Girl Day dreaming

Self-Regulation Strategies For Kids With ADHD

Symptoms related to ADHD can manifest differently from child to child. Redirecting hyperactive, impulsive, and/or inattentive behaviors can be achieved through following these strategies:

Engagement In Whole Body Listening

Educate your child that listening does not just include opening your ears to the sound of words, but that it in fact means that the entire body is calm, engaged, and focused. The child’s body should be directed toward the speaker or the task at hand, with feet still on the floor, hands still in their lap or on the desk, eyes looking at the task or person speaking, ears listening to the spoken content, and with their brain focused on the current material.

If your child is too hyperactive and is having trouble regaining whole body listening, encourage them to engage in muscle relaxation activities such as squeezing hands/fists/body into a ball tightly for 10 seconds and then releasing. They can do these reps about 5 times or until they are able to extinguish the extra energy causing them to become hyperactive.

On-topic vs. Off-topic Thinking

Help your child gain awareness about what their brain is processing. Chances are, if your child is thinking about Minecraft, a fun science experiment that he did in school, or what he will have for dinner that night, he is NOT listening to what you are saying. If your child appears inattentive, ask them what they are thinking about. If they reply in alignment with the message you have presented, they are using “on-topic” thinking which fosters enhanced focus/attention. If they reply that they were thinking about unrelated material, educate them that this is “off-topic” and they can shelve this idea until after their work is over or after the directive is completed.Girl Day dreaming

Stop-Sign Technique

Help your child reverse their acting and thinking processes. Impulsivity occurs at times when we are absently thinking and as a result, behave quickly. When we react before we think, we do not think about the potential ramifications of our actions and therefore can make poor choices. If you notice your child acting quickly and in the process of engaging in a non-preferred or unexpected behavior, shout out “stop” and/or hold your hand out to signal stop. Have your child cease whatever they were engaging in and have them evaluate the potential consequences if they continue doing what they are doing. Having the child assess the outcome of their action will help them reconfigure more compliant behaviors. You can help your child problem-solve in this process and model for them the appropriate steps for formulating the best choices through thinking before acting.

These strategies can be interactive and process-oriented between child and parent in the hope that the child can then internalize these strategies and autonomously utilize them. Don’t be afraid to help redirect your child, but also encourage them to utilize these skills independently.






Child misbehaving in school

Behavior In The Classroom

Many times children with behavioral concerns, attention issues, emotional concerns, or learning disorders will exhibit negative behaviors within the classroom setting.  Behaviors, by nature, are reasonable and driven by some factor.  The majority of the time, there is a purpose and a reason as to why a child engages in a negative behavior. What this indicates is that it is vital to figure out what the driving force of the behavior was as well as what the consequences of the behavior are.

If a parent or teacher has significant concerns about a child’s behavior, it is truly important to figure out what is going on.  Many times in these situations a Functional Behavioral Analysis (FBA) is required.  An FBAis when some behavioral specialist with the school will go and observe the child over several days and several times during the days.  The individual will first identify the percentage of time the child is off task in comparison to a few peers.  It is always important to have the percentage of off task behavior with several other children in the classroom.  This way there is anecdotal data indicating that child ‘X’ was off task xx% while the other children on average were off task only xx% which could indicate that the child in question actually is off task more than peers.

Child misbehaving in schoolOnce off-task time is established the focus is then on identifying the antecedents and consequences of the behaviors at hand.  There almost always is a driving force (the antecedent) which causes the behavior.  In addition, there usually is a reaction, either positive or negative (consequence), which results in increasing the likelihood of the behavior in the future.

Once the FBA has concluded and information has been disseminated to the team, the next step is to create an action plan to decrease negative behaviors while increasing positive, on-task behaviors.  This is when a functional intervention plan is created.  This plan utilizes the data created by the FBA to set up reinforcement of on-task behaviors, identify triggers and situations that might increase the negative behavior, and set up manageable goals.  A goal must be manageable and attainable.  For example, if a child is off task on average 80% of the day, a goal of being off task 10% of the day would be unrealistic.  What might be established is that with reinforcement and behavioral management, the goal for the first few weeks would be that the child is off task only 70% of the day, then slowly decrease it until the goal is consistent with the amount of time that the rest of the class is off task.

