Parenting an ADHD child is not for sissies. It is also not impossible, but you have to be aware of and know a lot of things.
In this series, we will cover these issues one at a time.

First issue is know yourself. If you have an ADHD child, the odds are that one of you also has ADHD. ADHD has a
heritability factor of about 80%, which is about the same as height. That means one of you almost certainly has ADHD.

This can be good or bad. You may remember your own issues with ADHD and be able to understand your child’s situation better than a non-ADHD parent.  On the other hand, you may have more problems dealing with your ADHD
child because your temperaments are too similiar or you may have a lot of your own issues about ADHD that negatively impact your ability to deal with your young ADHDer.

Whichever, you need to be aware of what you bring to the interaction with your ADHD child. Objectively look at your interactions and be aware of what happens. Does one of you (parents) always end up in yelling matches with your child?

Does one of you always get overwhelmed by your child and give up?

Understand that with an ADHD child you could have a knockdown drag out screaming match every day if you want to.

And understand, it will do no good as far as changing your child’s behavior. And, you will pay for it when they become teenagers.

Be aware that in dealing with ADHDers, you have to be firm. You have to be consistent. You have to be in control. If you lose control of yourself dealing with your ADHDer, you will surely lose the immediate battle plus you break down the behavioral structure you’re trying to build.

That’s why the first rule in dealing with an ADHD child is to know yourself– know your tendencies, know your strengths and weaknesses. Be brutally honest. Be objective.

Next step–look at your interactions

(This is an update of an earlier article)

Its easy as an ADHD parent to lose sight of what you’re trying to accomplish with your child.
There’s so much that could be improved.
So many areas that cause problems.
So many things that are irritating and frustrating.

One way to stay on track is to have a good idea of what you would like your child to be like when he or she is 18 or 21. This is not just about grades and school but  also about personal characteristics you’d like to see. For most of us that would include things like being responsible, honest and persistent.

Its really important to be clear on what you’re trying to teach your child.  It also helps you set priorities. Priorities help you decide how to intervene and whether to intervene. It also helps you decide what to reinforce and what to extinguish.

Say, for instance, responsibility is a strong value for you that you’d like to teach your child. You can recognize when he is being responsible  and encourage that. You can set up situations in which your child can be responsible and reinforce appropriate behavior. You can recognize that constant criticism about lack of responsibility is not effective.

You must have an appreciation of the principles of successive approximation when you use this approach. Successive approximation is just a fancy term that summarizes the idea that change happens a little bit at a time. If you are teaching responsibility, it is not different from learning to play  a musical instrument or learning an athletic skill. You have to learn a little bit at a time. First make a noise with your clarinet, then learn fingering, how to make the different notes, then scales, then simple songs and so on.

Personal characteristics that we’d like to see our children develop are the same way. You have to learn to recognize and praise small steps in the right direction. If your child does one small thing–like making his bed, but not totally cleaning his room. Praise for doing the bed,not criticism for failing to clean the whole room.

Its important to develop the ability to recognize these small improvements and encourage them. And remember to stay focused on the distant goal you have for your child.

Sometimes it seems like being the parent of an ADHD child is all about frustration and fear. Frustration that they can’t seem to get stuff done the way their peers, brothers and sisters can and fear that they won’t be able to make their way in the world.

I propose another way to look at it. An ADHD child is a chance to explore other options in life besides the-get-good-grades-go-to-college-get-a-good-job-work-until-you-retire option.

Those of you who are veterans of ADHD parenting probably know that this is a difficult path for an ADHD child to follow. They’re intelligent enough to do pretty much whatever they want, BUT that ADHD thing gets in the way of the routine aspects of school and life.ADHD kids are not good at being consistent or compliant.
They aren’t good at routine and they crave stimulation and excitement.

They aren’t probably going to do well in very structured jobs like office work and accounting, for example. They would likelier  be happy as salesman,actors,artists, public speakers and so on.They will want to pursue other career and lifestyle options.

