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ADHD in the Pre-school Child

Bobby’s parents were concerned. Following his fourth birthday in the summer he had been enrolled in preschool three months ago. The teacher had already requested several conferences with the parents regarding Bobby=s work and play habits as well as his behavior in the classroom.

His mother brought along a note his teacher had recently sent home: Bobby has trouble sitting for more than two minutes before he is up and running about the classroom. He is restless at circle time and wanders around the room. He disrupts the other children who are trying to work. He cannot concentrate for more than a minute or two on a task because he  is so easily distracted.

 Bobby’s Story

I learned that Bobby was the first child in his family. His mother reported that he had always been difficult to manage at home. Always active and restless, he had difficulty staying at the table through a meal and getting to sleep at night. He acted without thinking and was repeatedly in trouble for things like jumping on the furniture or getting into places that were off limits.

When his cousin of the same age visited, he pushed and shoved and was over-excited. But he was not angry and seemed genuinely sorrowful when confronted about what he had done.

His mother had noted these behaviors but did not know what to make of them since Bobby was here first child. AI thought maybe it was because he was a boy.

Once he began to have persistent trouble at preschool the parents suspected that something was not right. The teacher suggested that he might be hyperactive, the father volunteered.

But I thought he was too young. Doesn’t that problem only occur in older kids?@ his mom asked.

In fact, most children with attention problems and hyperactivity are not recognized until early elementary school.

However, the characteristic symptoms of ADHD are typically present from early in life. Often parents as they present a detailed history of the older child recall that the one with ADHD was different from early in life. These difficult behaviors at the time were not clearly different form the typical toddler and preschool pattern. Because no one could put a finger on these differences, they were ignored, or at least tolerated, during the early years. Confusing the picture is the fact that toddlers and preschoolers are by nature active, impulsive, and easily distracted. So the child with developmental problems may be somewhat difficult to separate out at this age.

But, then, along comes a Bobby whose restlessness, impulsiveness, and pure motor hyperactivity cannot be ignored. Such a child has problems paying attention, following directions, and participating in cooperative play appropriate for their age. They are over stimulated easily in large groups or when excited. In a one-on-one situation they may be more attentive and cooperative but even here the short attention span is likely to be noticeable.

For instance, they may have difficulty sitting still at the table through a meal. They will want you to read to them but may listen for only a few minutes before they are up and running or asking for another book. They may hit, push, and shove impulsively, but yet, they are not angry or mean. One common symptom at this age is an incessant need to talk without any control.

 The Diagnosis

Indeed, Bobby did have attention deficit disorder.

After detailed observations were obtained from his parents and teachers, developmental tests were administered. He was cognitively advanced being particularly strong  in verbal skills. However, his motor skills were mildly delayed. The examiner noted that he had a very hard time keeping Bobby focused on the tasks.

Following this evaluation, Bobby was treated with a small dose of Methylphenidate. There was marked improvement in his activity level and degree of impulsiveness. He was much more controlled in school as well as in the home setting.

His teacher later wrote: Now Bobby is able to realize when he has done something wrong. He more often chooses positive options. He is able to sit and concentrate. He is choosing to ask for work which requires that he sit for 10-15 minutes at time. The amount of detail in his daily journal has changed tremendously. Before, he would draw just few lines with dark color in his interpretation was usually something violent and aggressive. This week, however he is taking his time and the colors and the details of his drawings are bright and clear.

 Management

The management of the young child with ADHD is certainly more difficult and complicated than with older children.

First, as we have discussed, it is not always easy to separate the attention behaviors from those behaviors which are typical of preschoolers. Not only is the initial diagnosis more confusing but it is also more difficult for parents to decide how to respond to a specific behavior.

Secondly, the preschooler is not sufficiently mature cognitively to understand the consequences of his disruptive behaviors. Thus verbal signals are often not well understood or received. Parents find themselves constantly interrupting and re-directing behaviors.

The excessive impulsiveness leads the preschooler to behaviors that can be dangerous to themselves and others. Parents must be on their guard for things like climbing to dangerous heights, playing with matches or fire, running into the street, etc. The children must be watched compulsively.

