ADHD
ADHD Table Of Contents:
Attention Deficit Hyperactivity Disorder Overview
There’s a good chance you’ve heard of Attention Deficit Hyperactivity Disorder or ADHD before. It’s a disorder that interferes with one’s attention and impulses. Often, those with ADHD have more trouble thinking before they do or say something and are distracted by overactive thoughts and emotions. This can lead to impairment in many aspects of daily life like trouble in school, at work, or even in completing necessary daily tasks. Though many believe ADHD is exclusive to children, many adults also struggle with ADHD.
While this may seem daunting, having ADHD is not a bad thing. People with ADHD have the unique ability to slip into flow when they are interested or challenged. When this happens, they may perform better than the average person. This is similar to the idea of hyper-focusing due to overactivity of the brain, which is not always a good thing because someone with ADHD can hyper-focus on “unproductive” tasks. But it can lead to flow or quality of work that sets them apart from other people.
For instance, even if a child with ADHD may have trouble paying attention in classes at school, it doesn’t mean they aren’t paying attention at all; perhaps they are hyper-focused on something else their brain thinks is more deserving of their attention, like doodling on the corners of their paper or writing a short story in their head. Those are the things that children might be good at and where their passions may lay.
While hyper-focus isn’t always good, it’s not bad, either. It depends on what you are hyper-focused on.
A person with ADHD might race at a speed others cannot fathom, and they have to use energy to slow down to the speed of the rest of the world. Dr. Edward Hallowell describes this as having a sports car brain but having bicycle brakes.
What if we stopped asking those with ADHD to slow down? We can recognize their uniqueness and find ways to help them succeed in how they are instead of trying to teach them to conform to how other people function.
With The Headway Project, we’ll be taking a closer look at the intricacies of ADHD and the tools those with the disorder and parents of children with ADHD, can use to promote a healthier, more productive, and harmonious life.
A New Way Of Thinking About ADHD
The Idea of Interest Deficit Disorder
There are many situations in which children and teens with ADHD can perform as well as any other person and, in many cases, even better than their peers. These areas include:
When they are highly interested
New or novel situations
Situations that have frequent feedback and consequences or are supervised
One-on-one situations
Situations with upcoming deadlines
In cases like these, differences in performance is so dramatic that Dr. William Dodson has stated that people with ADHD/ADD likely have interest-based nervous systems, and Chris Dendy, member of the CHADD ( Children With Attention Deficit Disorder) Hall of Fame and author of several books about children and teenagers, has indicated we should probably refer to ADHD as an Interest Deficit Disorder.
Don’t Be Afraid to Look at ADHD in Your Own Way
Some parents and children find ways of looking at ADHD that make it more easily acceptable.
1. The ability to constantly monitor what is going on around them. In boring situations, such as school, children and teens are easily distracted by what is happening around them and have difficulty focusing on lectures or classwork.
2. The ability to respond immediately to an emergency, such as two planes about to collide or a pilot performing an emergency landing. Those whose “braking systems” are more efficient (those without ADHD) might have difficulties doing this. (In the classroom, this often manifests in the child or teen with ADHD saying or doing something before thinking about it and finding themselves in trouble.)
3. The ability to hyper-focus. From the explorer's or the hunter's perspective, when the hunt is on, the hyper-focused person will respond by pursuing. This is the same hyper/mission focus required for law enforcement, search and rescue, or the military. Having this ability might create problems at home and at school when people become focused on things to the point that they become angry and resentful or when they have to stop something that they are working on, or they are interested in.
Thinking of ADHD as having the “hunter” traits can give children, teens, and their parents more hope about the future. Many desirable jobs suit those traits. If people with ADHD are interested, they will excel at any modern-day “hunter” occupation. The following is a list of jobs people with ADHD are better suited for.
- Military personnel
- Emergency room personnel
- Emergency service individual
- Firefighter
- Forest Ranger
- Game Warden
- Police Officer
- Skilled Labor
- Surgeon
- Trial lawyer
A New Way To View ADHD
Through studies of evolutionary psychology, a new hypothesis or view of ADHD makes the case that people with ADHD are modern-day hunters. The theory states that these traits may be derived genetically from ancient explorers, warriors, or hunters. Thom Hartmann first introduced it in his book ADHD: A Hunter in a Farmer's World.
The analogy goes like this: People with ADHD make better hunters, and people without ADHD make better farmers. These hunter traits appear today, except our world today is primarily catered to farmer-friendly experiences.
To help put this into perspective, the chart below, adapted from Hartmann's book, compares ADHD traits, those traits from a "hunter" perspective, and the traits of "farmers."
There are many ways of looking at ADHD. Thinking about it as a disorder may not be the healthiest point of view. It may benefit you to view ADHD traits as those of a hunter or someone built for a life that isn't "farmer"-typical.
Hartmann's hypothesis that people with ADHD possibly have the same genes as hunters of a different age would be notoriously difficult to prove scientifically. However, the idea makes sense.
People with ADHD process information differently; they have similar traits, but everyone is affected differently. The three main areas are hyperactivity, impulsivity, and inattention, but not everyone has problems in all three areas. Many have inattention only ADHD (Inattentive Presentation), some have hyperactivity impulsivity without inattentiveness ADHD, (Hyperactive-Impulsive Presentation), and some have (ADHD, Combined Presentation). With all three categories, it can be mild, moderate, or severe in intensity. Many people think there is another emotionally dysregulated sub-type, but it is not currently diagnosed.
Rewriting the Narrative on ADHD
Research suggests that people with ADHD tend to excel in certain situations versus others because the significant symptoms of ADHD are likely to change as a consequence of the nature of the situation they happen to be in.
Some of these situations are:
One-to-one situations
When doing tasks that they enjoy or find interesting
When there is some immediate payoff for behaving well
When they are supervised
When they get their work done earlier in the day rather than later
Conversely, those with ADHD may manifest more of their symptoms in:
Group settings
When they must perform tedious work
When they must work independently of supervision
When their work must be done later in the day
For children, when they are with their mothers
Sometimes, or in some cases, these situational factors
may have little effect on the person’s level of ADHD
symptoms, but they have been noted often enough in
research to make such situational changes in their
symptoms important to appreciate (Barkley).
ADHD Varies by Setting
Barkley Workshop
Better Here: Worse Here:
Fun…………………………Boring
Immediate………………….Delayed Consequences
Frequent……………………Infrequent Feedback
High………………………...Low Salience
Early……………………… Late
Supervised………………….Unsupervised
One-to-one…………………Group Situations
Novelty……………………...Familiarity
Fathers……………………...Mothers
Strangers…………………….Parents
Clinic Exam Room…………Waiting Room
Having ADHD isn’t a bad thing; it just means that someone with ADHD’s needs is more specific than someone without ADHD. ADHD may work as a sort of “superpower” in situations that fit well with an ADHD person’s specialties.
For example, Own Beats Athlete tells us that people with ADHD who play sports have certain advantages sometimes.
ADHD athletes can simultaneously take in the whole court or field – they see everything.
ADHD athletes can hyper-focus amid competition chaos – that’s their reality.
ADHD athletes have a ton of energy – they’re the ones with legs in the second half of the race.
ADHD athletes are resourceful – if there’s a way, they’ll find it.
Everyone has to find a place in life where they excel. People with ADHD have to do the same, but instead of looking at ADHD as negative, it is more helpful to view it as a narrowing of options. Say someone has trouble with a skillset due to a symptom of ADHD—well, cross that activity off the list of possible things to do with their life! They should focus on what they are good at instead of what they aren’t.
STOP Procedure To Help With Brakes
What Careers Are ADHD-Friendly?
