What is ADHD

• ADHD is a diagnosed condition that affects the chemicals in the brain.
  
• You can't see it, we often don't understand it and it can be very confusing.
  
• There are many theories about when, why or how people get it.
  
• We do know that it is genetic and that it really does exist.
  
• It is not caused by 'bad' parenting, teaching or handling and can be improved, managed and helped with training.

ADHD Support Group Harrow
Phone 020 8426 1719

OUR MISSION STATEMENT is to relieve families and sufferers of Attention Deficit Hyperactivity Disorder. To enable us to do this we will work towards our group being welcoming, accessible and inclusive to all parents and carers. We will take active steps to encourage the participation of all sections of the community. The Support Group was set up in 1996 by a group of parents through the suggestion of Northwick Park Hospital. We aim to support the children and their parents or carers.

The support group is run by volunteers / parents and carers and relatives of children with ADHD. A project worker is employed to develop the group and support parents. We hold regular evening support meetings where parents / carers share experiences and have an opportunity to listen to guest speakers from the medical or educational profession. Topics also include alternative therapies and updated information on the latest research and treatments available.

Each Wednesday and Friday during term time, we run coffee mornings between 10.30am - 12pm with creche facilities, offering information and support to parents. A lending library is also available. Social events are held throughout the year and are great fun for everyone.

A 12 week 'Parenting your Child with ADHD' course is run termly, which looks at ways of building self esteem, effective communication, setting limits and dealing with feelings (theirs and ours) as well as ways of looking after ourselves. We are able to provide qualified babysitters to enable both parents / carers or single parents to attend. Six week 'Anger Management' courses also run throughout the year.

Funding has recently been granted to offer respite to parents / carers to provide care workers to look after children at the holiday playschemes within the borough of Harrow. Families will be assessed prior to this facility being offered.

ARE YOU AN ADULT STRUGGLING WITH ADHD OR SUSPECTED ADHD?

As a support group in Harrow, we are deeply concerned with what happens to our children when they are no longer under the care of CAMHS. Two of our members in particular feel passionate about the fact that ADHD does continue into adulthood, and therefore what help is around when that happens.

With this in mind, an informal group is now meeting at the Haven, 35 Pinner Green on the first Monday of each month from 8 - 10 pm. This group hopes to explore possibilities and to look at ways of helping each other. If you would like to know more, just turn up or contact Emma or Minoo on 020 8426 1719 or by email adultadhdharrow@yahoo.co.uk.

How does ADHD affect the sufferer?

How does it affect you?

Medication and alternatives

Interventions and strategies

Organisational skills

Impulsivity

Self esteem

Social and emotional

Tips for schools and teachers

Tips for relationships with parents

What of the future?


How Does ADHD Affect The Sufferer?

INSATIABLE
The world is not enough, no matter how much you give, they want more.
They can go on and on. Intrudes, interrogates, won't stop until they know all the details.

HYPERACTIVE
Restless, fidgety, always moving about.
Noisy and talkative.
Unable to settle to most activities.

ATTENTION DIFFICULTIES
Finds it hard to pay attention.
Forgets things and is disorganised
Has difficulty settling to tasks and getting started.
Poor short term memory.
Distant, dreamy.
Responds to one to one attention.

IMPULSIVENESS
Interrupts conversations.
Has difficulty taking turn.
Blurts out answers.
Acts without thinking.
'Explodes' often and seemingly without reason.

SOCIAL DIFFICULTIES
Acts 'silly' in front of others.
Reads others actions incorrectly, bossy.
Doesn't get invited to play or to parties, lack of friends.

HOW THEY FEEL
The brain is receiving all different messages, a bit like a television set when you continually point the remote control at it. It's difficult for them to tune into any one thing, they pick up a bit of everything but not enough to remember, recall or use the information efficiently. Someone had described this as "when I take my tablets I only hear one voice, if I don't take then I can hear twenty. "When they have 'tuned into something', maintaining that concentration is hard work so they shut out whatever else is going on around them. Adults are always telling them off, their peers reject them, they know they are not the same, as good as, as able or like the others. THEY FEEL REJECTED, UNLOVED, USELESS, STUPID, MISUNDERSTOOD, MISERABLE AND CONFUSED. These and many other feelings about themselves often lead to: LOW SELF ESTEEM.

SOME ASSOCIATED DIFFICULTIES
Dyslexia, dyspraxia, specific learning difficulties, emotional behaviour difficulties, poor presentation skills - very good at certain tasks, interests.