To complicate all of this, the preschooler’s response to stimulant medication is more erratic and unpredictable. Many physicians simply will not attempt to treat the young child with medication because they have had bad experiences with it or they are uncertain about how to administer it to this age child.

 The Use of Mediation With the Preschooler

Recent studies, however, have verified the fact that, indeed, preschoolers can be effectively and safely treated with stimulants with good response when the medication is managed appropriately for their age. The main problem is the narrow window between effective dose and side effects. However, by starting with a low dose and gradually moving upward, side effects can usually be avoided while finding that effective therapeutic window. While most stimulants are available in pill or capsule form only, there are some liquid form available. However, the liquids are all short-acting and require multiple doses during the day, however.

 Other Management Steps

In addition to medication when needed, other management steps are extremely important.

It is important for the home and school environment to be as calm and under-stimulating as possible while providing opportunities for learning. A consistent routine of living: eating, sleeping, play time, nap time, school, etc is essential.

An effective behavior modification plan is also important. Often behavioral counseling for the parents will be necessary to help them formulate discipline strategies and techniques to hand the specific bothersome behaviors of their preschooler. A developmental psychologist who understands preschoolers in a great help.

The preschooler with ADHD will often benefit from enrollment in a preschool at age three or four. The school should be quiet, structured, yet affirming in its atmosphere. Consistent behavioral management should be used.

Most of all, parents need relief. The supervision of the preschooler with ADHD is a very demanding, full-time job. This job can easily over-whelm the most energetic and well-meaning parents. Parents need to make good use of a competent preschool and mature sitters and relatives to get away and recharge their own batteries. Otherwise, they will collapse, emotionally, if not physically.

When confronted with the preschooler with ADHD we need to remember the natural tendency of ADHD to get better with chronological maturity. It we can provide right combinations of management at this early stage, we set the stage for more healthy growth later.

Try These Sports for the Child with ADHD

Certain sports are better suited for the ADHD child than others. Baseball, for example, is usually not a good choice. The slow pace and the need for well-developed motor and eye-hand coordination skills make it difficult for many children with ADHD .Stuck in left field, the ADHD child is likely to be off chasing a butterfly when the fly ball comes whizzing his direction.

Some of the more suitable sports for the ADHD child are:

Soccer. Soccer serves as a good building block for other sports because it enhances speed, endurance, and leg strength. It is relatively safe. Too, the hyperactive child does not look much different form other children on the field. Most communities have summer and fall soccer programs and communities in warmer climates have soccer programs year-round. Most children genuinely enjoy soccer; it is now the second largest sport for children in the United States.

Swimming. Swimming, with or without competition, is a good choice for many children with ADHD. The explosiveness of swimming is well matched to the impulsiveness of ADHD. Being a solitary sport, it does not require close cooperation with a large number of teammates as is necessary in the more traditional team sports.

Also swimming is an excellent activity for children with coordination problems. Motor skills needed for swimming seem to be different from those needed for activities on land; a clumsy child can actually be a good swimmer. Swimming, too, seems to enhance over all motor coordination. I have know many ADHD children who were able to experience success in competitive swimming when they failed at all other sports.

Karate. Tae Kwon Do and Karate have proven effective outlets for many ADHD children. Such martial arts are probably the most enjoyable sport after soccer.

Parents sometimes question this use of the martial arts fearing that they may over-stimulate the child or aggravate aggressiveness creating serious social problems. But this does not seem to happen.  The martial arts like tae kwon do and karate are two of the most therapeutic programs for children with  focus and organizational problems. Another benefit is that children can start as young as 6 or 7 years of age. These sports are beneficial because they involve structure, rules, rituals, a stop-and-think attitude. No techniques are taught until the child has learned to stop, listen and think. Classes are usually small. The techniques are monitored carefully, and it is emphasized over and over that these activities are sports and are not be used for any aggressive play. Students who disobey the rules are likely to be expelled from the class.

The martial arts teach and develop control of mind and body. Such control, of course, is the basic need of children with ADHD

The Place Of Sports In The Treatment Of ADHD

Jason was eight and really interested in sports. He also had ADHD. He was signed up for Little League Baseball and eagerly went to practices. Soon, however, his enthusiasm turned to frustration as he struck out, missed fly balls and sat on the bench a much of the time.

