Step by Step Help for Children with ADHD

A Self-Help Manual for Parents

David Daley, Cathy Laver-Bradbury, Anne Weeks, E Sonuga-Barke, Margaret Thompson

• Publisher: Jessica Kingsley Publishers
• Year: 2011
• ISBN:
  9780857002358
• Topic: Psicologia
• Subtopic: Disturbo da deficit di attenzione (ADD-ADHD)

Raising a child with ADHD can be distressing and exhausting for the whole family. But given the appropriate knowledge, and the right tools, parents can intervene to manage their child's behaviour, leading to improved relationships at home and, it is hoped, a more successful time at school.

This simple, flexible six-step programme is full of tried-and-tested ideas for parents and professionals supporting families of young children with ADHD. By practicing the techniques and strategies, parents will gain confidence in their parenting and, over time, will improve the child's management of the condition. The programme includes games that will help improve the child's attention, exercises to develop patience and tips for supporting the child in successful self-organization. There are also plenty of useful ideas for developing communication between parents and schools.

Based on research and extensive clinical experience, Step by Step Help for Children with ADHD will help families to adapt their parenting to the child, improving relationships and behaviours in the home and at play group.

Part 1

What is ADHD and What
Can We Do About It?

Chapter 1

Introduction

What is Childhood ADHD?

All children experience characteristic levels of activity. Some children are very inactive and some are hyperactive. Most doctors and scientists think about activity levels as being on a sliding scale with very inactive people at one end of the scale and very active (hyperactive) people at the other end.

If a child’s hyperactivity is causing him difficulty his parents might ask for a professional to meet with them. The child might be in trouble in playgroup or school for not concentrating or sitting down when instructed to, and running around all over the place during quiet activities. The child’s parents may also be finding his behaviour very difficult to manage at home.

Note: Although boys and girls can both have ADHD it is more common in boys. For convenience in this guide we refer to the child with ADHD as he – but you need to be aware that the child with ADHD might be a girl. ADHD in girls is often only noticed when they are older, as girls tend to be inattentive rather than overactive.

When an expert in the treatment of hyperactive children, such as a nurse, health visitor or doctor, sees your child he or she may ask very specific questions about his behaviour at playgroup or school and at home, and may also observe him in the clinic setting. He or she may decide your child’s symptoms of inattention and over-activity are severe enough for it to be possible that your child has a developmental disorder. That is to say, his symptoms are really a problem for him and he is finding life difficult. The rest of the family might also be finding life with their child difficult, and treatment of some kind might be suggested. The doctor or nurse might call your child’s condition ‘hyperactivity’ or Attention Deficit Hyperactive Disorder (ADHD). ADHD is a syndrome characterised by a collection of symptoms which include hyperactivity, poor attention and impulsivity.

ADHD is not a new disorder. It has been recognized for many years. Recent research has shown, though, how important it is to identify serious ADHD early in life. Early intervention helps children, and helps their families to adapt their parenting approach to the particular characteristics in their child. It is important to start treatment as early as possible to prevent the child’s behaviour becoming fixed, which might cause greater problems in the future. Some children who show signs of early ADHD can learn to manage their symptoms with the help of parents and their playgroup or school. It is possible that the symptoms may then stop being a problem for them.

We know that if as parents we can adapt our parenting to our particular child, and help our child to learn to control his behaviour, relationships at home will improve and will be more fun for both parent and child. The child should also do better at school.

We have developed a programme of treatment that is based on what we know about children with ADHD and their families.

The Six-Step Parenting Programme

Children with ADHD need to be parented in a different way from children who are not so active. If you can try these ideas out and practice them you will find that you and your child will get along better.

We will explain to you why children have the kinds of problems associated with ADHD and why different ways of handling the child will work. We have developed a simple treatment programme that you can work through yourself. You can work through the ideas at whatever pace you want. When we use it in clinics with families, they work through it a week at a time, but some families progress more quickly, and others take more time. What is important is to realize that it will not produce instant changes but will over time give you more confidence and provide you with ideas which work for children with ADHD. Practise, more practise, and consistency will produce real detectable changes in your child’s behaviour and attitude.

The Six-Step Parenting Programme, originally created by the New Forest Parenting Group, has been the subject of a number of research studies and has been used clinically for a number of years with a diverse range of parents. Whilst many ethnic groups have found some of the advice to be beneficial, in some cultures particular strategies may be difficult to administer. For example, some parents may find using eye contact for positive interactions difficult as their cultural beliefs may mean that a child making eye contact with an adult is not permitted. If you come across a strategy that you find difficult, rather than not use it, try to find a way to adapt it to meet the aim of the six steps within your cultural or personal beliefs. For example, instead of eye contact, touch could be used to signify that the child should listen, and then praise could be given. This would reinforce that the child needs to listen carefully and receive positive feedback, which in turn enables him to listen more and increases his self-esteem. As you will see in Step 1 this is the aim of eye contact in this strategy.

