ADHD: Managing everyday behaviour

I'm going to start by giving some examples, but I don't want to go into too much detail either so as not to give a "bad image" of them. They're generally tiresome children, exasperating at times, to be watched over like water on a stove... but they're so endearing, so good-natured, so "cuddly" and "I love you", so full of love, that I'd especially like no-one to lose sight of this aspect which helps to compensate for (and also to cope with) the more complicated moments. Example of a morning before leaving for school: That's it, he's up.The whole house is still asleep, but everyone knowshe'sup.He jumps out of bed, the floor echoes, he arrives at thestaircase and there he unloads it. Each step is copiously marked.It's official, he's awake.He looks in the cupboardfor something to eat for breakfast.And yet the cake, specially prepared for this purpose the day before, is thereinfront of him on the table, but he hasn't even seen it. He's found something because you hear the drawer close: wham! You're awake too. You go over to him.Hegreetsyou witha big smile and a big hello, loud and clear.It's clear that the other inhabitants of the house won'tbe able to resist,and you can already hearotherfootstepson thestairs. With a big hello and a big hug, he presses himself up against you and saysina very proud voice: "Yousee, Ididn't make any noise".You're not sure what to sayinthe face of suchenthusiasm.Yes, it's true, you knowhe didn't doiton purpose and thatdeep down he sincerely believes he did his best... well, he did his best. He certainly made an effort not to wake anyone up. He finished his breakfast and went upstairstoget ready forschool.He's got three pairs of trousers out, even though you'd prepared one pair with him the day before, and it'll take 10 or 20 calls beforehe finally gets to the bathroom to brush his teeth (fortunately there comes an age when girls can also be a source of motivation for a boy), whilehe's playing in his room with his pistols, breaking your ears early in the morning with "pling... you'redead" as he throws himself on the floor in a sort of somersault... He's dressed: phew!We're 15 minutes from the start...he'sgot toput his shoes on, there's still time... 1,2,3...7,8... you've stopped counting, there's no point, it just annoys you. His father rants in the bathroom.Quick something that works: "Say darling,are you wearingshoesordoyouneedhelp?"... and miraculously the cupboardopens: shoes in sight.Then youhearhimon thestairs... Is he putting his shoes on? "And then you hear the magical, sublime "Don't worry Mum, I'll put them on".You realise thathe hasn'teven started. His father realises too, and you think you can see smoke coming out of his ears.He's brooding, he's going to belatefor work again ifhe'snot ready. "Darling, I'mnot worried (at this point there'sno point, there's still the option of putting his bloody shoes on... but you might want to take a couple of minutes to do your hair... just for a bit) but we're leaving in less than 5 minutes. And then, a big plammm, he's just thrown away his pistol (yes, because despite your vigilance, he still had one... or did he find another one downstairs?) but miraculously, he puts on his jacket... "er, you'renot forgetting your shoes by any chance"... "Oh, yes, that'strue, he's still got one...or did he find another one downstairs?Oh, yes,that's right.You take the shoes out of the cupboard, give them to him and he simply says "Thanks Mum, you'retoo kind"... And that's how your day started. You then have the solution of punishing him, but you're going to punish him 30, 40, 50... times in one day. So what's the point of punishing him? You need to adopt a different form of education. Punishment means looking to the past, and does nothing to prepare for the future. It is there to eventually obtain a form of obedience dominated by fear and not by intelligence. Results on ordinary children can be obtained in the very short term and on a temporary basis, but nothing positive in the long term. With children suffering from ADHD, it doesn't work and reinforces a negative image of the child and a major loss of self-confidence. Thomas Gordon's book, Effective Parents, is a good educational resource. It invites us to reflect on the place we give to our children and the way we want to direct their behaviour. Children are not little monsters to be trained, but human beings who need to be respected (too!). The general idea is to help children develop their own personalities and blossom. So there's no question of forcing things on them, but there's no question of being lax either. The method is "win-win". The aim is to ensure that the child learns to respect the needs of others and in return be respected in the same way. We also discover active listening (a way of rephrasing the need and encouraging the child to find his own solution, an action based on empathy), "I" messages (as opposed to "you" messages), etc. So we're a long way from the "king parent" or dictator who decides everything and how, but in a communication approach where everyone has the right to speak as a full member of a family or community, whatever their age. What is generally found in books