Summer Plans for Children with Attention Deficit Disorders

Introduction

The time for making summer plans is fast approaching. For children who coast through life effortlessly summer is a time eagerly welcomed. Children and parents have a choice of interesting experiences. While there may be some "jitters" as camp start date approaches, kids likely get through them with a parent's gentle reassurance that the "butterflies" are normal.

For children and families affected by attention deficit disorders, that is ADHD, with or without hyperactivity and impulsive behaviors, the approach of summer can be fraught with fearful uncertainties. Will the camp or program take my child if they know what he or she is really like? Will my child fit in? Will I get the dreaded phone call saying he hurt someone or that he can't stay in the program? Will the staff really know how to handle the tantrums and oppositionality? Will they be able to see the sweet struggling child underneath the gruff veneer? Will they "freak out" when they hear he is taking one or two medications? A child with ADHD may be as nervous as the parents about the unknown experience, especially if he or she had difficulties in camp-type situations in the past.

This article is intended to help you acknowledge and set realistic goals for your child's summer experience and to guide you in asking the right questions as you try to find a good fit between your child and a summer program. While the choices may be challenging, being honest with yourself about your child's strengths and limitations, and being proactive and honest as you talk with program administrators will serve you well in the long run.

Children with ADHD come in many wonderful shapes and sizes. No two are the same, have the same needs, or present with the same management challenges. Seek out professionals who understand and embrace this concept and who are determined to individualize the approach to your child. As you read this article, you will need to pick and choose those attentional and behavioral issues that are relevant to you. In general, children with attentional difficulties have difficulty sustaining concentration when tasks are inherently less pleasing and interesting to them, when other stimulating things are competing for their interest and attention, and when tasks require several sequential steps or multiple things to be done at once. They are particularly vulnerable when they must stop doing something they enjoy, inhibit responding, or wait to take action. They often have considerable difficulty transitioning from one activity to another, especially if it means terminating a highly desired activity, similar to when you want them to stop playing on the computer to get washed for dinner.

Sound familiar? Of course it does. These are the sorts of daily challenges that summer programs present to children as they must wait to use a saw in woodworking, put down the sand at the lakeside, stop playing ball to go home, put down the rocks on the trail, or deal with eating in a timely manner in a very loud, very active lunchroom. These children are often easily frustrated when trying new or challenging things, leading sometimes to aggressive, overly sensitive, vigorous responses. These difficulties in regulating emotions are apparent with peers, as well as with adults.

Your child deserves a positive, esteem-building experience and needs to be shielded from esteem-deflating, negative experiences. Many research studies have demonstrated that children with ADHD often have other bonafide psychological disorders adding to the complexity of who these children are and what their needs are.

Step #1: Who is my child?

Your first step is to realistically assess your child's strengths, interests, and behavioral limitations. Write these down and review this list with the other caring and concerned people in your child's life, such as teachers, therapists, and recreational leaders. Think of specific situations and techniques when things have gone well. What were the characteristics of these situations? Who supervised the child? What did they do to calm him down or return him to the activity? What wastheir level of training? What were the characteristics of situations that did not work out?

Step #2: Researching programs

There are many resources for initially identifying programs. Your ultimate choice will require work on your part to track people down, get references, and follow-through on applications for much sought-after spots. Top quality programs fill early in the season! For starters, try contacting the local chapter of C.H.A.D.D. (Children and Adults with Attention Deficit Disorder), your local SEPTA Chapter (Special Education PTA), and the American Camping Association to inquire about appropriate programs in your area. Specialty magazines, such as Attention! ® Magazine also offer listings of ADHD specialty programs. There are also private referral services, some of which are "for-profit" services that have a financial arrangement with the camps they refer you to, while some do not. In the New York metropolitan area, the New York University Child Study Center runs the NYU Summer Program for Kids with ADHD.

Step #3: Questions & choices

The first question is "Should my child be in any program this summer?" This answer, almost certainly, is YES! You may feel guilty wanting "a break". You may feel overprotective of your child. But frankly, you probably need it and you deserve it. At the same time, a well run, structured program affords your child growth opportunities.

Perhaps the next questions will be "Does my child need a specialty camp or is a mainstreamed experience called for?" The decision will be based not only on your assessment of your child but the resources and flexibility of the program you are considering. There are several good programs that do not advertise being specifically "for ADHD children" but are more than happy to accommodate them and do so quite well. Open and honest communication with the program's directors about their actual past experiences with children similar to yours is essential. If your child has a history of utilizing time-outs, ask if they utilize this technique. If your child chooses not to participate in activities ask how they handle that. While some directors will be at ease with these inquiries, others may seem awkward, hesitant, and unsure, which should be a warning sign that they may not be geared up for children with ADHD.

