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Why ADD / ADHD Is a Gift

How To Stop Yelling At Your Kids, And What To Do Instead

With the pandemic keeping us at home more with our kids and not being able to get them out enough to run off excess energy I felt it would be helpful to give some tips to help out. I talk a lot about parental behaviors that are counter productive to changing the actions of our kids. Yelling and its negative affects is one of these responses that are not only counter productive, they are extremely harmful to our children.

The following article Catherine Pearson not only discusses the harmful affects it gives some great tips I offer my clients. Enjoy:

Spanking, research unequivocally tells us, is bad for kids. But yelling? Every parent does it at some point. How bad can it be? 

Pretty damn bad, it turns out.

The American Academy of Pediatrics says that yelling can elevate children’s stress hormones and lead to changes in the actual architecture of their little brains. And research also suggests it doesn’t particularly work. It can lead to more of the types of behaviors parents are trying to quell, instead of stopping them. On top of which, no parent likes yelling. 

So what then? How do you keep yourself from losing it, particularly if it has become a habit? And what can you do to get your kiddos to actually listen?

Here are 5 expert tips.

1. First, know there is a difference between yelling to protect and yelling in anger.

“Anger itself is an emotion designed to change behavior,” said Dr. Joseph Shrand, a psychiatrist and chief medical officer of Riverside Community Care in Massachusetts who wrote “Outsmarting Anger: 7 Strategies for Defusing Our Most Dangerous Emotion.” “Sometimes we yell to protect a kid, and that is a different kind of yelling. That’s an alarm. You’re raising your voice to alert your child that there is a danger.”

If you’re yelling at your kid because he is about to cross a street without looking, or she’s about to touch something scalding, or you’re attempting to prevent any of the million other accidents kids seem capable of getting into on any given day, go ahead. Your job is to keep your child safe. Sometimes yelling helps you do that.

2. When you feel the urge to yell in anger, tap your forehead instead.

Does that sound like an odd alternative? Here’s why it’s worth a try: “Anger comes from the limbic system, which is the ancient, emotional part of the brain,” Shrand said. The more thinking, rational part of the brain is the prefrontal cortex, he explained, which helps moderate decision-making and how you behave socially. It happens to be located right behind your forehead. 

To avoid yelling, you really want to “keep it frontal, don’t go limbic,” Shrand said. Which is why he recommends putting your hand on your forehead — even for just a second or two — and taking a deep breath in and out when you feel the urge to yell. 

“Ask yourself, ‘What do I really want to do and see next? Why am I angry?’” he said. Just that quick check-in — and physical reminder that you’re aiming for a more rational, measured response to your child’s behavior — can help squash the urge to scream. 

3. Or cluck like a chicken.

Carla Naumburg, a clinical social worker and author of “How To Stop Losing Your Sh*t With Your Kids,” likes this alternative to yelling: pause and do literally anything else. Take a breath, stay silent, hop up and down, put your hands flat on a counter to try and feel grounded. Or get silly instead.

“I have clucked like a chicken,” Naumburg told HuffPost, “because it helps get the energy out and because it’s so ridiculous it kind of snaps us all out of it.”

Another option? If you feel like you absolutely must yell, at least keep it vague rather than saying really pointed, hurtful things. “You can kind of yell without saying anything awful,” said Jennifer Kolari, a child and family therapist and author of “Connected Parenting: How to Raise A Great Kid.” Go for “Gah, I am so angry!”-type stuff, where you’re basically not really saying much. And you’re certainly not saying anything particularly mean or harmful. 

4. Channel your best “teacher voice.”

Not yelling at your kids does NOT mean you let them off the hook for behavior you don’t approve of. You can and should totally speak up, but calmly and sternly. Kolari often likens it to being on a plane with turbulence: If the pilot got up and walked around to ask how everyone was doing in a very sweet, soft voice, you’d probably be confused about what was going on and what was expected of you. Likewise, you’d probably freak out if the pilot started screaming. If the pilot spoke calmly but firmly and made it clear that you need to put your seatbelt on right now, you’d do it. 

When you scream and yell at your kid, they focus more on your anger than on the lesson you’re trying to impart.

“You undermine yourself when you yell,” Kolari said. “Find that authoritative voice — the one a teacher would use in the classroom. It’s far more effective.”

