ADHD: Part II

Determining the difference between an active child and one with Attention Deficit, Hyperactivity Disorder (ADHD) is difficult for a parent and often more difficult for doctors, teachers and psychologists. Even more daunting is the decision to medicate or not medicate a child who has been diagnosed with the disorder.

Last week I explored the diagnosis of the disorder and this week will examine the treatment.

As offered last week, many more children are diagnosed with the disorder than I feel have the disorder. To diagnose a child with a psychological disability is extremely serious and must be done with total assuredness. To ensure children are diagnosed appropriately everyone in the child's life must be interviewed to determine the child's behavior in different settings. Teachers, parents, grandparents, swimming coaches, pastors and playmates need to provide input into the child's behavior in every setting of the child's life. Then, the child needs to be tested for impulsiveness, attention, hyperactivity and emotional equilibrium by a psychologist.

Once the child is diagnosed with ADHD, a doctor, parent and child need to have a discussion about the possibility of psychotropic medical treatment for the disorder. The only person qualified to instruct and coach a family of the benefits and deficits of medication is a medical doctor. No other professional has the training to discuss medicating a child with ADHD except an MD. Nonmedical treatment is also available and often successful with children diagnosed with ADHD and for children who are active but not disordered.

Most nonmedical treatments are based on teaching the child to think before acting, attaining to the need for a child to avoid or gain external stimulus and to focus on ensuring a child's life is consistent, predictable and orderly. Numerous hints and ideas help treat a child with ADHD and treat an active child who does not have the disorder. These ideas include:

* Do not feed the chaos. Placing an active child in places and situations he tends to fail and expecting him to succeed breeds aggravation. The goal is to limit places where an active child fails and place him more often in places he succeeds. We can then slowly reintroduce the child to places where he struggles and teach strategies to be successful.

* Offer a small, hard toy with nubby points to hold and manipulate during class work.

* When the child needs to concentrate, have him sit on an exercise ball creating an off-balance seating position.

* Create a time when the child can be the center of attention in a positive, creative way - show and tell, telling a joke or reading a story.

* Active children often have a negative reputation due to their acting out behavior, which creates a feeling of helplessness. The child might think, "Why should I behave? People only notice when I make a mistake." Offer the child lots of love and positive attention by all adults in the child's life. These adults should make a point to check in with him and have an honest conversation about choices, behavior and his attitude every day.

* Overwhelm the child with honest nurturing and firm behavior modification.

* Decide which fights you want to fight. Safety rules are nonnegotiable (no hitting, don't run out into the street) but if the child rolls his eyes at you, you might let it go.

* Offer required homework and chores as necessary. Cut homework assignments and chores in half and offer active children small, incremental steps in the work required. An active child will see a whole page of work, a whole flowerbed to weed or the entire kitchen to clean and find it overwhelming and become distracted then distract others.

* Follow through with what you say 100 percent of the time every time. If an adult gives in once with a decision or punishment, the child will believe the adult will eventually give in if the child complains, cries, yells, fights or begs enough. It should not matter if you are in a store, restaurant, at a family gathering, with a group of friends or in school. If a parent gives-in while in a social setting, the child will use the social setting to win his way. If a teacher gives-in while in the educational setting, a child will use that setting to misbehave.

* No negotiations - if you want something done, tell the child to do it and expect it to be done. Do not yell or raise your voice. If the child raises his voice, remain calm and repeat what you want done.

* Inattentive children need to learn to think before acting. Do not allow this child to answer quickly. After asking a question - give him 15-20 seconds to think before he speaks. We need to slow down his impulsive thoughts and teach him to think before he acts.

* Impulsivity and lack of long-term gratification plagues a child with ADHD - reward good behavior often and repeatedly. The reward should begin at a constant interval (every hour), then spaced out (once a day) then intermittent (the child does not know when the reward will come).

* An active kid often has an excuse for most of his poor choices - the reason is not important and should not be listened to. Simply ask him what happened and help him reason how he is going to make it not happen again.

* Children with ADHD learn ineffective coping skills to deal with their disability. One-on-one counseling or guided peer reflective play teaches children appropriate responses to inappropriate behavior and "unlearns" ineffective skills.

I received numerous letters from last week's column with personal stories and insight to this difficult disorder. One letter hit a chord with me and I add it below. There are many ways to treat an active child and in my belief, medication should be the last resort.

A reader writes:

"Many years ago my son was diagnosed (in kindergarten) as being 'hyperactive' and we were told he would not be able to function in first grade. We lived in Cheney at the time and took him to a specialist in Spokane. This doctor suggested we make sure he got lots of outdoor exercise during the summer and if his first-grade teacher thought it necessary he would prescribe medication.

My son attended Campus School at EWU and his first-grade teacher had just returned from a year at George Washington University, where she studied hyperactive children. She was as anxious as we were to keep him from having to be medicated and we worked as a team to avoid it. He was a good swimmer and at age 7 we put him on the swim team. He was very competitive and before we knew it was swimming several hours a day!

Between this wonderful teacher (who had him for first and second grades) and the swim team, we were able to avoid medication and see a remarkable change in our son. By the time we moved to Coeur d'Alene (he was in third grade) we had a boy who was self-motivated and driven to succeed without interrupting others. He continued swimming all through high school and college, graduated from the Air Force Academy and has enjoyed a career as a pilot. We couldn't be more thankful!"

Send comments or other suggestions to Bill Rutherford at bprutherford@hotmail.com or visit pensiveparenting.com.