Questions & Answers for Parents of Children with Attention Deficit Disorder

1. Questions & Answers for Parents of Children with Attention Deficit Disorder

2. When parents are confronted with the possibility their child may suffer from Attention Deficit Disorder (ADD), there are generally more questions than answers. This presentation will help parents find answers to some general questions about ADD and their child. What is Attention Deficit Disorder (ADD)? How can I help my child? How can I help my child succeed in school? How can I be a better parent in order to help my entire family?

3. What is Attention Deficit Disorder (ADD)? • As a parent, it is important to understand the clinical definition of ADD. Questions that arise after this understanding include: • How common is ADD? • Is there more than on kind of ADD? • How can I tell if my child has ADD? • How will a doctor or profession determine if my child has ADD? • Did I cause this to happen to my child? • What are some of the potential problems my child may face? • Is it all bad news or does my child have some strengths?

4. What is Attention Deficit Disorder (ADD)? Attention Deficit Disorder as defined by the American Psychiatric Association is “…a persistent pattern of inattention, impulsivity, and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development” (Salend & Rohena, 2003, p. 260).

5. ADD is a psychiatric diagnosis rather than a separate disability category recognized by the Individuals with Disabilities Education Act (IDEA) (Salend & Rohena, 2003). Children with ADD may qualify for special education services under the IDEA category of ‘other health impairments’ (Turnbull, R., Turnbull A., Shank, Smith, & Leal, 2002). It is a brain disorder that may last a lifetime (Fell & Pierce, 1995). • The IDEA definition includes students • “having limited strength, vitality, or alertness, including a heightened alertness with respect to the education environment: • Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and • Adversely affects a child’s educational performance” (34 Code of Federal Regulations §300.7(9)as quoted in Turnball et al., 2002).

6. How common is ADD? • Millions of American children have been diagnosed with ADD • One of the most frequently diagnosed disorders in childhood • Perhaps affecting as much as 20% of school age children (Erk, 1995) • Most common neurological disorder of childhood (Erk, 1997) • 3.4 % of adolescent girls have ADHD • 7.3 % of adolescent boys have ADHD (McCleary, 2003)

7. Is there more than one kind of attention deficit disorder? • Three types of ADD • Inattention accompanied by hyperactivity (ADHD-HI or ADHD) • Predominantly inattentive (ADD/IA), without hyperactivity (ADD/WO), or undifferentiated (UADD). • Combination of hyperactivity and distractibility (ADHD-C) Common characteristics: “Their inattentiveness, disorganization, and poor motivation interfere with their learning and academic performance, their social interactions and friendships with others, and their emotional development” (Salend & Rohena, 2003, p. 261).

8. How can I tell if my child has ADD? Professional assessment is required but behaviors to observe include: • Inattentive to work or play activities • Not listening when spoken to • Not following directions at home or school • Having problems with organization • Being distracting • Moving or talking excessively • Acting in an impulsive manner • Interrupting • Failure to take turns in play or conversation A cluster of these behaviors must be present before the age of 7 Andinterfere with the individuals social, education, and occupational performance in two or more settings Andnot be related to other medical or psychiatric conditions (Salend & Rowena, 2003)

9. How will a doctor or other professional determine if my child has ADD? • A multi-method, multi-factor, multi-disciplinary assessment process will be used to identify and assess students with ADD which may include: • Behavior assessments, measurement of behavioral and social skills, functional behavioral assessments • Student academic performance factors • Consideration of cultural and linguistic factors • Determination IDEA or Section 504 eligibility (Salend & Rohena, 2003) • Complete physical and neurological evaluation by a physician (Schwiebert & Sealander, 1995)

10. Did I cause this to happen to my child? • Factors contributing to ADD: • Neurological condition – multifaceted and the focus of on-going research (Salend & Rohena, 2003); Brain dysfunction but not brain damage (Erk, 1997) • Biological factors – temperament (Salend & Rohena, 2003); Heredity (Erk, 1997) • Environmental factors – allergies, pre-, peri- and post-natal care • Experiential factors – interaction with family and others, cultural & economic background. (Salend & Rohena, 2003) • Malnutrition (Schwiebert & Sealander, 1995)

11. What are some of the potential problems my child may face? • May develop emotional, social, developmental, academic and/or family difficulties • May result in anger, aggression, depression or anxiety • At risk for dropping out of school • At risk for alcohol and/or drug abuse • Increased risk for delinquency (Schwiebert & Sealander, 1995)

12. Strengths of children with ADD: • Visualization • Vitality • Creativity • Activity (Armstrong, 1966) Many famous and very successful individuals may have suffered from ADD. These include names such as: • Winston Churchill • Florence Nightingale • Charles Darwin(Armstrong, 1996) • Thomas Edison • Pablo Picasso • Friedreich Nietzsche Is it all bad news or does my child have some strengths?

