“You are the bows from which your children as living arrows are sent forth.” — Kahlil Gibran

Parents who have children with ADHD love them, as they are usually quirky, think outside the box, are straight forward with their feelings, energetic, charming, and creative. Parents also know that they can be demanding, fiery, and very difficult to raise. Sometimes parents can feel shattered and helpless and don’t know where to turn.

Evidence-based treatment for ADHD includes a package of psycho-educational information, classroom strategies, parent training, medication, social skills groups, and if necessary specialist school placement. Parent training (PT) offers methods to learn specific behavioural management training to apply the principles at home. PT in a group may also give parents a sense of support and affinity with the other parents.

PT teaches behavioural strategies to parents and is one of the most effective forms of treatment as validated by multiple clinical trials. It helps parents to assist their children by giving them specific strategies. We know that the use of effective parenting techniques is one of the best predictors of success in adulthood. PT needs to be specific for ADHD because often the straight forward parenting programmes do not always work for these kids with challenging behaviours.

Last September, the National Institute for Health and Clinical Excellence (NICE) guidelines emphasised the importance of parent training as the first choice for treatment in many cases for children with ADHD. Eric Taylor, a Professor of psychiatry at King’s College Hospital and Britain’s leading ADHD authority stated in a BBC news item that “For milder cases, we recommend starting with behavioural therapy.”

What are effective parenting techniques for kids with ADHD? I have been facilitating groups for many years and the components of the PT always begin with systematically providing parents with factual information about ADHD and the common coexisting conditions these kids have. Parents need to know the facts and not be deceived by the sensationalism of the media and personal agendas promoted by those who ignore scientific evidence. Russell Barkley states: “Education and knowledge about the disorder is more powerful than anything else you do. Teaching people about their disorder is crucial. Our studies show it actually changes more behaviour than the active treatment. It gives people (teachers, family members, employers) knowledge from which they can re-frame their understanding of sufferers. That’s a very powerful act. So much change takes place just from giving people accurate information.”

PT utilises cognitive therapy techniques to enhance parental acceptance, understanding and management of the disorder. Parents have had to struggle with the stigma of having a child with challenging behaviour. They have often felt judged by professionals who indicated that their child’s problems were caused by poor parenting despite the puzzling aspect that their other children who did not have the condition were faring relatively well in most cases.

Parents need specific help, like managing their children in public places. PT gives them specific techniques for managing their own temper and frustration when they are disciplining. The apple never falls far from the tree, and research shows that ADHD is highly heritable, so often one or both parents can have ADHD themselves. The strategies are welcomed and appreciated by most parents. The saying, “If you keep doing what you’ve always done, you will keep getting what you’ve always gotten” is an appropriate description of the parent-child dynamic. PT helps parents to try out and become skilled at new and specific training steps to change old patterns in themselves and their parenting.

PT teaches strategies to parents to target not only their primary ADHD symptoms, but also many co-morbid features including oppositional defiant behaviours and conduct problems. PT interventions utilise parents as co-therapists, thus deriving indirect therapeutic benefits from their involvement in treatment. It helps parents to make clear, specific requests of children, to use praise and rewards for complaint and positive behaviour more then focusing on punishment. At the same time the use of natural, logical consistent consequences with empathy are crucial in helping kids with ADHD become more responsible and accountable for their behaviour.

PT involves various methods of contingency management (e.g. improving the effectiveness of commands) transition planning, altering tasks and environmental settings and modifying points of performance to help children with ADHD. Positive attending, token point systems, response cost, and tailor made time out (or loss of privileges for teens) from reinforcement are also key components.

Parents are taught specific ways to communicate verbally (or when to say nothing and detach) and to become more aware of their body language expressed to their children. The focus is also on enhancing their child’s strengths and talents, as this often gets overshadowed by the day to day problems. Helping parents create monitoring methods such as daily home-school cards and developing a partnership with teachers and understanding their child’s educational rights are vital to their child’s educational progress. Parents are also encouraged to take better care of themselves through self-nurturing and a healthy lifestyle.

Many children with ADHD suffer from problems with self-regulation much more than attention problems. Executive functioning deficits become an obstacle for the child to transfer external events into mental internal events, to move from other-control to self-control, to distinguish the here-and now from the anticipated future, and to progress from immediate to delayed gratification. PT offers strategies which include planning, problem solving, organisation, and using externalisation of time (clocks, beepers, calendars, visual time tables) to help with their time-blindness.

