Manage Anxiety in Your ADHD Kids

This month's blog is actually an interview that I had with the team at ImpactADHD. com. It focuses on building resilience and competency as a way to help ADHD kids manage their anxiety.  Check it out!  http://impactadhd.com/manage-emotions-and-impulses/kids-with-anxiety/

Reduce Holiday Overwhelm--Simplify!

Despite our best intentions, it seems like most families are frequently more stressed by the holiday season that they would like. Between our regular responsibilities of work, parenting and other life tasks, we now add shopping for gifts, planning family celebrations, attending holiday parties and cooking special foods. Perhaps you work all day, make dinner, put the kids to bed and then shop online or cook until midnight. Or maybe you rush out to shop during lunch, hurriedly eat a sandwich at your desk and then wrap gifts in the bathroom after the kids are asleep. Sound familiar? Everyone is excited about the holidays and there is much to enjoy. Yet, sometimes you may feel like things are rushed and out of control. Parents often feel so pressured during this season. ADHD kids, with their knack for picking up when things are frantic and responding to that energy, really benefit from slowing things down. When too much stimulation comes at them, they just don't have the ability to process what's happening effectively. They become easily overwhelmed and, depending on their personalities, act out their feelings in ways that, unfortunately, can be inappropriate. You, too, may be reacting to all of the things you have to do in ways that aren't your best self. How can you approach this holiday season so that everyone is calmer? Slowing down is the first, most important step. Many families just take on too much during this time of year. Perhaps you have some organizational or planning challenges yourself that add to feeling overwhelmed. Of course, exercise, yoga or meditation are generally helpful but you probably need more than that right now. Here are specific ways that you and your ADHD sons and daughters can manage the holidays with less stress and more calm:

1. Take a minute to think about your to-do list. It may very well seem too long and impossible to accomplish in the time you have. Go through the list and mark the things that are most important to you. Since this can be hard to do, talk with your partner or a friend to assist you in prioritizing and eliminating. Removing, consolidating or getting help is the first step in creating balance.
2. Ask your kids to reflect on their gift list. Maybe they can pick a few bigger gifts or activities instead of several smaller ones. This would make things a lot easier for you and possibly better for them. You can help your ADHD child or teen with this and model how to simplify.
3. Ask your children to assist you in activities they like--cooking, shopping and wrapping. This will also reduce your burden and encourage their participation. Most ADHD kids like to do things. Why not have them work with you on holiday projects? Even if it takes management, you are connecting with them, teaching all kinds of skills and involving them in the process. It's a win-win.
4. Talk with your family about the holiday plans. While it may be challenging for ADHD kids to plan ahead, they certainly have opinions about what they like to do. When some of their preferences are part of the picture, you increase the likelihood for their cooperative participation.
5. Set reasonable expectations for togetherness. Remember that ADHD kids especially need down time to regroup mentally and emotionally. Make sure there is time each day for this. It doesn't matter if they are reading, watching tv, playing a computer game, drawing, playing with Lego or listening to music--they need time with reduced input that they choose. This time helps their system de-activate. You, too, would probably benefit from some time like this.

It sounds corny but less is actually more in these weeks. Take some time to do less and you and ADHD kids will reap the benefits! Happy holidays to you and your family! 

ImpactADHD: 5 Steps to Improve Cooperation with Your Kids with ADHD

Are you pulling your hair out trying to think of ways to reduce your frustration and improve your child’s cooperation? Do you wonder why charts, reminders and incentives don’t seem to get your kids to do the stuff they need to do, especially when they have ADHD and related challenges? Read Sharon Saline’s 5 Steps to Improve Cooperation with Your Kids with ADHD. (October 2016)

Making ADHD Family Vacations Fun!

"Are we there yet?" "How much longer?" Family vacations often start with high hopes. Everyone imagines bubbly laughter, good food and happy connections. You are excited and so are your kids. Usually, things work out as you had hoped: people get along well and have a good time. Sometimes things don't work out as much as you would have liked. Arguments, tantrums, logistical difficulties bring everyone down. What are the ingredients for a successful ADHD family vacation? In the New York Times travel tips section on July 10, 2016, Kay Merrill, a family travel specialist, recently offered some ideas for making family getaways as good as you imagine them to be. Her article inspired me to create suggestions about traveling with ADHD kids.

1. Include everyone in the planning: Family trips work better when everyone's interests and needs are part of the equation. ADHD kids like information and respond well when presented with it. Even children as young as 5 years old have ideas about what they like to do. Put together a file (digital or hard copy) with maps, places to see and interesting activities that you have pre-selected as possibilities. Then, sit down as a family, look these over and see what intrigues folks. Rule things in that appeal to your children but also to you too. This way the trip can be fun for everyone.
2. Include everyone in the preparation: Everyone can play a role in getting the family ready for a trip. If your child can read and follow a list, then they are old enough to participate. Make a short packing list of things that they could put together:  favorite toys, games, books or even clothing. Be specific. Instead of saying "Pick 3 toys," try saying "Pick one doll, two of her outfits and 3 books." Instead of writing, "pack your clothes," ask them to lay out "2 swimsuits, 3 pairs of socks and 1 pajamas"--neutral items that don't require checking in with you to select. When ADHD kids help out like this, they gain a sense of competence and autonomy from being responsible for themselves. Simultaneously, you gain some much needed assistance in the packing process.
3. Create a break in the day: Packing too much into a vacation often has disastrous results. An itinerary of going, going, going all day is exhausting and overwhelming for everyone, especially ADHD kids. They often benefit from unstructured time to process their new experiences--whether that means reading, playing computer games or swimming in the hotel pool. You will likely benefit from a rest too. Talk with everyone in the family about what time of day would work best and use an alarm on your phone to make it happen.
4. Be open to the unexpected: Spontaneity often leads to amusing surprises and hilarious memories. Be flexible and curious about opportunities. In those inevitable challenging moments, try to find a silver lining and some laughter. Remember, you are on VACATION. The goal is to have fun. 

