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Home Survival Basics:
Swears, Lies, and Videogames
Martin L. Kutscher, MD
Departments of Pediatrics and Neurology, New York Medical College, Valhalla, NY.
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First, the bad news: many kids with ADHD are afflicted by numerous traits that are difficult to deal with. If we want to maximize our childs chance for a successful future--and avoid our own institutionalization--we had better learn some behavioral approaches to ADHD. It is hard to pick out the most important piece of advice. Problems and priorities change over time. But if your life is so hectic that you cant even get the time to read this whole chapter, read the section Just STOP!
Besides the works of Barkley, Greene, Phelan and others, many of the guidelines below are inspired by Chris A. Zeigler Dendys book entitled TEENAGERS WITH ADD: A Parents Guide. (See Books and Links.) This excellent and empathic book offers many additional practical suggestions for achieving success with ADHD at home and at school.
The good news is that these problems are nobodys fault. Not your childs; not yours. Indeed, the key to addressing these symptoms is to adopt what Barkley calls a disability perspective. They are true disabilities, just like problems with their inattention and learning. These symptoms happen to the ADHD person, as much as they happen to the people around them. No one chose to have these problems. Hate ADHD, not the person with it.
There are several reasons why it is hard to accept these undesirable behaviors as real disabilities:
· Unlike blindness or deafness, there is no external marker for these disabilities. As an example, consider a child who is deaf and has ADHD. No one would ever think of yelling at the child for his hearing problem. That would be blatantly ridiculous and unfair. Yet, when the same child over-reacts or is easily annoyed as part of his ADHD, it is much harder to accept those difficulties as an innate disability.
· Unlike physical disabilities, these personality problems often get directed at the caregiver. The deaf child, for example, is having difficulties but is not attacking us. Her problems evoke from us an instinct to aid her. In contrast, the ADHD child may yell or curse at the parent who is merely trying to help. In short, ADHDers are often not acting in an easily lovable way. No wonder that these disabilities are harder to accept.
· When our child acts up, the rest of society--along with us--tends to think of bad parenting as being the problem. As the child pulls candy off of the rack at the supermarket checkout line, we are sure everyone else is thinking, Why cant you control that child? What is wrong with you!?
· To accept that some people have a physiological reason for difficulty controlling their behavior runs counter to our deep convictions about who we are. Our society feels that we are under the control of our personality, or will, or soul. It is hard for us to accept that these aspects of ourselves are so heavily under the control of neurotransmitters.
A disability outlook is not as much "fun" as just considering ADHDers as "unique individuals with special traits." However, while we DO need to celebrate their differences as much as possible, the disability outlook helps because:
It cuts through the issue of "blame," either of the child or the parents.
It points the way for parents to see themselves as "therapists" for their problematic child--not as victims of him.
A realistic assessment of your child's starting point helps minimize your anger and frustration with her when she doesn't live up to the way you would like.
· Celebrate ADHD strengths: the energy, the why not? attitude, the ability to live in the present.
· However, given all of the ADHDers problems, it is sometimes hard to find anything to praise. Find some accomplishment to laud, and some activity to enjoy together. Laugh with each other. Keep a sense of humor. Hug.
· Remember that ADHD kids are typically a few years behind in social development. Adjust your expectations accordingly.
· When she is finally ready to apologize, talk, or cuddle; take her up on her offer right then and there. Your goal is to put some good times into your relationship. Take them as they come.
· Let your child know that you believe in him/her, despite the disabilities.
· When criticism is required, criticize the behavior, not the child.
· Try to avoid punishing bad behavior. Rather, Barkley suggests rewarding the good behavior you would rather replace it with. For example, instead of punishing cursing, reward each day when language remains civil.
· Only positive rewards will change behavior and improve attitude.
· When things start going badly, redirect to a positive direction rather than criticizing the misbehavior. For example, if the child is fighting with her sister, then suggest a new activity, rather than hand out a punishment.
· Dont nag. It hasnt worked yet. If you dont have anything nice to say, dont say it. Even simple comments like How was your day? may cause frustration in your child.
· Dont lecture. It doesnt work either. Plus, given their sense of time, ADHDers will find the experience interminable. Instead, give one or two brief, clear instructions. Insight transplants from you to your child, as Thomas Phelan calls them, are unlikely to work. (See Phelans excellent book Surviving Your Adolescents.)