The take home message about behavior in school is that in order to change behavior we have to first identify what the behavior we want to change is, how often it occurs, and why it occurs (what triggers it and what does the child get out of it).








Child having trouble reading

Learning Disabilities or ADHD: Which Is It?

My child is disorganized, has trouble during homework time and following directions, and doesn’t seem to be reading like other kids his age…Is it ADHD or maybe a learning issue?

ADHD and learning disabilities often co-occur. In fact, about 1/3 of children with ADHD also have an additional learning disability. Sometimes parents might wonder if the ADHD is causing the learning disability or if the learning disability causing the inattention. The fact is that they are two discrete disorders with their own set of symptoms. It is true that some of the symptoms may be common to both disorders including:

-          Poor executive functioning
-          Lack of organizational skills
-          Inefficient use of strategies (mnemonic tricks, imagery, rhymes)
-          Behavior problems
-          Low self-esteem

Learning and attention problems are on a continuum ranging from mild to severe.  With the various overlapping symptoms and the fact that behaviors, that may be a result of a learning disorder, can look like ADHD, it can be difficult to distinguish between the two. Although they are both neurologically based, they are assessed and treated differently. A learning disorder (i.e. dyslexia, reading, writing, math) can affect the way that information is stored and relayed back causing a breakdown in information and learning.

Intervention for learning disorders may include the following:

-          Academic skills tutoring
-          Development of compensatory strategies
-          Self-advocacy skills
-          Implementation of an Individualized Education Plan (IEP) or other school accommodations

Although ADHD can interfere with a child’s ability for learning, it is often treated with the following:

-          Behavioral modifications
-          Family counseling and parent training
-          Modifications to the learning environment
-          Implementation of medication
-          Classroom accommodations
-          Executive functioning tutoring

Whether your child struggles with a learning disability, ADHD or both, parent support and education are important to help your child succeed. CHADD.org  is a great website that offers resources such as training and classes that help with parenting and discipline concerns.

Tips to Help Your Child with Word Retrieval

Parents may notice that their child may take longer to respond, may have difficulty picking the right word or may use filler words like “um” or “uh” more often than expected. All of these are signs of word finding difficulties, or trouble retrieving a desired word. These children are not having difficulties with vocabulary, they know the words, they simply can’t always access them in a desired moment. Difficulties with word finding or word retrieval is commonly associated with ADHD, reading disorders, and specific language disorders. If left untreated, word finding difficulties can impact a child’s success in school, notably in both oral and written communication.

So my child has word finding difficulties – now what?

A licensed speech-language pathologist can help! Direct therapy can target these difficulties and create strategies to help both at home and at school.  Parents can also work with their children at home by incorporating these tips into their everyday communications:

Wait: your child knows what he wants to say, he may just need a little more time. Allowing your child to work through these difficulties, retrieve the desired word, and participate in a conversation will help not only his self-esteem, but will also encourage strategy use.

Describe it: encourage your child to describe an object or experience if he is struggling. As adults, we all have all said, “It’s on the tip of my tongue” and have used this strategy. Support your child by having him describe the following:

  • Color (it can be brown)
  • Shape (it’s round)
  • Size (it fits in my hand)
  • Feel (soft or crunchy)
  • Parts (might have chocolate chips, raisins, or sprinkles)
  • Where we find it (at the grocery store)
  • Who uses it (we all do)
  • When do we use it (after dinner)
  • What do we do with it (eat it)

These strategies can be helpful for children who are not having word finding difficulties, too! Describing things will encourage language development and growth and will allow children to expand their repertoire!



Relaxation Strategies for Children

How do we teach our children to relax and self-soothe in a society that is inundated with constant stimuli? How do we re-frame the evil term “boredom” into an opportunity to make peace with our inner thoughts and feelings and calm our body? Often times, even adults, need prompting to relax and take a load off.

Here are some examples of activities that both you and your children can engage in to “recharge your batteries” and face the world with a more balanced mindset:

1. Mindfulness—Easier said than done. Mindfulness is the practice of connecting the mind and body to enhance attention and focus to the task at hand.  It means living in the moment and quieting out other “noise” to focus your attention moment to moment. This is a nonjudgmental practice that incorporates all the senses to be fully present. Two of my favorite ways to practice mindfulness are when you are eating or bathing.

