Picture Maria, in the Sound of Music, who despite her best intentions and desire,  could not be confined within the walls of the Abbey or by the discipline needed in the religious lifestyle.  She opens the movie twirling in the wind in the freedom of a large alpine meadow only to return and be promptly  reprimanded by the authorities.  She explains  that she really had 'no choice' but to listen to the voices of nature calling her spirit.  She later excels in the loving of several motherless children as she expands their world and teaches them how to play, all the while, driving the father, a very orderly naval Captain, a bit nuts.  Although we may or may not characterize this figure as Attention Deficit Disorder, she does exhibit some wonderful characteristics of the ADD individual.  We do not mean to judge the true person on whom the play was based, but only look at the fictional and familiar character for what she might teach us. Maria  is independent, outspoken,  impulsive and based upon the above quote likely highly distractible.  She frequently challenges the status quo by words and action.  She is often in some sort of trouble as a result of those actions.  As much as those around her love her, she tries their patience in a myriad of ways.  How many of us struggle with loved ones in this same way?  The child who can't sit still. The spouse who can't stay focused? The friend who seems good natured but cannot show up on time?

The characteristics of the individual with ADD are impulsivity, distractibility, disorganization and often hyperactivity.   Individuals with Attention Deficit Disorder are also likely to be free spirited, easily bored, highly playful, intuitive and creative.  They often appear childlike in the spontaneity of their thinking and the fleetingness of thought.  They do, however, usually possess an uncanny ability to hyper focus and put out a remarkable effort and body of work.  Many historical figures including Einstein, Michelangelo, da Vinci and Edison are cited as likely ADD candidates.  They often share a propensity for managing many different projects simultaneously with follow through being unpredictable and non linear.  They also share a certain amount of isolation and  worry in their historical biographies.  Thus, although there may be creative genius in those diagnosed with Attention Deficit Disorder,  there is usually a considerable burden that is often carried.  The world may appreciate some of the efforts resulting from this work, but the world does not often operate on the same principles as the mind of the gifted individual with ADD.  It is most common for these children and adults to feel as if they have been born on the wrong planet or at the wrong time.  There is often a profound sense ofloneliness or awareness that they are not living up to the expectations of others. Depending upon how the ADD has been viewed in their life by significant others,  they may have significant self esteem problems and depression,  due to their difference.  They are often referred to as lazy, spacey, uncaring or even stupid or crazy.  It is not unusual for the individual with ADD to also have additional learning problems.  It is the purpose of this course to focus more directly on diagnosis and treatment with the history and biology of ADD/ADHD being more thoroughly explored through excellent resources and links.  The numbers of children and adults being diagnosed with this disorder has skyrocketed in the last two decades.

ADHD must rank as one of the top five clinical concerns at schools. How do we take kids natural enthusiasm and engagement with life and channel it into desks and standardized tests?  Personally, I strongly refrain from giving this diagnosis to a child any younger than 10.  In my own personal experience, I have a difficult time labeling overactive young children with a disorder. Before reaching this diagnosis, I want to see evidence that the child has enough time out of doors and in physical activity, that there is a limit on the amount of time spent watching TV or playing video games and that the nutritional  and sleep needs are being met.  I know this is not a popular approach and that many parents and educators are seriously overworked and overstressed and just "want the children to behave", but I ultimately do not see the medication of our children as the answer to our societal challenges. I see a need for a major reevaluation of what we consider success and appropriate behavior and learning.  This being said, I recognize and recommend both traditional and alternative treatment for the real clinical issues associated with ADD/ADHD in children and adults.

History of ADD/ADHD

Historically,  ADD has been given names such as Minimal Brain Dysfunction and Hyperactivity.  These have carried significant stigma for those so diagnosed.  It is difficult to say when ADD  was identified as a disorder.   It is likely there have always been children who were highly distractible and quick moving, as well as adults, who had difficulty focusing and carrying tasks to completion without being distracted. 

Today's Estimates

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.  Although some symptoms subside as the child matures into late adolescence, i.e. hyperactivity, this is not a syndrome that people "grow out of and there is an increasing incidence of adults being diagnosed with ADD.
  

