a few ways to keep a hyperactive child busy and happy

They always say to focus on the positive and I must say that one positive about an extremely active child is that it gets you out and and keeps you trying new things.  I've been on a small blogging hiatus just trying to keep up the adrenaline and keep him out of trouble over a very long March spring break.  Check out what we've been up to:

1) indoor trampoline park

2) parasailing

3) indoor water park

4) recording studio

5) roller hockey

What do you do to keep your kid busy?

The First Description of ADHD - the Lancet 1904

The Story of Fidgety Philip


"Let me see if Philip can
Be a little gentleman;
Let me see if he is able
To sit still for once at the table."
Thus Papa bade Phil behave;
And Mama looked very grave.
But Fidgety Phil,
He won't sit still;
He wriggles,
And giggles,
And then, I declare,
Swings backwards and forwards,
And tilts up his chair,
Just like any rocking horse--
"Philip! I am getting cross!"
See the naughty, restless child
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, plates, knives, forks and all.
How Mama did fret and frown,
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace . . .

my food thief and self control

Our son is constantly in search of his next sugar high.  I know this sounds like a problem most of us struggle with....however, he takes it to the next level.  If we have sugar in any form in our home he will find it and devour it all in one sitting.  We have bargained with him in all shapes in forms.  We've used sugar as a behavior reward and we've also rewarded him for using self control.  No matter what we do he is constantly seeking and negotiating for his next sugar high.  When we are exhausted by the negotiations we just physically place locks on the cabinets.  Don't think this deterred him.  Kaya merely saw this as a new challenge and woke up a few hours earlier to figure out how to get past the locks and sneak the cookies.

I was reminded of our "sugar dilemma" when I heard about a report that suggested that lack of self control predicts your future health, wealth and potential criminal behavior.  I had to laugh out loud because ever since my son was little and using his houdini tricks to get to the cookies I found myself telling him "use your powers for good".  He goes through such planning and effort to get cookies that it's hard not to think about how successful he could be if he just applied his skills to a more productive task. I've always felt that one day he'll either use his "powers" to become the next ruler of the world or with his lock picking skills he'll end up in jail.  Little did I know that research would validate my argument. 

An article published in the Proceedings of the National Academy of Science in January states that "The need to delay gratification, control impulses, and modulate emotional expression is the earliest and most ubiquitous demand that societies place on their children, and success at many life tasks depends critically on children’s mastery of such self-control."  This is very similar to the results of the original Stanford marshmellow test (which is quite entertaining to watch). 

In the study they followed 1000 children from birth to adulthood and looked at certain measures of self-control including parent, teacher, and self reports of impulsive aggression, hyperactivity, lack of persistence, inattention, and impulsivity (otherwise known as ADHD!) and how these affected health, wealth and happiness. At the age of 32, children with poor self-control were struggling financially, they were less likely to save and had acquired fewer financial building blocks for the future (e.g., home ownership, investment funds, retirement plans). They reported more money-management difficulties and had accumulated more credit problems. Poor self-control in childhood was a stronger predictor of these financial difficulties despite social class origins and IQ.  Children with poor self-control were also more likely to be convicted of a criminal offense.  Adolescents with low self-control made mistakes, such as starting smoking, leaving high school, and having an unplanned baby, that could ensnare them in lifestyles with lasting ill effects. 


It sounds like the children with the lowest levels of exhibited self-control would likely meet diagnostic criteria for ADHD.  I wonder if any of the children in the study who demonstrated low levels of self control early on were treated with medications or behavioral plans?  Did this change any of their outcomes?  


For now I'm still left with the conundrum that I somehow have to help my son master self control - at the moment I'll stick to shopping for a better lock to keep him out of the cabinets and I won't be leaving any marshmellows out unsupervised for awhile. 

Jessie

To find a service dog like Jessie or help fund dogs for other children go to: www.neads.org

Jessie

By Kaya Suner

Jessie is my dog.  She is a yellow lab.  They love kids.  Some people call them Labrador retrievers.  There are all kinds of labs – yellow labs, black labs and chocolate labs.  Jessie’s nickname is Calm Canine and sometimes Mutant Mutt.  Jessie loves to swim.  Some people get mixed up with human years and dog years.  In dog years Jessie is three and in human years she is twenty one.  I have had Jessie for about ten months.  We got Jessie in March.

