ADD/ADHD,Predominantly HyperactiveImpulsiveType

ChildrenwithAttentionDeficit/HyperactivityDisorder,PredominantlyHyperactive ImpulsiveTypeareveryactive.Thesechildrenareunabletositstillathomeandin school,maybeextremelyfidgetyorrestless,mayalwaysbemovingonebodypartor another,andmayneverseemtotire.Someofthesechildrenareaccidentpronedueto theirrisktakingandimpulsivebehaviors,whentheydonotthinkbeforetheyact.There appeartobesomedifferenceswithinthistypewithregardtogender;girlswhoare describedasthehyperactiveimpulsivetypetendtobeverytalkativeandareoften describedassocialbutterflies,whileboysareoftenrambunctiousandaggressive.

ThisADHDtypeisoftenidentifiedinchildrenveryearlyon.Parentsareoftenworried abouttheirchildrenbeingrisktakers,becomingconcernedabouttheirchildren'ssafety. Someparentsreportthatthesechildrenwereactiveinthewomb.Parentsreportthat, astoddlers,thesechildrenranbeforetheywalked,didnotliketotakenaps,andalways "gotintoeverything"athome.Aspreschoolers,thesechildrenoftencouldnotsitstill forareadingcircleinschool,couldrideatwowheelerbytheageof5,andsometimes struggledinsocialrelationshipsduetotheirinabilitytoregulatetheiractivitylevelsand monitorthephysicalcontactthattheymadewiththeirpeers.

AttentionDeficit/HyperactivityDisorder,HyperactiveImpulsiveTypeistheleast diagnosedsubtypeofAttentionDeficit/HyperactivityDisorderduetothefactthatmost youngsterswhodisplaythesesignsofhyperactivity/impulsivityalsostrugglewith distractibilityandinattention.Hyperactiveimpulsivetypesareabletosustaintheir attentiontotasksanddonotexperienceanyimpairmentathomeorinschoolasa resultofinattention.Someoftheseyoungsterswhoappeartobereckless,fidgety,and talkativemayalsodisplaysignsofAnxietyDisorder,exhibitingatypeof"nervous energy"thatmakesitseemliketheir"motors"andbrainsarealwayson.

Mostcommonly,youngsterswhodisplaysignsofhyperactivityandimpulsivityare diagnosedwithAttentionDeficit/HyperactivityDisorder,CombinedType.Thisdiagnosis requiresthatachilddisplaysacombinationofinattentiveandhyperactivesymptoms.

HelpingyoungsterswithAttentionDeficit/HyperactivityDisorderisnotassimpleas medicatingthem.Mostparentsdonotviewmedicationasafirstoptionbutpreferto utilizeparenting,behavioral,educational,andskilldevelopmentstrategiesasthe primarycourseofaction.Weencourageyoutolookthroughthefollowinglistof recommendations.Itisimportanttorecognizethatnoneofthesestrategieswill"cure"

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AttentionDeficit/HyperactivityDisorderbutmay,whenappliedappropriately,reduce someofitssymptoms.Wecautionparentsto"keepitsimple"byimplementinga moderatenumberofstrategiesatanyonetime.

GeneralGuidelines
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Expectandsupportvigorousdailyexercise.ReadthebookSparkbyJohnRatey, andlearnhowexercisedirectlychangesbrainchemistrythatimprovestheability ofADHDandlearningdisabledchildrentolearnandfocus. MakeyourADHDchildgooutdoors.Researchsuggeststhatthemorecontact ADHDchildrenhavewithnature,thelessdifficultytheyhavewithinattention. Watchwhatkidseat.Whileresearchdoesnotindicatethatdietorspecificfoods causeADHD,childrenwithADHDclearlyexperiencebehavioraleffectsfromthe foodthattheyeat. LearnasmuchasyoucanaboutADHDsothatyoucanknowwhentoadvocate foryourchildrenandwhentoholdthemresponsible. Learntostructureyourchildren'senvironmentsoastominimizethedistress thattheyexperienceasaresultoftheirattentionproblems. Beprepared.Alwayshavea"bagoftricks"availabletokeepyourchildfocused onanactivity.Thisstrategycanpreventproblemsacrossmanysettings. Usewhatworks.Forexample,whilemanyparentsareopposedtolettingtheir childrenplayvideogamesorwatchtelevision,theseactivitiessometimes provideyouwiththeopportunitytoaccomplishwhatyouneedtodoandalso keepyourchildhappy.Parentscanchooseappropriatelysothatchildrenare morelikelytoplayvideogamesorwatchtelevisionthatmightimprovetheir thinkingandproblemsolvingskills.Itisimportanttocontinuetosetlimitson theseandotheractivities,butparentsshouldnotfeelguiltyaboutusingthemto helpthemselvesandtheirchildren. Recognizewhereyourchild'sADHDhelps,aswellashampers,himorher.For manychildren,ADHDisa"deficit"intheclassroombutmaybeinanassetin otherareasoftheirlives,includinginterpersonalsituations,athletics,handson interests,andtasksthatrequireagreatdealofenergyandenthusiasm.The morechildrencanengageinactivitiesforwhichtheirADHDservesasastrength, themorelikelytheyaretodevelopapositivesenseofselfworth.

