ADD/ADHD Behavior Management Help for Parents and Teachers

image via Flickr, Rober Arévalo

image via Flickr, Rober Arévalo

How can parents, teachers, and childcare providers best manage behavior in children with ADD?

There is no simple technique that is effective in managing all children with ADD. Each child is unique and requires an individualized approach to promoting positive behavior change.

It begins with first really knowing who the child is and then setting realistic expectations.

When we discipline ourselves to do these two things, we minimize the likelihood that difficulties arise in the first place. Furthermore, when we reflect upon the child’s unique characteristics and set realistic expectations based upon these characteristics we equip ourselves with information essential to managing problems when they do occur:

STEP 1. Knowing who the child is

To understand the child’s unique pattern of individual characteristics, we must reflect on the answers to the following questions:

  • What are his strong and weak skills?
  • What are his attentional characteristics?
  • What are his physical abilities and limitations?
  • What stresses is he facing in his life?
  • What are his basic attitudes and beliefs?
  • How does he feel about himself?
  • Who are the significant people in his life?

STEP 2. Setting realistic expectations

Based upon the child’s unique pattern of individual characteristics, we must identify the appropriate expectations for academic achievement, social interaction, and independent functioning.

Encourage Independent Functioning

Only when these two steps have occurred can we effectively manage behavior, promote responsibility, and encourage independent functioning.

image via Flickr, Brad Flickinger

image via Flickr, Brad Flickinger

When problems emerge, we should take the actions described below (steps 3, 4, and 5) to ensure that individualized, effective management occurs.

These steps include determining the factors which are contributing to the problem, developing a plan which takes these factors into consideration, putting the plan into action, seeing what happens, and making changes in the plan as necessary:

 STEP 3. Determining the factors that are contributing to the problem behavior

To do this, we use our knowledge about the child’s unique characteristics to determine the following:

  • What specific expectation did the child fail to meet?
  • What characteristics of the child contributed to this failure/the problem?
  • What aspects of the child’s life circumstances contributed to the problem?

STEP 4. Developing a plan and putting it into action

In order to develop an action plan, we must reflect and act on the answers to the following questions:

  • Given who the child is and the factors contributing to the problem, does the expectation need to be modified? If yes, then how?
  • How is the expectation(s) best communicated to the child so that he understands it?
  • What can the child do, think, or say to increase the likelihood he will be successful in meeting the expectation?
  • What should happen if the child fails to meet the expectation; that is, should there be a consequence and what should it be?

STEP 5. Seeing what happens and making changes in the plan when necessary

image via Flickr, Simply CVR

image via Flickr, Simply CVR

We must reflect on the success of the plan; that is, we must determine whether or not the child is now behaving more appropriately. If he is not, we must identify what went wrong by answering the following questions and revising the action plan accordingly:

  • Were the expectations unrealistic?
  • Was the identified set of contributing factors inaccurate or incomplete?
  • Was the action plan–the method of communicating expectations, the structuring the environment, the child’s strategy, and the use of consequences–ineffective?

You’re not alone in struggling to identify and cope with the behavior challenges of ADD/ADHD!  Parenting and teaching children with Attention Deficit Disorder requires extra reserves of patience, reflection, and determination.  If you found hope in these questions, Dr. Liden provides more detailed guidance in his book, Accommodations for Success: A Guide and Workbook for Creating 504 Agreements and IEP’s for Children with ADD/ADHD.

7 Keys to Successful (and Safe) Medication Treatment for ADD

image via Flickr, Purple Sherbet Photography

image via Flickr, Purple Sherbet Photography

Medication is often needed to help individuals optimally manage their ADD.

Without the aide of medication, it is almost impossible for most individuals with ADD to function to the best of their abilities and take advantage of other intervention strategies.

Yet, fear of medication, much of it unfounded, stands as a major barrier for many people to even take the step to get evaluated for ADD, let alone begin treatment for it.  Based upon more than 30 years of experience with over 10,000 patients with ADD, I’ve found there are seven keys to a successful and safe experience with medication.

  1. Find the right physician.

    Successful management of ADD requires that prescribing physicians have had specific ADD training and lots of experience working with ADD and the medications used to treat it.  They should have strong communication skills, the willingness to listen to your concerns and address them in a timely manner and a commitment to providing regular long-term follow-up. Critically evaluate your physician and his/her approach before you commit to medication treatment.

  1. Get an accurate diagnosis.

    Most knowledgeable physicians follow systematic procedures to arrive at an accurate diagnosis.  This may include the use of checklists, questionnaires, structured interviews, and ideally, some objective testing of attention abilities.  It’s one thing to hear about symptoms from a patient or significant other, but actually observing the individual’s attention during testing raises the reliability and validity of a physician’s ability to diagnose ADD to a whole different level.  Objective testing helps sort out individuals who don’t really have ADD and weed out those who might be drug seeking.  It also provides a baseline that can be used to accurately judge responsiveness to medication treatment. Response to a trial of medication should never be used as a diagnostic test!

  1. Make sure someone looks at the whole you.

    Each individual with ADD has their own unique profile…different temperaments, skills, abilities, health status, life experiences, attitudes, and beliefs.  Understanding these individual differences and their potential impact on medication treatment are critical for a successful experience.  Incorporating them into the process can help you and your physician interpret and manage apparent side effects and comply with the appropriate medication regimen.  More than 70% of individuals with ADD have co-existing mental health and/or chronic medical problems, sometimes as a consequence of untreated ADD.  If these go unrecognized or untreated, they can sabotage a successful experience with medication.

