Fear of mistakes? Help your child with ADHD keep trying

“If I don’t try, I can’t fail!” and “If I can’t do it right, why bother at all?” are common refrains I hear from ADHD kids who come into my office. What is this unwillingness to try really about? Laziness, boredom, self-criticism? No, I don’t believe so. When children and teens with ADHD don’t want to make efforts or take risks, it’s usually because they have too limiting beliefs about themselves. Either they think they mostly fail and want to avoid more defeats or they think that it’s not acceptable for them to make mistakes. In both cases, the result is inaction.

Kids with ADHD usually have grown up with a series of negative comments about that are labeled “constructive feedback.” Actually these statements feel anything but constructive. One 10 year-old boy told me “There’s nothing good about feedback. It’s usually bad.” Even parental or teacher redirections are interpreted by kids and their concrete thinking as them being wrong, bad or improper. Avoidance and perfectionism can then emerge as coping mechanisms.

Children and especially teens with ADHD can be expert avoiders. Tired of feeling wrong or doing poorly in school more often than not, they just give up. Perfectionism in kids with ADHD usually comes from feeling like they are never good enough. It can stop them from starting anything, especially writing, before they even begin. Sometimes they will agonize for hours which will delay them even more. How can we keep your sons and daughters engaged and willing to attempt things?

  • Acknowledge past mistakes as something that happened but aren’t who they are. Since learning means messing up, regrouping and doing things anyway, investigate the details of what occurred with the original mistake.
  • Ask questions with no blame and a neutral tone of voice like you are a detective: “What happens when you sit down for a test in biology? I saw you study at home. . . What might have helped you before the test that you now know based on your experience?”
  • Break tasks down into smaller, more manageable parts. When something seems overwhelming, difficult or uninteresting, start small. Together, choose some fun activities that can be used as incentives. “Instead of creating all 5 paragraphs of your book report, let’s just work on the first one. Then we can play a game of cards and do the second.” Your assistance and even sometimes just your presence, can be the difference between doing nothing and starting something.
  • Be open about the mistakes you make. Talk about them and what you did to deal with your errors. By doing this, you not only model your own flaws and problem-solving skills but also the shared human experience of having foibles in the first place.
  • Practice self-forgiveness and accountability. Let your kids see how you do this and verbalize it for them as well. Watching you shows that they can do it too.

Addressing these challenges takes time. Be patient with yourself and your ADHD child or teen. If you notice that you are frustrated, take some space, regroup and try again later when you are calmer. Remember, any negativity from you about avoidance and perfectionism only make them stronger.

 

Does your child have an accurate ADHD diagnosis?

Recently, a study by the George Washington University Institute of Public Health reported that 12% of U.S. children, a whopping 5.7 millionDiagnose U.S. children ages 5-17, were diagnosed with ADHD in 2011, across all ethnic groups. This is a significant jump since the last time this population was studied in 2003. In fact, a 43% increase. The study also found that more girls have been diagnosed–up from 4.3% in 2003 to 7.3% in 2011–while the rates for boys remained steady. The study did not look into underlying causes for this increase but suggested it could be due to the tendency to over-diagnose and recommended more research.

How you can make sure that your child has an accurate ADHD diagnosis? Generally, there are three common routes leading to an ADHD diagnosis: via your pediatrician, via a psychotherapist or via the child’s school. Whichever route you choose, I want to put in a plug for psychological or educational evaluations. Testing can be a great way to understand how your child’s brain
works more in depth, how they are performing academically and what is going on emotionally. Only certified school psychologists and licensed psychologists (or neuropsychologists) are trained to and do these types of evaluations. You can go through your public school system for an evaluation. Or, you may decide 
to see someone in private practice. Both options, although different in terms of cost, time and depth of analysis, are beneficial. Sometimes health insurance companies will pay for testing but not always. Personally, I think these evaluationsPsychometrics Word Cloud Concept, however obtained, are absolutely worth it. The comprehensive information that you gain from these reports can be tremendously helpful to everyone–parents, kids, teachers. They assist you in specifically understanding how ADHD affects the brain, behavior and emotion of your child and can validate that she or he really has it. 

