Managing Childhood ADHD Without Drugs: Coursera ADHD Class Week 11

The last couple weeks of the Coursera class on ADHD focused on how to live with and manage ADHD symptoms without drugs. “Pills don’t teach skills” and whether parents of children with ADHD or adults with ADHD embrace the idea of medical therapy, drugs are not the only treatment approach for helping someone with ADHD thrive.

Students with ADHD need support both at home and within their school environment. In fact, the US Department of Education has put together a fairly comprehensive brochure on how to teach children with ADHD. After giving teachers some guidance on how to identify children with ADHD, it has three separate sections on how to help a child with ADHD be successful in the classroom. Although rumors abound about teachers that, subtly or not so subtly,  have told parents to put their kids on ADHD drugs, that isn’t one of the teaching strategies. Instead the pamphlet focuses on instruction techniques, effective behavioral interventions, and classroom accommodations. It suggests a student with ADHD should sit closer to the teacher and farther from distracting kids. Wow, who would have thought? I know some elementary school teachers are resistant to “special” seating “privileges” for students with ADHD, perhaps referencing this official brochure will help parents get the seemingly minor accommodations their children need. Multiple times the brochure makes the point that children without ADHD also thrive in classrooms that are structured to help children with ADHD. Basically, these are strategies that can help any teacher be more effective regardless of the makeup of their classroom in any given year.

At home, one of the most effective treatments for children with ADHD is teaching their parents better behavior management strategies. By acknowledging that their child has below age-level-norm organizational, self-control,  and coping skills, parents can structure the home environment with scaffolding supports to help the child succeed despite their ADHD symptoms. There are several different training programs for parents. Most have similar elements: stay calm and don’t get emotional, analyze what is working and what isn’t, rely on planning and praise to gain compliance, go to the child to give instructions — use eye contact and touch to get child’s attention before giving instructions, break large tasks into smaller ones, use labels, file cards, and other visual cues and organizers to make tasks less daunting, reduce time delays for consequences (positive and negative), and use warnings, “when-then”, token economies and time outs to guide behavior. Work with the child to create better habits and more effective behaviors. If the child is encouraged to help evaluate the results of the program, it can increase their commitment and desire to change.

One comprehensive parent behavioral training program covered in some detail was one developed by Russell Barkley. Dr. Barkley has written extensively about executive function, defiant children, and how to take charge of ADHD. Putting the effort into learning how to be a better parent for a child with ADHD is very worthwhile. Studies show that not only do children do better with more effective parenting, parental stress is also decreased and satisfaction is increased under these programs.

Adults with ADHD face slightly different challenges than kids with ADHD. Some of these challenges stem from the bad habits and/or negative thought patterns that can develop over a lifetime of living with ADHD. My next post, and the last in this series, will cover psychosocial treatments for adults with ADHD.

Personal Responsibility: Summer Report Card

Summer is almost over. Next week we have our back-to-school night and then school starts just after Labor Day. It is time to evaluate the results of my summer project to push the kids to take on more personal responsibility.

Well, apparently I am not so much a chart person. The chore chart idea only lasted a week and a half. They stopped filling in the charts and I stopped printing out the charts. Grade F for charted chore tracking.

Digging deeper into what exactly they were supposed to do, as defined by the unused charts, things start to look a bit better. On the personal chores list, even without a checklist, the kids consistently were about 90% successful in getting things done. While beds were not made, they used sunscreen enough to avoid burns, practiced piano, and brushed their teeth. They did need more reminders than would be ideal and there was a direct correlation between my reminders and their success. Since I rarely reminded them to make their beds, and they had no personally compelling reason to make them on their own, beds were not made most of the summer. The one exception to this happened about every two weeks when I forbid them from playing or having friends over because their rooms had gotten too messy. At those points the bedrooms were carefully cleaned.

The family chores followed basically the same pattern. They were/are perfectly capable of helping keep the house clean and did so easily when directed. They just didn’t reach the point where they would do it without being asked. I suspect part of this is the fact that since I specifically did not assign chores, each of the three kids waited to see if someone else would jump in and do the work. Reversing the pattern of 11 years, as often as possible I made sure it wasn’t me doing the chores when things were left undone. Instead I stepped in to directly assign chores as needed. Since June I have done the dishes less than 5 times. The kids no longer assume that it is my job. They just hope is isn’t their job. Overall I’m giving the concept of the kids taking on more responsibility for the house a grade of C. They know how to do the work and they are willing to do it, they just aren’t proactively seeing a need and filling it.

