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Dear Dr. Batya,
My son has just been diagnosed with ADHD. I am desperate for some pointers on how to get him to pay attention and listen. - Desperate Mom
Dear Desperate Mom,
It seems like everyone knows someone these days that has Attention Deficit Hyperactivity Disorder (ADHD). ADHD, while not a new phenomenon, is more commonly diagnosed now than it was 10 years ago. An estimated 5-6 percent of children, with boys far outnumbering girls, are affected.
ADHD may be confused with discipline problems, immaturity or developmental delay, and while these may be a component within ADHD, to be diagnosed with ADHD there must be attentional problems, impulsivity, low frustration toleration and difficulties in concentration. Many children have other problems, be they with learning, socialization, or medical concerns. An accurate diagnosis is essential for appropriate treatment and to ensure that children are not overmedicated. For many parents in general, attentional issues seem to demand the most attention! Here are a few suggestions for making your day just a little bit easier.
* Structure can help keep your child with ADHD well-organized and focused. Tasks can be broken down into smaller components, each having a beginning, middle and end. This allows a child to see the situation logically, set goals and problem solve in a step-by-step fashion. Giving a child time reminders (five minutes left) or letting him know when a task must be completed (I need this done now), keeps a child on task.
* Routines and rituals provide structure and comfort, and enable a child to figure out the rules. When a child can plan and predict, it is easier to focus without distraction. If a child goes to bed one night at eight o'clock and the next night at 10, how can he be expected to turn off TV early on the third night? Transitions are difficult for children with ADHD, so give warnings before moving on.
* Reduce outside distraction. Keep his room clutter-free and well-organized. Dressing is easier with fewer choices and well-marked cupboards. Keep noise level down, extraneous stimuli to a minimum, and the workspace neat.
* Get your child's attention! Call him by name so he knows you're talking to him. Make sure you have his attention and make eye contact before proceeding. Put your hand on his shoulders to ensure listening. Present material in an interesting and informative manner, and ensure motivation by setting the stage for success. Give information in more than one modality for better recall. Better than telling your child what groceries you need, write it down! When a child is hungry, tired or unwell, he may not attend.
* Everyone gets distracted from time to time. Simply redirect and remind a child to refocus or continue. A predetermined code word can remind a child to focus, yet prevent embarrassment. Be firm but not punitive. You know what your child is capable of achieving. Expect nothing less! Reassess, refine and reduce your expectations if you're constantly frustrated by your child's inability to remain on target. While a child should be challenged to accomplish a set of goals, they must be achievable. Speak softly once you have your child's attention, stay calm and be warm and accepting. Walk away or take a break if you need a breather, as your anger won't help your child's self-esteem. Recognize what triggers your emotional responding.
* Give simple, short, clear and concise directions. "Put on your red shirt and black pants" is more helpful than "Get ready for school." If you are not sure your message was understood, ask your child to repeat or rephrase your directive. This will enhance remembering. Keep lectures and extraneous information to a minimum, and don't overload a child with commands.
* Relate new situations to previously mastered tasks. Point out any similarities so the new task will be less daunting.
* Be consistent. This is one of the most difficult parenting tasks for a child with ADHD. Set limits, define rules and ensure goals are met. If you decide to change your mind after saying "no," does your child understand why? Tell your child what needs to be done rather than asking him if he can do it and you'll be more successful.
* Give frequent and immediate feedback and lavish a child with verbal praise and social rewards for appropriate behavior. Reward kids by spending special time together.
* Consider counseling to work on communication issues, conflict resolution, poor self-esteem, social-skills deficits, impulsivity and other issues.
Living with a child with ADHD presents many challenges. Your outlook will directly affect how your child does. Good luck!
The writer is a licensed clinical psychologist in Ra'anana. This column offers general psychological advice and is not intended to replace treatment by a mental health professional. firstname.lastname@example.org