ADD / ADHD Parenting Q & A

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ADD / ADHD Parenting Q & A

  1. 1. ADHD Awareness Expo www.adhdexpo.com ADD / ADHD Parenting Q & A Dr. Rory Stern enter. Sep 17 2010, 4:54 PM Rory F. Stern: Hi everyone Sep 17 2010, 4:54 PM slipreefish724: Do you recommend it as a good resource and tool when attempting to help a child with challenging behaviors?? Sep 17 2010, 4:56 PM Rory F. Stern: Hi everyone...so I am still learning the technology here and I might have lost your questions if you asked them already... So if you have questions for me, please go ahead and ask away
  2. 2. Sep 17 2010, 4:57 PM Rory F. Stern: @slipreelfish724 - Do you mean "what" tools do I recommend? Sep 17 2010, 4:58 PM Rory F. Stern: test test test Sep 17 2010, 4:59 PM Guest726 (guest): Hi, Rory! Sep 17 2010, 4:59 PM Rory F. Stern: Hi @726 Sep 17 2010, 4:59 PM Rory F. Stern: I'll begin answering questions soon if anyone has questions on Parenting Children with ADHD Sep 17 2010, 5:01 PM Rory F. Stern: @Nicole I don't necessarily have specific tools as much as I recommend setting clear rules, boundaries, and expectations as a family Sep 17 2010, 5:02 PM Rory F. Stern: With that comes the need for follow-through on the rules and both parents or caretakers to be on the same page....consistency is everything Sep 17 2010, 5:02 PM Rory F. Stern: That said, I do believe that some children can benefit from behavior charts...but that all depends on the individual child. It may work for some and not for others Sep 17 2010, 5:04 PM Rory F. Stern: @slipreelfish - did that answer your question too? Sep 17 2010, 5:05 PM Guest679 (guest): What evaluation do you recommend to diagnose 9 year old girls with ADHD that also have a diagnose with Neurcognitive Disorder, alcohol unknown but suspected and a Sensory/Regulatory Disorder?
  3. 3. Sep 17 2010, 5:07 PM Rory F. Stern: @679 - I would recommend speaking with a neuropsychologist about having a full evaluation if you are looking at multiple conditions to rule in or out Sep 17 2010, 5:07 PM Rory F. Stern: You also might need to see a sensory specialist to have that evaulated Sep 17 2010, 5:08 PM Rory F. Stern: ADHD is a difficult condition to diagnose, and the gold standard is a clinical interview Sep 17 2010, 5:09 PM Rory F. Stern: When you include other conditions, especially behavioral, psychological testing can help clarify the diagnostic picture Sep 17 2010, 5:10 PM Guest859 (guest): suggestions on positive behavior plans in school to encourage tolerance Sep 17 2010, 5:12 PM Rory F. Stern: @859 can you tell me a little more about what you mean? Do you mean behavior plans with the schools help? Or do you mean help with awareness and tolerance at the school? Sep 17 2010, 5:12 PM Bonnie (guest): What do you suggest for my 16 year old son who can't sleep well and is afraid of being alone in the dark. My husband tries to understand, but thinks we need to be tough on getting him to grow up. I understand what he is saying, but at the same time I know that these things are symptoms of ADD. Sep 17 2010, 5:13 PM Rory F. Stern: Hi Bonnie - I'd first want to know why he has a difficult time sleeping? Have you had him speak with a psychiatrist? Is it related to ADD? Is there something going on in the home or at school that is upsetting him? Sep 17 2010, 5:14 PM Rory F. Stern: If it's related to ADHD, I'd want to know if it is a side-effect of the medication? There are also sleep clinics that can check his sleep cycle to see if that is affected or how it is affect.
  4. 4. Sep 17 2010, 5:15 PM Rory F. Stern: It could be as simple as switching his diet or using "melatonin" to help with sleep...and if you consider that route, I would absolutely speak with a psychiatrist or your son's prescribing physician first. I am NOT a medical doctor, so always check first Sep 17 2010, 5:15 PM Rory F. Stern: The reason I asked about things at home or at school...could be related to anxiety, stress, or any number of factors. I am NOT suggesting something is going on, but I always want to look at the big picture... How is the child interacting with and responding to his environment? Sep 17 2010, 5:16 PM Rory F. Stern: In terms of being "more tough," that can work, but I always take the approach of understanding and comfort first. Sep 17 2010, 5:17 PM Rory F. Stern: At 16, I am going to think that there is some pattern or recent change affecting this behavior, so I want to understand the behavior and what caused the change... It's like they say, you get more bees with honey Sep 17 2010, 5:17 PM Rory F. Stern: I'm sure you know this Bonnie, but sleep is incredibly important for everyone, particularly for people with ADHD, so it's important we balance sleep, with exercise, and diet. Sep 17 2010, 5:18 PM Rory F. Stern: I want to make sleep a positive experience...so getting "more tough" could take away the positive benefits of going to sleep and recharging our batteries. Sep 17 2010, 5:18 PM Rory F. Stern: I hope that helps, and if you have more questions, please let me know or follow-up with information and I'll be happy to answer Sep 17 2010, 5:18 PM Rory F. Stern: Before I answer the next question, I just want to welcome you all here! Sep 17 2010, 5:19 PM Rory F. Stern: I see a lot of great questions and I will do my best to answer as many as I can.
