Parenting a Child with AD/HD
Patricia Quinn, M.D.
“Parenting a child with AD/HD is like riding an emotional roller coaster.” Father of a son with AD/HD
Attention Deficit Hyperactivity Disorder or AD/HD is a neurobiological condition that is thought to occur in over 5.4 million children in the United States alone. Main symptoms of the disorder include difficulty focusing, short attention span, distractibility, hyperactivity and impulsivity. A child with this disorder usually has difficulty controlling his behavior both at home and at school.
At school, disruptive behaviors and inconsistent academic performance often lead to academic underachievement. As a result, these problems attract attention in the classroom and the child is usually referred for an evaluation and diagnosis. An AD/HD diagnosis, in most cases, triggers an automatic process within the educational system leading to a multimodal treatment program that may include a classroom behavior management program, environmental modifications (accommodations), appropriate school placement, and/or treatment with medication.
AD/HD can also affect a child’s behaviors at home. However, it is here that AD/HD has a way of cutting through all rational processes, feeding directly into parental emotions. Parenting is a challenge under the best of circumstances and all parents can run out of patience. However, remaining rational in the face of certain behaviors associated with AD/HD can be extremely difficult. And, while it is important to know the effects AD/HD has on your child, it is equally important to understand the effect’s a child’s AD/HD has on you, the parent.
In a recent national survey of over 1000 parents or caregivers of children with AD/HD under the age of 12 conducted this past summer (July 12-18, 2011) commissioned by Noven Therapeutics (makers of the Daytrana patch for treatment of AD/HD) in collaboration with Additude Magazine, more than one-third of parents (36%) reported that they found their child’s behavior during weekday activities and events – including after school activities -- difficult to manage with 56% pin-pointing homework time to be the most difficult.
Children with AD/HD also need a great deal of supervision and parental involvement because of the difficulties they have with following through on routine daily activities at home. Sixty-five percent of parents surveyed felt that they needed to spend time closely shepherding their child through the morning and other routines. In addition, over one-quarter (27%) of the parents reported having difficulty managing their child’s behaviors during family or social events on weekends.
When asked about their child’s most common behaviors and reactions during these difficult after-school and weekend periods, parents shared that their child:
- Appears to not be listening (78%)
- Has difficulty finishing schoolwork or chores (74%)
- Exhibits defiance or oppositional behavior (64%)
The most common strategies used by parents to manage these behaviors included verbal reminders (77%) and discipline or negative consequences (74%). In addition to acknowledging how challenged they feel by their child’s behaviors, parents reported that they were frustrated by their own behaviors at these times. The majority of parents (72%) admitted that they felt that they yelled and criticized their children more than they would like. But, how are parents suppose to address these challenging situations and change their behaviors to better deal with these AD/HD moments? In my experience, a two-pronged approach that includes both the use of medication to treat AD/HD behaviors and a program for changing parenting perspectives, as well as a child’s behavior may be the answer.
AD/HD cannot be cured, but treatments are available whose primary aim is not only reducing symptom intensity and frequency, but also helping children and parents cope with and better manage daily activities. Behavioral therapy combined with stimulant medications is currently thought to be the best treatment approach for improving the lives of children with AD/HD and their families. Let’s take as closer look at what each of these treatments entails.
Stimulant medications are commonly recommended to treat AD/HD symptoms. These medications, which have been used since the early- to mid- 1990s, help to decrease impulsivity and hyperactivity, while increasing attention. There are several forms of medications that include different formulations of the compounds methylphenidate and amphetamine and are available in short, intermediate and long-acting forms including oral, as well as patch therapy. Hundreds of research studies have shown these medications to be safe and effective at reducing the core symptoms of AD/HD. They, however, must be used consistently to make a difference.
Deciding to medicate a child to treat and manage his AD/HD can be a difficult decision for parents often resulting in ambivalence and inconsistent administration. The recent survey was able to shed light on this situation as well. While the overwhelming majority of parents (94%), who choose to treat their children with medication do so to cover school day symptoms, 60 percent of them allow the medication to lapse during the difficult after-school time when the child has homework and other challenging activities. In addition, approximately 60 percent of parents do not continue medication treatment on the weekend despite the acknowledged challenges they have with managing AD/HD behaviors.
Making an Informed Decision
These results underscore the difficulty parents have in coping with the after-school and weekend challenges caused by their child’s AD/HD behaviors and confirm the need for more flexible medication options. With so many children participating in after-school and weekend activities, parents need to learn about various options for managing their child’s busy schedules and continuing treatments during these times. Parents need to learn about the importance of keeping symptoms under control and receive information that will allow them to assess all medication options currently available to treat the disorder. With this information, they will be able to make an informed decision and choose a medication regime that will meet their child’s and family’s needs.
Changing Parenting Perspectives
In addition, to better handle these difficult situations, it may be helpful to consider that parenting a child with AD/HD is very similar to the role of a ship’s captain. The captain does not assert his will against the forces of nature he encounters, but rather works with and respects the forces he encounters. It is important to note that even slight shifts in the interaction with a child with AD/HD can produce promising results for both parents and child.
The following are some ideas for parents of children with AD/HD to keep in mind when dealing with their child’s AD/HD moments:
- Know that your child is not doing things to annoy or upset you on purpose.
- Observe and understand what your primary reaction is towards your child with AD/HD. Is it anger, frustration, pity, empathy, enabling, etc.
- Think about possible alternative responses that you can make. With the right type of response most incidences can “blow over” in a short time. Misguided anger will only intensify the problem.
- Reflect on the fact that this particular incident in the larger scheme of things is only one of millions of responses your child will make in his or her lifetime.
- Realize that you, too, make mistakes, misread situations, and have the capacity to become volatile.
- If you find yourself becoming angry or frustrated, take a break from the situation and go for a walk, take some deep breathes, and/or enlist help from your spouse or significant other.
- Envision in your mind the kind of responses that you would like to make when your child misbehaves.
- Tell your spouse, significant other, or therapist how you want to interact with your child. This establishes a “response contract” and will help you to respond with this desired behavior more often.
In addition to changing their reactions to situations, parents can also improve behavior during some of these difficult situations by providing consistency and structure and setting-up behavioral programs for their child. Behavioral therapy programs give children with AD/HD practical instructions and assistance to modify how they think and behave. Instructions often include how to monitor one's behavior and self-reward for positive behaviors. It’s also important to establish a schedule and use tools to organize chores and schoolwork for children with AD/HD. Let’s look at “getting homework done” as an example to see how this might work, as it was reported to be a problem for more than half of the families surveyed.
Helpful Tips on Getting Homework Done
Children with AD/HD need consistency. Developing a routine for homework will give them the focus to finish it.
- Do homework at the same time every day.
- Designate a defined homework area for your child.
- Make sure all materials, books, and assignment sheets are at hand.
- Assist your child in prioritizing and getting started on assignments.
- Use a timer to challenge your child to stay on task.
- Praise and reward work on completion.
- Build in five- or 10-minute breaks.
- Have your child put finished homework in his backpack.
There certainly is a lot of information, and misinformation, out there about AD/HD. It’s understandable that parents feel overwhelmed and confused when attempting to understand, and seek treatment for their child’s condition. However, the key to successful management of AD/HD in children is helping parents and their children work together to make life better – and to get off that emotional roller coaster!