Most of us ADHD parents, especially the ones who don’t have ADHD themselves, have never considered these other options. We may even be a little afraid of them. They’re not what most people do.

We need to reframe this viewpoint and see it as a chance for us to grow  and have new life experiences vicariously. For instance, I never would have learned so much about gemstones if my ADHD child hadn’t developed an interest in gems and jewelry design.

Who knew?

No one on either side of the family has ever been in the jewelry or the design business. I can tell a sapphire from a ruby most days, but that’s about the limit to my knowledge. I was just pleased that he developed an interest, a passion and followed up by getting the training he needed.

I was thinking more of medical school or psychology, but that was never really in the cards.

The important thing is he followed his interests. He found something he’s passionate about and as his parents we get to learn, experience an area we never would have experienced.

So ADHD parents, think outside the box. Allow your ADHD child to deviate from the family plan and explore his/her interests.

Just medication is not going to improve your child’s academic performance!

A recent research study by Dr Jeffrey Epstein of the Center for ADHD at Cincinnati Children’s Hospital in Ohio indicates that just following pediatric guidelines for treatment of ADD, didn’t result in functional changes for children with ADHD. Just proper medication didn’t change their school performance at all.

More simply put:” Pills don’t teach Skills!”

The study suggested that ADHD kids needed additional training in organization and academic skillls to improve academic performance. This finding flies in the face of the “just give ‘em their meds and they’ll be all right.”school of treatment. Medication by itself will not help your child improve his or her grades.

This research combined with the research on the importance of working memory to academic performance (see Working Memory beats IQ in School, 02-23-2010) builds a strong case for the importance of computerized cognitive retraining (CCR) for improving academic performance of kids with ADHD.

I personally am more confident recommending CCR for students with ADHD after reading these studies.While the effectiveness of CCR in improving working memory is well-researched and well-proven, the extension to improved academic performance is now firmly established.

CCR improves academic performance. Period.

If your child is struggling in school, you need to strongly consider CCR. Approximately 30 sessions over a few months time will make a big difference.

Working memory is more important to academic success than IQ, according to recent research.  Why is that important to ADHD parents and what the heck is working memory anyway?

Working memory is the ability to keep information in awareness until a task is accomplished. An example would be when you tell your child to do three things and only two get done ( if  you’re lucky). People with ADHD have very poor working memory, so your child’s difficulties in school are likely related to difficulties with working memory.

The research was recently published in The Journal of Experimental Child Psychology by Dr. Tracy Alloway. It indicates that working memory is more important to academic success than IQ. Working memory is also the best predictor of reading,spelling and math

IQ is a very unreliable predictor of academic performance. Indeed, if I only had a nickel for every time a parent has told me– “He’s  very smart , he just doesn’t get good grades.”

So, the bad news is that here’s another problem for ADHD kids.

The good news is that working memory is something we know how to improve. The research on neuroplasticity indicates that the brain adapts and adjusts to the demands we make on it.

Computerized Cognitive Retraining(CCR) is a very effective, well-researched and efficient approach to improving working memory. We have known that CCR improves working memory,but we haven’t had direct evidence that it impacts education directly. Now we do.

This research also explains why tutoring for ADHD kids is frequently not effective. It’s not aimed at the right target. Its not designed to, nor does it improve working memory.

CCR can specifically target working memory and improve it . The improvements take 20-30 sessions of CCR to become noticeable and they last because you’re training and structurally changing your brain. MRI studies show that CCR causes growth in the specific part of the brain targeted by the program.

The part of your brain that’s involved in working memory actually gets bigger and more dense. (Density is good in this case because it means more dendritic connections, that is your neurons are talking to each other better.)

If you have questions about CCR and ADHD and/or school performance, feel free to contact me.

ADHD kids are plagued by emotions that are frequently out of control. They are emotionally labile–happy one minute, enraged the next. They appear to have little control over their emotions.