ParentingStrategies

Loveyourchildrenbytouching,hugging,tickling,andwrestlingwiththem.Kids needalotofphysicalcontact. 2. Involvechildreninestablishingrulesandregulations,schedules,andfamily activities. 3. Tellyourchildrenwhentheymisbehave,andexplainhowyoufeelabouttheir behavior.Then,havethemproposeothermoreacceptablewaysofbehaving.

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Helpyourchildrencorrecttheirerrorsandmistakesbyshowingor demonstratingwhattheyshoulddo.Dontnag! Giveyourchildrenanallowanceasearlyaspossible;then,helpthemtoplan howtospendwithinitslimit. Modelandteachorganizationalskills.Evenifyouyourselfarenotparticularly organized,beawareofmanyADHDchildren'sneedtolearnsuchskillsforhome andschool. Activelyteachplanningskills.Vocalizeoutloudhowyouplanyourdayorthe strategiesthatyouusetoaccomplishaseriesoftasks.Encouragechildrento stopandplanbeforetheyact. Keepchildrenbusywhileinthecar.ADHDHyperactiveImpulsivechildrenwho havesiblingstendtocausetroubleonbothshortandlongtripsbecausetheyare easilybored.ThissituationisagreatopportunityforADHDHyperactive Impulsivechildrentouseahandheldvideogameorcellphone.Listeningto musicorplayingselectedcardgamesarealsoimportantactivitiestohaveinyour "toolbox." BecausemanyADHDchildrenexperienceaperpetualspiralofdiscouragement withregardtheirschoolwork,theyshouldbegivenpraiseforminor accomplishmentsandevengoodeffortsthatendinfailure. Takechildrentolibraries,andencouragethemtoselectandcheckoutbooksof interest.Havethemsharetheirbookswithyou.Providestimulatingbooksand readingmaterialaroundthehouse.Serveasamodelforchildrenbyreadingand discussingmaterialthatisofpersonalinteresttoyou.Sharewiththemsomeof thethingsyouarereadinganddoing. Insistthatchildrencooperatesociallybyplaying,helping,andservingothersin thefamilyandthecommunity. Attendtophysicalfactors.Researchshowsthatagooddietandexercise improvementalperformance. Whenallissaidanddone,youcannottakecareofyourchildunlessyoutake careofyourself.Dontbashyourselffornotbeingaperfectparent.

ReducingImpulsivity

Teachmethodsformomentaryreflection.Forexample,teachchildrentocount tothreebeforeansweringaquestionortokeeptheirhandsintheirpockets whilewaitinginlineatschool. 2. Playgamesathomethatencouragewaitingandtakingturns.Findaboardgame orvideogameduringwhichyouneedtoalternateturnssoastohelpchildren learntodelaytheiractivity. 3. Encouragechildrentoaskadultsiftheycangetupandmove.Thisprocesshelps themtorecognizetheirneedformovementandtoreduceinappropriateor oppositionalbehavior.

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Modelselfcontrol.Talkoutloudabouthowyoumightwaittoeatdessertuntil afteryoufinishdinnerorfinishwashingthedishesbeforesittingdowntowatch television. 5. Keepchildrenrunning.Themoreactivechildrenare,thelesslikelytheyareto engageininappropriatelyimpulsivebehavior. 6. Provideroutines.Themorechildrenpracticearitualathome,suchasthesteps onetakesbeforegoingtobed,thelesslikelychildrenaretoengageinimpulsive andinappropriatebehavior.

