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Engelska - Advice for parents of children with ADHD

Children with ADHD vary greatly but often share certain characteristic features. These include finding it difficult to concentrate and pay attention for long periods, at particularly where things that do not immediately capture their interest are concerned. Some children are slow and passive, while others are impulsive and hyperactive. There are also children who alternate between these extremes.

The difficulties may be manifested in different ways while the child is growing up and also vary in different settings. The children are unpredictable and may have good days and bad days. The parents tend to describe these children as difficult to control and to get to adapt to routines and rules that are necessary for everyday life to function. The child ignores orders and requests, is lacking in independence and demanding, acts without thinking, often with strong emotional reactions, and quite often gives the impression of being immature for his or her age and egocentric. The child finds it difficult to control and regulate behaviour and to adapt to the expectations of people around. Many children with ADHD have difficulty finding the motivation and energy to get things done, particularly in the case of tasks that seem boring. If they are subjected to too many stimuli at the same time, they may become stressed and confused. They may then behave in an unfocused and chaotic way or quite simply shut themselves off. They find it more difficult than others to establish relationship and context in things they experience and have greater difficulty in learning from their experiences.

Being a parent of children with difficulties of this kind can be stressful, and the way the child acts can affect the whole family The child needs a lot of support and help. It can be difficult to know what demands you can make and how to respond to your child. The best advice is to proceed by trial and error in dialogue with the child and see what works and what does not. It is largely a case of accepting your child the way he or she is. Some practical tips are nevertheless given here on how to make everyday existence better and help your child to develop in a positive direction.

Realistic demands and expectations

It is important for you as a parent to really understand how your child functions. Your child is not to blame for his or her difficulties any more than you are. Avoid moralising, and instead learn as much as you can about your child’s disabilities. Get to know your child properly, swap experience with others and read and listen to information about ADHD. Do not make excessive demands on your child by asking for things you think they ought to be able to manage by comparison with children of the same age or brothers and sisters. Base yourself instead on what your child can actually manage. Give priority to the things that are most important and simplest. Let your child have the experience of succeeding in tasks. If you want to gradually increase the level of requirement, do so in small steps as your child accomplishes a task.

Structure in everyday life

Jumbled, unstructured and unpredictable environments can make children’s difficulties worse and cause a great deal of unnecessary stress and confusion. Try to create an ADHDfriendly environment by keeping things neat and tidy, having things in particular places, thinking about the sound level and other things that can cause stress. Avoid too many activities and if possible avoid rushing.

Try to create everyday routines with regard to morning and evening, mealtimes, homework etc. Children with ADHD feel happiest if the day is predictable and well structured. It is often helpful to make the day or week clear by having a chart on which activities and times are written in or shown as pictures. The chart should be placed somewhere where the child can see it. It is also a good idea if it stays with the child during the day.

Clear and supportive communication

Children with ADHD find it very difficult to assimilate messages that are ambiguous, vague or long-winded. You should therefore try hard to be straightforward and unambiguous when talking to your child, particularly if you give them a challenge. Do not plead or threaten and do not explain too much. Make sure your child is listening and set brief challenges one step at a time. Say exactly what it is you want your child to do and use statements - not questions or negations. Think about your tone and the pitch of your voice. Ask your child to repeat so that you know that they have not misunderstood. You can also help your child to get a better grip on their existence by putting things that happen into words, helping the child to see recurring themes, explaining context, helping the child to focus on the essentials, taking one thing at a time etc. In that way you can help your child to structure and organise all the information they would otherwise have difficulty coping with. As your child may find it difficult to store information and remember, frequent reminders will be needed. Reminder notes, clearly arranged charts or instructions, reminder alarms etc., can help a great deal.

Encouragement, praise and reward

The best way of getting your child to function better is deliberately to give encouragement and praise when they do something good. Try to find as many opportunities as possible during the day to show your child this kind of appreciation. You should also praise your child for things you may think are trivial or obvious. Consider talking about something your child did that you thought was good and give praise immediately following the positive behaviour. Some children may be more motivated to behave well if you introduce a system of reward such as gold stars or stickers. A points system can be used for older children. You can let your child collect points they can then use to buy various benefits, such as a fun activity. It is important for your child to be involved in deciding what rewards to choose so that it really is something the child appreciates.

Ignoring problem behaviour

Not just positive attention but negative attention too can lead to your child continuing with a type of behaviour. It may therefore sometimes be a good idea to refrain from correcting your child when they do silly things and simply ignore then. It should be you as an adult who controls your child, not your child who controls you by succeeding in provoking you. Many things can be allowed to pass and disregarded on closer consideration. Your child will then feel that it is not worth it and will drop arguments that are unnecessary and cause strain. It’s important to choose what wars to wage and try to keep a cool head!

