Attention Deficit Hyperactivity Disorder ADHD

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					Attention Deficit Hyperactivity
      Disorder (ADHD)

     Tips for Understanding and
    Managing ADHD in the Home
     Presented by: Brett L. Patterson, M.A.
   Goals for This Presentation
• Provide a basic understanding of what
  ADHD is, and what it is not.
• Attempt to answer any questions and dispel
  any myths that many people have
  regarding ADHD.
• Introduce some guiding principles for
  dealing with ADHD behaviors.
              ADHD Exposed
• ADHD is identifiable via behavioral, not physical
  characteristics, making it more likely to be
  misunderstood.
• Misperceptions:
   – Behaviors that directly result from ADHD are not
     primarily attributable to poor parenting, lack of
     discipline, low motivation, or intentional “trouble
     making.”
   – Not everything that fidgets and/or behaves defiantly is
     ADHD.
           What Is ADHD?
• Neurobehavioral disorder marked by:
  – Inattention
  – Difficulties controlling impulses
  – Excessive motor activity (hyperactivity)
• Be aware…the mere presence of these
  behaviors does not mean the child has
  ADHD.
   Indicators of ADHD as a Developmental
           Disorder (Barkley, 1995)
• Seen in early child           • Child not able to perform
  development                     at age-appropriate levels
• Behaviors clearly             • Not accounted for by
  distinguish child from          environment of social
  non-ADHD children               causes
• Occurs across several         • Related to brain function
  situations (though not        • Associated with other
  necessarily in all of them)     biological factors that can
• Behaviors persistent over       affect brain function (i.e.
  time                            head injuries, genetics)
      Things We Can See (aka,
       Common Complaints)
• Difficulties sustaining attention
  –   Daydreaming
  –   Child doesn’t listen
  –   Always losing things
  –   Forgetful
  –   Easily distracted
  –   Needs constant supervision
  –   Child doesn’t finish anything he/she starts
  Common Complaints (cont’d)
• Problems with impulse control
  –   Impatient/Difficulties waiting for things
  –   Always interrupting others
  –   Blurts out answers
  –   Doesn’t take turns
  –   Tries to take shortcuts on many tasks
      (including chores, homework, etc.)
  Common Complaints (cont’d)
• Hyperactivity
  –   Always on the go
  –   Squirmy…can’t sit still
  –   Talks too much
  –   Frequently hums or makes odd noises
  –   Unable to “put the brakes on” motor activity
  –   Child has two speeds; asleep and awake
What Do These Behaviors Have
        in Common?
• Problem isn’t as much sustaining attention
  as it is sustaining inhibition…this is the
  hallmark of ADHD
• Inhibition: a mental process that restrains
  an action (behavior) or emotion
• Problems of inhibition are not a matter of
  choice, but are instead a result of what is
  (or is not) going on in the child’s brain
  ADHD and the Human Brain
• Portions of brain’s frontal lobe are
  responsible for “Executive” functions:
  – Consolidating information from other areas of
    the brain
  – “Considers” potential consequences and
    implications of behaviors
  – Puts “brakes” on (inhibits) impulsive reactions
  – Initiates appropriate response to environment
  ADHD and the Brain (cont’d)
• Research suggests that in in children with
  ADHD, these “executive” areas of the
  brain are under-active
• Increasing the activity level in these areas
  of the ADHD brain have been shown to
  decrease behavioral symptoms. This is the
  logic behind using Stimulant medications
  as a first line treatment for the disorder.
    Common Stimulant
      Medications
• Methylphenidate (Ritalin)
• Dextroamphetamine
  (Dexedrine)
• Amphetamine/
  Dextroamphetamine (Adderall)
• Pemoline (Cylert)
    Things That Look Like ADHD
• Depression             • Learning disabilities
• Anxiety                • Parenting problems
• Hearing problems       • Substance use
• Visual problems        • Medication side-
• Seizure disorder         effects
• Oppositional defiant   • Lead poisoning
  disorder
• Autism
  Ten Guiding Principles for Raising a
   Child with ADHD (Barkley, 1995)
1. Give your child more immediate
   feedback and consequences
2. Give more frequent feedback
3. Use larger and more powerful
   consequences
4. Use incentives before punishment
5. Strive for consistency
     Ten Guiding Principles for Raising a
         Child with ADHD (cont’d)
6.  Act, don’t yak!
7.  Plan ahead for problem situations
8.  Keep a disability perspective
9.  Don’t personalize your child’s problems
    or the disorder
10. Practice forgiveness
 In Using These Principles, It Is
   Important That the Parent:
• Pause before reacting to the child
• Use the ensuing delay to remember all
  10 guiding principles (post them
  around the house if necessary)
• Choose a response that is consistent
  with the principles
  Additional Tips for Managing
        ADHD Behaviors
• Pay positive attention to your child…catch
  them being good
• Give effective commands
  – Short, sweet, and straightforward
  – Limit the number of tasks to 1-2 per command
• Maintain clear and consistent expectations
• Communicate realistic consequences for
  inability to meet expectations
    Tips for Managing ADHD
             (Cont’d)
• Manage the child’s environment
  – Limit distracting influences during times when
    child is asked to be on task (i.e. homework)
• Maintain a regular and predictable daily
  schedule
• When eliciting child’s input, limit (but
  don’t eliminate) the number of choices
  available to him/her to 2-3 options
      Tips for Managing ADHD
               (Cont’d)
•   Be patient
•   Be persistent
•   Be understanding
•   *Most importantly, remember to
    differentiate the behaviors from the child
    – Bad behaviors are not synonymous with a bad
      child
 Resources Available to Parents
• Children and Adults with ADD (CHADD): a
  family support organization that provides a
  variety of services. (www.chadd.org or the
  Central OK chapter phone number is 405-722-
  1233
• There is a plethora of readings available to those
  interested in obtaining more information on
  ADHD. One that I have found particularly useful
  in working with parents is Taking Charge of
  ADHD: The Complete Authoritative Guide for
  Parents, by Russell A. Barkley, Ph.D. (1995)