SOME MECHANISMS THEY MAY DEVELOP TO HELP THEM COPE
Subdued/elective mute ("what's the point")
Oppositional/argumentative (need to win at/achieve something)
Apparently unfeeling/uncaring (a bold exterior to cover the inner sensitive part)
A bully (meeting a need to be superior at something)
Troublesome ("I usually get told off for it anyway so I may as well have the fun of doing it")
Class clown (acceptance by peers, encouraged by peers and it beats letting on that "I don't understand what's going on")

ADHD WITHOUT THE HYPERACTIVITY
This is sometimes referred to as ADD Attention Deficit Disorder. Although ADHD is more common in boys than girls, probably because they are more disruptive and hyperactive, girl's symptoms often go unnoticed. Children with ADD appear to live in their own world.They don't have the apparent loudness, confidence or impulsiveness.They may appear overly sensitive, serious or sad. They appear sullen or sulky, day dream, cry often or easily. They isolate themselves, it's easier than trying to fit in. They can be compliant, submissive, shy, fearful and also stubborn. They may be overly anxious to please or overly considerate of another's feelings.

How does it affect you?

EXASPERATING, CHALLENGING. SELF-DOUBTFUL, EXHAUSTING, ANGRY, INADEQUATE, CONFUSING!!!!!

LOOKING AFTER YOURSELVES!!

1. Appreciate what you DO do for your CHILDREN.
2.Think about what you WANT and SAY so.
3. Ask for SUPPORT and HELP and LISTENING time.
4. Speak from "I" clearly and briefly.
5. Say how YOU FEEL - give information to the other person.
6. Remember to ask yourself WHOSE problem is it.
7. Remember to say "NO" softly and firmly.
8. Do a DEAL.
9. Negotiate, particularly with the adults in your life. Enlist their help, and understanding of what you are doing. Share your strategies with other members of family and friends to encourage consistency of approach.
10. Take TIME out for yourself.
11. Do MORE of the things you like (both in and out of the home).
12. SMALL CHANGES can make a BIG difference

.
Medication and alternatives

The consultant will have taken considerable care before diagnosing a child with ADHD. The normal medication prescribed will be Methylphenidate (Ritalin, Equasym). This is a psycho stimulant (amphetamine derivative), it is fast acting (30 mins approx), and has a short duration (3-4 hours). It is very efficient on a short term level, reducing spontaneity and increasing perseverance.

Some possible side effects:
Decreased appetite, Insomnia, Tics, Sadness, Lethargy, Headaches,
High blood pressure, Growth restriction, Irritability, Behaviour rebound. Methylphenidate is not a cure for ADHD, it should not be used in isolation (many other strategies and measures are required to enhance the sufferer's life and prospects) and should not be school's or parent's answer "to all our problems". There has been research into alternative therapies including brushing techniques, osteocraneopathy, EEG neuro feedback and various forms of psychotherapy. Dietary supplements of omega 3 fatty acids and zinc are available and some families have consulted with homeopaths and dieticians. Exclusion diets have been recommended to some and many children have an adverse reaction to certain E numbers and food additives. Some families are trying yoga as a relaxation therapy and noticing significant changes. There appears to be liitle evidence that any of these alternative therapies are effective but for some one or two of the treatments may have some effect.

Interventions and strategies

• Offer small, visible, immediate rewards. Targets must be attainable. Reward effort, these children wont always succeed and may have tried hard. Mild punishments that are focused on and specific to the unacceptable behaviour. Give brief instructions, one at a time, remain calm and quiet. Avoid exasperation when repeating instructions or changing the wording of the instruction. Use a time out / warning card system (1,2,3 Magic has proved a very successful system for our group members). Be clear and concise about rules and expectations. Offer loads of praise, look for the good parts and ignore much of the trivial unacceptable bits. Use low level controlling language.
• Use 'post it' notes around the house to remind them of basic rules e.g. No swearing, No hitting, No slamming doors etc.

Organisational skills

• From an early age use pictures to remind children of the order in which daily tasks are carried out (getting dressed may be a picture of underwear first, followed by trousers / skirt then jumper, washing may be a picture of face, then hands then toothbrush etc). Use pictures to show timetables e.g. change out of school uniform, do homework, have tea then television. As children become able to read, the pictures can be replaced with lists e.g. on the bedroom door - 'have you made your bed?', 'have you put your dirty washing away?' - for packing school bag, leaving and locking the house etc.
• Encourage children to take responsibility from an early age, they will need longer to register routines in their memory.