  1. Participate in objective medication trial tests.

    image via Flickr, Purple Sherbet Photography

    image via Flickr, Purple Sherbet Photography

    Judging the effectiveness of a given dosage or regimen of medication by relying on informal, unstructured observations or simple checklist/behavior ratings forms is fraught with difficulties.  Some observers don’t really understand what they should be looking for or have preconceived ideas about what should or shouldn’t happen, while others may have attitudes or beliefs about medication that color their observations.  The context of where people are making their observations can also result in great variability…monitoring effectiveness in a structured classroom is very different from watching a child play with peers in the backyard or sit in front of the TV or computer.  Asking an adult with ADD “How’s it going?” is like asking the blind to lead the blind…what it takes to make accurate self-observations is good attention and that’s the very thing they don’t have!  It is far better to find the right starting dose for a particular medication by participating in serial objective tests of attention on various doses of medication beginning with the lowest one that could make a difference and advancing as needed until an optimal dose is found.  This process helps ensure that the initial starting dose that you or your child starts taking in the real world is in the right ball park.  Then, fine tuning can be done based upon targeted observations in multiple life arenas.  The right medication, dosage, and daily regimen varies greatly from individual to individual based upon their unique attentional profile, degree of their problem, and the genetically-based way they metabolize various medications.  It is not uncommon for an optimal medication regimen to exceed the drug manufacturer’s marketing guidelines.

  1. Request a regimen that provides you all day coverage.

    ADD is a neurologically-based problem that is present 24 hours per day, 7 days a week, 365 days a year.  It affects all aspects of life functioning.  As the day proceeds, the demands for efficient attention don’t decrease, they actually increase…it’s harder to pay attention during homework time, completing chores, maintaining healthy eating habits, driving a car, controlling emotional reactions, and communicating with others than it is to pay attention at school or work.  Therefore, individuals with ADD should have medication regimens that give them good attention from as close to the moment they wake up in the morning to the time they go to bed at night.  This might require using different combinations of medications: multiple doses of a short-acting medication, a long-acting combined with a short-acting, 2 doses of a long-acting or a stimulant in combination with a non-stimulant (e.g., Strattera).  It is safe to take multiple doses of these medications during the day because their effects are not additive.  More importantly, all day coverage helps reduce the serious risks that come with untreated ADD.  All day, all week coverage actually helps reduce the frequency of more common side effects such as appetite suppression and sleep disruption.

  1. Establish and maintain a Healthy Daily Routine (HDR).

    Having a balanced HDR is probably the most important thing you can do to have a positive experience with medication treatment for ADD.  Maintaining a predictable bedtime and wake time seven days a week, eating at least three meals a day, getting daily aerobic exercise, practicing some type of mind centering every day, and setting up a structure for staying on top of daily responsibilities provide an important foundation for success with medication.  Each of the elements of a balanced HDR in and of themselves helps improve aspects of your attention and your ability to regulate your behavior.  As a result, the medication doesn’t have to work so hard to get you to where you need to be, which could mean being able to use lower doses of the medications.  A balanced HDR will also help eliminate or reduce many of the more common side effects that occasionally occur with the medications used to treat ADD.  So, Get Balance!  It’s good for ADD, it minimizes side effects, makes the medication experience go more smoothly, and it’s the right thing to do for your overall health.

  1. Never use medication as the sole form of treatment.

    image via Flickr, Purple Sherbet Photography

    image via Flickr, Purple Sherbet Photography

    Relying on medication as the sole form of treatment is a setup for problems.  Dramatic things can happen when an individual with ADD starts using a proper medication regimen.  Many positive things will happen: you’ll be more alert during the day, less impulsive, less distractible, and better able to sustain your focus.  These changes may lead to increased performance at school and work, better follow through with responsibilities, greater behavior control and improved relationships with others.  However, the medication opens up a “new world”, not only the good but also a greater awareness of problem areas.  If you’re a sensitive, intense person, there may be more things to be sensitive and intense about, you may tune into areas where you have been dropping the ball, or behaviors that are problematic and irritating to others.  Therefore, having improved attention can be difficult, anxiety producing or even depressing.  Sometimes these consequences of improved self-awareness are misinterpreted as side effects of the medication.

Most individuals starting medication need support to understand and cope with this “new world” and develop new strategies to address problems with emotional regulation, independent functioning, and social/communication difficulties that they become more aware of.  Having an experienced counselor or coach to help lead you down a path to success is critical.  They can help you process your experiences, define the contributors to your problems, brainstorm new strategies to address problems, and support acceptance of who you really are.  In addition, they can help you establish and maintain the all important HDR.  Medication treatment for ADD goes much better when you walk down this new path with an experienced guide!


Dr. Craig B. Liden | The Being Well CenterCraig B. Liden, MD  is an internationally recognized expert in the diagnosis and treatment of ADD/ADHD.  Since the 1980’s, Dr. Liden has been in private practice evaluating and treating behavior and developmental issues across the life span.   He has treated more than 10,000 patients with ADD/ADHD and related co-morbidities.  Dr. Liden  has written and lectured extensively about ADD/ADHD, education, individual differences and a variety of health problems, most recently publishing Accommodations for Success: A Guide and Workbook for Creating 504 Agreements and IEP’s for Children with ADD/ADHD and ADD/ADHD Basics 101: How to Be A Good Consumer of Diagnostic and Treatment Services for ADD/ADHD.   Dr. Liden is the Founder and Medical Director of The Being Well Center located in Pittsburgh, PA.  He is available for speaking engagements, workshops, and interviews.

