- Mental Health
Tips for Parenting a Child with ADD or ADHD
Learning Through Trial and Error
Being the mother of a child with Attention Deficit Hyperactivity Disorder (ADHD) and another with Attention Deficit Disorder (ADD), Post Traumatic Stress Disorder (PTSD), and a learning disability, I am often asked, “How do you do it?”
Usually my reply is witty, and I jokingly say, “I have absolutely no clue!” but the truth is I do it one day at a time. Oh, and with a lot of coffee. Coffee is like heaven in a cup.
Over the years I’ve learned quite a bit through trial and error. I’m sure my children have often wished I was a genius that had all the answers. Unfortunately, I’m far from genius and as a result I’ve made my share of mistakes, like that one time I absent mindedly let my son have an entire can of caffeinated soda before school. He didn’t make it off the school bus before I was receiving a call for a parent/teacher conference…
Thankfully, my children are resilient, strong, and what they lack in some areas they make up for in others, so it all balances out well enough. Put them in the same room unsupervised for very long and they’ll start World War III, though. That’s for another article.
I Wish I Had Known
There are so many things I wish I had known at the beginning of our journey, and I’m sure my children wish they had known a few things as well. As I mentioned before, we’ve learned almost everything we know through much trial and error, and it hasn’t always been pleasant. I did not know anyone that had a child with an attention disorder, much less two, and PTSD was so rare even the school counselor didn’t exactly know how to handle it. Ultimately, I’ve resorted to homeschooling my children, although I haven’t always educated them at home, and not always successfully. We have gained a lot of ground in recent years with the homeschooling, but again, there is so much I wish I had known in the beginning.
I would like to share several things I’ve learned about the attention disorders, as both of my children are alike in this area, and this has probably been one of our greatest challenges. The hyperactivity in my son has been a bit more of a challenge because he has impulse control issues, but I believe the lack of attention is where the biggest struggle came in. Below you will find a lot of the things I wish I had known.
Avoiding Caffeine and Noting Possible Food Allergies
Avoid caffeine. I know that most medications on the market to treat attention disorders are actually stimulants, but neither of my children handle caffeine very well at all. They experience a “crash” from artificial stimulants like caffeine. After the extreme burst of energy, they crash and are generally very irritable and tired, and usually resort to telling me they just don’t feel good.
Gluten and some food dyes can have the same effect as caffeine in some children with attention disorders, so be sure to communicate with your physician if you notice any odd behaviors. They can test your child for allergies to these things and you can eliminate them from their diets if they cause problems.
It is important to note that a lot of children with ADHD will have an atypical response to some things; for example, some cough syrups that would knock me out actually make my children extremely hyper. If I were to take one of their stimulant medications it would make me hyper, whereas it seems to calm them down. They don’t always respond as one would expect. Each child is different and it is good practice to make note of these differences for caregivers, physicians, etc.
If you choose to medicate your children, I have three suggestions:
- Stimulant medications are very difficult for children to adjust to and they absolutely must be monitored while taking them. Ask your physician to start with the lowest possible dose of whatever your physician prescribes, no matter how strong your child’s symptoms are. They can always slowly titrate or "raise" the dose up to a level that works. You also have the option to try different medications until you find one that suits your needs.
- All stimulant medications that treat attention disorders cause loss of appetite in children; it is the most common side effect listed, and in my experience, extended release formulas affected their appetite the most. It is important to feed them their meals before they take their medication. If the child will be given a stimulant medication at school, because it is a controlled substance you will need your physician to specifically state in a note to the school nurse that the medication is to be taken after breakfast and/or after lunch. I ran into this problem every single year that my children were in public school.
- If at all possible, avoid an evening dose of stimulant medications, and again, always discuss medication dosing and/or changes with your physician (more on evening dosing below).
Sleep problems are common. When your child tells you they cannot sleep, they probably aren’t being dishonest or just making excuses to avoid bedtime. This has been a life-long issue with both of my children. I have raised 8 children and only 2 of them have problems initiating sleep - the two children with attention disorders. They simply cannot quiet their own minds.
Also, a lot of children who deal with hyperactivity simply cannot stay still and have problems with impulse control. My son frequently says, “I feel like if I don’t do something that I’m thinking about, I will just explode!” My son has lain awake for hours at a time and struggled immensely with his impulse control. He has to get out of bed, has to move, swing his feet, tap, open and close his door, organize things in his room, come see what I’m doing and go back to his room, etc. He can’t help it. It has brought him to tears countless times because he knows all I want is for him to lie down, close his eyes, and go to sleep. The only way this can happen for him is if he is completely and utterly exhausted and could fall asleep standing up (a rare occurrence).