"When my son went to High School I would stay upstairs with my daughter until he had left the house, it saved arguments in the mornings. As he left, I would call down the stairs 'have you got your keys, money and bag?' He always accused me of nagging! One morning, I had to leave home early so he had to get himself out of the door. On returning home that evening I asked him how it had gone. He said 'I was just about to close the door when I remembered "keys", "money", "bag". On realising I had all of these things I shut the door and went to school' My 'nagging' had paid off! We don't use the word nag in our house, we call it training. My children are aware that they find it more difficult than others to learn daily routines and instructions and accept that by patiently breaking down tasks and monitoring progress they do eventually become second nature. Sometimes it all feels like a constant battle and then I look back and remember how challenging some behaviours and tasks were and realise that these things aren't a problem anymore. New challenges have often replaced them and we can work on those in similar ways.

Impulsivity

Many parents have their children tested for hearing difficulties as they say 'he just doesn't seem to hear us'. They feel that the child doesn't learn from experience because he can't pause long enough to reflect before he acts.

• Give immediate rewards when you notice the child waiting, even if only a few seconds. Reinforce others who do show patience. Play games where it is important to wait before speaking. Use 'touch' as a method of acknowledging that you know your child has something to say and must wait e.g.interruptions during phone calls, place a hand on their shoulder or give them a cuddle. Pre-empt angry or dangerous outbursts and be there to intervene. For a number of years certain games were banned in our house because they always led to arguments. Wrestling on the television is still a no no! My children never know when to stop so play fighting and teasing are not allowed. Anger management and training on lengthening response times are very useful. Put a laminated card in their pocket, stuck to the desk, on the fridge. Use egg and kitchen timers to encourage short periods of stillness followed by the opportunity to move. Remove the children from situations, they often can't cope with what's going on around them. Encourage acceptable sitting positions i.e. feet flat on the floor, no rocking of chair, hands above table. Allow them to have a 'fiddle thing', something they are permitted to fiddle with, a stress ball in their pocket. Ask them, in a non-confrontational manner, to reflect on what they are doing and how it may affect other people.
• Praise them when they have remained calm, it may be when playing a computer game and they still remained calm, ask them to reflect on how they felt and try to emulate this feeling for other activities.

Self esteem

THE HIDDEN COSTS OF CRITICISM

• Being desperate to please someone. Crying out for approval.Unsure of self worth.Feeling hungry for praise. Poor self image.Lack of confidence.
• Learned helplessness.

REPLACE 3 C'S WITH 3 A'S

Confrontation - Acceptance
Criticism - Anticipation
Control - Approval

• Children battle with their peers to be better, right. By saying 'you could do better' or 'you did better last time' we create internal competition. Praise even the smallest things. 'Well done you didn't interrupt', 'Thank you for speaking quietly', 'I like it when you play nicely'. Remember to praise instantly, ADHD kids forget quickly. Never say nothing (on the assumption that they know you are pleased). Be specific, describe the behaviour ' well done for saying thank you', 'good boy for remembering your shoes'. Set up opportunities for your child to hear you praise them, tell a friend or relative, within their hearing, how happy you are with them, be specific. PRAISE OFTEN! You can never praise too much. Use immediate rewards - future or saved rewards are rarely achieved as they stumble along the way and this causes disappointment and despair often expressed as anger and then we take the earned reward away.
• Be spontaneous JUST DO IT!

Yes, we are praising them for what they should be doing but aren't. They're not doing it and praising them stands a good chance of making it happen.Other children may feel left out - if they are old enough explain you are trying to make things better for everyone, ask them to offer their own praise, praising them will show the ADHD child a good example.

PRIORITISE

Distinguish what are: Urgent and important!
Distinguish what are: Important but not urgent!
Distinguish what are: Not important and not urgent.

We can only work on specific behaviour tasks at one time, choose 3 and be consistent and firm about those. They will improve and then you can work on another one. ADHD kids live for the here and now: They will not reflect on all the things you have done for them in the past, they will respond to how you are right now. Experiment with different ideas / methods and remember to be consistent and share your strategies with others who deal with your child. Persevere - It wont happen over night. Remember, punishment leads to resentment and hostility often expressed as anger. Rewards are not bribes, they are deserved and legitimate positive consequences (bribery refers to promoting dishonesty or other anti-social behaviour).