Biology of ADD/ADHD

The biological perspective in lay terms is as follows: ADD is a neurobiological disorder. The most recent research shows that the 
symptoms of ADD are caused by a chemical imbalance in the brain. To understand how this disorder interferes with one's ability to focus, sustain attention, and with memory formation and retrieval, it is important to understand how the brain communicates information. Each brain cell has one axon, the part of the cell that sends messages to other cells; and many dendrites, the part that receives messages from other cells. There is a space between the axon and the next brain cell (they do not connect or touch). This space is called a neural gap.

Since these nerve endings don't actually touch, special chemicals called neurotransmitters carry (transmit) the message from the end of the axon to the dendrites that will receive it. With ADD there is a flaw in the way the brain manages the neurotransmitter production, storage or flow, causing imbalances. There is either not enough of them, or the levels are not regulated, swinging wildly  from high to low. 
Basic Information About Attention Deficit Disorders by 
Rebecca Chapman Booth Please read Basic Information About Attention Deficit Disorders.

(Please note that certain links may require you entering the home page initially then searching  ADD or by  title .  This is just a function of how some links are set up. )

More specifically,  it is acknowledged that we do not fully understand the neurobiology involved in ADD.   Research includes studies that have shown a deficit in glucose metabolism by Alan Zametkin, et al at the National Institute of Mental Health.  There has also been research into depressed frontal lobe activity and deficiencies of the neurotransmitters dopamine  and  norepinephrine.  Although  these studies are promising, it is repeatedly mentioned throughout the literature that we are only at the beginning the medical understanding of this complex disease.  What is agreed upon is that there are fundamental differences in the functioning of the brain of an individual with ADD/ADHD.   For a more in depth discussion of the neurobiology of this disorder and a history of the research Chapter Nine:  A Local Habitation and a Name; The Biology of ADD of Driven to Distraction is  an excellent resource.

 

What Causes ADHD? from NIMH.gov

One of the first questions a parent will have is “Why? What went wrong?” “Did I do something to cause this?” There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most substantiated causes appear to fall in the realm of neurobiology and genetics. This is not to say that environmental factors may not influence the severity of the disorder, and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to give rise to the condition by themselves.

The parents’ focus should be on looking forward and finding the best possible way to help their child. Scientists are studying causes in an effort to identify better ways to treat, and perhaps someday, to prevent ADHD. They are finding more and more evidence that ADHD does not stem from the home environment, but from biological causes. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child’s behavior.

Over the last few decades, scientists have come up with possible theories about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.

Environmental Agents

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Brain Injury

One early theory was that attention disorders were caused by brain injury. Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with ADHD have been found to have suffered a traumatic brain injury.

Food Additives and Sugar

It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.3A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.4

In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.5

Genetics

Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close

 relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population.6 Many studies of twins now show that a strong genetic influence exists in the disorder.7

Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.8

 

Attention Deficit Hyperactivity Disorder from the NIMH.gov

Symptoms

The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child’s life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.

Symptoms of ADHD will appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Different symptoms may appear in different settings, depending on the demands the situation may pose for the child’s self-control. A child who “can’t sit still” or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a “discipline problem,” while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD. All children are sometimes restless, sometimes act without thinking, sometimes daydream the time away. When the child’s hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. But because the symptoms vary so much across settings, ADHD is not easy to diagnose. This is especially true when inattentiveness is the primary symptom.

According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders2 (DSM-IV-TR), there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. Or they may show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms).

Hyperactivity-Impulsivity

Hyperactive children always seem to be “on the go” or constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. Or they may wiggle their feet, touch everything, or noisily tap their pencil. Hyperactive teenagers or adults may feel internally restless. They often report needing to stay busy and may try to do several things at once.

Impulsive children seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they’re upset. Even as teenagers or adults, they may impulsively choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.

Some signs of hyperactivity-impulsivity are:

• Feeling restless, often fidgeting with hands or feet, or squirming while seated

• Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected

• Blurting out answers before hearing the whole question

• Having difficulty waiting in line or taking turns.

Inattention

Children who are inattentive have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.

Homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school. They will forget to bring a book home, or bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is often accompanied by frustration for both parent and child.

The DSM-IV-TR gives these signs of inattention:

• Often becoming easily distracted by irrelevant sights and sounds

• Often failing to pay attention to details and making careless mistakes

• Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task

• Often skipping from one uncompleted activity to another.