5. Remember: Repeating things over and over doesn’t mean you’re failing as a parent…

…it means you’re doing your job. In many ways, a parents’ role is to act like their children’s frontal lobes, which don’t fully develop until they’re in their 20s. They need to hear some things over and over until they really get it, Kolari said. So repetition doesn’t necessarily mean that you’re failing or that they’re being undisciplined. It means you’re doing your job as a parent and repeating the lessons they need to hear as they develop. 

Also important to keep in mind? You will yell at times. We all do.

“If you raised a child who’d never been yelled at, you’d mess them up anyway,” chuckled Kolari. When they got yelled at by a friend, or coach or boss down the line, they’d just totally crumble. So if you feel bad about an interaction you had, apologize. But don’t beat yourself up about it. It’s important to have compassion for your kiddo and for yourself. 

“When your relationship is strong — when your connection with your child is strong — it’s kind of like giving them emotional shock absorbers,” Kolari said. So if and when you do yell, they can bounce back.

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Helping Kids and Yourself Through The Challenges of Confinement

Change can be challenging at any time. It can especially challenging when an unknown like a dangerous virus completely upends the regular flow of life. If we are dealing with children who are now separated from their friends and many are trying to deal with school with less guidance and support it can be even more stressful. Here are some helpful tips to making things easier to deal with.

  1. Create and stick to a routine. Go to sleep and wake up at close to the same time time they were used to for school.  Write down a schedule that is varied and includes time for school work as well as self-care.

2. Because this is school time make sure school is the priority and that phones etc. are      off limits for times when school is scheduled. Build in breaks for snacks and     movement.

2. Get out at least once a day, for at least thirty minutes. Make sure you have a place     where you can avoid close contact with others. If you have a dog having children     walk them is a great way to get them out and be responsible at the same time. It can     also be a good way for the entire family to relax together. If your child is at high risk     or you are living with those who are high risk, open the windows and use a fan to     bring in fresh air if it isn’t too cold. It is amazing how much fresh air can do for spirits.

3. Make sure to schedule in some other time to move each day, again daily for at least     thirty minutes. There are lots of exercise shows and YouTube videos that offer free     movement classes, and if all else fails, turn on the music and have a dance party!

4. Make sure your kids are connecting with friends through FaceTime, Skype, phone     calls, texting, as part of the schedule. Set up virtual playdates with friends daily via     FaceTime, Facebook Messenger Kids, Zoom, etc—your kids miss their friends, just     as you do! Connecting with other people is important to their mental health as well     as your own(so be sure you are staying connected with others through calls and     texts).

5. Develop a self-care toolkit. This can look different for everyone. Have your whole     family make one for themselves with things they can share with a family member. A     lot of successful self-care strategies involve a sensory component (seven senses:     touch, taste, sight, hearing, smell, vestibular (movement) and proprioceptive     (comforting pressure). An idea for each: a soft blanket or stuffed animal, a hot     chocolate, photos of vacations, comforting music, lavender or eucalyptus oil, a     rocking chair, or weighted blanket. Writing in a  journal, or reading an inspirational     book aloud are good for expressing feelings. Coloring mandalas that can be printed     from online sites, painting or breathing techniques, and meditation are great stress     relievers. Mint gum, Listerine strips, ginger ale, frozen Starburst, ice packs, and cold     are also good for anxiety regulation. For children, it is great to help them create a     self-regulation comfort box (often a shoe-box or bin they can decorate) that they can     use on the ready for self-aid when overwhelmed.

6. Baking together is a wonderful way to connect and ease tension. Individual pizza     night or cooking each persons favorite foods on alternating evenings goes a long     way to build love and cooperation.

7. Spend extra time playing with children. Children rarely communicate how they are     feeling, but will often communicate these feelings through play. Don’t be surprised     to see therapeutic themes of illness, doctor visits, and isolation be themes. Play is     cathartic and helpful for children—it is how they process their world and problem     solve, and there’s a lot they are seeing and experiencing in the now that they don’t     fully understand or feel comfortable with.

8. Everyone choose their own retreat space. Space is at a premium, particularly with     city living. It is important that everyone has their own separate space for work and     for relaxation. For children, help them identify a place where they can go to retreat     when stressed. You can make this place cozy by using blankets, pillows, cushions,     scarves, beanbags, tents, and “forts”. It is good to know that even when we are on     top of each other, we have our own special place to go to be alone.