I wish you well on your family trip--whether you stay close to home or venture further afield. ENJOY!!

Interview w/ Maggie Wray Ph.D: Unstoppable Teens | Helping teens develop the skills they need

Interview w/ Maggie Wray Ph.D: Unstoppable Teens | Helping teens develop the skills they need

Click logo below to listen.

Get More Love in Your ADHD Family

Too often ADHD families are so busy dealing with the stress of daily living that cultivating loving connections can take a back seat more that everyone would like. Recently I read "The 5 love languages: The secret to love that lasts" by Gary Chapman. In this best-selling book, he starts with the idea (from Dr. Ross Campbell) that we carry around from childhood an internal 'emotional love tank" waiting to be filled with caring, affection and kindness. When this happens, children develop normally but when the tank is empty, kids misbehave (p.20). Mr. Chapman thinks adults have the same needs but fail to give love in ways their partners can actually receive it. In looking at couples and how they can improve their relationships, he identifies 5 ways of communicating love: words of affirmation, quality time, receiving gifts, acts of service and physical touch. I think Mr. Chapman's ideas apply just as well to ADHD families. When you are running to the lacrosse field to bring your daughter the cleats she forgot yet again, when you are arguing with your son to pick up the mountain of dirty clothes off his floor so you can find the missing library book or when you are sitting down for the nightly homework struggle, taking the time to consider how to express your love for your ADHD child is likely not at the forefront of your mind. You are just trying to manage the stressful situation in front of you. But, there are other moments when it can be. Quieter, calmer times like the moments when you read a story, when you share a snack, when you chat casually in the car. The value of the Mr. Chapman's model lies in figuring out how your ADHD son or daughter best receives love and tries to express it to you. This understanding will promote a natural give-and-take of closeness that will fuel both of your love tanks. First, start with yourself. Ask yourself what feels best to you. Is it when someone says something nice to you about you or something you have done (words of affirmation)? Is it spending meaningful time doing something together (quality time)? Is it getting a special something, a token of thanks (receiving gifts)? Is it when someone does something helpful or nice for you (acts of service)? Is it being hugged, caressed or holding hands (physical touch)? While these all may be important, try to decide on your top two choices. Then consider your child. What do you notice feels good to him or her? What do you think helps the two of you feel close? Again, pick your top two choices. Next, ask them. This conversation itself is already enriching your relationship. See if you can make an agreement about what filling their love tank looks like (be as specific as possible but ruling out buying gifts daily). Have them pick the most important one or two. Remember, that what nourishes them might be different than what nourishes you. That's okay. The goal here is to deepen the positive bonds between you. As their parent, your job is to initiate that. Making a concerted effort to put some extra attention and energy into nurturing the love language that feeds your child the most will certainly strengthen your connection to each other. This bond produces the cooperation, affection, honesty and fun we all want in our families. ADHD kids, who often suffer from feelings of low self-worth and wrestle with many daily frustrations, particularly benefit from being seen and heard. You will reap many rewards--affection, cooperation, humor--by doing more of what feeds them. I am confident that they will start to reciprocate as well and you, too, will get some fuel for your own love tank.

Creating incentives that work

Creating Incentives that Work: How to do you get your child or teen to do things around the house? Do you ask your daughter nicely to set the table at first but then resort to yelling when she won’t get off her phone? Do you calmly warn your son that it is time to turn off the television but then shut it off angrily when he ignores you? Is there more stress than cooperation in your family than your would ideally like? Many parents struggle with the challenge of motivating their children and teens to do what they are supposed to do when they need to it—whether or not the kids have ADHD. In our world today, the technological gadgets and social media networking sites are far more seductive and rewarding than ever before. For kids with ADHD, such activities are more than distractions: they are completely absorbing. To set successful limits on these activities and help your son or daughter focus on what needs to be done now (like chores, homework, job, etc), you have to use an effective incentive program to reward desired behaviors. Now, you may ask: “What is the difference between a rewards and a bribe?” Good question!! A bribe is something appealing that you give to someone before she performs the desired task. For instance, we see bribes in crime shows on television all of the time: “Hey, here’s a hundred bucks if you take this package across the street.” Frequently, the package doesn’t arrive and the runner takes off with the cash. An incentive is something appealing that you give to someone after they have completed the desired action. On a crime show, this would look like: “Here’s a package that goes across the street. When you have delivered it successfully, come back and I’ll give you a hundred bucks.” The runner delivers the package, returns and gets paid his wage. Now obviously, I am not suggesting that we should make our families into crime shows. These are just examples to clarify that incentives reward desired behaviors. Research on children and teens with ADHD has shown that reward incentives that are desirable for the kids and immediately given out support improved behavior on a number of executive functioning tasks. This means that when the incentives are attractive, they can help improve skills such as planning, organizing, persistence and self-control. Here are some guidelines for setting up incentives that work for your ADHD kids and will work for you too!

