Kids with ADHD are often engaging in misbehaviors, such as fidgeting, hyperactivity, and talking, more out of impulse than out of deliberate action. Impulsivity is a key element of ADHD. For instance, they may not realize they are swinging their feet and kicking the chair next to them until it is pointed out to them, usually in the form of a reprimand. At which point, they often get upset and mad because they didn't want to get in trouble, but they were not aware of their impulses.
Kids with ADHD have a natural tendency to engage in behavior that is often disruptive, and they tend to spend a large part of their day at school, and even at home, being on the receiving end of a significant amount of correcting and scolding. By the time they enter my therapy room, they are often already referring to themselves as "the bad kid." The one who's name is always getting called in class, the kid who always has to stay inside for recess, and the one who never gets to participate in special activities. This can certainly do a number on one's self-esteem, especially since people with ADHD tend to possess a 'rejection hypersensitivity,' meaning they can be more sensitive to rejection or judgement from others than people without ADHD.
A tell-tale sign for me when I'm assessing a child for ADHD is their reaction to getting into trouble. A child with a behavioral disorder, like oppositional defiant disorder, usually expresses anger after they get in trouble. They are either angry at their classmate for telling on them, or angry with their teacher because she punished them, or angry at a friend who "started it." They tend to blame others' for their own actions that got them into trouble.
On the flip side, kids with ADHD often get angry as well, but it's not with other people... it's with THEMSELVES. They're mad at themselves for having "messed-up again." They DID NOT want to get in trouble...in fact, they were trying their hardest to do well, and their impulse or lack of focus got in the way again. Knowing this, my goal is to find ways to set them up for success and create structure within their daily routines without further harming their self-esteem, which is already on rocky ground.
As a therapist who works with children with ADHD and their families on a daily basis, there are a few practical tips that I, myself, can't go without, and that I coach parents through utilizing in their daily lives with their high energy kiddos, and now I present them to you.
6 ESSENTIAL TIPS FOR YOUNG CHILDREN WITH ADHD (THAT WON'T FURTHER DAMAGE THEIR SELF-ESTEEM.)
#1. Give additional warnings before transitions are about to occur.
I'll go ahead and repeat this one again: GIVE ADDITIONAL WARNINGS BEFORE THINGS ARE GOING TO CHANGE.
In a way, be a GPS for your child's routine. If you were driving in a new place, and your GPS didn't tell you where to turn until you were already upon the intersection and in the wrong lane, you would freak out, right? Your GPS is helpful because it tells you what'S coming up 2 miles before, and then 1 mile before, and then 500 feet before you have to take action. Some even tell what turning lane to use so that you'll be set up for successful navigating after you've gotten through the intersection. Think about doing this with your kids.
Ex. "in five minutes it will be time to stop playing and clean-up," and then "in two minutes it will be time to stop playing and clean-up", and then again at 1 minute, and then at 30 seconds.
Ex. You might want to throw in an, "in case you wanted to find a good stopping point." (hint hint)
Children with ADHD have a particularly challenging time organizing their thoughts and planning ahead. When they suddenly have to change pace, they freak-out like someone in the wrong turning lane. Giving a heads-up helps your child to mentally organize his tasks before the transition occurs and allows him to reach a stopping point in the current activity. Try to keep things from changing all-of-a-sudden if you can. As they get older, this will get easier, you won't need to give as many warnings, and they will be able to learn how to manage transitions independently
#2. Break down instructions and expectations.
Break down instructions and directions into small action steps and give the instructions one at a time.
Ex. Rather than "clean-up your room," say "First, put the toys back into their baskets" then once that is complete say, "now place the baskets onto the shelf."
Children with ADHD have difficulty remembering or keeping track of more than one thing at a time. "Clean-up your room" is easy to understand if you are a teenager or an adult, but can be harder for a young child to understand, especially if attention and concentration are more challenging for your child. If you think about it, knowing what "clean-up your room" means requires being able to independently know all of the steps that go into that, which is a lot.
**Note: breaking down instructions into smaller pieces is always something that should be done with very young toddlers and pre-school children, whether they have ADHD or not.
#3. Say what you WANT them to do...NOT what you want them to stop doing.
When a child's behavior becomes frustrating for adults, it's easy for us to fall into yelling "Stop" and "Don't do that." This is NOT an argument for the philosophy of children should never be told "no." Limit-setting and structure is important, especially with kids who have ADHD. While all children protest against limits and structure, routine helps them to stay organized and know what's coming next. What I'm suggesting is HOW those limits and rules should be stated.
Tell them what you WANT them to do. If you do have to say "stop (fill in the blank______)," always immediately follow-up with what they should, or could do instead, that is a positive choice.
Ex. rather than "don't run" say, "walk."
Ex. Rather than, "don't touch your friends," say "keep your hands in your lap."
Ex. (Child throwing ball inside and it's about to knock something over.) You might say, "Stop throwing the ball inside".....then add, "If you want to play with the ball, you may toss it outside."
When we tell someone what we don't want them to do, we leave it up to them to figure out for themselves what it is we do want them to do. They are having to take what we've said, and flip it in their minds to determine what needs to be done. If I'm told, "don't run" I haven't actually been told what I'm supposed to do, only what not to do. This is easy for older kids, teens and adults to figure out, but very difficult for young kids, especially those with ADHD." By telling them what you want them to do, you are taking the guess-work out of figuring out what action steps they should take.
