When ADD Means 'Acceptance Deficit Disorder'?

Why is it often so difficult for parents to accept their child with ADHD? ADHD symptoms can create a daily grind on family functioning. Getting from bed to table without a stop at the toy box, then to school with that science report, then through homework under 70 decibels, and finally to sleep with fewer than three curtain calls can feel more like mere survival than the victories those daily milestones really are. Parents who are positive by nature find spontaneous praise of tiny accomplishments easier, but others can learn to do this when its power is pointed out.

Explaining that ADHD inherently includes trouble with judging time helps families understand why children with ADHD are "creatures of the moment." This means that giving praise immediately after tiny accomplishments is most effective in shaping the desired behaviors. Some parents find a strategy of constant praise to smack of coddling or bribery, and reject it; this can be especially true as children get older. But recommending a 3-week trial of bits of reinforcement can show the doubter that the improvement in behavior and tone in the household is worth the compromise. "Brief praise immediately" is a good mnemonic.

Eliciting details of a typical day, both at the initial diagnostic visit and at each follow-up, gives you the chance to ask how the family facilitates the "transitions" that are characteristically sticky in ADHD, as well as a source of conflict and frustration (a.k.a. anger). For example, although parents may be forgiving of their child’s trouble in attending to schoolwork, they may then be livid when the child shows perfect attention to a video game. It is helpful to educate the entire family that the child’s tendency to inattention is relative to his or her interest in the task.

Then, once engaged, kids with ADHD have more trouble than do others in moving on to something boring, like brushing teeth or eating dinner. This makes parents judge the child as "stubborn" or "only doing wants he wants to do." Our challenge is to help parents see the "transition difficulty" objectively as part of the deficit of ADHD.

Part of the solution to transition trouble is installing positive routines and habits (which come from a different part of the brain) through cheerful repetition. Cheerleading a young child through tooth brushing with a song eventually makes it an automatic behavior that doesn’t stress the weaker memory/transition functions.

Getting up, going to school, moving to the dinner table, engaging in homework, and going to bed are the major transition culprits. Some techniques that help include turning off electronics before a transition, setting aside extra time, using timers and alarm clocks to build time awareness, and singing songs or playing music to lighten the mood. Other helpful techniques involve rewarding with praise, marks, points, chips, or nickels for doing "a little better than before" at "moving on." Making the child and family more mentally aware of these trickier moments so that they take transitions on as a project is an important intervention in itself.

Although parents know they should not play favorites, this is harder to do when one sibling has ADHD. Sarah’s correct perception that Mom doesn’t yell as much at her mild-mannered brother Jason exacerbates jealousy and increases the squabbles. It can help to coach parents to find a specific activity or interest to share with each child, and to be sure to talk at home about how each person is special.

Parents are never alone in their own heads. It is hard for a parent not to criticize the way her son taunts his sister when the parent hears the voice of her own father from the past, echoing in her brain about the same behavior. This pattern can carry over even when the memory is of a correction to her brother and not herself. Reflecting with the parents, "Does this remind you of something from your own life?" may bring out this connection so that it is open to conscious control. Try asking, "How would your parents have handled this?" to reveal the origins of a strict, demanding, or even harsh reaction pattern that a parent himself learned from experience with his own parent as a child. It is possible that he himself was the hyperactive one?

What two parents don’t have different experiences and reaction patterns? Differences can spark innovation, but also can lead to discord over what to do. When parents argue about management, it is an opening for the child both to slip out from under their gaze and also to feel guilty for the fight he is leaving behind. It is more difficult for a parent to be accepting of the child if one party feels (or says), "We wouldn’t always be late if it weren’t for the ADHD on your side of the family!" With 25% of parents of a child with ADHD having ADHD themselves, they may not have to look far for the blame. Helping the child get organized, planning out those long-term projects, and focusing on the positive are all harder if the parent has the executive dysfunction of ADHD him- or herself. Instead, any residual parental low self-esteem or anger at a tendency to lose things can contaminate that parent’s opinion of the child. Even the spouse may displace irritation with the parent’s "messiness" onto the offspring, and overdo the criticism. Sometimes, referring a parent who you suspect may have ADHD for their own diagnosis and treatment can be the biggest contribution to the family you can make.