Summertime.  A time to be carefree;  a free spirit; a new world explorer.  Or maybe not.

Our son loves to be home.  Given his choice, he would stay home pretty much most of the time — in his pajamas with his hair all messy and toys all around him.  He doesn’t, of course.  He is usually pretty busy between school, sports, OT and so forth.  However, we have had a two week break between the end of school and before summer camp starts.  Getting him out of the house with the babysitter has been a real challenge.

Don’t get me wrong.  In general, the babysitter situation, as I wrote in my last post, is working out well.  We hired a 17 year old boy and our son loves playing soccer, basketball and XBOX with him.  This is good.  However, he does not want to leave the house to go to the playground, or to the batting cages or to the YMCA pool.  I attribute this to his being uncomfortable with anything new which I think is part of his cognitive rigidity aspect of ADHD.  It is difficult for our son to face new situations and changes.

My approach to this has been twofold.  First, try to get a good friend to do the activity with him.  The idea being that a good friend provides our son with the comfortable framework that he needs.  Secondly, I strongly encourage him to try the activity (encourage might be a bit euphemistic) and tell him that if he does like not the activity then, after he tries it, he can come home.  Usually he then goes and has a great time!!

We go through this for every new activity.  It is frustrating, it is annoying and it makes me sad that it is often so difficult for him.  I remember my summer days of free flowing play and exploration and wish that things could be easier for our son.

I often question myself on whether he is just being a homebody or is it a form of anxiety/cognitive rigidity?    My mother’s instinct tells me that it is his anxiety.  And so we soldier on trying to think of new ways to make him comfortable enough to try new activities, situations and sports.  It is a daily battle that I wish was not a battle for him at all.

Do you face a similar situation?  How do you handle it?  Any ideas for me and for others would be greatly appreciated!!

Until next time …. Take care!!

Karen

I certainly hope that my posts help each of you with ideas and suggestions for approaching your day to day life.  I know that often just the process of writing the blog post helps me to think through the day to day situations that we face as a family. 

In a previous post I wrote about ADHD and anger.  I explored how anger management is a challenge for those with ADHD because, like behavior regulation challenges – a hallmark of ADHD, anger management is a regulation of the emotions.  Because of the impaired nature of the Executive Functioning in those with ADHD, emotions are often more intense and more challenging to regulate.  As a result, I look at how our son handles frustration and anger as not a discipline issue but an opportunity to teach him how to handle frustration and anger constructively.

Hand in hand with the anger and frustration is often hitting.  To tell the truth, I have had concerns about our son’s hitting and have tried to teach him to use his words instead of his hands/body in expressing his anger and frustration.  His hitting kind of remained a fuzzy situation that has bothered me in the back of my head but it is not something I had really spent a great deal of time focusing on.  As I prepared to write this post, I thought through the reason for that.

First of all, we do not have any troubles with him hitting other kids. Well, except for his sister, which I really attribute to the typical sibling interaction.  I fondly remember my brother and I beating the c—p out of each other through high school!!  Secondly, we have no discipline challenges with him at school whatsoever.  So what I realize bothers me is that he does lash out at his father and myself from time to time.

So I have done some research on the topic and have discovered that aggressive behavior is common in young children.  Until a child reaches something like the age of six or so, he is not developmentally mature enough to curb his or her impulse to hit.  Our son is older than six but his ability to handle frustration maturely is still in development and the fact that he largely directs it at his father and I is okay for me for now. 

Why do I think it is okay, for now?  I think that developmentally he is not able to fully control his emotions yet. In addition, we are a safe place for him to direct his anger and frustration – he is working so hard that I think he needs a safe place to express his frustrations.  Finally, he often is least able to handle his frustration or anger when he is tired or when he has spent too much time in front of the tv or video games.   It is up to my husband and I to make sure that he is getting enough sleep and exercise and that we help guide him when he is in overtired situations.  I often verbalize that you are angry and frustrated because you are tired and dad and I need to make sure that you get enough sleep tonight.

What have we done to help him address those situations when he wants to hit?

•  Figure out another outlet for his anger.  We have chosen an “anger” pillow that he can take out his frustrations on.

•  Teaching him words to associate with a situation.  We literally practice the phrases, “you are making me angry”, “I am really frustrated right now” or “I need the anger pillow.”  I am also careful to make sure that I use the phrases myself – “I am really frustrated because I can follow your crumb trail from the kitchen to the living room.