Labs are bred to catch fish in the ocean.   They collect the net with the fish in it and bring it to the boat.  They have webbed feet to swim and can swim very fast.  When Jessie gets out of the water she smells gross.  Well, she always smells gross.  Jessie loves to lick me but sometimes I don’t like it because her breath smells.

Jessie is an assistance dog.  An assistance dog is a dog that helps people.  You have to have a special need to have an assistance dog.  Jessie is from Virginia I don’t know where in Virginia, but we got Jessie at a place called N.E.A.D.S in Mass.  Assistance dogs are more calm than most dogs.  I think Jessie is the most calm dog.  Jessie was trained in prison.

An assistance dog will not bite, claw, bark or chew the sofa apart.  It is hard to have an assistance dog.  You have to let them play every morning and night for 45 minutes, let them go to the bathroom every morning and night, and feed them every morning and night.  Assistance dogs are trained to do a log commands like sit, stay, down, heel and fetch.  Those are only basic commands.

Since Jessie is an assistance dog she can go anywhere, like planes.  She sits right under our feet.  Jessie has to wear a special vest when she goes places with us.  On the plane she has to wear a big puffy vest.

Dan is the name of the guy who gave us Jessie.  We had to do a lot with him.  We  had to go to the mall we had to go to restaurants we had to go to stores and Jessie was there with us.  We also had to do commands with her at N.E.A.D.S before we got to take her home.

It was about a week before we took Jessie home.  It was hard work.  When we took Jessie home we were all excited but she was sniffing the whole house for about two days. Jessie really likes our house. 

When we go to hockey and Jessie comes, she is scared of the buzzer.  Jessie is scared of a lot of things.  She is scared of smoke alarms and fish. 

Jessie can be a loon sometimes.  Jessie loves to play with her friends at the park.  Jessie has played with a pig and a sheep.  Jessie loves to chase me.  I like Jessie a lot. 

Our service dog Jessie

Jessie

By Kaya Suner

Jessie is my dog.  She is a yellow lab.  They love kids.  Some people call them Labrador retrievers.  There are all kinds of labs – yellow labs, black labs and chocolate labs.  Jessie’s nickname is Calm Canine and sometimes Mutant Mutt.  Jessie loves to swim.  Some people get mixed up with human years and dog years.  In dog years Jessie is three and in human years she is twenty one.  I have had Jessie for about ten months.  We got Jessie in March.

Labs are bred to catch fish in the ocean.   They collect the net with the fish in it and bring it to the boat.  They have webbed feet to swim and can swim very fast.  When Jessie gets out of the water she smells gross.  Well, she always smells gross.  Jessie loves to lick me but sometimes I don’t like it because her breath smells.

Jessie is an assistance dog.  An assistance dog is a dog that helps people.  You have to have a special need to have an assistance dog.  Jessie is from Virginia I don’t know where in Virginia, but we got Jessie at a place called N.E.A.D.S in Mass.  Assistance dogs are more calm than most dogs.  I think Jessie is the most calm dog.  Jessie was trained in prison.

An assistance dog will not bite, claw, bark or chew the sofa apart.  It is hard to have an assistance dog.  You have to let them play every morning and night for 45 minutes, let them go to the bathroom every morning and night, and feed them every morning and night.  Assistance dogs are trained to do a log commands like sit, stay, down, heel and fetch.  Those are only basic commands.

Since Jessie is an assistance dog she can go anywhere, like planes.  She sits right under our feet.  Jessie has to wear a special vest when she goes places with us.  On the plane she has to wear a big puffy vest.

Dan is the name of the guy who gave us Jessie.  We had to do a lot with him.  We  had to go to the mall we had to go to restaurants we had to go to stores and Jessie was there with us.  We also had to do commands with her at N.E.A.D.S before we got to take her home.

It was about a week before we took Jessie home.  It was hard work.  When we took Jessie home we were all excited but she was sniffing the whole house for about two days. Jessie really likes our house. 

When we go to hockey and Jessie comes, she is scared of the buzzer.  Jessie is scared of a lot of things.  She is scared of smoke alarms and fish. 