Of course, pediatricians are absolutely helpful and well-informed in the diagnosis process and often they are the first people many parents talk to about ADHD. To make an ADHD diagnosis, they usually rely on speaking with you to get a sense of what is going on with your son or daughter (including gathering additional developmental or family history) and giving you some forms for you and the school to fill out. The Vanderbilt, Conors and BASC scales are common ones. Based on that information and any other relevant information that you have, your doctor will make a diagnosis. Many mental health practitioners do something similar and lots and lots of experts think these are sufficient, which they often are.

But, in light of the statistics at the top of this post, what could be happening differently? Most parents want to be sure that their kids have ADHD before giving them medication, putting them in special classes or getting them expensive tutors etc. I think testing provides you with the extra information that promotes a fuller understanding of what is going on for your child. Many pediatricians and mental health practitioners recommend it but some do not. I think reliable testing and valid interpretations of the results could make a big difference.

Today, my goal is to encourage you to obtain testing, if you haven’t already, and especially if you are uncertain that your child has been correctly diagnosed. I have seen numerous families in my practice be reassured and enlightened by the results, even though they can be complicated and sometimes overly focussed on weaknesses and problems. While the process of getting tested may be cumbersome, I believe the pros outweigh the cons. If you think your child may be incorrectly diagnosed, I encourage you to speak to your pediatrician or school psychologist and arrange for a formal evaluation.

Four children in the library

Making the most out of 2014

Happy new year! As we welcome 2014, many of us are thinking about how to make this year as good as or better than the last. What changes do we want to see for ourselves and for our children? Usually, people with ADHD/ADD can quickly create a list of several things about themselves that they don’t like and would like to improve. But several is too many. This year, 2014, let’s pick just ONE thing to focus on and do it really well!Making the most out of 2014

First, look around your life–your house, your job, your relationships, your habits and start of list of things you want to change, brainstorming up to 5 items. You can do this with your child or teen too but keep the limit to 3 items because we don’t want to overwhelm them with negativity or what’s wrong with them. It’s important to emphasize changing behaviors not personal flaws. This can be a useful family exercise too as you model for your child or teen that everyone has aspects of his or her life that can benefit from some tinkering.

Secondly, examine your list closely. Rule out items that are just pure fantasy. Look at the ones that are general or vague and make them more specific. For example, being more organized is a great goal but it isn’t precise enough to lead you or your child to do anything differently. Being more organized with my homework; being more organized about my bills; being more organized with my clothes: these are all more exact and will likely result in more success. You can create a program for something specific and actually accomplish it.

Thirdly, pick ONE thing from your list and have your son or daughter do the same. This could be the item that is screaming “Arrggh, don’t pick me” or “I hate this so I am not going to pick it” or “Yes, I have been putting this off for months (or years) so now is the time to go for it.” Examine this item closely. Is it do-able? Do you need help or support to accomplish it? Who could assist you? If your teen wants to be more organized about his notebook, how could you or someone he knows help him with making a plan for this? What does ONGOING support look like? If you want to clean up your basement, do you need a friend to aide you in deciding what to keep and what to give or throw away? Can you make an accurate schedule to tackle one area at a time?

Finally, the key to being successful with your ONE new year’s resolution is to STICK WITH IT. Create a time frame for yourself or your child and rely on it. Use technology for reminders such as making a repeating calendar item to check up on that notebook or spend 2 hours in the basement. Don’t give up when it becomes hard or you forget to do it. Recalibrate and start again. You have the whole year.

Talking About the Teenage Brain at Versan Conference in Montego Bay and Kingston, Jamaica

Versan Seminar-Dr Sharon SalineLast month, I had the great privilege to travel to Jamaica to present my talk, “What were you thinking? Understanding the Teen Brain,”at the “Recession-Proofing Your Education” Conferences in Kingston and Montego Bay sponsored by Versan Educational Services. Versan is an international educational organization that advises, places and trains students for boarding schools and colleges around the world. Ms. Sandra Bramwell, the founder and director, is one of the most energetic, eloquent and kind-hearted women whom I have ever met. She is also a visionary. The conferences were attended by over 175 parents, teens and guidance counselors as well as radio stations. 

Versan Seminar-Mrs Bramwell
Dr. Saline with Ms. Sandra Bramwell, founder and director of Versan Educational Services.