• Recognizing his feelings and verbalizing them.  “I know that you are upset because I am not allowing you to play your DS.  In order for you to be healthy, you need to play and get fresh air. 

• Reinforce verbally that hitting is wrong.  It is as simple as saying over and over again, “you are not allowed to hit.”  I also have our son look at the person that was hit and apologize sincerely. 

• Reinforce when you see frustration and anger handled appropriately.  “I am so proud of you for using the anger pillow instead of hitting me.”  I have, with fits and starts in the past, tried to do reward charts but I have found that our son reacts most positively when rewarded immediately.  So I often praise immediately, offer a treat or say let’s do this together as a reward for your great behavior.

So after writing this blog post, I have found that I am less concerned about his hitting than I used to be at the back of my mind and I have resolved with renewed vigor to keep doing the steps outlined above.

Let me know your thoughts and what works for you.

Until next time …… take care.

BED TIME. Does reading these two words give you nightmares as a parent of a child with ADHD? Apparently it is VERY common for children with ADHD (and adults with ADHD too) to resist bed time. It is a nightly challenge for us in our household.
When thinking about ADHD and sleep, it might be helpful to think what I call the 4 stages of sleep:

• Bed time
• Falling asleep
• Staying asleep
• Waking up

Bed time for children with ADHD is challenging because, well, they often just don’t want to stop. However, once in bed, many children and adults with ADHD have trouble falling asleep, staying asleep and then, once asleep, waking up. According to research, prior to puberty 10-15% of children with ADHD have trouble getting to sleep. This is 2x the rate found in children and adolescents who do not have ADHD. The number of individuals with ADHD experiencing trouble getting to sleep dramatically increases with age (oh joy – another thing to look forward to!):

• 50% of children with ADHD have difficulty falling asleep almost every night by age 12 ½
• By age 30, more than 70% of adults with ADHD report that they spend more than 1 hour trying to fall asleep at night

Yikes!! [These figures were found in the February/March 2004 issue of Additude in an article written by William Dobson M.D. entitled, “ADHD Sleep Advice – End Bedtime Battles”.]

Fortunately for us, our son does not have trouble sleeping once we actually get him settled down into bed. It is bed time, itself, that is our challenge right now. So what helps us with bed time?

• Routine, routine, routine – routine is our best friend. We are probably our own worst enemy because on the weekends, we do not stick to the routine but a routine associated with bed time and a routine on the time itself have helped tremendously.
• One on one time with parents – our son still loves to cuddle with mom and dad. Nothing calms him down faster than when we lay down with him and cuddle. We chat quietly about our day and have a few quiet laughs, hugs and kisses. I don’t know if it is the sense of security, the routine or the cuddling that calms him down but it works for us.

Other suggestions for bed time settling down and falling asleep include:

• Turning off the TV and shutting down video games about an hour before bed time. TV and video stimulate all childrens’ nervous systems – imagine what it does to the nervous system of a child with ADHD.
• Avoiding caffeine before bed time. Not only is caffeine a stimulant but it is also a diuretic. Nothing worse than trying to sleep when you really need to pee!
• Having milk and ice cream. Dairy foods contain an amino acid that converts the active ingredients in milk to melatonin and serotonin. Both melatonin and serotonin help the body fall asleep.
• Practicing deep breathing. Practice releasing the tensions, energy and worries from the day and preparing for sleep through deep breathing.
• Taking Melatonin.
• Taking a bedtime medication prescribed by your doctor.
• Using sensory products such as weighted blankets or special tents that give a sense of security.
• Playing nature sound CDs, meditation CDs, white noise or calming music.
• Drinking “Organic Nighty Night” tea (we have actually used this) or other types of soothing teas.
• De-cluttering the child’s room to limit distractions.
• Taking a warm bathes or shower.
• Using lavender in the child’s room to calm.
• Making sure the child has plenty of exercise throughout the day.
• Behavior therapy.

Hopefully within this list you will find some ideas to help you and your child to find a bed time routine which results in a smooth transition from an awake state to an asleep state! (Is there such a thing as a smooth transition with a child with ADHD?)

Trouble with staying asleep is a whole other issue. I would examine food and exercise habits but also consult a doctor to make sure other conditions like sleep apnea or restless leg syndrome are not impeding a good night’s rest.