1. Take a few moments and think about what your child LOVES to do: the options can range from go out for ice cream, to playing Minecraft, to using Facebook or Instagram, to watching television, to sleepovers, to using your car. Make a list of all of these things BEFORE your start a conversation with him. Remember that these are privileges, not entitlements.
2. In a calm moment, ask your daughter what are her favorite ways of spending time. Write these down and then go over your ideas with her.
3. Together, pick one area of his life that could use improvement: getting started with homework, cleaning up after dinner, hanging up the wet towel from his shower instead of leaving it on his bedroom floor, getting to school on time, etc.
4. Now, pick one item from the favorite activities list and link it directly to the activity you have chosen. For example, if the desired goal is getting ready for school on time and the favorite activity
5. This is a process of negotiation but you must hold firm about the goal and figure out collaboratively what the appropriate incentive is to obtain it. If things get tense, take a mutual break but come back to it before the day is over.

You CAN create a win-win situation with this process. You obtain the behavior that you want without losing your cool and your child or teen gets something s/he wants too.

Change Writing Challenges into Writing Successes

Over the years, I have noticed that many, many ADHD kids seem to have trouble with writing. While some kids like it because it is a venue for expressing their many ideas quickly and creatively, others despise it because getting even a few words on the page is torturous. Sometimes the physical act of writing is hard and penmanship can be tough to decipher. Organizing thoughts in their heads and translating them into coherent essays requires that several key Executive Functioning skills run simultaneously like clockwork. These skills, naturally weaker in people with ADHD, synthesize writing into a linear, well-formed essay. Writing can often be a source of tension in ADHD families for children who struggle with it. Just as asking neutral, probing questions about learning styles related to reading and math skills leads you to helping your child improve in those areas, discussing your child’s individual and idiosyncratic process of writing with them can reduce the mystery and frustration about it. In a calm moment, grab a pen and paper and try a conversation like this:

1. Together, identify something that is easy or not that bad  about writing. Maybe it’s getting an idea, maybe it’s researching a topic, maybe it’s the typing. Find something and jot it down. Emphasize aloud that this is something your child or teen does well.
2. Next, help your son or daughter make a list. This list will use a rating scale from 1 to 10: 10=THE VERY HARDEST PARTS of writing; 1=THE LEAST HARDEST PARTS of writing. Using this language is important. You have already found something (maybe a few things) that your daughter says is easy. Now you are trying to get a specific sense of what the most difficult aspects of writing are and how she thinks about them. Use the list of basic skills needed for writing (shown below) to help you. Add any of your own that you think would be important. Some ADHD kids prefer to talk out their ideas instead of writing them down; include this on your list too if it is true for your child.
3. Brainstorm alternatives to areas that your child identifies as THE VERY HARDEST PARTS. These ideas can include getting writing support at school from teachers, going to a writing center at school, working with a friend or finding a writing tutor. They can also involve breaking writing assignments into smaller, achievable parts and making sure their teachers give them clear guidelines for writing that take into account where they need the most help.

List of basic Executive Functioning skills needed for writing: Coming up with basic ideas (initiation) Selecting ideas that are relevant and do-able (prioritizing) Remembering information about the topic to focus ideas (working memory) Making an outline or plan of your project (planning, prioritizing, organizing) Putting together research with your own thoughts (organizing, sequencing) Amount of time it takes to do writing (time management) Being able to continue on the project until it is finished (goal persistence) In general,  I don’t advise having you proofread or teach writing to your ADHD child or teen if there is already conflict about written work in your home. If your child is open to your assistance, then of course give it. Otherwise, let the teachers or tutors do this so you can stay with your role as supportive parent. That's what your son or daughter really needs most to help them manage their writing frustration and build confidence.  Good luck!

Does your child have an accurate ADHD diagnosis?

Recently, a study by the George Washington University Institute of Public Health reported that 12% of U.S. children, a whopping 5.7 million U.S. children ages 5-17, were diagnosed with ADHD in 2011, across all ethnic groups. This is a significant jump since the last time this population was studied in 2003. In fact, a 43% increase. The study also found that more girls have been diagnosed–up from 4.3% in 2003 to 7.3% in 2011–while the rates for boys remained steady. The study did not look into underlying causes for this increase but suggested it could be due to the tendency to over-diagnose and recommended more research. How you can make sure that your child has an accurate ADHD diagnosis? Generally, there are three common routes leading to an ADHD diagnosis: via your pediatrician, via a psychotherapist or via the child’s school. Whichever route you choose, I want to put in a plug for psychological or educational evaluations. Testing can be a great way to understand how your child’s brain works more in depth, how they are performing academically and what is going on emotionally. Only certified school psychologists and licensed psychologists (or neuropsychologists) are trained to and do these types of evaluations. You can go through your public school system for an evaluation. Or, you may decide to see someone in private practice. Both options, although different in terms of cost, time and depth of analysis, are beneficial. Sometimes health insurance companies will pay for testing but not always. Personally, I think these evaluations, however obtained, are absolutely worth it. The comprehensive information that you gain from these reports can be tremendously helpful to everyone–parents, kids, teachers. They assist you in specifically understanding how ADHD affects the brain, behavior and emotion of your child and can validate that she or he really has it. Of course, pediatricians are absolutely helpful and well-informed in the diagnosis process and often they are the first people many parents talk to about ADHD. To make an ADHD diagnosis, they usually rely on speaking with you to get a sense of what is going on with your son or daughter (including gathering additional developmental or family history) and giving you some forms for you and the school to fill out. The Vanderbilt, Conors and BASC scales are common ones. Based on that information and any other relevant information that you have, your doctor will make a diagnosis. Many mental health practitioners do something similar and lots and lots of experts think these are sufficient, which they often are. But, in light of the statistics at the top of this post, what could be happening differently? Most parents want to be sure that their kids have ADHD before giving them medication, putting them in special classes or getting them expensive tutors etc. I think testing provides you with the extra information that promotes a fuller understanding of what is going on for your child. Many pediatricians and mental health practitioners recommend it but some do not. I think reliable testing and valid interpretations of the results could make a big difference. Today, my goal is to encourage you to obtain testing, if you haven’t already, and especially if you are uncertain that your child has been correctly diagnosed. I have seen numerous families in my practice be reassured and enlightened by the results, even though they can be complicated and sometimes overly focussed on weaknesses and problems. While the process of getting tested may be cumbersome, I believe the pros outweigh the cons. If you think your child may be incorrectly diagnosed, I encourage you to speak to your pediatrician or school psychologist and arrange for a formal evaluation.