  • Eating. We commonly eat in transit, in front of the TV, talking with others, or while multitasking. When we don’t focus on just the act of eating we miss a lot of cues such as satiety, flavor, texture, etc. Practice mindfulness when eating. Prepare your food and sit in a quiet space. Before indulging your food notice your body cues about the food. Are you starving, craving salt, is your stomach growling. Still, before consummation, notice the color of your food, the texture of your sandwich, the way the sandwich smells. We are wanting to eat with all our senses. Take a bite. What does it taste like and smell like? How does the meat and cheese and bread feel in your mouth? How many bites does it take to swallow? What does the sandwich feel like in your stomach? You get the picture. When we focus on the experience of eating in the moment we are more attune to how we feel and our mind and body and in connection.
  • Bathing. The same can be said for bathing. Notice how the water feels on your body, the temperature, the texture. Notice the smells of the product and how it feels to massage your scalp full of shampoo. Remember, use your senses to be present in the experience and try and steer clear of other intrusive thoughts that may enter about your upcoming day.

2. Music—Music can be such a relaxing outlet but make sure that the music matches the mood that you are seeking. Kids commonly want to relax to Top 40 hits, Hip Hop, or other high energy music but this in fact does not aid in relaxation as the body will mirror the energy it is hearing. If you truly want to relax, I recommend jazz or classical in addition to natural noises provided by a sound machine (waves crashing, rain falling, rainforest, etc.). Listening to music can help kids relax in times of transition (after school before homework, after homework and before bed) or when they are emotionally triggered.

3. Deep Breathing and Muscle Relaxation—Relaxing the body and calming our breath can enhance relaxation either when someone is emotionally triggered to be upset or anxious, during transitions, or prior to upcoming stressful events. Deep breathing requires breathing in through your nose for 5 seconds, holding the breath for 5 seconds, and exhaling the breath through the mouth for 5 seconds. Repeat this 5 times. Muscle relaxation includes tightening and then releasing various muscle groups. Sit in a chair or lay down in a quiet space. Start from the bottom of the body and work your way up. Squeeze your feet and toes tightly for 10 seconds and then release. Squeeze your calves for 10 seconds and then release. Squeeze your thigh muscles for 10 seconds and then release. Continue up the body. By isolating each individual large muscle group you are calling your attention to that part of the body and scanning it to release any tension or stress. You can use these strategies when you want to relax or you can make these into habits and incorporate them into a daily routine.

Click here for 10 ways to help your child unwind before bed.



Signs of a Sensory Issue and Who Can Help

Everyone (children and adults both) have sensory issues and concerns.  As adults, we often learn to avoid noxious sensory inputs that we find to be bothersome.  Oftentimes, children are unable to avoid the sensory concerns that they find to be bothersome.  These sensory concerns can at times have a significant impact on a child’s social, emotional, and academic functioning.  Parents and educators are often unsure of when to actually seek help or what help to seek.

Questions to think about your child’s ability to deal with sensory input include the following:

  1. Does he have trouble with bright lights?  (has to have sun glasses at all times outside)
  2. Does he hate being touched?  (avoids hugs and contact from others)
  3. Does she seek out constant contact from others? (always wants to be hugged)
  4. Does he talk too loudly or too softly?

If you answer yes to any of these questions, it may prove beneficial to have your child evaluated.  Pediatric Occupational Therapists are often well trained in the assessment and intervention of sensory concerns.  They can  often work with the child to develop tolerance to the avoidant stimuli while also providing accommodations within his or her environment that help the child.

It is important to always keep in mind that there may be other medical or psychological concerns evident.  If you suspect that there may be something in addition to sensory concerns, have a consultation with the occupational therapist in order to determine if additional assessments or interventions are needed.

Additionally, don’t rule out ADHD and many other very associated issues.  You can learn more by visiting a pediatric neuropsychologist who can pinpoint the best treatment strategy.

Click here to download your Sensory Processing Disorder Red Flag Checklist.

Learning Disabilities Demystified

Learning concerns are one of the most common neurological issues with which children and adolescents present.  It has been estimated that approximately six percent of the general population meet the clinical criteria for a diagnosis of a learning disability.  The Diagnostic and Statistical Manual, Fifth Edition (American Psychiatric Association, 2013), which is the guide book for psychologists and psychiatrists that provides information regarding diagnostic information, indicates that there are several essential features of specific learning disabilities in children.

