Transcript ADHD Principles For Parent / Teenager Interactions

ADHD
Common Behaviors
Elham Shirazi MD
Child & Adolescent
Psychiatrist
Many ADHD :
Act
younger than they are
Are forgetful
Argue or talk back
Hard to wake up
Have a messy room
Don’t learn from discipline
Act without thinking of consequences
If you want to correct every misbehavior
You will be worn out physically &
emotionally !
 Pick
your battles carefully
 Use reprimands sparingly
Your teenager can learn to
compensate
But it will take time !
Seek Independence & Freedom
1. Encourage independence
 Give as much freedom as you feel he can
cope with
 Give opportunities to make his decisions
2 . Trust until proven not trustworthy
3 . Be 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. Consider compromise
5. Set up win-win solution

Allowed to go to beach with friends with a
parent supervision
6. 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
1. State rules clearly
2. Post them in writing helps
3. Develop rules jointly
more likely to remember & comply
4. A few stated rules are better
Act Younger

Social development 30% behind peers

LLD

Want privileges of his age
but may not handle them maturely
Impaired communication skills
Trouble following & remembering lengthy
explanations & requests
Trouble finding right words to answer quickly
& organized
1. Adjust expectations
 To appropriate age level
 Don’t take misbehavior personally
2. Ask his help in solving problems
3. Teach desired behavior
4. 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

1. Anticipate 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 impulsively
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?
1. Make 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 & leave
 Can’t remember >2-3 things
 Trouble picking important points
3. Avoid preaching
4. Write instructions down
5. 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 Things
1. 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
5. List steps for a clean room
Make up bed
 Hang up clothes
 Pick up thinges of floor
 Put them in closet & vaccuum

6. Help cleaning / organization
Work with him on weekly/monthly basis
 Make learning pleasant (listen to music,talk
about hobbies,…)

7. 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
times
2. Rent or buy a beeper
3. Teach awareness of time
Difficulty Planning Ahead
 Prefer
to do things on the spur of moment
1. Teach planning
2. 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
1. Use positive reinforcement
2. Use logical consequences
3. Reward or punish immediately
4. Create new consequences /
rewards
5. Be consistent
6. Try “Grandma’s Rule“
7. Use behavior charts
8. Use rewards / may include
money
9. Redirect interests
10. Give second & third chances
11. Avoid power struggles
Low Frustration Tolerance
Irritability / Emotionality
 Easy
frustrated
 Respond more emotionally
 Irritable or moody
 65% oppositional
 Arguing over smallest issues
 Never 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
1. Use active listening
2. Be supportive
Treat your teenager with respect
3. Teach problem solving skills
4. 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 not easy
1. Ignore minor infraction
2. 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 ! )
3. Give space & time to cool
off
Need time alone when had
emotional blown-up
4. Impose a consequence
5. 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 behavior
2. Don’t try to assess degree of
guilt or excuse
Dishonest
1.If you know the answer, don’t
ask !
2. Don’t create opportunities to lie
3. Eliminate some punishment
4. Develop plan to solve the
problem
5. Impose a consequence
Difficulty With Family Events
1. Keep outings simple
2. Reduce demands
3. Keep outings brief
4. Provide a safety release valve
5. Look for creative solutions
6. Medication may help
Difficulty Participating In Sports
Exercising
is good :
stress
sleep better
restlessness
good for heart
hyperactivity
production of neurotransmitter
50%
poor motor coordination
Poor hand-eye coordination
Gross motor skills may be better
1. Play large muscle sports
swimming , soccer , track , wrestling ,
karate
2. Play an active position that
requires full attention
positions which involve higher activity levels
are more likely to hold attention & focus
3. 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
community activities
physical activities, organized sports,
religious groups, overnight parties, ski trips,...
2. Plan interesting family outings
schedule
family events that allow your
teenager be active
3. Encourage hobbies & interests
discover
his interests by exposing him to
variety of activities
discuss options & let him pick one out
4. Make special plans for holidays
Difficulty With Family Events
1. Keep outings simple
2. Reduce demands
3. Keep outings brief
4. Provide a safety release valve
5. Look for creative solutions
6. Medication may help