Career guidance with adults and teens with Attention Deficit Hyperactivity Disorder requires looking at variables counselors working with non-ADHD clients usually do not consider. If the process of making a career choice includes knowledge of what makes a job ADHD-friendly instead of ADHD-hostile, a person with Attention Deficit Hyperactivity Disorder can soar and break the cycle of frustration in school and the workplace.
Sharon Levine's criteria for ADHD-Friendly are: allows the worker to work autonomously; enables the worker to remain active rather than stay in one place all day; the duties are varied, and the worker can use his creativity to obtain stimulation for the adrenaline/dopamine to flow. Some jobs meet all criteria, whereas others only meet some of the criteria.
It should be noted that when it comes to finding an ADHD-friendly career, the most important factor is that it needs to be something the individual is interested in. Here is an accumulation of separate career categories below for lists of ADHD-friendly jobs.
* Click on the images to learn more.
Top Ten Facts for Understanding and Living with ADHD/ADD
People with ADHD have an interest-based nervous symptom – other importance-based service system (More accurately IDHD/IDD)
Boredom is kryptonite for people with ADD/ADHD
The brain and something not interesting = the south poles of two magnets.
Perform as well in situations they are interested in and sometimes better because of hyperfocus.
2. ADHD/ADD are developmental delays in the ability in low-interest situations to sustain/focus attention, to inhibit (stop) responding and to react emotionally appropriately to the situation because the attention and inhibition (braking) areas of the brain (frontal lobe inhibition areas) are smaller and less active (5 to 30%) resulting in a 30% delay in self-control and focusing attention in boring situations.
Intervene/discipline at the self-control age-(a 10-year-old doing homework or cleaning the room needs to be treated like a six or seven-year-old).
People with ADHD/ADD in low-interest situations are in a state of sensory deprivation, they need “constant” stimulation, are “always” bored, and if it gets too quiet, someone usually gets in “trouble”.
3. Emotional intensity (many times emotional dysregulation) is as much of a part of ADHD as inattention, impulsivity, and hyperactivity. Research shows that the emotional intensity associated with the impulsivity-hyperactivity factor of ADHD in the long term is more impairing. See our section below about RSD, Rejection Sensitive Dysphoria.
Excessive emotionality responds as well to medication as inattention, impulsivity, and overactivity.
Emotionality is a significant factor in oppositional defiant disorder, which also responds equally to ADHD medication.
Emotionality accounts for why children often fire their parents, wish they were never born, say their life is miserable, etcetera when made to stop something if they are hyper-focused or told no. A few minutes later, they may be generally over it and can’t understand why their parents are still upset.
4. ADHD/ADD are extremes of genetically based traits (like height and IQ). Hunter traits
Increases situational awareness (i.e., air traffic controller/combat) (distractibility in a boring situation)
Able to react instantaneously (i.e., air traffic controller-able to prevent aircraft from colliding; in combat, able to react without hesitation when attacked). These traits in a boring situation, such as in school, are seen as impulsiveness (blurting something out to be helpful, getting out of the seat to help another classmate, picking up trash, or getting a drink of water).
Able to hyperfocus. (Interesting/exciting situations-ability to mission focus for an extended period of time); often appears to be defiant by refusing to stop what he/she is doing.
5. ADHD/ADD Performance Varies by Setting (Barkley Workshop)
High interest
Fun
Immediate frequent feedback and consequences
One-to-one
New
6. Find ways to think about ADHD and ADD that help make sense of their difficulties and point towards things to do to make things better. (Metaphors, similes, etc.)
ADD/ADHD mental focus difficulties are as crippling as poor visual focus in school and jobs. Medication and other practices that increase dopamine are to mental focus as glasses are too visual focus.
ADHD is a breaking problem. Stopping and thinking before acting ready, fire, aim, “whoops.”
A helpful metaphor for kids with ADHD and their parents. “You have a sports car brain but bicycle (tricycle) brakes, and It is hard to win races when you can't stop at stop signs.
ADD steering wheel problem or a radio stuck on the wrong channel.
7. ADHD Reframe “Metaphor” of the Hunter in the Farmer's World- "Traits"
Constantly monitoring their environment (ready to respond to changes in the environment quickly).
Able to respond immediately to emergencies such as an emergency landing or rescuing someone in an accident.
When it becomes hyper-focused (opposing poles of magnets), it is capable of sustained and relentless persistence, such as in a high-speed car chase or in a military mission.
Enjoys new ideas and excitement about “The Hunt” and is hot on the trail.
Is willing and able to take risks and face dangers.
Takes decisive action in many situations.
The characteristic of paying attention to many things at once in school and other boring situations is seen as distractibility, and hyperfocus is often seen as oppositional defiance or uncooperativeness.
8. ADHD-friendly jobs. Top 10 list. See below.
“In Career Counseling for People with Attention Deficit Disorder” By Sharon Levine In ADD Success Stories by Thom Hartmann, Underwood Books, 1995 Hundreds of ADD/ADHD friendly jobs are listed.
9. Medication risks and risks of choosing not to use medication.
Driving- without meds, 3x’s the accident and fatality rate as those taking meds
Work- Norway- people who take meds as kids have a higher employment rate as adult
ADHD and Crime.15 studies 21% To 45% of Prisoners have ADHD mostly have not been treated
Substance abuse: teens who take medications reduce the use of illegal drugs. Children with ADD/ADHD who take meds: half the studies show decreased substance abuse as adults. Lifetime 50% reduction in substance abuse
Kids who take medication show increased normalization of prefrontal inhibition areas.
10. Parenting considerations:
Raising a child with ADD/ADHD presents difficult challenges and requires much more energy. Parents of ADHD children have to constantly keep younger children safe and focused, fight homework battles, and often have to spend countless hours dealing with their problem behavior at home and school. Parents of ADD kids often spend hours with homework and chores battles, as well as dealing with school performance problems.
A typical 10-year-old with ADHD is able to function more like a typical 7-year-old. This can be thought of as the person’s self-control or executive functioning age, and this has implications for making both the child’s and the parent’s life less stressful and frustrating. For example, if a 10-year-old child blurts something out inappropriately, the guidelines for timeout would be to spend around ten minutes in timeout. If they are a child with average difficulties and with ADHD, the timeout should be adjusted to their self-control age of 7 or, in the more severe cases, should be reduced even more. In other situations, such as sending your 10-year-old to clean their room, because of his or her difficulties focusing in boring situations, they will need to be supervised/assisted like a 7-year-old or possibly younger child. If they are expected to perform like most 10-year-olds, the room most likely will not get cleaned, and you and your child will be frustrated and upset.
Children with ADHD are typically emotionally overreactive as one of the braking (inhibition) areas in the brain is emotional control and regulation. Almost all of these kids react intensely, particularly to frustration and anger, and because of their impulsivity at these times, they will often say what all other children think. This results in them getting themselves in a lot of “hot water,” and parents often have to deal with their own frustration and anger towards these kids as well as intervening with teachers, neighbors, etc., because of their overreactivity. A helpful way to think of their emotions is every molehill gets reacted to as if it is a mountain.
ADHD Children will need more one-on-one “quality” time to balance out the negativity associated with dealing with their behavioral issues. Otherwise, the ratio of positive to negative interactions fails to meet the minimum requirement for a healthy relationship (at least three positives to every negative). Sometimes it is hard to “Catch them being good.”
ADHD and Rejection-Sensitive Dysphoria, RSD
Many people with ADHD also struggle with emotional dysregulation. Another view is that people with ADHD often have something called Rejection-Sensitive Dysphoria (RSD). RSD is defined as extreme emotional pain triggered by real or imagined criticism from important people in your life. This basically means being highly sensitive to criticism, but it is much more complicated than that.