How ADD Messes Up Marriage

image via Flickr, kylesteed

image via Flickr, kylesteed

What is the impact of ADD on marriage?

The impact of ADD on marriage is often profound. Over the years, in working with couples I have found extremely common events occur over and over and over again.

ADD and the Impulse Spouse

Frequently, marital difficulties begin before the wedding: the impulsive ADD individual meets someone; he quickly gets caught up in feeling—feeling loved, feeling sexual, feeling connected; with all the intensity of feeling, thinking does not occur; before the two really know each other, they get married. Maybe in a week, or a month, or six months, but very soon, one or the other and, often, both know they have made a terrible mistake.   Years later, they are in my office trying figure out what to do now.

ADD and the Child-Spouse

For couples that chose to marry after getting to know each other, the key issues are different. Frequently, I see them when the spouse who does not have ADD has reached his limit.   When they married, he loved her but now he has had enough. He is tired of getting her out of bed with a morning phone call or two or three, tired having to walk through an obstacle course of stuff to get to the shower, tired of ordering pizza for dinner, tired of the of the impulsive spending, tired of paying late fees because the bills were lost, tired of folding the laundry at midnight . . . he wanted a partner and feeling resentful that he has a child.

ADD and the Insensitive Spouse

There are still other couples that make their way to my office when the partner without ADD feels that her spouse is just not as connected to her as she had hoped. While he is a nice guy, he seems insensitive to her emotions, oblivious to her stresses, and in his own little world from after dinner to bedtime when she needs to talk.   Her conclusion is that she either has married an insensitive jerk or he doesn’t love her anymore. My experience with these couples is that, most often, neither of these is true. Rather, she has married a good man with ADD who still loves her. His poor attention, however, interferes with his ability to read between the lines, tune into nonverbal cues, and monitor his own lack of responsiveness.


Have you had relationships struggle or fail and now suspect the roots trace back to ADD’s challenges?  Looking for a change?  Get started with Dr. Liden’s book, ADD Basics 101, currently available as a free download e-book.

9 Traits You Should Know About Your Temperament

Temperament refers to our in-born (not learned) behavioral style. We all come into the world with a unique set of temperamental characteristics that remain stable throughout our lifetime. These characteristics modulate how we respond to every situation in our lives. Understanding our own temperament as individuals and the temperament of our children is incredibly helpful in being the best we can be and in bringing out the best in our children.

In our experience, understanding the concept of temperament and applying that knowledge to ourselves as parents and spouses and to those around us helps us to better understand behavior…struggles, failures, and successes. In fact, failure to understand a child’s temperament and the role it plays in his behavior and performance can be a major source of frustration for parents.

add treatment, family, the being well centerIn our model, there are nine dimensions of temperament and we all fall somewhere along a continuum for each one. The ranges for these continuums are presented in the next section for each temperamental trait. It is important to know that where an individual falls along this continuum for any given temperamental trait is neither good nor bad…it just is! In fact, the same temperamental trait (e.g., being very intense) that is helpful to us in one situation may interfere with our behavior or performance in another.

A key goal should be to understand our temperament and the temperament of the children we live and work with. We need to critically consider how any extreme temperamental traits might be contributing to problems in performance, behavior, or social interaction. When temperamental extremes do interfere with performance, behavior or social interaction, we need to learn how best to work around or control these extremes.

Therefore, when we suspect that an ADD/ADHD child’s or adult’s temperamental characteristics play a role in his failure to meet an expectation at school or work, we know we must develop some type of accommodation to address this contribution.

1. Activity Level refers to the amount of activity from high to low that we engage in throughout our day. Some of us are always moving and physically active; others of us are more sedentary and spend most of our time engaged in quiet activities. The child with a high activity level is likely to be in his element in gym class and playing tag during recess and to have more difficulty staying settled during quiet seated activities; on the other hand, the child with a low activity level might prefer sitting and drawing or reading during free time rather than going outside to play an active game.

2. Rhythmicity refers to the predictability of our daily bodily routines for sleeping, eating and going to the bathroom. It ranges from highly regular to highly irregular. Those of us who are highly rhythmic are hungry, have a bowel movement, and feel sleepy at about the same times every day. Others of us, who are highly irregular do not have a schedule or rhythm at all…our wake-up time varies from day to day; we feel ready for bed at different times and need to go to the bathroom at various, unpredictable times throughout our day. This unpredictability can present a challenge for the child who is asked to adhere to a rigid school schedule where everyone eats and takes bathroom breaks at the same time every day.

3. Threshold of Response refers to the amount of stimulation, ranging from high to low, we require before responding. Those of us with a low threshold require very little to make us happy, sad, angry, etc. Others of us with a high threshold require a lot before we react. The child with a very high threshold may be injured and not seem to notice his pain. At the other extreme, the child with a very low threshold may be bothered by the slightest noise, the frown from the teacher, the tags in clothing, the buzz of the fluorescent lights, the seams in socks, and the taste, texture or smell of food.