  5. 5. Sep 17 2010, 5:19 PM Rory F. Stern: If you were here before we started at 5:00 PM, I need to ask you to ask your question again. I made a "goof" and lost some of the questions. Sep 17 2010, 5:19 PM Guest30 (guest): Hi Dr Rory nice to meet you. I am going to be working with a child who is 4 years old with ADHD and he is also deaf. Also i will have two boys with Autism any advice Sep 17 2010, 5:19 PM Rory F. Stern: Hi Guest30 - Nice to meet you too. Sep 17 2010, 5:21 PM Rory F. Stern: At 4 years old, it can often be difficult to tell the difference between "normal" development and ADHD...they can look a lot alike Sep 17 2010, 5:21 PM Rory F. Stern: Best advice I can offer in this situation is a lot of love, encouragement, and praise for the child. Sep 17 2010, 5:21 PM Rory F. Stern: Does he know how to sign? Sep 17 2010, 5:22 PM Rory F. Stern: How will you communicate with him? Sep 17 2010, 5:22 PM Rory F. Stern: At 4, this boy is pre-verbal, so your communication will be largely non-verbal...physical communication...so you will want to be a positive role model. Sep 17 2010, 5:23 PM Rory F. Stern: Keep in mind that children at this age are still developing and looking to take in the world in a very curious way... Be positive, supportive, and patient... Sep 17 2010, 5:24 PM Guest150 (guest): Hello Dr. stern and thank you for the time you are giving to help . I have a 10 year
  6. 6. old son hw was diagnosed by three different resources. He is not hiperactive but does lose his focus, memory and reading comprehension. As hard as i have tried to look for resources and the best enviroment he has fallen bak in school after taking mediaction off. It seems i have to star medication . I know ADHD is forever but then my concern is if he doesnt learn to thrive without medication , he would then take it for life? Sep 17 2010, 5:25 PM Rory F. Stern: Hi Guest150 - You are welcome, but thank you for being here and for asking such a great question Sep 17 2010, 5:26 PM Rory F. Stern: Medication can be very tricky. It has been "proven" to be effective, but we must remember that there are always underlying "issues" that still need to be addressed. While medication might improve focus, we still need to provide an opportunity to learn strategies that will help a child be more productive in particular settings. Sep 17 2010, 5:26 PM Rory F. Stern: So if we are talking about school, yes medication might help with focus, but there is still a need to work on social skills, study skills, good note taking, etc... (just as an example) Sep 17 2010, 5:26 PM Rory F. Stern: The reason I am saying this is to address your question about "medications for life" Sep 17 2010, 5:27 PM Rory F. Stern: While I can't speak to how long your child might need or benefit from medication, we know a number of things about ADHD over the lifespan Sep 17 2010, 5:27 PM Rory F. Stern: ADHD typically persists into adulthood for about 60% of those diagnosed as children. Many symptoms can "disappear" or lessen with age...for instance the hyperactive ones Sep 17 2010, 5:28 PM Rory F. Stern: The other piece of these symptoms lessening is typically the application of strategies learned as child that help someone "naturally" cope, react, and manage particular situations Sep 17 2010, 5:28 PM Rory F. Stern: So....your child might NOT need to be on medication forever. It all depends on their symptoms, how their individual ADHD affects them, and the goals you and your doctor (with your
  7. 7. child) have for being on the medication. Sep 17 2010, 5:29 PM Lori-SouthAfrica (guest): What suggestions do you have about a 14 y.o. ODD girl that does not/will not pick up her clothes, towel,etc., off the floor. She leaves the bathwater in, does not flush the loo, leaves thelight on, even though she is not there.is disrespectful of her mom (who is borderline dysfunctional ADD, but is trying really hard). She is also rude and tries to hurt her mom without explanation (e.g. I hate you phase at the moment.) Sep 17 2010, 5:30 PM Rory F. Stern: Hi Lori! First off, my heart goes out to you. This sounds like a difficult situation, and I am glad you are actively looking for help. I know this can't be easy Sep 17 2010, 5:31 PM Rory F. Stern: Now I should telly ou...I do not specialize in ODD...so I will offer what advice I can, and hopefully we can find you a resource through a colleague who does understand ODD better than me Sep 17 2010, 5:32 PM Rory F. Stern: In any situation when I work with families, I always let everyone know that safety is first....everyone has the right to safety Sep 17 2010, 5:33 PM Rory F. Stern: That's what I would address first in this situation....Being rude, disrespectful, or harmful are things I will not tolerate Sep 17 2010, 5:34 PM Rory F. Stern: I would make that very clear... Assuming you agree with that Sep 17 2010, 5:34 PM Rory F. Stern: The other problems you describe are things that will take time, effort, and patience....and could possibly need to be addressed one at a time Sep 17 2010, 5:36 PM Rory F. Stern: In terms of the behavior issues Lori, I would ask you how does your daughter respond to consequences Sep 17 2010, 5:36 PM