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BehavioralManagement
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ADHDchildrenquicklyhabituatetorewards.Itmaybenecessarytochangethe rewardsregularly. Parentscanbenefitfromongoingtrainingandsupportthroughtheuseof behavioralmanagementtechniqueswithADHDchildren.Often,parentsneed supportinmaintainingthesestrategies. Createpositivealternativechoicesbasedonyourchildspurposesand encouragehim/hertomakeachoice(e.g.,Ifyouwantyourchildtofinisha project,say,Wouldyouliketenminutesorfifteentofinishyourproject?). GiveanADHDchildlotsofdirectwarningsaboutupcomingtransitions.The feelingofbeinglost,outofcontrol,anxious,andoverwhelmedbystimulation cancomewhentheADHDchildisrequiredtopullhis/herfocusfromoneactivity toanother.Thesemomentsoftransitionmustbemanagedcarefully. Parentsneedtolearntobeabletoattendtoachildscomplianceandtoreward his/hercompliance. Ahometokeneconomyorrewardsystemmayneedtobeestablishedforsome difficultchildren. Parentsneedtogiveonedirectionatatimetotheirchildren,sincemultiple directionsatonceareverydifficultforADHDchildrentomanage.

ParentEducation

KnowledgeandunderstandingofthesymptomsofADHDareoftenhelpfulfor parents.Websites,books,parentingclasses,andfamilytherapywillhelpparents manageachildwithattentionaldifficulties. 2. Itisalsoimportantforparentstounderstandthecausesofoppositionaldefiant behavior,sincemanychildrenwithattentionalproblemsmaydemonstratesuch behavior. 3. Issuessuchasachildstemperamentanddisabilitiesneedtobeunderstood. 4. ParentsofADHDchildrenneedtobefullyeducatedintheuseoftimeout proceduresandthemethodsofemployingthesestrategiesbothathomeandin public.
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NurturingYourChild'sStrengths
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Lookforandencouragechildren'sstrengths,interests,andabilities.Helpthem tousethesestrongpointstocompensatefortheirlimitationsoranydisabilities theymayhave. Recognizewhatinterestsandengagesyourchildren."Nudge"themtopursue theseinterestsastheygetolder.Forexample,anADHDchildwholovestobe outdoorsshouldbesteeredtowardlearningaboutnature,anthropology, archaeology,landscaping,conservation,environmentalengineering,orother outdoorprofessionalfields.Startthisprocessatanearlyage,asthese youngstersarelikelytoexcelintheseareasasopposedtoinanindoor classroom. HelpyourchildrenseethestrengthsintheirADHDprofile,suchastheirabilityto focusonthingsofgreatinteresttothemortheirhighenergylevel.Helpthemto beoptimisticabouttheirfuture.Describeanumberofotherverysuccessful peoplewhohavereportedlyhadADHD,suchasMichaelJordan,Justin Timberlake,WillSmith,andMichaelPhelps. KeepyourADHDchildoutdoorsandactive.ADHDchildrenwithhyperactivity tendtobehappiestwhentheyaremovingandwhentheirbodiesareengaged. Encouragechildrentoplayselectedpositionsinselectedteamsports.ADHD HyperactiveImpulsivechildrenoftendobestinsportsthatinvolveagreatdeal ofmovementandaction.Sportssuchassoccer,basketball,hockey,andlacrosse areparticularlysuitable.Ifchildrenchoosetoplaysportssuchasbaseball,then guidethemintopositionslikepitcher,catcher,orfirstbaseman,inwhichthere arehigherlevelsofaction.ManyADHDchildrenstrugglewhenplayingamore idleposition,likeoutfielder. Findactivitiesthatallowchildrentokeeptheirhandsandtheirmindsactive. ManyADHDHyperactiveImpulsivechildrenenjoyplayingwithlegos,engagingin creativeartprojects,ortakingthingsapartandputtingthembacktogether.Find junk,oddsandends,oroldelectronicsthatthechildcanplaywithfreelyandcan laterthrowaway.Makesurethatthechildhasasafeplacetoengageinthis kindofactivitysoastoavoidmakingamess.

Homework

Encourageshort,frequentbreaksforyourchildtogetupandmove.During thesebreaks,donotletyourchildwatchtelevisionorplayvideogames.Instead, encouragehim/hertodosomethingphysical. 2. Beforestartinghis/herhomework,giveyourchildsome"runningaround"time duringwhichhe/sheisveryphysicallyactive.Ashortrestperiodwithahealthy snackandaglassofmilkorjuicewillfosterhomeworkcompletion. 3. Useatimerwhileyourchildstudies,settingitfor10to15minutes.Increasethe amountoftimeasyourchildmastersthisamount.

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4. 5.