I tend to believe that having trouble waking up is probably correlated to the earlier phases of sleep like having trouble falling asleep or staying asleep. We definitely have trouble waking our son up some mornings but it is usually when he is tired. He needs more sleep towards the end of the week versus the beginning of the week because he works so hard at school and at home with homework. We give him a hot shower every morning and wrap him in warm towels when he gets out of the shower (wouldn’t it be nice if we all could have warm towels in the morning) and that helps him in waking up!

In the academic world, the correlation between ADHD and sleep disorders is one which needs to be further explored. What is known is that sleep problems are rampant in people who have ADHD. However, the big unanswered question is whether sleep problems are secondary to having ADHD or whether sleep disorders are another cause of ADHD. Right now, there is no answer. What is known is that the proper amount of sleep is important for anyone. Children with ADHD, however, need their sleep even more because the lack of sleep can make a life that is challenging even more so.

I hope this article is helpful in giving you some ideas to try in establishing a way to help your child transition more peacefully from being awake to being asleep.

As always, take care …. Until next time.
Karen

The outbursts, the tantrums, the eruptions … day in and day out. It is so stressful. Is it ODD? What is it? Should I be concerned?

The answer to the “should I be concerned question” is both yes and no. Yes, because any child needs to be taught how to handle situations and frustrations with a healthy response. No, because if you look at the problem through the lens of ADHD, it is another symptom of the disorder.

Believe me, I often stress over the angry outbursts and tantrums. They raise my stress level and there are days that they make me exhausted beyond belief. I have found, however, that a shift in my mental framework towards the angry outbursts help. Let me explain.

I thoroughly believe at this point that ADHD is a neurological disorder that impacts the executive functioning within the frontal lobe of the brain. I have written on numerous occasions that this can manifest itself in many different ways. Most associated with ADHD is either hyperactivity or inattention. Both are forms of behavior regulation. Hyperactivity is the inability to control or limit one’s activity and inattention is the inability to maintain attention when there is no interest in an activity or the activity is too challenging (i.e. too frustrating).

So why have I consistently put anger in a different category?

I have even done research into ODD, being concerned that his anger is an indication of ODD. (About 1/3^rd of kids with ADHD do develop some form of ODD) Well, duh, it dawned on me that really anger or lack of handling anger is just another form of regulation. It is emotional regulation versus behavioral regulation but it is really just another form of regulation.

So I have another one of those enlightened moments that seems so stupid after the fact. Gee why did I not realize that anger is just another regulation/management issue that is so challenging for someone with ADHD?

I have noticed that when our son spends more time watching TV or playing video games that he seems to be an angrier child. Exercise is important for any child but can be the difference between a reasonable child and a tantrum child for someone with ADHD. I even say to my son, “Wow, you have watched too much TV/played too many video games – you are angry boy. “ This helps him to identify what is going on and helps him to stop and think.

We still need to teach our son how to handle situations that make him upset or frustrated. It helps me, though, to think of it as a situation that needs to be managed (exercise and fresh air) and taught and not as a discipline problem.

I hope this approach helps you too.

Until next time …. Take care.

One of the challenges associated with ADHD and ADD is “executive functioning”. I have talked about this before. This like so many other things is a confusing element to ADHD but one that I feel is really important to be aware of and necessary to understand the challenges of your child holistically. In fact, many experts in the field of ADHD/ADD are starting to suggest that ADHD be re-conceptualized as an “executive disorder” and deemphasize the focus on hyperactivity and attention. Problems with executive functioning are not limited, however, to only those with ADHD or ADD. Executive dysfunction sometimes is the only problem and sometimes is part of a larger problem.

The easiest way to think of executive functioning is that it is the administrative or managerial part of the human brain. Executive functioning has to do with organization, planning, self-control, and time management, for instance. Like anything else, any individual with executive functioning issues will have areas of strength and areas of weakness within the broad spectrum of executive functioning.
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One of the things I struggle with as a parent of a child with neurological issues is really grasping everything.  There are times when I feel that I have a handle on things and there are times that I worry about all kinds of issues.  Does he have other psychological and behavioral issues?  Is he suffering from clinical anxiety, does he have ODD, what is immaturity, bad behavior and what is executive functioning deficits?  Sometimes I think I might go mad with all of the questions running around my head!

One term that I have heard fairly often and frequently worry about is ODD, Oppositional Defiant Disorder.  Many parents have not heard about this disorder but it apparently is one of the most common psychiatric problems in children affecting around 5% of the child population.  It also affects a high percentage of children with ADHD … around 30 to 40% of those with ADHD also have ODD. In fact it is exceptionally rare for a child to only have ODD; ODD is commonly associated with ADHD and depression/anxiety.  Oh that lovely comorbidity thing again!!