13. Once a child has been diagnosed with ADD, parents may ask many questions including the following: How can I help my child? What is a holistic approach to ADD? What are some common interventions I can expect for my child with ADD?

14. How can I help my child? • Your most important role is that of a parent. Enjoy your child. Provide close and loving support. Your involvement can reap tremendous educational benefits for your child. Share information, become an expert observer and communicate with key personnel (Fell & Pierce, 1995). • Seek help. Parent training can help you help your child reduce activity level, minimize conflict and anger intensity, and increase on-task behavior. Increased parenting skills can have a positive effect on the behavior of your child (Erk, 1997). • Employ a holistic approach focusing on internal empowerment rather than external control. Help your child discover their inner resources through a combination of strategies. We know what kids ‘can’t’ do. We need to focus on what they ‘can’ do (Armstrong, 1996).

15. What is a holistic approach to ADD? • Possible Holistic Approaches: • Cognitive – use focusing and attention training techniques including biofeedback, organizational strategies, etc. • Ecological – limit television, use music and art, good diet • Physical – strong physical education program • Emotional – build self-esteem • Behavioral – use contracting, immediate feedback, natural logical consequences, etc. • Social –teach effective communication skills, social skills, peer tutoring, cooperative learning, etc. • Educational – use computers, hand-on learning, multiple intelligences, develop creativity (Armstrong, 1996)

16. What are some common of interventions I can expect for my child with ADD? Behavioral and social interventions – class environment, tasks, novelty and stimulation on repetitive tasks, improved task structure such as shape, color and texture, smaller class sizes, direct instruction, peer mediation, time-out, token economy (rewards) (Schwiebert & Sealander, 1995). Educational interventions (Salend & Rohena, 2003) Cognitive interventions such as problem solving, teaching cognitive strategies, self monitoring, bibliotherapy (Schwiebert & Sealander, 1995) Pharmacological interventions, possibly Ritalin, Dexedrine, or Cylert (Schwiebert & Sealander, 1995) Home-School partnerships with families (Salend & Rohena, 2003)

17. Concerned parents of children diagnosed with ADD must learn to adapt to an education system that may require parental involvement. Frequently asked questions include: What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher? What are some strategies I can use at home to help my child succeed in school? How can I be a good advocate for my child?

18. What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher? Educational interventions - TGIF model is often effective for ADD students: • Teacher-directed instruction – high rates of active student engagement, fast-paced lessons, immediate and positive feedback; and correction procedures for student errors – Some specific techniques include asking frequent questions, an on-task chart, and social skills education such as following instructions • Guided practice activities – teacher leads and prompts students through structured activities • Independent practice activities – Teacher provides fewer prompts and less guidance to build fluency and generalize information • Final measurement – End-of-unit performance assessment – with continuous measurement of student understanding throughout the unit (Kemp & Fister, 2003)

19. What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher? (Con’t.) • ADD students need structured daily schedules with opportunities for movement • Strategies must beinteresting relevant, motivating, and multisensory • Encourage active participation, interaction with others, and choices incorporating learning styles and strengths • Use graphic organizers; Allow students to write their own books (Ostoits, 1999) • Encourage students to interact with classmates during assignments and when possible involve family members, peers, and community (Church et al., 2003)

20. What are some specific educational interventions for children with ADD that I may suggest for my child’s teacher? (Con’t.) • Use simple, noncompetitive games • Help students recognize non-verbal language and unwritten rules to enhance social and friendship skills • Set behavior goals, acknowledge and comment on appropriate behavior, and offer rewards that fostercooperation and social interaction • Help students learn to evaluate the effectiveness of their social strategies and help clarify rules • Encourage students to develop outside interests • Encourage sharing of concerns (Church et al., 2003)

21. What are some strategies I can use at home to help my child succeed in school? • Be a partner in your child’s education • Help your child see how they are different from and are similar to others • Help them learn to handle criticism constructively • Develop an understanding of their strengths and weaknesses • Help your child develop study skills and learning strategies to foster cognitive and social-emotional growth • Help children understand they are not alone in the problem • Help your child face challenges and maximize their potential (Fouse & Morrison, 1997)

22. How can I be a good advocate for my child? • Develop your advocacy skills • Understand that families of children with ADD are vulnerable to stress • Avoid jargon – ask for explanations if you don’t understand what is being said • Attend all meetings and conferences to expand your knowledge and support your child’s learning and include all important family and caregivers in decisions and strategies • Seekstrategies for managing your child’s behavior – he or she is not misbehaving to be malicious! (Mathur & Smith, 2003)

23. How can I be a good advocate for my child? (con’t.) 6. Network with other families and use the internet to get current information about ADD 7. Use a dialogue notebook between home and school 8. Be prepared to mend fences (Mathur & Smith, 2003) 9. Don’t isolate yourself from family and friends because of difficulties with ADD 10. Believe in yourself – you are a good parent! (McCleary, 2002)

24. Parents with an ADD child must understand their need for assistance and support. Frequently asked questions include: How can I help be a better parent in order to help my entire family? I’m feeling so stressed. Is this normal? What can I do about the stress I’m feeling? What kind of help is available to me as a parent?