is inapplicable to living with an ADHD child: isolation, punishment, assertion of parental authority (or rather authoritarianism)... To the point where the child feels 'unloved', 'bad', 'wicked'... In short, he loses what little self-esteem he may have. They will only exist in their own eyes through their inappropriate and negative behaviour. They will thus reinforce their attitudes in order to at least exist in the eyes of those close to them. So over time I began to think about what we wanted for our family and what we didn't want. Helping some parents, I heard myself explaining how we had decided to go about it... so I tried to write it down. The general idea is the following postulate: "Family life has good moments with all its members, that all family members find something in it and that they feel loved, respected and safe within this family. It's a cocoon, a place where we can say things to each other, a safe place where behaviour is not dictated by fear of parental reprisals, turf battles... Like many parents, I started with punishments and restrictions, but with an ADHD child, what do you do when after a morning you've had 10/15 punishments? Are you going to take away all his toys, punish him for everything? What does this child think... that he's going to be punished anyway? Isolate him all the time... stick him in his room, put him in the corner: how many times a day, how long each time? So much humiliation, so little result! Or the opposite of the expected results: even more excitement for him, for the punishing adult, a worsening of the problems even with more pronounced hyperactivity (which will in fact resemble purely reactive hyperactivity), permanent defiance... Change tack: if none of this works, then talk about rewards and positive recognition or valuing the positive aspect of behaviour: it's better to value successes than to crystallise the many imperfections! I later discovered that this was called 'behaviour modification'. So yes, there are things to be done. I don't claim to have all the knowledge, far from it. Rather, my intention is simply to give you a few ideas, which you can then adapt to suit your own family choices and objectives. The aim of behaviour modification is to reduce or stop the frequency or intensity of unacceptable behaviour. Some people use reward charts. You may find the idea useful. All you have to do is draw up a chart on which you note the behaviours you would like to see changed. Good behaviour = a green point, bad behaviour = a red point. After X green points (usually 10), the child wins a reward. We tried it. I soon went back to it. Why was that? Because the immediate aspect of the reward wasn't there. These ADHD children are impulsive, they're in the moment and rewarding them afterwards didn't seem like a good idea. Because it's too much like the famous (and I'd say smoky) behaviour chart you find at school: gold star, silver star... points, red point/green point, good points, pictures... and home isn't school! Because generally the idea is to reward with something material and therefore to buy. * So the financial aspect is not negligible. * How do you deal with the rest of the siblings: do you buy them things too? Is there a monthly budget for all the children? * Do we necessarily associate pleasure (reward) with something material? Doesn't our society already have enough of this relentless consumerism? Is this really the value I want to give my child, my children? Nevertheless, as some parents of ADHD children use it successfully, I had to talk to you about it. We can also ask ourselves why this method is so successful with certain children. The reward chart system is similar to "the donkey and the carrot". The idea is that without the carrot, the donkey won't move forward. Some even add the stick to make it go a little faster, a little straighter... And once the donkey has eaten several carrots, will it still be hungry? Is this what really feeds the donkey? So, certainly in the short term, there are results, just as it is also true that if you give 100 lashes, you will have results... but these results will only be superficial, totally linked to the reward which, if it is taken away, everything has to start all over again. This is the risk of the Pavlovian reflex in a conditioning logic. But educating a child is an in-depth process. The excessive and extreme behaviours of ADHD children require in-depth work. It's a long-term process, the results of which will be long but profound. What seems to be innate in other children, what seems to be logically achieved by deducing rules, will not be the case (or very little) in an ADHD child; the social codes will have to be learnt laboriously by this child. Yes, you need patience, patience and a lot of love. The key is to find ways of changing behaviour over the long term. To modify a behaviour, you first need to clearly identify the deviant behaviour. Quite often, it is this deviant behaviour that is highlighted and therefore reinforced: the more it is highlighted, the more it is talked about, the more it exists. So we need to act in the opposite direction... and this is not 'natural' for parents and society in general, which is more inclined