Parenting Inattentive-hyperactive Children And Youth - Presentation

Community Education Service in collaboration with Child & Adolescent Mental Health

Parenting Inattentive/Hyperactive Children and Youth

Funding generously provided by Encana Corporation and the Alberta Children’s Hospital Foundation

Outline 1. What is Attention Deficit/Hyperactivity Disorder (AD/HD)? - Possible Causes - Characteristics - Diagnostic Criteria - Additional Criteria 2. Related Problems 3. Treatment Options

Outline 4. Strategies - Social Skills Strategies - Basic Strategies - Specific Strategies 5. Good things about having AD/HD 6. Community Resources

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What is Attention Deficit/Hyperactivity Disorder (AD/HD)?

AD/HD is: { { { { { {

Complex neurobiological condition AD/HD is the most common psychiatric disorder for children Affects between 5 – 12% of school age children 8 – 10% of males and 3 - 4% of females under 18 years have AD/HD Males outnumber females (3:1 to 6:1) Not caused by poor parenting

Possible Causes of AD/HD? {

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Brain function (i.e. neurology) - altered brain messenger substances (neurotransmitters) - under activity and/or reduced blood flow in the frontal area of the brain Heredity and genetics Brain injury The role of environment

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Characteristics 1) Predominantly Inattention 2) Predominantly Impulsivity/ Hyperactivity 3) Combined Type

Diagnostic Criteria 1) Inattention { {

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Careless mistakes Poor sustained attention Poor listening Lack of follow through and task completion Disorganized

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Poor sustained mental effort Loses things Easily distracted Forgetful 6 out of 9 symptoms need to be present (for 6 months)

Diagnostic Criteria 2) Hyperactivity/Impulsivity { { { { { {

Fidgets/ squirms Leaves seat Runs/climbs a lot Can’t play quietly “On the go” Talks excessively

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Blurts out answers Difficulty waiting Interrupts/intrudes 6 out of 9 symptoms need to be present (for 6 months)

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Diagnostic Criteria 3) Combined Type {

Combines criteria of both 1 and 2

Additional Criteria { {

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Symptoms present before age 7 Symptoms present in 2 or more settings (at home, school, or work) Significant difficulties in social, academic, and occupational functioning Symptoms do not occur exclusively during the course of PDD, Schizophrenia, or another psychotic disorder and are not accounted for by other disorders (mood disorder, anxiety disorder, dissociative disorder, a personality disorder, or a physical condition).

Related Problems

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Related Problems { { { { { { {

Learning Disabilities (Nonverbal Learning Disorder) Oppositional Defiant Disorder Conduct Disorder Tic Disorder (e.g. Tourette’s Syndrome) Mood/Anxiety Disorder (Depression and Bi-Polar) Substance Use and Abuse Other (Asperger’s, Sensory Integration)

Treatment Options

Treatment Options {

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Child, parent, and teacher education about this disorder Behavior modification Parent training Family Therapy Anger Management & Social Skills Training Stimulant medication/Non-stimulant medications - Ritalin, Dexedrine, Strattera

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Treatment Options Medication { { {

Two types of medications used are stimulants and non-stimulants A combination of therapy and medication is the most successful treatment Parents and families are encouraged to talk to their physician and other healthcare professionals to gather information to make a decision around treatment.

Treatment Options Methylphenidate (Stimulant)

Amphetamines (Stimulant)

Atomoxetine (Non-Stimulant)

Methylphenidate IR (Ritalin®)

Adderall ER®

Strattera®

Methylphenidate SR (Ritalin®)

Adderall XR®

Methylphenidate ER (Concerta®)

Dexedrine IR®

Methylphenidate CR (Biphentin®)

Dexedrine SR ®

Treatment Options {

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Adaptations to the student’s educational program/environment Close positive home/school communication and cooperation is critical Social skills training (individual or group)

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Treatment Options Alternative Therapies {

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Vitamins/dietary supplements: including these in your child’s diet to reduce symptoms of AD/HD Elimination diets: removing certain additives and food from your child’s diet for a given period of time if you think they may be affecting their behaviour Biofeedback: a stress reducing technique used to control certain body responses (ie. heart rate, muscle tension). It can help children/adolescents with ADHD to normalize brain wave patterns.