Children diagnosed with the Predominantly Inattentive Type of ADHD are seldom impulsive or hyperactive, yet they have significant problems paying attention. They appear to be daydreaming, “spacey,” easily confused, slow moving, and lethargic. They may have difficulty processing information as quickly and accurately as other children. When the teacher gives oral or even written instructions, this child has a hard time understanding what he or she is supposed to do and makes frequent mistakes. Yet the child may sit quietly, unobtrusively, and even appear to be working but not fully attending to or understanding the task and the instructions.

These children don’t show significant problems with impulsivity and overactivity in the classroom, on the school ground, or at home. They may get along better with other children than the more impulsive and hyperactive types of ADHD, and they may not have the same sorts of social problems so common with the combined type of ADHD. So often their problems with inattention are overlooked. But they need help just as much as children with other types of ADHD, who cause more obvious problems in the classroom.

Is It Really ADHD?

Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Since most people sometimes blurt out things they didn’t mean to say, or jump from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD?

Because everyone shows some of these behaviors at times, the diagnosis requires that such behavior be demonstrated to a degree that is inappropriate for the person’s age. The diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. Above all, the behaviors must create a real handicap in at least two areas of a person’s life such as in the schoolroom, on the playground, at home, in the community, or in social settings. So someone who shows some symptoms but whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere receive an ADHD diagnosis.

To assess whether a child has ADHD, specialists consider several critical questions:

• Are these behaviors excessive, long-term, and pervasive?

• That is, do they occur more often than in other children the same age?

• Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or in the schoolroom?

The person’s pattern of behavior is compared against a set of criteria and characteristics of the disorder as listed in the DSM-IV-TR.

One of the things that threw me off course early in my psychotherapeutic training, regarding this diagnosis was that many of the children I would see with this diagnosis came from alcoholic and or abusive homes.  These  hypervigilant, hyperfocused and hyperactive behaviors often result from living in these wildly unpredictable and unsafe surroundings.  On the other hand ,it is often noted that untreated ADD can mask a tendency to drug/alcohol abuse and other high risk impulsive behaviors.  It may have been that some of the parents were self medicating.  Abuse and alcoholism would take precedent in treatment.  Connecting the involved individual up with resources and support for recovery would give you  and  them the ability to see through the addiction to know if there was a diagnosis  in need of medication underneath. 

Attention Deficit Hyperactivity Disorder in Adults

Attention deficit hyperactivity disorder is a highly publicized childhood disorder that affects approximately 3 percent to 5 percent of all children. What is much less well known is the probability that, of children who have ADHD, many will still have it as adults. Several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.16

The first studies on adults who were never diagnosed as children as having ADHD, but showed symptoms as adults, were done in the late 1970s by Drs. Paul Wender, Frederick Reimherr, and David Wood. These symptomatic adults were retrospectively diagnosed with ADHD after the researchers’ interviews with their parents. The researchers developed clinical criteria for the diagnosis of adult ADHD (the Utah Criteria), which combined past history of ADHD with current evidence of ADHD behaviors.17 Other diagnostic assessments are now available; among them are the widely used Conners Rating Scale and the Brown Attention Deficit Disorder Scale.

Typically, adults with ADHD are unaware that they have this disorder—they often just feel that it’s impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day’s work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult

Women and Girls with ADD

Women and girls make up under twenty percent of all ADD diagnoses.  This is fact could be due to a lack of recognition of the differing symptoms.  It is generally agreed that the hyperactivity is often less in the female population.  High risk taking behavior can take other forms especially in terms of relationship.  Women with ADD may be attracted to high risk romance that involves al  a lot of drama and sometimes violence.  They often complain of being bored with the status quo relationship.  Another aspect is that women often have several relationships not staying with one for any length of time.  Additionally, it is often mentioned that they go through periods of promiscuity sampling many relationships.  Many of the traditional characteristics are still present distractibility, impulsivity and inattentiveness they have often been attributed to other characteristics of the female psyche.  Aside from substance abuse tendencies one thing I have noted in several ADD women is a tendency to overspend.  Curiously, a desired object goes from a clear desire to a must have necessity in a matter of minutes or days.  This often requires them juggling bills and such to fit it in.  There is often a let down after the purchase only to be followed by another must have situation in a short period of time.