Early sport experiences for ADHD children all too often follow a similar pattern. The result is that they are turned off sports altogether. Such occurrences are unfortunate. Although little research exists to document the use of sports and recreation in children with ADHD, the experience of many people working with children suggests that, when used properly, they can make a significant contribution to the child’s overall growth and development.

Carefully chosen activities, perhaps combined with the use of appropriate medication, can enhance the child’s confidence, self-esteem, fitness, and social adjustment. While conventional treatment with medication, behavior modification and academic intervention are mainstays of management, children with ADHD need the physical, psychological and social benefits which sports and other recreational activities can provide.

Integrating recreation and sports into a management plan requires thoughtful planning. We are all familiar with “individual education plans”. ADHD children might well benefit from “individual recreation plans”. In selecting an activity for a child, various factors need to be considered: What are the child’s assets as far are coordination, body strength and attention? Why have previous sports activities failed? What are the child’s interests–what does he or she do in his free time? How mature is the child physically and emotionally.

Thus, it is important for the parents to talk to the coach or recreation leader about their child’s skills and problems before a program begins. Parents worry that this will create a negative attitude in the coach or teacher. On the contrary, most coaches want and need to know about strengths and weakness the child may have. If not made aware of the child’s needs, the coach will probably interpret his negative behaviors or inexperience as lack of interest or rebellion. The end result is a bad impression of the child.

A bonus coming from athletic activity is that as parents participate with the child, barriers are let down and more meaningful communication can occur. While attempts at dialogue at the dinner table may lag, spontaneous and meaningful conversation can usually be elicited while shooting baskets or playing a game of ping-pong.

Too many ADHD children have been turned off sports and physical recreational activities because of bad experiences in the past. These negative attitudes need to be turned around so that the child can enjoy the benefits of recreation and fitness activities. Carefully chosen activities can not only be pleasurable but provide significant therapeutic benefits to child with ADHD.

The next blog will outline the best sports for children with ADHD.

Positive Relationships Sets the Stage for Success

Our chance of success in parenting is greatly increased as we positively meet the normal, healthy needs of our children for love, acceptance, meaning, and mastery. As these needs are met our children will be less tempted to seek a place for themselves through deviant, undesirable behavior.

Our children need to know that we love them in spite of what they do. Our love and concern as parents is not conditioned on their behavior. By honestly accepting our children and liking them while not necessarily accepting or liking their behavior,  we keep the door open to change and growth. Love is, and has always been, the most powerful force in the world.

When it comes to relating to children, patience is a virtue but is not always easy to express.
“Stop acting like a child,” I overhead one frustrated mother say to her six-year-old. Although I could understand why this mother erupted in such frustration in the middle of the supermarket, her remark mirrors our frequent inappropriate expectations of our children. Much of the behavior of children that is so frustrating to us as adults is simply our children being, well, children.

To be effective as parents, we need to  Our love and concern as parents is not conditioned on the child’s behavior.have some idea of what is appropriate behavior for our children’s age and stage of development and not attack them for things they cannot help. A young father got very angry with his three-year-old son for using a paper cup as a football during a formal reception. Actually this was pretty normal behavior for a toddler who was ignored in the midst of all the adult activity.

Another mother was frustrated because her thirteen-year-old daughter ran to her room  slamming the door when her mother disapproved of the dress she was wearing. Actually, such pouting and anger are quite typical of the adolescent. We need to remember that children are uniquely children—growing organisms who have not yet reached perfection. Punishment of the child for things he or she cannot help or does not understand will only create frustration, confusion and, likely, rebellion.

We often use up so much energy nagging and correcting our children that we have little energy left to relate to them in positive ways. This is particularly true with ADHD children. In the happy families I have known, however, the interactions have a positive tone and direction. In angry, unhappy families, most interactions have a negative tone. This is one area where all of us as parents can work toward a better record. We can tip the balance in our families in a more positive direction by applying some of the following principles to our relationships:

Listen to the child. Listen without interrupting or correcting. Listen to just hear what he or she has to say.

