Lecture 3: Helping your ADHD-child function better in everyday situations

Strategies for rearing your child:

* Encourage desirable behaviour.

* Prevent undesirable behaviour.

* Overlook minor misdemeanors. “Choose your battles”.

* Negotiate and solve problems.

* Correct the child and set limits when it is needed.

The next powerpoint had a pyramid for problem solving and the ordinary child. The ones that are easy to take care of. At the base, the widest part of the pyramid, you encourage and enhance positive behaviour. They behave so well, so this is easy to do. At the middle section of the pyramid,  getting more narrow, you set rules and they are respected by that child without nagging. The very top of the pyramid which is very small, is where you set limits. Yes, even the perfect child can do some bad things, but you rarely have to set limits because they mostly obey the rules.

Now, over to the child with ADHD. The pyramid gets dominated by nagging and criticism and too little encouragement and praise. At the base of the pyramid, you have to set limits. It’s the biggest part in the problem solving. The middle part is full of the child breaking the rules and the result is nagging, nagging, nagging. At the top of the pyramid comes precious little encouragement and praise. What are the disadvantages of this sort of problem solving when it comes to your child with ADHD?

* The strategies you use in this pyramid, are ineffective and they make life really sad. Associating with your child is not a nice thing at all.

* There is a great risk that the parent gives up parenthood  and lets the child take over. Teachers do this as well. “Fine do as your please, see if I care”. They give up, don’t try anymore.

* See the previous lecture’s evil circle.

To get the right balance between encouragement and setting limits you have to:

* Give five times more love and encouragement than reproaches and criticism.

* It demands a conscious educational approach.

Seize the good moments

* Show interest in your child’s activities. The psychologists played up a scene where the parent comes home tired from work and just wants to relax with a newspaper. But the child wants dad to look at what he has built with Lego, especially since he doesn’t usually sit still and build things. No matter how tired you are, you must go and look at what the child has built, since it is such a rare moment that might not come back.

* Let the child take the initiative — follow along.

* Make sure you read the child’s signals.

* Encourage the child’s own ideas.

* When you comment on something, do it in a describing way not just “well done”.

To encourage and praise is an art in itself

* Encourage and praise positive behaviour.

* Describe what the child DID well, not what they are. We do this latter thing a lot without thinking “What a good boy you are for doing…”. When it is supposed to be “That was a very good thing you did when you…”.

* Praise “productive behaviour” (that leads to good things, things getting done etc).

* Give praise right away for positive behaviour, not hours after the fact.

* Praise often – even things that are supposed to be automatic. “That was so good that you went in and took a shower so I did not have to tell you”.

* Praise the smallest progress.

* Use a lot of ways to show appreciation.

* Avoid combining praise and criticism. They pointed out that football trainers, and such, often make this mistake. They praise and criticize in the same sentence. “Well played but NN did not stand where he was supposed to and NN did not stop that ball…” Another example was from the hanging up of the jacket, in the previous lecture. You don’t say “Good that you hung up the jacket BUT you forgot the boots in front of the door and the school bag ended up in the living room!”. NOT the right way to praise.

To give clear orders

* Get your child’s attention.

* Use positive words.

* Give short and specific instructions.

* Use a neutral and nice tone of voice.

* “Charge up” with positive, encouraging energy.

* Divide in steps if needed – and write them down.

* Amplify with clear body language.

* Avoid using questions when you give an order and do not use instructions with the word NOT in them.

* Make sure that the child has understood what he is supposed to do.

* Monitor and support while the child does the task.

* Encourage and praise when the child is following the order.

One thing a child with ADHD is having a terrible time with, is CHANGE! They can not handle it well at all, so you have to prepare them for the change to come. How do I do that then?

* Walk up to the child and show that you are interested in the activity they are presently occupied with.

* Tell the child what he or she is supposed to do next and for how long.

* It’s a good ide to use a timer of some sort. I was about to publish a blog post about a month ago,  about what my son received from the work therapist, but I never got it proofread. I will publish that blog post after this one, so you can all see it. If one is desperate one can use a time glass or an egg clock but the “timstock” (=time-log) as it is called in Swedish, is the best I have ever seen since the child can really SEE the time disappearing. Often these children are vision-centred and can not handle abstract things like time, and they are often late in learning the clock. Time means nothing to them.

* Remind the child when it is time to stop the present activity.

* If the child now starts being contrary and refusing, screaming as my son does, then do NOT start arguing but go through with the change even if the child protests. Do not give them extra computer time or let them put off showering for another hour!

* This is where routines come in. These children need strict routines as to avoid all the fighting about what to do next. You can’t be flexible with the routines when it comes to an ADHD child. You can’t be spontaneous which might go against some parents’ way of doing things or against their personalities. But strict routines is what this child needs and must have. In some ways, holidays become a nightmare, because at these times, we often get lax with routines and this is not in the best interest for these children.

To apply First – Then

* Always have them do the boring things first and then the fun. They are not going to want to do the boring things later, after the fun. So do not let them sit by the computer and then expect them to clean their rooms or do their homework. It doesn’t work!