This is a cause of significant distress for the child and everyone around him or her.

One of the characteristics of ADHD children who are sucessful in later life is the ability to deal with and manage emotions.

A useful set of techniques for dealing with emotion is cognitive behavioral therapy. The basic assumption of CBT is that our emotions are generated by the way we think about situations and events, not by the situations or events themselves.

This could obviously be a little abstract for a very young child, but it can be simplified by focusing on what the child is thinking rather than on what he’s feeling or shouldn’t be doing.

The discussion following an emotional outburst can then become a discussion of what you were thinking and how what you were thinking caused you to feel. Emphasis is always on you having responsibility for your emotions because you generate your emotions.

It takes time for the child to be able to use this technique. The major step is getting awareness of the link between thought and emotion  and acceptance of the responsibility for the emotion.

The second assumption of CBT is that if we change our thinking we change our emotions. Exaggerated emotions are caused by exaggerated (unrealistic or irrational) thinking.

Changing our thinking to more realistic and logical thoughts will result in more modulated emotions. It doesn’t mean you’ll never get irritated or frustrated  again, but it does mean that episodes of eyeball bulging, vein popping rage should be much less frequent.

Technique-after a meltdown,
1. help the child identify the emotion. Were you angry at Billy or afraid your friends would like him better than you?
2. help him identify the exaggerated thoughts–nobody will ever like me, I’ll be all alone forever. Billy’s a poop-head.
3.help him establish some emotional distance–through humor, exaggeration, distraction.
4.help him come up with more rational, logical thoughts–Billy’s not really a poop-head, I actually like him. I just didn’t like what he did today.Or even if my friends all played with Billy today, he won’t be here tomorrow and they’ve been my friends for years, so we’ll probably play again. And no, I won’t be alone forever.
This is a useful technique that improves with age and experience. It gives the ADHD child one set of tools for dealing with emotions. It’s also helpful for ADHD parents!

Disorganization is one of the hallmarks of the ADHD brain. We’ve already talked about the need for external structure to improve performance for ADHD’ers.

This is the first step in developing an internalized ability to organize. For a child with ADHD to learn to be a reasonably organized person, he or she must experience organization and observe organization. There must be an adult in the environment who is reasonably well-organized to serve as a model.

Knowing that the heritability of ADHD is about 80%, it is likely that there is also one disorganized adult in the environment. This adult must model attempts to be organized and, most importantly, place a positive value on being organized.

It’s really difficult for a child with ADHD to make efforts at being organized if one parent is extremely negative about organization or makes fun of it (look how obsessive-compulsive she is).

There is no one way to be organized. There are countless systems, organizers and strategies for keeping up. Some school systems even give out agendas. The problem is finding a match between the system and the ADHD’ers cognitive style.

There are two big differences in cognitive style which, in a gross oversimplification, we’ll call left brain and right brain.

The left brain organizational systems are typically linear, overwhelmingly logical and frankly boring. They consist of organizing by to do lists which are, in some cases, merely straight lists of assignments done without any prioritizing.

The right brain systems are more visual and emphasize visual systems for organization that are based on using visual cues to attain organization.These systems will tend to use color or other visually striking ways to organize information. Mind mapping is a new and highly effective strategy for using visual techniques to improve organization and planning. It’s available for computer use from a variety of free downloads including http://freemind.sourveforge.net.

For people who are highly visual, mind mapping or color  coding are likely to be more effective strategies for organization. These are also the kind of people who do not do well with file cabinets and other linear organization strategies. These people need to see things to be able to work with them. They need large desks with room for different piles of stuff. They are not happy nor are they effective with a bare desk and a full file cabinet. If they can’t see it, it doesn’t exist therefore they will forget about it and never get around to doing anything about it.

These people typically don’t like paper with lines, staying inside the box and other manifestations of organization. Give them a blank piece of paper and teach them mind mapping strategies and their performance will improve.

