Erik von Hahn, an associate clinical professor at Tufts University School of Medicine who specializes in developmental-behavioral pediatrics, says there are options for controlling attention deficit hyperactivity disorder
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As is true for any children, those with ADHD need to learn to monitor their own behaviors and, when needed, change their behaviors. This process can be referred to as “self-monitoring” (notice what you are doing) and “self-regulation” (change your behaviors if needed, based upon what you noticed).
Let’s look at two important examples of behavioral self-regulation skills that children need to learn: social/safety rules and planning/organizational skills. Most children with ADHD typically don’t master these skills for a long time.
Through feedback children learn safety rules such as “look both ways before you cross the street,” “wait for your turn before speaking” or “think about what you are going to say before you say it.”
Children with ADHD can learn these same skills, but have a performance deficit: they know what they are supposed to do, but impulsivity and distractibility prevent them from performing successfully on a consistent basis. One of the reasons children become reliant upon medications is that the effort involved in performing successfully all day long is too much for them.
That said, all children need to be taught to pay attention to their own behaviors and to modify their behaviors if they are off-track. Children with ADHD are no different from other children in this regard, but they do need to be taught more often and over a longer period of time. The best way to improve self-noticing and self-regulating skills is for parents to teach them these two concepts through feedback and discussion.
When teaching children, it’s good to have a pre-rehearsed script or phrase. Here’s an example of feedback a parent could offer when something has gone wrong: Hmm, let’s think about what just happened. Is that what you really wanted to do? Did that happen without your thinking about it? And: What do you think you should do now? The adult is teaching the child about noticing and then lets the child figure out on his/her own how to self-regulate.
Just as it’s important to teach children when they have not been paying attention to their own behaviors, it’s also important to teach them when they have been paying attention. They need to know what it means to perform successfully. The following script can be useful: I noticed that you stopped to look both ways before crossing the street. Good for you. Or: I noticed that you waited before taking your turn. Good for you. Or: I noticed that you did not get all of your jobs done. But then, somehow, you figured out that things weren’t done, and you did something about it. Good for you.
You will have to be on your toes to catch your child being successful. Most adults don’t notice these kinds of successes; they think of these successes as normal or expected. However, self-corrective behaviors such as the ones I’ve described are not that common in children, and are especially uncommon for a child with ADHD. These behaviors need to be noticed and reinforced or praised!
The other important area for feedback and instruction is task completion and getting jobs done. As children grow, it’s very important to teach them planning strategies, such as making lists of tasks and chores. The child or youth will need to be taught to actually use the list for self-monitoring, and to return to tasks and finish whatever was not finished when they notice that they forgot one step or another. The instruction has to be deliberate, occur often and be carried out with smaller goals in mind.
Even though many parents and teachers sometimes carefully prepare children and youth with good teaching, both adults and children often experience frustration. Prepare yourself, and prepare your child for the inevitable: Kids with ADHD seem not to learn from the strategies that you so carefully prepared. Their impulsivity keeps getting in their way.
Part of the treatment has to include advance planning for mishaps. You can use a script like this one: OK, so those are the strategies. So now let’s think about what you should do if you forget to use the strategies. How will you know? How can you backtrack and make up for some missed steps?
There are some scientifically developed options available to teach these skills. For example, children with ADHD can participate in neurocognitive training, which often consists of a computer-based activity that includes EEG feedback. It helps the children pay attention to their own behavior and notice when impulsivity or distractibility occur.
Though there still isn’t a solid scientific basis for using mindfulness training such as meditation or yoga, they apparently hold some promise.
Regardless of what specialized treatments you may hear about, you will still have to teach your child self-monitoring and self-regulation skills in everyday situations.
As long as your relationship with your child remains collaborative and positive, adult modeling, adult-child conversations and positive feedback are the best guarantee for a successful transition into adulthood.