Avoid holiday stress: Practice gratitude with your ADHD child

It's that holiday time of the year again. In all of the hustle and bustle to plan get togethers, shop for presents, wrap them and prepare festive meals, we sometimes are  just too busy to stop and consider the blessings in our lives. I am not talking about the things people post on Facebook or Instagram. Rather, I am thinking about being grateful for our families and the people in them--for the ways that make them unique and lovable to you. Being able to appreciate ADHD kids for who they are--talents, warts and all is especially important to helping them develop the healthy self-esteem they need to grow into happy, productive adults. Ideally, noticing what your child is doing well happens every day or close to it. During the holidays, when many families spend extra time together, you have additional opportunities to connect positively with your kids and show them how grateful you are to have them in your life. Too often, ADHD kids hear more about the ways in which they miss the mark than the ways that they make a hit. Paying attention to what you love about them offers a balance for those 'misses' and the holidays are the perfect time to even the score a bit. At this time of year, when the days are shorter, when we are living in the midst of giving and receiving, I encourage you to bring some extra light to your ADHD families by thinking about these questions:

1. What do you really appreciate about your ADHD son or daughter? When was the last time you told them? Can you make an effort to say something during the next week at a time when they are showing you what you love?
2. What unique gifts does your ADHD son or daughter have? How do you let them know what is special about them?
3. What interests your child? How can you join them in something that is fun for them over the holidays even if it isn't your favorite thing?

Acknowledging the positive, noticing individual talents and doing activities together all show your ADHD child or teen that you care about who they are and you are glad that they are in your lives. They see how much they matter to you while you are showing them what giving love really looks like. You also nurture their self-confidence by spending quality time together. Most importantly, you reflect the essence of the holiday season by giving and receiving joy from the strength of your connectedness with your child and family. Ultimately, isn't this what celebrating the holidays is all about?! I wish you and your families peace, love and health in the New Year.

Frustrated and fed up? Use the the 5 C's of ADHD Parenting!

Parents often ask me for the keys to raise their ADHD kids into effective, happy adults. Sometimes it's hard for them to see that the struggles of today will eventually transform into the successes of tomorrow. Between the daily reminders about organization, homework completion, doing chores and treating others respectfully, it can be easy to lose your temper and your faith that your efforts will pay off. Will your ADHD sons and daughters will learn the life lessons you are trying to teach them? How can you maintain your cool, your hope and your positivity in light of the inevitable bumps you will encounter?

5 C's of ADHD parenting

In over 25 years of working with youth and families, I have seen that there are ways of being a capable ADHD parent and raising capable ADHD kids that really work. They are what I call the 5 C's of ADHD parenting: self-Control, Compassion, Collaboration, Consistency and Celebration. By using these tools, you can reduce your stress, create peace in your family and increase cooperation and love all around.

1. Self-Control

Learning to manage your own feelings first so you can act effectively and teach your ADHD child to do the same.

2. Compassion

Meet your child where they are, not where you expect them to be.

3. Collaboration

Work together with your child and co-parent (if one exists) to find solutions to daily challenges instead of imposing your rules on them.

4. Consistency

Do what you say you will do--over and over and over again.

5. Celebration

Acknowledge what’s working and doing more of it, day after day after day.

Incorporating the 5 C's

The trick to using the 5 C's is making them part of your parenting routines. Take time to cool off when you are aggravated with your son; show concern and support for your daughter when her struggles annoy you; talk about any problems and come up with alternatives as a team; be steady and predictable. Even when you feel like giving up, stay positive–and notice what is going well, no matter how small. Start today and you will see a difference before you know it!

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Read more blog posts! Learn more about Dr. Saline's Home Study Seminar for Parents of kids with ADHD: https://drsharonsaline.com/product/home-seminar/

To Time Out or Not to Time Out?

Many parents of ADHD children and teens come into my office and report that nothing really works in terms of discipline and consequences. “My son just doesn’t care what we take away” or “my daughter laughs when we ground her.” While all kids balk at rules sometimes, those with ADHD, because of their ADHD, seem to do this more often and louder. To be successful at reining in and re-directing undesirable behaviors in ADHD kids, parents not only have to be incredibly patient but also consistent, clear and calm. From this firm ground, you can then make well-considered decisions about the rapidly changing emotional meltdowns and behavioral infractions you encounter with your child. Today’s parents have, in general, moved away from physical punishment such as spanking to using Time Outs. But Time Outs still focus on the “wrong-ness” of the action. Time Outs seem to give parents and children a break when they most need it and emotions are running high. But, most kids experience them as punishment which makes them feel worse about themselves. They frequently feel like they are bad people who are engaging in bad behaviors that, because of their ADHD, they often can’t control. In addition, Time Outs usually don’t teach emotional regulation because learning this key executive functioning skill requires interaction not isolation. Kids benefit from discussing ways of managing big feelings and getting help using these techniques at times when they are the hardest to implement. Of course, a child in Time Out will eventually calm down but they usually don’t come away from the experience with the necessary skills they will need the next time they get triggered and have a meltdown. I believe that people need some separation from each other when emotions get high but this separation has to be negotiated and agreed upon before it is implemented. This means making a plan together for those times when things get heated or out of control that works well for everyone. Imposing a physical separation such as sending your son to his room when he is in a meltdown may not be the most effective solution for him even though it would give you some relief. He may need a quiet few moments with you on the couch rubbing his head and reading a book. You may need 20 minutes alone in your room with some deep breathing or mindless television. So, I like to advocate for Time Apart Together: a pre-negotiated break from the problematic interactions that doesn’t banishment your ornery teen to his room out of mutual anger and frustration. The Time Apart Together System (TATS) is based on creating an environment that teaches self-management through collaboration when people are not upset. This technique relies on the parent-child bond that is the main incentive for cooperation in the first place. I am certain that neither you, your ADHD child or teen or anyone else who is resides with you likes the meltdowns, yelling and emotional escalation that often precede a standard Time Out. Here’s how to use Together Time Apart:

