6 Tips for a Stress-Free Holiday for Kids with ADHD

Make your Holiday Stress-Free 

The most joyful time of the year can also be the most stressful time of the year for children with ADHD and behavioral issues. Engaging in unfamiliar social settings, such as at holiday parties with friends and distant relatives, can be a triggering time for children. Be aware of this potential struggle and follow these six tips to help your child have as much fun as possible during this busy season:

1. Practice hellos and goodbyes – Rehearsing this behavior and eye contact will help your child smoothly handle arriving and leaving a holiday party. Tell your child that he doesn’t have to say a lot. A simple, “Hi, it’s nice to meet you!” will work for an introduction and a “Thank you!” will work on his way out of the door.

2. Role-play receiving gifts – Practice with your child what to do if he gets a gift he doesn’t like, a gift he already has, and a gift he loves. Act out these scenarios and give your child tips on how to be appreciative of any gift he gets.

3. Script conversation starters – Before going off to mingle with the other parents, make sure your child is settled in with a group of children. Remind him of ways to start conversations with them. Questions such as, “Do you play sports?” and “What’s your favorite movie?” are fool-proof ways for your child to jump right into the group.

4. Plan a schedule with your child – Your child knowing exactly what events are coming up is a useful way to manage anxiety. Use a calendar to countdown days until the next big party and to help him get excited for it. Also, make sure you don’t over schedule events for your child so that he has enough rest time amidst all of the festivities.

5. Practice breathing exercises – To calm your child down in a stressful situation, give him tips to take deep breaths and clear his mind and frustration. Rehearse the “stop, relax, think” technique with im, and encourage him to use this trick when he’s frustrated in a social setting.

6. Applaud successful behavior – Encourage your child by pointing out what he did well at a party! This will only lead to more successful behavior.

Why I Don't Diagnose ODD (Part Four)

As we wrap up this series on why oppositional defiant disorder is often misdiagnosed, let’s talk about depression. 

“She doesn’t care about anything.”

“He’s lazy! Every day instead of doing homework or studying he goes straight to bed.”

“She is so grumpy and cries at the drop of a hat.”

“She won’t even try in school.  When pushed she gets very angry and says the meanest things.”

“He skips school or falls asleep in class half the time.”

“Every time I ask her to do something she argues or tells me she is too tired.”

“She can’t make up her mind about anything until we ask her to do something and then she won’t do it.”

Does any of this sound like common rhetoric in your household? Depressed kids seem apathetic and don’t see the use in doing most anything constructive. They tend to withdraw from people or activities that they previously enjoyed.  They sleep a lot but are often tired ‘all the time’.  They are labeled lazy or emotional.

Recently, one of my college-aged patients with well managed ADHD failed out of college because on many days she was too depressed to get out bed and go to class.  When she got behind she started feeling even more worthless and guilty, which deepened the depression to the point that she became suicidal when contemplating telling her parents about her failure.

While many times treating the ADHD will reduce anxiety and depression, sometimes a depressive disorder can be the primary cause of this type of behavior. If your child shows any kind of symptoms of depression, I urge you to contact your provider.

Paying the Wrong Kind of Attention to ADHD

An email alerted me of a study concerning ADHD medication.  Since I prescribe it every day and take it myself, I’m always interested.

When I clicked on the link I was directed to a July 15 article with this headline:  “Do ADHD Medications Boost Substance Abuse Risk?”  The article was reporting on a June 2016 study from the University of Michigan published the Journal of the American Academy of Child and Adolescent Psychiatry.

In brief, the study concluded that if stimulant medication treatment is started earlier (before age 9) and continued, it actually cuts the rate of substance abuse in half.  Put another way, treatment cuts the risk back down to the rate for kids that do not have ADHD.

You might think that the media would have noticed a study from a respected university publishing in a major medical journal on a topic that affects ten percent of Americans. They haven’t.  They either aren’t paying attention or they aren’t willing to be perceived as highlighting even one of the significant benefits of stimulant medication.  Make no mistake; this is a landmark study that re-affirms previous work suggesting the same conclusion.  But society and the media seem interested only in perpetuating the myth of “over-medicating” kids in increasing numbers as well as emphasizing the recognized but avoidable side effects of stimulants.  While this may help sell copy, it doesn’t help families like mine who struggle with ADHD every day because it keeps them afraid of reaching out for help.

ADHD is the most common neuro-genetic disorder of childhood.  It is associated with significant complications and mortality.  In addition to doubling the risk of substance abuse, it increases the risk of school failure and under performance, accidents, divorce, premature death, anxiety, depression, suicide and incarceration.  All of these adverse outcomes have been shown to improve when ADHD is treated with stimulant medication.

Why are we not being proactive? Why are we are not advocating screening and early intervention?  ADHD meets all the criteria of a medical disorder that we should look for proactively.  It is common, can have bad outcomes, and is very treatable.

It’s time we pay the right kind of attention to ADHD. 

So back to the HealthDay article and its headline.  If it had been an article on an asthma medication helping kids improve their fitness it would have read something like, “New Asthma Medication Improves Fitness in Kids.”  But because it is about ADHD medication it was posed as a question that suggests the opposite of the study’s finding.