· Dont argue. It takes two to fight. No argument can occur without your permission.
· Dont offer unscheduled, spontaneous advice. What are the odds that your Nintendo playing teen will respond pleasantly to your request to discuss right now that book report due in two weeks?
· Phelan calls these last four points The Four Cardinal Sins. These "sins" are ineffective and actually harmful. Why would we use them? Instead, either a) decide that the issue is aggravating but not significant enough to warrant intervention (i.e., stay quiet); or b) make an appointment with your child to discuss the issue. Other strategies are described below.
An interaction between you and your child can fall into one of three categories: a) useful; b) useless; or c) harmful. Actually, there is no such thing as the useless category. All useless interventions actually fall eventually into harmful, because they just lead to further frustration all aroundmaking the next interaction even less likely to be helpful. Sometimes, relationships are at the point when a simple Hello, how are you? consistently provokes an irritated response. So, if the question is not useful, dont ask it. If asking the child to clean up his room has not worked for 12 years, it probably wont be effective today. At these times, Phelan suggests that if you dont have anything really nice to say (e.g.: Heres five bucks just because I feel like it), then stay quiet.
Amazingly, many of us keep using the same useless or harmful strategies over and over again, as if they might magically work on the 401th try. An unproductive chide or ineffective command may make you feel better for two seconds, but wont improve your childs life--or your relationship with her. So why do it? Seriously.
· Listen when the child talks. Teach and model the skill of first rephrasing what the other said. Then respond.
· Ask yourself: Why did he do that? There is a reason, even if it does not appear rational. Often, the behaviors make sense if we remember that ADHD children live almost exclusively in the present without much ability for foresight. For example, they may want to play Nintendo rather than do homework. If we remember that they are living in the present, choosing to play Nintendo right now actually makes sense.
· Dont take it personally. (Easier said than done.) Remember that this is a disability. You just happen to be the person in the room.
· Involve the teen in the problem-solving process.
· Try to give choices. This empowers the child.
· Negotiate!!! Teach and model flexibility. Teach seeking win-win solutions. Keep expectations reasonable. The time to negotiate is before you take a final stand. Final stands remain final.
· Stickers and token reward systems do not work in secondary school age children. They need to feel more like a partner.
· Younger children may respond to sticker charts or token systems as described under Plan A below.
Restore the child's basic desire to please before attempting behavioral systems.
Reward systems rely on children's natural desire to please their parents. If a child's basic relationships with her parents are so full of anger and resentment that she no longer finds pride in pleasing her parents, then those basic relationships need some healing first, before behavioral modification programs are likely to be successful. Set aside a period of special time (up to 30 minutes) where the goal is simply to exist together pleasantly in the same room. The child gets to choose the (reasonable) activity, and the parent gets to enjoy being near their child without provoking a world war. Avoid saying anything critical--even if it would be helpful. Keep questions and comments (even positive ones) to a minimal level. After all, interruptions are still annoying. The goal here is to put your account of good/bad interactions into a positive balance, making it more likely for the child to want to please you. That sets the stage for smoother discipline setting in the future. Dr. David Rabiner (see http://www.helpforadd.com/behtreat.htm) and Dr. Russell Barkley (see Resources) provide a full explanation of this technique.
In order for typical behavior modification and reward systems to be used, the following criteria must be met:
· The behavior must be worth the effort of changing.
· The child must have the ability to consistently control the behavior.
· The reward/punishment is likely to work. (For example, punishment is unlikely to correct forgetful behavior.)
· Those with allegedly cooler heads can apply the plan consistently.
· It is the child's problem.
If these criteria are met, consider plans under Reward Systems/Tokens.
· Children with ADHD need frequent, strong, and immediate feedback and rewards.
· The rules need to be succinctly reviewed at the scene before they are needed.
· ADHDers are drawn towards the most attractive stimulus. Reward systems capitalize on this trait by using a carrot to lead the child in a productive direction.
· But dont bribes lead them to do things for the wrong reasons? Yes, but they already havent responded to the right reasons. That appeal has already failed by the time enticements are added.
· The rewards will need frequent rotation to maintain their power.