RSD is highly associated with ADHD and may cause people to try hard to gain acceptance from others. Or they might avoid social situations in which they might get hurt.
People with RSD are:
more easily embarrassed
more easily angered
have excessively high standards
often have low self-esteem
have increased anxiety
have problems with relationships
withdrawn from social situations
They may feel like they don’t live up to other’s expectations, and this can get to a point where they might think about self-harm.
RSD is characterized by intense episodes that are easily triggered but do not last long. RSD is typically thought to be associated with overactivity of the central nervous system—just like those with ADHD—or having overly critical or rejecting parents, being bullied, or being mistreated during childhood. Any of these situations can lead to increased stress and excessive emotional reactivity to rejection.
RSD can be confused with or lead to a diagnosis of Bipolar Disorder, Personality Disorder, PTSD, OCD, Depression, or Social Phobia. It occurs when people overly interpret criticism or a social snub or overreact to an ambiguous health symptom. It is like exaggerating the importance or significance of an event that could be meaningless. RSD associated with ADHD may play a role in the increased risk for anxiety and depression experienced by people with ADHD.
Rejection Sensitive Dysphoria
What Does RSD Look Like;
Sudden emotional outbursts following real or perceived criticism or rejection
Withdrawal from social situations
Negative self-talk and thoughts of self-harm
Avoidance of social settings in which they might fail or be criticized (for this reason, RSD is often hard to distinguish from Social Anxiety Disorder)
Low self-esteem and poor self-perception
Constant harsh and negative self-talk leads them to become “their own worst enemy.” Rumination and perseveration
Relationship problems, especially feeling constantly attacked and responding defensively.
RSD/ ED is not always present. It comes in triggered episodes.
People with RSD are usually ashamed of their over-reactions and hide them so that they will not be further embarrassed and thought of as mentally or emotionally unstable.
Even when RSD is present, it is difficult to measure; therefore, this research is limited.
According to Dr. William Dodson, emotional dysregulation was consciously excluded from the diagnostic criteria for ADHD and effectively forgotten for many years. Over the last decade, researchers have developed several new ways of looking at ADHD through its lifecycle. By the end of 2019, this re-evaluation of the very fundamental aspects of ADHD led the European Union to issue its 10-year update of the Consensus Guidelines on Adult ADHD, which redefined adolescent and adult ADHD to include difficulty with emotional regulation as one of only six fundamental features in the ADHD syndrome:
1. inattention and hyperfocus
2. impulsivity
3. hyperactivity
4. emotional dysregulation
5. excessive mind wandering
6. behavioral self-regulation (which they equated with executive function deficits)
How is Emotional Dysregulation Treated: Dr. William Dodson
Although the alpha agonist medications, guanfacine and clonidine, have been FDA-approved for the treatment of ADHD for decades, they were not directly associated with the terms of rejection sensitivity and emotional dysregulation for all of the reasons noted above. Nonetheless, it has been my clinical experience and the experience of others that the symptoms of RSD/ED can be significantly relieved with clonidine and guanfacine in about 60% of adolescents and adults. To me, this observation strongly indicates that RSD is neurological and not something that is due to a lack of skills. Skills do not come in pill form.
There currently exists no formal research on using alpha agonist medications to treat symptoms of RSD or ED on patients with ADHD.
Treatment for ADHD
Treatment for ADHD should include education about the characteristics (symptoms, if you prefer) associated with ADHD and how these impact the individual in just about every area of life. Demystification is a term used to describe helping a person understand these differences without feeling that they are somehow wrong because of how they are wired. First-line treatments include medication, various forms of talk therapy, coaching and techniques for coping.
Individual Treatment Approaches Include:
Discussion regarding medical and non-medical options
Managing Co-Occurring Problems (Anxiety/ Depression/Defiance)
Address Executive Skill Deficits
Cognitive Behavioral Therapy (CBT) or Mindfulness-Based Cognitive Therapy (MBCT) (education, behavioral goals, structure, incentives)
Self Compassion Training
Examine the Impact ADHD Has on Self-concept
Organization, Structured, Consistent Schedule/ Time Block Planning
Help the Person Build a Support System/ ADHD Coaching/ CHADD? Therapeutic Stories.
Externalizing Structure (regular times for wake-up, meals, homework, outdoor play, and bedtime)
Occupational Therapy (sensory integration), Speech Language Therapy
Mind Body Exercises (Yoga and Meditation)
Omega-3 fatty Acids, Neurofeedback, and Working-memory Training,
Explore Natural Ways to Boost Dopamine
Manage Stress, Mood, and Threat
Calming Strategies
School/Work Support Strategies (IEP-504 plan)
Tutoring
Exercise/Nutrition/Sleep
Parenting Support (More Praise than Corrections)
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Completing a task (the more challenging, the better)
•Physical contact - A big hug
•Listening to music
•Good night’s sleep
•Take a cold shower
•Drink green tea
•Deeper breathing
•Physical activity
•Meditation
•Creative activities like art, drawing, painting, writing, photography, playing games, or cooking
•Eat fruit to increase tyrosine
•Doing something new
•Turn off phone/computer notifications and replace phone time with any of the above.
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Breath Awareness
•Finger Trace Breathing and Hand Play Games (Five Finger Breathing), Counting (noticing) # of Breaths per minute
•STOP Procedure
•Putting on the Brakes (Dr. Hallowell)
•Self Time Out
•Practicing Mindful Walking/Talking/Thinking
•Writing/ Drawing
•Self Regulation Skills
•Understanding The Need To Slow Down/Reduce Arousal/ Manage Stress
•Developing Personal Strategies To Keep Calm and Carry On
•Meditation
•Breath Awareness (Counting Breaths)
•Body Scan
•Open Awareness
•Loving Kindness a task (the more challenging, the better)
•Physical contact - A big hug
•Listening to music
•Good night’s sleep
•Turn off phone/computer notifications
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Daily Mind Body Integration Exercises (Yoga and Meditation)
•Daily Practices/Strategies to Manage Stress, Improve Mood, and Reduce Threat
•Practicing Slowing The Body Down, Mindful Walking/Talking/Thinking
•Practice Pausing, Stop Procedure/ RAIN Procedure
•Strengthen Understanding of The Brain-Body Connection
•Attention is a Series of Skills That can be Cultivated. Build Executive Skills/Dedicated Time/Place. Practice Skills Every Day
•Focus on Small Daily Pleasurable Experiences, Building Tiny Habits/Prompts for Behaviors You Want to Strengthen
•Set Aside Quiet Time for Self, Practice Self-Compassion
•Strengthen “Attitudes of Mindfulness”
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A widely used approach to ADHD is cognitive behavioral therapy (CBT). This type of therapy helps change negative thought patterns into positive, healthier ways of thinking. The idea is that if you change the way you think about a situation, your feelings and behaviors can change, too. For example, CBT may help change "all or nothing" thinking, in which many people with ADHD tend to think that their accomplishments must be either perfect or a failure.
CBT is very focused on giving you tools to help deal with stresses and challenges in life. Working on self-esteem is also an important aspect of ADHD treatment.
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ADHD can lead to frequent emotional ups and downs. People driving slowly or waiting in line can make a person with ADHD quite irritable. Minor setbacks, such as a project not turning out quite right or a boss who changes deadlines can be emotionally challenging.
It's also common for adults with ADHD to have other mental health conditions. An estimated 50% of adults with ADHD, for example, also have an anxiety disorder, according to the Anxiety and Depression Association of America. Having ADHD along with another condition can severely interfere with daily functioning so these issues must also be managed.