1. Identify together what contributes to meltdowns and what types of 'breaks' would help everyone slow down and calm down. When you see your child heading towards an eruption, try one: You can even give it a special name. I have worked with people who call them anything from “Pink Elephant”, “Take Ten” to “That Dr. Sharon Thing.” You too can ask for a break when you feel as if you are losing it. In a few weeks, once you have tried out the interventions several times, discuss how your new plan is working.
2. Sometimes a time in—the opposite of what you, as a parent feels like doing when you are in a dither, can be most helpful. Try taking a deep breath, counting to ten and giving a hug, starting an activity like reading a book or having a game of catch. Comfort and distraction can be great antidotes for anger and emotional eruptions.
3. Once the meltdown has started is not the time for any negotiation or teaching. Your ADHD child’s thinking brain has been kidnapped by her emotion brain—it’s fight or flight mode. Stay nearby and stay calm but don’t give in to her demands. Take some mental notes and use them when you re-evaluate the TATS that you have devised.

Good luck on embarking on your family’s TATS today!

MCPAP: More than Prescribing: Five Ways Primary Care Providers Can Help Children with Attention Deficit Hyperactivity Disorder (ADHD) and Their Families

MCPAP: More than Prescribing: Five Ways Primary Care Providers Can Help Children with Attention Deficit Hyperactivity Disorder (ADHD) and Their Families

Anne* and her husband, Victor, came into my office for an initial parent visit looking tired and worried. Their daughter, Olivia, aged 9, had recently received a diagnosis of ADHD, Combined type, from her pediatrician. They appreciated how their physician validated their concerns and offered hope about their daughter’s situation. Anne summarized: “Our pediatrician was helpful in recommending that we read “Driven to Distraction” and referring us for testing and to your practice and website. She was supportive and receptive to our concerns but she wasn’t able to target interventions about living with ADHD that fit our daughter. We wanted something more.” Click logo below to read more.

Keeping the Vacation Alive After You Return Home

How many of us long for our family summer vacations and then feel like they whiz by all too quickly? We return from our days off with that certain "I've just had a break glow" only to see it fade too soon and too fast. Vacations offer us a much-needed respite not only from our daily routines but also from the typical ways we interact. These breaks are especially needed by ADHD kids. They can really benefit from a different environment, meeting new people and taking time away from academics. Hopefully, you and your ADHD child or teen have also been able to have fun together. These positive connections enrich your relationship by nourishing the bonds that foster collaboration. Soon, however, your ADHD son or daughter will go back to school and you will be catapulted into the busy-ness of life once again. How can you keep the vacation glow alive? Time functions differently for ADHD kids. They live primarily in the present don't spend much time in the past. They focus on the future when it is immediately in front of them and they don't tend to linger on the past. In addition, ADHD kids (and adults too) frequently have working memory deficits. This means that it can be hard to recall or hold onto things in their brain. Information that is recorded in the brain doesn't transfer efficiently to long term memory storage. Furthermore, many kids with and without ADHD are so often distracted by their technology that they miss out on what is going on around them or forget about it when "an important text" interrupts their current activity. Thus, the glow from the vacation can evaporate much too soon. How can you help them stay connected to the benefits of time off and incorporate them into your home once you get home? Try these tips to recapture and preserve the glow from your family vacation: 1. During a meal or other family time (for instance, being in a car is always a good time to talk because you are all there together), review some of the highlights of your family trip. Be specific. "That double chocolate ice cream cone was the best!" "I loved riding that big wave right up the sand." Write them down if you can and maybe put a phrase or two around the house on post-its. 2. Together with your ADHD son or daughter, find some pictures or video from the vacation that illustrate or connect to those moments. Try to post some of these images in a common space in the house as well. Maybe watch a video clip or two. Allow yourselves to reminisce. 3. Share some stories about your family vacation with friends or family, encouraging the kids to participate (even with interruptions). The goal here is to rekindle the excitement of the original experience and keep it alive. 4. Do this periodically for the next month or two. It will help all of you remember what fun you had and the closeness you shared. Enjoy your vacation!

