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1 Presented by the National Resource Center on ADHD

2 Gina Richman, PhD Kristi Phillips, PsyD Child and Family Therapy Clinic The Kennedy Krieger Institute and The Johns Hopkins University School of Medicine

3

4 Call the National Resource Center on ADHD (800)

5 Send us your feedback about today s webinar! Following the webinar, a survey will appear on your screen. Please take a moment to complete this survey. Thank you for helping us plan future webinars that meet the interests of the ADHD community!

6 Gina Richman, PhD Kristi Phillips, PsyD Child and Family Therapy Clinic The Kennedy Krieger Institute and The Johns Hopkins University School of Medicine Disclaimer: The information provided here is supported by Cooperative Agreement Number 1U84DD from the Centers for Disease Control and Prevention (CDC). The Ask the Expert webinars contents are solely the responsibility of the invited guest Expert and do not necessarily represent the official views of CDC. Neither CHADD, the National Resource Center on ADHD, nor the CDC endorses, supports, represents or guarantees the accuracy of any material or content presented in the Ask the Expert webinars, nor endorses any opinions expressed in any material or content of the webinars. CHADD and the National Resource Center on ADHD offer webinars for educational purposes only; the information presented should not be regarded as medical advice or treatment information.

7 To Ask A Question:

8 Gina Richman, PhD Kristi Phillips, PsyD Child and Family Therapy Clinic The Kennedy Krieger Institute and The Johns Hopkins University School of Medicine

9 Provide an understanding of the symptom presentation of ADHD Review the impact of these symptoms on behavioral and emotional functioning in children with ADHD Discuss the impact of behavioral and emotional concerns on relationships (i.e. peer, parent, and sibling relationships) Discuss strategies to enhance healthy relationships

10 Attention-Deficit/Hyperactivity Disorder (ADHD) Inattentive Behaviors Poor memory Difficulty attending to detail Problems organizing tasks and materials Easily distracted and forgetful Avoids or dislikes tasks that require sustained attention Hyperactive/Impulsive Behaviors Fidgetiness/Difficulty staying seated High levels of physical activity during inappropriate times Talks excessively Difficulty waiting his/her turn Interrupts or intrudes on discussions

11 Thinking Skills Working Memory Planning Organization Time management Metacognition Behavior Skills Inhibition Emotional control Sustained attention Task initiation Goal-Directed Persistence Flexibility

12 Emotional Dysregulation Anxiety Depression Learning Difficulties Social Skills Deficits Family Relationship Difficulties 12

13 Inattention and difficulties in executive functioning Difficulty learning from watching others Inattention to facial expressions and social cues Disorganized play/jumping from one activity to another Give and take during play is inequitable 13

14 Hyperactivity Difficulty with turn taking; impulsive in taking the lead at inappropriate times Engagement in one task is brief and completion is not met Overly active/appearing aggressive Difficulty with transitions Classroom behaviors may result in negative perceptions among peers and impact these relationships 14

15 Impulsivity Child may: Appear to act without thinking Inadvertently insult a peer Show disregard of social space and boundaries Have difficulty compromising or taking another s perspective when making choices Have problems with turn taking and holding back on thoughts that result in negative action 15

16 As the child gets older and the academic demands increase, difficulties with executive functioning could be further impacted This comes at a time when the expectation is for the child to function more independently yet the child may need a more comprehensive system of support Increased demands, decreased success can lead to higher levels of anxiety and depression 16

17 Impulsivity can increase a child s risk of misusing social media or technology that can have a negative impact The use of technology can further isolate a child who has difficulty in social relationships A child s impulsivity and lack of emotional regulation may lead to a reliance on the use of poor coping strategies such as anger or aggression 17

18 Child may show: Lower than desired compliance with rules and family values and have difficulty learning from consequences Important Considerations: What are you trying to teach? Why? Eventual independence Family values How can you support his/her strengths? What can you do to create new strengths while understanding areas of weakness?

19 Managing the eventual quest for independence Parents are learning to be flexible in the face of anxiety-provoking changes Renegotiating rules of relationship over time

20 Frequent conflict-based interactions Feelings of resentment Child dealing with ADHD symptoms Sibling(s) of child dealing with ADHD symptoms Misunderstanding of child with ADHD s intention Important Considerations: How close in age are the children? Are you mindful that the rule remain consistent or are you making accommodations for the child with ADHD? Do you have an understanding of the relationship they want?