9. Expect behavioral issues in children, and respond gently. We are all struggling with     disruption in routine, none more than children, especially AD(H)D children who rely     on routines constructed by others to make them feel safe and to know what comes     next. Expect increased anxiety, worries and fears, nightmares, difficulty separating     or sleeping, testing limits, and meltdowns. Do not introduce major behavioral plans     or consequences at this time—hold stable and focus on emotional connection.     remember that these are scary and unpredictable times for children. This is an     excellent time to begin to observe your children more closely to learn their triggers.     When you can notice when they are triggered and distract them or help them use     movement to keep them from escalating you can learn to avoid out of control     behavior in positive ways.

10. Lower expectations and practice radical self-acceptance for your child and yourself.       We are all dealing with higher levels of fear and stress. This does not make a       formula for excellence. Do your best and forgive yourself and your child when you       don’t measure up. We all do the best we can with the awareness we have. There is       no failing just learning. You cannot fail at this—there is no roadmap, parenting     doesn’t come with an instruction manual. There is no no precedent for this, and we     are all truly doing the best we can in an impossible situation. Forgive and go on.

11. Limit social media and COVID conversation, especially around children. There is a       lot of information on COVID-19 to consume, much is sensationalized, negatively       skewed, and alarmist. Find a few trusted sources that you can check in with a few       times a day, and set a time limit for yourself on how much you consume (again 30       minutes tops, 2-3 times daily). Keep news and alarming conversations out of       earshot from children—they see and hear everything, and can become very       frightened by what they hear.

12. Notice the good in the world, the helpers. Look for  of stories of people       sacrificing, donating, and supporting one another in miraculous ways. Find a way to       help others. Find ways, big and small, to give back to others. Call or have your       children write and deliver notes to elderly neighbors or family members. Offer to       pick up food for them and leave on their door step. And find the humor by watching       a funny movie or YouTube videos to make you laugh.

13. Find something you or your children can control, and control the heck out of it.       Organize your bookshelves, purge a closet, paint a room, group your toys, clean       the garage. It helps to anchor and ground us when the bigger things are chaotic.

14. Find a long-term project to dive into. It’s a perfect time to learn how to play the       keyboard, learn a new card game, put together a huge jigsaw puzzle, learn how to       use a computer program, play a multi-hour game of life, paint a picture, read the       Harry Potter series, binge watch an 8-season show, knit a scarf, learn to draw,       write a book. Find something that will keep you and your children busy, distracted,       and engaged to take breaks from what is going on in the outside world and prepare       for the uncertainty life holds.

15. Engage in repetitive movements and left-right movements. Research has shown       that repetitive movement (knitting, coloring, painting, clay sculpting, jump roping       etc) especially left-right movement (running, drumming, skating, hopping) can be       effective at self-soothing and maintaining self-regulation in moments of distress.       Brain Gym movement is perfect for this. If your not familiar with it I discuss it in my       book, The Gift of ADD:Secrets For Transforming Liabilities Into Possibilities For       Parents and Teachers.

The times are challenging but you are up to the challenge by using self-care and having a plan. May you stay healthy and safe!

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Young adult outcomes for individuals with remitted, persistent, and late-onset ADHD

Multiple studies have indicated that, on average, youth with ADHD have poorer outcomes in young adulthood in multiple areas compared to their unaffected peers.

A limitation of these studies, however, is that they have not typically distinguished between individuals whose ADHD persists into adulthood from those where the condition remits.

Youth whose ADHD remits may still experience adverse outcomes in young adulthood relative to others, perhaps because early difficulties related to ADHD sets them on a negative developmental path. Alternatively, negative outcomes in young adulthood may only be prominent among those whose ADHD persists.

Beyond this unresolved issue, there are some individuals for whom excessive ADHD symptoms emerge for the first time in young adulthood. Although this pattern accounts for a large percentage of adults with elevated ADHD symptoms, little is known about how their functioning compares to those with childhood onset.

A study published recently in the British Journal of Psychiatry provides a close look at how young adult outcomes in these groups compare [Agnew-Blais et al., (2018). Young adult mental health and functional outcomes in an 18-year prospective cohort of twins. British Journal of Psychiatry, 213, 626-534].

Participants were a population cohort of 2232 twins born in England and Wales in 1994-1995. As part of a larger assessment, participants were evaluated for ADHD at ages 5, 7, 10, and 12. They were evaluated again at age 18.

