discord may result or contribute to the tension. Eating and toilet training issues may also be part of the picture. Christine becomes the child that you can never please. She doesn't want orange juice; she doesn't want her glass on the side of her plate; and maybe she doesn't even want that glass. She demands her favorite mug (which is in the dishwasher) and refuses to drink unless she has it. Christine is quickly becoming a tyrant with her parents dancing to her tune to keep the "peace." As one parent put it, she felt that she was being held hostage by a three-year-old. As you can see from the brief description of the subtypes above, there is far more to AD/HD in preschoolers than "hyperactivity." If you are the parent of a preschool girl and suspect that she may have AD/HD, here is a list of questions to ask yourself:

• Is your child aggressive?

• Does she have difficulty with transitions?

• Do certain textures or types of clothing bother her?

• Does she have difficulty falling asleep or staying asleep?

• Is she difficult to console, or is her reaction out of proportion to a given situation?

• Are tantrums unprovoked?

• Does she crave movement?

• Does she engage in risk-taking or dangerous behaviors?

• Is she highly impulsive?

• Does she have problems with eating or toileting?

• Is she excessively withdrawn?

• Can she follow directions?

Does the normal oppositional behavior of the "terrible twos" continue as she becomes three, four and beyond? (A more extensive questionnaire can be found at the end of the preschool chapter in Understanding Girls with AD/HD.) Many parents wonder if preschool is "too soon" to identify AD/HD, and parents are often told by schools that it cannot be diagnosed until a child is as old as 7, 8 or 9. Sadly, many parents wait, when research strongly suggests that children who are identified and helped early benefit greatly. Understanding your daughter and what her needs are can only benefit her, allowing you to make better choices for her in her preschool years. With the benefit of early identification, you can make more appropriate choices for child care and preschool settings, and can structure your household in a way that will be more appropriate for and supportive of your child's needs.

Handling the Situation

Once a preschool girl has been diagnosed with AD/HD, several positive steps can be taken to make things better at home and in school. The most important first step is seeking help. Girls with AD/HD are difficult to handle in any setting. Whether the little girl is hyperactive or shy, irritable or stubborn, parents and teachers need to become aware of how to assist her in becoming better integrated into a program and relating positively to others. Parents and teachers may also need to become more knowledgeable about the disorder, its manifestations, what works, and what doesn't work by reading many of the good books available on this subject. Clare Jones has written one of these, Sourcebook for Children with Attention Deficit Disorder: A Management Guide for Early Childhood Professionals and Parents (1994, Communications Skills Builders, San Antonio, Texas).

Parents, caretakers and teachers also need to remain positive. Remember that it is the girl's behaviors that are the problem, not the girl herself. Many girls grow up feeling that they are "bad" or "not very smart" or that there was "something wrong with them" because of all the negative comments they have heard from when they were very young. It is also important to read about AD/HD and how to parent a difficult child.

Attend parenting classes or seek the help of a therapist or family counselor to assist you in the important process of learning new behavior management strategies. They can help you better deal with your child's behaviors and help address or eliminate problem situations such as transitions. Working with an expert can also help you choose appropriate activities for your daughter/ student based on her developmental level. In working with a girl with AD/HD, it is also always important to anticipate difficult situations. Girls with AD/HD should be offered fewer choices to avoid power struggles.

When a girl with AD/HD has very "out of control" behaviors or is a danger to herself or others, the issue of holding often arises. Using this technique, the adult in charge of the situation will hold the girl tightly until she has calmed down. Girls are often able to tell you if they are "okay" and no longer need to be held. Time-out may also work if the girl is sufficiently "in control" at the time or once she has calmed down. Physical punishment or spanking is rarely appropriate under any circumstances.

For girls with a high level of hyperactivity or impulsivity or who are dangerous to themselves or others, the use of medication even at this young age may be indicated.

Aggressivity and uncontrolled temper tantrums may negatively affect family and/or peer relationships, and for these girls the use of medication can be a lifesaver. Studies have shown that medication can decrease activity levels, improve compliance and improve mother-child interactions.

Additional therapies may be necessary to address motor or language delays. The girl with AD/HD may already be experiencing learning difficulties based on her "cognitive style;" she doesn't need the additional burdens of other developmental delays. An occupational or physical therapist and/or a speech pathologist may be necessary as adjuncts to her educational program.

Proper classroom placement is also important. Girls with AD/HD do better in a structured setting, but it is always important to seek out as good a "match" as possible. Placement should take into account the individual needs of each girl. This includes such issues as activity level, organizational skills, fine and gross motor development, and the need for structure and creativity. The teacher's attitude and education regarding learning difference, the school's philosophy and individual teaching styles all need to taken into consideration. Classrooms — as well as the home — should be childproofed to protect the impulsive girl.

