Return to ADDvisor Volume 1 1999 Index

Number 8, December 1, 1999
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In this issue:


1. ADHD - What Do We Do After the Diagnosis?

2. 12 Core Principles for Managing ADHD.

3. Maternal Depression: 10 Things You Can Do to Cope.


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ADHD-WHAT DO WE DO AFTER THE DIAGNOSIS?
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When parents truly understand that their child is afflicted with a chronic
neurobiological disorder, they will sometimes experience a grief reaction. Coming to terms with the fact that your child has a chronic disability that will most likely follow them their entire life (about 70% maintain significant symptoms into adulthood) is not good news.

Knowing that this disorder may effect (or continue to effect) your child's
academic performance, peer relationships, behavior, ability to avoid trouble, ability to avoid substance use, marital relationship, driving record, job performance, self esteem, ability to persist toward a goal, etc., can be extremely unsettling, to say the least. As a result many parents will feel sad for a period of time following their true comprehension of the possible magnitude of the disorder. Understanding that these feelings are normal and allowing them to run their course is the first step toward productively dealing with this problem.

What is the Next Step?

The next step is for the parent to become an ADHD expert. This includes developing a thorough knowledge of the disorder and its treatment. Two excellent texts to assist in this process are: "Taking Charge of ADHD. The Complete Authoritative Guide for Parents." This is authored by Russell Barkley, Ph.D. and published by Guilford Press. Another suggested reading is "I Would If I Could" by Michael Gordon. Understanding which treatments are supported by scientific research is also very important in helping a parent to decide what kind of help to obtain.

Unproven/Disproven Therapies

There are many unproven/disproven therapies for ADHD. Some of these include: dietary management (research has shown this has been helpful with about 5% of children under the age of 5.), megavitamin therapy, sensory-integration therapy, chiropractic manipulation, relaxation training, EMG/EEG biofeedback training, social skills training and self control training.

Interventions

There are numerous interventions that are empirically justified. The
treatments that have been supported by a significant number of research studies include: Pharmacological therapies (medication - stimulants have an approximate 80% success rate), parent counseling about ADHD, parent training in child management, parent training in adolescent management, teacher/school counseling about ADHD, teacher/school training in classroom/school management, special education services, parent support associations (e.g. CHADD).

Since it is common for other problems to accompany ADHD (most common are anxiety, depression, oppositional/defiant/conduct disorders, substance use disorders and learning disabilities) diagnosis and treatment of these disorders through individual or group therapy is often indicated.

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12 CORE PRINCIPLES
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Russell Barkley, Ph.D., outlines 12 core principles for managing ADHD.

1) Bridge time: Externalize time limits via time schedules.

2) Immediacy of consequences: Use feedback and consequences as quickly as possible following the desirable or undesirable behavior.

3) Frequency of consequences: ADHD children require feedback and
consequences much more often than normal children.

4) Intensity of consequences: ADHD children seem to need higher magnitude consequences than normal children.

5) Change rewards periodically: This prevents boredom.

6) "Act don't yak": ADHD is not due to a failure of knowledge or reasoning. Use feedback, rewards, and punishments swiftly and often.

7) Use positives before negatives: Set up a reward program to encourage desired behaviors.

8) Anticipate problems: ADHD children often have trouble in the same
situations over repeated occasions. Set up a plan to manage the problem before it occurs.

9) Keep a disability perspective: ADHD is a neurodevelopmental disorder with a strong hereditary predisposition. Their handicap manifests itself in the way they regulate their behavior. Although they do not look disabled, they are neurologically handicapped.

10) Maintain a sense of priorities: Do not engage in conflicts with the
child over trivial, minor rule violations.

11) Don't personalize the child's problems: Maintain a sense of humor,
your methods and programs will not work all the time with an ADHD child.

12) Practice forgiveness: For your child, others and yourself for the
mistakes that are certainly going to be made in managing such a child.

We will continue our discussion of treatment of the ADHD child in the January 1, 2000 newsletter, which will include a detailed look at medications and behavior management.

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MATERNAL DEPRESSION: 10 THINGS YOU CAN DO TO COPE
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A very interesting article appeared in the most recent issue of the
Journal of Attention Disorders titled "Levels of Self-Reported Depression Among Mothers of Children with Attention-Deficit/Hyperactivity Disorder." In this article the authors report that

1) Mothers of ADHD children experience significantly higher degrees of depression than mothers of non-ADHD children.

2) Mothers of children with Hyperactive-Impulsive or Combined Type ADHD experience significantly more depression than mothers of Inattentive Type ADHD and

3) Mothers of multiple ADHD children experience more depressive symptoms than mothers of only one ADHD child. What does this mean for mothers of ADHD children and what should they do?

1) Understand that you are at greater risk for reactive depression than the general population.

2) Be easy on yourself - being the mother of an ADHD child is a difficult task, do not expect perfection.

3) Forgive yourself - you will make many mistakes, as raising a child with ADHD is anything but routine.

4) Educate yourself - continue to read this newsletter, look for books
(many can be found at the ADD Warehouse at www.addwarehouse.com). Explore other sources of information such as the CHADD website (www.CHADD.org).

5) Join CHADD and attend your local CHADD chapters' meeting for information and support. Call 1-800-233-4050 to find out the location of your local chapter.

6) Join our twice monthly group phone calls for education and support (see our web page at ADDvisor.com for more information and a sign up sheet).

7) Do not isolate yourself. Talk to other parents you respect about how
they handle difficult issues with their non-ADHD kids.

8) Keep the lines of communication open with teachers by developing a positive relationship with teachers through frequent contact and supporting them in their role.

9) Make it your personal mission to praise your child at every possible
opportunity, large and small. It will build your relationship, build
his/her self-esteem and improve their behavior.

10) Take care of yourself. In addition to doing what you need to do to stay healthy, give yourself some time off occasionally to recharge your batteries. Get a massage, spend the night away with a friend - do what you need to do to stay mentally healthy. You're one of the most important links to your child's success.

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Please stay in touch. We are here to help you. If you have a topic of
particular interest, please let us know. Questions are also welcome.

CONTACT INFORMATION

_______________________

Alan R. Graham, Ph.D. 

Bill Benninger, Ph.D.

ADDvisor.com

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Email: Alan@ADDvisor.com

Bill@ADDvisor.com

Web: www.ADDvisor.com

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