Post on 13-Dec-2015
ADHD
Common Behaviors
Elham Shirazi MDChild & Adolescent Psychiatrist
Many ADHD :
Act younger than they areAre forgetful Argue or talk backHard to wake upHave a messy roomDon’t learn from disciplineAct without thinking of consequences
If you want to correct every misbehavior You will be worn out physically & emotionally !
Pick your battles carefullyUse reprimands sparingly
Your teenager can learn to compensate
But it will take time !
Seek Independence & FreedomSeek Independence & Freedom1. 1. Encourage independenceEncourage independence Give as much freedom as you feel he can
cope with Give opportunities to make his decisions
2 .2 . Trust until proven not trustworthyTrust until proven not trustworthy
3 .3 . Be observant of activities & friendsBe observant of activities & friends Intervene when isn’t handling independence
well Take away privileges,but extend them again to
give him a 2nd chance
4. 4. Consider compromiseConsider compromise
5. Set up win-win solution5. Set up win-win solution Allowed to go to beach with friends with a
parent supervision
6. Offer an attractive alternative6. Offer an attractive alternative As interesting , with sufficient freedom Propose an interesting activity before he has
ideas of his own
Disobey / Conflict with Adults Don’t always do as parents & teachers
ask them
but often , their failure is inadvertent ! Variety of reasons :
Forget, don’t listen, don’t hear, immaturity, impulsivity, can’t focus on one activity, losing track of time, avoid unpleasant job
Often oblivious to rewards & punishment
Conflict
Available Options
1. 1. State rules clearlyState rules clearly
2. Post them in writing helps2. Post them in writing helps
3. Develop rules jointly3. Develop rules jointly
more likely to remember & comply
4. A few stated rules are better4. A few stated rules are better
Act Younger Social development 30% behind peers
LLD Impaired communication skills
Trouble following & remembering lengthy explanations & requests
Trouble finding right words to answer quickly & organized
Want privileges of his age
but may not handle them maturely
Available Options
1. Adjust expectations1. Adjust expectations To appropriate age level Don’t take misbehavior personally
2. Ask his help in solving problems2. Ask his help in solving problems
3. Teach desired behavior3. Teach desired behavior
4. Impose consequence if necessary4. Impose consequence if necessary
Act Impulsive
If a thought crosses their mind, they may act on it If they think it, they may say it
more likely to say : Ready, Fire!, Aim (& Oosp !! at the end)
They often say / do things they wish they could take back
Keeping secrets terrible time Live for moment delay gratification is
difficult
Available Options
1. 1. Anticipate problemsAnticipate problems Buy a small gift to open before christmas Put car keys away Put money in saving account Don’t tell him secrets
2. Avoid tempting to act impulsively2. Avoid tempting to act impulsively
3. Consider medication 3. Consider medication
Difficulty Paying Attention
View the world through a wide angle lens
Pay attention to every thing at once
Trouble selecting what is most important Sometimes over focus
Concentrate on single activity for hours Misleading adults
He deliberately don’t pay attention !
Trying to talk with ADHD can be frustrating
Are you listening to me?
Available Options
1. 1. Make eye contact / use touchMake eye contact / use touch Stand/sit in front of him