I have had countless discussions with physicians about the sleep issues. First, we discovered the extended release stimulant medications were causing a huge problem, both with appetite and with initiating sleep. We opted to switch to the quick release medication and give smaller doses three times per day because these wear off quickly and you can almost time them.
After switching to the quick release medication, the dose we were prescribed to give after school was affecting sleep and appetite, so our physician allowed us to eliminate the evening dose, and although the problems didn’t disappear, they were not as severe.
Most of the stronger sleep medications my children have been prescribed have had side effects that were not safe in our situation. The side effects from the prescription sleep aids have been severe night terrors, sleep walking, hallucinations, dry mouth, restless legs, and daytime somnolence. Although I do support medicating children when absolutely necessary to improve their quality of life, safety is still paramount and these side effects were overwhelming for us.
I discussed my concerns with our physician and we were able to find a low-dose over-the-counter antihistamine like diphenhydramine that works great and has very minimal side effects, the worst being dry mouth.
With or without medication, the bottom line is these children still struggle to quiet their mind enough for easy sleep initiation. Patience is an absolute must during bedtime routines. As my children have gotten older and our schedule became more flexible, I have allowed them to read, write, or draw until they can sleep.
Again, I homeschool my children, so our schedules are a bit more flexible with our morning routines.
Teaching Good Sleep Hygiene
Good sleep hygiene is another absolute must if you want them to sleep.
- No electronics such as televisions, game systems, computers, tablets, cell phones, or music players. Have them separate from your child’s bedroom and make them put their cellphones, etc. in a separate room at night.
- A dark or at least dimly-lit room with very little distraction is also important.
- A clean decluttered sleeping space is ideal for children with attention disorders.
- Start the bedtime routine earlier rather than later, meaning don’t wait until 10 minutes before bed and demand they go to bed right this minute. Start quiet activities about an hour before bedtime such as writing, drawing, or working on a model or puzzle. Reading is usually difficult for a child with an attention disorder, so don’t expect this to be the activity they choose. It is almost painful for them at times to pay attention enough to read.
- Video games, as much as you grow to appreciate the quiet focused attention they somehow manage to have while playing them, are a bad idea when preparing for bed. (More on hyper-focusing below).
Sleep Deprivation, Whether Mild or Moderate, Has a Huge Impact on Behavior
Because of the insomnia, most often children with attention disorders are not well-rested when they need to get up in the morning for school or whatever activity has been scheduled for them. This causes another set of problems for children with attention disorders. They are often irritable, whiney, slow-moving, uncooperative, and have very little motivation to get started. This will be where you often see the peak of their inability to stay focused and on task as their disorder will be coupled with mild to moderate sleep deprivation.
Patience is an absolute must with a child that has not had enough sleep. I am gentle and calm with them in the mornings, and I try to be understanding. I gently redirect and try to avoid harsh discipline or angry tones. They are already upset and have no control over why they are feeling sleep deprived. It is a vicious cycle they often get stuck in. Having them go to bed earlier feels like punishment and they still can’t sleep so it doesn’t solve the problem. Layering punishment on top of something they have no control over makes the problem worse.
This does not mean it is okay for children to act out, be allowed to be disobedient, or for you to offer no structure, but as you begin to learn their moods, peak times of struggle, and are able to see exactly what the problem is stemming from, you can discern whether it is choice or something they simply cannot control.
One morning years ago I had to wrap my arms completely around my son, sit down in the floor, and just rock with him until he was able to calm down. He resisted at first, but quickly gave in. This was the alternate to me punishing him for lashing out in a complete melt down because he became over stimulated. He thanked me later for helping him to calm down. I have often remembered that situation when trying to decide whether to discipline him or redirect him.