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Usemusicduringyourchild'sstudytime.Tryitout,andseewhatworks. Usually,instrumentalmusicisbest. Searchforwaystoreduceconfrontationsaroundhomework.Seeifyoucanfind aplace,time,orsettingthatworks"mostofthetime"foryourchild(perhaps useadiarytodeterminethebesttimes).Remember,mosthomeworkisnotfun, andyoumaywanttointegrateopportunitiesforrewardingactivitiesafter homeworkiscompleted. Ifyourchildworkshardatdoinghis/herhomeworkbutdoesitveryslowly,then itmaybeworthwhiletotalktohis/herteacheraboutreducingtheworkload. Kidsneedtimetohavefun,runaround,andjustrelax. Useselfmonitoringlogsforprogressonlongtermprojectsthataredonejointly byyouandyourchild. Changeworksitesandtakecreativebreaks(forexample,movefromthekitchen tabletootherrooms).Breaksshouldbebriefandnotoverlyengaging(for example,gettinguptohaveasmallsnackratherthansittingdowntowatch television).

Medication
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Doyourresearch.Parentsarestronglyencouragedtofullyeducatethemselves aboutthevarioustypesofavailablemedications,theireffectiveness,andtheir potentialsideeffects. Consultwithapediatriciantodiscusswhetherornotmedicationisappropriate foryourchild. Talkwithfriendsorrelativeswhohaveexperiencemedicatingtheirchildrenfor attentionproblems. Considerimplementingbehavioralandschoolbasedstrategiespriortotheuse ofmedication.Researchindicatesthatthereisgreateroverallsuccesswith ADHDchildrenwhennonmedicalinterventionsarethefirstlineofapproachand thenmedicationfollows. Startyourchildonamedicationwhenyoucanobservehim/herthroughoutthe entireday.Itisstronglyrecommendedthatyoustartyourchildonamedication overaweekendorschoolvacation,whentheparentisabletoobservethe childsbehaviorthroughoutthecourseofanentiredayandevening. Learnaboutthesideeffectsofmedication.Thereareanumberofsimple strategiestominimizeconcernssuchasdisturbancesinsleeping,eating,and mood. Childrenwhomayreportsomelossofappetite,particularlyatlunchtime,can oftencompensatebyeatingaveryhealthybreakfastandhavinghealthysnacks availabletothemintheevening,whentheycanbecomeveryhungry. Childrenwhoexperiencedifficultiesinfallingasleepasasideeffectoftheir medicationmaysimplyneedaslightlylaterbedtime.Theycanbeencouragedto engageinarelaxingactivity,suchasreading,drawing,orlisteningtoquiet music,priortogoingtosleep.

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Childrenwhohaveslightreboundeffects,becomingmoodywhilethe medicationiswearingoff,maybenefitfromquiettime,anopportunitytowatch amovieortelevisionshoworengageinanothernonstressfulactivityduringthis periodoftheday.Thesereboundeffectsfrequentlyoccurinthemidtolate afternoon. 10. Manychildrenonmedicationaremoreefficientatdoingtheirhomework directlyafterschool,sincethemedicationmaystillbeassistingthemintheir focusingcapacities.Giveyourchildashortbreak,asnack,andtrytohelpthem seehowtheyaremoreefficientatgettingtheirhomeworkdonewhenthe medicationisstillbeinghelpful. 11. Ifyouchoosetotrymedication,bepatient!Don'tgiveupifthemedication doesn'tseemtoworkorsideeffectsmakemattersworse.Manychildrenwill needtotryafewdifferentmedicationsanddosagesinordertofindwhatworks best.Experiencedphysicianswillhearyourconcernsandmakeappropriate medicationchangesforyourchild.Withpropermedicationmanagement,your childwillreapthebenefitsofimprovedsocial,emotional,andbehavioral development.
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RecommendedWebsites
http://learningworksforkids.com/(Thebestwebsiteforlearninghowtouseinnovative technologiestohelpyourchildwithADHD) http://www.nimh.nih.gov/publicat/adhd.cfm(TheNationalInstituteofMentalHealth websiteoffersextensiveinformationthataddressesanumberofquestionsparentsand teachersmighthaveaboutADHD.) http://www.chadd.org/AM/Template.cfm?Section=Understanding(AlargeADHD organizationthathasmanygreatresources.) http://www.Idonline.org/ld_indepth/add_adhd/addadhd.html(Asitethatprovides basicinformationaboutADHD,itscommontreatments,legalrights,anduseful interventionideasforteachersandparents.) http://www.help4adhd.org/(TheNationalResourceCenterforADHDwebsite, establishedthroughU.S.CenterforDiseaseControl[CDC],answersFAQs,provideslinks toreliablewebsites,andprovidesopportunitiestoaskquestionsofspecialists.) http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=symptoms(MayoClinic providesagoodoveralldescriptionofADHDsymptoms.)