The programme is organized into six steps. We suggest that you work through the material over the next few weeks, reading and concentrating on one step at a time. Try out the ideas we have suggested in that step for managing your own child’s ADHD symptoms. When you are comfortable with the ideas and confident they are working in practice, move onto the next step. As you move on, keep practising the previous steps, if necessary going back to the elements that are not working so well for you and your child.

At each step, the programme will give you something new to work on and suggest you practice it as much as you can. We will also suggest games to play with your child that will help him improve his attention. Most of these games involve using a traditional pack of cards, which is cheap to buy and easy to carry around. We will give you ideas to help your child learn to wait for longer and not be so impatient. We will make practical suggestions that will help your child learn to organize himself better.

The most important aspect of the programme is when we explain to you why a child with ADHD behaves the way he does, so that you can understand that your child’s behaviour is the way it is because he has underlying problems, not because he is naughty.

He might, for example, have problems listening, paying attention or waiting his turn.

There will be, of course, times when your child like any other might just be being naughty, so we have to help you learn to identify when that might be the case so you can deal with that too. The fundamental point though is that children who have ADHD have real problems that underlie much of their behaviour and are not, in the main, deliberately being naughty.

We will help you observe your child so that you can work out why he has his own particular problems. This will enable you to tailor the strategies and ideas we present to your own child’s behaviour. We hope this means that your child’s behaviour improves and, which is very important, that you and your child will get along better. These changes will not take place overnight. It takes time to adapt established behaviours, both for you and your child. Be patient and keep practicing the ideas we give you. Talk to all the other adults who look after your child and try to include them in your plans for change.

Understanding ADHD: What are the symptoms of ADHD?

ADHD is one of the most researched disorders of childhood. The main features of ADHD are:

• a short attention span
• impulsivity (which means that children cannot stop themselves from doing things)
• overactive behaviour.

Parents often find these symptoms very difficult to deal with, and can become very frustrated with their young child. As there is often a family history of ADHD, one or other parent might have symptoms or characteristics of the syndrome too, which can add to the relationship difficulties.

Children with ADHD can have other symptoms as well as the three main elements listed above. Your child may have some or all of them. It might be useful to put a tick against the symptoms or signs of ADHD which your child has, so you can remind yourself that these are part of his ADHD and not just naughty behaviour.

Some children with ADHD may also have poor coordination in gross motor skills (for example running and playing games) and /or fine motor skills (such as writing or using cutlery). Your child with ADHD may also show the following signs of the disorder:

• a poor short-term memory (remembering things they are asked to do immediately)
• a very active brain, which means that they like to be kept busy
• hating to wait – therefore they will do anything to avoid being bored
• talking and fidgeting when they are supposed to sit quietly
• interrupting when people are talking.

Remember that each child is an individual, though, and therefore the difficulties he presents are unique. Children with ADHD are often very lovable children, but they can be hard work!

Children who have ADHD may also be very emotional children in that they are very sensitive and they can for example believe that other children are making fun of them. They might then hit out, and get into trouble. Parents and teachers can then end up in a negative battle with the child, with everyone getting upset, whereas a more positive strategy takes into account the child’s initial sensitivity.

The symptoms of ADHD lead to characteristic behaviours in children. Your child may for example:

• find it hard to concentrate and not be able to continue with activities such as writing or colouring for very long
• move from one activity to another without finishing anything
• rarely play for a long time, and not enjoy playing with toys or games, preferring active games
• often appear not to hear you when you speak to him – if you ask him to do something he will often forget what you have asked him to do
• have a short attention span
• fidget constantly, make noises, talk all the time
• be easily distracted by others
• be reckless, impulsive and prone to accidents.

Research has shown that children with hyperactivity are four times more likely to have accidents. It is very important that you help your child to listen when you talk about dangerous situations, for example, crossing busy roads, so that he understands the dangers, and you will need to repeat that advice on a regular basis.

The following common characteristics and problems children may have alongside their ADHD have been reported by parents and researchers:

• difficulties settling for bed and/or getting off to sleep
• waking up through the night or early in the morning
• tending to eat frequent small meals or be a faddy eater, preferring to snack if they are allowed
• social dis-inhibition – a lack of normal caution, speaking to total strangers even though you have warned him not to
• a lack of social skills, being unpopular with other children and having very few, or no, friends
• frequent crying, a poor opinion of himself, and a feeling that no one likes him.

ADHD exists when a child shows a number of the above difficulties both at home and at school or playgroup. It is a complex disorder. As we have said children with ADHD may also have other problems, such as specific learning difficulties, aggression and anxiety or sleeping difficulties.

It is important to see ADHD as a developmental problem rather than an illness. The way your child behaves is not unusual, just unusual for their age. He may be behaving like a much younger child. It is vital that you realize that your child’s problems may not go away unless you and he work on changing the behaviour to be more positive. This means him learning how to cope with the problems he has, for example difficulties with attention, over-activity and impulsivity. Some children do not always have all three main symptoms. For example, your child may only have a very poor attention span.

Children with ADHD are more likely to be active...