Tuesday, May 19, 2015

Tips for Parents who have Children Diagnosed with ADHD

Any parent who has a child that has been diagnosed with ADHD can use help managing their lives! The following tips may offer assistance:

STRUCTURE - Children with ADHD need structure to function successfully.
  • Providing meals, bath, homework and bedtime as closely as possible at the same time every day can be helpful.
  • These kids also benefit by doing their homework in the same place every day.
  • Allowing them to do something physical after school instead of sitting down immediately to start their homework can help them to focus.
  • Having them break down their work into small manageable “bites” can often be the answer to decreasing their sense of being overwhelmed.
  • Giving them 25-30 minute increments for homework or tasks then a 5-10 minute break can also be very effective.
  • At home you need to check their homework and ensure they have put it into their book bag. Often they will have completed their homework but forget to turn it in. They will need your patience and your help to stay organized as this is often very challenging for them. Providing a check list for chores, routines and homework can also help your child improve their organization.

PREDICTABILITY- ADHD children need predictability or they tend to get anxious, antsy or act out.

TRANSITIONS - Transitions can be difficult. To decrease their anxiety, provide them with a simple, succinct explanation ahead of time and rehearse the transition with them when appropriate.

BRIEF EXPLANATIONS - Keep your words brief. When our explanations are too long, these kids will often tune out as it is difficult for them to continue concentrating. They often are uncomfortable admitting this at home and school. This leads to moving forward with insufficient information, thus leading to trouble.

HELP WITH SHORT-TERM MEMORY - Most people don’t understand that ADHD kids may have short-term memory problems – you may think that they are not listening but they really are! This is why they don’t recall the directions. What will increase their success is giving them no more than 2 step directions and showing them exactly what you want to do. They learn visually so it is helpful for them to have a picture of the activity. Check off lists can also be helpful with pictures for children who are younger.

RELAXATION - ADHD children frequently act impulsively. They need you to help them slow down, take some deep breaths and look at the consequences of their behavior before just plunging in.  Since they can be anxious it is helpful to teach them relaxation skills:
·         Deep breathing (slowly)
·         Give the whole family the opportunity to have a “calm half hour” when no one talks, no electronics, and everyone does something quietly. This teaches them it is okay to not always be on the go; and relaxation actually feels good!
·         Recognize when your child may be over-stimulated.  
·         Planning less activities in a row or introducing calming activities can go a long way to help your child self regulate.
·         Help your child find some activities that are self soothing is also important.

NOTICE WHAT THEY DO WELL - As with all children, it’s important to notice when they are doing things well and to provide an enthusiastic response.  Children with ADHD often develop a poor sense of self-esteem as adults are correcting them quite a bit. They often feel that they can do nothing right (“Lower your voice, can’t you settle down? Why do you always have to be moving? Why aren’t you paying attention to me? Why can’t you ever do your homework without a scene?”).

COGNITIVE BEHAVIORAL THERAPY - Sometimes therapy can help them to develop a greater belief in themselves as well as provide support to parents who are often feeling frustrated and overwhelmed. Cognitive Behavioral Therapy is a key component to your child’s success as it helps them learn that what they think determines how they feel. Learning how to challenge their thoughts can give them an invaluable tool for handling their emotions. Since impatience is often a product of having ADHD, many children can benefit by learning good anger management skills which help them in developing healthy relations and self-control.

HELP THEM TO LEARN HOW TO DO OTHER THINGS WELL - Creating a behavior program where two behaviors are targeted and the child earns a point for each time the target behavior is executed is essential. These points lead up to a reward which increases their incentive to change their behavior. Rewards can be material, extra time with you, choosing what they will have for dinner, staying up later, or having a friend over are a few suggestions. It is essential to ignore the behavior you do not want and reinforce the behavior you do want enthusiastically!

HELP THEM LEARN GOOD SOCIAL SKILLS - In addition, they can use some assistance with social skills. They tend to interrupt peers when they are talking – they are sometimes concerned that they will forget what they want to say! They may need your help in understanding how they represent themselves to others. Rehearsing effective communication, friendship skills, how to handle being bullied, manners and how to decrease their impulsivity, etc., is a way for your child to feel more confident. Help your child to be able to pick out their strengths and state them to themselves often. This helps them to develop positive self-talk.

MOVEMENT IS KEY - Children with ADHD sometimes learn kinesthetically which means they like motion. When their body is occupied it is easier for them to focus (for example, chewing gum, squeezing a squishy ball, using clay, swinging their foot back and forth, etc.).  They require a lot of physical exercise which helps them to ground their energy, decrease overstimulation and hyperactivity. Getting a mini trampoline works well when they need to get their energy out when the weather is inclement. If enrolling them in sports, they do best in a sport such as soccer, hockey, or lacrosse which has continuous movement. Playing baseball may be more difficult as it may be difficult for them to wait their turn.