12 PRINCIPLES OF RAISING A CHILD WITH ADHD
Russell Barkley
Principle 1. Use the Keys to Success
a. Professional Evaluation.
b. Identify and Promote special talents and aptitudes
c. Find community resources to develop them.
d. Believe in, accept, and support your child.
Principle 2. Remember That It’s a Disorder!
a. 30 % delay in focusing and self-control, primarily in uninteresting/boring situations.
b. Adjust your expectations/discipline/interventions to their self-control (executive) age. REMEMBER THE 30 % RULE. IT WILL ELIMINATE A GREAT DEAL OF THE CONFLICT BETEEN YOU AND YOUR CHILD/TEEN.
Principle 3. Be a Shepherd, Not an Engineer
a. Provide protection
b. Find the best neighborhood you can.
c. The younger your child is, the more influence parents have.
d. Make accommodations for delays in attention span, organization problems, and self-control.
e. Make home more fun, interesting, stimulating, and educational. i.e., swing set, educational toys, interesting books,
f. Provide good nourishment- reduce junk food and sugary drinks—and more nutritious meals.
g. Provide consistent and predictable routines. i.e., morning, dinnertime, homework, bedtime, etc.
h. Take good care of yourself. Critical.
a. Nutrition
b. Exercise
c. Sleep
d. Recharge your emotional batteries.
Principle 4. Get your Priorities Straight
a. Avoid arguments over minor issues,
b. Figure out what requests you can let go.
c. Review the time of day that is particularly difficult and prioritize the most important things that need to be done.
d. Will doing this request help their development and functioning?
e. Prioritize important and urgent things and let go of the unimportant.
f. Manage transitions effectively.
Principle 5. Mindful Parenting: Be There and Be Aware
Principle 6. Promote Your Child’s Self-Awareness and Accountability
a. Model self-awareness and accountability- evaluate out loud how you did in situations. Talk about others’ feelings and reactions.
b. Narrate to your child a social scene involving other children.
c. Interview your child about their life, friends, behaviors, feelings, etc
d. Use verbal and nonverbal cues when the child is not appropriate.
e. Use random timing and consequences if needed. (use timers set randomly)
f. Use picture cues. For problem behaviors and catch them being good
g. Turtle technique- stop and scan the room.
h. Mirror Method- do work facing a mirror.
i. Cues for older kids
a. Paper clip, etc.
b. Tap on the shoulder*
c. Secret verbal signal*
d. Random tones
e. Vibrating cueing system.
j. Use videos of the child’s behavior and social interactions.
k. Day in review sessions.
l. Teach children Mindfullness Meditation
m. Consider a Behavior Report Card.
n. Social Commitments.
o. Clarify household rules and reinforce them consistently.
PRINCIPLE 7. Touch More, Reward More, Talk Less
Problem: Parents of children with ADHD talk too much, and the eternal self-motivation of children with ADHD and ADD is weak.
Solution: Touch more, talk less, and use frequent, immediate, and external rewards at the point of performance.
a. When asking your child to do something for you, put your hand on the child’s shoulder or arm, look into their eyes, briefly say what needs to be said, have the child repeat the instruction, and depart with a show of affection.
b. Because usual rewards and motivation with schoolwork and chores are too weak for children with ADHD, use immediate and frequent feedback and consequences to sustain behavior towards a task such as a home token program or point system.
c. Think of self-motivation and organization skills, etc., as a fuel tank that needs to be replenished for everyone. This can be done by using frequent rewards, self-talk, cutting down the work into smaller units by taking frequent breaks, taking a pause for three minutes to relax or to focus on your breathing, clear the mind of negative thoughts, visualize reaching the goal and enjoying the reward, use a picture of the reward, and exercise often.
d. Cautions: don’t reward everything, especially those things that the child finds interesting or pleasurable, as this will decrease their interest and pleasure in these activities.
PRINCIPLE 8. Make Time Real
Problem: Time “escapes” children with ADHD.
Solution: Externalize time and break it down.
a. Remember, whenever you put a time limit or requirement on anything for your child with ADHD, you are disabling the child (exception – immediate deadlines can be motivating).
b. Use external clocks for short texts. Timers are especially helpful. Reduce or eliminate time delays on assignments for long-term projects by breaking them up into sub-projects, each with a deadline and important consequences.
c. Use 3 x 5 cards for multi-step projects.
d. Create a daily timeline for school days.
e. Use a calendar to show your child how many days there are before special activities or events.
f. Manage waiting time by distracting your child with activities such as games on cell phones or tablets, taking along small toys that are enjoyable, and for unexpected times, getting creative and acting fast, such as finding something, singing a song, playing a road trip game, etc.
PRINCIPLE 9. Working Memory Isn’t Working: Offload It and Make It Physical!
Problem: Children with ADHD can’t hold in mind the information they need to complete tasks.
Solution: Offload working memory and make it physical.
a. Transfer necessary information to something that can be seen, including making lists, making picture sequences, providing written rules for homework and chores, making chore cards, encouraging self-talk out loud, creating behavior contracts, and using smart devices.
PRINCIPLE 10. Get Organized
Problem: ADHD disrupts self-organization
Solution: Help your child get and stay organized at the point of performance
a. Find the best place for children to perform - few distractions and that can frequently be monitored by a parent or teacher.
b. Identify the materials that need to be located at this place in order to complete the tasks.
c. Identify the best time for this kind of work to be done.
d. Organize play spaces.
e. Don’t let the organization override its purpose.
PRINCIPLE 11. Make Problem-Solving Concrete
Problem: People with ADHD have trouble holding things in mind and manipulating them to solve problems.
Solution: Make problem-solving physical and manual.
a. Externalize mathematics calculation by using a number line, poker chips, marbles, Legos, and a calculator, and use number tables to perform calculations.
b. Writing assignments about a reading passage. Scan, glance over the passage, read the first paragraph and vocalize what it says, and write down ideas about it or make a picture about it. Then, review each part after it has been done after each paragraph.
c. Four steps to every problem:
1. State the problem out loud.
2. Break it down into specific smaller steps.
3. Brainstorm solutions and write a giant idea down, and don’t evaluate.
4. Critique and sort the ideas you have written down. Have the child state the advantages and disadvantages of each solution. When the solution is decided, have the child assist in organizing the steps and a plan.
5. State the situation and break it down, list the options, note the advantages and disadvantages, note the problems with each, and then see if a solution is evitable*.
PRINCIPLE 12. Be Proactive: Plan for Difficult Situations at Home and Away
Problem: Parents of children with ADHD often operate in the reactive mode
SOLUTION: Get Proactive
a. Make a list of problem situations in the home or in public places.
b. Think about what you could do beforehand or in the situation to head off the problem behavior.
c. Keep in mind your child’s thirty percent delay in their ability to focus attention and self-control difficulties, particularly in boring situations.
d. Develop transitions in those situations that are problematic by stating the rules, the reward that can be earned, and the negative consequences, and have something for your child to do.
e. Put the transition plan into action before entering a problem situation. Explain to your child the plan. Review the rules, explain the reward, explain the punishment, give the child something to do right away, and give frequent feedback, particularly positive feedback, throughout the situation and evaluate at the end.
13: Additional Problem.
Problem: Children with ADHD are emotionally overreactive and often dysregulated.
Solution: Understand the six places to head off emotional dysregulation.
a. Choose your situations carefully, avoiding, when possible, those that are problematic.
b. Modify the situation.
c. Focus and redirect attention.
d. Change the child’s thinking about it.
e. Modify the child’s response.
f. Alter the consequences.