Routine and Structure
Routines are essential to a child with an attention disorder. They need to know what to expect. My children know when they should be awake, when it will be time to do school and for how long, when it is time for breakfast, lunch, and dinner, when it will be time to do chores, when they can have free time and for how long, when it is time to come inside to shower and prepare for bed, etc. I am a little lenient on the length of time it takes to complete each task because there is quite a bit of redirection that takes place, but for the most part they stick to their schedules within an acceptable amount of leeway time. I do not, however, inform them that they have 10 minutes to goof off before doing what I expect them to do. If it takes an extra 10 minutes to accomplish a task, I try to be patient as long as there is an effort being made. It helps both them and myself to know when things are going to happen, and I am able to set boundaries and consequences if they stray outside of those boundaries because these times do not change. Surprise changes in their routines never end well and the rest of their day is chaos if something changes their routine.
Micromanaging a child with an attention disorder usually never ends well. They become frustrated and will focus more on you distracting them rather than what they are trying to accomplish. Don't nag them, interrupt them, etc. Redirection is okay, but I tend to wait a moment before I speak. My son absolutely cannot begin a task and stick with it until it is completed without doing something else in the process. He will have to escape the dishes at least two or three times before they are completed. I wait to see if he can redirect himself before I step in. He will go use the restroom. If he does not return then I will say something. After he returns and washes/rinses some of the dishes, he will stop again and turn on music or take the trash out, or something. Again, I wait to see if he can redirect back to the dishes. Sometimes he can and sometimes he can't. I do give him an opportunity before I step in with gentle redirection.
Break Down Large Tasks Into Smaller Tasks
Large jobs or very time-consuming tasks are best if they can be broken down into small portions with breaks or small interval rewards. I will use cleaning their bedroom as an example as this is one of the hardest for my son to complete. Here is what it typically looks like:
- Gather all the dirty clothes and bring them to the laundry room.
- Take a 3-minute break.
- Put all the books and small items back on the bookshelf neatly in the correct bins.
- Take a 3-minute break.
- Pick up all the games, both board games and pieces and electronic games and return to their cases. Put them away where they go neatly. This includes game controllers, cords, headphones, etc.
- Take a 3-minute break.
- Pull everything out from under the bed, dresser, nightstand, etc. and put into a pile in the middle of the room.
- Take a 3-minute break.
- Sort into piles everything he pulled from underneath things.
- Take a 3-minute break.
- Put each pile away where it belongs neatly.
- Take a 3-minute break.
- Get the vacuum, vacuum the floor, and then put vacuum away.
At this point he’s done and he gets free time for an extended amount of time after the room is clean. He usually wants either video games or to go outside and relieve the tension of being stuck to something for so long with me redirecting the entire time. This makes him extremely irritable but he feels such relief when the task is finally completed. It takes him about an hour to actually clean his room.
If we are in a big hurry I can sometimes make a game out of larger tasks. “I bet you can’t get all of your dirty clothes gathered up and into the laundry room in 5 minutes!" If he does it, I make a big deal out of it and move onto the next suggestion. If we win the race and the whole room is cleaned, I reward him in some way. Sometimes I can give a reward like a small toy or permission to go on a special outing or something he’s asked about.
To keep this task as small and manageable as possible, I do suggest tidying up his room daily, and for the most part he does, but it gets a real cleaning once a week and it is the bane of his existence. If it gets too bad and he’s having a particularly bad day, I will go in and grab the dirty clothes and the big items and put them away myself. His space isn’t that big, but he sure can make a huge mess in a short amount of time with his short attention span! It is overwhelming sometimes, and I will step in and help because it calms him and makes him more able to focus, not to mention it helps with sleep, etc.
Keep Distractions to a Minimum
Something as small as a barking dog during homework will almost guarantee the homework is not going to get done. Electronics used for recreation are also a huge distraction. They probably need a computer to research school projects, but you’ll have to monitor and make sure they’re researching and not getting distracted by games and the like.
My children are probably each other's biggest distraction. They cannot do anything with the other one in the same room without being distracted the entire time. My daughter does her school work in her room with me checking on her from time to time, and my son does his at a desk in our kitchen area so they are separate from each other. I have to make one or the other leave the room while a chore is being completed as well and my daughter usually takes our dogs into her room while my son is completing a chore in our family space (kitchen or living room).
I've mentioned this before, but you can be a distraction as well. Again, no micromanaging or they will focus on you instead of the task at hand. I also avoid making phone calls or doing things such as watching television, etc. in the same space while the children are trying to accomplish something.
Understand How Their Mind Works
It is impossible for children with an attention disorder to complete any task without an internal struggle. Some children handle it better than others, but all of them struggle. My children dread the tasks that require their full attention and they usually try to avoid them.