More left brained people are more comfortable with a linear language and logic-based systems, but if they have ADHD, they are going to need to make this system more interesting. There are lots of ways of doing this, but with kids now days using some electronic or digital organizer will likely be more effective.

Kids typically don’t like large clunky organizers like most of the agendas, schools issue. They want something small that will fit in a pocket and are cool or hot or whatever the current term is for something that’s fashionable. PDA’s (personal digital assistant) are an option as are most cell phones. Paper and pencil systems, like Day Timer, can also be helpful. They come with custom covers/holders that sometimes pass the cool test.

Once you’ve got the hardware, the trick is to use it regularly. You’re ahead of the game if you match cognitive style with the organization system. You still have to teach some of the basic techniques of organization such as taking big projects and breaking them down into smaller, easy-to-accomplish tasks and tracking them.

To get regular use from the system you have to check regularly and insure that your ADHD’er is using it. After 8 to 12 weeks of checking daily, you can likely back off some.

This combination of external organization, organizational strategies keyed to cognitive style and regular checking should cause your ADHD’er to internalize organization.

More information seeADHD brains — external structure.

]]> http://terrygingrasphd.com/adhd-brains-internal-structure/feed/ 3 http://terrygingrasphd.com/training-adhd-brains-structure/ http://terrygingrasphd.com/training-adhd-brains-structure/#comments Thu, 19 Nov 2009 13:49:47 +0000 TGingras http://terrygingrasphd.com/?p=53

Chaos without reinforces chaos within.  ADHD Brains are different.

ADHD kids live with chronic chaos–in their brains. Their innner experience is frequently disorganized, unfocused  and not particularly goal oriented.

When scientists look at their brain functions, ADHD kids have underactive frontal lobes  and generate more of the brain waves associated with disorganized thinking.

They, more so than other children need external structure in their lives. A chaotic home life without consistency or structure makes their internal chaos worse.

On the other hand, a home life with a structure, with routines they can depend on will help them improve their internal organization.

The brain demonstrates neuroplasticity, that is, it changes, actually changes its structure based on the demands you make on it. You establish routines for your ADHD child and eventually ( you know nothing comes fast with this group) he or she internalizes it.

You are teaching organization by demonstrating it.

Want to handle the problems of getting up in the morning? Have a routine for it and follow it precisely.

Problems with homework? Have a routine for it. This is the time you do your homework every day. This is where you do your homework every day. These are your materials to do your homework. They will be here every day.

Also, and very important for a variety of reasons,  is a  family meal time. We meet for our meal, discuss the events of the day, discuss any problems we have ( no anger or frustration from parents,please). This is a time to get to make sure we still know each other. No TV. No cell phones. No texting. No game boys.

Routines provide structure. They also provide comfort for children. Structure makes the world more predictable. Having a strong family structure also makes it easier to adapt and adjust to the structures in other environments, like school.

Eventually, with consistency structures are internalized by children. They start to expect them and eventually, they start developing their own structures/ routines.

Chaos without leads to chaos within.

Organization without leads to organization within.

ADHD brains require special handling.

T–

For more information on ADHD brains, see Training ADHD Brains-Meditation @ http://terrygingrasphd.com

When I was a boy psychologist first learning about ADHD, I thought meditation, relaxation training and/or hypnosis  should be an effective treatment because it trains the mind to focus.

One of the attempts to define hypnosis even calls it a state of heightened focus. Additionally, my patients were reporting heightened abilities to concentrate after starting one of these programs.

Unfortunately, at that time, there was no scientific research supporting the effectiveness of any of these procedures with ADHD.  Russell Barkley, the well-known researcher, specifically said meditation wsas not effective for ADHD

Well, here we are 20+ years later and we have research support that meditation is effective for reducing ADHD symptoms.

There are several studies available, mostly researching mindfulness meditation. There are even studies utilizing functional MRI to document brain changes–increased thickness and density ( these are good things for your brain indicating increased capacity in the area that’s growing).