to stigmatise what's going wrong rather than highlight what's going right. So, above all, we need to focus on adapted behaviour: we need to value all behaviour that is adapted or comes close to the expected behaviour, while no longer stigmatising non-adapted behaviour. How do you change a behaviour? Thefirst step is to make a list of behaviours that are considered to be deviant, and rank them in order of importance. This order is defined by the parents; the same behaviour will not necessarily be perceived in the same way from one family to another, depending on the family's own degree of acceptance and tolerance. I tolerate behaviour that my neighbour won't and vice versa... but as our neighbour doesn't live with us, everything's fine. In other words, these are your own criteria, not those of others. These criteria have to make sense to you and your family, they are not principles. Take the first behaviour on the list, the one that bothers you the most. You need to clearly identify it. Describe it, clearly define the problem; then specify the desired behaviour. To help you, you can write : the problem encountered a clear description of the problem a clear description of the desired behaviour. Establishing a rule Only implement one rule at a time. A rule focuses on a single behaviour and does not include several.Example: In the car park, get in and out of the car without running. Keep your seat belt on when in the car Speak in a low or normal voice when my little sister is having a nap. A rule does not contain any negations; rules are statements only. Secondly, Discussion between the parents (both parents together) and the child alone. The aim is not to make accusations; if you start a series of reproaches, you will lose sight of the ultimate aim of the discussion, which is to make the child aware of his deviant behaviour. Simply describe the child's behaviour (without superlatives, without using words that are difficult to hear...). Ask them what they think about it and how they feel when they behave in this way. Let them talk, and create a relaxed, trusting atmosphere where each party can express themselves freely, without judgement. This is also an opportunity to hear what your child has to say. Very often the words that come out of the conversation stick, because the child also realises that this behaviour is not what is expected of him or her. Don't say anything, but if they reproach you, listen to them. Give them time to talk, don't interrupt. Why is it important to know how your child feels? Because all too often these deviant behaviours lead to inappropriate responses, responses that may have hurt them, responses that they have not understood... Don't justify yourself, accept what they say and learn to listen. When they've finished, ask them how they could do things differently, how they should behave in a particular situation. Remember that we're only aiming for one rule, so we're only talking about one deviant behaviour. Stick to this theme and don't deviate into others, don't fall into the temptation of making a display of deviant behaviour. Together, establish a rule that will be achievable. Then explain that by following this rule, you will save time, which you can then give back as a reward. Everyone wins: the child gets a reward and you get a reward too. Inappropriate behaviour should be ignored. Beware of negative reinforcement: Highlighting negative behaviour by means of a remark, a thought or a particular attitude is tantamount to emphasising it. In the end, this is tantamount to reinforcing it (negative reinforcement) and putting the child at the centre of a form of power linked to the "obnubilation" of this behaviour. The child attracts attention, but the attention you give him is in no way the right kind of attention or the kind he needs. They've often figured out how to make you angry, how to get you out of your depth, how to do it... and even more so with children with oppositional defiant disorder (ODD often associated with ADHD). Don't forget that you're the adult. You're the one who has to control yourself, you're the one who has to guide him. I'm not saying you have to accept everything, but if you have to express your dissatisfaction, do so using "I" phrases, talking about yourself and not about the child, naming your feelings. You have the right to break down too. You can always start again later. The key is to reinforce positive behaviour: - Immediate reward : If your child has obeyed the established rule (or behaved in a completely appropriate way when he normally wouldn't), you should reward him immediately. Tell them straight away that they've earned a reward and name the reward: 3 minutes of TV, 5 minutes of games, 3 minutes of reading, 3 minutes of extra bath time, 3 minutes just for you, etc. Tell them when they can do the reward (immediately, after homework, when their little sister is having her bath, after dinner, etc.). Don't forget the reward, don't put it off until tomorrow. They've earned it. You can even remind him when he's done it why he's won it (he's obeyed rule X and you're very proud of what he's achieved) and how (by obeying the rule, you haven't wasted time correcting him and you can