Each time I give this talk, I am always curious what the audience members will find most interesting and relevant to their lives. Sometimes people are curious about the recent findings in brain research that the pre-frontal cortex continues to develop until the mid-twenties. Sometimes people are interested in learning more about teens and sleep. And sometimes, people would just like to what is ‘normal’ teen behavior and what is not.

Versan Seminar-Dr Sharon Saline Lecture

 

 

 

 

 

 

At both of my talks in Jamaica, the attendees were especially interested by two issues that are related to executive functioning skills.

1. A 2011 NIMH-funded study about emotional recognition found that adolescents showed a 50% accuracy of correctly naming emotions versus the adults in the study who showed 100% accuracy. This finding means that adolescents misinterpreted the facial expressions that they were shown in half the cases. When I emphasized that this result implies that teens are reading situations incorrectly about half of the time and then responding to that misreading, people were amused but also concerned. We talked about how understanding facial expressions correctly relies on executive functioning skills which are still developing. Teens wondered if they could speed up the course of development. “Miss,” on young man asked, “Is there any way to speed up the development process if I work really hard? I would like it to be finished by the time I am 20, not 25.” “Well,” I said, “You can work hard on strengthening your executive functioning skills like planning, organizing, judgment and self-awareness but your brain will grow at its own rate and you can’t really make that go any faster.”  He was visibly disappointed.

2.Time management: I talked about backwards design, which seemed to be a new concept. We looked at how challenging it can be to get ready and out of the house on time for school in the morning. With the eager participation of one mother and daughter, we traced their morning routine as it unfolds now with all of its bumps and then rearranged it by going backwards from the time of arrival at school. The audience found this technique very useful.

Versan Seminar StudentsI really appreciated the frank feedback that the Jamaicans gave right after my talk—“I liked the part about learning how to make better decisions but not so much about the brain cells”—and their warmth and humor. It was refreshing (and a bit comforting) to see that parents and teens in the Caribbean have many of the same questions and concerns that we have here in the USA.

Effective Communication – The Rule of Three

Parents and teachers often complain to me that kids with ADHD don’t remember things they are told. This forgetfulness happens for a number of reasons—poor working memory, internal or external distractions, limited ability to sequence information into steps, anxiety about forgetting—and changing how you talk to a child or teen with ADHD can improve memory. When you are asking someone with ADHD to do something, that request should only have one component. The chances of him or her remembering more than one thing at a time are very slim, even with the aide of medication. So, keep your task SIMPLE.Mother and daughter smiling at each other

The rule of three is critical to successfully making these changes. 1. Say the youngster’s name. 2. Look directly at him/her AT EYE LEVEL, making sure your gaze is returned and held. 3. State your task clearly and calmly. Ask the child or teen to repeat your request EXACTLY and then, ask for a second repetition. These three steps have to be followed in this sequence in order for them to work most effectively. They activate several ways for connecting—sight, sound, repetition–that trigger different and simultaneous neural pathways.

When the single task is completed, then you can give another one in exactly the same manner. Communicating in this easy, direct manner improves the likelihood that the task is remembered and completed. Everyone will be less frustrated and feel more confident that things actually get done!

Using Technology as Friend Not Foe

Everybody needs reminders sometimes. Children and teens with ADHD seem to need more reminders than other youngsters and often feel like they are being nagged. Technology, although a frequent source of distraction, can be extremely helpful in providing kids with ADHD the cues they need and reduce the “nagging” factor. Parents and educators can use cell phones, iPods to help kids improve their organization, reduce forgetfulness and learn to be more independent.Boy in headphones looking tablet computer on the nature

If someone has a phone or an iPod, then s/he has an aide that they carry around constantly. I rarely come across a teen who doesn’t know where the phone is at all times. A child with an iPod is equally attached to his/her electronic device. Use the phone or iPod as the reminder machine so you don’t have to do this. Set alarms for chores, homework times, work breaks, appointments and even turning in assignments. Pick ONE and only one task that your teen or child forgets to do and set the alarm for that event. Watch him/her set it up so that the alarm has a label related to the task. Make sure all adults who interact with the youngster throughout the day understand the reminder program that you are starting. This alarm will then cue the teen to do the expected task.

When you have success with this one thing, then you can add in another, but NO MORE than three per day. By having the technology do the cuing, then you are teaching self-reliance and building self-esteem simultaneously. You will support changes in behaviors without running them.