Treatment Options Alternative Therapies cont’d {

Sensory integration training – using light, sound, tactile stimulation to “exercise the brain”.

Note: Evidence-based research is underway on many of these therapies and information is still being gathered about how effective they are.

Strategies

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Social Skills Strategies {

Listening/Attending

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Role-playing

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Turn-taking

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Modeling

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Anger management

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Relaxation training

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Problem-solving

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Communication skills

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Cooperation

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Emotional regulation

training {

Therapeutic games

Basic Strategies {

Establish predictable

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known to child

Prepare child in advance for any change

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Consistency in rules and consequences over time

of routine {

Simple and concrete consequences that are

daily routines

Simple concrete rules

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Regular physical activity

and expectations that

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Quiet wind down

are known to child

Specific Strategies 1. Accept that your child will be active and energetic, because of the makeup of their brain. {

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It is helpful for these children if their caregivers can be calm and tolerant Label the behavior and not the child (e.g. the child is NOT bad)

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Specific Strategies 2. Provide outlets for releasing extra energy. {

These children need daily physical activities, involvement in sports such as running, dance, martial arts or family playtime

Specific Strategies 3. Find activities at which your child can succeed. {

All children need to experience success to feel good about themselves

Specific Strategies 4. Problem Solving - A person who has AD/HD may have difficulties solving problems. She or he might: o

See the problem as more difficult than it truly is

o

Have trouble finding solutions for the problem, or get stuck in one way of dealing with the problem even though it isn’t working

o

Find it hard to put a plan into action.

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Specific Strategies Problem Solving (cont’d) o

Identify the problem

o

Identify possible actions to help solve the problem

o

Compare the good and bad points of the different solutions

o

Pick the best action

Specific Strategies Problem Solving (cont’d) o Identify the problem and potential actions to take to help solve the problem Identify the problem by paying attention to how your mood changes through the week. Focus on only one problem at a time.

The Problem:

ƒ

ƒ

People who can support me:

ƒ

Friends, siblings, parents, other concerned adults?

What I want to happen:

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3 things I could do (action)

ƒ

What would you like the end result to be?

Consider things that you can do with and without the help of someone else. Don’t try to decide which one is best. ƒ It’s okay if you tried something and it didn’t’ work. ƒ

Specific Strategies Problem Solving (cont’d) o

Compare the good and bad points of the different solutions

Action

Good Points

Bad Points

1. 2. 3.

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Specific Strategies Problem Solving (cont’d) o

Pick the best action

o

Be assertive: strike a balance between what you want and what others want, stating your own view and listening to the views of others

Specific Strategies 5. Set small, reachable goals. a) Choose a goal – SMART Specific, Measurable, Agreeable, Realistic, Timeline b) Carry out the goal c) Evaluate the goal d) Celebrate

Specific Strategies Goal Setting cont’d: a) Choose a goal for the next week, and make the goal: o

o o o o

Specific: unclear goals are less likely to be carried out and result in feelings of failure Measurable: develop a goal that is easy for you to track your progress and success Agreeable: develop a goal that works for you and those around you (e.g., your family) Realistic: goals that are too big often result in feeling discouraged. Should be easy enough to carry out Scheduled: the more exact in stating your goal, the more likely to carry it out

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Specific Strategies Goal Setting cont’d: b) Carry out the goal c) Evaluate your progress/success d) Celebrate o Recognize what has been accomplished (Parents can help acknowledge the child’s success). o Give credit for trying to accomplish the goal and review or revise as needed.

Specific Strategies 6. Keep home environment organized {

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It is helpful to have a regular routine and be as consistent as possible in daily activities, such as mealtime, homework and bedtime Provide logical spaces to keep your child’s schoolwork, toys, and clothes to reduce the possibility of these items being lost

Specific Strategies 7. Avoid fatigue in these children {

When they are tired, their self-control often breaks down and their hyperactivity becomes worse

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Specific Strategies 8. Maintain stimulation at an appropriate level {

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Some children need more quiet time Some children need to be kept busy, but NOT over stimulated

Specific Strategies 9. Prepare for formal gatherings {

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The hyperactivity can be difficult to manage in formal settings, such as church or restaurant Make sure you have something for your child to do and rehearse your child through appropriate behavior Discuss positive and negative consequences to redirect actions