ADVOCATE FOR THEM IN SCHOOL - Parents play a very crucial role as their child’s advocate in the school system. When your child is diagnosed with ADHD they are entitled to modifications at school which enhances their ability to learn. The law that provides them with the right to modifications is called “The American Disabilities Act” (ADA). Unless they have any learning disabilities they are not qualified as “Special Ed” but rather “Other Health Impaired” under what is called a “504 plan”. Schools will rarely tell you about this option unless you bring it up. Possible modifications:
  • Taking tests in a room other than the classroom so there will be fewer distractions
  • Getting more time to take a test since their attention may wander. This can also provide them some extra time to check their work as they often rush through to finish, increasing their chances to make careless mistakes.
  • They can check in with the school social worker/psychologist at the beginning and the end of the day to process any problems that may have come up.
  • They can be allowed to chew gum, use a squishy ball, have a wiggle seat, get up for a sensory break, leave the room for a stretch break or drink of water, bring papers to the office for a teacher, have a classroom job and have the teacher give them a subtle cue when they are off task.

After school activities that allow for expending energy and making friendships are pivotal to their success.

MEDICATION? - You may want to consider options to treat the child’s ADHD with medication. You will need to consult with a good Child Psychiatrist. After the diagnosis is made it is often permissible to obtain the medication from your primary care physician. However, a mental health professional is required to diagnose your child.

Children with ADHD have many gifts such as well developed intuition, sensitivity, creativity, intellectual prowess and unique ways of looking at the world. They can teach us a great deal from their perspective!


Andrea Schear, LCSW

Friday, May 15, 2015

Magnifying the Uncomfortable

The other day my husband, who has been having seasonal allergy problems this year, told me that he heard on the news that this year we are experiencing a “tsunami of pollen”.  In my interesting imagination, I thought of a disaster movie with an actual tsunami of pollen coming toward us all! What a calamity!!! Who would play the hero of the movie…the fighter of the pollen tsunami? Would it be Brad Pitt or some younger buff star?

Actually, I just laughed and told him that this was a classic cognitive distortion, or what we call here at NECBT, a Mental Mishap. The proper name for this is “Magnification”; making something much bigger than it is, or creating mountains out of molehills.  We do this so often with the words that we use. Think of how many times the weatherman said this past winter, “It is absolutely HORRIBLE out there!”.  Or, how many times a co-worker has said to you, “the traffic is TERRIBLE today!”.

How does this dramatic use of language help us? Do we use it to receive sympathy? Or do we use it because it seems true to us?  The first thing I want to explore is the definitions of horrible and terrible. Horrible and terrible have a similar definition: Very shocking and unpleasant. Is the weather or traffic very shocking?  The truth is that it may be unpleasant but it certainly is expected. The use of this language is just magnifying the uncomfortable.

The problem with magnifying what is uncomfortable is that the only thing it does is cause us to feel worse about the normal frustrations of every day life. It doesn’t make us feel better. When we use magnifying words, it clouds our thinking which in turn clouds how we feel. Changing the way we use our words can change the way we feel. Or, as we teach patients, the words we use shape our perception of reality and how we deal with our reality. If we come to work feeling really grumpy because the traffic was “horrible”, how is that going to impact the rest of our day? If instead we came to work acknowledging that some days the traffic is worse than others (a rational thought), we will get on with our work with a healthier outlook and in turn feel calm.

Try to be more aware of your own magnification. As for the pollen tsunami, let’s call it what it is….Spring!


Bonnie Lillis, LPC

Clinical Director, NECBT

Friday, May 1, 2015

What is OCD (Obsessive Compulsive Disorder) – How to Get it Under Control

Obsessive Compulsive Disorder (OCD) is one of the most debilitating forms of anxiety. It plays on one’s thoughts putting meaning to meaningless things.  OCD pushes one to believe that they are in control of their anxiety by engaging in behaviors that relieve one of those anxious feelings; however, in reality the person is not in control - the OCD is.

A common question people who struggle with OCD tend to ask is “when will these thoughts stop popping into my head or will my OCD completely go away?”  The truth is those thoughts will not stop popping into one’s brain and the OCD will not completely go away. The good news is you can learn to control OCD and learn to live a healthy, productive life by treating the OCD with Interpersonal Cognitive Behavioral Therapy
(I-CBT), Exposure Response Prevention (ERP), and some medication.

So what is Interpersonal Cognitive Behavior Therapy and how can it make OCD easier to live with?  I-CBT is a type of therapy where we learn to identify irrational thoughts and change the way we think. Therefore, we change those well learned irrational thoughts to rational thoughts and begin to feel calmer and act better. Once you learn I-CBT then you can begin to learn and implement Exposure Response prevention (ERP) into your life.

ERP is a component of I-CBT. The individual who is being treated for OCD will be exposed to that feared thought or stimulus which triggers the individual to engage in compulsions. The individual will be blocked from engaging in the compulsions, which will bring the person’s anxiety up and then slowly back down.  The repetition of doing this exercise will cause the brain to habituate. When the brain habituates, the need to engage in compulsions goes to sleep. Once the brain habituates it is important to continue to practice the exposures to prevent an OCD relapse.  You could think of this as a bear going into hibernation. This may seem like a lot of work. However, rationally speaking, it is much more productive then spending and wasting so much of the time that OCD takes out of your life.

Also, it is important to note that I-CBT combined with ERP is extremely effective with specific phobias and other related anxiety disorders.  If you or someone that you know could benefit from our treatment at NECBT, please do not hesitate to call us at 860-430-5515.

David Goldwerd, MHC. I-CBT Clinician

www.necbt.com