Jessie can be a loon sometimes.  Jessie loves to play with her friends at the park.  Jessie has played with a pig and a sheep.  Jessie loves to chase me.  I like Jessie a lot. 

can we train our kids like pavlov?

Pavlov makes it seem easy.  Ring a bell and the dog drools.


In my personal experience trying to condition my son's behavior has been nothing but easy. 
We've tried paper behavior charts, different size rewards from little toys to trips to disney.  We've tried whiteboards and picture charts, and lastly this week we tried an online version of a behavior system...adhdnanny.com.  Of all the chart systems we've tried this one seemed to have the largest appeal to our son because it is in a "club penguin" type setup where he can cash in points for rewards online.   However, 2 weeks in we are already slacking...are we lazy? or does the novelty or effect wear off?  Sometimes I wonder who needs the training him or me?


So why do we keep on trying?  Most of the research about how best to manage ADHD suggests that "multimodal" treatment -  a combination of medication management and behavioral therapy is most effective (although this is controversial at this point).   Most of this data comes from the National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA).  In the initial study a combination of behavioral therapy and medication outperformed medication alone on several behavioral rating scales. However, on follow up studies the advantage of behavioral therapy is less clear -  the picture is confused by the difficult of keeping up with the behavioral therapy. Even when state of the art behavioral treatment was provided to families at NO CHARGE, almost 40% of families were unable and/or unwilling to fully take advantage of it.  In the study the behavioral treatment included parent training, child-focused treatment, and a school-based intervention. 


Parent training involved 27 group sessions and 8 individual sessions per family. The focus was on teaching parents specific behavioral strategies to deal with the challenges that children with ADHD often present. The child-focused treatment was a summer treatment program that children attended for 8 weeks, 5 days a week, during the summer. This program employed intensive behavioral interventions that were administered by counselors/aides who were supervised by the therapists conducting the parent training. The basic model was one in which children were able to earn various rewards based on their ability to follow well- defined rules and meet certain behavioral expectations. Social skills training and specialized academic instruction was also provided.


The school-based treatment had 2 components: 10 to 16 sessions of biweekly teacher consultation focused on classroom behavior management strategies, and 12 weeks of a part-time paraprofessional aide who worked directly in the classroom with the child. Throughout the school year, a Daily Report Card was used to link the child's behavior at school to consequences at home. The Daily Report Card was a 1-page teacher-completed ratings of the the child's success on specific behaviors. This was brought home daily by the child to be reviewed by parents with rewards for a successful day provided as indicated.


Whoaa!  Who on earth could implement or sustain that type of behavioral program?  Our longest stretch with a simple behavioral chart has lasted 2 weeks tops.   Some days I wonder why keep trying, we will never come close to the ideal behavioral plan outlined by the MTA study.   However, every time we start and stop we do see short term improvements  so I will continue to look for the nirvana of behavioral plans/charts/chips we can stick to.... if anyone out there has the answer please post below :)

ADHD Tweeters

Enjoy this List of ADHD tweeters!  Here is the list if the link doesn't work:

1. @CHADDING (CHADD-Children and Adults with Attention Deficit/Hyperactivity Disorder) Here is where you will find the nation's leading non-profit organization serving individuals with AD/HD and their families on Twitter.

2. @ADDitudeMag ADDitude is a magazine, website and community for families touched by Attention Deficit Disorder. You will find their editors and bloggers tweeting here.

3. @ADDclasses ADDclasses.com offers virtual support and educational resources for those whose lives are affected by ADD. You'll find them tweeting information, resources and connecting you to others in the ADD/ADHD community.

4. @TerryMatlen helping moms and women survive living with ADHD at www.momswithadhd.com, she tweets from here.

5. @livingwithadd this is Tara McGillicudy, ADD/ADHD support mentor and founder of ADDclasses.com.

6. @simpleadhdexpert find the tweets of Ben Glenn, speaker, author, artist and ADHD advocate, also a contributing blogger at ADDitudeMag.com.

7. @nickmortensen tweeting here: Nick Mortensen, comedian turned speaker and ADHD advocate extraordinaire.

8. @TotallyADD community manager for TotallyADD.com, Aerin Guy, tweets from this account providing humor and important information for the adult ADHD community.

