Worried your child has ADHD: first steps
If you’re worried that your child has attention deficit hyperactivity disorder (ADHD), it’s a good idea to seek professional advice.
For example, you might have noticed that your child seems to have difficulty staying focused and completing tasks at school. Or perhaps your child seems to have trouble paying attention or controlling his impulses.
The first step is to visit your child’s GP or paediatrician. If your child isn’t already seeing a paediatrician, her GP might refer her to one or to a child psychologist or psychiatrist for further assessment.
If your child is diagnosed with ADHD, you, your child and your health professional can work together to develop an individualised management plan.
Sometimes children aren’t diagnosed with ADHD until they’re teenagers. This is because their symptoms might not cause problems until later childhood or the teenage years, when schoolwork and other life demands – for example, starting secondary school – become more challenging.
Managing ADHD in older children and teenagers
Managing ADHD in teenagers is first about accepting that your child will behave in challenging ways at times and might have difficulties at school. Also, teenagers go through lots of social, emotional and physical changes, which can make things even more complicated. And teenagers with ADHD can develop mental health difficulties, including anxiety and/or depression.
Gathering information is key to understanding your child’s condition and how to manage it. And it’s part of working with health professionals to develop a management plan, which can help with your child’s social and educational development.
Developing a management plan involves getting a balance between what you and your child’s teachers expect your child to do and what he actually can do. It might include setting up a daily routine, clear rules and consequences for your child’s behaviour.
To get the balance right, a management plan might include:
- behaviour strategies, including strategies for the classroom and home
- support for any other learning, behaviour and emotional problems your child might have
The best plans are usually based on sound professional advice that takes into account what suits your child and family. Plans should consider all aspects of your child’s life, including your child’s needs and responsibilities at home, at school and in other social settings. They should also include some long-term goals – for example, skills you’d like your child to have by the time she leaves school.
Discussing your plan with family, therapists and teachers will help everybody have realistic expectations of your child’s behaviour. You can also let people know about useful ways to handle your child’s behaviour, as well as the things your child finds difficult. And if other people need to supervise your child and his medication, they’ll need to know how much he takes and when.
Behaviour strategies for ADHD in teenagers
As your child moves into the teenage years, you and she might face different challenges in managing her behaviour.
Your child will want and need more independence as he gets older, and he’s likely to be pushing the boundaries you set. This is all normal. But your child’s ADHD symptoms – and any social and academic difficulties he has – might make the journey to independence a bit harder.
Behaviour strategies focus on teaching your child the skills she needs to increase her cooperative behaviour and reduce her challenging behaviour. The ideas we suggest below might also be useful for encouraging your child to take responsibility for managing her own behaviour.
You can start learning about and using these strategies even if you’re still waiting for an official diagnosis for your child.
Clear verbal instructions
Your child will find it easier to behave well if he has a good understanding of what you want him to do. Clear, easy-to-follow verbal instructions linked to consequences will help. You can help your child to follow verbal instructions by:
- making sure you have your child’s attention and keeping eye contact
- keeping instructions clear and brief, with the shortest number of steps
- showing your child what to do – for example, showing your child how to put clothes away in the wardrobe.
Your child might find it hard to cooperate and might even argue with you. If your child is behaving angrily or defiantly, you could try:
- keeping your voice and face calm
- walking away for a little while and then coming back – for example, ‘I’m going to get a glass of water. I’ll be back in one minute and you can tell me what’s on your mind’
- encouraging your child to make a choice about her behaviour and its consequences – for example, ‘You could choose to keep arguing and miss your screen time. Or you could take a break and we’ll talk in five minutes. Let me know what you decide’.
Tiredness and energy levels
Tiredness and lack of sleep can make your child’s behaviour, emotions, attention, social relationships and school performance worse. You can help your child get enough rest and keep up his energy by:
- encouraging your child to get at least 9-10 hours of sleep each night, and to go to sleep and get up at much the same time each day
- providing healthy food options to help with energy and alertness
- building rest breaks into activities
- encouraging your child to break up his learning tasks, like reading or homework, with brief stretches of physical activity
- keeping screen time to a minimum during the day and making sure all electronic devices are switched off at least an hour before bed.