have a good time). In the early stages, try to ensure that the reward involves the presence of one of the parents: read a book, play a game, etc. so that you can have (or rediscover) moments of pleasure with this difficult child. When the child has earned a reward, whatever his behaviour afterwards (however exasperating it may be), never take away the reward - what's earned is earned. - Express your satisfaction emphatically You knew very well how to reproach him when his behaviour was inappropriate... so you should show him how proud you are of his success. Don't use negatives and use "I" as much as possible to express your feelings: "We went to the bakery and you walked well beside me on the way. On the way there and on the way back. I was very proud to have my little boy next to me. Really, it's a great success, I'm really happy with you. That's great, and I'd like to tell you how pleased I am. I also want to please you, what do you want to please you? The two of us were able to go for a walk and have a chat, and what fun that was! We'll do it again, because I like chatting with you. In fact, I think we both gained from it, didn't we? In case of failure, Understand that your child's behaviour is not going to change overnight. So start by rewarding only positive behaviour. You can tell him that it wasn't easy for him, or for you, that he didn't succeed in the objective you set together, that it's not a big deal and that we can analyse what may have happened and what we can do to make him more successful next time. Then, little by little over time, this behaviour will improve and become part of "normal" behaviour. But this will go through several phases, including a fluctuating phase of successes and failures. If the rule is broken : Repeat the rule to the child immediately. Ask the child to repeat the rule in his/her own words. No punishment or expulsion: just a reminder of the rule. Reinforcement: once the child has been reminded of the rule and named it, encourage them to regain control, open a door for them by building on an appropriate behaviour they have already performed: "I remember when we both came back from the bakery and you were walking next to me and I thought that was great. It was really great. That's what we need to achieve. No accusations, just positive things! When the rule is established It's easy to see when a rule has been learnt. When this is the case, you can introduce a new rule (redo a list, priorities may have changed!) and explain to the child that you are very proud of him, his efforts and his success. Gradually, the rewards become part of the recognition of success. Rewards are no longer given systematically. If the child asks why, simply explain that you are very proud of him and that you feel he has understood what was expected of him. You should then discuss this with them and make them understand that their (positive) behaviour is "normal", without taking anything away from their success. On the other hand, you can use verbal encouragement during this period. When the rule is established... and things get out of hand : First of all, this is a normal process and nothing serious. You need to distinguish between : "not on purpose", forgetfulness, too much excitement.... Take into account the environmental factors that may have led to the rule being broken. In this case, you remind them of the rule and ask them to remind you. You ask them what they should have done. You don't want the child to think that you didn't see anything. There's no point in punishing him in this case because he didn't do it on purpose. When you say "on purpose", you mean that he did it on purpose, that it annoyed him, that he deliberately broke the rule. He couldn't control his impulse. Ask the child to go to his or her room and think. The idea is not to punish them but to encourage them to think. This time will also enable you to avoid knee-jerk reactions and to recover (stay calm). Generally speaking, it's you who needs this time alone to manage the child properly and stay on top of things. The important thing is to avoid saying anything that goes beyond what you're thinking and which, with your irritation helping, the day's tiredness also encourages you to take a step backwards, which could be harmful for the child. You can also say clearly, "You see, I can't do it any more, I must not have the right words because I can't get the minimum from you. So I think it's best if we go our separate ways for a while. I'll tell you when the pressure's off. I'm talking to you about myself, but it's not your fault. I haven't found the right words, the right attitude. Maybe you're too excited yourself... (also allowing him to take his share of the responsibility)". You can also tell him how you felt: "When you did that, this is how I felt...". There's no point leaving him isolated in his room for too long. When you've calmed down, you can go into the child's room and say, "Now that the pressure's off, I'm ready to talk to you, aren't you? If the child isn't ready or hasn't calmed down: "You can come back to me when you're ready". You then introduce a discussion with the child: What do you think of what you've done? What has happened for