ADHD

Common Behaviors

Elham Shirazi MDChild & Adolescent Psychiatrist

Many ADHD :

Act younger than they areAre forgetful Argue or talk backHard to wake upHave a messy roomDon’t learn from disciplineAct without thinking of consequences

If you want to correct every misbehavior You will be worn out physically & emotionally !

Pick your battles carefullyUse reprimands sparingly

Your teenager can learn to compensate

But it will take time !

Seek Independence & FreedomSeek Independence & Freedom1. 1. Encourage independenceEncourage independence Give as much freedom as you feel he can

cope with Give opportunities to make his decisions

2 .2 . Trust until proven not trustworthyTrust until proven not trustworthy

3 .3 . Be observant of activities & friendsBe observant of activities & friends Intervene when isn’t handling independence

well Take away privileges,but extend them again to

give him a 2nd chance

4. 4. Consider compromiseConsider compromise

5. Set up win-win solution5. Set up win-win solution Allowed to go to beach with friends with a

parent supervision

6. Offer an attractive alternative6. Offer an attractive alternative As interesting , with sufficient freedom Propose an interesting activity before he has

ideas of his own

Disobey / Conflict with Adults Don’t always do as parents & teachers

ask them

but often , their failure is inadvertent ! Variety of reasons :

Forget, don’t listen, don’t hear, immaturity, impulsivity, can’t focus on one activity, losing track of time, avoid unpleasant job

Often oblivious to rewards & punishment

Conflict

Available Options

1. 1. State rules clearlyState rules clearly

2. Post them in writing helps2. Post them in writing helps

3. Develop rules jointly3. Develop rules jointly

more likely to remember & comply

4. A few stated rules are better4. A few stated rules are better

Act Younger Social development 30% behind peers

LLD Impaired communication skills

Trouble following & remembering lengthy explanations & requests

Trouble finding right words to answer quickly & organized

Want privileges of his age

but may not handle them maturely

Available Options

1. Adjust expectations1. Adjust expectations To appropriate age level Don’t take misbehavior personally

2. Ask his help in solving problems2. Ask his help in solving problems

3. Teach desired behavior3. Teach desired behavior

4. Impose consequence if necessary4. Impose consequence if necessary

Act Impulsive

If a thought crosses their mind, they may act on it If they think it, they may say it

more likely to say : Ready, Fire!, Aim (& Oosp !! at the end)

They often say / do things they wish they could take back

Keeping secrets terrible time Live for moment delay gratification is

difficult

Available Options

1. 1. Anticipate problemsAnticipate problems Buy a small gift to open before christmas Put car keys away Put money in saving account Don’t tell him secrets

2. Avoid tempting to act impulsively2. Avoid tempting to act impulsively

3. Consider medication 3. Consider medication

Difficulty Paying Attention

View the world through a wide angle lens

Pay attention to every thing at once

Trouble selecting what is most important Sometimes over focus

Concentrate on single activity for hours Misleading adults

He deliberately don’t pay attention !

Trying to talk with ADHD can be frustrating

Are you listening to me?

Available Options

1. 1. Make eye contact / use touchMake eye contact / use touch Stand/sit in front of him

(close proximity) Place your hands on his shoulder/knee

(touch) Say his name (sound) Avoid power struggle

2. Keep comments brief & leave2. Keep comments brief & leave Can’t remember >2-3 things Trouble picking important points

Available Options

3. Avoid preaching3. Avoid preaching

4. Write instructions down4. Write instructions down

5. Accept his listening style5. Accept his listening style Sometimes they hear even appearing

not to listen Ignore his restlessness & accept his

listening style

Forgetful / Doesn’t Do Chores

1. Make a written list

2. Use post-it notes

3. Help get started / show how to do

4. Ask what help?

Disorganized / Lose Things1. Put name on possessions

2. Purchase less expensive things

3. Help be organized Have specific place for belongings Teach time management constantly

4. Serve as a couch Give reminders about important

responsibilities

Available Options

5. 5. List steps for a clean roomList steps for a clean room Make up bed Hang up clothes Pick up thinges of floor Put them in closet & vaccuum

6. Help cleaning / organization6. Help cleaning / organization Work with him on weekly/monthly basis Make learning pleasant (listen to music,talk

about hobbies,…)

7. Close door to messy room7. Close door to messy room You don’t have to look at the mess

Lack Of Awareness Of Time Are often late Difficulty guessing how long it will be take