One of the biggest misunderstood things about these children is their need or ability to hyper-focus. Most people assume that just because they can play a video game uninterrupted for hours with no trouble, they should be able to do this with other tasks as well. My daughter can watch music videos for hours without getting distracted; however, she cannot play a video game for even 10 minutes. This hyper-focusing is rewarding to children because it is soothing, psychologically rewarding, and their minds, although busy, are focused. It is somewhat of a relief to them. This hyper-focusing behavior cannot be applied to everything. It is not something they can control. The hyper-focusing often will last hours as they lose all track of time and often cannot break the "spell" alone. I almost always have to step in and break the hyper-focused attention for my son, and it usually results in irritability from him when I do.
Sometimes we have lazy days where I will allow the children to do what they want, kind of give their brains a break. They, without fail, pick their hyper-focus activities and relax for hours doing them. There is controversy over allowing children too much time to hyper-focus on anything, limiting screen time, etc., but I have personally found that my children do a lot better after being allowed to just zone out and have a lazy day, than if I am constantly stimulating them and redirecting them, forcing them to focus on things they would otherwise avoid.
I asked my son to describe what his mind sounds like to me. I was shocked with his response. He said "Mom, you know how when you're in the car and someone else is flipping through the radio stations too fast? You hear pieces of songs, and you hear one song you really want to hear, but they don't stop changing the station for you to listen to it because it isn't what they want to hear. It makes you mad. I'm just a kid so no one does what I say. That's what I feel like all the time. I want to think about one thing but the radio station keeps changing and I can't."
My daughter broke her foot once. She described her mind like trying to take a shower with a cast on that you can’t get wet and that you can never take off. She said it was like she knew she needed to shower, and after a long time she really wanted to take a shower, but she dreaded it because it was so hard because of the cast. She has to think of a lot of stuff instead of just washing, holding her cast out of the way, making sure the water doesn't get on it, the bag covering the cast was itchy, she was uncomfortable, it was heavy and hard to hold out of the way, her foot hurt, she needed help but it was embarrassing because she was in the shower, etc.
My kids have quite a bit of insight into how their mind works, but them knowing and understanding their struggles causes distraction before a task ever gets started. They dread it.
This is what it’s like with everything these children do. Most of the time they are misunderstood, and they are braced for that at all times and usually won’t even try to explain themselves after a while. They just dismiss the opportunity to explain and just deal with whatever consequence they’re dealt.
They are often rejected or avoided, told over and over and over to be quiet, stay still, and calm down, so often that they don’t even pay attention to it anymore. It’s like background noise.
They constantly deal with being repeat offenders and they cannot help it, so they end up feeling hopeless. We as parents usually end up frustrated with the repeat offenses and often feel disrespected and disobeyed.
It becomes extremely difficult to communicate and work with a child with an attention disorder if you do not maintain the perception that they cannot control the attention issues, most have impulse control issues, and all of them rely heavily on calm and gentle external redirection to stay on task. Patience, patience, patience. I cannot say it enough.
Instant Gratification and Short Periods of Discipline
Children with attention disorders do better with instant gratification rewards rather than waiting to receive a reward after an extended period of time.
I cannot ask either of my children to do something for a whole week to earn a reward for the upcoming weekend, such as “If you do your chores all week without being told you can go to a friend’s house and spend the night.” It is very unfair to them, challenges them way too much, and they never make it an entire week, therefore they never get the reward. It actually causes somewhat of a rebellion.
I use smaller instant gratification rewards, like an extended break, a new game or toy, a snack or treat, a day off of school, going out to lunch or dinner, letting them choose what we eat for the next meal, etc. If it is on a weekend, I will allow a friend to stay the night if the bedroom gets cleaned (even with my help), or I’ll let them stay up past bedtime, etc. I usually don't ask them to earn large rewards with large blocks of good behavior. I do not use their attention span to earn anything. I can't and it is setting them up for failure, which is very unfair.
I also do not use extended periods of discipline. I don't ground them for an entire week or take things away for long periods of time expecting them to perform some task correctly for an extended period of time to earn it back. They can't. I will not allow them to go outside for the rest of that day, or I will take away a game system or the internet or something along those lines for a day or maximum two days. I have to constantly remind myself their attention span is very little, their moods shift pretty continuously, and they often don't even know they've done anything wrong. It is not their intent to cause problems.
I Need a Break Too!