Do something the child likes. For some this may be reading and talking, others playing touch football, others working on a craft project, or repairing the car.

Give the child some space. Let the child do his or her own thing as long as the activity does not infringe on the rights of others. We are saying, in essence, “I trust you to make some choices for yourself about what you will do with your time.”

Avoid conflict when possible. Conflict, at times and to some degree, is inevitable. While most parents seek to avoid conflict, some seem to delight in having a head on collision with their children. However, both parents and children gain when potential conflict is avoided. A power struggle only creates hostility and negative feelings which hurts everyone. When you do need to draw the line and establish a limit, do so firmly and quickly with as little verbal combat as possible.

Look for the child’s good points. Everyone has some gift. Everyone does something well. Everyone has some redeeming features. The sparkle is there if we only look for it. Ours will be a much happier family if we look for the other persons talents rather than their faults.

As parents we teach through relationships .

We show our children what love is by loving. We teach forgiveness by forgiving. We teach honesty by being honest. We cannot substitute things for affection. Often adults have been heard to say, “I received everything I needed form my parents except the love and understanding I needed most.”

The child with ADHD draws criticism and negative feedback like a magnet. Relationships in the family often mushroom into a back hole of negativism. Parents find themselves constantly correcting, redirecting, and limiting. The child too often responds in sullenness and more self-defeating behavior. It takes effort to reorient the family atmosphere to a more positive spin. But it can be done. And it is well worth the effort.

The ADHD Child and Summer Camp

It is that time of year! Millions of kids across the country will be packing up their knapsacks, waving goodbye to mom and dad, and heading for the hills—literally. Yes, they will be off to summer camp.

What about camp for your ADHD child? Is camp good for him? Is she ready for camp? These are good questions. The answer, of course depends on a multitude of factors. The issues condense to two important areas:

Is your child With ADHD ready for camp?

Is camp ready for your child with ADHD?

Let’s look at the second question first. This question is really asking if the camp under consideration is one that is appropriate for a child with ADHD. Does the camp have a philosophy of inclusion in which they are interested and equipped to work with children with varying backgrounds and needs? Does the administration and staff have some knowledge about ADHD? Is the staff trained in the needed skills of reinforcement and behavioral management? If your child is taking medication, is the camp able to administer it properly.

Although few in number, camps for children with ADHD and/or other learning difficulties does exist. These camps are designed to present a general camping experience for the child while at the same time providing specific therapy and education relating to the ADHD. To find out about such camps in your area you might check with the local chapter of CH.A.D.D. or LDA (Leaning Disabilities Association). If you are unable to locate a local chapter, contact the national offices of these organizations.  Also, check with your school counselor. He or she might have a list of specialty summer camps.

Is your child ready for camp? The answer to this question is somewhat more complicated. Most importantly, the child’s attention deficit should be sufficiently controlled so that he will have a positive and helpful experience. His behavior should be at the point that undue re-direction or behavior modification will not be required.

While there is no sure way to know, there are a few points that indicate that your child is ready for the camp experience. Look for the following readiness cues: Does your child make friends easily? Does she adapt well to new situations? Does he respond well to adult supervision? Does she enjoy successful sleep-overs at the homes of her friends or relatives?”

If your child hasn’t experienced success in most of these areas, she or he probably is not ready for sleep-away camp. But she might be ready for a less socially demanding experience such as day camp. If day camp is too big a step, encourage your child to spend a few days with a favorite friend or relative. Then be sure to praise her success at being away from home.

In general, I would suggest that most children with ADHD are not ready for a week-long sleep away camp until ten or older. For many, this time will not come until their early teens. Of course there could be exceptions with the more mature child. Day camp could be a very good alternative for the child with ADHD.

What Are the Benefits of Camp?

Attending camp gives children an opportunity to learn many new skills—how to swim, ride a horse, sail a boat, hit a tennis ball, use a bow and arrow, tie a knot. It also gives them a chance to master important emotional, developmental, and social skills—how to get along with other people, establish peer relationships, tolerate differences, work as a team, and become more independent.  Camp also gives parents and kids a chance to practice the art of letting go. The experience lets children develop autonomy and a sense of self-respect. A successful camp experience can be a big boost to self-esteem. For parents, the separation allows them to take a break, care for some of their own needs, and recharge their parenting batteries. They also need to experience autonomy from their child—in preparation for what is to come in the very near future.