1. Set a wristwatch alarm for key 1. Set a wristwatch alarm for key timestimes

2. Rent or buy a beeper2. Rent or buy a beeper

3. Teach awareness of time3. Teach awareness of time

Difficulty Planning Ahead

Prefer to do things on the spur of moment

1. Teach planning 1. Teach planning

2. Teach time management2. Teach time management Including him when planning family

activities Using a weekly calendar Estimate time required for each step

Difficult to Discipline

Don’t learn from their mistakes Don’t make connection between

behavior & consequences Low sensitivity to rewards & punishment Traditional punishment doesn’t work

parents use harsher discipline

Many times : Genuinely sorry when doing something wrong

Available Options

1. Use positive reinforcement1. Use positive reinforcement

2. Use logical consequences2. Use logical consequences

3. Reward or punish immediately3. Reward or punish immediately

4. Create new consequences / 4. Create new consequences / rewardsrewards

5. Be consistent5. Be consistent

6. Try “Grandma’s Rule6. Try “Grandma’s Rule“

Available Options

7. Use behavior charts7. Use behavior charts

8. Use rewards / may include 8. Use rewards / may include moneymoney

9. Redirect interests9. Redirect interests

10. Give second & third chances10. Give second & third chances

11. Avoid power struggles11. Avoid power struggles

Low Frustration Tolerance Irritability / Emotionality

Easy frustratedRespond more emotionally Irritable or moody65% oppositionalArguing over smallest issuesNever certain what mood to expect

Defensive & angry at person correcting him

Respond to stress with angry temper outbursts

Overreact to crisis Blame unfair action of others Direct anger at person they love the most

/ they feel safest Sensitive to criticism or disapproval Fear of being embarrassed

Available Options

1. 1. Use active listeningUse active listening

2. 2. Be supportiveBe supportive Treat your teenager with respect

3. Teach problem solving skills3. Teach problem solving skills

4. Teach anger control4. Teach anger control He is learning from family & parents He will model your behavior Bragging about things he does well

Verbal Fights / Arguing Being a parent & not responding angrily is Being a parent & not responding angrily is

not easynot easy

1. Ignore minor infraction1. Ignore minor infraction

2. Walk away from conflict2. Walk away from conflict ( I know you are upset, but cursing is not

acceptable around me, I will not stay here & listen to you talk that way. I will come back later & we will talk when you have calmed down or when you can talk without cursing ! )

Available Options

3. Give space & time to cool 3. Give space & time to cool offoff

Need time alone when had emotional blown-up

4. Impose a consequence4. Impose a consequence

5. Adjust medication5. Adjust medication

Don’t Accept Responsibility for Actions

May blame someone/ something else for their actions

Trouble admitting they have done something wrong

Trouble saying they are sorry

1. Deal with problem behavior1. Deal with problem behavior

2. Don’t try to assess degree of 2. Don’t try to assess degree of guilt or excuse guilt or excuse

DishonestDishonest1.1.If you know the answer, don’t If you know the answer, don’t

ask ! ask !

2. Don’t create opportunities to lie2. Don’t create opportunities to lie

3. 3. Eliminate some punishment Eliminate some punishment

4. 4. Develop plan to solve the Develop plan to solve the problemproblem

5. 5. Impose a consequenceImpose a consequence

Difficulty With Family Events

1. 1. Keep outings simple Keep outings simple 2. Reduce demands 2. Reduce demands 3. Keep outings brief3. Keep outings brief4. Provide a safety release valve4. Provide a safety release valve5. Look for creative solutions5. Look for creative solutions6. Medication may help6. Medication may help

Difficulty Participating In Sports

Exercising is good : stress sleep better restlessness good for heart hyperactivity production of neurotransmitter

50% poor motor coordinationPoor hand-eye coordination Gross motor skills may be better

1. 1. Play large muscle sportsPlay large muscle sportsswimming , soccer , track , wrestling , karate

2. Play an active position that 2. Play an active position that requires full attentionrequires full attentionpositions which involve higher activity levels are more likely to hold attention & focus

3. Consider medication before game3. Consider medication before game

Restless / Easily Bored

Feeling restless complain of being bored

Wants to do something constantly Wants to go somewhere constantly

1. Encourage involvement in 1. Encourage involvement in community activitiescommunity activities physical activities, organized sports, religious groups, overnight parties, ski trips,...

2. 2. Plan interesting family outingsPlan interesting family outingsschedule family events that allow your teenager be active

3. Encourage hobbies & interests3. Encourage hobbies & interestsdiscover his interests by exposing him to variety of activities discuss options & let him pick one out

4. Make special plans for holidays4. Make special plans for holidays

Difficulty With Family Events

1. 1. Keep outings simple Keep outings simple 2. Reduce demands 2. Reduce demands 3. Keep outings brief3. Keep outings brief4. Provide a safety release valve4. Provide a safety release valve5. Look for creative solutions5. Look for creative solutions6. Medication may help6. Medication may help