  8. 8. Rory F. Stern: You'll have to focus on one of these issues at a time as I mentioned, and I would let her know what the minimum expectation is... What is acceptable and what is not. Sep 17 2010, 5:37 PM Rory F. Stern: Now that alone won't necessarily make a difference, but you've got to start with the basics...with a foundation before we do anything else Sep 17 2010, 5:37 PM Rory F. Stern: I am firm believer in having a strong, positive foundation before we move anywhere else Sep 17 2010, 5:38 PM Guest679 (guest): I've done both. I am an occupational therapist too. They are currently doing The Listening Program. A neuropsychologist did diagnose ADHD but said it was unclear. Sep 17 2010, 5:38 PM Rory F. Stern: @679 This is where the diagnosis gets so frustrating, it can be so unclear for so many different reasons. Sometimes it just takes time to figure out what is going on...and time is the only obstacle we can't force Sep 17 2010, 5:39 PM Guest805 (guest): One on one teaching within a country setting - Does it have more positive benefits Sep 17 2010, 5:39 PM Rory F. Stern: @805 I think one on one teaching or at least some additional one on one support can absolutely be beneficial. Sep 17 2010, 5:39 PM Rory F. Stern: I would be interested in focusing on a learning environment or support structures that are positive and account for the child's individual learning style Sep 17 2010, 5:40 PM Rory F. Stern: So many schools are set up to teach to the masses, and I'm sure I don't have to tell you, a lot of children learn differently Sep 17 2010, 5:40 PM Rory F. Stern: Encouragement is everything and can make a HUGE difference when working with a student
  9. 9. Sep 17 2010, 5:40 PM Rory F. Stern: Anytime a teacher, tutor, or other educator can really reach out and give positive support to a child, that is a great benefit Sep 17 2010, 5:42 PM Guest726 (guest): My 14 yo boy is diagnosed inattentive ADD with dysthymia - he has low energy and poor appetite and is irritable. He thinks ADD is "bulls**t" and doesn't want to talk about it. He thinks everyone forgets to turn in their finished homework and forgets to follow directions. He never knows when meetings are for things he is involved in. Now in high school the demands on him will even be greater. How do I get him to accept ADD and prepare for what he will need? Sep 17 2010, 5:43 PM Rory F. Stern: @726 - I would want to focus for a moment on the clarity of the diagnosis. September 2010 < Prev 1... 89 90 91 92 93 94 95 96 97 Next > Sep 17 2010, 5:43 PM Rory F. Stern: Is it ADHD that is contributing to the dysthimia, or is the dysthimia contributing or exacerbating the ADHD symptoms? Sep 17 2010, 5:43 PM Rory F. Stern: In this case I would focus in on diagnosis being of utter importance....this will then lead to the right treatment approach and help us understand what we are treating Sep 17 2010, 5:44 PM Rory F. Stern: With dysthimia, I'd want to address treatment there and find out if your son is taking medication...or otherwise find out how that is being addressed? Sep 17 2010, 5:45 PM Rory F. Stern: Getting your son to "accept Sep 17 2010, 5:45 PM Rory F. Stern: his diagnose could be very tricky. How does he respond or would he respond to specific descriptors of his behavior.... Sep 17 2010, 5:45 PM
  10. 10. Rory F. Stern: For example, my son has a difficult time keeping track of assignments... He has a difficult time with focus and attention when he is bored. Is he "accepting" of that? Sep 17 2010, 5:46 PM Rory F. Stern: The most important part of "treatment" or support is when a child / teen "buys-in" to what is causing them difficulties. Sep 17 2010, 5:46 PM Rory F. Stern: If they are unwilling, then you have to start there and consider how you will help him gain more understanding of who he is... Sep 17 2010, 5:47 PM Rory F. Stern: I am curious...does he think that having ADD is a bad thing...so he wants to "deny" it? Sep 17 2010, 5:47 PM Rory F. Stern: Does he get picked on in school for being different? Sep 17 2010, 5:47 PM Rory F. Stern: Can we help develop his strengths to build his self-esteem so he knows what he is good at or passionate about? Sep 17 2010, 5:48 PM Rory F. Stern: Also keep in mind that teens are going through a lot hormonally and develomentally, so that can change the picture as well Sep 17 2010, 5:48 PM Rory F. Stern: Teens are notorious for "rebelling" - and maybe that's where the fight in him comes from Sep 17 2010, 5:49 PM Rory F. Stern: There is a lot here, and I feel for you. I really would suggest again that we start with a strong foundation...understanding, education, and advocacy. Sep 17 2010, 5:49 PM Rory F. Stern: I wouldn't necessarily push the diagnosis on him right now, as much as I would focus on helping him understand who he is...if that is possible...if he open to that.