When “I’m Sorry” Just Doesn’t Cut It Any More

How many times have parents of ADHD kids heard them say, “I’m sorry” but it didn’t feel like they really understood what they had done? That it didn’t feel genuine? Most Adhd kids harbor feelings of being wrong or doing bad things from an early age. They likely have been admonished at school and at home numerous times for: impulsivity, being overly active, daydreaming or social awkwardness. Basically, they are reprimanded for doing things which have seemed nearly impossible to be in their awareness or control. Apologies are just one more thing on the long list of what they should do better and usually aren’t a big priority. In my clinical practice, I often play games with ADHD children and teens while we talk about issues in their lives. Yahtzee, Battleship, Checkers, Uno are longstanding choices. But my favorite game to play with my clients is Sorry. I love playing this game because it is always interesting to me to see how each person proceeds to say it. We set the ground rules for saying “Sorry” at the very beginning and they are simple: You must look the other player in the eye and say “Sorry” directly and clearly. That’s all there is. Here’s what is fascinating. Some kids cooperate easily and with good humor. Others have a lot of trouble following through: they will mumble, avert their eyes, say it as fast as they can or omit saying anything at all. Over the years, I have observed that most of the ADHD kids who struggle with simple apologies during the game also struggle at home, at school or with friends with personal accountability. They often harbor such a deep sense of shame about their various misbehaviors or mistakes that apologizing is just too painful. So, when arrive at the "sorry" part of the game and I see them avoid it, I try to turn it into something playful before addressing their discomfort later more directly. Then, we can talk about how to give real apology and mean it: using eye contact, tone of voice and volume. As adults, we realize the importance of accountability, humility and the acknowledgment of our errors and our limitations in the context of maintaining and nurturing our relationships with family, friends, colleagues, etc. Often, it isn’t so easy for us to apologize for own our hurtful words or actions. So, it makes sense that ADHD kids and teens are not only reluctant to be, in their own minds, wrong AGAIN but at some level, very accustomed to having committed yet another mistake. They frequently want to say a quick “Sorry”, get it over with and move on. How can we teach our ADHD children and teens to do better without shaming them further? Sometimes just asking for eye contact and a thoughtful “I am sorry because . . .” can be enough. But at other times, something more may be called for. I like Apologies of Action because they integrate words with doing. Some people call this “Making Amends.” Either way, it is a collaborative, teaching process: your ADHD child or teen learns that their speech and actions affect others and that reparations can be made. When she says or does something hurtful, she needs to make her apology meaningful—not just a throw away. This requires a combination of a verbal apology and doing something to help the person. For example, one ADHD teen I know was driving his parents’ car (with their permission) and backed accidentally into a mailbox in a snow bank. He felt terrible but couldn’t make a real apology which infuriated them. When they sat down to talk about the next day, he shared his embarrassment, guilt and regret about the accident. The parents accepted his apology but also asked him for his participation in repairing the car. He met with his father and the insurance adjuster to report the incident. He went with the mother to get an estimate on the damages to the car. He wasn’t allowed to drive the rental car so he had to bike places instead. In the end, he told me that it “turned out okay. I was surprised. I learned about what to do if this happens again and I showed my parents that I really was sorry.” In another family, if their ADHD daughter breaks her sister’s Lego creations, she has to apologize and then work with her to rebuild something. The actions logically follow the affront. I encourage you to think about how you can assist your children or teen in learning to make sincere apologies and following them with actions when appropriate which isn’t all of the time. These aren’t punishments; they are efforts to make amends. Pick and choose the moments when you use Apologies of Actions based on when a simple, genuine “I’m sorry” is enough.

Frustrated with a lack of progress? Improve your consistency!

Many parents who are frustrated with their ADHD children come into my office and complain that “No matter what we do, our son (or daughter) doesn’t change. Nothing works.” As I meet with these families, the heart of the problem usually lies with inconsistency. Sometimes parents can create a plan of action to deal with behaviors and stick with it; other times, they are improvising moment by moment. Too often, they get stuck and feel defeated. With all of these different scenarios, the ADHD kids, who thrive on predictability, can end up feeling confused. How can we change these patterns and create more success? Inconsistent parenting reflects mixed messages and unclear rules that evolve over time and unintentionally. It’s not something people decide to do: it frequently occurs because parents are tired, worn down and out of ideas. Inconsistent parenting can look like this: One school night, you let your 10 year old ADHD son stay up until 11 pm to watch the football play-off game because you don’t want to miss any of the action to put him to bed. Yet, a few days later, when he wants to watch a basketball game with you past 10 pm, you refuse. Here’s another example: You tell your teenage daughter that she will lose her phone for the evening when she doesn’t clean up her room as you both agreed but then you let her keep it when she goes out so you can reach her. Consistent parenting means having the same consequences for the same behaviors over time—again and again and again. They don’t change and can’t be negotiated. It means that you don’t give your ADHD children and teens consequences that you can’t enforce or remember or don’t want to deal with. ADHD kids need to know what is coming so they can learn from their experiences and start to understand that their actions have effects. This is exactly where their executive functioning skills are weak. It takes time and repetition. You have to lay the foundation for this consistency by establishing clear guidelines for behavior with your son or daughter that mean something to them and to you. The process is collaborative but ultimately not democratic; you still have the final and most powerful vote because, after all, you are the responsible adult. How can you begin this process?

1. Get some paper and a pen and sit down with your family. Start with a fair assessment of the basic rules. Ask your kids what they think the consequences should be for not following them. Sometimes they will come up with ideas that are far more impactful that you will.
2. Pick the top 3 issues and create a plan of action for not cooperating. Write everything down.
3. Meet alone with your parenting partner (if you have one) and go through this list. Ask yourselves if you can honestly follow through on the consequences and how you can support each other to do so. If you can’t do them, come up with other ideas that you can enact.
4. Meet again with the family. Go over the plan. Post it in a place where everyone can see it and refer to it when needed.
5. For the next 3 months, meet every two weeks to check in, see how things are going and make any necessary changes to what you are doing that would help things go more smoothly.

Good luck!