14. Practice Forgiveness daily.
a. Forgiving your child by reminding yourself of their problems with attention, particularly in boring situations. Watch your child sleeping. Make a list of your frustrations with the child. Practice forgiveness.
b. Forgiving yourself for not being a perfect parent and/or becoming exasperated.
c. Forgiving others who don’t understand the challenges that a person with ADHD or a parent of an ADHD child has and make judgments or nasty remarks about the child and about your parenting skills.
PARENTING YOUR CHILD WITH INATTENTION, IMPULSIVITY, AND /OR HYPERACTIVITY
Parenting is one of the most difficult, if not the most difficult, challenges adults with children must meet. Parenting children with inattention, impulsivity, and or over-activity requires even more time and energy. Research shows that education about ADHD is among the most effective things in helping parents raise their children. So, let’s learn a few facts to help with that understanding.
Self-Control Age
Attention, impulsivity, and over-activity are traits that are genetically based, and research has shown that they are as much inherited as height and IQ. These traits are related to areas in front of the brain that involve inhibition and attention. Think of the inhibition as the brakes of the brain and the attention as the steering wheel of the brain. These are smaller and less active in a brain with ADHD, which results in an average of about a 30% delay in self-control, distractibility, and focusing attention, mainly evident in boring or uninteresting situations.
For example, this means that a typical 10-year-old with ADHD or focusing difficulties may function more like a typical 7-year-old. This can be thought of as the person’s self-control or executive functioning age.
Here’s a secret: Separating the child’s actual age from their self-control age may make both the child’s and the parent’s life less stressful and frustrating. If you are sending your 10-year-old to clean their room, they will need to be supervised/assisted like a 7-year-old or possibly younger child because of his or her difficulties focusing in boring situations,
If they are expected to perform like most 10-year-olds, the room most likely will not get cleaned, and you and your child will be frustrated and upset.
Reactivity in Young People with ADHD
Children with ADHD are emotionally over-reactive, as one of the braking (inhibition) areas in the brain is involved in emotional control and regulation. Almost all of these kids react intensely, particularly to frustration and anger, and because of their impulsivity, they will often say what all other children think. This results in them getting themselves in a lot of trouble, and parents often have to deal with their own frustration towards these kids and intervene with teachers, neighbors, etc., because of their reactivity. A helpful way to think of their emotions is this: every molehill gets reacted to as if it is a mountain.
Important Ideas to Remember
Accept the fact that children with ADHD require more energy to raise than other children. Parents of younger ADHD children need to constantly keep them safe and focused during their elementary years while fighting the homework battles and often in the middle and high school years dealing with their problem behaviors at home and at school. Life is difficult, and when we accept this fact, the challenges in life become less daunting. The stress may be there still, but it is manageable.
While understanding these facts and their consequences in daily life with these children will not make raising them easy, it will make it less demanding and exhausting. Finding people in the community who understand young people with ADHD while also having the understanding of the kinds of jobs they can be successful in can make raising these children less difficult and even joyful.
Frequently Asked Questions from Parents of Children with ADHD
1) What’s going on in the mind of a kid with ADHD? Why do they act out?
2) What causes ADHD?
3) How do stimulants work? Do any stimulants help? Like coffee?
4) What are the risks associated with untreated ADHD?
5) To what extent can a child control their ADHD behaviors?
6) What is it like to have ADHD as an adult?
7) What can I do to make life easier for a child who has ADHD?
8) What can I do to make life easier for an adult who has ADHD?
Using Behavior Therapy to Promote Discipline and Focus
How to change your child’s behavior with a few adjustments to your parenting approach.
Behavior therapy is a structured discipline strategy based on rewards and consequences – such as increased or decreased TV privileges – that aims to incrementally teach children preferred ways of behaving. The desired behavior – waking up on time or reducing interruptions – varies widely from child to child. According to the American Psychological Association, behavior therapy, rather than medication, should be the first line of treatment for children with ADHD under the age of five. William Pelham, Jr., Ph.D., director of the Center for Children and Families at the State University of New York at Buffalo, recommends starting with behavior therapy only for all children (Barkley and AAP disagree).
The benefit of using behavior therapy first is that, if a child also needs medication, he can often get by with a smaller dose,” says Pelham. Also, parents who see that medication is working are less motivated to follow through with behavior therapy. That would be fine if the data showed that medication alone helped the long-term trajectory of ADHD kids. It doesn’t, according to most experts.
How do you implement a course of behavioral therapy at home? Have you ever given your child a time-out for talking back – or a “heads-up” before taking him to the supermarket or another setting that is likely to challenge his self-control? Then you already have a sense of how behavior therapy works. A lot of behavior modification is just common-sense parenting,” says Pelham. “The problem is that none of us were trained how to be good parents, and none of us expected to have children who needed parents with great parenting skills and patience.”
The basic idea is to set specific rules governing your child’s behavior with positive consequences for following them and negative consequences for infractions. Try the following four-step plan:
Step One
Name a single goal for which you can easily measure progress. If your goals are too diverse (going to bed at a certain time, being dressed by 8 am, doing homework immediately after school), you likely won’t be able to observe and keep track of your child’s accomplishments. You may also overwhelm your child and set him up for disappointment if he slips on one or more goals.
Step Two
Create a chart or other visual reminder that outlines exactly what is expected of your child and how their behavior will be assessed. Post the chart or checklist where your child will see it – this serves as a reminder and cuts down on dreaded parental nagging.
Step Three
Reward your child quickly and effusively each time she achieves the desired behavior. Place stars on the child’s reminder chart and extend a special privilege, like 15 minutes of additional playtime after dinner. The rewards need not be expensive, but they should be meaningful to your child – and worth working for.
Experts often advise parents to discourage negative behavior by ignoring it because children may act up to get attention. If the negative behavior is too serious to ignore, take away a privilege – for example, 15 minutes of television time. At the same time, parents should keep an eye out for the negative triggers that encourage this bad behavior and do their best to alleviate them.
Step Four
Speak to your child’s teacher about the behavior therapy tactics you’re using at home and work with her to devise a way for her to keep track of and reward desired behavior at school as well. You might employ a daily report card or regular journal entries to keep track.
Steer Clear of These Common Mistakes:
Murky rules: State your expectations clearly and post them around the house
Unclear commands: Spell out your desires in detail, not generalities
Dwelling on the negative: Praise your child for doing something well at least five times as often as you criticize bad behavior
Little patience: Keep in mind that children with ADHD often struggle to transfer what they’ve learned from setting to setting, so be prepared to maintain a role as your child’s advocate for a long time.
Medicine for ADHD
ADHD medications can reduce hyperactivity, impulsive behavior, and attention problems, allowing a person to perform better at home, on the job, and in school and to function with more consistency and success in their daily life. Medication can reduce hyperactivity, inattentiveness, and impulsivity symptoms in children and adults with ADHD. But finding the medication that works best for you may take some trial and error, and what works at first may not always work the best, and medication may stop being the best way to treat ADHD. Things may change, and that’s okay.
Whether or not medication is the right way for those with ADHD is up to the individual; medication may not be the best option for everyone. It depends on many factors.
However, it’s essential to know some facts and statistics surrounding ADHD before deciding to try medication. Here are a few examples:
School: People with untreated ADHD have a 36% dropout rate in school. Only 5% of people with ADHD graduate college, while 33% of people who don’t have ADHD graduate.
Driving: Unmedicated people with ADHD have 3x accident and fatality rates as those taking medication or those who don’t have ADHD.
Work: A study from Norway shows that people with ADHD who began taking medication as children have higher employment rates as adults than those with ADHD who did not take medication as children.
Treated ADHD shows an overall stabilization of prefrontal inhibition areas.