  11. 11. Sep 17 2010, 5:50 PM Rory F. Stern: And of course, I would suggest figuring out which of his diagnoses is "causing" the most trouble for him...that may call for a specialist to determine whether the ADHD or dysthimia is more present Sep 17 2010, 5:50 PM Bonnie (guest): He has always had a hard time sleeping, his doctor did say that it is probably related. He is on strattera, but this hasn't gone away. I feel really bad that I can't help. Sep 17 2010, 5:51 PM Rory F. Stern: Bonnie...it is hard and I definitely feel bad as well. I would consider speaking with a sleep or doctor, or looking into the "melatonin" option - again speaking with a doctor about this... There are a number of natural aides that can help with sleep. Sep 17 2010, 5:51 PM Rory F. Stern: Then of course there is the issue of the side-effects of the medications... Is it the right dose? Is it the right med? Sep 17 2010, 5:51 PM chrzzz (guest): What your opinion of manditory testing for adhd? Can a child once he/she becomes an adult sue for damages if parents neglects their child and never has them tested for adhd? Sep 17 2010, 5:52 PM Rory F. Stern: Hi Chrzzz... This is interesting when you mention the word "neglect" Sep 17 2010, 5:53 PM Rory F. Stern: It is an interesting idea, but I don't believe a parent could be sued...unless the neglect was harmful enough... I have never been asked this before Sep 17 2010, 5:53 PM Rory F. Stern: Mandatory testing is also interesting, but very difficult considering how many people have ADHD-like characteristics in the population, but won't fully meet the criteria for diagnosis. Sep 17 2010, 5:54 PM Rory F. Stern: In this situation I would encourage the child in question to speak with someone at school about this and see what resources are available for testing, evalution, or support in the schools when parents are not willing to request
  12. 12. Sep 17 2010, 5:54 PM Guest859 (guest): Well...my 13 year old is struggling academically...and feels when hes corrected that he is not accepted. he is very impulsive..and no, the teachers in genenral dont understand. I thought if i could have 2 or 3 target behaviors in place with rewards, i could make it a more positive environment..and this would also guide the teachers into better reponses to him when he is disruptive... Sep 17 2010, 5:54 PM Rory F. Stern: @859...thank you for the extra info. This is very helpful Sep 17 2010, 5:55 PM Rory F. Stern: In this case, related to teachers, I might speak with them about using "non-verbal" cues when he is being discupritve in class Sep 17 2010, 5:56 PM Rory F. Stern: Not many students like being singled out in front of their peers, so you can ask the teacher to tap him on his shoulder, or walk by him and tap a pencil on the desk...something that your child will recognize as a sign to focus or to remind him that he is being disruptive Sep 17 2010, 5:57 PM Rory F. Stern: As for "target behaviors" and rewards, you might consider a behavior chart... I can recommend two resources. Sep 17 2010, 5:57 PM Rory F. Stern: 1) www.freebehaviorcharts.com FreeBehaviorCharts.com — Parents & Teachers: These free behavior charts work with kids at home and at school… } Sep 17 2010, 5:57 PM Rory F. Stern: 2) www.smartdiscipline.com Smart Discipline helping parents with child behavior.