21 Ask yourself: What type of parent am I? Where did my parenting style come from? Overinvolved/micromanaging Caring but lack effective follow-through Afraid to confront child Tough love child needs to learn hard lessons in life Permissive/punitive expect too much, impose harsh consequences, inconsistent follow-through Parents who disagree

22 Authoritative/Democratic They view themselves as teachers Solicit input from child and model respect Give child a reasonable chance at solving problems independently Build on strengths Collaborative approach to problem-solving Limit blame/negative tone solution focused Share ideas in non-judgmental manner Willing to impose reasonable consequences Work toward contracting

23 Rules and Structure Create house rules via a family meeting Enforce the rules and be consistent Decide in advance if there is an exception to a rule Make sure you have consequences for rule violations Create and have your child follow a daily routine Write the routine down and post it Reward for following the routine Change out the rewards frequently to maintain motivation Be consistent with reinforcement Involve child so they can help create the charts and set rewards Provide consistent support and praise for partial success to build skills over time Remember Rome wasn t build in a day. Notice small change. 23

24 Curfew Location Whom your child is with Contact with friend s parents Acceptable use of electronics Risky behaviors People, places, situations that are off limits Illegal activities (i.e. drug and alcohol use)

25 Social Skills Groups/Activities Formally in school or in therapy Informally by participating in an extracurricular activity Facilitate a playdate and provide feedback on observed social interactions 25

26 Perspective Taking Help child identify facial expressions/body language and interpret what others might be thinking or feeling For impulsivity, teach child how to stop and think before engaging in a behavior or interaction 26

27 Do not assume your child is not using their skills You will need to help your child acquire skills Embrace your child s desire for independence and control Appropriately gauge risks Move from external to internal motivation It feels good when doing something for yourself versus for some one else

28 Work with child without alienating them with negativity Understand your child s needs based on developmental level Provide just enough support for your child to be successful (i.e. don t do everything) Keep support in place until you see mastery Fade support gradually

29 Be prepared to negotiate Convey helpful intentions Focus on goal of increasing future independence with tasks Clarify rationale behind addressing the problem

30 Don ts Insults Interruptions Criticism Defensiveness Lectures Distractions Sarcasm Stonewalling Yelling Swearing Dos State the issue clearly Take turns Note pros and cons Calmly disagree Be concise and direct Pay attention Talk in normal tone Say what you feel Accept responsibility Use respectful language

31 Listening Listen attentively Do not interrupt Clarify what you hear Reflect on what you hear Summarize Speaking Speak attentively Ask meaningful questions Do not over-speak Accept silence Avoid crossexamining

32 Make sure you mean it Do not express your direction or expectation as a favor Do not give too many directions at once Focus on what your child should be doing: Do not focus on what they should not be doing Avoid competing distractions when giving directions

33 Expert can help with problem-solving and relationship enhancement Address roadblocks to your relationship with your child Provide more nuanced feedback on skillsdeficit issues

34 Smart but Scattered Teens - Richard Guare et al. Smart but Scattered - Peg Dawson and Richard Guare Your Defiant Teen - Russell Barkley SOS for Parents - Lynn Clarke

35 Gina Richman, PhD Kristi Phillips, PsyD Child and Family Therapy Clinic The Kennedy Krieger Institute and The Johns Hopkins University School of Medicine

36 Monday, Jan. 26, 3 p.m. Register Now at

37

38 The information provided in this episode of Ask the Expert is supported by Cooperative Agreement Number 5U38DD from the Centers for Disease Control and Prevention (CDC). The Ask the Expert webinars contents are solely the responsibility of the invited guest Expert and do not necessarily represent the official views of CDC. Neither CHADD and the National Resource Center on ADHD, nor the CDC endorses, supports, represents or guarantees the accuracy of any material or content presented in the Ask the Expert webinars, nor endorses any opinions expressed in any material or content of the webinars. CHADD and the National Resource Center on ADHD offer webinars for educational purposes only; the information presented should not be regarded as medical advice or treatment information.

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