We need to watch our language and stop this type of slant that stigmatizes mental illness in general and ADHD in particular.

ADHD and OCD in Childhood – The Chicken, the Egg or Both

Obsessive Compulsive Disorder is not rare in childhood and it is more common in children with ADHD. Few parents come to my office concerned that their child has OCD. They are more worried about social skills issues and disruptive behavior at school and meltdowns and tantrums at home. Often a teacher or some other professional will have suggested that the child has ADHD, ODD-Oppositional Defiant Disorder or ASD, Autism Spectrum Disorder or Asperger’s Disorder (no longer diagnosed). These observations are a great place to start. When we listen to the voices of people who know the child well and then take the time to look carefully at the presenting symptoms, we are more likely to get the diagnosis right. Remember that sometimes OCD occurs with ADHD and sometimes OCD diagnosis alone best explains the patient’s symptoms. In other words, the diagnosis can be either or both. To make matters more confusing some patients have other conditions tagging along. Mood disorders, anxiety and tics are all more common in these kids. At my office, Focus-MD, we find that when we look at the whole child, including their struggles and their strengths, we are better able to arrive at a correct diagnosis or combination of diagnoses that make sense to parents. Helping you put the pieces of the behavior puzzle together is what we strive to do every day. 

How to spot OCD

Just because your child’s room is a mess doesn’t mean that he/she doesn’t have OCD. Remember both neat freaks and hoarders have OCD. The neat are obsessed with cleanliness and order while hoarders are obsessed that they may need that half used ketchup packet tomorrow.  One compulsively cleans, the other compulsively holds on to trash. Look for these common symptoms

Symptoms of OCD

1. Counting
2. Lining things up
3. Sorting
4. Making things symmetrical
5. Checking behavior—asking the same question over and over even when the answer  is known or verifying that the door is locked a certain number of times. This is also called Need to Know.
6. Need to Tell—will start stories all over from the  beginning if narrative gets out-of-order or they forget a detail.  Will need you to listen to the detail that is in their mind no matter if it doesn’t matter.
7. Persistent thoughts
8. Rituals – having to do things in a certain order.
9. Food aversion due to texture or one food touching another or having to eat foods in a certain order.
10. Sensory issues — loud noises, tags in clothes, the way under wear or socks fit or feel, texture of clothes or other fabrics.
11. Picking at fingers, biting nails, twirling or pulling out hair, eye lashes or eyebrows.

In reading below you will see that OCD impairments can look a like with ADHD problems.

Functional Impairment in OCD compared to ADHD

OCD compared to ODD

• OCD kids are often defiant but they don’t tend to be vindictive or spiteful like ODD kids.
• Once they have their way, they’re happy again though they’ll remember a grudge!
• In OCD it’s ‘my way or the highway’.
• In ODD it’s ‘anyway but your way’.

OCD compared to ASD

• OCD kids have more reciprocal interaction than ASD kids.
• Their social skills issues are not a lack of interpersonal connection but rather that things have to be a certain way on certain things.
• They will talk about or engage other things but on certain topics/procedures but they are very inflexible.
• ASD kids are happier with parallel interaction if any at all.

Treat Your ADHD Brain Like a Race Car and Get on the Road to Better Focus.

ADHD brains are like race cars. I don’t know who coined the metaphor, but I use it frequently with my patients. ADHD brains are fast; they are powerful. Some of the most creative and successful people on the planet drive one. But here’s the flip side: the steering is difficult and the brakes are lousy.

Like any car, a race car requires maintenance. Things like oil, gas, a clean windshield and air in the tires are all essential regardless of the type of car—whether it’s a Ferrari or a Yugo from back in the day. It’s the same situation with the brain. Good nutrition, exercise, adequate sleep, fresh air and sunshine are all important for any brain to function well, and these are even more important for ADHD brains. But like any high performance vehicle,  an ADHD brain requires much more than typical maintenance.

Here are some strategies to tune up your ADHD care, race car style:

Medication. A race car can go nowhere without the motor being fueled effectively. An ADHD brain lacks the right chemistry for attention, motor and impulse control, so it usually needs medication to enhance those chemical connections. Think of medication as a necessary fuel additive that helps the brain run smoothly. Most of us need medication to operate more efficiently and without it, some of us won’t even make it out of the garage.

Skills. It takes skill to drive a high performance vehicle. Getting medication optimized to the just right dose of the just right medication is often the first part of acquiring the skills needed. Another key is being in the right academic or work setting. With the medication and environment tuned, some ADHD brains are able to flourish and develop the needed executive function to be less frustrated. But for others, more help is needed.

A team. No race car gets to the finish line without a pit crew. And ADHD patients often benefit from a pit crew of their own—supportive people who understand ADHD mentality and play specific roles in the patient’s life. Putting together that pit crew—whether it’s adding an ADHD coach, a nutritionist, a behavior therapist or someone to help with organization skills— and getting them to work in harmony can be difficult for families.

““Every day I learn something new about ADHD from the wisdom of my patients.””

— James Wiley, MD, FAAP