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ADD and ADHD - how to manage them

attention; deficit; hyperactivity; disorder; behaviour; ADD; ADHD; sleep; apnoea; hyper; hypo; active; hyperactive; school; teacher; omega; 3; fatty; acids; fish; oil;

It is best if your child and your family have several different types of help with ADD/ADHD including ways of helping your child in the classroom, plans to help with specific behaviours, support for any learning difficulties, family support and drug treatment.

Contents

If children do not have help for ADD/ADHD, they will still get better at controlling their own behaviour as they get older, but they may have had many difficult years at school.

Related topic: ADD and ADHD - what are they?

What you can do

It is best if your child and your family have several different types of help with ADD/ADHD including ways of helping your child in the classroom, plans to help with specific behaviours, support for any learning difficulties, family support and drug treatment.

  • The best help for a child with ADD/ADHD starts with a careful and thorough assessment.
  • For your child to get the best help it is important that everyone who is working with him talks with each other, works together and also explains clearly to him what is happening so that he understands.
  • Medication may be used as it is usually effective and is the easiest treatment, but it works best if your child also has help with behaviour and learning. 
  • Whatever actions are decided on, it is also important that everyone knows what to expect from them - including your child.
  • Make sure that your child is given explanations about what is happening and why. There is a topic in the Kid's Health section of this site which may be useful. 'If your friend has Attention Deficit Disorder (ADD)'

Things to try

The following are some practical suggestions, some or all of which may help your child.

  • Have clear and consistent routines at home and school.
  • Look for things at home and school that may be stressing your child. Children with ADD/ADHD are often more upset when things go wrong than other children. For example if they are being bullied at school or there are family problems at home, they will find it really hard to behave well.
  • If you know there are things which will be very difficult for your child, try to avoid them until your child is more able to manage (eg. staying calm at big birthday parties will be very hard to do, and staying calm in supermarkets is almost impossible).
  • Make sure that your child is not tired or hungry when she needs to behave well (eg. have food in the car if you need to drive far after school).
  • Allow wind-down time between activities (eg. allow her time on the play equipment after school before she has to sit still in the car).
  • Try to ignore irritating behaviour that is really not important, so that she is not being told off all the time.
  • Don't give too many choices. Say "Would you like to do this or that?" rather than "What would you like to do?"
  • Many children who are stressed will manage better if they have some time for exercise each day which is not controlled by 'rules' - eg they could try running around the oval, riding a bike or running around in a playground. They may find that the rules of organised sport are difficult to follow when they are mentally tired but not physically tired.
  • Have fun and relaxing things that your child likes to do for when things get stressful. You need to consider what would be relaxing for them - sitting reading a book is not likely to be relaxing - while playing an exciting computer game may be relaxing.

At school

Some ideas that teachers have found useful:

  • Have the child sit at the front of the class at school, so that if his attention wanders the teacher can remind him of the task.
  • Use work areas that do not have distractions for school work and home work. For example find him a quiet spot to work, and remove any clutter from the desk.
  • A notebook to go from school to home and back can help to make sure that everyone is clear about what is expected and what he is doing. Make sure that it does not become a 'bad news' book about his behaviour.
  • When you want him to change an activity, let him know that you are going to ask him to do something different and that he needs to listen carefully.
  • Make sure you have eye contact with him before you tell him what you want.
  • Keep instructions short and clear, one instruction at a time. Give the instructions in 2 or 3 ways. Many children cannot remember what they are told. Have the instructions written on the board too, or on paper, which he can stick on his desk.
  • Break up tasks into small bits that the child can manage, and go onto the next bit when he has finished the first. For example, get him to put away one activity before telling him to get out the things needed for the next activity. When he has done that, tell him where he needs to move to. Get him to say what he is doing to himself as he does it. You can gradually give more directions and longer tasks as he gets older.
  • Give children rewards and/or praise when they are able to concentrate on what they are doing and finish a task.

Have regular meetings between the parents and the home group teacher so that joint stragegies can be worked out, discussed and modified if necessary. It is important for the young person to know that his teacher and parents are working with him to help him.

Using medication (drugs)

  • There is increasing evidence that using medication is the most effective way to get an improvement in a child's ability to think, concentrate, learn and behave better, often because the other supports that could help a child are not available at school (teachers usually do not have enough time to focus on one child at the expense of all the other children in the class), and supports for families can be hard to find. However many children are now on medication that they do not need.
  • More than 80% of children who have ADHD will have some benefit from medication.
  • Treatment does not make the problem go away (when the medication is stopped the difficulties may come back) but the learning that the child has done while on medication might make the problems less severe. The child will also have become older, and this will usually help with behaviour.
  • Medications most commonly used for ADD/ADHD have been used for a lot of years and are known to be safe when used for several years. The most commonly used medications are methylphenidate and dexamphetamine.
  • The use of medicine for ADD needs ongoing close supervision by a doctor, to make sure your child is getting the right dose, and to check for any possible side-effects of the drugs. Children on these medications can:
    • lose their appetite, lose weight and occasionally grow more slowly than expected
    • become sadder and more tearful than usual
    • have some problems with going to sleep.
  • Problems with side effects can usually be managed by changing the type, amount and/or time of taking the medication.
  • Drug treatment may be needed for long periods - it is important to make sure the child is on the lowest dose that is effective.
  • For more information have a look at the fact sheet 'ADHD - stimulant medication' from the Royal Children's Hospital, Victoria

 Self-esteem

Children and young people with attention deficit disorder can find it difficult to feel good about themselves. Many things that others take for granted are hard for them. Sometimes they feel that they are different, which can make them unhappy and lonely.