9. @adhdmomma Penny Williams, creator, author and editor of A Mom's View of ADHD tweets from this account, sharing real life as a mom of a child with ADHD.

10. @CoachforADHD Laura Rolands tweets and shares her knowledge as a coach for students, adults and families dealing with ADD/ADHD.

+1 For good measure: @petequily another adult ADHD coach and blogger, who knows what it's like himself. Thought provoking and expressive, you may find him tweeting politics now and then.

Best episode of parenthood yet!

I just watched  the February 1st episode of Parenthood on NBC and it was right on!  I would love to know who is writing for the show because it's depiction of parenting a child with a "syndrome" disorder feels very real to me.  On this episode Max's grandfather decides he is going to take him on an overnight camping trip because it's a Braverman tradition.  Max's has Asperger's syndrome so his mom puts together a manual on how to handle Max while they are away.  His grandfather of course thinks she is capital C crazy and over the top neurotic.  Well those of us who have been there know how this goes....by the end of the camping trip it becomes clear why there is a manual (see my previous post "I'm a little burnt out).  Watch the episode for free online, trust me you won't feel alone anymore.  If you click this link you can find autism experts discussing the episodes.

Do moms get a snow day?

Do you remember the pure unadulterated joy of seeing (or did we hear it on the radio back then?) your schools name go up for cancellation on a snow day?  That serene "I have no responsibilities today" feeling that would come over you.  I can't remember the last time I felt that way and now my son's snow days are a reminder of how infrequently we get to feel that way.  Imagine a day where you could eliminate all of your responsibilities and worries and just play.   What would that feel like?

Boys will be boys

I can't even begin to count the number of times I've been told "boys will be boys" when I describe some of my kids behaviors.  Although my son's academic struggles are clearly more complicated, I was fascinated by this TED talk, Gaming to re-engage boys in learning, which explains how elementary education is doing a disservice to boys as a whole.

Getting used to being a joiner...

I have never thought of myself as much of a "joiner".  Perhaps I have some of my son's social skills struggles because from an early age I have found the whole "group" setting difficult to manage.  I always feel like I don't quite fit in, or I worry that I'm speaking out of turn or speaking too much or that I won't get that sense of "belonging" that everyone else feels.   I visualize myself as that character on the reality shows that everyone ostracizes or who just doesn't mesh with the group.   In practice this probably isn't the case but that feeling scares me so much it keeps me from joining.  The rebellious, underdog part of me probably doesn't want to feel like I'm drinking the same juice as everyone else and probably derives some pleasure from feeling "a little different".  

Ultimately it's not always healthy to be on the outside.  As a matter of fact it can be quite lonely.  Recently I've been reminded of how important it is to have a setting or group where you can share your experiences can be very rewarding.  I am currently participating in CHADDs online Parent to Parent Classes -  we are on week 2.   After the first webinar (an online lecture forum where everyone can participate) there was clearly so much in common between participants and the need to share resources, experiences and get things "off their chest"  was palpable.   The distance a webinar creates (vs. a face to face class) perhaps makes it easier to share more freely.  Although I have not participated in my local CHADD meetings, this joining at a distance feels right for me.

For parents struggling with their children who have ADHD or a comorbid disorder I highly recommend the CHADD parent to parent classes.  So far it has been an excellent experience and I get the sense that the 20 parents I am sharing this experience with will be in touch for a long time!  Two thumbs up for CHADD's parent to parent classes.

Are labels useful or harmful?

Okay.  Please watch the following with a grain of salt.  I did think long and hard before reposting this video because I do not support the group that made it or their particular message, however, that being said I do like this video clip because it does (unintentionally I'm sure) advocate for a strength based view of these disorders.   By that I mean it does a good job of delivering the message that many of these psychiatric "labels" also have their positives.  I do not condone the anti-psychiatry, anti-medication message.  Many of these labels also help to define a "problem" and then better address it - either through medications or other means.  I mostly reposted it because I do love the idea of focusing on strengths, rather than the labels.

http://www.youtube.com/watch?v=Wv49RFo1ckQ&feature=player_embedded

Making it fun is worth it!