4. Frustration Tolerance refers to the level of difficulty we are able to experience before we become frustrated. Frustration tolerance ranges from high to low. Those of us who have a high frustration tolerance are able experience an awful lot of difficulty before we feel frustration. Others of us who have a low frustration tolerance become frustrated very easily. The child with a high frustration tolerance may be able to deal with repeated struggles and failures in the classroom without experiencing significant frustration. The child with a very low frustration tolerance, however, can be quick to experience frustration when asked to perform tasks of only moderate difficulty. This, in turn, sets him up for repeated struggles and can turn into negativity towards school and other learning situations.

5. Intensity of Response refers to the strength of our responses ranging from high tolow. These responses can be demonstrated outwardly or experienced inwardly. So it is not always easy to judge someone’s intensity of response by what we see. Our intensity is independent of the quality (negative or positive) of our response and the immediacy of our response (threshold).

add in school children | the being well centerThose of us with a high intensity of response experience or show strong responses. When we are happy we are very, very happy; when we are sad, we are very, very sad; when we are angry, we are very, very angry. Others of us who have a low intensity of response barely show a blip on the screen when our emotions are set off. A child with high intensity may become overly silly at birthday celebrations, rageful during a conflict on the playground, and immobilized with nervousness on math time-tests. On the other hand, the child with low intensity of response may not seem to react at all; she does not experience extreme excitement over a special event or intense disappointment over a failure. In fact, we may find it difficult to read the reactions of a child with low intensity, often misjudging low intensity for not caring.

It is important to remember that when observing for intensity of response, we can’t always judge the book by looking at the cover; some very intense people experience all their intensity internally; nail-biting, skin-picking, complaints of a tightness in one’s chest, stomachaches, jaw aches, or headaches, etc., may be our only clues to what is going on inside.

High intensity of response (externally or internally) is a very powerful temperamental trait. When present, it can rule over everything: good thinking, paying attention, proper self-control, and appropriate social skills to name a few. Failure to identify a high intensity response pattern and appropriately accommodate for it can, inadvertently, set a child up for turning to a variety of other dysfunctional behaviors in an attempt to cope with her strong reactions including such things as over-eating, drug use, and developing an “I don’t care” attitude.

6. Mood refers to the overall quality of emotion throughout the day ranging from very positive to very negative. Those of us with positive mood spend the greater portion of our day in a pleasant mood; we are likely to put a positive spin on everything; problems are challenges. Others of us with a negative mood may seem more critical throughout our day; we are likely to see the glass as half empty. A child with positive mood is generally pleasant in the classroom and may even struggle to recognize when difficulties are present or percolating. The child with negative mood is likely to respond with frown, a headshake, or critical comment to most anyone or anything.

7. Approach-Withdrawal refers to our initial response to new persons, places, events, and ideas ranging from highly approach to highly withdrawal. Those of us who are highly approach readily jump into attempting new tasks, meeting new people, and trying new foods. Others of us who are highly withdrawal resist trying a new activity, avoid attending a party with strangers, and step back from a different kind of food. The child who is highly approach will not hesitate to start a conversation with a new student or teacher, jump into new activities and embrace new concepts and academic challenges. The child who is highly withdrawal may struggle with new students, avoid new playground activities, and step back from an unfamiliar concept in the classroom.

8. Adaptability refers to the amount of time and effort it takes to adapt or accommodate to a new person, situation, or concept after our initial approach or withdrawal response. This can range from easy (highly adaptable) to very slow (non-adaptable). Those of us who are highly adaptable easily integrate new routines, expectations, and concepts into our life. Those of us who are slow to adapt struggle tremendously with these same changes. In the classroom, the child who is highly adaptable readily goes with the flow regardless of the changes in his day, such as routines, class structures, and rules. The child who is slow to adapt may require an extended time to get into the flow at the beginning of each school year, struggle with changing expectations, buck new rules, and resist changes in routines. This same child may seem slow to understand and integrate new concepts that are presented even when they are in sync with his ability level.

9. Persistence refers to how long we stick with tasks regardless of their difficulty ranging from very long to very short. Some of us are highly persistent even in the face of tremendous difficulty; we keep going and going and going. Others of us spend only a short time on a challenging task before giving up and moving on to something else. The child with long persistence resists giving up and will practice a task repeatedly until he has mastered it. This same child may struggle to stop an activity when it is time to move on if he has not yet mastered or completed it. The child with short persistence may stop practice before mastery, struggle to stick with longer, more complex tasks, and be ready to put down a challenging book long before the last page.

A Final Word about Temperament

9 Temperament Traits | The Being Well CenterEach of our temperamental traits is important and plays a significant role in shaping who we are, how we behave, and how we experience and respond to the world around us. While we have defined and discussed these traits individually, it is important to remember that in the real world these traits do not exist in isolation; they interact with each other to influence our behavior in a complex way. Subtle differences in temperamental profiles can result in dramatic differences in how they present themselves in our homes and classrooms.

For example, a child with a negative mood, long persistence, slow adaptability, low frustration tolerance, and high intensity of reaction may be very difficult to work with when this set of characteristics interact with each other to result in frequent, very big negative reactions that last a long time in response to the inevitable changes and challenges that occur every day in the classroom.

On the other hand, a different child with a very similar profile including a negative mood, long persistence, slow adaptability, low frustration tolerance, but a low intensity of reaction may be much less difficult to work with. This is because his low intensity of reaction means his frequent, negative reactions to the changes and challenges in the classroom will be milder and, even if they do persist, their small magnitude may not register on anyone’s radar.

