Parenting a Child with ADD / ADHD

Keep things in perspective.

• Remember, your child's behavior is related to a disorder. Most of the time it is not intentional.
• Hold on to your sense of humor. What's embarrassing today may be a funny family story ten years from now.
• Don't sweat the small stuff. One chore left undone isn't a big deal when your child has completed two others plus the day's homework.
• Be willing to make some compromises. If you're a perfectionist or someone who prizes order and decorum, your child is not the only one who needs to change.

Pay attention to the siblings.

• Educate siblings about ADD/ADHD.
• Establish a clear set of rules that everyone in the home must follow.
• Spend quality time with all your kids. Plan activities that are enjoyable for the whole family.
• Don't take the successes of your unaffected kids for granted. Praise their unique qualities, abilities, and achievements.

Let your unaffected children be kids. Don't enlist them as assistant parents — or blame them if the sibling with ADD/ADHD misbehaves under their supervision.

Take care of yourself.

• Look after your own health, and find ways to reduce stress.
• Find the support you need and take advantage of it.
• Cut yourself some slack if your child with ADD/ADHD doesn't become a model child overnight: you're a parent, not a magician.   

Managing your child's ADD/ADHD

Children with ADD/ADHD generally have deficits in executive function: the ability to think and plan ahead, organize, control impulses, follow through, and complete tasks. That means you need to take over as the executive, providing extra guidance while your child slowly acquires executive skills of his or her own.

Your most important attributes in this process are common sense and a positive attitude. Common sense will tell you which behaviors to work on the most, when to negotiate and when to stand firm, and how to head off problems before they start. A positive attitude will help you see the small, praiseworthy successes that can add up to permanent improvement in your child's behavior.

Tips for managing your child's ADHD:

• Strong Communication. Be clear and concise when communicating with your child. Give instructions one step at a time; make requests one at a time.
• Be consistent. What you expect one day should be what you expect every day. Don't give in just because you're tired or the child is nagging.
• Set a good example. Show your child the behaviors you'd like to see. Be a model of patience, healthy habits, and good manners. Be at least as organized as you want your child to be.
• Anticipate and avoid problems. Know your child's triggers and what situations lead to problems. Become adept at heading off trouble before it starts.
• Praise good behavior. Praise is a powerful reinforcer, so make every effort to "catch your child being good".
• Negotiate and consult with your child. You're a parent, not a drill sergeant, so try to avoid barking orders at your child. Start a dialogue, and be open to what your kid has to say.
• Pick your battles. Not every situation requires intervention. Keep the big picture in mind and let the little things slide. If you don't, your home will be one of constant conflict and criticism.

Behavioral strategies for parents

There are many strategies you can use at home to increase your child's appropriate behaviors and decrease the inappropriate, disruptive ones.

Strategies for improving communication

• Go up to your child and make direct eye contact before giving an instruction.
• Check for understanding: "Tell me what I want you to do."
• Give verbal directions one at a time, not in a long list.
• Physical contact can help the child focus.
• Encourage your child to talk through a situation rather than just plunging in.
• Go over steps in a procedure before and during activities, including those you and your child do together.
• Express expectations in written or visual form as well as verbal, such as a chore chart or a checklist.

Strategies for maintaining structure

• Establish predictable routines for morning and evening.
• Keep your child busy with scheduled, supervised activities, but don't pile on so many that the child is overwhelmed.
• Insufficient sleep makes attention problems worse, so insist that your child have a regular bedtime and enough rest.
• Make sure your child has a quiet, private space of his or her own, even if it's just a table with a blanket thrown over it.
• Plan ahead to make sure your child doesn't become overtired or hungry during outings; review rules on behavior beforehand.
• Make sure other caregivers are familiar with daily routines and behavioral goals and adhere to them.