The disorganization aspect of ADD can be particularly tough on women when they enter a family situation.  They often share society's mindset that the woman can keep the home together. They can often keep other multi tasks together but their houses are usually chaotic from start to finish.  This can add some doubt as to their self worth.  Actually they will usually admit that they find house work very boring and low on the list of priorities.  They often don't even 'see' the mess.

"Sometimes I walk around my house when a guest is due to arrive and look at it through the eyes of my mother.  I am truly shocked to see how many things are laying about.  I quickly get to the business of picking up and putting away.  A day or two later I have no idea where I put them!" (32 yr. old female with ADD)

It is important to reiterate that these characteristics exist along a continuum.  It is only when they interfere with the individual's functioning that they would require treatment.  Girls with ADD are looked at as everything from day dreamers to, chatterboxes to tomboys.  Again this is only a problem when it interferes with their success at life.  It is thought that the girls with difficulties may be overlooked because they do not get in as much trouble but instead 'fade away'.   We do not want to eliminate individuality in our treatment of people.  We want to build upon the strengths that symptom endows.     Please visit  http://addvance.com/help/women/index.html

Diagnosing ADHD in an Adult from NIMH

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in frequent automobile accidents. 

To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms.18 The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient’s childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for ADHD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.

The Family and the ADHD Child

Medication can help the ADHD child in everyday life. He or she may be better able to control some of the behavior problems that have led to trouble with parents and siblings. But it takes time to undo the frustration, blame, and anger that may have gone on for so long. Both parents and children may need special help to develop techniques for managing the patterns of behavior. In such cases, mental health professionals can counsel the child and the family, helping them to develop new skills, attitudes, and ways of relating to each other. In individual counseling, the therapist helps children with ADHD learn to feel better about themselves. The therapist can also help them to identify and build on their strengths, cope with daily problems, and control their attention and aggression. Sometimes only the child with ADHD needs counseling support. But in many cases, because the problem affects the family as a whole, the entire family may need help. The therapist assists the family in finding better ways to handle the disruptive behaviors and promote change. If the child is young, most of the therapist’s work is with the parents, teaching them techniques for coping with and improving their child’s behavior.

Several intervention approaches are available. Knowing something about the various types of interventions makes it easier for families to choose a therapist that is right for their needs.

Psychological testing is important to distinguish ADD from other more serious personality disorders such as the Antisocial Personality, Narcissism and Borderline Personality Disorder.  We would not want to mistakenly treat someone in the wrong manner due to the common occurrence of certain symptoms. The severity and social inappropriateness of symptoms are usually good indicators of the level of disturbance present .

Educational testing is also helpful to determine whether there are additional learning disabilities present.  Individuals with ADD also exhibit auditory processing difficulties.  Again working with the medical community is necessary and helpful to best serve these clients.  An Individualized Educational Plan (IEP) can be requested by the parents to best serve their child's needs in school.  Often when the learning disabilities are addressed much of the disruptive behavior disappears.

Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. It does not address the symptoms or underlying causes of the disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change or better cope with their disorder.

Behavioral therapy (BT) helps people develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behavior. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally charged events. Or the support might be in self-monitoring one’s own behavior and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting.

Social skills training can also help children learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors important in developing and maintaining social relationships, like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to “read” other people’s facial expression and tone of voice in order to respond appropriately. Social skills training helps the child to develop better ways to play and work with other children.

Support groups help parents connect with other people who have similar problems and concerns with their ADHD children. Members of support groups often meet on a regular basis (such as monthly) to hear lectures from experts on ADHD, share frustrations and successes, and obtain referrals to qualified specialists and information about what works. There is strength in numbers, and sharing experiences with others who have similar problems helps people know that they aren’t alone. National organizations are listed at the end of this document.

Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child’s behavior. One such technique is the use of token or point systems for immediately rewarding good behavior or work. Another is the use of “time-out” or isolation to a chair or bedroom when the child becomes too unruly or out of control. During time-outs, the child is removed from the agitating situation and sits alone quietly for a short time to calm down. Parents may also be taught to give the child “quality time” each day, in which they share a pleasurable or relaxing activity. During this time together, the parent looks for opportunities to notice and point out what the child does well, and praise his or her strengths and abilities.