Therefore, as we examine a child’s temperamental profile, it is important to look closely at each trait separately and then consider how each of these individual traits may interact with the others to shape the behavior and personality we are observing.

We’d like to share a quick worksheet to help you apply the 9 Temperament Traits to yourself or a loved one.  Download: 9 TEMPERAMENT TRAITS WORKSHEET.  Where do you fall on the spectrum?  Your spouse?  Your children?

The ADD Adolescent

ADD diagnosis teenagerWhat specific behaviors indicate that an adolescent might have ADD?

Efficient attention is required for success in all areas of life. As an ever-present filter between the individual’s external and internal worlds, it screens all incoming and outgoing information to and from the brain. In this way, attention has a profound influence on how an individual experiences events and behaves in all life spheres: school, job, home, and neighborhood. It interacts with other skills and abilities to shape the quality of social interactions, school/job performance, and independent functioning. Therefore, behaviors that suggest attentional difficulty can appear in any area of a person’s life. The following behaviors identify some of the more common red flags that might signal ADD in adolescent children ages 12 to 18 years old.

Adolescent (Twelve to Eighteen)

  • Not being able to organize free time
  • Failing to plan long-term assignments (e.g., reports, projects, and tests)
  • Failing to keep track of assignments
  • Writing disorganized compositions and reports
  • Demonstrating poor reading comprehension of higher level materials
  • Failing to pay attention to personal hygiene
  • Needing constant reminding/nagging to be responsible
  • Skipping school
  • Getting into trouble with the law; committing delinquent acts
  • Getting caught!
  • Getting off the topic in conversations
  • Interrupting and failing to take turns when talking
  • Flying off the handle and doing impulsive things
  • Behaving inappropriately in social situations without realizing it
  • Going beyond simple experimentation with drugs and/or alcohol

ADD Basics 101 | Dr. Craig LidenIf you just recognized someone you know in this list, go to ADDBasics.org and download Dr. Liden’s free guide, ADD Basics 101. In 10 clear steps, Dr. Liden will guide you to an accurate, trustworthy diagnosis and outline what you should look for in an effective treatment plan.


 

AFScovers2Maybe you already have a child identified with ADD/ADHD who is struggling in school.  Dr. Liden’s book, Accommodations for Success, is an amazing resource to help you understand your child better and get her the individualized help she needs to soar at school.

 


Check back tomorrow for red flags in adults’ behavior…

Catch up on previous posts in the Pay Attention series.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Do people have ADD from birth?

ADD Basics FamilyAs we continue laying out the truth about ADD/ADHD, we turn to some of the most common, burning questions my patients, friends, family, and colleagues most commonly ask me.  The answers to these questions form a critical foundation to understanding the truth about Attention Deficit Disorder.

If people are born with ADD, why don’t problems show up right after birth?

ADD becomes apparent only when the inborn attentional differences interfere with the individual’s ability to meet expectations in the environment. Depending upon the severity of a person’s attentional differences, his temperament, the status of other skills and abilities, and the specific nature of environmental expectations, ADD can crop up at any point along the life span from infancy to old age. Let’s take a look at how this can happen.

Typically, individuals with ADD appear to be normal at birth. As children, they are minimally, if at all, delayed in meeting major milestones of accomplishment such as walking and talking. They generally reach school age with only minor problems in controlling their behavior and interacting with peers. The first grade classroom is often the first place where specific expectations for paying attention occur. As a result, the entry into school is one of the more common times when ADD first shows up. Other key transition points in the individual’s life where expectations for increased efficiency of attention can lead to the emergence of ADD include the following:

  • Movement to the upper elementary grades where time constraints are imposed and increased demands are placed on children to function independently
  • Movement to junior/senior high school where more refined organizational and study skills are required
  • Movement to college where fewer supports are available and the ability to function independently is essential
  • Movement into a new home away from parents where there are no supports and the ability to function independently is even more critical
  • Marrying or cohabiting with a partner where functioning impacts upon the quality of life of another person and demands for efficient problem-solving are high
  • Becoming a parent where responsibilities for keeping it all together, all the time is essential

Individuals with ADD who have strengths in other areas (e.g., strong language skills, a charming personality, intellectual giftedness) can go a long time in life without being identified as having a problem. I have seen many children go through elementary school with A’s and B’s only to have the bottom fall out upon entry to middle school or junior high school. In these circumstances, careful probing of the educational history of these children often reveals evidence of attentional weaknesses that have either been overcome with sheer brain power or been overlooked by parents and teachers because these subtle weaknesses hadn’t really led to failure.

While failure to meet increasing school demands is a very common way for ADD to be uncovered, it can also happen as a result of failure to meet increasing demands for independent functioning, social interaction, or problem-solving at home, in childcare, in the neighborhood, or on the job.

Meet Michael

Michael is a good example of this. He is a 10-year-old boy who has always done very well, academically and socially. He has learned new concepts quickly, has shown a gift for memorizing facts, has been easy to get along with, and has always been a great conversationalist.

Until two months ago, he had also functioned very well at home. At that time, however, his mother got a new job that meant she was no longer able to be with Michael after school. And, despite all of her attempts, she had been unable to find someone who would stay with Michael until her new workday ended. So, for the first time, Michael was on his own everyday from 3:00 p.m. to 6:00 p.m.