5 Features of Learning Disabilities in Children:

  1. Persistent difficulties learning basic foundational academic skills with onset during the early elementary years.  The manual indicates that these foundation academic skills include: reading of single words accurately and fluently, reading comprehension, written expression and spelling, arithmetic computation, and mathematical reasoning.
  2. A child’s performance is well below average for his or her age.
  3. Learning difficulties are readily apparent in the early school years in most individuals.  That being said, there are some instances in which the concerns are not fully evident until later in the individual’s academic life.
  4. The learning disorder is specific in that it is not attributed to other factors such as intellectual disability, socio-economic status, medical conditions, or environmental factors.
  5. The deficit may be restricted only one academic skill or domain.

Prior studies have indicated that learning disorders are more common in males than females.  There are several long-term consequences associated with learning disorders in which the individual never receives any intervention, including:  lower academic achievement, higher rates of high school dropout, higher levels of psychological distress, higher rates of unemployment, and lower incomes.
Data has indicated that children with learning disabilities are often at risk for a variety of co-existing conditions including ADHD and social-emotional concerns.  Click here for more information on learning disabilities.


ADHD and Picky Eating

Attention Deficit Hyperactivity Disorder (ADHD) is a very common diagnosis seen in a pediatric therapy clinic. It is not uncommon for parents to report difficulty with their child with ADHD and picky eating. The most common complaints for parents of children with ADHD who have trouble with mealtimes are distracted eaters, decreased appetites, and picky eaters.

Distracted Eaters

Distracted eaters are attending to external stimuli (e.g., TV, other conversations) or internal stimuli (e.g. lost in own thoughts) during mealtimes. Here are some strategies to help:
  • Decrease the external distractions: Eliminate other distractions like the TV or videogames playing in the background, dogs running around, telephones buzzing, etc. Have your child face other family members and face away from the busy kitchen area to encourage attention in the appropriate direction. Require your child to stay in the room and at the table for the duration of the mealtime.
  • Decrease internal distractions: Use solid placemats, plates, and utensils when eating. Colorful patterns or animated pictures can be distracting. Sometimes having a child engage in motor activities before sitting for a meal can help regulate him to be ready to sit and attend for a period.

Decreased Appetites

An almost universal side effect of stimulant medication used for ADHD is the suppression of appetite. In particular, the dextroamphetamines (e.g., Adderall, Vyvanse) seem to have the highest incidence of suppressing appetite. Here are some tips to manage decreased appetites:

  • Give the morning medication dose after breakfast to ensure an adequate meal is consumed before the side effect of decreased appetite sets in.
  • Provide proteins during lunchtime and small, healthy snacks during the day. Smaller snack-sized portions are often more visually manageable for children than an entire plate of food. Protein shakes are good options during this time.
  • Serve a larger dinner meal at the end of the day when the drug has worn off. Kids will typically make up many of the calories lost during the reduced daytime eating with a larger evening meal.
  • Consider not using the drug on weekends if your child continues to struggle with this side effect. Allowing one or two days of increased calories a week can counteract for a decreased intake during the weekdays.

Picky Eaters

Kids can be picky eaters for a variety of reasons. Evolution dictates children be wary of trying new things in order to survive. They may have a negative association with eating or have sensory issues causing anxiety with certain foods. Cognitive and developmental disorders also may impact the types of food eaten. Similarly, kids with low tone (i.e., decreased strength, coordination, and postural control) may be picky about the foods that are easier for them to eat.

Any of the above issues may co-occur with ADHD.