This system of rewards and penalties can be an effective way to modify a child’s behavior. The parents (or teacher) identify a few desirable behaviors that they want to encourage in the child—such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn’t. A reward can be small, perhaps a token that can be exchanged for special privileges, but it should be something the child wants and is eager to earn. The penalty might be removal of a token or a brief time-out. Make an effort to find your child being good. The goal, over time, is to help children learn to control their own behavior and to choose the more desired behavior. The technique works well with all children, although children with ADHD may need more frequent rewards.

In addition, parents may learn to structure situations in ways that will allow their child to succeed. This may include allowing only one or two playmates at a time, so that their child doesn’t get overstimulated. Or if their child has trouble completing tasks, they may learn to help the child divide a large task into small steps, then praise the child as each step is completed. Regardless of the specific technique parents may use to modify their child’s behavior, some general principles appear to be useful for most children with ADHD. These include providing more frequent and immediate feedback (including rewards and punishment), setting up more structure in advance of potential problem situations, and providing greater supervision and encouragement to children with ADHD in relatively unrewarding or tedious situations.

Parents may also learn to use stress management methods, such as meditation, relaxation techniques, and exercise, to increase their own tolerance for frustration so that they can respond more calmly to their child’s behavior.

Some Simple Behavioral Interventions

Children with ADHD may need help in organizing. Therefore:

• Schedule. Have the same routine every day, from wake-up time to bedtime. The schedule should include homework time and playtime (including outdoor recreation and indoor activities such as computer games). Have the schedule on the refrigerator or a bulletin board in the kitchen. If a schedule change must be made, make it as far in advance as possible.

• Organize needed everyday items. Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies.

• Use homework and notebook organizers. Stress the importance of writing down assignments and bringing home needed books.

• Children with ADHD need consistent rules that they can understand and follow. If rules are followed, give small rewards. Children with ADHD often receive, and expect, criticism.

• Look for good behavior and praise it.

Your ADHD Child and School

You are your child’s best advocate. To be a good advocate for your child, learn as much as you can about ADHD and how it affects your child at home, in school, and in social situations.

If your child has shown symptoms of ADHD from an early age and has been evaluated, diagnosed, and treated with either behavior modification or medication or a combination of both, when your child enters the school system, let his or her teachers know. They will be better prepared to help the child come into this new world away from home.

If your child enters school and experiences difficulties that lead you to suspect that he or she has ADHD, you can either seek the services of an outside professional or you can ask the local school district to conduct an evaluation. Some parents prefer to go to a professional of their own choice. But it is the school’s obligation to evaluate children that they suspect have ADHD or some other disability that is affecting not only their academic work but their interactions with classmates and teachers.

If you feel that your child has ADHD and isn’t learning in school as he or she should, you should find out just who in the school system you should contact. Your child’s teacher should be able to help you with this information. Then you can request—in writing—that the school system evaluate your child. The letter should include the date, your and your child’s names, and the reason for requesting an evaluation. Keep a copy of the letter in your own files.

Until the last few years, many school systems were reluctant to evaluate a child with ADHD. But recent laws have made clear the school’s obligation to the child suspected of having ADHD that is affecting adversely his or her performance in school. If the school persists in refusing to evaluate your child, you can either get a private evaluation or enlist some help in negotiating with the school. Help is often as close as a local parent group. Each state has a Parent Training and Information (PTI) center as well as a Protection and Advocacy (P&A) agency. (For information on the law and on the PTI and P&A, see the section on support groups and organizations at the end of this document.)

Once your child has been diagnosed with ADHD and qualifies for special education services, the school, working with you, must assess the child’s strengths and weaknesses and design an Individualized Educational Program (IEP). You should be able periodically to review and approve your child’s IEP. Each school year brings a new teacher and new schoolwork, a transition that can be quite difficult for the child with ADHD. Your child needs lots of support and encouragement at this time. Never forget the cardinal rule—you are your child’s best advocate.