· When punishment is required, keep it immediate and controlled. You are not really trying to punish; presumably, you are trying to correct future behaviors. A modest, immediate punishment is likely to be at least as effective as a prolonged one. A spiral of increasing punishments is unlikely to work, and just saddles everyone with a prolonged period of unhappiness in the future.
· Enticements can be as simple as First we work, then we get to play. Or, If you only tease your sister twice this week, then you get your allowance.
· Formal systems are described in many books, including those by Silver and Barkley (see Books and links). Token systems entail earning points for good behavior (or loosing them for bad behavior) that are then traded in for any privilege.
· Practically speaking, formal token systems are difficult to maintain, and work best with elementary school children
Most typical children will respond well to typical enticements and threats of punishment. If you made it this far, your child probably isnt one of them. You are ready for:
Consider the two following scenarios:
First scenario: Mother: John, can you please go do two hours of homework?
John: Stop! Go away!
Second scenario: Mother: John, can I make you fresh pancakes for breakfast?
John: Stop! Go away!
Whats going on here? John gives the same response whether asked about something good or bad. His negative response clearly has nothing to do with the actual request. It has to do with his being interrupted. It has to do with his being overwhelmed. It has to do with his ADHD. Obviously, rewards and punishments wont work in this setting. The problem is an inability to control a sensation of being overwhelmed, not a problem with motivation. (After all, you are already offering fresh pancakes.)
When typical rewards and punishments dont work, you may need an approach that Ross Greene refers to as Plan B. Here, our focus is on preventing over-heated meltdowns. We anticipate problems and try to head them off: we stop, we stay calm, and we negotiate if possible.
STOP! Those four letters are the key to behavioral treatment for most people with ADHD. The exclamation point is a reminder of how important the step is; and how hard it can be, as well.
As described so well by Russell Barkley, the primary difficulty in ADHD is a lack of inhibition of the present (so that you can use your other executive functions to plan the future). In other words, people with ADHD have trouble putting on the brakes. They have trouble stopping. Nothing good comes from speeding out of control. So, their first step is to just STOP!
Once everyone stops, then time can cool our minds. The brakes come on. Executive function can regain control. We can chart a productive course.
There are several amazing things that come from just stopping (if you can do it):
1. It works! Time heals. Even 5 or 10 minutes is usually enough for even the most ADHD brain to regain composure. If it routinely takes more than 30 minutes to regain it, consider other diagnoses such as depression or bipolar depression.
2. With the benefit of time to regain composure, most people will reach the right conclusion. They will begin to come around and comply. If you just state calmly what is expected as you leave the scene of the impending argument, you will be typically surprised that--at some point fairly soon--the child is addressing the situation. Not always. But surprisingly often. After all, ADHDers are usually far from stupid. They know how to think. They know the rules of morality. They know the right thing to do. They just need a little longer than the rest of us to regain control and sort it all out. A formal procedure for thinking through choices is described in the chapter on Problem Solving Skills.
3. Once you and the child have cooled down, the other behavioral methods will usually be quite clear. In other words, most of the advise in sections on behavioral management will seem almost blatantly obvious--if you are calm. For example, we discuss keeping it positive. We discuss seeking to understand and making the child part of the problem solving process. We discuss choosing only productive punishments. When you are calm, these approaches are not exactly rocket science, and are almost self-evident. When you are screaming, these approaches are not available.
Yes, you. There is no one else reading this right now. I mean you, the parent. You have to put on the brakes as well. You are a human being who is struggling with self-control also. Although your brain theoretically has normal control, ADHD in the family can be so exacerbating and even demoralizing that our ability to stop and see things clearly is debilitated as well. [Note that there is a forty percent chance that one of the parents also has ADHD--so indeed there may be other reasons why stopping is so hard in these families.]
Why would we expect the child to be the only one trying--and succeeding--at exerting self-control? Why would we expect the only one with a recognized physiological disability in self-control be the only one working on the project? How about ourselves? You may answer, Well, Im so overwhelmed and stressed by my environment that its hard to stay in control. Welcome to the club. Thats what your child is experiencing also. You wont let him get away with that excuse....
She is already over-whelmed. She is already overloaded and over stimulated. Being screamed at just inflames the situation, and ultimately makes it harder for your child to achieve her goal: regaining composure so that her own brain can reach the right decision.
