Last night when I put my son to bed I made sure that I told him how much I love him, and found some good things to say about him. Although I would often do this on an ad hoc basis, yesterday I did it with special emphasis. Now I know that it is a crucial action that will help to build his self esteem, fend off depression and help to improve all of our lives by making him feel better about himself.
This was part of one of the key strategies that Sydney based Psychologist Ian Wallace talked about yesterday (11 April 2015) at a seminar he addressed in Canberra. The seminar was run by ADDACT, the Canberra and Queanbeyan ADHD Support Group.
Ian Wallace is the author of “You and your ADD Child”, one of the go-to books for parents grappling with ADHD children, and he is one of Australia's foremost authorities on ADHD. He has been specialising in ADHD since the early 1990s, and wrote his book in 1996 to help answer people's questions, also to address the lack of resources available to parents.
Ian has very kindly given me permission to publish this article, as long as I give it the caveat that it is my interpretation of his seminar.
People with ADHD usually have other conditions as well
About 50 people came to the seminar which ran for three and a half hours. In that time Ian talked about ADHD, its cohorts such as ODD, anxiety, Sensory Processing Disorder, gave us many insights into the issues and lots of ideas about how parents can help their children at home and teachers can help them at school.
For me, who has been investigating management of these conditions for a decade, it was one of the most useful and valuable sessions I have had on this difficult journey. In one afternoon Ian wrapped up years of bits and pieces that I had gleaned from various experts. He combined it with old and new information, and put it all into a neat package that I can use with my family, and with schools to help my child, who is one of 2 to 11 percent of children estimated to have the condition depending on which source you find (footnote 1). It was so useful that I decided to summarise some of its key points here for people who were not able to attend.
ADHD is real and is not simply bad parenting
Ian said that he was convinced early on that ADHD is a real condition, and that there was a need for more help and resources for families.
“Very early in my career, I saw a family, who had three kids, in which the middle child had "behavioural problems", but the other two kids were well behaved and achieving. The parents were great, but they had been told it was bad parenting that caused the problems,” Mr Wallace said.
“I questioned how they had good parenting skills with one child, lost them with the second child and re-discovered them with the youngest child.”
“I knew that there had to be other answers and began researching, until I came upon the concept of what was then ADD, in USA. Soon after, I began to see kids thrive and improve, with appropriate treatment for ADHD. As well, they were generally funny, vibrant, enthusiastic kids, who just needed someone to really believe in them.”
Kids with ADHD experience 90 per cent negative interactions during a typical day
With great kindness and compassion, Ian started the seminar by focussing on how it feels to be an ADHD child. ADHD children have a tough time, he said.
For a while, he stood in their shoes, showing us how they can't remember all the instructions that we parents and their teachers constantly bombard them with, and how this creates negative cycles of emotion that put more pressure on an already pressured child. How they often get to school, where they are regarded as a problem and they find themselves in trouble a lot and are subjected to behaviour plans. Compounded with this, they often can't cope with the school work as many of them have learning difficulties, and it can lead to them feeling hopeless. The days often continue negatively, which leads to them becoming more and more unhappy and disruptive. This then continues into the evening and often the day ends badly setting the child up for more failure the next day.
This he said leads to a child who then sees themselves as a problem and they only become more stressed. Parents who are trying desperately to help their child fit in only fuel the situation by overloading them with information – do this, eat your breakfast, get your cap, don't forget to take your bag, and then get into the car.
After building a picture of basically a very stressed and miserable child it was easy to see how a negative cycle of behaviour escalates with consequent impacts on school and home life. Parents often are blamed for their children's bad behaviour, and this compounds the issues. It isn't a parenting problem, he says. It is a disability.
Focus on what is driving the behaviour
For difficult behaviour he said that it is crucial that you identify what is driving it. ADHD is often comes along with other conditions such as Oppositional Defiance Disorder, Anxiety, Sensory Processing Disorder and Learning difficulties (these are then referred to as 'comorbid' in the lingo).
The interactions between these issues are where many of the problems come into play, Ian said.
Managing them relies on understanding what the particular factors are that are leading to the undesirable behaviour, and working with those. Multi-modal treatment is the key to helping these children.
This may mean medication, behaviour modification teamed with Occupational Therapy.
He also talked about the role that medication can play in helping ADHD children, but stressed it is not a magic bullet. He said that it is an important part of multi modal treatment, and that it is necessary that it is seen as such. He also talked about how treatments are being refined, so that lower doses of several drugs being used together to treat the different conditions a child has can be more effective than increasing the dose of just one. There are also alternative natural treatments, such as melatonin, that can help in specific cases.
Multi-modal treatment may require collaboration with other professions
The answers, Mr Wallace suggests, lie in understanding what is going on, and finding ways to help the children so that they don't develop the negative behaviour in the first place.
Children who spit out their food for instance or refuse to eat it may be suffering from Sensory Processing Disorder. They are not being naughty or intentionally difficult.
“To them the food might taste and feel as if it has sand mixed in it,” Ian said.
“If you understand that this is the case, then you can work out a strategy to deal with the food refusal - for instance you might need to change the food offered, or work with an Occupational Therapist to try to reduce the sensitivity that is causing the problem. ”
Neuroimaging shows that brains function differently in kids with ADHD
ADHD Children may appear lazy or negligent when in fact there could be a reason for not performing as expected. Our ADHD children can have real problems that impair their functioning such as visual form constancy which basically means they are not be able to see and follow information in the same way that other children do, putting them at a disadvantage.
Developmental delays in fine motor skills are common, meaning that handwriting is messy and hard to read.
They may have a sequencing problem, which means that they are unable to put things that they are learning into a sequence. They may interrupt a lot because they are terrified that they will forget something that they have just thought of.
