Understanding Attention Deficit Disorder
Usually because of lack of time, lack of knowledge or both, the mistake that's usually made in treating ADD is to just put a child on medication and nothing else. This is wrong. If medication is needed, it should always be used in addition, and not instead of, a total treatment package. Here is our five-step package for managing the child with ADD.
1. Feed your child foods that improve behavior and school performance. If your child goes off to school with junk food, expect junk performance. Send your child off to school with a healthy breakfast. Research shows that breakfast eaters generally make higher grades, pay closer attention and behave better in school than breakfast skippers. Best breakfasts for learning and behavior is one high in protein and complex carbohydrates, such as whole grain cereal and yogurt, eggs and whole grain toast, whole grain pancakes and fruit. Ditto this nutritional advice for lunch. Feed your child healthy fats: those from vegetable oils, fish, nuts, avocados and flax seeds. Studies have shown that some children with ADD have insufficient essential fatty acids in their diet. Seafood and vegetable oils are valuable sources of nutritious fatty acids.
2. Develop behavior management strategies, such as impulse control strategies: "Think it through first" tools. Teach your child to say to himself, "Stop!" or "Count to 10," or "Imagine what will happen if you do it," or "Put yourself behind the eyes of the other person first." In essence, you want to teach your child to think through what he's about to do. For children with poor attention spans, break down instructions into one task at a time: "Brush teeth," "Put on your pajamas," or "Pick out a story," rather than overwhelming them with all three instructions at one time. Busy the bored child. In issuing directives, use what we call the one-sentence rule: Keep it simple. Long, drawn-out instructions cause the ADD child to tune out. Rather than shouting to the child from another room, "Johnny, come to dinner," use what we call the "legs first -- mouth second" approach. Connect before you direct. Go up to the child and look him in the eye and issue his directions with eye-to-eye contact. This type of direction giving makes impressions on the inattentive child. Use reminders, word pictures or brief notes that jog the child's hazy memory and keep him from forgetting routines. Prompts, such as a certain look that reminds the about-to-mess-up child that he knows better: "Where do jackets go?" "Teeth?" as a reminder to brush his teeth. During a particularly intense day, your child may need hourly, sometimes minute-by-minute, reminders, such as "You are forgetting..." "You know what to do..." Don't nag. Put a little humor in your directives: "Dress the bed, then dress yourself." Use "when ... then" consequences. "When you finish your homework, then you can go out and play." "When your teeth are brushed, then we can begin the story."
3. Set your child up for school success. Do a site visit to the classroom. Interview the teacher. Work out learning and teaching strategies that complement your child's individual style of learning. Consider tutoring. Again, ADD is primarily a difference. Some children think, learn and act differently, therefore they need a different style of teaching. Instead of giving your child a passage to memorize, give him a part in the play where he actually acts out the character.
4. Consider neurofeedback training. This is the newest form of treatment for ADD. Neurofeedback is sort of like weight-training for the brain. If you want to build up your muscles, you go to a gym and start an exercise routine. With neurofeedback, you go to a training center and exercise the neuropathways to build up your brain so that you can concentrate better. For a child, it's like going to gymnastics or piano lessons. In neurofeedback, a computer converts brain waves into game-like displays, such as a fish moving through a maze, puzzle pieces fitting together, or colorful images. The child's attentiveness controls what happens on the screen. If the child's mind wanders, as it does when he spaces out in the class, the colors on the monitor change or the action stops. The better he holds his attention, the better feedback he gets on the computer screen, and it's fun. Neurofeedback is like a workout for the wandering mind. The child learns to exercise pathways of the brain that control attention. The cost of neurofeedback is about the same as professional tutoring. It is expensive, with weekly or bi-weekly sessions over a 6-month to a year period running anywhere from $3,000 to $5,000. There are neurofeedback training centers in all major cities.
5. Medications. Remember, as I have said before, medications should be used in addition to the total management plan, not instead of it. As a pediatrician and father, I am concerned that each day several million American children go to school under the influence of mind-changing medications. Drugs should not be given with the attitude that they will control the child, but rather that the drug will help the child control himself. Stimulant drugs, such as Ritalin, are thought to work by stimulating the secretion of neurotransmitters, especially the neurotransmitters involving learning and behavior control centers, so that the child can pay appropriate attention and control inappropriate behavior. The working centers of the brain function it is to inhibit impulsive behavior. Think of stimulants as acting like a zoom lens that helps the child know his focus from general arousal to the task at hand. If your child does need medication, be sure to reinforce the fact that the child did it, not the pill, when the child succeeds. When I prescribe Ritalin, I call it "the focus pill." Be sure your child realizes that the pill is just to help him focus and to help the behavior and school management strategies sink in. ADD children tend to be smart. They feel "If nothing is wrong with me, why do I have to go to the doctor every month to get pills?" and "Why do I have to stand in line for my pill at the school nurse's office while all my friends are on the playground?" They may feel that they are bad, dumb or sick. With the help of your doctor or ADD counselor, be sure to clear up these misconceptions. Be sure to frame your child in a positive light. Children with ADD are constantly bombarded with negative terms, so it's up to you to become your child's advocate. If a person showers negatives on your child, such as "He's so disruptive," respond with "Yes, he's so enthusiastic." If a persons says, "She sure is hyperactive," respond with "Yes, she's very interested in everything."
Always keep in mind that ADD is a difference and not necessarily a deficit or disorder. Many famous people who have made this world a better and more interesting place in which to live had ADD, such as Edison, Churchill and Mozart. Mozart was capable of going through an incredible state of hyperfocus so he could compose an entire opera in only a few weeks, yet he had problems completing many other tasks. He was socially impulsive, financially irresponsible and died a pauper. Edison is another example of the ability to hyperfocus. He was in perpetual motion in his seat and his mind would wander. All of these people used these ADD traits to their advantage. How dull and different history would have been without them! These children are spontaneous, creative, and have the ability to intensely focus on tasks they like and those that have relevance. Your job as a parent is to shape the child's specialness to work to the child's advantage and not disadvantage. In some ways, parenting the child with ADD is like being a gardener -- you can't change the color of the flower or the time of the year it blooms, yet you can prune the plants and pick the weeds to help the flower blossom more beautifully.