The earliest signs of overload include voices getting raised, muscles tightened, faces reddened, or grunting. This is the time to defuse. At this point, you may be able to salvage the situation with humor, negotiation, redirecting the conversation in a different direction, or maybe even taking a few deep breaths.
A little later, the signs of being overwhelmed get pretty obvious, if we would just listen. They are usually something subtle like: STOP! Get out! Leave me alone! I cant take it, anymore! Your child is not making this stuff up. That is how he feels. Pretty awful. Take his advice. Stop. He is actually telling you in clear words just what you need to know: I need to stop now. Ideally, he would have said it calmly. Ideally.
This is not the time to give in to our impulse to just get it over with. You might have the self-control to do that. Your ADHD child was not born that way. Dont assume that just because you can handle it, that he can as well. All brains have equal rights, but all brains are not constructed the same.
Encourage compliance with the system be ensuring that the child recognizes that this cooling off period is not punishment. It is not like the old punitive time out system, which works best with elementary students. Rather, the child gets to go do some pleasant--yet soothing--activity. Consider reading (their choice--magazines and comics are okay), Legos, or listening to music. Adrenaline producing activities such as Nintendo are probably not a good idea. Truly cool activities, like playing on the computer or watching TV may be hard to stop after the intended 5 minutes. Do not forget a similar system for yourself.
If that doesnt work--and there are some oppositional children for whom it wont--then ignore the child. It takes two to fight. No one can enlist you in an argument unless you enter the arena.
The decision to declare a cooling off period has nothing to do with a decision as to who won. You are not giving in. Calmly state the rule or action that is required, and end the discussion. Come back later when cool heads prevail.
Good point. But, here are your choices:
1. Keep fighting for 30 minutes, get nothing accomplished after that, chip away at our relationship with our child, and increase household frustration levels making the next blowup more likely; or
2. Take a 5-10 minute break, get something accomplished, maintain our relationship with our child, and lower household frustration levels making the next blowup less likely.
When you STOP and think about it, the choice is pretty obvious, isnt it? Yet when faced with that choice in the heat of the moment, most of us have been taking the wrong course.
Indeed, this is not always a terribly efficient system. However, neither you nor your child has been dealt great choices. But STOPPING is the least bad option. It certainly beats the alternative of counter-productive screaming. You already know that does not work.
Good luck, and do not expect results overnight. This is a multi-year task to learn. Model it well. Once youve stopped, you are ready for the next steps:
· Your child is already overwhelmed and confused. Parental anger does not work, and only makes the situation worse--but then, you already have discovered that.
· STAY CALM. That deserves repeating. STAY CALM. (Much easier said than done.)
· LOWER YOUR VOICE.
· WALK AWAY. Announce that discussion will begin again once everyone has achieved composure.
· Once calm, negotiate, negotiate, negotiate. Parents need to model negotiation, not inflexibility. Dont worry about losing control: the parent always gets to decide which compromise is accepted.
· PICK YOUR FIGHTS. Is this fight worth chipping away at your relationship with your child? Remember, this is not war. The family that stays together wins.
· ADHD is the inability to inhibit behaviors. Why do we expect ADHDers to be the only ones who actually control themselves? As adults with better self-control, shouldnt we be the first to actually use it?
· Dont say things that you will regret, such as gratuitously hurtful comments or punishments that you cannot enforce.
· For homework, stick calmly by a simple rule: First we work, then we play.
Remember: negative behaviors usually occur because the
ADHDer is spinning out of control, not because he is evil. While evil
behavior would need to be aggressively squelched, the much more common
overwhelmed behavior needs to calmly defused.
Remember: negative behaviors usually occur because the ADHDer is spinning out of control, not because he is evil. While evil behavior would need to be aggressively squelched, the much more common overwhelmed behavior needs to calmly defused.
· Zeigler-Dendy has the very useful suggestion that rules be enforced with a no-fault approach. In other words, avoid arguments based on whose fault it is. Just deal with the end results. For example, it doesnt matter why a child arrives home late. It doesnt matter that you forgot to remind her again about the time her usual curfew. It doesnt matter that the cat ate her watch. It does not matter that the car ran out of gas. It does not matter that you didnt buy her a reliable car. She is late, this is the consequence, and this is the plan to prevent it from happening again. It really simplifies discussion, doesnt it?