Most households with kids specifically assign jobs to each kid and I may have to adopt this strategy for the upcoming school year. However, I’d still rather see them treating the house as their own and doing what needs to be done without being told. Before we go to strictly assigned chores, I’m trying one more strategy. They now have to make a daily list of all household chores to do that day and then collaboratively split the jobs among themselves. We will see how it goes. . .

One chore that received an A+ wasn’t even on my radar back in June. Laundry. I showed the kids how to use the washer and dryer and told the older two, ages 11 and 9, that if they needed clean clothes they knew how to get them. (The youngest, age 7, has helped out with his clothes though he is physically too small to take over 100% of the job.) Over the last month, I haven’t washed the two older kids’ clothes at all.  The kids have proactively carried their clothes to the basement, washed and dried them, and returned the clean clothes back to the bedrooms. They haven’t even called my attention to this extra work they are doing. I guess having clean clothes to wear is a powerful motivator.

 

 

Personal Responsibility

Regular readers will know that I’m pushing the kids this summer to develop some new, powerful, personal habits. This push has dovetailed nicely with my increasing awareness that like many US children, mine are not contributing much to the ongoing running and maintenance of the household and are failing to become self-reliant.

Elizabeth Kolbert of The New Yorker, suggests that the current generation of US children are perhaps the most dependent and indulged in the history of the world. This topic fascinates and worries me on both a personal level and a societal level. How effective will our kids be in their 20s, 30s and beyond? Will they be the capable, thinking adults that our country will need to get through the 21st Century? While we are striving hard to provide our children with an easy and worry-free childhood, we are bequeathing them a world with crumbling infrastructure, global warming, economic issues, and food pressures that will be anything but cushy. Our kids need to be ready to take on the adult challenges of their generation.

Well, first steps first. This summer in our house the kids are taking care of themselves, their rooms, and some of the basics around the house.  Each of them has personal, daily chores and there are also daily and weekly family chores. They are not being paid for the chores. They do not receive allowances. I am trying to get the idea across that money does not magically appear because they made their beds or did the dishes. That isn’t the way the real world works. The work that must be done to keep a household running is not work that they, or anyone else in the house, gets paid to do. I am also not assigning the family chores — allowing them the opportunity to step up and do what needs to be done without being told. When they have done a family chore they get to sign their name on the chart. (Anyone whose name does not appear with enough frequency will have consequences.)

So far, with reminders from me, most things are getting done. Hopefully by the end of summer they will be more proactive.

 

 

 

 

Creating Powerful Habits, part 3

This summer I will be working with my three kids to instill some new, healthy habits that will hopefully last a lifetime. We will be testing out the latest research on habit creation. It suggests that to set a pattern of behavior there needs to be a trigger that simultaneously sparks a desire for a specific reward and starts the action pattern to get to the reward. For example, donuts arriving at the office triggers a mouth-watering craving and before you know it, you are half way through your first donut.

The last three weeks I have attempted to set a new habit for myself of jogging first thing in the morning, three mornings a week. I am not a runner and have not been exercising regularly so this is a challenge. Using what I have learned, I first set the schedule and tried to make the behavior pattern as simple as possible. Running clothes are by the bed, the route is set, the time is set. Variables and choices need to be eliminated as much as possible to create a specific habit. The mere process of making a choice is mentally draining and diminishes the will power I need to get out the door and start my run. Habits in a way are the exact opposite of thoughtful choice. We can make a thoughtful choice to create or change a habit but the habit itself is automated.

In my attempt to set this behavior pattern the challenge is getting out the door. Once I am on the path all I need to do is run the pattern. I’m still working on setting the proper reward. Because scent is such a power trigger, I change-up the shampoo and soap in the shower on days when I run. I am also tracking and documenting the runs in detail so I can visually see the pattern I’m creating.

I am highly motivated to set my new jogging habit. I doubt the kids will be personally motivated to create the habits I choose. That means setting a simple behavior pattern and consistent, high value rewards will be key. Although I won’t finalize my choices for new habits to instill until school is out, my short list for all three kids includes:

  • Daily morning exercise and/or stretching
  • Daily morning face washing and application of sunscreen
  • Morning bed making
  • Evening bedroom straightening

Of course each of the above is just an idea. To make them habits the specific behaviors need to be broken down into detailed actions that can be consistently replicated with valuable, self-reinforcing rewards at the end of each habit.