Having two children with attention disorders requires a lot of my attention and patience, and I will admit there are times I want to pull my hair out, but I have given myself permission to take small timeouts too. I call it “Take 5.” I don’t care what we are doing, if I get overwhelmed I say, “Okay! Let’s take 5!” I go in my room or outside and separate myself from the task at hand and the children. If I have to turn the stove off when cooking or perhaps even let the dog run around the bathroom covered in soap because I was in the middle of bathing them (this has happened before), I don’t care. I stop and for 5 minutes the children know not to bother me unless it is a real emergency - blood or fire or something equivalent to such. There is to be no screaming or fighting during my 5 minutes. Do not knock on my door or call my name. If they have an urge to fight or yell at each other they had better separate for the 5. (My children are 12 and 14 for the record so this is not a safety concern). They can resume said argument after 5 minutes, but they had better be quiet during the Take 5. They lose a privilege if they disrespect me during this time.
I have communicated with them openly and honestly that sometimes I feel overwhelmed too and have impulse control problems when I get too upset, and although those times are fewer and farther apart than my children’s, it happens, and I absolutely need a break or I'll "explode” too. The kids understand it more than anyone I’m sure. They don’t like me to yell, slam doors, cry, etc. so they understand that I sometimes just need to stop and breathe.
The kids can request a Take 5 too. My daughter often requests it due to her PTSD. A lot of things are overwhelming for her and she has to stop, escape, breathe, think, then resume. Sometimes she can’t resume. We take it incident by incident.
Sometimes my Take 5 can turn into Take 10 depending on how frustrated I've allowed myself to get, but the point is to take care of yourself too and give yourself permission to breathe.
Communication is Key
Communication is paramount to your child’s success and your ability to parent. Communicate your thoughts, feelings, hopes, etc. Talk openly with their doctors and never hesitate to ask questions. Remember, the only dumb question is the one that is unasked.
Communicate with their teachers and any other educators or authority figures in their lives, including the school bus driver if necessary. If you find that your child’s teachers are not cooperating with the tried and true methods of calming your child or enabling your child to learn, don’t hesitate to ask your pediatrician to write a letter requesting said action be taken for the benefit of your child’s mental health. Our pediatrician requested oral testing for my daughter where they read her tests to her, and short frequent breaks for my son, and both requests were complied with only after the pediatrician requested it.
We also discovered keeping my son occupied was also a great tool in school, passing out papers, taking things to the office, sharpening pencils, etc. Through communication I was able to get all his teachers to use this tool to keep him occupied when he was restless.
Communicate with their friends’ parents as well. There have been several situations where once I explained my son’s ADHD to his friends’ parents, they were much more accepting and understanding. All it takes is a behavior cue or small redirection to let him know he’s getting out of hand. He is eager to please, although he needs a little help sometimes. Once the parents knew how simple it was to redirect him and that I supported them doing so, they welcomed him into their homes more readily, which has greatly benefitted him and his self-esteem.
My daughter's ADD and PTSD coupled with a learning disability has required constant communication on her behalf. More often than not she is too scared to advocate for herself or she gets so full of anxiety that she can't communicate. I can almost look at her and tell what is going on inside her now, but most people cannot do this. It is our job as parents to be their voice. Don't be scared to speak for them.
Every Situation is Unique
Some of these suggestions may or may not work for you or your situation. All children are unique and each one handles every situation differently. It’s best to sit down and talk with your child about how they are feeling and get their input as well. Most of these children tend to be brilliant, they just struggle having enough of an attention span to adequately display it. My son can rattle off math equations at lightning speed verbally, but as soon as you sit him down with a math book, paper, and pencil, you’d think he couldn’t even add 2+2. He just cannot handle being forced to write down something he can do quicker in his head. I’ve been left standing with my mouth open in awe at his abilities more times than I can count, but I would have had no clue had I not listened to him.
Don’t ever hesitate to ask for help if you’re feeling overwhelmed or like the situation has gotten out of control. There have been many times I have had to reach out for help.
Remember, don’t forget to take time out for yourself. You cannot be the best parent you can be if you are neglecting yourself. Don’t feel guilty if you need a break every once in a while. Even parents with seemingly perfect children need a break.
I hope this helped you in some way. Know that you are not alone, and every storm runs out of rain! Go hug that beautiful child of yours and realize just how much they’ve taught you about love, patience, and being an individual! I’m pretty sure your level of creative parenting far surpasses the average persons!
© 2018 Tracy Sheppard