Pay attention to your gut reactions. If you have a hyperactive, energetic, tree-climbing, impatient, low frustration tolerant child, the local museum's art appreciation and computer graphics workshop, with one adult, one high school aide and twenty-two children indoors, with only a once-a-week pool session may not work out. If you have a child who loves sports and active things, but can not tolerate competition, does not take instruction well, and has difficulty staying with one thing too long, the town tennis program led by well-intentioned high school tennis stars, with little or no experience in behavior management, is a recipe for disaster.

You may be considering sleepaway camp. Take into account your child's history with new situations and with separations in particular. How does the camp prepare first timers? How do they deal with homesickness and separation problems? Especially at overnight camp, find out how much time the child will be in unstructured situations. Children with ADHD and other issues fare much better in highly structured situations, with supervision by mature staff, specially trained in behavior modification techniques. Camps that are committed to integrating children with ADHD will be able to describe specifics, such as professionals who do staff training and ongoing consultation during the summer, or perhaps describe a Daily Behavior Report Card they used with a child.

Step #4: Accreditation and references

Many camps and programs choose to participate in the accreditation process of the American Camping Association, which is a voluntary process intended to ensure a commitment to certain safety, training, and programming standards. Not all programs that may indeed be appropriate for your child will choose to affiliate with this organization. In any event, be sure to ask for references of parents who also send children with ADHD to the camp and follow-up on asking them about their experiences.

Step #5: To tell or not to tell - that is the question

Parents often ask me whether they should tell program directors the truth about their children or try to give their children the benefit of an unbiased, "clean slate," fearing that labeling their child as "difficult" has a negative biasing effect. The fact is that the best predictor of future behavior is still past behavior, and if your child's behavioral difficulties are going to intimidate program staff, it is best to find out ahead of time. You need to be a role model and set the stage for ongoing, open communication that will enhance your child's experience once he is in the program. Of course, to decrease the shock value of a label or an official psychiatric diagnosis, you will want to focus on behaviors, not labels, and on the strategies you and others have used that have helped your child adjust socially, to routines, to limits, and to frustration and anxiety. You will want to make a written list of these strategies to share with your child's counselors, as well.

Step #6: Medication

There are several schools of thought regarding the administration of medication during summer vacations. The most current, well-designed, long-term, large-scale research studies indicate that children taking medications for ADHD are best served by maintaining their schedule year round. As children enter new and unstructured situations, often supervised by less experienced individuals who know them less well, it seems ill advised to withdraw significant supports that help your child function better. As always, discussion with your own health advisors is recommended before you make any changes.

Step #7: A Match is Made

So, you have done your "due diligence" and have found a program that seems like a "good fit." The directors are aware of your child's needs and interests, have convinced you through their knowledge, ease, references, and possibly their program accreditation, that they have what it takes to help your child have a successful summer experience. You have given them your written list of tried and true strategies to deal with the most likely behavioral issues and you are all well on your way. Your child, although mostly excited, expresses some healthy ambivalence about how things will work out. Your role is to focus on reinforcing coping skills and strategies. You can role-play the various situations he or she has concerns about, or that you anticipate, and praise your child for good problem solving. You will want to make sure that your child knows who to go to, and where to go, if they feel uncertain or need help. In many cases, I have helped children prepare for summer camps (and helped the camp programs prepare for the child) by having the children write letters to their new counselors ahead of time. They can introduce themselves, explain who they are, and what they like to do. Additionally, they also can describe the kinds of difficulties they sometimes have and what is helpful to them at those times. One teenager explained that he likes to take lots of risks but doesn't hurt himself. Another seven-year-old youngster explained to our day camp director that he does better leaving a group to calm down rather than taking the (usual and customary) time-out. These extra steps go a long way toward maximizing a child's experience. It is also a very positive self-advocacy step for the child.

Step #8: Use your Resources

Parents often overlook an important set of resources for the summer staff - namely the adults who deal with the child the rest of the year. Encourage your child's teachers, coaches, and therapists to communicate directly with summer staff so they have a head start in deciding what approaches work best with your child.

Planning ahead ensures the best possible fit between a program and your child making for year round success.

NYU Summer Program for Kids with ADHD

The NYU Summer Program for Kids with ADHD is the first summer program in the New York metropolitan area designed to make summer a fun, productive and successful experience for children with ADHD. It is an eight-week, all-day therapeutic clinical program based on research effectiveness. The daily schedule includes a full variety of sports, academic and computer activities, and arts and crafts; social skills strategies geared specifically to the needs and deficits of children with ADHD are practiced. The program has an outstanding staff-to-child ratio, with one staff member for every 1-to-2 children. Counselors are senior-level undergraduate students and graduate students who have received specialized training in behavior modification, social skills training and classroom management. Areas of focus include classroom behavior, cooperation, academic performance and social skills, as well as athletic skills. Parents are taught specialized parenting skills to enhance parent-child relations. For information call Dr. Karen Fleiss (212) 263-0760.

About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at www.AboutOurKids.org.