How To Prepare the Child for Camp?

Since children can be fearful of the unknown, it is a good idea to share as much information as possible about the camp. If the facility is within driving distance, you might plan a visit ahead of time. Such a visit allows the child to see the place as well as talk with some of the staff. Much of the mystique as well as the fear is thus removed.

If a personal visit is not possible, ask the camp for whatever information they may have: brochures, pictures, videos of the camp.

Above all, talk with the child about his hopes, dreams, and fears about camp. Listen to what he has to say. Discuss any concerns. Certainly, do not belittle the worries and fears. Let the child know that while you think the camp experience will be good for all of you, you will miss him and will look forward to his return. It also helps if the child is able to attend camp with a friend.

Non-Stimulant Medication Approved for Treatment of ADHD

The FDA has approved a new medication for the treatment of ADHD (Attention Deficit Hyperactivity Disorder). Kapvay is the first non-stimulant approved to treat ADHD in children and adolescents. It can be used either with or one of the traditional stimulant medications or can be used alone in the treatment of ADHD.

Clonidine extended-release tablets (Kapvay) acts on the brain in a different way, and acts in a different part of the brain, than the stimulants. Taken twice a day, Clonidine, in these early studies, improved core ADHD symptoms. In clinical trials, the most common adverse effects were sleepiness and sedation.

We will need more experience with this medication in order to know its long term usefulness. Clonidine in its original form has been around for years. It is used primarily in adults as a treatment for high blood pressure. This older form has been used off label by some psychiatrists to treat oppositional behavior and certain types of sleep problems in children with ADHD.

Most likely, the primarily use of Kapvay will be as an adjunct medication used along with stimulants when the involved child has more impulsive behavior and or/has sleep problems. Those of us treating children with ADHD are pleased to have an additional option available in the management of children with various forms of ADHD.

The Power of Positive Relationships

Our chance of success in parenting is greatly increased as we positively meet the normal, healthy needs of our children for love, acceptance, meaning, and mastery. As these needs are met our children will be less tempted to seek a place for themselves through deviant, undesirable behavior.

Our children need to know that we love them in spite of what they do. Our love and concern as parents is not conditioned on their behavior. By honestly accepting our children and liking them while not necessarily accepting or liking their behavior, we keep the door open to change and growth. Love is, and has always been, the most powerful force in the world.

When it comes to relating to children, patience is a virtue but is not always easy to express.

“Stop acting like a child,” I overhead one frustrated mother say to her six-year-old. Although I could understand why this mother erupted in such frustration in the middle of the supermarket, her remark mirrors our frequent inappropriate expectations of our children. Much of the behavior of children that is so frustrating to us as adults is simply our children being, well, children.

To be effective as parents, we need to have some idea of what is appropriate behavior for our children’s age and stage of development and not attack them for things they cannot help. A young father got very angry with his three-year-old son for using a paper cup as a football during a formal reception. Actually this was pretty normal behavior for a toddler who was ignored in the midst of all the adult activity.

Another mother was frustrated because her thirteen-year-old daughter ran to her room  slamming the door when her mother disapproved of the dress she was wearing. Actually, such pouting and anger are quite typical of the adolescent. We need to remember that children are uniquely children —growing organisms who have not yet reached perfection. Punishment of the child for things he or she cannot help or does not understand will only create frustration, confusion and, likely, rebellion.

We often use up so much energy nagging and correcting our children that we have little energy left to relate to them in positive ways. This is particularly true with ADHD children. In the happy families I have known, however, the interactions have a positive tone and direction. In angry, unhappy families, most interactions have a negative tone. This is one area where all of us as parents can work toward a better record. We can tip the balance in our families in a more positive direction by applying some of the following principles to our relationships:

Listen to the child. Listen without interrupting or correcting. Listen to just hear what he or she has to say.

Do something the child likes. For some this may be reading and talking, others playing touch football, others working on a craft project, or repairing the car.