"What did THAT mean?" Is it disrespect or self-expression?

As 21st century parents, we want our kids to share their feelings and talk through their problems with us. We encourage them to let out their feelings and believe that this is basically healthy, which it often is. But sometimes this self-expression is inappropriate and we are surprised, even shocked, by what we hear. My clients have frequently reported their dismay when their ADHD sons or daughters (depending on their ages), have said things like, "I hate you!" "You're a terrible mother. "Don't you know anything?" "What is your problem?" "You are so stupid." Then, there's cursing, slamming doors, eye rolling, or punching the wall. In today's world, when many parents want their ADHD children to learn to speak up for themselves and strengthen their own voices, it can be hard to know when things have gone too far. The lines between self-expression and disrespect can become blurred really fast. What starts out as a joke can quickly turn mean and what seems like a discussion can turn suddenly into a shouting match. ADHD kids, because they struggle with impulse control, understanding limits and reading social cues can get carried away or inappropriate without always knowing it. What should parents do? I think that parents first have to assess for themselves what constitutes disrespectful behaviors. We all have our limits: what are yours? In my house, eye-rolling and name-calling were at the top of our list. Telling me what a jerk I am just isn't okay. You can tell me that you are angry, that you don't like what I said or what I am doing, but you don't get to call me names. Likewise, I don't get to call you names either--no matter how frustrated and fed up I may be. Clear boundaries are essential for ADHD kids who can't always monitor their words and actions effectively. They have big feelings and limited skills in expressing them. They need assistance and feedback based on consistent family guidelines. They also need some concrete tools that reduce disrespectful language and actions and increase more acceptable ones. How can you teach your ADHD sons and daughters to share what is going on for them in ways that other people can hear? Here are some useful tips:

1. Consider what really pushes YOUR buttons as unacceptable ways of speaking or behaving. Write down the top 3 offending actions. (If you have a partner, do this exercise together so you can present a united front with your family.) It's also important to ask yourself if you engage in any of those 3 behaviors. Be honest because respect goes both ways. Believe me, your ADHD son or daughter will be the first person to point out any of your transgressions.
2. Think about (and discuss) what types of self-expression you want to encourage. Would you like your daughter to use her words when she feels upset instead of going to her room and crying? Would you like your son to control his body and stop slamming doors? Be specific about these goals.
3. Sit down with your ADHD child or teen. Ask them what they consider to be disrespectful--what they do and what others have done to them. Suggest some relevant recent family or school incidents if they are stuck. "Remember when Sam pushed you on the playground and called you 'a crybaby?" Share some of your own earlier reflections. Decide together which of all of these ideas and observations you would all like to see changed first.
4. Introduce this alternative method of self expression using this formula: "I feel ________ when you ____________." It may be awkward and corny at first but it's important to keep using this so it becomes a viable alternative for appropriate sharing. Usually ADHD kids benefit when you post it in a common space like the refrigerator. Refer to it often, especially when things are heating up. If your kids use it, then let them know you appreciate their efforts.

Want more family harmony? Change your T.O.V!

It's a rainy Sunday morning and you decide to make pancakes for the family for breakfast as a nice treat. You whip up the batter and drop large creamy spoonfuls onto the sizzling griddle. As the golden discs bubble, your 11  year old ADHD daughter bounces into the kitchen. "I'm so hungry. WHEN will the pancakes be ready? I want to eat NOW!" You start to feel the hair on the back of your neck prickle as that familiar irritation sets in and try to stay calm.  "Soon. Why don't you set the table while they finish? Then we can press the chocolate chips in and make smiley faces." "No. I just want to eat NOW!" she says turning up the volume considerably. In  turn, you raise your voice: "I am trying to do something nice here and all you have to do is set the table to help out. NOW DO IT!" She yells "NOOOOOOO!" and runs to her room. You shout after her "No chocolate chips for you then" and flip the pancakes with an aggressive thwack. How did a simple conversation escalate into an unpleasant argument? Why can't your daughter modulate how she expresses herself and just cooperate with your request? Why did you allow yourself to be upset by her in the first place? Families with ADHD children and teens often struggle with emotional reactivity and verbal impulse control. Negative feelings and unpleasant words can intensify in the blink of an eye so that the interaction derails quickly into hostility, screaming and tears. These situations can be easily turned around by bringing everyone's attention to T.O.V.--Tone Of Voice. So often, ADHD kids don't really hear how they say things to other people and don't fully understand the effects of what they are saying on them. They need help learning how to slow down and reflect on what they just expressed. But, since they are usually sensitive to criticism, direct feedback can frequently backfire. Introducing T.O.V. allows your son or daughter to reflect for themselves on how they can say something differently and lets them come up with their own changes on how they are speaking. They learn several executive functioning skills simultaneously: emotional regulation, personal insight and self-control. Here's how it works:

1. In a calm moment, you explain to your ADHD son or daughter (and perhaps your other children too--it works with everyone!) that sometimes people need help learning how their words and their tone of voice affect others. To that end, you will be saying to them "T. O. V." when you think they should alter how they are speaking to you and, at times, to each other. Then, you will give them a minute or two to change how their tone of voice and try again. Sometimes, all of us just need to re-calibrate and do something over. 
2. If your child or teen can't manage to change how they are talking to you, then taking an immediate, timed break for personal space can help. This break allows everyone to calm down and  regroup; it is not a punishment. Usually breaks of up to 5-10 minutes are sufficient but some people need more time. Agree on the time of the breaks when you have the initial conversation.
3. If your son or daughter changes how they are speaking to you by lowering their volume, altering their words from provocative to more neutral or shifting their attitude, YOUR JOB is to respond to their new statements and move forward. Of course, you can appreciate their efforts when the conversation is over which provides positive reinforcement for them.
4. Be prepared that they may call "T.O.V" on you sometimes too, especially if you are yelling. How you respond to this is critical: try acknowledging your feelings or laughing at yourself or admitting that you could do better. However, the goal is not to create a constant calling out of "T.O.V." in your household. It's used for helping your child re-group in selective moments, such as once or twice a day. If you overuse it, it will lose its impact.