  13. 13. Sep 17 2010, 5:57 PM Rory F. Stern: Both of those resources are from colleagues I work closely with and trust when it comes to behavior Sep 17 2010, 5:58 PM Lori-SouthAfrica (guest): she is ADD, ODD co-morbid Sep 17 2010, 5:58 PM Rory F. Stern: Thank you Lori for the additional info. I hope this advice was helpful. It's hard sometimes to get everything right on chat like this I am much more of a "people" person and like talking Sep 17 2010, 5:58 PM Guest150 (guest): Thank you Sep 17 2010, 5:59 PM Rory F. Stern: @150 You are welcome. I really hope this was helpful Sep 17 2010, 5:59 PM Guest805 (guest): Thank you i live in cyprus and there is no support out here i am trained to work with Autism and learning problems. Helping familys who need it Sep 17 2010, 5:59 PM Rory F. Stern: @805 My pleasure. It's difficult when there are no supports near you. Please let Tara or myself know if we can help you further. Sep 17 2010, 5:59 PM Guest726 (guest): I think it is both Sep 17 2010, 6:00 PM Rory F. Stern: Thank you...and yes, it can be both. The trick is in figuring out which one is more prominent. Which one do we need to address first...that's all I meant. Sep 17 2010, 6:00 PM Guest679 (guest): One of my 9 year girls responds to her mom and dad with I wish I could kill you or I am going to kill you. Stupid used to be her response. This is when she needs to stop doing something or to do something. She also says often in respone to others too when corrected or given a request, She hurt my feelings. How do I help her work through her emotions. Does this sound like symptoms of
  14. 14. ADHD? Sep 17 2010, 6:00 PM Rory F. Stern: @679 - I'm not certain I would group this as "ADHD" like Sep 17 2010, 6:01 PM Rory F. Stern: But it is definitely troubling Sep 17 2010, 6:01 PM Rory F. Stern: I mentioned earlier setting up clear rules about what is acceptable and what is not. Sep 17 2010, 6:01 PM Rory F. Stern: Safety comes first in the work I do with children...that's for both children and adults. Sep 17 2010, 6:01 PM Rory F. Stern: Words like those count to me as "not safe" Sep 17 2010, 6:03 PM Rory F. Stern: In terms of helping her work through these issues, I would suggest a positive environment where she can express herself without being judged...or being offensive to you or the parents... Sep 17 2010, 6:03 PM Rory F. Stern: And that to me is therapy... Would she be willing to speak with someone? Sep 17 2010, 6:04 PM Marr (guest): I have a friend whose husband had an anyisum, he was dxed ADHD with some Autism. Would ADHD be addressed first or the Autism? Sep 17 2010, 6:04 PM Rory F. Stern: @Marr - that is a great question and I'm afraid I don't know in this particular case. Sep 17 2010, 6:04 PM Rory F. Stern: My suggestion again would be to speak with a specialist...possibly a psychiatrist to find out which condition is causing the most difficulty
  15. 15. Sep 17 2010, 6:05 PM Marr (guest): He is very difficult and refuses medication, which is was better behaviorily. Sep 17 2010, 6:05 PM Rory F. Stern: That's frustrating I'm sure. I wish I had a better answer Sep 17 2010, 6:06 PM Rory F. Stern: Thank you everyone for your questions. I hope there was some helpful information. Sep 17 2010, 6:06 PM Marr (guest): I'm assuming what you said about teens might be be good for his wife to try. Sep 17 2010, 6:07 PM Rory F. Stern: It could help Sep 17 2010, 6:07 PM Guest150 (guest): Dr. Stern before this chat ends, in what state do you practice? Sep 17 2010, 6:08 PM Rory F. Stern: @150 I am located in Massachusetts, but work primarily as a coach now....so I work internationally Sep 17 2010, 6:08 PM Marr (guest): Thanks you for trying to help! Sep 17 2010, 6:09 PM Rory F. Stern: I'm sorry Marr...I wish I could help more. It hurts when I can't offer you something Sep 17 2010, 6:09 PM Guest805 (guest): Marr i may be able to help you as i am Trained for Autism i will email you anna Sep 17 2010, 6:09 PM Rory F. Stern: @Marr - this is from one of our attendees. I hope you two can connect
  16. 16. Sep 17 2010, 6:09 PM Marr (guest): Thank you anna!!! Sep 17 2010, 6:10 PM Rory F. Stern: Thank you everyone. If you have any questions, please feel free to let us know in the forums, or through expo@adhdexpo.com Sep 17 2010, 6:10 PM Rory F. Stern: Goodnight everyone! Learn more about Dr. Rory Stern at: www.adhdfamilyonline.com Our Sponsor www.advancedbrain.com

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