· This approach is particularly useful for ADHD people who always blame others for their problems. There is no point in their blaming you if blame is not being made relevant.
· Could this sometimes be unfair? Sometimes, yes. But in the long run, arguments are diminished, and that is to everyones advantage.
· A second important result of this approach is that it allows us to avoid direct criticism of the child. We punish the end behavior and its end results. We are not directly criticizing the child. After all, we are not assigning blame to anyone. Thus, this approach is a rediscovery of the old adage, Criticize the behavior, not the child.
· Lying is often a part of ADHD. It is part of the disability.
· Lying will typically get better over the long run.
· Lying may occur because the child is totally befuddled how he got into this mess. There simply is no logical explanation (ADHD is not logical), so they make one up.
· Clearly, sticking to a lie once you have been clearly caught is not a logical choice. Observing the unbelievable mental contortions of these children as they muddle through a lie provides a valuable window into their remarkable lack of problem-solving skills.
· Dont set them up to lie. If you already know about an infringement, just state the facts that you know, and proceed with the consequences. Do not use this as an honesty test.
· Minimize the need to lie by eliminating some punishments that the child lies to avoid.
· Develop a plan to solve the original problem area that led to the lie.
1. Keep a sense of humor. Seek to enjoy, not to scream.
2. Celebrate the ADHD persons humor, creativity, and passion.
3. Hate ADHD, not the person with it.
4. You do not have a standard child. You can view the issue as a disability. Or, you can view it as wonderful uniqueness. Or, you can view it as both. The perspective of standard, though, is not an option.
5. Recognize that attention issues in the child are only the tip of the iceberg that the whole family must address.
6. The patient in ADHD is the whole family.
7. Instead of punishing wrong behavior, set a reward for the correct behavior you would rather replace it with. Rewards should be immediate, frequent, powerful, clearly defined, and consistent.
8. Plan ahead. Give warnings before transitions. Discuss in advance what is expected. Have the child repeat out loud the terms he just agreed to.
9. Dont argue; nag; or attempt unsolicited and spontaneous transplants of your wisdom to your child. Instead, either a) decide that the issue is aggravating but not significant enough to warrant intervention; or b) make an appointment with your child to discuss the issue.
10. Head off big fights before they begin. Seek to diffuse, not to inflame. When tempers flare, allow everyone to cool off. Serious discussion can only occur during times of composure. Remember: negative behaviors usually occur because the ADHDer is spinning out of control, not because he is evil. While evil behavior would need to be aggressively squelched, the much more common overwhelmed behavior needs to calmly defused.
11. Especially with teens, negotiate, negotiate, negotiate. Parents need to model negotiation, not inflexibility. Dont worry about losing control: the parent always gets to decide when negotiation is over and which compromise is accepted.
12. Pick your fights. Is the issue at hand worth chipping away at your relationship with your child? Can your child really control the offending behavior at this moment?
13. Although it is not the childs fault, he will still ultimately be the one to take the consequences of his behavior.
14. This is hard work.
15. You will make it through this; you have no choice.
16. The children who need love the most will always ask for it in the most unloving ways. [Words of a teacher quoted by Russell Barkley.]
17. If it is working, keep doing it. If not, do something else.
18. Forgive your child and yourself nightly. You didnt ask to live with the effects of ADHD any more than did your child.
19. Review this text, and others, periodically. You are going to forget this stuff, and different principles will likely be needed at different stages. A good way to remember to review is by subscription to some of the free monthly newsletters on ADHD (see resources).
20. Steven Covey (The Seven Habits of Highly Effective People) suggests imagining your child delivering your eulogy. What do you want him to say about you? Keep those bigger goals in mind as you choose your interactions/reactions to your child.
21. This is not a contest with your child. The winner is not the one with more points. The winner is the one whos child still loves them when they graduate high school.
Remember, the chances for success are good, especially for children with: higher socio-economic status, higher intelligence, better early peer relations, less aggression, less psychopathology in the parents, and less conflict with their parents. We cant solve all of the problems at once. Stay calm. Shell probably get into college even if todays English homework is late. Take one day at a time; this is the 50-year plan. Forgive yourself daily for your own imperfections as you deal with a difficult situation. Have some fun. And keep your endpoint in mind. Your endpoint is not just your childs academic and social success--it also includes a good relationship with you.
See also section on Reward Systems
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