Now here is where it gets interesting when trying to instill lifelong habits in kids. Frequently adults turn to the easy rewards of treats (usually some form of sugar) or money when trying to encourage kids. Our local public elementary schools consistently use candy to encourage the younger kids and then candy and fake money (that can be spent on donated toys and treats) in the older grades. However, in order for a habit to be internalized, I suspect the reward also needs to be internalized. Rewards for habits that last a lifetime need to be rewards that last a lifetime and work for kids living at home, young adults on their own with limited resources, and older adults. Candy is cheap but we really don’t want another generation growing up fat  because they “deserve” the candy bar. Empty calories are not a good reward. While working hard as an adult might lead to more income, it is not something that easily translates into a reliable reward. For instance, I think my run this morning was a $100 effort but I’m still waiting on that reward.

I need to develop rewards that are highly reinforcing for the kids and will last a lifetime. Any ideas?

Creating Powerful Habits, part 2

Knowing we have a responsibility to help our kids develop good habits begs the question, which good habits?

The list of habits we can instill runs the gamut from regular toothbrushing to standing to the side when the elevator first opens. It is impossible for us to foster all good habits so we much choose the most effective ones that will have the greatest impact.

According to Paul O’Neill of Alcoa and others in Charles Duhigg’s book, The Power of Habit, in businesses there are certain keystone habits that can influence how people work, eat, play, live, spend, and communicate. Keystone habits can work the same in individuals. So which habits are keystone habits?

Keystone habits that research has shown trigger other good habits include:

  • regular exercise
  • eating dinner together as a family
  • making your bed every morning
  • eating breakfast

The above master habits can help people eat better, become more productive, show more patience, use credit cards less frequently, feel less stressed, have greater emotional control, and more confidence.

I’m betting to the above list we can add a few more such as:

  • wearing sunscreen daily
  • a behavioral pattern for handling and working through frustration and problem solving
  • looking people in eye when talking to them
  • maintaining an organized work area
  • a habitual system for working on and tracking long-term projects as daily or weekly activities

What other important habits should we help our kids develop and how can we do so?

 

 

Creating Powerful Habits, part 1

As a psych major, I’ve always been interested in how our brains work. As a mom this interest has become focused on, for lack of a better description, best common practices. How can we best help our kids to grow up as secure, compassionate, effective, happy, and successful adults? How will the experiences and thoughts of our young children shape them into the types of adults they will be when they are 20? 30? 60? How much has already been pre-determined by genetics and how much can we realistically influence?

Over the weekend I started reading a fascinating book that appears to offer a relative straightforward answer to the above questions. The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg was just published on February 28, 2012 and encompasses the latest research on habit formation. The bestselling book is fascinating and is getting a great deal of positive press.

According to Mr. Duhigg, scientists have been able to show that once a habit is formed, we work on autopilot conserving our energy and brain cells for more involved pursuits. They have also shown that habits never disappear. They can be covered over by new habits but the old habits remain in our brains, ready to spring into action when triggered by just the right cue. While Mr. Duhigg focuses more on the habits of individuals, organizations and societies, I find the potential for parents far more compelling.

The habit formation loop is simple: Cue -> Routine -> Reward. While it can be difficult to change our own poor habits as adults (although if you are interested, Mr. Duhigg’s site has a How to Change a Habit flowchart) creating good habits for our kids might be easier. We manipulate their worlds already. We are in charge of many of their rewards. A little bit of planning, dedication, and finesse on our parts and we can equip our kids with a solid set of ingrained actions and thought processes that will help them live happy and fulfilling lives.

The importance of actively helping our kids create positive habits is brought home by another recently published book that is in the news, The End of Illness by David B. Agus, MD. Dr. Agus, a leading oncologist, is calling for a complete change in the way we approach health. One of the items he lays out as critical to optimal, long-term health is daily routine.

If we accept that part of our parenting duties is to help our kids create habits and daily routines that will serve them well as adults, our jobs just got both more complicated and much, much more interesting. Check back to follow our progress as I go through the book and work with the kids to create powerful new habits.