Give the child some space. Let the child do his or her own thing as long as the activity does not infringe on the rights of others. We are saying, in essence, “I trust you to make some choices for yourself about what you will do with your time.”

Avoid conflict when possible. Conflict, at times and to some degree, is inevitable. While most parents seek to avoid conflict, some seem to delight in having a head on collision with their children. However, both parents and children gain when potential conflict is avoided. A power struggle only creates hostility and negative feelings which hurt everyone. When you do need to draw the line and establish a limit, do so firmly and quickly with as little verbal combat as possible.

Look for the child’s good points. Everyone has some gift. Everyone does something well. Everyone has some redeeming features. The sparkle is there if we only look for it. Ours will be a much happier family if we look for each other’s talents rather than each other’s faults.

We set limits firmly and consistently but without anger. Even as we seek to understand our child, we remember we are the parent. We need to let our child know clearly what our expectations are. If the line between expected and inappropriate behavior is blurred, the child tends to push until they have some sense of where the line is.

As parents we teach through relationships. We show our children what love is by loving. We teach forgiveness by forgiving. We teach honesty by being honest. We cannot substitute things for affection. Often adults have been heard to say, “I received everything I needed form my parents except the love and understanding I needed most.”

The child with ADHD draws criticism and negative feedback like a magnet. Relationships in the family often mushroom into a back hole of negativism. Parents find themselves constantly correcting, redirecting, and limiting. The child too often responds in sullenness and more self-defeating behavior. It takes effort to reorient the family atmosphere to a more positive spin. But it can be done.

Structure of Time and Place

Most children as well as adults, when left on their own, eventually will fit their daily routine into some sort of pattern that allows them to function successfully. Due to their internal disorganization, however, children with ADHD fail to do this effectively. They have difficulty focusing on a goal and aiming at it. Their increased susceptibility to distractions makes it difficult for them to stay focused on what is important at any given time.

The more unstructured, disorganized and distracting the environment, the more the child is disorganized and disoriented as to his goals. This, in turn, leads to confusion and frustration which leads to more disorganized, unsuccessful behavior. Thus in an unstructured, unregulated environment the child is caught up in a spiraling web of deteriorating behavior. The more inconsistent and unpredictable the environment, the more disorganized the child’s behavior becomes. This then induces more disorganization and inconsistency in his environment. The downward spiral of confusion and frustration goes on and on…and on.

An environment that calms, organizes, and structures the child’s life is one of the primary steps in a strategy for success. The following techniques are basic:

1. The first step is to provide a dependable time structure to the child’s day. Some elements

of this are:

a. Getting up the same time every day.

b. Regular daily schedule.

c. Regular routine for school, play naps, etc.

d. Regular time for homework.

e. Regular bedtime.

Such a regular, dependable routine does several things for the child. Each planned activity presents him or her a framework on which he can hang his day. The set routine gives him short‑term goals to work towards. The time structure acts like handrails on the stairs which help the child keep his behavior more goal-directed. Having certain activities to do at specific times makes him less likely to wander off into distracting, bothersome behavior.

In implementing such a time structure, the parent first decides on what would be a desirable daily pattern that fits the parents, as well as the child’s, needs. At this point, it would be helpful to sketch out the daily schedule. The parents need to make sure the key elements (getting up, meals, school, bed time) are such that they can enforce them consistently. They then discuss the schedule with the child.

The parents do not have to make a big production out of this scheduling task. They might simply say something like this: “This is going to be our schedule. Let’s discuss it.” If the child is old enough, the schedule can be written and posted in his room or some other conspicuous place. An older child (seven or eight or older) might participate in determining the contents of the schedule. Once the schedule has been determined, the parent enforces it consistently, but gently.

This does not mean that the family must live a totally monotonous, unchanging life for the sake of this one child. But the day‑to‑day routine of the child should be as consistent as possible within the family’s power to make it so. Certainly, there will be times when a break in the routine is needed. When change in this regular routine is necessary, however, it helps to prepare the child ahead of time and clearly state what you expect of him or her.