I hope that you will give this a try!!!

Celebrate Valentine's Day with REAL Heart!

This week, television shows, Hallmark cards and advertisements tell us repeatedly that Valentine's Day is about celebrating love--romantic love, familial love, friendship love. I even saw a Valentine's Day card for your dog! It can all be a bit overwhelming, especially if you are feeling less loving than the commercials suggest you should be. I would like to suggest that you can transform this day into something meaningful for you and your ADHD son or daughter by being authentic and acknowledging what is positive in your relationship. Often we are so busy with our chaotic lives that we neglect to notice and name things that are going well and move quickly onto what isn't working. While it is great to give and receive funny cards and candy on Valentine's Day, it can also feel wonderful to share and name things that family members like and appreciate about each other. It might sound corny but such conversations or written words, however brief, can have lasting effects. Taking the time to add your own comments about a positive behavior or attitude on a card or at a meal will show that you really see your child's efforts to do well and encourage more of them. Even teenagers who can seem indifferent or combative to you actually listen to your positive feedback. The trick is keeping your comments "short and sweet": you have to grab their attention, be succinct and speak genuinely or your ADHD son or daughter will smell a rat and stop listening immediately. Here are my tips for a Valentine's Day with REAL heart for you and your ADHD child: 1. Talk to your family and set a time for Valentine's Day cards, gifts or exchanges. It doesn't have to be a big deal; just a time when everyone can be together. Make an agreement about the general plan: "We will be giving cards and not gifts." Or, "We will give gifts that are homemade only." Or, "No cards, no gifts, only chocolate." Do what seems natural for your family. Participation is not mandatory but attendance is. 2. If you give cards, write a few things that your son or daughter does that you like. BE SPECIFIC. "I like how you hum when you eat your food." "I love when you give me a hug before bed." "I appreciate when you clear your plate after dinner." "I like your sense of style, even though it's different from mine." If you are doing a verbal exchange, plan what you have to say so you it doesn't seem like you are making things up at the last minute. 3. When you get together as a family, share your cards or comments without elaborating or dwelling on them. Your ADHD son or daughter has a limited attention span and we want this to be fun. Lingering on topics, even if they are good ones, promotes distractedness. Reciprocity and connection, however brief, are the goals here. Enjoy an authentic Valentine's Day!

Trouble starting something? Get MOTIVATED! (RECYCLED 9/22/2021)

Have you ever asked your ADHD son to start his homework over and over and still he doesn't sit down to do it? Even if he is failing the class and it means he won't be able to play on the basketball team? Even if it means that he won't be able to go out on Friday night? It's hard not to become immensely frustrated with him and his behavior at this point. Most likely, he can't start his homework because he lacks motivation--either internal or external--which would get him going. How can parents assist their children in developing motivation? Let's first reflect on ourselves and what helps us do things. It's easy to do something you like, whether it's reading an engrossing novel or playing tennis on a sunny day. It is MUCH harder to do something that you don't like such as folding laundry or taking out the trash. When a task is fundamentally unrewarding or uninteresting, we are not very compelled to do it. We lack internal motivation. When a task doesn't have meaningful deadlines or immediate consequences to get us started (i.e. your boss expects the report tomorrow), it lacks external motivation. In both cases, we have to find something to get us going and our adult brains rely on fully matured frontal lobes to do so.  ADHD children and teens have not yet developed the executive functioning skills to overcome poor focus, disinterest or boredom to get unpleasant tasks done. They often do not possess the strategies or solutions to address either internal or external motivation deficits. If something seems unappealing, they turn away from it--even if the consequences are serious. Most kids have to rely on external rewards to rouse themselves; internal motivation, and the satisfaction a person receives when a dreaded task is completed, comes later-- in early adulthood. So children and teens need help from adults in their lives to create external rewards that are both meaningful and encouraging. Here are some tips on how you can create effective external rewards that will MOTIVATE your son or daughter: 1. Talk about the concept of external motivation. Most ADHD children and teens will acknowledge when they struggle with focusing and what tasks lack inherent interest or value for them. Ask what has assisted them in doing such things in the past and what would entice them to do them now. 2. Decide in advance with your child what the rewards will be for finishing something that is difficult to do. For example, if your son finishes his history project on time, maybe he can go out for pizza with his friends. Or, if he works for 30 minutes, he can earn 10 minutes of social media or music time. Do not remove the agreed upon reward if he engages in a separate behavior that you don't like. If he earned the reward for doing the agreed-upon activity, then he should have it. 3. Remember, (as I have written about in previous blogs) Most ADHD kids and teens have a great deal of difficulty starting something unpleasant because the task seems too large. Break it down into smaller components with timed rest periods during which your son or daughter can engage in a desired activity. Let's say, for example, your 10 year old daughter's room is a mess and you want her to pick it up. Think realistically together with her about how long she can actually work before she gets distracted, let's say 15 minutes. Then, set up 3 15 minute work periods with 5 minute movement, snack or bathroom breaks. Remember that she may need help figuring out where to begin or she may want you to stay in her room and guide her through the process. Your support can be a key to her success. Good luck with your efforts and let's get started!!