Another thing to consider when thinking about medication for ADHD comes from Russell Barkley, Ph.D. He speaks on the life expectancy of those with ADHD, and some of his words may be shocking, but they’re based on over fifty years of research.
According to Barkley, ADHD has a worse life expectancy risk factor than diabetes, smoking, obesity, and alcohol use combined. Having ADHD costs a person nearly thirteen years of life, on average. Barkley adds, “And on top of all the findings of greater risk for accidental injury and suicide….About two-thirds of the people with ADHD have a life expectancy reduced by up to 21 years.” Changing this risk factor can be done smoothly and simply by changing lifestyle behavior and implementing good habits.
ADHD’s link to addiction and behavioral problems plays a huge role in these outcomes. A person with ADHD may have low conscientiousness, and if we can help them step away from this kind of trait, other risk factors will lessen. That’s where treatment comes in. Sometimes, it’s hard even to be diagnosed, let alone set up for treatment, with ADHD. Many clinicians focus on secondary lifestyle problems like smoking or alcohol or even depression or anxiety, not the underlying ADHD. Focusing on downstream symptoms fails again and again. Then, the clinician might blame their failure on lack of motivation when it might be undiagnosed and untreated ADHD.
Finding the right doctor and starting on the right path for treatment is imperative, whether that means taking medication or not.
Many more facts and statistics surround treated vs. untreated people with ADHD. Medication may or may not be suitable for you and your body and mind. There are many highly effective non-medical treatments for ADHD, but it is important to understand ADHD as a developmental disorder, so these strategies will take time and will require a lot of work.
Deciding about medication has many implications. We recommend reviewing your options with your doctor and taking it one step at a time if the idea feels overwhelming.
ADHD Treatment Supplements
Facts About Fish Oil
Can this common supplement sharpen your child’s focus?
By Karen Barrow
Found mainly in cold water and fatty fish, such as sardines, tuna, and salmon, omega-3 fatty acids are believed to be important in brain and nerve cell function. The body cannot make omega-3 fatty acids by itself, and most people don’t consume enough of them in food to derive benefits, which is why fish oil supplements are so popular today.
While omega-3 fatty acids seem to improve mental focus, several small recent studies suggest that the compounds may be especially helpful to those with ADHD.
Edward Hallowell, M.D. founder of the Hallowell Center for ADHD In Massachusetts, recommends that all of his patients take an omega-3 supplement and notes that “it seems to help most with mental focus, not hyperactivity or impulsivity.” It may take up to six weeks for patients to begin seeing benefits.
Picking the Right Pill
There are two main types of omega-3 fatty acids in fish oil: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
The most popular omega-3 supplements differ in the amounts of EPA and DHA they contain. Based on the most recent research, Dr. John Rately recommends that you choose a supplement that has at least three times the amount of EPA to DHA. “The data seem to show that those using supplements containing higher ratios of EPA get a better response in ADHD symptoms, including mood swings and aggression,” says Ratey.
Children may take up to 2.5 grams of fish oil each day; adults may take up to 6 grams.
Be aware that high doses of omega-3s may cause nausea, diarrhea, and other gastrointestinal discomfort. Consult your doctor before adding this supplement to your routine.
“I tell my patients that there are two things they need to do for their health: Exercise and consume omega-3s.” John Ratey, M.D., associate clinical professor of psychiatry at Harvard Medical School and coauthor of Driven to Distraction (Touchstone)
ADHD NUTRITION: Balanced Meals, Better Behavior
Strike the perfect balance between fruits and vegetables, protein, and complex carbs to ease some ADHD symptoms.
By Karen Barrow
Choosing the right foods – or cutting back on the wrong ones – may be a proactive way to prevent ADHD symptoms from swinging out of control.
Dr. Edward Hallowell advises all of his patients to think about their plates when preparing a meal. Half of the plate, he recommends, should be filled with fruit and vegetables, one-fourth with carbohydrates, and one-fourth with protein. This combination is a balanced diet, and it may control swings in behavior caused by hunger, surges in blood sugar, or a shortfall of a particular nutrient.
Protein is particularly important, in part because it prevents surges in blood sugar that may increase hyperactivity. The brain makes a variety of chemical messengers, or neurotransmitters, to regulate wakefulness and sleep. Certain neurotransmitters, including dopamine and norepinephrine, boost alertness. Others, including serotonin, cause drowsiness.
Studies by Massachusetts Institute of Technology neuroscientist Richard Wurtman, Ph.D., and others have shown that dietary protein triggers the synthesis of alertness-inducing neurotransmitters, while dietary carbohydrates trigger the synthesis of neurotransmitters that cause drowsiness.
These findings add credence to the popular belief that people with ADD fare better on a protein-rich breakfast and lunch. However, Hallowell also advocates eating several servings of whole grains each day to prevent blood sugar levels from spiking and then plummeting and cutting back on foods that contain dyes and excess sugar.
How Diet and Meds May Interact
Eating a high-fat breakfast can cause the body to absorb a stimulant medication more slowly and so delay the drug’s effectiveness. Feed your child a low-fat morning meal to maximize the benefits of meds.
Appetite suppression is one of the most common side effects of ADHD medications. For many parents, the solution is simply to keep mealtimes flexible and to serve their child a large meal that’s high in calories and nutrients late in the evening after the medication has worn off for the day.
Helpful Titles on Amazon.com…
The Kid-Friendly ADHD and Autism Cookbook, by Pamela Compart and Dana Laake
The A.D.D. and A.D.H.D. Diet!, by Rachel Bell and Howard Peiper
EXERCISE: A MED WITHOUT SIDE EFFECTS
How physical activity can improve focus in children with ADHD.
When you walk, run, or do a set of jumping jacks or pushups, your brain releases several important chemicals, including endorphins – hormone-like compounds that regulate mood, pleasure, and pain. That same burst of activity also elevates the brain’s dopamine, norepinephrine, and serotonin levels. These brain chemicals affect focus and attention, which are in short supply in those with ADHD.
“Exercise turns on the attention system, the so-called executive functions – sequencing, working memory, prioritizing, inhibiting, and sustaining attention,” says John Ratey, M.D., an associate clinical professor of psychiatry at Harvard Medical School. “On a practical level, it causes kids to be less impulsive, which makes them more primed to learn.”
Walking for 30 minutes four times a week will do the trick. But studies have shown that any of the martial arts, ballet, ice skating, gymnastics, rock climbing, mountain hiking, whitewater paddling, and – sorry to tell you, Mom – skateboarding is especially good for adults and children with ADHD. Why, exactly?” The technical movement inherent in these types of sports activates a vast array of brain areas that control balance, timing, sequencing, evaluating consequences, switching, error correction, fine motor adjustments, inhibition, and, of course, intense focus and concentration.
Finally, exercise helps kids push through past failures and attack things they didn’t succeed at before. “The refrain of many ADHD kids is, “No matter what I do, I’m going to fail,” says Ratey, author of Spark: The Revolutionary New Science of Exercise and the Brain (Little, Brown). “Rat studies show that exercise reduces learned helplessness. In fact, if you’re aerobically fit, the less likely you are to learn helplessness.”
“Think of exercise as medication,” he says. “For a very small handful of people with ADHD, it may actually be a replacement for stimulants, but, for most, it’s complementary – something they should absolutely do, along with taking meds, to help increase attention and improve mood.”
“Physical activities that involve coordination and complex movements – such as martial arts, dance, and basketball – cause connections to form between neurons in the cerebellum. That’s the region of the brain that controls, among other things, our social interactions.” - Dr. Edward Hallowell.