Often, too, everyone concentrates on what they do wrong or all the things they need help with, rather than what they can do well. This makes them feel bad and they end up misbehaving more.

Here are some things you can do to help your child appreciate all the good things about herself.

  • Encourage your child to do things she enjoys and does well, take an interest and show you are proud of her.
  • Set goals and tasks in small steps so that she can succeed. Make them more difficult gradually so she has lots of chances to succeed.
  • Try to ignore irritating behaviour so that she is not being told off all the time.
  • Let her know you are proud of what she can do - tell her and leave her little notes when you see she does something well.
  • Let her know that what she does to help in the home is really important.
  • Give lots of support and reassurance.
  • Spend time having fun with her and love her.

Making friends

Children with attention deficit disorder sometimes find it difficult to play well with others and make friends. They find it difficult to take turns and wait, and they may need your help to learn how to do this.

  • Start your child in a small group with no more than one or two other children.
  • Teach your child about how to join a group and start a conversation. He needs to understand that to join a group you have to move close to the people and listen to what they are talking about first, before you say anything. You may have to practice with the child exactly what to say.
  • Arrange some structured activity for when friends come over at first.
  • Teach your child about what friends do, eg. how to share, wait for a turn and not push in. Then give lots of encouragement when he gets it right. Have little practices at home if there are some things he is struggling with. For example, if he has trouble with interrupting, you could be having a conversation and let him practise waiting for a break before he interrupts. Make a break after only a short time at first, so he can do it successfully.
  • Teach your child some ways to cope with teasing, eg. pretend not to hear, walk away, tell a teacher etc. (Check the Kid's Health topic 'Being teased'.)
  • Help your child find groups where there is some adult guidance, eg. Boy Scouts, a sport that he can manage.

There is also a topic on the Kid's Health part of this site called 'Making friends' which might be helpful.

Children with behaviour problems, such as young children with ADHD, may not be invited to parties or invited over to play with other children. This can be very hurtful to your child and you could feel sad and/or angry. You may need to invite one or two friends over to your place to play so that your child can learn about playing well. If you are able to get to know a parent you may be able to ask that parent if your child could visit for a short time. Take this slowly so that your child can learn how to behave with friends and so that other parents can learn that he or she can be a good guest. As children with ADHD get older they generally learn the social 'rules' better and can spend more time with their close friends.

Teenagers and ADD/ADHD

While older children and teenagers are usually a lot better at managing their behaviour in the classroom and at home, they often still have difficulties with concentrating and learning.

  • Someone with ADHD may begin to fall way behind other young people of the same age at school, even though he would be able to do well if his ADHD was under control.
  • He may have missed out on learning a lot of things when he was younger – then when he needs that knowledge in higher grades, he cannot succeed.
  • In higher grades, students need to be able to sit still and concentrate for longer periods of time – this may be more than many students with ADHD can manage, and they may get into trouble with teachers.
  • If no one at school knows they have ADHD, it may mean that they are not getting the special help they need.
  • For young people who are not able to plan and organise themselves (eg. they don't hear the teacher's instructions, or lose assignments and homework), school gets very difficult – this can result in poor marks, being kept back in lower grades, poor self-esteem, skipping days at school and leaving school early.

Older children, teenagers and adults may manage learning, concentrating and completing tasks if they continue to have medication.

For more about this, have a look at the Teen Heath topic 'ADD - how it can affect teenagers'.

Looking after yourself

  • Don't get discouraged. Every parent finds living with a child with ADD/ADHD very tiring. You will need to say things 'a hundred times' and still she will have trouble remembering.
  • Parents may feel angry at times when their child's behaviour does not improve even when you try so hard. The topic 'Feeling angry' may be helpful.
  • Some parents find that sharing their problems with other parents who are also having difficulties with behaviour can be helpful. Check with your local community health centre for parent groups for ADD/ADHD.

Other things that may help children

  • Recent research has also shown that many children with ADD/ADHD have low levels of iron in their body. Low iron levels can affect brain development and the way the brain works. Some doctors are also now starting to recommend that some children with ADD/ADHD have extra iron in their diet, or take iron tablets.

     

    Can fish oil help your child?

    • Omega-3 fatty acids are important for our eyes and for parts of the brain used for memory, learning and reasoning. If we do not eat enough omega-3, these may be impaired. Omega-3 is found in fish and seafood. Many people who don't eat much seafood choose to take 'fish oil supplements', as these contain large amounts of omega-3.
    • There has been a lot in the news lately suggesting that it may be helpful for some children with behaviour problems (including those with ADD or ADHD) to take extra fish oil, but research shows mixed results about the benefits of fish oils in children. If you do chose to give your child fish oil do not stop other medication.
    • For more information, have a look at this fact sheet published by the Royal Children's Hospital in Victoria. 'Fish oils - what the research says'
  • Reminders

    • Make sure that your child's behaviour is not caused by something else. Have a proper medical assessment.
    • ADD/ADHD is only one of many possible explanations for inattentive, distractible or hyperactive behaviour in children.
    • The management of ADD/ADHD is not simple. It involves many people - it is important to share difficulties and successes, especially with teachers.

    Resources, books about ADD and ADHD, and references are in the topic 'ADD and ADHD – what are they?'

    Royal Children's Hospital (Victoria) 
    http://www.rch.org.au/rch/home.cfm

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    The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

    This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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