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http://kidshealth.org/teen/diseases_conditions/learning/adhd.html#(Awebsitefor teenswithADHDthatincludesalistofstrategiesforteenstoemployintheirownlives aswellasbooksthattheymaybeinterestedinreading.) http://www.keepkidshealthy.com/medicine_cabinet/adhd_medications.html(A websitethatprovidesreliableinformationaboutmedicationforADHD.) http://www.webmd.com/addadhd/tc/attentiondeficithyperactivitydisorderadhd medications (AnothersitefromwhichtolearnaboutmedicationforADHD.)

SelectedBooksonADHDforParents

Barkley,RussellA.TakingChargeofADHD:TheComplete,AuthoritativeGuidefor Parents.NewYork,NY:GuilfordPress,2000.Acomprehensiveguidebytheleading expertonADHD.

HonosWebb,Lara.TheGiftofADHD:HowtoTransformYourChild'sProblemsinto Strengths.Oakland,CA:NewHarbingerPublications,Inc.,2005.Suggeststhatmanyof thetraitsthatlabelkidswithADHDmaybeanexpressionofdeepergiftsandoffersnew positivetechniquesfordealingwithADHD.

Ingersoll,Barbara.DaredevilsandDaydreamers.NewYork,NY:BroadwayBooks,2003. AwellwrittenupdateofYourHyperactiveChild.Readable,informative,anddetailed. Iseman,JacquelineS.,SueJeweler,andStephanM.Silverman.SchoolSuccessforKids withADHD.Waco,TX:PrufrockPress,2009.StrategiestohelpyourADHDchildat school.

Monastra,VincentJ.ParentingChildrenwithADHD:10LessonsthatMedicineCannot Teach(APALifetools).Washington,D.C.:AmericanPsychologicalAssociation,2004. ExplainsthecausesofADHDandhownutrition,medication,andcertaintherapeutic procedurescanimproveattention,concentration,andbehavioralcontrol.Includesa planforparentsandwaystoworkwithchildren'sschools.

Parker,HarveyC.ProblemSolverGuideforStudentswithADHD.NorthBranch,MN: SpecialtyPress,2001.Ideasforstudyhabits,socialization,andwrittenlanguageskills. Ratey,JohnJ.,M.D.withEricHagerman.Spark:TheRevolutionaryNewScienceof ExerciseandtheBrain.NewYork:Little,BrownandCompany,2008.Greatbook describinghowexerciseimprovesattention,learning,andstressmanagement.

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Rief,SandraF.HowToReachandTeachChildrenwithADD/ADHD:Practical Techniques,Strategies,andInterventions.SanFrancisco,CA:JosseyBass,2005. Includesreallifecasestudies,interviews,studentinterventionplans,andstrategiesfor enhancingclassroomperformance.

SelectedBooksonADHDforChildrenandTeens

Galvin,MatthewR.OttoLearnsaboutHisMedicine:AStoryaboutMedicationfor ChildrenwithADHD.Washington,DC:MaginationPress,2001.Thisbookaboutacar helpsexplaintochildrenwhytheyshouldtaketheirmedicationtofeelbetter.Ages48.

Kraus,Jeanne.Annie'sPlan:TakingChargeofSchoolworkandHomework.Washington, DC:MaginationPress,2006.Presentsa10PointSchoolworkPlananda10Point HomeworkPlanthatcanhelpreadersmasterorganizationalandstudyskills.

Nadeau,KathleenG.andEllenB.DixonLearningtoSlowDown&PayAttention:ABook forKidsaboutADHD.Washington,DC:MaginationPress,2004.Suggestionsforand challengesencounteredinADHD.Ages611.

Petersen,Christine.DoesEveryoneHaveADHD?ATeen'sGuidetoDiagnosisand Treatment.London:FranklinWatts,2007.Aguidedesignedforteenstounderstand ADHDandhowtotreatit.Forteens.

Quinn,PatriciaO.andJudithM.Stern(Eds.).PuttingontheBrakes,SecondEdition: UnderstandingorTakingControlofYourADDorADHD.Washington,DC:Magination Press,2008.Acollectionofarticles,activities,andpuzzlesforchildrenwithADD.Ages 813.

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