WORKING-MEMORY TRAINING
It may look like a video game, but this software is a serious business – reducing attention and hyperactivity in children with ADHD.
ADD talks with Bradley Gibson, Ph.D., lead author of a recent Notre Dame study underscoring the benefits of working-memory therapy, and Barbara Ingersoll, Ph.D., a trainer for Cogmed, the company that created the training module used in the research.
What is working memory?
It is the ability to hold onto information long enough to accomplish a specific goal – like holding a phone number in your mind as you dial it.
How does improving working memory help kids focus?
When you improve working memory, you improve fluid IQ – the ability to solve problems or adapt to situations as they occur. Most kids who complete memory training become more alert to their surroundings. They remember to bring books and materials to and from school and are more aware of social cues.
How does Cogmed working memory training work?
The working-memory program is downloaded onto a home computer. A child logs on and completes eight exercises, each consisting of 15 trials. The exercises, which look and sound like a video game, become increasingly harder. A trainer calls once a week to talk with the parents. The training is rigorous, so few children under age seven can stick with it. Children who have recently been diagnosed with AHD should have their medication titrated before beginning training.
How long is the training, and how much does it cost?
The training runs five weeks, five days a week, an hour a day. It ranges from $1,500 to $2,000, and it is not covered by most insurance plans.
What percentage of kids show improvement after?
About 75 to 80 percent of kids show improvement – that is, inattention and hyperactivity are reduced. MRIs of children who completed training showed physical changes in the brain’s pre-frontal and parietal regions. At six-month and one-year follow-ups, about 80 percent of subjects maintained or improved their working memory gains.
Is working memory training a substitute for medication?
The program does not claim to replace medication.
Low-tech Ways to Help Your Child Improve His Working Memory
Let your child know when he’s about to hear information he needs to retain. You can say, “I want you to remember this,” or “Put on your thinking cap.”
Teach your child to engage several senses. If she’s learning to read, for example, have her trace letters with her finger while saying the sounds and looking at the symbols.
Provide a count of the details to be remembered. You might say, “There are ten new vocabulary words. Five are verbs related to transportation, and five are adjectives that describe speed.”
Help your child create charts, rhymes, and raps to remember spelling rules, multiplication tables, and history facts. Rhythm makes information memorable.
Encourage your child to highlight or underline important facts as he reads and to re-read the underlined material.
THE BENEFITS OF ‘GREEN TIME’ FOR ADHD CHILDREN
Recent studies suggest that more time spent in backyards and parks translates into better focus and behavior for ADHD kids.
A 2007 study in the Journal of Public Health confirmed that as little as 20 minutes of daily “green time” can reduce the symptoms of ADHD in children. The survey of 500 boys and girls ages five to 18 noted sizeable benefits after time spent outdoors recovering from “attention fatigue.” (Attention fatigue occurs after long periods spent concentrating, inhibiting impulses, or being patient.)
When you concentrate on a task like writing, neurotransmitters in the brain’s prefrontal cortex get depleted,” says Frances Kuo, Ph.D., author of a similar study by the University of Illinois. “Being in a natural environment seems to let the system replenish itself.”
In his book, Last Child in the Woods, Richard Louv traces a host of emerging trends, from higher levels of childhood obesity and depression to a dearth of creativity and lower academic performance, back to what he calls a “nature deficit” in today’s plugged-in kids. He argues that the human brain is hard-wired to thrive on the sensory input provided by swaying trees and gurgling brooks, and their absence may change us in fundamental ways.
Research also shows that aerobic activity can help relieve ADHD symptoms, so here are some ideas for getting your children outside and moving toward greater health:
Commute smarter. Walk or bike to school via the greenest route available – waking up a few minutes early will pay off with sustained attention all day.
Walk the dog. A dog is an enthusiastic fitness partner who will help you walk or run outside on a daily schedule.
Ride a bike. Whether it’s a leisurely ride around the neighborhood or a hard and fast workout that satisfies your need for speed, biking is a great way to get out in nature.
Row a boat. Paddling a canoe, kayak, or rowboat works the upper body and displays nature from a new vantage point.
“The greater the exposure to nature, the greater the attentiveness.” – Frances Kuo, Ph.D.
A “Green” Tip
Gardening offers a bounty of visual, tactile, and olfactory delights. Plus, watering plants each day teaches responsibility, and awaiting late-season blooms helps kids understand delayed gratification.
NEUROFEEDBACK: A PROMISING THERAPY FOR ADHD CHILDREN
How these high-tech brain exercises can help reduce impulsivity and increase attentiveness in children with ADHD.
By Pamela V. Michaels
Why neurofeedback? Each year, many parents of children with ADHD begin researching this treatment because traditional medication has stopped working (or never worked), produces unwelcome side effects, or, most commonly, does not manage all the symptoms of ADHD.
Today, approximately 10,000 U.S. children are receiving neurofeedback treatments to reduce impulsivity and increase attentiveness, according to Cynthia Kerson, executive director of the International Society for Neurofeedback and Research. Seventy-five to 80 percent of them have some type of attention deficit condition.
What Does Neurofeedback Entail?
Sessions are brief (approximately 30 minutes) and painless, but they are expensive. The average course of treatment can range from $2,000 to $5,000.
Children younger than six and those who don’t understand what’s being asked of them should avoid neurofeedback. Side effects include sleepiness, headaches, and/or crankiness right after a session. These are usually relieved by a short nap or protein-rich snack. Some children experience a temporary increase in mood swings around the eighth week of treatment. Reducing medication dosage may alleviate the side effects. Talk with your doctor.
How does a parent know if the therapy is working? According to experts, the practitioner should see increased activation of the brain’s frontal lobe after five sessions. If not, treatment should be postponed. To find a qualified practitioner in your area, contact the Biofeedback Certification Institute of America (bcia.org).
Treatment Specifics
Neurofeedback is based on a simple principle. “The brain emits different types of waves, depending on whether we are in a focused state or day-dreaming,” explains Siegfried Othmer, Ph.D., chief scientist at the EEG Institute in Woodland Hills, California. Neurofeedback aims to teach the patient to produce the brain-wave patterns associated with focus. The result: Some symptoms of ADHD – impulsivity, distractibility, and acting out – diminish.
Here's how the treatment is structured. First, the patient dons a cap lined with electrodes and is asked to perform a complex cognitive task. The results are shown as a color-coded map that indicates areas of the brain demonstrating too much or too little brain-wave activity – the theoretical sources of the patient’s ADHD symptoms. This digital map is compared with other brain-wave patterns stored in databases – and can help fine-tune a treatment plan by delineating sites for the electrodes. During treatment, the child wears the same headgear while sitting before a video screen. His goal is to move the characters in a computer or video game by producing short bursts of sustained brain-wave activity in those areas of the brain thought to be under-aroused. The software generates the game and monitors and records brain activity. Loss of focus will cause the game to stop. It plays only when the child exercises that portion of the brain that is deficient in focus.
Neurofeedback Detractors
Neurofeedback has its share of critics, many of whom have valid objections. Unlike medication, the therapy hasn’t been rigorously tested in large, double-blind studies. Some experts also claim that studies don’t clearly prove whether improvements in children are due to the therapy or to one-on-one time with a therapist. Another criticism is that while neurofeedback may sharpen attention in some children, it doesn’t always improve the other problems associated with ADHD.
While some experts admit that neurofeedback has promise, they believe that it should be used in combination with medication.