So what is ODD?  One of the best descriptions I have heard of ODD is by Jim Chandler, MD, FRCPC.  (http://jamesdauntchandler.tripod.com/).  According to Chandler, “ODD is a psychiatric disorder that is really just the far end of the stubbornness spectrum.  The line that divides being just difficult and stubborn from ODD is a set of diagnostic criteria.”

The criteria for ODD are:

A pattern of negativistic, hostile and defiant behavior lasting at least six months during which four or more of the following are present:

• Often loses temper
• Often argues with adults
• Often actively defies or refuses to comply with adults’ requests or rules
• Often deliberately annoys people
• Often blames others for his or her mistakes or misbehavior
• Is often touchy or easily annoyed by others
• Is often angry and resentful
• Is often spiteful and vindictive

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

Now why do I worry about this so much and why am I confused?  I think any parent of child with ADHD probably struggles with getting their child to cooperate with homework, chores and the other necessities of life.  Our son often throws fits and refuses to cooperate.  This is pretty much a daily occurrence.  Are they outrageous, knock down fits?  No.  He occasionally has an outrageous fit but not often.  But why does he throw these everyday fits:

• Is it because some times he gets his way?
• Is it because of executive functioning deficits which cause a low threshold for frustration?
• Is it a side effect of the medication?
• Is it a transition issue?
• Is it because he is exhausted from school?
• Is it signs of ODD?

I think this is the most difficult part of our son’s neurological challenges – not knowing the answers to everyday occurrences.  Am I doing something wrong?  Am I doing something right?  What should I be doing?  And the internal battle of questions rages on and on in my head non-stop.

I decided to do some research into ODD for today’s blog post because it is an area I have been concerned about but have not really had the time to research.  What I found to be the key criteria for ODD is spitefulness and vindictiveness.  This coupled with a blaming others for his or her mistakes or misbehavior are key signs of ODD.  According to Chandler, “the destructiveness and disagreeableness are purposeful.  They like to see you get mad.”  It is this description that turned on the lightbulb for me.  Our son often refuses to cooperate but he is not spiteful or vindictive. He is “oppositional” mostly because he does not want to do what I am asking not because he wants to see me get mad.

To read Jim Chandler full pamphlet on Oppositional Defiant Disorder, please go to http://jamesdauntchandler.tripod.com/ODD_CD/oddcdpamphlet.pdf.  It is a straightforward description with examples that I found to be tremendously enlightening.  Most other sources of information that I found online stuck with the Diagnostic and Statistical Manual of Mental Disorders definition as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.  Most sources of information are very clinical with very few examples.

So I am happy to say that our son’s stubbornness does not seem to fit within the range of Oppositional Defiant Disorder.  Yeah!  Cross that off the list, for now (J).  So now I need to worry if it is a side effect of the medication ….. sigh.

The post can be found at the Can Mom Be Calm Blog

http://canmombecalm.blogspot.com/2009/09/ignore-behavior-not-child.html

This is an excerpt of the post …

My ABA Lead therapist and pretty much everyone else told me that I need to firm up on Spencer and ignore his attention-seeking behavior. This includes when he climbs on me, pinches, scatters, and throws things. I know that they are right. I believe it in my heart but gosh…. for an anxious person like me… ignoring is really so hard to do. “Ignore the behavior, not the child,” she said as she reminded me that I should praise his positive behaviors.

I hate to think that my child thinks of me as a toy but I guess it is partly true. Sometimes he pinches me and I am so used to it, that I don’t even say “ouch.” So then, Spencer will even say it for me, “Ouch?” like .. “Hey, how come you are not saying ‘ouch,’ I love it when you say that.”

I think that I can achieve “ignoring” as a behavior modification method if I can remember that “ignoring” is active. That is what was told to me in my parent training program for ADHD preschoolers at NYU Medical Center. They said that I shouldn’t ignore activities that are harmful to him, to others or to property but rather ignore attention-seeking behaviors like whining, nagging, and tantrums. (Tantrums are the hardest because of the neighbors downstairs but I will have to try.)

TO READ THE FULL POST PLEASE GO TO http://canmombecalm.blogspot.com/2009/09/ignore-behavior-not-child.html