you? Let the child talk. Listen to what they think about the situation. How did they feel? How does he think we, and the other people involved, felt? What does he think he'll do next time... and how might he go about it? How might he go about it introduces the notion of control. What can he do to control himself? How can we help them regain control when we sense they are slipping? ADHD children often sense when they are about to lose control. With experience, parents can also sense when the situation is about to get out of hand. The problem is that the child is unable to regain control, that he allows himself to be overwhelmed, that he is unable to stop getting excited, that he falls into a kind of one-upmanship... and then he can't go back, he can't do it (see the action of dopamine: here - read the paragraph: where does it come from?). Introduce the notion of wanting to take control... even if it's not a question of willpower but of the disorder itself. The idea is to make him aware that he can have a kind of power over his disorder. They need to feel that they can do something about it: they need to be stronger than their impulsivity, stronger than... It's a difficult battle for them, and it's at the very heart of the problem. So we have to find strategies to help them. These strategies are put in place with the child. Parents and child discuss them together: - stop, think, act: Raise your hand like a red light and say "stop", wait a second and say "think", wait for the child to think, they may even ask you questions like "why", once they have thought (so you can help them think out loud), lower your hand and say "act". If you see that he's not thinking or stopping, you can try using a situation that worked: "remember when you.... I was really happy..." and repeat the "stop, think, act". - Ask them what we can do to help them regain control: they may have some ideas. You can then set up some little tricks between you and him. This is also a good time to explain to him that he needs to fight against his impulsiveness (which leads to low frustration levels, aggressiveness, inappropriate responses, etc.): be stronger than his impulsiveness. The idea is also to "unburden" the child of his inappropriate behaviour and to make him understand that his parents are aware that he has a disorder; this is also the way to teach him what his disorder is and how it works. Children need to know their disorder in order to understand themselves better and to want to take power over it. It takes time, it's a long process, but you mustn't get discouraged. Example: " When I feel like I'm going off the deep end, I come to you and you give me a hug to help me calm down... You tell me to go to my room before things really get out of hand... You remind me that it's impulsivity that's winning the day "... Cuddling and/or physical closeness can help children to calm down. They can act as a break in the surge of excitement (a real cuddle calms things down with gentle words), so don't hesitate to use and abuse them. There are two benefits to cuddling: a return to calm and the introduction of the feeling that you love this little "zebulon". The love, the fact of feeling loved will also give him self-confidence, you have confidence in what he can do. Confidence in him You've lost it over time or it's quite damaged. You can't blame him, he's given you so much to shout about, bursting with limitless imagination, doing things you hadn't even imagined, hadn't even planned... But this trust is essential: absolute trust. Parents must be the first people to have confidence in your child. It's this trust that will give them confidence in themselves. It's a gift, a treasure that we give him. Over time, they will learn that we trust them, that we love them despite all the things they do wrong. Their home should be a place where they feel loved and safe. They know they can count on their parents, and even their brothers and sisters, for their love and understanding. This doesn't mean that parents accept their children's outbursts, but it does mean that they forgive them. They have the right to be unhappy, angry or even furious and to express it, but this will never call into question the confidence they have in the fact that their child is making an effort and that they love him unconditionally. After a difficult day, don't deliberately skip the evening kiss. Mistakes can be made, tomorrow will be another day. You never go to bed, and more generally you never leave angry, without a kiss. You never know what might happen while you're away. After a difficult day, one of those days that you'd like to take off the calendar, take a moment and find a moment of happiness in your day. If you think about it, there are few "great moments" of happiness in a lifetime. On the other hand, there are always several moments of "small happiness" in a day. Learn to see these small pleasures. Learn to look for them at the end of the day and to gorge yourself on them (your child's "I love you", a smile, a wink, a brief moment of complicity...) It's these moments of happiness that you need to remember; they're what will help you, day after day, to get going again the next day. Give yourself this gift!