Social and emotional

• Give positive feedback - Avoid extensive criticism - Create opportunities for directed play Anger management -Individual counselling - Relaxation techniques - Peer counselling, Circle of friends - Buddy system

• Encourage conversation about incidents, how other people may be feeling, how that makes you feel.

AT THE END OF THE DAY TRY THIS FEEDBACK MODEL

What did I do? What did I like about it? What would I have liked to be different? This model is very positive and non critical and can be adapted to use for the child's behaviour and the way in which you describe events.
e.g. I asked you to go to bed, well done, you looked at me so I know you heard and it would be really nice if you went straight away.

POSITIVE PRAISE BEDTIME BOOK Take a notebook - at bedtime each night find 3 things that you have a positive feeling about and tell your child how you feel and write them into the book e.g. I liked the way you folded your school uniform today, I felt really proud when your teacher showed me your work etc. Even at the end of a very difficult day you can find something positive no matter how small. Extend the positive praise to the rest of the family, encourage the child to find positives about themselves and you

.
Tips for schools and teachers

We do know that ADHD is genetic. Given this, 50% of the parents you speak to may have ADHD. They may have already experienced some learning difficulties, social exclusion or self esteem issues. Many parents tell us that they feel 'the whole playground looks at them as a teacher approaches, thinking what's my child done now?' They feel judged and embarrassed. Many strategies already mentioned can be carried over into the classroom. Here are some more specific ones that may help:

FOR FIDGETING

• Allow them to 'fiddle' with something quiet and appropriate, a stress ball, pipe cleaner. Allow them to move, taking a fictitious message to another teacher / office, collect something from within the classroom.
• If tapping is a problem, encourage them to tap their own arm or leg, now you have quiet tapping.

FOR DAYDREAMING

• Encourage physical responses, thumbs up / thumbs down during question and answer sessions. Give them a word or picture before discussion begins, they then have to raise their hand / thumb each time the word is mentioned. Keep activities that require sustained concentration to a minimum. Break down instructions into smaller shorter tasks. Position the student closer to you and away from distractions. Use a light touch on the arm or shoulder to refocus attention, this is far more effective than continually calling their name (self esteem).
• Use appropriate peers to model and encourage sustained concentration.

FOR CALLING OUT

• Reward student immediately he doesn't call out. Reinforce peers who do not call out (be careful about making comparisons). Use learning support staff / other students as whispering companions so that even though the child can not always give you the answer, they do have the opportunity to 'get it off their chests'. Give all students three squares of paper, each time they call out they lose a piece, the student with the most left receives a predetermined privilege.
• Give the student opportunities to take a leading role.

FOR INDEPENDENT WORKING

• Break tasks and instructions into smaller bites. Use cue cards to tick off when each step has been completed. Use a piece of card with a hole in it so that student only needs to read one question at a time.Reduce expectation so that student can experience achievement.Allow student to take brief breaks at their desks between tasks.Use timers for required periods of work and break times e.g. 5 minutes timer to work, 1 minute timer for break.Set targets 'I will be back in 5 minutes, how many can you do by then?'
• Ensure student understands instructions at start of task.

FOR ORGANISATIONAL / MEMORY PROBLEMS

• Encourage student to repeat instructions back to you. Use notes on desks to remind of rules / tasks etc. Colour code regular everyday tasks. Allow time at end of lesson / day to ensure student has everything he needs. Allow student to record 'note taking' and record instructions for them to play back. Keep the ADHD child at the front of the line for movement around school and for every success allow them to move one person back. Keep the older ADHD child at the back of the line when entering the classroom so that by the time they enter, everybody else is settled and only their seat is available.
• Keep classroom movement to a minimum, encouraging other students to move to the ADHD child.

FOR GENERAL BEHAVIOUR ISSUES

• Use visible reward / warning systems. 2 pots, one empty and one with 10 marbles inside and 3 rules on the outside. Each time you notice the student breaking one of the rules take a marble from the full pot to the empty one, when the behaviour changes, transfer the marble back again. You and the student are aiming to keep all marbles by the end of the day. Use 3 different coloured cards, one is a warning, two is for the student to realise that they need to take time out and the third is for you to instruct the student to take time out. Time out could be within the classroom or outside, if the student has chosen to take their time out voluntarily they should be praised, this is the first step towards them realising the pattern of their behaviour and your level of tolerance. Encourage other senior members of staff to accept you sending the student to them for praise and not only punishment. Peer arguments allow each student to have an uninterrupted opportunity to put their side of the story, they often 'trip up' and you can then back track and help them see the problems. Offer daily / weekly rewards, a special golden time when they can choose a friend/s to play with. This encourages peers to want to be their friends so that they also benefit from the reward. Use table point systems to encourage other childen on the table to help the ADHD child with their behaviour and organisational skills, reward the table for helping the child and not moaning about them. Anticipate problem areas, be prepared, give advance warnings.
• Follow routines, these children learn well by rote.