The new expectation for him was “keep yourself busy and stay out of trouble for three unsupervised, unstructured hours.” This new demand uncovered Michael’s impulsivity, distractibility, and lack of ability to think through the ramifications of his behavior. He broke a living room lamp by rough housing in “off-limits territory”; he burned a hole in the new family room couch while “fooling around” with a butane lighter; and he soaked the bathroom carpet when he ran to answer the telephone, forgetting to first turn off the faucet.

Without his mom around to help him structure his time, to remind him of the house rules, and to watch over his activities, Michael had become dysfunctional.

Meet Emma

Emma’s story is similar. She is a 22-year first year elementary school teacher who has just married. Emma is gifted, kind, funny, sensitive, and very hardworking. Until now she has done well in almost every sphere of her life, but she has never been asked to establish her own home, to share finances, nights, and laundry with someone else, to complete daily lesson plans for five subjects, to effectively manage thirty fifth-grade children for six hours every day, and to negotiate unclear work politics all at the same time.

Emma is a mess. Despite her intelligence, her hard work, her sense of humor and her likeability, she is not experiencing success anywhere in her life.

Catch up on previous posts in the Pay Attention series.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Jeff is a great kid! He just forgets.

Do you recognize these people?

bwc_lifespan

Annie, age 35

Annie is an attractive mother of three.  To look at her you would never guess what a disaster every area of her life has been since college.  As a young teacher, she never developed lesson plans and couldn’t control her classes.  She wanted to do something else but didn’t feel she had the skills.  Instead, she started a family.  As a homemaker, she rarely cooks a meal, struggles to pick up the house before her husband gets home from work, and has 45 half-done projects.  She manages the family finances–writes the checks, but forgets to mail them.  Her relationship with her husband is poor, and she feels guilty about not meeting her children’s needs.  She’s depressed, and her self-esteem is in the pits.

Adam, age 19

In high school, Adam was the class clown; everyone liked him.  Now, he goes to college because “that’s what everybody does!”  With the distractions of college life–being away from home for the first time, fraternity parties, weekend football games, and wild roommates–he is no longer able to get by on his quick mind and entertaining personality.  By the end of his first semester, he is on academic probation.  Despite this warning, threats by his parents, and all his good intentions, at the end of the second semester, Adam is asked not to return next fall.

Jeff, age 11

Jeff is a great kid!  He just forgets.  He forgets what his homework is.  He forgets to bring home the science book to study for tomorrow’s unit test.  He forgets to bring home his instrument for band practice.  He forgets to hang up his coat, to put his shoes away, and to throw his dirty clothes in the hamper.  He forgets to take out the garbage and to feed the dog.  He forgets to brush his teeth, to tuck his shirt in, and to make his bed.  If Mom wasn’t there to nag him, he’d probably forget everything–but still, he is a great kid.

Do you recognize Justin, Karen, or Lisa?
Do you recognize Melissa, Mark, or Betty?
Do you recognize Tina, Doug, or John?

These are my patients.  You may have recognized your son or daughter, your spouse, your parents, even yourself.  I’ve come to appreciate how ADD can look quite different across the lifespan, depending on circumstances, temperament, and expectations.  For some people, managing a home and family brings the conflict with ADD to a head.  For others, it’s the high expectations (and failures) at college.  Still others struggle in the smaller ways, like chronically forgetting homework.

Our current blog series is here to help you sort through the challenges of identifying and treating ADD / ADHD.  You might find there are a number of things you don’t know about ADD (but should).  You might find that you recognize my patients.  If you’re seeking answers, you’re always welcome at The Being Well Center, or you can download my free e-book, ADD Basics 101, in which I guide you through 10 clear steps to securing a diagnosis and treatment plan you can trust.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Helicopter Parenting at College

For many college students, going away to school represents the first real opportunity to be on their own…some relish it, some fear it!  For many parents, this is a time when they may struggle to let go and allow their child to demonstrate self mastery, to show responsibility in meeting multiple new expectations, and to dig down deep to grow, achieve and, ultimately, graduate!

Navigating college challenges: the temperament of your significant others

Navigating college challenges: the temperament of your significant others

Large numbers of parents can’t negotiate the difficult transition from encouraging dependency to facilitating independence.  As a result, they become “helicopter parents,” hovering over every aspect of their college student’s life…daily “how are you doing” phone calls, repeated text reminders, wake-up calls, go to bed admonitions, daily grade checks on the college website, over the phone sobriety checks, tightly managing the bank account, and not so subtle threats about what will happen if he or she messes up!

It never ceases to amaze us how far co-dependent parents will go to protect their child from the reality of college life challenges.  One young man who recently came to us for help because he was struggling to meet expectations (i.e., submitting monthly reports, generating narratives to describe sales calls, etc.) in a job he secured with a Fortune 500 Technology Company after graduation.  As it turns out, these were demands he never really had to face at college.  “I never wrote one paper at college.  I would send the syllabus or the rubric for an assignment to my Mom who would do the whole thing and send it back to me to give to my professor!”

Most parents sense that this degree of co-dependency is wrong but persist because the pattern is deeply ingrained.  Oftentimes, it developed years earlier in elementary or middle school.  Nagging about homework.  Making flash cards for their child to use to study for exams.  Obsessive editing of papers and essays.  Doing the homework.  Eliminating chores.  Tolerating underage drinking or drug use.  Minimizing problems.  Blaming the teachers.  Providing rewards for doing the basics.