* When you do this… then you will … is the right approach. Never say “If you do not… then you will…”

* Let the child suggest the fun activity he can do after doing the boring activity.

* Make the child part of the agreement.

* BE CONSISTANT AND TRUSTWORTHY! My husband falls short of this all the time, and a child will not stand for this. If he can not trust to get the reward after the boring thing, then he will NOT do the boring thing without lots of fighting. They do have a short memory, but they do not forget being let down! This point is more important than you think, especially when it comes to reward systems, which is something you will need to have when it comes to certain tasks. More about that later on.

* Ignore protests.

STRUCTURE in the everyday life

* Once again we were told that spontaneity has no place in an ADHD child’s life, you have to follow set routines.

* You can’t use fuzzy statements like the word “MAYBE”. Never use maybe. The child with ADHD interprets that word as a YES.

* ADHD children have to over-learn things. And if the situation is not the same, they don’t know what to do. How to explain this. Being on vacation is the perfect example. The child knows that it has to go shower in the evening. But he is in a new place and might have seen the shower, but suddenly it is not automatic anymore to go in to the shower after eating dinner. The child will suddenly look disoriented and behave like a headless chicken. Suddenly you are dealing with a much younger child that has to be told exactly everything it has to do. Another example is the child going to a Birthday party and peeing on itself because it did not know where the lavatory was and did not think to ask.

* You have to have the child do one thing at a time. You can’t have them “take your washed clothes with you on the way upstairs, when you are going up there anyway to fetch your homework, and while you are up there, tell your brother that dinner will be ready in half an hour…”

* Break down the activity in smaller parts so the child actually can succeed. You can’t say “Get ready for school” but will have to break it all up in to “Get up”, “Get dressed”, “Eat breakfast”, “Pack your backpack”, “Put your jacket and shoes on”, “Leave for the bus” etc.

* Decide when, where, how and in what order you want the steps to be done.

* Make a visual schedule for the steps. In our case, you will see the big coloured white board in my next blog post, that was given to us by the work therapist. But you can create something similar yourself.

* Make sure the child is in on it and understands what the plan is.

* Be consistent and do the same thing every day.

* Remind and encourage.

* Understand that Rome was not built-in one day, it will take time.

Orderliness

* Simplicity and Rationality.

* Every object has to have a “home”.

* Mark storage boxes so the child knows what goes where.

* Have practical and simple storage to encourage it being used.

* Do not have too many things in the child’s room.

* The child can not create order himself, you have to help clean and sanitize.

Memory help

* Use calendars, planners, schedules. These children get really attached to them since they present stability, security, the fixed point.

* Use post it notes.

* Write lists.

* Pictures on a white board (see next blog).

* Tape recorder.

* Mobile phone can remind you of several things.

Help with time

* Time glass

* Clock

* Mobile phone can be set to beep

* Timelog

The four things that create structure are in other words

* Every day routines

* Orderliness

* Memory help

* Time help

But even when you do all these things, you still will have problems with certain things. In our case, and many other parents having the same problem, it is getting our son to go and take a shower and then go to bed. He screams, refuses, argues and try to buy time, he negotiates and promises to do it after his favourite TV program, only ALL programs are his favourites. Then a reward system can be the only way to get over this problem. Mind you, you can not attack the entire problem in one go. We have started on the shower thing.

Why is the reward system necessary? Children with ADHD lack a chemical (dopamin) in their brain that leads to that they are in bigger need of rewards than other children. And they want quick rewards. If they get a choice between getting to buy some candy today or go to the cinema in two weeks, they will always go for the candy today. Then when the two weeks are up, they will whine about not getting to go to the cinema and will have forgot all about the deal.

Talking about Dopamin and the need for quick reward, I might as well mention what was said about computer games. When these children are on those “then they can suddenly concentrate!” Why? Because their brain “damage” demands quick rewards and many rewards, and computer games answer this need perfectly. This does not mean that it is alright to sit on the computer all the time, which the child would gladly do. They easily, very easily, get addicted to it. And one of the things that they warned about was when not to let them play on computers and mobile phones. Two hours before bedtime, they need to wind down. They can not do these sort of interactive activities or they will never be able to go to sleep. And there is always a conflict as it is, to get them to go to bed because they complain “but I can’t go to sleep anyway”.

That said, back to reward systems: What to remember when you set up a reward system:

* The child has to succeed in the beginning. So the first reward has to come already after five attempts.

* You can’t ever deduct from a reward, only add-on. An example was given. This child has been promised to receive an allowance for sitting still in school. The child did just that, but hit a child. The parent can not start subtracting money away from the allowance, as a punishment for all other not so good things the child has done. The reward is for sitting still and if the child has done that, the reward stands. The hitting is something entirely different. The next thing to approach! One child, the psychologist mentioned,  had so much money subtracted from his reward each week, that he had told her, that he had counted out that he would not get an allowance for the next 46 years! What was the point in behaving at all then, was the child’s question?

* If a reward system has been set up in school, then less must be expected of the ADHD child. If the teacher has promised a reward to the children if the do math for 40 minutes, then the ADHD child must be allowed to do only 20 minutes. Because for him that is on the same level as the 40 minutes for the “normal” child.