REMEMBER TO REWARD EFFORT, NOT ONLY SUCCESS,
THEY MAY HAVE TRIED VERY HARD.

STRUCTURE

• ADHD kids need stucture. They need their environment to structure externally what they can't structure internally. They benefit greatly from lists / timetables. They need reminders, previews, directions, limits and consistency. They need STRUCTURE.

Tips for relationships with parents

• Use a link book to record smiley faces, parents should be encouraged to draw 1-3 smiley faces for morning behaviour / homework tasks and it will only take seconds for you to record 1-3 for the day or part day. This is a quick and easy way to see how the family is coping with homework. It also minimizes the need for parents to approach you or you them on a daily basis and can be used to encourage organisational skills because it should be the student's responsibility to present the book. Daily praise will be possible and weekly rewards should be offered. Write negative reports in a diary and only report positive comments to parents in the playground, try to find something positive every day. Respect parents' feelings on medication and remember medication should never stand alone, behaviour management is crucial to the child's progress. Accept and encourage consistent approaches, share ideas and successes. Parents may not experience the same difficulties at home as you are in the classroom, there is often less stucture to conform to, more stimulating equipment, T.Vs / computers and lower expectations. Only children benefit from more one to one attention that is not always possible in an educational setting.
• Parents may tell you about problems at home that you don't witness in the classroom - believe them. Children often feel secure enough at home to let out how they really feel, frequently seen as behaviour / psychological difficulties that are communicating disturbing experiences at school.

What of the future?

A review (Casey and Keilitz 1990) concludes that about 35% of juvenile offenders are learning disabled. Hyperactivity may stimulate an early onset of disobedience, conduct problems and delinquency. The risk of serious conduct problems and deliquency may become more acute when physical agression accompanies diobedience at an early age. Whether a decrease in hyperactivity is associated with a decrease in problem behaviour is less certain (Rolf Loeber, Deliquency and Crime, current theories, Cambridge University Press).

One explanation is that learning disabilities produce poor academic achievement and thus negative attitudes from relatives, peers and school officials. The poor grades and negative attitudes, in turn, result in the child's association with others who are also failing in and disenchanted with school, causing truancy, delinquency and additional school related problems (Murray 1976, Cott 1978, Fishbein and Thatcher 1986, Fink 1990). The more proximate cause of delinquency is the combination of school failure, social rejection and association with 'bad' companions. (Theories of Delinquency, Donald J Shoemaker, Oxford University Press 1996). Twin studies have shown not only that the trait of hyperactivity involves a particular strong genetic influence (Eaves et al 1997, Simonoff et al, in press, Thapar & McGuffin 1994) but also that antisocial behaviour associated with hyperactivity is likewise strongly genetically influenced (Silberg et al 1996a) and that there is a strong genetic overlap between hyperactivity and disruptive behaviour, especially in middle childhood (Silberg et al 1996b).

FRIGHTENING ISN'T IT?

WE AT THE ADHD SUPPORT GROUP HARROW DO NOT BELIEVE THAT THIS IS THE FUTURE FOR OUR CHILDREN.

Many of the symptoms will improve with age - emotions mature and self control improves. 'Although ADHD cannot be cured, it can be effectively managed if parents help the child, when he / she is young, to learn skills and strategies to help themselves.' (ADHD Information for parents - Harrow Psychological Health Services).

ADULT ADHD is commonly thought to only affect children. But new research from British Columbia in Canada finds that as many as six in every 100 adults suffers from ADHD too. Treatment is available, usually stimulant medications such as Methylphenidate and psychotherapy (Woman magazine 2003).Many professionals mention that adults become serial criminals or philanderers. They may find it difficult to settle into a career or relationship. A number of parents we meet recognise the symptoms in themselves or their partners. Joining groups and learning new strategies helps them in the management of both their own and their children's condition.

And many become successful, sociable business people leading fulfilling lives in spite of their early difficulties.