Once this pattern is established, it can grow ugly in high school.  The child oftentimes is dependent upon a nag or a reminder to get things done, yet becomes resentful, disrespectful, and manipulative when they get one:  “Quit nagging me!  I’ll get it done!  Why don’t you trust me?”  Such interchanges can put parents back on their heels:  “Damned if they do” (having to tolerate an “attitude” brimming with anger, intensity and negativity” or “Damned if they don’t” (fear of their child failing, losing opportunities, and not experiencing success).

When college comes along, it all gets magnified.  Parents can justify their enabling behaviors because they are only “rightfully” protecting their financial investment!

As parents, the forces behind enabling/co-dependent behavior are particularly powerful…love, protection, empathy, fear, sensitivity, sacrifice, and guilt.  So powerful, in fact, that they can sabotage all the positive things parents can do to promote their child’s independence and chances for success.

Here are some of the things they can do to trip parents up:

  • — Interfere with their ability to take an honest look at their child’s strengths and weaknesses
  • — Make them feel defensive when their child fails to meet an expectation
  • — Blind them to their child’s role in his difficulties
  • — Lead them to do for their child rather than support him to do for himself
  • — Inhibit them from imposing necessary and appropriate consequences
  • — Encourage them to blame others when things do not go smoothly
  • — Act as a barrier that prevents them from allowing their child to take on ever increasing responsibilities for himself

Because co-dependency is so common (particularly in parents of children with ADD/ADHD) and it can be a critical barrier to success at college, we encourage parents to examine their enabling tendencies before and during their child’s college years.  In our new book, Accommodations for Success we have a simple survey called “First Things First” that can help parents assess their enabling tendencies.  Check it out!  Be honest and see where you stand!  “What’s you enabling quotient?”

Sometimes, just being more aware of enabling tendencies helps parents reduce or control them.  However, when enabling tendencies interfere with a parent’s ability to develop and /or follow through with doing the right things to promote their child’s success parents may need to reach out for help.  This may be as simple as requesting a significant other to be a source of feedback when one demonstrates thinking and behavior that is enabling in nature.  Of course, inherent in this strategy is the need to be committed to being non-defensive and accepting of the feedback!

Some parents find that it is important to develop a support network or a buddy to regularly meet with to discuss some of these difficult issues.  Some find it most helpful to meet individually with knowledgeable professionals to help find a pathway to healthy thinking and behaving when it comes to promoting their child’s growth and development.  If you need some extra support with your co-dependent tendencies, give us a call at the Being Well Center…we’ve helped thousands of parents get their act together.

Failure to get these enabling behaviors under control can be a major barrier to independence and success.  Sometimes parents have to step out of the way in order to allow their child/student to move forward and reach his/her full potential.  If this is hard for you, then it is important to reach out to a spouse, a co-worker, or a professional for support to meet this most difficult challenge!  Stay on guard and work to avoid allowing these tendencies to interfere with your child’s success at college.

Help for the ADD Individual’s Significant Others: Parents, Spouses, and Partners

photo courtesy of Glyn Lowe

At The Being Well Center we embrace the whole person diagnostically and therapeutically.  That means we always put significant others (parents, spouses, partners) into the mix.  The nature and intensity of this involvement varies on a case-by-case basis.  The following are some of the ways our comprehensive approach involves significant others

The Problem Definition Appointment

On occasions, parents and significant others aren’t sure whether the BWC is the right place to meet their needs.  Sometimes the identified patient (i.e. child, adolescent, young adult, or older adult) isn’t ready to get help, but the significant others are at wits end trying to figure out what to do next.

Our Problem Definition Appointment is the ideal answer for these types of situations. During this 1-1/2 hour appointment with Dr. Liden or a senior member of our team, significant others are provided with a non-judgmental environment where they can openly and honestly express all of their concerns.  We guide them to tell their story and share all aspects of the difficulties they have been experiencing.  We explore the efforts they have made to address their concerns and begin to uncover what did work, what didn’t, and why.

We are particularly adept at getting to know significant others quickly, including their temperament, attitudes, values, hopes and fears.

At the end of the session, we suggest what seems to be the best next step.  This might mean further involvement at the BWC or, when appropriate, referral to another resource that we feel will better meet their needs.

We give preliminary tips, suggestions, and guidance that they can start using right away and we work hard to instill confidence in them that “things can get better!”

Ongoing Supportive Counseling

After the problem definition appointment, when an identified patient (child, adolescent, young adult, etc.) is resistive to some type of evaluation or other intervention, we provide ongoing supportive counseling to significant others.

The goals of this type of support include:

  • Facilitating an understanding of the whole individual and the fact that problems are never the result of one factor, but always the result of a multiplicity of factors interacting together.  This helps reduce much of the guilt that significant others normally carry with them.
  • Helping significant others identify and manage any co-dependent or enabling behaviors that could stand in the way of moving forward.  We try to help parents get out of the “you’re dammed if you do and dammed if you don’t” bind.
  • Helping significant others become more self-aware of their role in the problems they are experiencing and empowering them to take steps to exert better self-control over their actions.  We have found that taking charge of yourself is the best way to begin changing a bad situation.  The only thing you really can control is you, so we try and help parents successfully do it.
  • Assisting significant others to take some action steps, including establishing more appropriate expectations for their child, setting up clear “house-rules” to be followed, and defining meaningful and appropriate consequences when expectations and rules aren’t met.  We help significant others present these changes to their child and we’re there to provide ongoing support to help them follow through and stick with their action plans.
  • Providing support to parents while their children are away at a distant program and aftercare support when they return.