Results from these evaluations were used to classify participants into one of four groups:

ADHD remitters (n=193) – ADHD diagnosed during at least one of the childhood assessments but not at age 18.

ADHD persisters (n=54) – ADHD diagnosed during at least one of the childhood assessments and also at age 18.

Late onset (n=112) – ADHD diagnosed at age 18 but not earlier.

Comparison group (n= 1681) – ADHD never diagnosed.

At age 18, individuals in these groups were compared on a variety of outcomes including mental health, physical health, substance use, life satisfaction, problematic technology use, e.g., compulsive internet use, education, employment status, and criminal convictions.

In making these comparisons, the researchers controlled for childhood variables that could contribute to group differences, including IQ, childhood socioeconomic status.

Results

Mental health oucomes – ADHD remitters were no more likely than comparison subjects to be depressed (21.4% vs. 17.9%) or struggle with generalized anxiety disorder (6.4% vs. 5.8%) at age 18. They were, however, more likely to be diagnosed with conduct disorder (23.6% vs. 11.9%)

Rates of all 3 disorders were considerably higher among ADHD persisters (35.2% for depression, 24.1% for generalized anxiety disorder, and 38.5% for conduct disorder) and those in the late-onset group (42.9%, 16.1%, and 35.1%)..

Substance use – Those with persistent and late-onset ADHD showed elevated rates of cannabis (i.e, marijuana) dependence and other illicit drug use relative to those without ADHD or remitted ADHD.

Rates of cannabis dependence were 3.2%, 5.7%, 14.8% and 11.6% for comparison, remitters, persisters, and late-onset groups respectively. For other illicit drug use, the rates were 15.5%, 21.8%, 29.6% and 30.4%.

Alcohol dependence, in contrast, was only higher among late-onset subjects compared to the other groups, who did not differ from each other.

Life satisfaction and problematic technology use – Compared to those without ADHD, the remitted ADHD group showed mildly lower life satisfaction, while the persistent group had both lower life satisfaction and more problematic technology use. The same was true for those in the late-onset ADHD group.

Physical health outcomes – Those in the remitted and persistent groups were more likely to be obese as young adults compared to those who never had ADHD. This was not true, however, for late-onset individuals.

The risk of daily cigarette smoking was similarly elevated in all ADHD groups compared to those without ADHD.

Education and employment – Educational outcomes were poorer for all ADHD groups and especially low among those with persistent ADHD.

Individuals in all ADHD groups were also more likely to be out of both school and work compared to those without ADHD, and, to have higher rates of criminal convictions.

The role of familial and genetic influences – Because study participants were all twins, and members of twin pairs often differed on diagnostic status, the authors could examine how ADHD versus genetic similarity and shared family experience contributed to young adult outcomes.

Compared to their unaffected co-twin, participants with ADHD in either childhood or adulthood were more likely to experience depression, anxiety, suicide/self-harm, lower educational attainment and life-satisfaction, and problematic technology use.

These poorer outcomes among participants with ADHD are thus not due to genetic similarities or shared family environmental factors, e.g., parental psychopathology or family stress. Instead, they are more likely to reflect a consequence of ADHD itself.

Summary and implications – Overall, results from this study confirm prior research that children and adults with ADHD typically experience a range of negative outcomes relative to unaffected peers.

However, the nature and intensity of those negative outcomes was found to vary by developmental pattern.

Individuals with childhood ADHD that remitted were faring better in young adulthood compared to other ADHD groups as they were not at increased risk for either mental health problems or illicit drug use.

However, they did show lower educational attainment, increased risk of obesity, more frequent smoking, mildly lower life satisfaction, and higher rates of criminal convictions than their unaffected peers.

Those whose ADHD persisted experienced not only experienced these same negative outcomes, generally of greater magnitude, but also had poorer mental health outcomes and were more likely to be involved in illicit drug use. Similar negative outcomes were evident among the late-onset group,

Overall, even though outcomes are better when ADHD remits, some negative consequences in young adulthood remain likely. And, when ADHD persists, the likelihood of multiple negative outcomes increases.

Finally, although current diagnostic criteria require some impairment from ADHD symptoms by age 12 for the diagnosis to be made, individuals whose symptoms don’t emerge until adulthood are also highly likely to struggle in multiple areas. Clearly, these are individuals for whom clinical treatment is warranted.

