Manage Anxiety in Your ADHD Kids

This month’s blog is actually an interview that I had with the team at ImpactADHD. com. It focuses on building resilience and competency as a way to help ADHD kids manage their anxiety.  Check it out!  http://impactadhd.com/manage-emotions-and-impulses/kids-with-anxiety/

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

Savor the Summer and Take Your ADHD Kids Outside

As we head into the last weeks of summer and for some, the early return to school, it’s worth taking some time to savor the great outdoors. Spending time in nature is beneficial and fun for all of us: we can kick off our shoes and wade into the ocean, hike to a beautiful vista or just have a picnic in our own backyards. It’s especially great for kids with ADHD. When any of us venture outside to a beach, park or any green spot, our entire demeanor shifts. We shed some of the stress of our daily lives, feel more relaxed and connect with the atmosphere around us. Children, teens and adults start to feel a welcome sense of spaciousness and freedom. Family Bonding Happiness Togetherness Park
For kids with ADHD, this freedom is often sorely needed.

Children and teens with ADHD need a chance to let go from the pressures of all things that they struggle to remember to do and from not feeling good enough at doing them. They spend so much time trying to focus, stay organized and correct their mistakes that a break from these pressures is a welcome relief. On a family excursion outdoors, they can just be in the moment. They can enjoy the diversity of outside activities and explore the many facets of the natural environment. They may be happy just to be in a different physical space and do nothing at all. These experiences in nature can be very restorative for them and for you as parents too. They also provide ideal times for family fun as the ‘shoulds’ of our daily routines are transformed into games, explorations and discoveries.

Here are some tips to having a successful summer family outings with ADHD kids or teens:

1. Pick a location that offers something for everyone and doesn’t require much planning. Talk with your family about the experience and what people want to do so you can all collaborate on making a good experience for everyone.Happy family playing on the beach at the day time

2. Limit your expectations. Whatever happens has to be okay with you and okay with your child. Share your hope for the day and listen to theirs.

3. Give your teen or child a few specific, simple tasks to do in preparation that are written down and can be checked off. This gives them more practice in developing those ever-needed executive planning and organizing skills.

4. Create some guidelines about appropriate behaviors for the excursion (not more than 3 because the kids won’t likely remember them). These should revolve around safety primarily and be logical and explicit (e.g. no swimming alone or without permission, no hiking away from the group, no wandering off from the picnic area).  Remind your child or teen of these 3 guidelines as you arrive at the location.

5. Focus on the positive. There will likely be a blip or two. Something may happen that will frustrate you or your child. Take a deep breath, focus on what’s most important and help him/her recalibrate. You could both try paying attention to something appealing in the nature around you to help you move on.

Enjoy your adventures!

Follow me on Twitter to learn more about my integrative strategies for attention, behavior and learning @drsharonsaline!

 

Feeling overwhelmed by something? Break it down!

One of the most common problems for many kids with ADHD is getting overwhelmed by a task. Whether it is doing homework, cleaning up a bedroom or looking for a summer job, they feel swamped and don’t know where to begin. Often they avoid doing these things rather skillfully and don’t respond to reminders you offer them. How can you help your child minimize his or her procrastination and get down to business?Frustrated high school student

One of the main issues behind most procrastination behaviors involves the size of the task. Something small can feel enormous. When a project seems too big for any of us, it’s usually daunting to start it. For kids with ADHD, that feeling of intimidation is especially powerful and immobilizing. They often think: “Why start something that seems impossible to finish or even partially finish? What even bother?” So they can freeze and unwittingly become masters of avoidance.

The best solution to feeling overwhelmed by a project, task or chore is to break it down into smaller pieces–sometimes really small pieces. We want your child or teen to be able to accomplish at least one step towards completion and no step is too little in this process. With the confidence of doing something instead of worrying and negative self-talk, they will be moving along towards the goal at hand. It’s this movement that builds confidence and further action.

Of course, the big question is: “How do I create tasks that are the right size to promote starting them?” The answers lie in working collaboratively with your child or teen to set up a plan that fits his capabilities. Being as specific as possible and remaining calm in the face of any frustration are the keys to working together successfully. For instance, when the room is very messy, agree that you will each pick up a few pieces of clothing per night so cleaning up is more tolerable. Or, when there are 30 math problems, try starting with half or even less (providing the teacher agrees to this) and increase steadily when those are successfully attempted and finished.Asian Teen Playing or Working on a Laptop Computer

Here’s how to get started:

1. Before you sit down with your son or daughter, ask yourself “How long can he really focus on a chore or homework before he gets distracted or bored?” You know your child quite well and, whatever the answer is, keep that in mind when you create the plan.

2. Schedule a time when things are calm to talk about this issue. Ask her how long she thinks that she can concentrate before she needs a break. She might not be able to assess this very well so then you can offer your insights. Whatever she suggests, go with the smallest amount of time that comes up. If it’s 15 minutes, great; if it’s 45 minutes, great too. Decide together how many work periods she can handle in one day. For example, ADHD kids from 8-11 years old can usually do about 20-30 minutes of homework per day; ADHD middle schoolers can handle about 30-60 minutes ; ADHD high schoolers manage 1-2 hours. Talk about starting with the most difficult components of the task first when concentration is the strongest.