Preschool is not too early to begin working to understand your daughter's needs. Women whose AD/HD was not diagnosed and treated until adulthood, express a common regret: "I wish they'd understood when I was a girl." If AD/HD "runs" in your family and your preschool daughter seems to demonstrate a number of the traits identified in the list of questions above, an evaluation of your daughter by a highly experienced child psychologist, psychiatrist or developmental pediatrician may be in order so that you can begin to develop some of the AD/HD-friendly supports that can help your daughter reach her potential.

In future articles, girls in elementary, middle and high school will be discussed, and the Girls' AD/HD Self-Report Questionnaire will be presented.

This article is based on information contained in the recently published book, Understanding Girls with AD/HD, by Kathleen Nadeau, Ph.D., Ellen Littman, Ph.D., and Patricia Quinn, M.D..

Attention!® Magazine Volume 6, Number 5, Page 42


Wednesday, February 9, 2011

Ask the Expert chat with Russell Barkley, PhD, sponsored by CHADD and the National Resource Center on ADHD

Participant: In your opinion, are all five executive functions discussed in your video affected to the same degree in a person with ADHD?

Russell Barkley: No. Although all of them are affected to some extent, this can vary from person to person. That variation may have to do with how the person came to have ADHD (acquired brain damage, genetics, etc.) and with which parts of the executive system are more or less impaired in their case. It also may have to do with their pre-existing level of other abilities, such as verbal and spatial skills.

In my view, executive functioning is self-regulation. People do things to themselves in order to modify their own behavior so that they are more likely to attain a goal or change some future consequence to improve their welfare. That is self-regulation. There are at least five to six things people do to themselves:
• Self-direct their attention is one that produces self-awareness.
• A second is to visualize their past to themselves.
• A third is to talk to themselves in their mind.
• A fourth is to be able to inhibit and modify their emotional reactions to events. This can also assist with self-motivation.
• A fifth is that they are able to restrain themselves, or what one could call self-discipline. They inhibit strong urges to act.
• Finally, people are able to play with information in their mind. To take it apart, manipulate it in various ways, and recombine it to form new arrangements.

That is what they do when they are engaged in mental problem-solving. They play around with ideas until they find a good combination that seems to overcome the obstacle or problem. By adulthood, people are able to do all of these things in their mind - a sort of Swiss army knife of mind tools for self-control toward the future. Our self-control is always aimed at changing our future. That is what makes an EF executive in nature. It is self-change in order to achieve some goal.

Read more of the transcript of this exciting and informative chat with Russell Barkley about the importance of executive function in understanding and managing ADHD

Friday, February 4, 2011

Especially for Parents

http://www.chadd.org/AM/Template.cfm?Section=Especially_For_Parents

Helpful Advice for ADHD Parents

Parenting When You Have ADHD Yourself

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Raising a child with ADHD is challenging for any parent. But consistency, organization, and follow-through become much harder when you have ADHD yourself. How can you overcome this double challenge to your family?

Members OnlyArticles with a key are available to CHADD members. If you are a member, please log in. If you are not a member, join CHADD today.

Parenting a Child with ADHD - This fact sheet from CHADD's National Resource Center on ADHD is a great place to start. As a parent, you can help create home and school environments that improve your child's chances for success.

Psychosocial Treatment for Children and Adolescents with ADHD - Behavior modification is the only nonmedical treatment for AD/HD with a large scientific-evidence base.

Members OnlyEmotional Stressors of Parenting Children with ADHD - The key is to take care of yourself so that you can take care of your child with ADHD.

Members OnlyRearview Mirrors - You did then, what you knew how to do, and when you knew better, you did better.

Members OnlyLook to Their Gifts: First in a Series about Mothering Children with ADHD - How you, the parent, react to your child’s diagnosis is critical to how that child will perceive and deal with his or her condition.

Members OnlyConsider Their Future: Second in a Series about Mothering Children with ADHD - Once you see the excessive activity or impulsivity or lack of ability to pay attention or focus, you need to have your child tested. Trying to deny the existence of AD/HD doesn’t work.

Members OnlyRaising Children with ADHD When You Have ADHD Yourself: Implications, Issues, and Interventions - The first step is to be sure the parent who has symptoms of ADHD gets diagnosed and treated. You will find it much easier to become an effective parent.

Members OnlyWhen ADHD is All in the Family - Cynthia Hammer writes about her experience as an adult with ADHD and as a parent of children with ADHD.

Members OnlyFrom Definace to Compliance: What Parents Need to Know to Transform Resistance into Obedience - Imagine how much easier life would be if your child actually complied with your commands without first making you maneuver through an obstacle course of resistance and conflict.

Members Only

Suviving the Ride: Parenting Teens with ADHD - Parenting a teen with ADHD may be compared to riding a roller coaster.

Members OnlyA Study in Contrasts - Mmy experience with AD/HD is a study in contrasts. When my daughter was growing up, she struggled with oppositionality—which meant we all struggled with oppositionality.

And More

Especially For Parents is CHADD's website area full of parenting information on every aspect of ADHD.

Members OnlyParent to Parent is a CHADD-sponsored seven-week class designed to give parents all the tools and skills they need to successfully manage ADHD within the family.