CONCLUSION

Although, I recognize under the current pressures, costs and mandates of our educational system  that this idea is impossible, I have often thought every student should have an IEP where the teachers and adjunctive staff take time to consider the needs of the child and the ability of the school, family and adjunctive professionals to meet the needs.  While parents are most definitely your child best advocate, you are also the individual or parents who will have to do most of the work.  Children and adults with ADD/ADHD need structure and consistency throughout their lives, as well as, the recognition that time to be active ,creative and playful is essential.  It is in the family environment where we spend the most time.  In this environment the tools for coping with ADD/ADHD must be consistent.  It is not the teacher or therapist , who can insure the follow through with given tools and assignments.  This has to come through the home from you.   You may want to take the time to design your own IEP with your child(ren). Focus simply on the goals in areas of interests, friends, academic involvement and community involvement. Make it a flexible structure that can be modified when things change. Make it fun and interesting and something that enhances a the sense of self esteem and self appreciation.  Include things that require self discipline and follow through such as chores and grades alongside things that are fun and stimulating like exploring new subjects or favorite subjects more deeply.

Understand your child, their gifts and challenges. Take the time to decide what you feel is in the best interest of your child. Not all parents want to medicate their kids.  Not all parents think academic success is essential to happiness in life. Take time to notice, if you are living a life that is filled with the qualities of happiness you desire.  Make certain that you take time to see the child in front of you.  Many families I have seen over the years just needed time to see that their kids were very different than themselves.  While the parents might be slow and easy and enjoy watching television or using the computer the kids might be happier running and jumping and playing at a park.  Conversely, the parents might be physically active and outdoors- loving individuals and they have a child who prefers books, inside time , art and reading. There needs to be a personal assessment of who you believe your child to be and who they really are.  Take the time to notice what activities make them the happiest.  What do they gravitate towards when given options.  Do they like to draw, paint, sing, dance?  Do they like to spend time alone reading?  Or do they prefer to be around people? Do they prefer to run and jump and hang upside down on the monkey bars?  

• Drop any judgments of who they should be

• or what girls should be like

• or what boys should be like

• or what it takes to be successful in this world. 

The world is full of opportunities for all kinds of people.  History is filled with examples of people who were not considered to be particularly talented going on to accomplish many things.  If you teach your kids to respect the rights and space of others and, if you practice this in relation to your children, friends, neighbors and family members, your children will learn to cope and navigate their way through the world.  Take the time to know your child.  They do  not fit into your schedule, your needs or your desires.  They are here as an individual who needs to be considered independently and taught how to negotiate and cooperate within a family and the world at large.

DOWN TIME   

If you are always feeling too busy, overscheduled, too tired for a quiet moment without activities or television, it will impact the quality of your life and relationships.  People kids and adults alike need down time.  Moments without extra input where our minds, bodies and souls can relax.  Conversation and interaction are the places where social skills are built.  If you have a child or partner who cannot sit down and focus increasing activities is not going to help.  If you cannot sit down at the end of a day and check in over a cup of tea or a drink of sparkling water, it will impact the ability of your family to come together.  In our family my husband and I alternate time when we are in the living room, just available to talk.  With our older kids this may turn into watching a show and discussing the characters and their motivation or it may be just listening to whatever they want to share.  Recently, we had a guest visit with her 13 year old daughter.  The mother had said to me, on more than one occasion, that she wished her daughter would open up and talk to her more.  Through a series of events this daughter was present when I met an old friend from high school and her new partner.  The talk turned to our meeting in junior high and our very wild drug experimenting years through high school.  I am a firm believer that it is ok for kids at certain ages to hear more from the trials and tribulations of adults without a lecture or agenda.  We have all done things that wee fun at the time and regretted later, but we don not regret all things that were fun.  Over time we hopefully gain perspective and are able to share our lessons with a certain wisdom.  My visiting friend was worried that her daughter would not be interacting enough during the visit,  I assured her that however she wanted to spend her time was ok with us.  We have lived with two teens and their friends for many years now and have worked with this age group for many more.  What I have learned is that some of their deepest learning comes through being around and listening.  This is what happened with her daughter . As we played Scrabble, she contentedly IM ed and looked up words for us online.  Interestingly, enough when Mom and daughter returned home, the conversations between them began and their was a processing of the young girls friendships, hopes, dreams and fears.  Try not to push your kids into things, rather open the door and give them the ability to peek through.   Thank you for joining us on www.Innerlandscape-art.com    Please feel free to email us your suggestions and comments regarding this article and whether you found it helpful at info@innerlandscape-art.com  If you are looking for continuing education courses for professionals in psychology, social work, nursing, marriage and family counseling, substance abuse and related fields, please visit www.innerlandscape.com.