Tips for Parents: ADHD and Giftedness - What Do Parents Need to Know?

Treatment issues

• It is widely believed that combined treatments (e.g., psychostimulant medication, behavior management, parent training, social skills training, and/or psychoeducational accommodations) offer the greatest likelihood of managing ADHD symptoms as well as co-existing conditions that may be present (anxiety, depression, etc.). At the same time, 15% – 25% of children do not respond to stimulants so they have to rely exclusively on psychosocial treatments for their symptoms.

Behavioral Interventions

• Practice “catching them when they are good” or focusing on the positive aspects of your child’s behavior.
• Behavioral intervention success rates vary from individual to individual. Some gifted children do not do well with behavioral strategies because they perceive them as manipulative or contrived. Others respond positively. It is important with any reward / positive reinforcement program that the student participates in its development so that he/she can have ownership in the program.
• One behavioral strategy would be to institute a reward system for homework completion. Furthermore, gifted students with ADHD may need breaks to a more frequent degree than would gifted students without ADHD. For example, a gifted student with ADHD may be able to work on a subject matter for 15 minutes, and then benefit from a 5 minute break. The times working and breaking can be adjusted to meet your child’s needs. Parents may also want to try rewarding their child for attending for gradually longer periods of time. Some students may need more coaching/assistance to complete homework than would be considered typical; this is not enabling the child but is setting him or her up for success.
• Students typically prefer immediate over delayed reinforcement. Children with ADHD often have an impaired sense of time, which further exacerbates the delay in reinforcement issue (e.g., when is this reinforcer ever going to happen??). Those without ADHD may (as a group) be able to persist in the absence of immediate external reinforcement due to their greater ability to self-regulate intrinsic motivation by using self-directed language (e.g., when a child can tell himself that he will find satisfaction after completing a paper).

Medications

• As reported by Dr. Russell Barkley, the leading researcher in the field, up to 20% of students may be able to stop taking medications after about a year for various reasons (mild ADHD, maturity to a level where medication is not needed, change in educational setting, or the development of coping skills so that medications are no longer needed). A child who is removed from medications may need them again in the future when the demands of his/her situation changes. Dr. Barkley recommends stopping medications in October (if you are considering weaning the child off medication) so that the school year is off to a good start if medication turns out to be still warranted.
• ADHD symptoms can continue to be treated with stimulants during in the years post puberty. It remains unclear whether adolescents with ADHD respond better to higher or lower doses of medications, so treatment must be individualized.

Predictors for Long Term Success

The research shows that ADHD is not typically outgrown – 80% of those diagnosed in childhood continue to display symptoms to a significant degree in adolescence and young adulthood. However, that means that 20% do not. This may be because these adolescents were misdiagnosed as children or that they no longer exhibit symptoms severe enough to meet the diagnostic criteria for ADHD.

There are several factors that are linked to long-term success in children who have ADHD:

• General level of intelligence in the adolescent is related to positive outcomes (academic, educational attainment, and level of employment). That is, the higher the IQ the better the chances of academic and career attainment.
• The amount/severity of peer relationship problems in childhood usually predicts the level of problems that the child will face when he/she enters adolescence and adulthood.
• The degree of aggression/conduct problems is related to poorer outcomes in educational adjustment and attainment, poorer social relationships, and increased risk for substance abuse. That is, the more aggressive the child, the worse the related outcomes.
• The degree of hostility in interactions between parents and their children with ADHD is significantly associated to the degree to which parents and their children will argue. Additionally, parent and parent-child conflict is related to generally aggressive behavior in adolescents.
• The more severe the symptoms of ADHD, the more at-risk for academic difficulties.

In thinking about college, it is vital that the gifted student with ADHD investigate university and/or college services for students with disabilities. Students will find that accommodations vary significantly from setting to setting. Also, documentation needed to obtain services varies so it is important to know what “data” you need in order to qualify for accommodations at the college/university you choose.

Finally, to all parents, You are human beings whose patience can wax and wean depending on your circumstances. When you are feeling your own aggression/agitation rise, give yourself a timeout from the situation so that you can calm down. That is a better solution than taking out your frustration on your child. We all make mistakes, but everyone suffers if you blame yourself for a past that you cannot change.