These, he said are disabilities and should be seen as such, as helping children with these problems is integral to helping to improve their chances of success and their behaviour.
Unique kids need unique strategies
“Unique kids need unique strategies,” he said. The answer lies in using several strategies to help set a child up for success, to make life easier and better for them. To bring everyone concerned with the welfare of the child together to work as a team. It is critical that these strategies be tailored to the individual child and that they consider other conditions, as well as ADHD.
Avoid information overload & superfluous words
The first technique he suggests lies in reducing the morning routine to simple keywords or target words that can be easily remembered by an ADHD child...cap, bag, car. The use of repetition, and routine can help to get the morning happening smoothly. Structure, routine and consistency, he said, are very important.
Effective use of new technology can make life much easier. Ian said that he used to recommend using a diary on the desk and notes to help with remembering schoolwork, but now he said technology has make managing and assisting the situation much easier for us, we can put information on ipads. Homework can be captured with a snapshot that will assist with memory, or loaded onto a website that a family can access through a portal for instance.
He talked about self esteem, how important it is to build that to help children cope with day to day lives. He suggested that we should not see our ADHD children as being hopeless, but as children who have a mixture of strengths and weaknesses. Some ADHD children, he said, have astonishing talents, which may be very hard to find and see. Here he suggested that we work to help ADHD children build strengths, look for positives and do it often and end each day with it. He suggested that we make sure we spend 50 percent of our time on strengths and then address weakness and issues. But be positive first.
Another strategy he recommended was to focus on rewards rather than punishments as rewards were another important management tool. He stressed that rewards need to be immediate - the slow build up of points to get something on Friday won't work for an ADHD child. They also need to be meaningful to the child. Certificates while well meaning may miss the mark if a child can't yet read and doesn't value them. He said that he often will find something that a child values, such as footy cards, or dominos and give a small reward often. For example, if the child listens to Ian for ten minutes, he or she will get a domino.
Contrary to contemporary advice for parents to ignore undesirable behaviour though, he said that it is important to address it with ADHD children immediately. The technique he suggested was a soft slow voice of authority. Punctuated, calm and rhythmic, short.
"Mate. Think. Stop."
Mr Wallace suggested that it is important to pick the battles, not worry about some things that you might with a non ADHD child. “Don't fight what is not important,” he said.
Children may not know how ask for help, in which case a parent can assist with role plays, so that the child learns by doing it. There again, break it down, just three simple words.
Children with anxiety can be terrified that they will get it wrong. Again. So it is important to show that it is OK to make mistakes. “Tell them, I make mistakes all the time. It is Ok to make mistakes,” Ian said.
Another useful strategy he suggested is choice therapy. In particular defiant children will be more cooperative if they are given a choice, he suggested.
Negotiating effective classroom strategies helps teachers & the whole class
In terms of working with schools Mr Wallace said that partnership between parents and teachers is critically important. Teachers also are often overloaded, and trying to manage several children with issues as well as the rest of the class, meaning that it isn't practical to lump a whole lot of expectations on them for your particular child. He suggested we start with three ideas and give it several weeks to see how it is going. He said it is also important that the teacher sees that the issues that the child has are a disability and that it is treated as such.
He suggested that the placement of a child in a classroom is critical for them, as they need to be close to the teacher with a direct line of vision to them. The teacher can also use discrete visual cues such as two cards on a desk, that they can tap as they walk past to remind a child of what they are working on that week, and a quick thumbs up to show that the child is doing well.
1 in 3 parents of a child with ADHD will also have ADHD
Finally he said that parents should remember how important it is to look after themselves. Looking after challenging children is a very tough gig and that they actually are doing a great job. However, the strength that we need has to come from somewhere, and to keep it coming, we need to give ourselves a break. This may be even more important if one or both parents also have ADHD.
He also said it is also important to remember that many ADHD traits that cause problems in childhood may be strengths in adulthood .
When Ian started practising, it was commonly thought that most children with ADHD would grow out of it but practitioners now agree that this is not the case. Around 80 per cent of kids with ADHD will still experience symptoms in adulthood - but this may be a good thing if people with ADHD are able to take advantage of their many strengths.
I think that the most valuable message he gave us was a message of hope. He talked about a lot of the children he has seen in thirty years of clinical practice. How many of them, with the right support, have grown up to be very successful functioning adults, some of them doctors, engineers, architects, engineers, artists, performers, comics, theatre producers, designers, self employed tradesman, business brokers, or creative directors in the advertising world.
Ian Wallace is the Director of Forestway Psychology Centre (in Dee Why, Sydney)
where he specialises in working with families, including kids with ADHD and other related behavioural disorders.
Unfortunately due to his commitments he is not able to take on new clients.
However, Ian regularly presents talks and seminars for television, radio, universities, schools and parent support groups around Australia. He is a weekly guest on Mornings on Channel 9, after being a regular on Mornings with Kerri-Anne on Channel 9 for 10 years. He regularly features on A Current Affair, Nine News and 7 News.
He also writes for a number of magazines and regularly makes other media appearances. He covers areas such as ADHD and ADD, Adults with ADHD, coping with co-morbid Disruptive Behaviour Disorders, Learning Difficulties and latest trends in management, as well as many other common parenting issues.
His book “You and your ADD Child” is now out of print, but second hand copies can be purchased on Amazon or see if you can borrow a copy from your local support group. He told us that he is considering rewriting and updating the book. We certainly hope he does, it is a real goldmine of information.
Rose Schmedding is a Canberra based writer. The article was edited by fellow writer Pip Marks.
1 According to the American Psychiatric Association (APA), 5 percent of American children have ADHD. Other sources have the percentage higher or lower - Centers for Disease Control says that the rate is 11 percent of American children, ages 4 to 17. Closer to home, varying sources put the figures between 2 and 11 percent.