2. The next step is the structure of place.

“A place for everything and everything in its place,” is more than a motto for the person with ADHD. It is a necessity. A search for a lost baseball glove can be a frustrating experience for a normal ten‑year‑old. But for a ten-year-old with ADHD, it can be a disaster, ending in an emotional explosion. Such problems can be prevented by helping the child organize his world (at least his room and his belongings) so that there is a place for everything.

This could involve other elements such as:

a. A regular, non‑distracting, place to do homework.

b. Labels on drawers and shelves to help the child locate the contents. (Some parents have successfully used color codes on drawers and shelves.)

c. In strange new surroundings, such as on vacation, new school, or visiting friends, it helps to take the child on a tour and show him the layout and locations of important particulars of the area.

These are simple steps but can make a big difference in the life of the child with ADHD—and that of his parents.

Overcoming—Rather Than Being Overcome by ADHD

Day-to-day experience as well as scientific observation attests to the fact that different children exposed to the same degree of stress or frustration are not all affected in the same manner. Some are stymied and squelched by their obstacles; others thrive as if the obstacle was more of a stimulus than a roadblock. Those of us working with children with ADHD see this frequently.

Peter Wyman, Ph.D. and associates studied this question several years ago. (The Journal of The American Academy of Child Adolescent Psychiatry, 1992:; 31 (5):904-910)

The researchers looked at demographically comparable groups of children exposed to major life-stress. They interviewed both stress-resilient and stress-affected children assessing perceptions of their care-giving environments, peer relationships, and themselves. Four variables correctly classified 74% of the children in one or the other group. Stress-resilient children, compared to the stress-affected children, reported more:

positive relationships with primary care givers (i.e., parents)

stable family environments

consistent family discipline practices

positive expectations for the future.

These findings support the view that care giver-child relationships play a key role in moderating children’s developmental outcome under conditions of high stress.

This study also points out the extreme importance of a positive parent-child relationship in helping a child overcome obstacles. Children with ADHD and leaning disabilities have many reasons to be stressed. Many will grow into healthy, well-adjusted adults in spite of their difficulties. Stable families, applying consistent, loving discipline in an affirming spirit greatly enhance the chance of success

Driving Competence of Teens with ADHD

We know from experience that adolescents and young adults with Attention Deficit Hyperactivity Disorder (ADHD) are more likely to be involved in car crashes and moving traffic violations.

In an attempt to define this relationship even more, a recent study looked at 25 clinic-referred young adults ages 17-30 with ADHD and 23 controls matched for age, gender, and educational level. Each individual was interviewed to determine his or her driving history. Official state driving records were also reviewed. The subjects’ driving abilities were assessed using a computerized program; driving knowledge was tested by a Driver Performance Analysis System. The two groups did not differ on intelligence testing.

All ADHD subjects had been cited at least once for speeding—twice the rate for controls. Teens with ADHD had had their licenses suspended or revoked significantly more often than controls and were nearly four times more likely to have been involved as drivers in a crash. Problems in driving associated with ADHD were not found to be in the areas of driving knowledge but in actual performance of motor vehicle operation.

The most anxious moment in the life of parents is watching their newly licensed teen drive out of the driveway in the family car. They know that their son or daughter is moving out into a scary, complex world. This anxiety is compounded when the teen has ADHD.

No doubt, the more common characteristics of ADHD such as distractibility, impulsiveness, and increased risk taking make the teen with ADHD more vulnerable drivers. So what can be done to help our teens be safer behind the wheel?

While there are no guarantees, we can tip the scales in the direction of safety by honestly facing the challenges:

♦We openly discuss with our teen how his or her ADHD symptoms can affect driving. We can talk about their vulnerability to distractions and role play as to how to overcome common distractions.

♦At the right time we enroll our potential driver in a good driving education program to make sure he or she has the benefit of comprehensive driving knowledge and skills.

♦Realistically, many teens with ADHD will not be ready to drive at 16 or 17 and may need to wait until they are older to get that coveted license.

♦The teen that continues to have a high level of symptoms, especially of inattentiveness and impulsiveness may need to continue medication into the driving years in order to have sufficient control in order to be a safe drive.

♦Once the teen is driving, parents should monitor closely their driving habits and help them see areas in which they need to focus their attention and work on improving.

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