* The reward must come directly. You can’t say that you will go and buy something later that week… The reward schedule should sit at a central point where the child and you can see it. It must be clear. The child must know WHO is in charge of it, WHEN the rewards will come and WHAT the reward will be. It can not be what this mother on the course had done. She had said that her child would get a surprise when she had done this and this for so long. When the surprise came, the child did not think that was a reward at all. It has to be something that tempts the child to change its behaviour! For the daughter of that mother, to bake with her mother or go to the supermarket with her, was not enough, so she refused to follow the scheme after the first “surprise”.

* You have to be creative because these children tire very fast of a system.

* Like said above, you can only deal with one behaviour at a time. Not have several schemes going at the same time, nor several behaviours baked in to one scheme because then the child is not very likely to succeed and this will among other things, lower their self-esteem.

* Be clear in what you expect for the reward.

* See to that the reward scheme is adapted to the child’s age and developmental level.

* Do not start with the child having to go too long without a reward. It should be easy to succeed in the beginning and after  a while you space the rewards further and further apart. Finally it doesn’t have to be physical objects received.

* Make sure the child gets excited about the whole thing as well.

* Make a deal with the child.

rewardsscheme

When it comes to my child, we decided together how far apart the rewards were going to come since they were not cheap for me to buy. I have them in my closet so he knows that when he is done, he gets it right away. He decided with me, in which order the rewards where going to be handed out. He knows that I give the order and he will go right away and as told, or he will not get to glue on a dot, on our chart. If I have to say it twice or if he clowns around, no dot.

What could the rewards be? Anything the child likes. My oldest son Johannes, that suffers something within the autism spectra, had to have reward schemes with different things. One was to not poop in his underwear. We had to set it up after he pooped in 15 panties one day! Then it had gone too far in our opinion. He loved knights. I found these cheap plastic knights and I drew each one up on the chart. Let’s say, he stopped pooping in his panties!!! In the US I heard of parents that had physical objects as a reward every other time, and an event every other time, like going to a one-dollar cinema, or going to McDonald’s, going to the zoo, going to a bowling alley… Use your imagination. With my “Kitty”, I have bought Lego mini figures. Yes, they cost a little more than I liked, BUT I was getting them for him anyway and did not just want to hand them over to him like that. Or save them for Christmas or Birthday. They are a very good incentive!

At the end of the lecture, we talked about some things that helps out with routines. One thing mentioned was that the child might need a packing list. It is not easy for the child to remember what to pack for gym class for example. They had made a key ring full of pictures that can hang on the gym bag. Printed out pictures of everything and then laminated, whole punched and then on to a key ring.

Another situation when the child might need help is when he has to do a choice. Taking him to a supermarket or clothing shop is never a good idea! Too many choices. In my case, I avoid it as much as I can. I order clothes over the internet to avoid hysterical outbursts in the shop and misbehaviour. Too many times we have just had to leave the shop with nothing in tow. The binder had this idea that when it comes to choices, one can prepare the child. One child might not be able to choose which candy to buy on Saturdays. Then the parent had printed out pictures of the child’s favourites and at home, they decided what to buy in the supermarket. Otherwise you will stand like I did in Normandy, at a museum shop, with a crying child that doesn’t know which souvenir to buy and to stand like that for an hour, is not a fun vacation!

If a child wants to save up for something, it might mean trouble since they have no sense of the value of money. They suggested you have a picture of the object they want to buy and then you make photocopies of the actual money needed broken up in to a ten kronor coin or 20 kronor bill. Then the child can glue them on, as soon as they have ten or 20, till they reach the right amount that you have written up as well.

What all this is about, is to make everything visual to children that have a difficult time understanding abstract things like time, money needed, … You can’t structure your ADHD child’s life too much! The more you structure it, the more secure the child will feel, and the more likely the child is to succeed and feel good about itself.

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3 Comments

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3 responses to “Lecture 3: Helping your ADHD-child function better in everyday situations

  1. congratulations for the beautiful text
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  2. It’s incredible that it has been so many years! I’m glad you could take the day to remember him extra much and that you really can remember all the sunshine moments. It is not so strange that ADHD reminds you of autism. It falls in what they now call the autism spectra. Before autism was very narrowly classified, now it covers SO much. Almost too much. When it covers too much, then it becomes too common and people react with stupid comments like “oh every other child is classified in that spectra now so it doesn’t mean anything anymore”. It makes diagnosis hollow if that makes sense.
    They have just set up an independent school/free school, in our next door village, that is for children with autism or are in the autism spectra. I have started to check out their website if we have to put “Gubby” there. It will probably be months before he gets a diagnosis of some kind, if he gets one. But better be a little bit prepared! I can’t say how devastated I am over it all, that would be an understatement. And the fact that they are going to start testing “Boo” on Friday. It feels like too much!!!

  3. chrystynas@rogers.com

    Hi Reminds me of learning to be a parent of an autistic child. Structure, organization and repetition. Yesterday would have been Teddy’s 24th birthday. We celebrated with a family dinner and remembered our little sunshine. Memories are forever. Christine

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