25. I’m feeling so stressed. Is this normal? Stressors faced by parents of ADD children: • Parent factors such as health, depression, sense of competence, personality, and psychopathology • Child factors such as adaptability, acceptability, demandingness, mood, hyperactivity • Socio-economic factors such as parent role restrictions, spousal relationship, and social support • Parent and child conflict is determined by all three of the above (McCleary, 2002)

26. What can I do about the stress I’m feeling? • Problem focused coping • Learning about ADHD, • Learning about child development and parent-child relationships • Restricting the child’s activity • Arguing • Working to change school expectations (McCleary, 2002) Coping is what parents do to manage stressors – based on your resources and how well you can use them • Emotion focused coping: • Time apart • Venting frustrations • Reappraising situation as less stressful (McCleary, 2002)

27. What kind of help is available to me as a parent? • Parent education and/or counseling about dealing with your ADD child may: • Improve your ability to make treatment decisions • Improveconfidence • Correct misperceptions about ADHD/provide information • Changenegative attitudes about behavior • Provide training on problem solving, communication and conflict resolutions • Empower you to establish support groups • Encourage you to increase social support networks • Improve coping skills (McCleary, 2002)

28. PARENTS AND TEACHERS As you deal with ADD students and children, take the advice of Sir Winston Churchill: “NEVER, NEVER, NEVER GIVE UP!”

29. Helpful web sites and references for additional answers to your questions. What is Attention Deficit Disorder (ADD)? http://www.nimh.nih.gov/ Barkley, R.A. (1990). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guildford Press. How can I help my child? http://www.chadd.org/ Crock, W. (1991). Help for the hyperactive child. Jackson, TN: Professional Books. How can I help my child succeed in school? http://www.add.org/ Parker, H.C. (1992). The ADD hyperactivity handbook for schools. Plantation, FL: Impact Publications. How can I help I be a better parent in order to help my entire family? http://www.adhd.com/ Anderson, S. (2001). ADHD and the role of parents. Drug Benefit Trends, 13, 21-24.

30. References Armstrong, T. (1996). A holistic approach to attention deficit disorder. Educational Leadership, 53(54), 34-36. Church, K., Gottschalk, C. M. & Leddy, J.N. (2003). Enhance social and friendship skills. Intervention in School & Clinic, 38(5), 307-310. Erk, R. R. (1995). The evolution of attention deficit disorders terminology. Elementary School Guidance & Counseling, 29(4), 243-249. Erk, R. R. (1997). Multidimensional treatment of attention deficit disorder: A family oriented approach. Journal of Mental Health Counseling, 19(1), 3-23. Fell, B. & Pierce, K. (1995). Meeting the ADD challenge: A multimodal plan for parents, students, teachers and physicians. Intervention in School and Clinic, 30(4), 198-202. Fouse, B & Morrison, J. A. (1997). Using children’s books as an intervention for attention deficit disorder. The Reading Teacher, 50(5), 442-445. Kemp, K. & Fister, S. (1995). Academic strategies for children with ADD. Intervention in School & Clinic, 30(4), 203-210.

31. References (continued) Mann, S. (1996). The ADD strategies worksheet. School Counselor, 44(2), 155-158. Mathur, S. & Smith R. M. (2003). Collaborate with Families of Children with ADD. Intervention in School and Clinic, 38(5), 311-315. McCleary, L. (2002). Parenting adolescents with attention deficit hyperactivity disorder. Health and Social Work, 27(4), 285-292. Ostoits, J. (1999). Reading strategies for students with ADD and ADHD in the inclusive classroom. Preventing School Failure, 43(3), 129-132. Salend, S. J. & Rohena, E. (2003). Students with attention deficit disorders: An overview. Intervention in School and Clinic, 38(5), 259-266. Schwiebert, V. L. & Sealander, K. A. (1995). Attention deficit hyperactivity disorder: An overview for school counselors. Elementary School Guidance and Counseling, 29(4), 249-261. Turnbull R., Turnbull A., Shank, M., Smith, S., & Leal, D. (2002). Exceptional lives: Special education in today’s schools (3rd ed.). Upper Saddle River, NJ: Pearson Education, Inc.