Neurofeedback (NFB) is also called…Neurotherapy, Neurofeedback, EEG Biofeedback
The Healing Power of Neurofeedback, by Stephen Larsen and Thom Hartmann
The Open-Focus Brain, by Les Fehmi and Jim Robbins
Getting Rid of Ritalin, by Robert W. Hill and Eduardo Castro
“If I had a child with ADHD, I might use neurofeedback as one part of the treatment regimen, but I wouldn’t use it instead of other treatments that are better supported (by research).”
David Rabiner, Ph.D., senior research scientist at Duke University Center for Child and Family Policy
Accommodations for High School and College
ADHD
Preferential seating, i.e., sitting near the front of the room and away from doors, windows, and other distractions.
Provide a copy of the instructor’s notes or have a designated note taker if note-taking is problematic.
Provided copies of textbooks on tape and/or computer-aided instruction in areas of low interest.
Allowed to take tests in a distraction-free environment
Allowed extra time on exams with a time limit or that require a lot of writing.
Allowed to tape record lectures
Use word processing programs with grammar and spelling checkers for his papers, classwork, and homework as is feasible.
Use computer-aided instruction when possible
Shorten assignments; break longer assignments into smaller parts.
Simplify/repeat/reword complex directions and check for understanding.
On-task reminders/redirections as needed
One-on-one instruction when needed
Break long-term projects into smaller parts and prepare a timeline for each part. Use a “month-at-a-glance” calendar to track long-term assignments. Organize when work segments are to be completed.
Scratch paper or electronic devices (always available in the real world) to aid in problem-solving or simple arithmetic/word processing/spell check.
Processing (Visual Motor) Speed
Allow extra time on tests that require extensive writing.
Allow to take tests orally when extensive writing is required.
Being provided a copy of classroom notes from the teacher or a designated note taker.
Use word processing programs with grammar and spelling checkers for all papers and homework as is feasible.
Tape record lectures.
When copying from the board is required, provide students with the information or allow the use of note-takers.
When an assignment is to copy questions from the board or book and then write the answers, allow to write the answers only.
Reduce the amount of work to the amount needed for mastery.
Working Memory
1. Provide a copy of notes from another student or the teacher if note-taking is a problem
2. Reduce distractions with preferential seating and with testing in separate rooms.
3. New information or instructions may need to be kept brief and to the point or repeated concisely.
4. Develop and use checklists.
5. Allowed extra time on exams.
6. Shorten assignments; break longer assignments into smaller parts.
7. Break long-term projects into smaller parts and prepare a timeline for each part. Use a “month-at-a-glance” calendar to track long-term assignments. Organize when work segments are to be completed.
8. Use a planner
Handwriting
Allow extra time on tests that require extensive writing.
Allow to take tests orally when extensive writing is required.
Being provided a copy of classroom notes from the teacher or a designated note taker.
Use word processing programs with grammar and spelling checkers for all papers and homework as is feasible.
When copying from the board is required, provide students with the information or allow the use of note-takers.
When the assignment is to copy questions from the board or book and then write the answers, allow to write the answers only.
If writing is illegible, allow verbal clarification.
Material Taken From:
Amishi Jha•Peak Mind
•Hallowell and Ratey: ADHD 2.0 and Driven to Distraction
•Race car engine-bicycle brakes
•(VAST) Variable Attention Stimulus Traits
•Positive outlook with treatment
•Lidia Zylowska: Mindfulness Prescriptions for ADULT ADHD
•Kristin Neff: Self-Compassion, The Proven Power of Being Kind to Yourself
•B. J. Fogg: Tiny Habits, The Small Changes That Change Everything
•Thom Hartman: ADD Success Stories, ADD: A Different Perspective, Think Fast
•Social Anthropology
•Hunter in a Farmer’s World Viewpoint (understanding ADHD)
•Huberman Lab Podcast: Neurology, Neurochemistry, Medication it stand out
Material taken From
Bibliography
Vanderbilt checklists
Arnold, L.E. & Wolraich, M. L. (2016)* Contemporary Diagnosis of Attention Disorders Fourth Edition. *: Handbooks in Healthcare Company.
Barkley, R.A. (2015). Attention deficit hyperactivity disorder: A Handbook for Diagnosis and Treatment 4th ed. New York: The Guilford Press.
Barkley, R. A., (2016). Managing ADHD in School. Eau Claire, WI: Guilford Press.
Barkley, R. A. (2005).* Taking Charge of ADHD: The complete authoritative guide for parents. New York: Guilford. Call Guilford Publications, Phone: 800-365-7006.
Barkley, R. A., (2010).* Taking charge of adult ADHD. Washington, DC: PESI Publishing and Media.
Brown, T. (2000). Attention deficit disorder: and the unfocused mind in children and adults. New Haven, CT: Yale University Press.
Barkley, R.A. ADHD Report, a bimonthly newsletter for clinicians edited by Dr. Barkley with contributions from leading clinicians and researchers. Call Guilford Publications at 800-365-7006 to subscribe or go to www.guilford.com.
Corman, C.A. & Hollowell, E.M. (2006). Positively ADD: Real success stories to inspire your dreams. Walker & Company
Dendy, C.A.Z. (2004). Teenagers with ADD and ADHD, 2nd ed. Bethesda, MD: Woodbine House.
Dendy, C.A.Z. (2011). Teaching teens with ADD, ADHD, and executive function deficits. Bethesda, MD: Woodbine House.
Dendy, C.A.Z. & Zeigler, A. (2007) A bird’s-eye view of the life ADD and ADHD: Advice from young survivors, 2nd ed. Cedar Bluff, AL: Cherish the Children.
Dendy, C.A.Z. & Zeigler A. (2011) DVD Real life ADHD: A survival guide for children.
Greene, R. (1998) The Explosive Child. Harper Collins.
Hallowell, E.M. & Ratey, J.J. (2006). Delivered from distraction, getting the most out of life with attention deficit disorder. New York: Ballantine Books.
Hartmann, T. (1993). Attention deficit disorder: A different perception. Penn Valley, CA: Underwood-Miller.
Hurt, E.l. & Arnold, L E. “Dietary Management of ADHD” in Barkley, R.A. (2015). Attention deficit hyperactivity disorder: A Handbook for Diagnosis and Treatment 4th ed. New York: The Guilford Press. Pp. 630-640.
Mitchell, J. T. et al. (2014) “Mindfulness Meditation for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotional Dysregulation” Journal Of Attention Disorders. Article (PDF Available) in Journal of Attention Disorders · December 2013.
McCallon, T. D. If He Outgrew It, What Is He Doing in My Prison? 1998. http://adultaddstrengths.com/2008/11/18/if-he-outgrew-it-what-is-he-doing-in-my-prison/
Quily, Pete.(2011). ADHD and Crime. 21% To 45% 0f Prisoners Have ADHD 15 Peer Reviewed Studies Show. Crime & Jail Are Costly, Treatment Is Cheap http://adultaddstrengths.com/2011/01/12/adhd-and-crime-ignore-now-jail-later-15-clinical-studies/
Rabiner, D. “Does ADHD medication treatment in childhood increase adult employment?”, Journal of Attention Disorders, 13, 175-187.
Robin, A. R. (1998). ADHD in adolescents: Diagnosis and treatment. New York: Guilford.
Safren, S. et al. Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program. New York: Oxford University Press.
Snyder, M. (2001). ADHD and driving, A guide for parents of teens with AD/HD. Whitefish Consultants.
Swanberg, Dennis, Passno, & Larimore, Walt. ADHD Doesn’t Mean Disaster. Carol Stream Illinois: Tyndale House Publishers. 2003.
NICHQ Vanderbilt Assessment Scales. www.nichq.org/resource/nichq-vanderbilt-assessment-scales
Zylowska, L. (2012) Mindfulness Prescription for Adult ADHD. Boston: Trumpeter Books.