Over the last hour I've been reviewing several blog posts about how ADHD children are handled at school.  Mostly the specific issue about delivering negative consequences for what most would consider *expected* behaviors such as organizational challenges (forgetting to bring home homework) and then specifically punishing by taking away recess which is so necessary for their brains to function.  Then I logged onto facebook and saw a great video clip that seems to be slightly viral that shows that you can change behavior by making things FUN!  what an awesome thought.  By making a staircase into a piano the winners of this competition were able to get 66% of people to take the stairs rather than the escalator.   I wish this whole idea could be incorporated into education for kids with ADHD, I have no doubt if school were FUN it would be much more likely to motivate than negative consequences....

check out the fun theory at: http://www.thefuntheory.com/

here is an article about taking away recess for kids with ADHD
http://add.about.com/od/schoolissues/f/The-Importance-Of-Recess-For-Children-With-Adhd.htm

Medication power struggles

Some days it feels like every relationship is a power struggle.  If I'm not engaged in a struggle for control/power with my child then it's his teacher or school.  Every year without fail we seem to engage in a power struggle with our son's teachers about his medications.  Of all people I understand that my child is VERY hyperactive and he is "easier to handle" while on stimulants.  However, I still like (actually love) my child without his medications and prefer his temperament and personality off his stimulant medication.  Sometimes I do wonder if the only goal of medicating is so he can be "handled" in a school setting.  Like any busy family there is the rare occasion he goes off to school and we forget to give him his medication.  As of this writing, this has only happened twice this year and yesterday was the second time.  Clearly I know he didn't take it because I am the one who gets him off to school everyday.  Without fail, at 8:30 am there was a message from his school asking that I bring his medication to school (20 minutes away mind you) because they couldn't "handle" him.  I am at work seeing patients at this point and it is clearly not feasible for this to happen.  When I return the call to say this the teacher is clearly ticked off, and when my son gets home in the afternoon he reports to me that she said to him directly, "I can't handle you today".

As a physician I am very aware of the positive aspects of medications, but at times I feel like the question of whether to medicate or not medicate for ADHD is somewhat trivialized and is much more difficult than it seems.   When our son first took medications in 1st grade his psychiatrist used the analogy of a diabetic who can't get by without insulin.  I personally have never bought into this analogy....my son is not going to die of ADHD where a diabetic will most certainly become quite sick without insulin.   Also, the side effects of stimulant medication can often worsen the behavioral problems when the child is coming off the medication at the end of the day and in our experience clearly make him irritable.

Is it really that simple?  Does a child with ADHD need medication the way a diabetic needs insulin?  Over the years we've come to acknowledge that until our son develops maturity and some executive function skills to regulate his own behavior and it's impact on himself in others in group settings that the medication serves as a substitute.  I am still hopeful that with time he will develop a skillset that will allow him to function without medication.  Wishful thinking?  maybe.

Managing new settings -" I'm a little burnt out"

"I am a little burnt out"... was the last thing my son's snowboard instructor said to me after we spent the last 3 days skiing/snowboarding.   My husband and I are lucky enough to be involved in the medical staffing for the Dew Tour (an extreme sports competition) and had the opportunity to spend several days in Killington, VT with our son.  This is an amazing opportunity for our son but every year I hesitate about making the trip with him.  We need to negotiate work and play which is always a difficult balance with Kaya. As always he initially resisted taking lessons because he has had enough feedback at this point to know that he doesn't do well in group settings.  If it were up to him we would do all day private lessons, however, this is pretty cost prohibitive. 

So after the usual negotiations and reassurances that he would likely be on of the only kids taking group lessons in the middle of the week on a non-school vacation week we dropped him off at ski school.  I am sure those of you with a child with learning differences/ADHD/autism can relate to the difficulty of explaining to yet another person who is "new" to your child what to expect.  On the outside and in his best moments he seems like every other 9 year old boy so when you launch into your 30 minute preamble about what to expect and that you'll have your cell phone on you should there be any issues, the "new" person always gives you that look like you are the most overbearing/neurotic parent on earth.  I can't tell you how many times I've heard, "don't worry, I've had plenty of kids like him".   Every time, I wonder "should I have even brought it up?, I'm sure it will be fine", but without fail I come to pick him up and they say "he seemed worried" or "do you know he talks ALOT" and then I remember, oh yeah, I DO know my child.  I have to resist saying, "remember those 30 minutes when you were thinking - wow this mom is overbearing - well that was me telling you!" 