Strategies for improving organization and time management

• Set up your home in an organized way: a place for everything and everything in its place.
• Your child should have a specific, regular place for doing homework, away from distractions.
• Have your child lay out clothes for the next morning before going to bed; make sure what the child needs to take to school is in a special place, ready to grab.
• Give your child a special notebook for writing down assignments.
• Put clocks throughout the house, with a big one in your child's bedroom.
• Allow enough time for what your child needs to do, such as homework or getting ready in the morning.
• Build lots of regular breaks into homework time.

Using Rewards and Consequences to Promote Good Behavior

Using the mind-body connection

Although ADD/ADHD is a condition that affects the mind, studies show that exercise, physical surroundings, and diet can make a difference in symptoms.

Exercise and physical awareness

Strenuous exercise can be a huge benefit for children with ADD/ADHD. They have energy to burn, and organized sports and other physical activities can help them focus their attention on specific movements and skills. Exercise also improves concentration, decreases depression and anxiety, and promotes brain growth.

   Find a sport that your child will enjoy and that suits his or her strengths. For example, sports such as softball that involve a lot of down time are not the best fit for children with attention problems. Individual sports or team sports like basketball and hockey that require constant motion are better options. Children with ADD/ADHD may also benefit from martial arts training, tae kwon do, and yoga, which enhance mental control as they work out the body.

"Green time"

Researchers have found that children with ADD/ADHD benefit from spending time in nature. Kids experience a greater reduction of ADHD symptoms when they play in a park full of grass and trees than on a concrete playground.

Parents may want to take note of this promising approach to managing ADHD. Even in cities, most families have access to parks and other natural settings. And when parents join their children in "green time," they also get a much-needed breath of fresh air for themselves.

Diet and nutrition

Children benefit from fresh foods and regular meal times; it's best for <em>all</em> kids to stay away from junk food and soda. These tenets are especially true for children with ADD/ADHD, whose impulsiveness and distractedness can easily lead to missed meals, disordered eating, overeating and obesity.

Specific foods probably don't cause ADD/ADHD, but some researchers have claimed there's a connection between chemicals found in many foods, including artificial colors and other additives, and the severity of ADD/ADHD symptoms. However, common sense and discipline, rather than special foods or restrictive diets, are what's most important.

Relationship help for kids with ADD/ADHD

Children with ADD/ADHD often have difficulty with simple social interactions and with reading social cues. Their relative emotional immaturity can make them stand out among children their own age and make them targets for other children's unethical behavior. They may talk too much, interrupt frequently, and come off as aggressive or "too intense." Accordingly, parents often worry that their child with ADD/ADHD will attract undesirable people as friends or will be unable to make friends and to sustain important relationships as teens and adults.

Don't forget, though, that many kids with ADHD are quite intelligent and creative and eventually will figure out for themselves how to get along with others and how to spot people who aren't appropriate as friends. Moreover, personality traits that might exasperate parents, teachers, and other authority figures may come across to other people as quirky, funny, and charming. Your job is to help your child with ADD/ADHD become a better listener, learn to read people's faces and body language, and interact smoothly in groups.

Finding support for childhood ADD/ADHD

One of the most important things to remember in rearing a child with ADD/ADHD is that you don't have to do it all by yourself. Be willing to ask for support and coordinate services from your child's doctors, therapists, and teachers. Also, take advantage of support groups for yourself and for your child.

Support groups for parents of children with ADHD:

• connect parents with others dealing with the same issues.
• offer a forum for giving and receiving advice.
• provide a safe place to vent feelings and share experiences.

Support groups for children with ADD/ADHD:

• give kids a place to share helpful strategies.
• show children that they aren't alone; they're not the only kids with these problems.
• teach children how to transfer the skills they've learned to the larger world.

There are also social skills groups geared toward children with ADD/ADHD that can teach them the nuances of social interaction and help them try out learned social skills in the real world. Ask your school psychologist or a mental health clinic for a referral to a local social skills group.

Ellen Jaffe-Gill, Lisa Flores Dumke, M.A., Robert Segal, M.A., Tina de Benedictis., Ph.D., Melinda Smith, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 9/04/07.