(close proximity) Place your hands on his shoulder/knee
(touch) Say his name (sound) Avoid power struggle
2. Keep comments brief & leave2. Keep comments brief & leave Can’t remember >2-3 things Trouble picking important points
Available Options
3. Avoid preaching3. Avoid preaching
4. Write instructions down4. Write instructions down
5. Accept his listening style5. Accept his listening style Sometimes they hear even appearing
not to listen Ignore his restlessness & accept his
listening style
Forgetful / Doesn’t Do Chores
1. Make a written list
2. Use post-it notes
3. Help get started / show how to do
4. Ask what help?
Disorganized / Lose Things1. Put name on possessions
2. Purchase less expensive things
3. Help be organized Have specific place for belongings Teach time management constantly
4. Serve as a couch Give reminders about important
responsibilities
Available Options
5. 5. List steps for a clean roomList steps for a clean room Make up bed Hang up clothes Pick up thinges of floor Put them in closet & vaccuum
6. Help cleaning / organization6. Help cleaning / organization Work with him on weekly/monthly basis Make learning pleasant (listen to music,talk
about hobbies,…)
7. Close door to messy room7. Close door to messy room You don’t have to look at the mess
Lack Of Awareness Of Time Are often late Difficulty guessing how long it will be take
1. Set a wristwatch alarm for key 1. Set a wristwatch alarm for key timestimes
2. Rent or buy a beeper2. Rent or buy a beeper
3. Teach awareness of time3. Teach awareness of time
Difficulty Planning Ahead
Prefer to do things on the spur of moment
1. Teach planning 1. Teach planning
2. Teach time management2. Teach time management Including him when planning family
activities Using a weekly calendar Estimate time required for each step
Difficult to Discipline
Don’t learn from their mistakes Don’t make connection between
behavior & consequences Low sensitivity to rewards & punishment Traditional punishment doesn’t work
parents use harsher discipline
Many times : Genuinely sorry when doing something wrong
Available Options
1. Use positive reinforcement1. Use positive reinforcement
2. Use logical consequences2. Use logical consequences
3. Reward or punish immediately3. Reward or punish immediately
4. Create new consequences / 4. Create new consequences / rewardsrewards
5. Be consistent5. Be consistent
6. Try “Grandma’s Rule6. Try “Grandma’s Rule“
Available Options
7. Use behavior charts7. Use behavior charts
8. Use rewards / may include 8. Use rewards / may include moneymoney
9. Redirect interests9. Redirect interests
10. Give second & third chances10. Give second & third chances
11. Avoid power struggles11. Avoid power struggles
Low Frustration Tolerance Irritability / Emotionality
Easy frustratedRespond more emotionally Irritable or moody65% oppositionalArguing over smallest issuesNever certain what mood to expect
Defensive & angry at person correcting him
Respond to stress with angry temper outbursts
Overreact to crisis Blame unfair action of others Direct anger at person they love the most
/ they feel safest Sensitive to criticism or disapproval Fear of being embarrassed
Available Options
1. 1. Use active listeningUse active listening
2. 2. Be supportiveBe supportive Treat your teenager with respect
3. Teach problem solving skills3. Teach problem solving skills
4. Teach anger control4. Teach anger control He is learning from family & parents He will model your behavior Bragging about things he does well
Verbal Fights / Arguing Being a parent & not responding angrily is Being a parent & not responding angrily is
not easynot easy
1. Ignore minor infraction1. Ignore minor infraction
2. Walk away from conflict2. Walk away from conflict ( I know you are upset, but cursing is not
acceptable around me, I will not stay here & listen to you talk that way. I will come back later & we will talk when you have calmed down or when you can talk without cursing ! )
Available Options
3. Give space & time to cool 3. Give space & time to cool offoff
Need time alone when had emotional blown-up
4. Impose a consequence4. Impose a consequence
5. Adjust medication5. Adjust medication
Don’t Accept Responsibility for Actions
May blame someone/ something else for their actions
Trouble admitting they have done something wrong
Trouble saying they are sorry
1. Deal with problem behavior1. Deal with problem behavior
2. Don’t try to assess degree of 2. Don’t try to assess degree of guilt or excuse guilt or excuse
DishonestDishonest1.1.If you know the answer, don’t If you know the answer, don’t
ask ! ask !
2. Don’t create opportunities to lie2. Don’t create opportunities to lie
3. 3. Eliminate some punishment Eliminate some punishment
4. 4. Develop plan to solve the Develop plan to solve the problemproblem
5. 5. Impose a consequenceImpose a consequence
Difficulty With Family Events
1. 1. Keep outings simple Keep outings simple 2. Reduce demands 2. Reduce demands 3. Keep outings brief3. Keep outings brief4. Provide a safety release valve4. Provide a safety release valve5. Look for creative solutions5. Look for creative solutions6. Medication may help6. Medication may help
Difficulty Participating In Sports
Exercising is good : stress sleep better restlessness good for heart hyperactivity production of neurotransmitter
50% poor motor coordinationPoor hand-eye coordination Gross motor skills may be better
1. 1. Play large muscle sportsPlay large muscle sportsswimming , soccer , track , wrestling , karate
2. Play an active position that 2. Play an active position that requires full attentionrequires full attentionpositions which involve higher activity levels are more likely to hold attention & focus
3. Consider medication before game3. Consider medication before game
Restless / Easily Bored
Feeling restless complain of being bored
Wants to do something constantly Wants to go somewhere constantly
1. Encourage involvement in 1. Encourage involvement in community activitiescommunity activities physical activities, organized sports, religious groups, overnight parties, ski trips,...
2. 2. Plan interesting family outingsPlan interesting family outingsschedule family events that allow your teenager be active
3. Encourage hobbies & interests3. Encourage hobbies & interestsdiscover his interests by exposing him to variety of activities discuss options & let him pick one out
4. Make special plans for holidays4. Make special plans for holidays
Difficulty With Family Events
1. 1. Keep outings simple Keep outings simple 2. Reduce demands 2. Reduce demands 3. Keep outings brief3. Keep outings brief4. Provide a safety release valve4. Provide a safety release valve5. Look for creative solutions5. Look for creative solutions6. Medication may help6. Medication may help