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What is ADHD?

     What is ADHD and how does it show itself in elementary-school aged children? The DSM-IV, the diagnostic manual of the American Psychiatric Association, suggests that the behaviors fall into three general categories. These are impulsivity, inattentiveness, and physical hyperactivity. Not all individuals with ADHD have the hyperactive component. Because other conditions, such as anxiety and learning disabilities, can mimic ADHD, one must approach the diagnosis carefully.

Accepting the Diagnosis

     Many families go through a period of uncertainty during the time leading up to the eventual diagnosis. The experience of "getting diagnosed" is powerful and can either be a blessed relief or a crushing blow. Many parents experience this as a loss and need to go through a process of mourning so that they can eventually accept their child as he or she is. The classic stages of mourning, denial, anger, grief and acceptance all apply here. Parents and teachers may have different perspectives on this phase of the process of acceptance. The professionals need to be patient with parents as they come to terms with their child's condition. They should not be too quick to pathologize parents who become emotional or angry in meetings. Some of the nicest, most conscientious parents may become angry and tearful in meetings. Parents and children may go through repeated episodes of mourning as they experience the effects of the ADHD in different settings and at different ages.

     Community support is important during and after the time of the initial diagnosis. It is easy for a family to become overworked or overwhelmed. At such a point, the family might be tempted to withdraw into itself just when support is most needed. Extended family can be an important source of support, but can sometimes also be a source of tension. Parents often feel that extended family members do not understand the situation. Educating grandparents and extended family can take time.

Behavioral Planning

     In the home, structure and behavioral planning are often helpful. One has to tread a careful line so that one does not squelch the spontaneous child too much. Complex behavioral plans may look good on paper, but often do not last long in the rush of the real world. The key components to a good behavior plan are simplicity, consistency and frequent rewards. A weekly reward does not mean much to an impulsive child with a short attention span. If the child chooses to work toward a larger reward, he should receive tokens as incremental steps toward the goal. The plan should reward incremental improvements in behavior. Any plan that expects an immediate cessation of undesirable behavior is doomed. The good plan is set up so that the child is able to achieve some measure of incremental success the first day.

     Parents are often tempted to use corporal punishment because they feel that nothing less will get a child's attention. Actually, one should especially avoid such punishment in ADHD children because they are impulsive and more likely to imitate a violent act. One must be extra careful to avoid teaching them to resolve conflicts with violence. Parents must also walk the tightrope of advocating for appropriate accommodations yet also teaching their child to have a sense of personal responsibility for their actions.

Childproofing

     In many ADHD children, particularly the hyperactive ones, there can be serious safety considerations. Impulsivity is a common feature of ADHD and it may manifest itself in climbing tall trees, getting into medicine cabinets, and playing with power tools. Their motor hyperactivity makes them quite fast, and they can be into tremendous trouble in the time it takes a parent to load laundry into the washing machine. Some ADHD children have coordination and balance disorders, but do not have the judgement to accommodate to their difficulties.

     Many people think of childproofing as only for families with babies. All families should probably childproof to some extent until everyone goes to college. This is especially important for families affected by ADHD. Many family crises could be minimized if valuable breakable objects were locked safely away. Certain stain-repellant paints, vinyl wallpaper, and carpet treatments make accidents less costly. Linoleum with the pattern printed through the entire thickness of the material is less likely to show scratches. Sometimes one can plan indoor traffic patterns to keep muddy feet off certain surfaces.

     Although a family may have their own house well childproofed, the grandparents may not have their breakables out of the way. It is often best to discuss childproofing plans before the visit. If it is not possible to get the breakables out of the way, bring your own games and toys, or plan to play outside as much as possible.

Dealing with emergency rooms.

Medication