Specific Strategies 10. Maintain firm & consistent discipline {

Set realistic goals - pick your battles

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Don’t ignore unsafe behavior

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Intervene early

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Give appropriate consequences or suggest alternative acceptable activity

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Specific Strategies 11. Use timely, age-appropriate consequences {

Time out

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Natural consequences

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Loss of privileges

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Physical punishment is not appropriate

Specific Strategies 12. Reward positive behaviour {

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Praise and reward your child’s efforts to pay attention Offer kind words, hugs etc. as soon as positive behaviour is noticed

Specific Strategies 13. Help your child stay “on task” {

Keep instructions brief

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Offer frequent, friendly reminders

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Use charts and checklists for homework and chores

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Specific Strategies 14. Advocate for your child {

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“You know your child best, need to be their biggest fan” Learn as much as possible about AD/HD and how it will affect your child at home, in school, and in social situations Help others understand their behavior.

Specific Strategies 15. Self-Care: Daily! {

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Life can never be stress free. Part of the learning to cope with stress is coming to the realization that one cannot solve every problem one encounters Its important to take into account one’s physical and emotional limitations, and to have reasonable expectations about what one can handle on one’s own and when it is time to get some help.

Self-Care Strategies {

Express your feelings!

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Periodically get away from it all

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Child benefits most when adult happy and comfortable

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Take care of yourself

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Nurture adult relationships

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Join a parent support group

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Good Things About Having AD/HD

Good Things about Having AD/HD {

Happy and enthusiastic

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Never boring

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Charming

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Full of energy

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Sees things differently

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Requires less sleep

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Great memory for things

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Observant of details

that interest them

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Are the first to volunteer

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Very good with younger children

Good Things About Having AD/HD {

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Doesn’t usually hold

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Easy to talk with

grudges

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Great sense of humor

Risk takers - try new

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Innovative

things

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Spontaneous

Can do several things at

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Creative and imaginative

one time {

Fun to be with

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Good Things About Having AD/HD {

Sensitive/ compassionate

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Loving and caring

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Curious

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Interested in new things

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Candid

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Positive of life in spite of troubles

Community Resources {

C.H.A.D.D.

403-225-8512

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Learning Disabilities Association

403-283-6606

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Calgary Learning Centre

403-686-9300

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Access Mental Health

403-943-1500

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Health Link

403-943-LINK (5465)

Credible Websites {

American Academy of Paediatrics www.aap.org

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Canadian ADHD Resource Alliance www.caddra.ca

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Canadian Mental Health Board www.cmha.ca

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C.H.A.D.D (Children and Adults with AD/HD http://www.chadd.org/

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Medline Plus www.nimh.nih.gov

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National Institute of Mental Health www.nimh.nih.gov

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References Barkley, Russel A. (2005). Taking Charge of ADHD: The Complete Authoritative Guide for Parents. New York: The Guilford Press. Mayo Foundation for Medical Education and Research (1998 – 2008). Retrieved July 7, 2008, from www.mayoclinic.com. Moghadam, H. (2006). Attention Deficit – Hyperactivity Disorder. Calgary: Detselig Enterprises Ltd. National Institute of Mental Health (NIMH) (2008). Retrieved July 7, 2008, from www.nimh.nih.gov. National Standard: The Authority on Integrative Medicine (n.d.). Retrieved July 7, 2008, from www.naturalstandard.com.hinc.lib.ucalgary.ca/.

Acknowledgements We would like to acknowledge the contributions of the many clinicians who participated in our Focus Groups and thus contributed to refreshing the content of this presentation. As well, we would like to thank the following clinicians who have gone the ‘extra mile’ and made significant editorial and/or content contributions to this presentation: Susan Ponting, M.Ed., R. Psych., Mental Health Education Specialist, Community Education Service Lindsay Hope-Ross, M.Sc., R. Psych., Clinical Supervisor, Healthy Minds/Healthy Children Rekha Jabbal, B.SP, Pharmacy Clinical Practice Leader Child and Adolescent Mental Health

Community Education Service To register for notification or an upcoming education session go to: www.fcrc.sacyhn.ca For general CES enquiries Email: [email protected] Call: 403-955-7420

Funding generously provided by Encana Corporation and the Alberta Children’s Hospital Foundation

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