Although, at the end or our really pretty good ski/snowboard trip I have to say "kudos" to both Kaya and his instructor for making it 3 full days together.  I feel a little guilty that it makes me feel a little better to know that Kaya exhausted someone new after only 3 days, because I spend a lot of my time exhausted and I find it hard to explain and I feel like I must be missing something.  It just reminds me that it is tiring to care for somehow who is "always on the go"....
If you struggle with "explaining" your child every time you put him in a new setting with a new teacher/supervisor, I have come across the idea of making a "biography" page for you child that covers the basics like likes/dislikes, things you need to know, etc....  

Check out the parentingspecialneeds.org.....http://parentingspecialneeds.org/attachments/19_about_me_forms.pdf

is exercise more important than school?

I am not proud of myself.  Today I chose exercise (for myself) over potentially getting my child to school on time.  In my defense I did abbreviate my exercise routine and there does happen to be some version of an ice storm/rain/snow event going on during the school commute this morning in New England. Also in my defense, the child refused to take the bus this morning because he couldn't find his snowpants and that's how I ended up being school chauffeur.  Needless to say my kid was rather pissed at me.  Like many kids with anxiety and ADHD he is ironically obsessive about being on time despite his inability to be organized enough to be on time.  I myself do not have a diagnosis of ADHD but timeliness has never been my forte either and I 've come to accept this as a constant struggle.   As I obsess over whether my choice was selfish or not I got to thinking about how desperately I need that morning exercise routine to structure and feel in control of my day.    This got me to thinking about the link between physical activity and executive function.  Intuitively I have no doubt there is a strong connection.  When my son was initially diagnosed with ADHD he was simultaneously referred to occupational therapy where he was diagnosed with sensory processing disorder.  One of the first prescriptions for his "sensory diet" was daily exercise, preferably before school.  This prompted me to do a quick search of the data regarding exercise in "normal" subjects and exercise in kids with ADHD to see if it improves executive function.  Executive function is defined as the activities that organize the brain:  planning, paying attention and organizing goal directed tasks.   From a brief perusal of the scientific literature it seems the jury is out....there are several studies suggesting that bouts of exercise do improve the ability to pay attention and organize tasks, however, it is not clear if these effects are sustained over time, how much and how often to exercise and whether this is only specific to certain types of people.   That being said I have successfully written this blog post after my bout of exercise and I certainly see a difference in my child after an hour of vigorous exercise, particulary in his mood. So for this family exercise will continue to take a priority.

to read more on exercise and the brain:
http://www.usatoday.com/news/health/2007-10-29-exercise-brains_N.htm

description of executive function on CHADD website:
http://www.help4adhd.org/faq.cfm?fid=40&varLang=en

Use your powers for good

As I head downstairs at 7am I can hear my son rustling around in the kitchen, however, from the noise coming from the kitchen I'm pretty sure he's not walking.  As I round the bend at the bottom of the stairs I see him on rollerblades, shirtless, spraying febreze all over the kitchen. When I try to piece together the thought process that ultimately led to this activity I realize that I will never figure it out because his mind works at a different speed and occasionally in a different reality than mine.  Every morning I have to remind him that it's going to take a few minutes for me to catch up to where he is in the half hour he's been up before me.  I know there are many parents out there that can relate to this scene.  My son is 9 years old and was diagnosed with the alphabet soup of  ADHD, generalized anxiety and sensory processing disorder several years ago, however, to us he has always been just who he is...and we love him that way.   Has he faced numerous challenges in the last 9 years....certainly!  Do we struggle with him as parents because he is a "little more" than most kids....certainly!  Is our mission to navigate life beside him trying to bring out his best qualities and strengthen or work around the areas where he struggles...definitely!  This blog will highlight some of the areas where we've struggled and succeeded as well as some of our failures and some of the resources and tools we've discovered along the way that have helped us all be the best that we can be....our own superme!  I know many people out there struggle with similar difficulties trying to showcase their strengths and overcome their struggles with some pretty basic activities of daily living...eating, sleeping, organizing, making and keeping friends and I hope we can share strategies and tools that will help all of us be our best and find our superpowers!