#4. Catch them Doing the RIGHT Thing
This. Is. HUGE.
And not just for kids with ADHD, but really ANY Child....better yet, ANYbody.
As humans, it's in our nature to focus on what's going wrong. Focusing on what might go wrong, or endanger us, or threaten us, is what has allowed us to survive and evolve over many millennia. As one of my professor's in grad school once said,
“It was more important to avoid the lion than to find the blueberry...”
While this is our nature, it's essential to be mindful of our natural inclination to pounce on every last thing going wrong, while simultaneously forgetting to notice all of the things that were going right. When you see, or "catch" your child doing the right thing, and they are doing what you want them to do, even if it's just a little thing, give them a specific, process praise for that choice.
Meaning, a verbal praise that includes what the child did that earned them the praise and that is about an action they took. You want to make the praise specific so that your child connects their positive decision, or action, with why they are getting the praise.
Ex. when you catch your child walking calmly or staying in his seat, say "I like the way you are keeping your body calm, even though it's hard."
Ex. "Good job keeping your feet in criss-cross apple sauce"
Ex. Rather than, "you're such a good boy," say "You're doing a great job of following the rules today."
Positive reinforcement is an amazing tool with all children, but especially children with ADHD, because it's like I've said: they want to do well; it's that their impulses get in the way sometimes. Getting that bit of praise gives them an incentive to overcome the impulses, because who doesn't like to feel like they are doing well. It also points out to them, "hey, look what I'm doing, I can do this." When working with children in my practice, just one simple, specific, process praise "catching them doing the right thing" is usually sufficient to keep them doing the positive behavior throughout the remainder of the session. It's THAT powerful.
Click to read more about giving effective praises.
#5. Reward Positive Decisions and Behavior.
You would be utterly amazed what a child is willing to do for a single sticker. That's right, a tiny piece of paper with a little adhesive on the back. Yes, from time-to-time there might need to be natural consequences given for poor choices...but there should also be incentives available for good choices!
I know...I've heard the argument against reward-systems: "they shouldn't need a reward to do what they are already supposed to be doing." But here's the thing... all humans, no matter how old, do what works to get a need met or earn an incentive. Do we, as adults, always just do what we are supposed to do for that reason alone, or do we respond to rewards as well?
For instance, what is the incentive to make positive financial choices and save money? Maybe a vacation, a down-payment on a house, or a new car? What is the incentive to study? Maybe make an A or make the honor roll? What's the incentive to get-up everyday and go to work? The paycheck you're given every two weeks. Ask yourself, if there was nothing positive to be gained from these sometime unpleasant tasks, would you do them as readily as you do now?
Now I think when some hear the word reward, they imagine themselves at Toys-R-Us everyday buying a material gift. That's not what I'm talking about, and yes, that would be excessive. What I'm talking about are very basic things and even better, experiences, that can serve as rewards.
Ex. Establish a chart that allows your child to earn a sticker for each time you "catch him doing the right thing" without having to be told.
Ex. Allow your child to choose what's for dinner if they get through the whole school day with good behavior marks.
Ex. 10 minutes of extra game/screen time
Ex. Maybe for a whole week of good behavior, your child gets to pick a movie or an activity that you all do as a family.
And don't forget, those praises I mentioned in #4 are rewards in and of themselves.
This can work for all kids, but the key for children with ADHD is to make the rewards frequent at first. Some parents start with wanting their child to have good school behavior for a whole week before being given a reward. You may be able to eventually get there, but it's baby steps at first. You may have to start with a small reward each day with a larger reward for a whole week. Heck, for some kids, you have to start by the hour, and work your way up from there.
Some kids can hold onto a goal for a whole week, but kids with ADHD have a significantly hard-time doing this because they have difficulty remembering things that are happening far off in the future. Once kids are older, they can easily do this, but young kids have not developed a good sense of time yet, so a week might feel more like a month. This helps children with ADHD stay mentally organized and motivated on the task of learning and following the rules and helps to begin creating good habits. As these behaviors become more automatic in the child, the reinforcers can gradually be decreased to a lower frequency, happening less often as the child is able to better manage independently.
#6. Encourage High Energy Activity
Encourage burning off excess energy at appropriate times. Encourage regular use of sporting activities, such as soccer or basketball that require high levels of continuous energy exertion. Encourage running, jumping, and high-energy physical activity at recess, P.E., or gym time, while, of course, providing adequate hydration. And also, of course, as long as there are no medical reasons why your child might need to refrain from such activity.
Kids who have the hyperactivity component of ADHD literally have more kinesthetic and physical energy than the average person. If a proper channel for that energy is not provided, it will come out in the form of hyperactive behavior, fidgeting, inappropriate physical activity at inappropriate times, like circle time, or lesson-time, or meal-times. Children with ADHD being a little fatigued can actually help them to focus because the excess energy has been expended. When one of my patients with ADHD comes to a session after having done something very physical during the day or when they are a little tired, they tend to have less difficulty with behavior, require less redirection and reminders, and are able to converse and engage in therapy more comprehensibly. For most kids, being fatigued often leads to crankiness, but not for kids with ADHD, it brings their energy level down to the normal level of their peers.
Hope this was helpful and stay-tuned for future posts on managing ADHD in kids and teenagers!! If you have specific concerns or need to troubleshoot you child's ADHD, definitely seek out the advice of a mental health professional who can customize a plan for you and your child!!