Regular, predictable routines
Keep changes in routine to a minimum. You can help your child manage her symptoms by:
- letting her know in advance about changes – for example, you can say, ‘In five minutes, you’ll need to shut down the computer and turn your phone off’
- talking to your child about her daily schedule. You can also work with your child’s teachers to check that your child is keeping up with her workload
- helping your child with scheduling and organisation by setting up a reminder system at home – for example, a daily timetable with tasks that your child ticks when she has done them.
You can help your child develop his social skills by:
- teaching him what to do if somebody teases or bullies him – for example, walking away
- reminding him of the consequences of specific actions – for example, less time on the phone or computer if he doesn’t ring home to say he’s going to be late
- role-modelling fair and consistent behaviour towards your child and others.
Praise for positive behaviour
Praise and encouragement are powerful motivators. Teenagers might seem self-sufficient, but your child still wants and needs approval. When you notice and comment on her positive behaviour, you encourage her to keep behaving in that way. You could try:
- encouraging your child to do activities where she’s got a good chance of going well – for example, sports, music lessons, drama classes and so on
- going over highlights with your child at the end of each day. You can also talk through things she might have had trouble with.
In the classroom
You can talk with your child’s teacher about:
- dividing tasks into smaller chunks
- offering one-on-one help whenever possible
- planning the classroom so that children with additional needs are seated near the front of the room and away from distractions
- making a visual checklist of tasks that need to be completed
- allowing some extra time to finish tasks.
To get the support your child needs for any learning problems at school, you might need to ‘speak up’ for your child. This could involve talking to your child’s classroom teacher, the principal, the additional needs support officer or teacher or others about special programs, funding and other help for your child.
Schools can help by setting out these support plans in your child’s individual learning plan. The school should also work with you to set and review your child’s goals in regular support group meetings.
Doctors will sometimes prescribe stimulant medications for children and teenagers diagnosed with ADHD if children’s symptoms are causing significant problems. These medications improve the way the parts of the brain ‘talk’ to each other. This can help children and teenagers with attention and self-control.
Methylphenidate is the most commonly used medication of this type. It’s marketed under the brand names Ritalin®, Ritalin LA® and Concerta®. These different types of methylphenidate vary in how long their effects last – from 3-4 hours for Ritalin to about 10 hours for Concerta.
Dexamphetamine is another stimulant medication, and it also comes in short-acting and long-acting forms. It’s marketed under brand names Adderall® (short-acting) and Vyvanse®(long-acting).
Your child’s paediatrician or psychiatrist will work out with you which drug and dose will be best for your child.
Here are a few questions you might want to ask your doctor:
- What are the side effects of the medication?
- How long do side effects last?
- How should side effects be monitored?
- Does my child need to take the medication every day, including weekends and holidays?
- Can my child stop taking it suddenly?
Stimulant medications can cause some side effects – for example, loss of appetite. This can affect your child’s weight gain. There might also be some minor effects on your child’s height growth. Occasionally stimulants can make people feel more anxious.
If your child has been prescribed stimulant medication, your health professional should be monitoring him closely. If there are side effects that are causing problems, your health professional might change the type, dose or timing of medication to help with this.
There are some other medications available for treating ADHD. One is Strattera® (atomoxetine). This medication might reduce anxiety a bit too. Another is Catapres® (clonidine).
Managing medication in older children and teenagers
As children get older, they often want to take more responsibility for their medication, which is a good thing. Some children also go through a period where they don’t like the idea of taking medications.
Either way, if your child can share her feelings about taking medication, you’ll be better able to understand where she’s coming from. Listening to your child will also help you understand how the medication affects her daily activities.
It’s also good to encourage your child to discuss things with his GP or paediatrician. You might suggest he has part of his appointments alone with the doctor.
Support for yourself
Looking after yourself by asking for help and support is a big part of managing your child’s ADHD. Here are some options for you to think about:
- Ask for help from family members and friends. If your child relates well to a particular family member, like an aunt or a grandparent, that person might be able to spend some time with your child so you can have some time out.
- Go to a support group, or join an online forum for parents of older children and teenagers with ADHD.
- Talk to your child’s health professional about any difficulties you’re having.
- Learn about stress and how you can handle it.