Mindfulness meditation is a technique that focuses on increasing awareness of basic sensory information, as in breath mindfully. This technique involves focusing on your breathing and constantly redirecting your attention back to your breathing when it starts to wander.

The technique involves calmly redirecting your attention with the expectation that you will gradually find it easier to stay focused.

There are all sorts of variations on these techniques include the Transcendental Meditation  technique of using a focus word on each exhalation. And most of us have heard of the all-purpose “Om” spoken out loud as an aid to meditation.

Mindfulness meditation has been demonstrated to alter attentional networks, change EEG patterns  and change dopamine (neurotransmitter ) levels.

Practically, meditation is easy to understand, somewhat more difficult to do. Surpisingly, (to me anyway) I have had reasonably good results in my private practice with this technique.

It requires no equipment although some simpler biofeedback equipment, such as the Heartmath  EmWave Personal Stress Reliever may enhance the effect and make compliance easier.

If you decide to use mindfulness meditation you should find a qualified instructor at least initially. It should be someone with specific training in meditation and ADHD such as your basic baby boomer psychologist who was exposed to all the meditation techniques back in the 60s.

Pick somebody with training and credentials. The nice exercise instructor reading a technique out of a book after an exercise class is not a good choice.

Meditation is an  effective technique and needs to be taken seriously. It will be worth it  in the long run.

T–

For more information on ADHD, see Training the ADHD brain–computerized cognitive retraining @ http://terrygingrasphd.com

Another drug-free approach to improving cognitive performance is neurofeedback.

It is a biofeedback methodology that gives the individual feedback about the kind of brainwaves being generated and trains the individual to produce the appropriate brain waves.

The brain waves associated with focused attention are called Beta. The brain waves associated with disorganized thinking are called Theta. With ADHD clients , we’re training the patient to increase Beta and decrease Theta.

This change, increasing Beta and decreasing Theta, eventually becomes permanent. This leads to consistently improved control of attention, with less time being spent in relatively disorganized mental states.

We could go into more detail, outlining all the different brain waves and their frequencies, but the basic premise is the same–if you have ADHD, Theta bad, Beta good.

If you’re from the 60s or 70s ,  the only brain wave , you have probably heard of is Alpha which is associated with calm, peace and relaxation. There are many approaches to generating Alpha, but there is not consistent reasearch suggesting that alpha training is beneficial for ADHD.

Treatment takes about 30 sessions.  Improvement  i n ability to concentrate and control behavior is thought to be permanent. A session lasts about 45 minutes.

The patient has electrodes stuck to their scalp in various precisely measured locations. This sounds really bad but is about the same as putting tape on the scalp. It is totally painless. The electrode has a small cavity that is filled with electrode gel–a sort of sticky substance kind of like chapstick, that improves electrical conductance. Understand the electrodes are passive receivers, they do not send electricity into the brain, they merely measure the electrical impulses that the brain is producing.

Although this procedure–geting hooked up–can take a little time, most little boys kind of enjoy the process. After hook-up they wires coming off their scalpto the machine. In my clinic, we use a wireless system that allows  a lot of movement without pulling the electrodes off.

Treatment sessions normally consist of learning to control brain waves, while watching videos or listening to audio cassettes. (The speed of presentation and , indeed, whether it is presented at all is controlled by the patient’s brain waves.  If the patient is meeting the training criterion, the dvd or cd plays normally. Fall out of criterion and they slow or stop.)

We use a system that allows us to combine neurofeedback and cognitive retraining as well as play games and do dvds or cds. This makes sessions relatively enjoyable and pleasant.

It takes 15-20 sessions before much progress is seen. Most treatment protocols go to about 30. Research is solid and generally supportive of neurofeedback.

It is definitely a treatment approach that you should consider.

T–

For more information on ADHD treatment, see Trainiing the ADHD Brain–computerized cognitive retraining @ http://terrygingrasphd.com