Setting boundaries

It is obviously necessary sometimes to set boundaries when your child displays really bad behaviour. It is important to have a strategy in these situations so that you can intervene calmly and effectively without becoming emotional or losing your cool. Do not let your child drive you “mad” and try to remain calm. Refer to an agreement you have made with your child, at most give a warning. If your child does not mend their ways - intervene for example by telling them to leave the table and go to their room. You can also make use of withdrawal of benefits if you operate a reward system. Praise your child as soon as they stop their negative behaviour by commenting on the positive things they do instead.

Preventing problem situations

by planning Much of your child’s problem behaviour can be prevented by watching out for and predicting situations they usually find it difficult to cope with. It is important to keep one step ahead. Situations that entail a transition from one activity to another or situations that are unstructured and where your child does not have any clear idea of what they should do often trigger problem behaviour. One way of helping your child with transitional situations may be to prepare them a short time ahead, for example by saying that in five minutes it will be time to turn off the television and go to bed. It often makes it easier if you have something enjoyable to offer as a temptation after your child has managed to do something tricky, for example promising a bedtime story. You can also prevent problems by planning ahead for situations that tend to spiral out of control. If you are going out shopping, for example, simply give your child a “timetable” to keep to with precise instructions about what they are to do when you reach the shop. Do not forget to let your child be involved in the planning by making their own suggestions and to remind your child what you agreed. You should also remember to praise and reward your child when they have managed to keep to the agreement.

Problem-solving

Many children with ADHD have difficulty finding solutions to problems. The child’s impulsiveness way of acting means that they act in an unconsidered way and without the ability to stop and think about what solutions could be imagined to a problem, less still what might be the best solution. The consequence may be learnt helplessness. Your child may also find it difficult to adjust and come up with a different solution if something does not work. This is what often underlies outbursts and other powerful emotional reactions. As the child’s parent you can increase their independence and flexibility by training them to come up with different solutions to a problem, reflect on the advantages and drawbacks of different solutions and decide to try out and then assess the chosen solution.

Classmates and siblings

Many children with ADHD have problems with children of the same age and in their relationships with brothers and sisters. This may be due to not mastering the skills required in social dealings with others, such as showing interest in others, understanding and following rules, listening, showing consideration, not taking up too much or too little space etc. It may also be due to the child, despite knowing what to do, not managing to apply the skill in a given situation, for example as a result of impulsivity gaining the upper hand. As a parent, you can help by showing and explaining and make a conscious effort to create occasions and activities in which your child can practise social skills. Brothers and sisters may sometimes feel sidelined, and it may be important sometimes to devote time to doing different things with them. You can also try to spend time on joint activities in which both the child with ADHD and their siblings can take part without it descending into quarrels.

Family and friends

Family and friends are sometimes a great source of support, but not always. There are families who have cut themselves off completely to avoid being exposed to intolerance. The attitude of people around is very often due to ignorance. Practise standing up for your child sharing the knowledge you as a parent have on how the child functions. Explain without apologising and tell people around you the best way they can help.

Pre-school and school

Many children with ADHD find it difficult to cope with the demands made on them in pre-school and particularly in school, to mix with others, to follow rules, operate independently, listen and understand instructions, to work independently, to get ready in time, to keep their things tidy and so on.

These children need individually adapted education and a teaching situation in which they can learn at their own pace, and they need a lot of individual support. A great deal depends on the attitude and understanding of the individual teacher, but also on what resources the pre-school/school is willing to make available. As a parent you are an indispensable resource for the pre-school and school with your knowledge of the child. Offer your knowledge and be prepared to make demands. Never accept your child being subjected to bullying or other forms of exclusion. Ask for a programme of action to be drawn up in which you as parent take part in the planning of the child’s time in pre-school and schooling.

Make sure that regular meetings are held at which the programme is assessed and revised. Agree on homework and if necessary produce an individual chart. Clarify the responsibilities of the pre-school/school and those that you have as parent. You can create a simple reporting system for daily contact between home and pre-school/school, for example a contact book.

Finally

Do not ask too much of yourself and make sure you have support for yourself. It is important that you conserve your energy and have time left over for yourself and the rest of the family. Do not worry too much about your child’s future. Most children with ADHD eventually learn to live with their difficulties and find a place in society where they feel at home. As a parent, you are the most important person in guiding your child in this direction.

Written by Agneta Hellström, Child and Adolescent Psychiatry Unit, Uppsala University Hospital

Factual material reviewed by: Henrik Pelling, Head of Child and Adolescent Psychiatry Unit, Uppsala University Hospital