Parents who want to participate may need to ask around for evidence-based classes. Parents can ask their local CAMHS if these groups are run and can also contact http://www.addiss.co.uk and http://www.adders.org . There is also a government programme called the Parenting Programme Evaluation Tool (PPET) which has been developed with reference to international standards of best practice in the delivery of early intervention and prevention programmes. http://www.commissioningtoolkit.org/

In our local community there is a group of veteran parents who have also been trained to support other parents via groups, workshops and local events — http://www.helpp.me.uk. Their focus is on helping other parents manage and cope with the impact of conditions like ADHD and autism, helping with school problems, and supporting parents who may be waiting for an initial appointment with their child at their local CAMHS.

There are also lots of great books for parents of children and adolescents with ADHD, but I recommend a brand new book called: Superparenting for ADD: An Innovative Approach to Raising Your Distracted Child by two giants in the field of ADHD, Dr Edward Hallowell and Dr Peter Jensen.

I end with something inspirational written by Hal Meyer, a friend and colleague of mine who has given me permission to share this (and change Mom to Mum). He is the original author; however various versions have appeared over the internet .

Letter to Mum and Dad

Dear Mum and Dad,

1. Don’t spoil me. I know quite well that I ought not have all that I ask for. I am only testing you. Love is not measured by the number of gifts you bestow on me, but the way you listen to me. Respect me and guide me as I grow up.
2. Don’t be afraid to be firm with me. I prefer it, it makes me feel secure. It helps me learn boundaries.
3. Don’t let me form bad habits. I have to rely on you to detect them in the early stages.
4. Don’t make me feel smaller than I am. It only makes me behave stupidly “big.” My self esteem is fragile.
5. Don’t try to discuss my behavior in the heat of the situation. For some reason my hearing is not very good then and my cooperation is even worse.
6. Don’t correct me in front of others, if you can help it.
7. Don’t make me feel that my mistakes are sins. It upsets my sense of values. We all make mistakes. Help me learn from my mistakes, not suffer because of them.
8. Don’t protect me from consequences. I need to learn the painful way sometimes.
9. Don’t be too upset when I say “I hate you.” It isn’t you I hate but your power to thwart me and the fear that I have lost control of the situation. I do know that words and actions can hurt more than physical abuse. We need to both try harder.
10. Don’t take too much notice of my whines and complaints. Sometimes they get me the attention that I need, but you and I both know I’d be better off getting attention in a “healthier” way.
11. Don’t ignore bad habits. They are danger signs that you and I have a problem.
12. Don’t nag. If you do I will have to protect myself by appearing deaf.
13. Don’t forget that I can not explain myself as well as I should like. This is why I am not always accurate. Many times I do things that I am not sure why I did it. They were not to hurt you– or myself. I really did not know why.
14. Don’t put me off when I ask questions. If you do, you will find that I stop asking questions of you and will seek information elsewhere.
15. Don’t be inconsistent. That completely confuses me and makes me lose faith in you.
16. Don’t tell me my fears are silly. They are terrible and real and you can do much to reassure me if you understand.
17. Don’t ever suggest that you are perfect or infallible. It gives me too great a shock when I discover that you are neither. No one is perfect, nor always right or wrong. That’s okay.
18. Help me grow to know the difference between right and wrong.
19. Don’t ever think that it is beneath your dignity to apologize to me. An honest apology makes me feel surprisingly warm towards you.
20. Don’t use force with me. I respond more rapidly to being led than to force or to ultimatums.
21. Don’t forget how quickly I am growing up. It must be very difficult for you to keep pace with me, but please do try. Help me grow.
22. Don’t forget that I don’t thrive without lots of love and understanding, but I don’t need to tell you that I don’t need smothering, but providing examples.
23. Don’t make promises you cannot keep. Remember that I feel badly when promises are broken.
24. I am sorry for the words I spoke and the promises I made that I could not keep.
25. I am sorry for all the things I meant to do and I did not; for the things I tried to do and did not succeed in doing.
26. We must hold fast to our dreams
    For if dreams die
    Life is like a broken winged bird that cannot fly.
    Hold fast to our dreams
    For when dreams go
    Life is a barren field
    Frozen with snow. (Langston Hughes)
27. Please keep yourself fit and healthy, I need you!

Copyright © 2006 Harold Meyer. All rights reserved.

Reference:

Harold “Hal” Meyer, M.B.A., founded The A.D.D. Resource Center in 1993. The Resource Center was a natural outgrowth of the work he had begun in 1989, as co-founder of CHADD of New York City (Children & Adults with Attention-Deficit/Hyperactivity Disorder) http://HaroldMeyer.org

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