3. Then discuss the length and range of acceptable activities of the break he will need after the work period. The activities should be something from which he can easily disengage without an argument. Activities to consider are having a snack or a drink, playing a brief game (e.g. TicTacToe), taking a brief walk around the room or the house and using the bathroom. Avoid technology during breaks because stopping their usage is typically quite difficult. Breaks of about 5-10 minutes are usually adequate for school-age kids.

4. Try it out! If it’s still hard for your son or daughter to accomplish something, then the task remains too big. To make it smaller, reduce the length of the work period. I have seen parents start with 5 minute work periods and eventually move up until 30 minutes, going slowly and steadily. This may mean you may get less help initially with raking the leaves or only one page of math problems is completed. However, frustrating this may be for you (and understandably it could be), remain patient. No matter what, the breaks do not change in length. Longer breaks seem to be harder for kids to recover from and then you are back at the beginning of procrastination problems.

Remember, that every successful step benefits from recognition. Praise what images-4you see being accomplished so that your child will eventually learn to do this for himself. This process of breaking things down can also be helpful in school where you, your child and his teachers can all be involved in determining the size and scope of what work periods and breaks look like for him.

 

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.

Personal Project Planners

Whether it’s writing a paper or cleaning up your desk, some projects are just hard to get to and even harder to finish. You simply consider organizing the mound of papers and junk on your kitchen table and a wave of fatigue sweeps over you, causing you to run suddenly for the couch in front of the television or your comfortable bed. Or, you mention the dreaded task like writing that college essay and your daughter suddenly has field hockey practice and hastily leaves the house. Starting a task that seems unpleasant or problematic, creating steps to move it along, and then completing it can be challenging for EVERYONE, especially people with ADHD. The project, the chore, and the paper all seem insurmountable because they appear overwhelming. The key to to success is breaking them into manageable parts.

Copy filesWhen you, your child or student create a customized plan that creates these , then you are already on the road to completion. Although there are many how-to forms for homework, chores and long-term projects, many of them are complicated and labor intensive. The goal of using any form is to provide structure for the planning, prioritizing and sequencing aspects of executive functioning skills that get you from the beginning to the end of a task.

Here’s how you can create your own forms that suit you (and your child’s) specific management skills which will take some effort in the beginning but will definitely yield results. You will need a pen and a piece of paper.

  1. Choose the topic or task and write that on the top of the paper.
  2. Make a grid with 3 vertical columns and several horizontal ones. Label the columns “Possibilities, Pros, Cons.” It should look like this:
Possibilities Pros Cons
  1. Put any ideas about the project in the possibilities column, followed by what is good and bad about that idea. For example, if the task is organizing the stuff in the basement, the possibilities list might range from “taking everything to the dump” to “getting rid of anything that I haven’t used in 5 years.”
  2. Create the sequential steps needed to accomplish the task using another grid with 5 vertical columns and several horizontal ones. Use the labels suggested below OR create your own. Make as many numbered rows as required to finish the project. Make the actions as specific as possible. Estimating the time it takes to do a step and then comparing that guess with the actual time the passed improves those all-important time management skills as well!
Action Materials needed Time Estimate Actual Time Finished!
1.
2.
3.
4.
5.
6.
7.

Although many kids and adults with ADHD often reject the structure and practice of this process, I have found that my clients ultimately embrace such programs and find them extremely helpful. These “roadmaps” reduce anxiety, clarify goals and build confidence as activities are completed. So, swallow any resistance and try one today!

 

 

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.

Spring Cleaning: Moving Stuff OUT

As the trees and flowers begin to bloom, many parents take a look around their homes and long to clean out the family nest. Sometimes, the task seems just too overwhelming and you don’t get any further than a big sigh. Garage Sale BoxAt other times, you start with the best intentions but can’t get past the battles about what to keep and what to get rid of. Here are some simple steps that you can use to organize the belongings of your children or teens this spring (and maybe even your own)!

The path to organizing success involves the 3 P’s: patience, perseverance and practice. It requires a sense of humor and the ability to keep focused on your goal. Improve collaboration with your son or daughter and avoid power struggles by using the following steps:

1. Choose your target carefully. Make it manageable and give it a specific period of time. For example, go for cleaning out JUST the closet and give yourself a limit of around an hour. Or, concentrate on picking things off the floor and do the closet on a different day. Keep track of the time so you don’t run out!

2. Engage your child or teen in the process, using incentives. This means offering your child or teen something s/he may want to do as a reward for working with you on this project. Examples may include extra screen time (tv or computer or gaming systems), fun activity (biking, board games, playing sports), time with friends or a special food treat.

3. Get 4 bags and label each one: “keep”, “trash”, “give away”, “unsure”. Divide the STUFF into these bags. If your child or teen has trouble with letting go of belongings, help him or her make choices by talking about what is really being used and how someone else might want what your son or daughter does not.Cleaning my room

When you have your 4 bags, go through the “unsure” bag carefully one more time, putting its contents in the other 3 bags. Then put away the “keep” items immediately and deal with the “trash” and “give away” bags. Remember it is critical to value what you have done together. Look at your accomplishment and congratulate yourselves on the success of your efforts!!