While the above findings can inspire pessimism, better outcomes for the remitter group highlights the need for effective early intervention.

And, it is especially important to highlight that not a single negative outcome that was experienced by over 40% of individuals in any of the ADHD groups. In most cases, although negative rates were higher among the ADHD groups than in non-affected individuals, they were often under 20% of the group.

Thus, rather than being cause for discouragement, these results highlight that although more youth with ADHD will struggle in young adulthood compared to their unaffected peers, the majority will not be significantly impaired as young adults in important domains of functioning.

An important priority for future research is thus to identify which ADHD youth are most likely to have persistent struggles and what factors best accounts for meaningful differences in young adult outcomes.

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Don’t Overlook Sleep Problems in Children with ADHD   

Problems with sleep are common in children with ADHD; in fact, past studies indicate that sleep problems occur in between 70 and 85%.

Because of this, the American Academy of Pediatrics recommends that sleep difficulties should be assessed as part of a comprehensive ADHD evaluation.

In some children, significant sleep difficulties may be an important contributor to apparent ADHD symptoms, and could contribute to a child being incorrectly diagnosed. For example, consistent insufficient sleep would certainly contribute to trouble with attention and focus. For other children, sleep problems may co-exist with ADHD and contribute to significant functional impairment on their own.

Although the link between ADHD and sleep difficulties is well-documented, evaluating sleep difficulties during an ADHD assessment may be routinely overlooked – see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129712/

In addition, the clinical importance of this association is not fully clear because prior research has not examined whether sleep problems in youth with ADHD contribute to impairment in their daily functioning above and beyond their ADHD symptoms. For example, a child’s problems in daily functioning may be primarily driven by ADHD their symptoms, with sleep problems contributing little.

Alternatively, sleep problems may create significant difficulties for their daily functioning beyond what ADHD symptoms explain; in this case, treating the child’s sleep difficulties should be an important treatment target.

A study recently published online in the Journal of Attention Disorders [Craig et al., The functional impact of sleep disorders in children with ADHD. Journal of Attention Disorders. DOI: 10.1177/1087054716685840] took a close look at this important issue. Participants were 192 children – mean age of about 10 – who had been carefully diagnosed with ADHD; over three-fourths were male.

Measures

Sleep – Parents rated children’s sleep using the Pediatric Sleep Questionnaire, which inquires about a broad range of sleep-related behaviors. Ratings were used to identify youth who struggled with excessive

daytime sleepiness (EDS), sleep-related breathing disorder (SRBD), insomnia, and periodic limb movements (PLMS).

ADHD symptoms – Core ADHD symptoms were rated using a standardized behavior rating scale called the SNAP. Using this measure, parents and teachers rated children on each of 18 ADHD symptoms.

Functioning – Children’s daily functioning was assessed using the 50-item Weiss Functional Impairment Scale; this scale assesses functioning in multiple domains: family, learning and school, life skills, self-concept, social activities, and risky activities. Parents also complete a Health-related quality of life measure on their child.

Results

1. What is the nature of sleep problems in youth with ADHD?

The most prevalent sleep problem – reported for 42% of the sample – was excessive daytime sleepiness. This was followed by insomnia (30%), PLMS (26%), and SRBD (25%). In addition, 18% of parents reported substantial variability in their child’s sleep from night to night. A number of children had multiple sleep difficulties but this number was not provided.

2. Do sleep problems impair children’s daily functioning above and beyond ADHD symptoms?

This question was the crux of the study. Analyses indicated that sleep problems – specifically, excessive daytime sleepiness – contributed to significantly lower life skills even after controlling for ADHD symptoms. For social impairment, higher levels of insomnia predicted greater impairment, above and beyond impairment explained by ADHD symptoms. When examining parent reports of their child’s quality of life, excessive day time sleepiness predicted lower ratings.

It is important to note that because all children had ADHD, the variability in functional impairment ratings was likely compressed relative to what would be found in a non-clinical sample. This makes finding significant associations between sleep difficulties and functional impairment more difficult. This may explain, for example, why a significant relationship between sleep difficulties and school functioning was not found.

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Video Game-Based Tx Boosts Attention in Kids With ADH

Digital intervention shows promise as add-on to standard therapy 

Since we know kids are addicted to devises anyway here is a positive way to make a difference in symptoms.

Read the article here: https://www.medpagetoday.com/pediatrics/adhd-add/85061

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