We have found that when we help empower parents to “change the game” then the child, adolescent or young adult by necessity has to make some type of change as well.  We hope that change becomes getting involved with the BWC for help with their problems.

Implementing Success Plans

We always include significant others in the implementation of our success plan for their child, adolescent or young adult who has gotten involved with the BWC.  When a child, adolescent, young adult or spouse chooses to get involved with the BWC, the first step is a Discovery Session where we look at the problems from everyone’s perspective: the child’s, parents’, schools’, other professionals’, etc.  We call it “simultaneous sampling” . . . looking at the same issues from a variety of perspectives helps us make sure we’re getting an accurate picture.  We use a series of comprehensive questionnaires and structured interview formats to achieve this goal.

Once a success plan is developed, significant others always have some role . . .

  • We help them learn how to become a supportive part of the success plan without taking away the child’s, adolescents or young adult’s responsibility.
  • We facilitate understanding and acceptance of the individual differences of all family members and use this to improve family communication patterns and dynamics.
  • We help all parents refine their parenting skills . . . we don’t take children into a room and shrink their heads while the parents sit in a waiting room.  Rather, we do very directive counseling and always find a way to help parents find a role in facilitating their child’s success.
  • We regularly meet with parents to get their perspective on “how things are going”.  We try to tease out the reasons a parent and child would see behaviors differently and try to get them on the same page.
  • We advocate for our patients needs at all levels of school and will support parents at meetings.  We contribute to the development of 504 agreements and IEP’s.

Supportive Relationships for Life Concerns

The relationships we develop with parents and significant others over time are special . . . partly because of our unique philosophy and mainly because of the type of people who are on the BWC staff.  Over time parents/significant others feel a sense of trust and competency that makes them feel comfortable asking us about almost everything . . . their mom’s cancer, their financial struggles, their personal development, whose a good doctor, what should they should do with their lives.  We feel humbled by the trust patients and families put in us and work hard every day to be worthy of it.

Many of these services for significant others can be provided by our innovative GuideU appointments that employ creative use of video conferencing technology.  Tight schedules, bad weather, and distance never have to be barriers to getting BWC support.  We are currently working on implementing the same innovative technology to conduct virtual support groups for parents with shared issues.

At the BWC, we’re always one step ahead!

STRESSES – The Challenge of Taking Medication at College

When students arrive on campus, the demands for efficient attention and self management skills (that is executive functioning) immediately soar . . . challenging academics, consistent study habits, maintenance of healthy daily routines for sleep, eating and exercise, money management, and more complex social decision making.

c@c_whole_you_blog_stresses

Meeting college demands is particularly challenging for students with ADD/ADHD and for the overwhelming majority of them, this means having the aid of a medication regimen that provides benefits throughout the whole day.

We’ve learned from our experience in our Confidence@College program that college is a bad time to try to “fly on my own” and go without medication treatment.  In fact, in our C@C patient population, we have found that acceptance of the need for medication and compliance with an appropriate all-day medication regimen is near the top of the list of factors that contribute our 81% success rate.

For some ADD/ADHD individuals who have been able to get by without medication in the past, entrance into college with its increased demands means having to seriously consider the use of medication for the first time.  For others who have been able to get by with a medication regimen geared to get them through the school day, it means revising their regimen to provide coverage into the evening hours.  And for others, it means committing to taking the medication 7 days a week!

Don’t let an improper use or lack of medication keep you or your student from success at college!

At The Being Well Center, patients who enroll in our Confidence@College program always start with a Discovery Session where we identify the key problem areas and survey the whole person so we can pinpoint the barriers to success and uncover strengths we can mobilize to meet these new challenges.  We then develop an individualized Success Plan.  When medication is a part of the success plan we conduct systematic medication trial testing using objective testing procedures to find the right medication and a treatment regimen that provides efficient attention throughout the waking day.

Before students arrive on campus we brainstorm with them and their parents how they are going to get their medication and how to securely store it.  We go over the logistics of when they will take the medication based upon their weekly schedule.  In addition, we review the dangers of diversion of the medication and make sure we have a mechanism in place to closely track the quantity of medication we provide them.

Once students are on campus, we use innovative technologies and support from our staff through our GuideU video counseling sessions to ensure the student complies with the medication regimen and maintains healthy daily routines, the foundation for a successful medication experience.  We identify signs of sub-therapeutic treatment and possible side effects quickly and our medical staff fine tunes the treatment regimen as needed.

We’re there to ensure success during the whole college experience not just in the classroom, library or study carrel.  We make sure our patients are aware of the importance of taking the medication during evening hours and weekends where social activities provide high risk challenges for un-medicated ADD/ADHD students.  Impulsivity, poor self awareness, weak self monitoring and ineffective problem solving can lead to social decisions that can be disastrous . . . alcohol intoxication, substance abuse, unprotected sex leading to unplanned pregnancy or STD, or illegal activities.  One night of un-medicated “fun” can lead to expulsion from school and life-long consequences.

If you’re at the top of your game, college can be an exciting and enriching experience intellectually, developmentally, and socially, and can provide you with what it takes to independently fulfill your dreams and aspirations through life.  Compliance with the right medication regimen helps this become a reality for students with ADD/ADHD!

Be confident with your child’s success at college . . . call us at the BWC and set up an appointment to participate in our C@C program.  We’ll make sure your child has all the tools, including an optimal medication regimen if needed, to succeed at college.