Here are some strategies to help your picky eaters:

  • Meal Routine: Too much grazing throughout the day may result in a lack of hunger at specific mealtimes. Three meals and two snacks should be offered per day to ensure hormonal balance triggering “hunger”. There should be a beginning, middle, and end to every meal.
  • Exposure: The best role model for food it you! Having family dinners and presenting children to a variety of foods that you, as caregivers, model eating is a critical way to expose your child to the idea that food isn’t scary.
  • Posture: Ideal eating position is hips, knees, and ankles positioned at 90 degree angles. Boosters/chairs should be utilized to ensure the child is at the appropriate table height. If your child has a hard time remaining in a chair, move-and-sit cushions can provide sensory input to help your child stay seated for a longer.
  • Desensitize: For some children, decreasing the sensitivities of the mouth may help with food intake. Using a vibrating tooth brush, a chewy tube or a washcloth tug-o-war are good options to desensitize the child.
  • Get the kids involved: Taking the kids with you when you grocery shop and letting them help pick out the foods will help with compliance. Encourage your child to help with creating the menu, choosing the foods, and preparing the meal are other ways to help your child become involved in mealtimes.

Children with ADHD may have a difficult time with mealtime. Remember to be patient and do the best you can to provide them as many healthy food options as possible. The rest is up to them. For other tips on how to parent a child with ADHD, click here.


Are You a Parent with ADHD?

How many times have you caught yourself going from starting dinner, to doing laundry and helping with homework, to find that dinner is burned and the laundry is in a wet pile? This is one of the many scenarios a parent with ADHD may struggle with on a daily basis. Parenting is one of the toughest jobs out there, and parenting with ADHD can be even tougher. ADHD can present itself differently from childhood to adulthood. You may be a situation where you were diagnosed as a child and are learning to cope with the symptoms as an adult. OR, maybe you are an adult who was never diagnosed as a child (but should have been).  Red on to understand how ADHD symptoms may manifest in adults.

Do Any of These Scenarios Sound Familiar?

  • I often miss deadlines at work
  • I lose things easily
  • I have a hard time completing house work
  • I have trouble managing my bills
  • I get easily distracted and, at times, tune people out when they are talking to me
  • I start a few different projects (i.e. laundry, dishes, vacuuming) without finishing them
  • I tend to get bored easily
  • I procrastinate when needing to complete a task
  • I act impulsively sometimes (i.e. shopping, eating) without thinking of the consequences
  • I am quick to yell when I am frustrated
  • I am accident prone
  • My work space is messy
  • I prefer to do things my way rather than follow rules
  • ADHD runs in my family or my child has ADHD

We can all probably relate to a few these! This doesn’t necessarily mean you have ADHD, but if there are several symptoms that tend to disrupt your functioning on a daily or weekly basis, you may want to reach out for support. You can talk to your primary care physician or find a mental health professional for treatment and to help you learn some strategies to better manage your symptoms.

How ADHD Impacts Your Child’s Social Skills and Friendships

ADHD is a neurobiological disorder that can affect your child’s ability to regulate his behavior and observe, understand, and respond to his or her social environment.

Does your child…

  • Often have problems getting along with other children (i.e. sharing, cooperating, keeping promises)?
  • Struggle to make and keep friends?
  • Tend to play with kids younger than him?
  • Become upset, aggressive, or frustrated easily when they lose a game or things don’t go their way?
  • Have difficulty following directions and rules?

Peer relationship issues tend to be a common problem area in children with ADHD. Children with ADHD tend to act in a way that provokes negative reactions from peers, and can become a target for teasing.  The hallmark symptoms of ADHD, such as hyperactivity and impulsivity, can be the main culprits to blame! These children tend to live in the NOW… meaning what they can achieve right now is what is important! The consequences, like losing friends and being left out the next time, are overlooked. Social skills (i.e. sharing, keeping promises, expressing interest in another person) have NO IMMEDIATE GRATIFICATION. These kiddos then have difficulty understanding the concept of building friendships based on these learned skills.

What can you do to help?

  • Practice social skills at home and when you observe your child playing with other children.
  • Avoid activities that require complex rules for success and a lot of passive time (i.e. choosing an infield vs. outfield position in T-Ball). They can become bored and distracted easily.
  • Keep groups small.
  • Discourage play with aggressive peers.
  • Experts have found more positive social interactions when there is less competition – this causes emotional over arousal, increased disorganized behavior, and frustration.
  • Make sure you are modeling appropriate social behavior at home.
  • Encourage friendships – invite kids over to your house and keep the play structured and supervised
  • Work with your child’s teacher and involve her in the process.
  • Enroll in social skills training class or contact a professional if more help is needed.

Sources:
Taking Charge of ADHD, Revised Edition: The Complete, Authoritative Guide for Parents  By Russell A. Barkley