attention deficit hyperactivity disorder

ADHD: Non-medication help…

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

ADHD kidIt seems like every day I have another parent asking me if their child has ADHD (aka Attention Deficit/Hyperactivity Disorder). The answer isn’t an easy one, neither is the solution. I wrote a post trying to help answer this very question. If you want more information about how to know if your child’s behavior may or may not be ADHD, read Hyperactive or just busy…Could  your child have ADHD?

If you think your child has ADHD, but aren’t sure if they need medication or not, there are some things you can do that should help. Will these effective parenting tips keep your child from needing medication? No. If a child is in need of medication, then, I recommend medicating them. Medication alone can not help a child that is truly ADHD. The most effective treatment is medication along with therapy and effective parenting. 

I’ve talked before about effective parenting. I don’t think enough attention is paid to the importance of proper parenting. I see parents that want me to fix their child, when the problem is that the child is in need of consistency and routine. Children NEED consistent routines, especially children with ADHD.

  • Routine is unbelievably important. Doing things according to a schedule helps a child learn what to anticipate day after day. Using lists or pictures can be helpful to remind children what they are responsible for and keep them on task. Even with routine, your ADHD child will still need help getting everything done.
  • Make sure the rules are clear and followed consistently. If you have rules that are only enforced some of the time, the child will not know when they do or don’t have to follow the rules. This leads to frustration for the child and the parent. And, needless to say, inconsistent results!
  • Give the kids something to be responsible for…this could be helping to take care of pets, taking out the trash, or other chores around the house. This helps the child feel important, learn responsibility, and also builds self-esteem. You will have to remind your child to do their chores, it isn’t going to just happen. Having a list and checking off chores/responsibilities as they accomplish them can be helpful, and is a good way to reinforce good behavior.
  • Praise and Positive Reinforcement is a must for disciplining all children, especially children with ADHD. Recognize & Praise good behavior and accomplishments. Just getting homework or small chores done can be challenging for children with attention issues.
  • Limit “screen time” – This includes all screens, such as TV, video games, computer, etc. Screen time should be limited to just 2-3 hours per day, and should be turned off at least 1 hour before bedtime. This isn’t hard to enforce during the school year because there is limited free time after school. It is a little more challenging during the Summer. Being more liberal with this rule during the summer is ok, just remember, you will see a difference in the child’s behavior; and it is essential to get back into a school routine a week or 2 before school actually starts.
  • Have a good bedtime routine with an acceptable bedtime. Kids in preschool and early elementary grades should be in bed by 7:30-8:30, upper elementary should be 8:30-9, middle school 9-9:30, and high school should be between 9-10. For more information about sleep, please see my blog, Sleep is Crucial for Healthy Development. A tired child has trouble focusing, paying attention, and retaining information. For preschool aged children, there is a significant correlation between hyperactive and impulsive behavior and short sleep duration.
  • Watch what your child is eating, 3 healthy meals and snacks are important for good brain function. Adding essential fatty acids to a child’s diet helps promote good brain function. Eliminate artificial food dyes (AFDs) from the child’s diet. AFDs have been proven to increase hyperactivity in the majority of children. A study done in Great Britain in 2006 documented that 75% of children demonstrated hyperactive behavior correlated with ingestion of AFDs and Sodium Benzoate. I have recommended this intervention to many families, and received many Thank You’s because it makes such an obvious difference in the child’s behavior. I firmly believe that AFDs should be eliminated from our food supply altogether. AFDs have been outlawed in Canada, Britain, Germany and a few other countries.
  • If your child has allergies, treat allergies with a daily allergy medication. Allergies can make ADHD worse! Allergies are a hypersensitivity, ADHD is a hypersensitive state…1+1=2, it’s that simple (not really, but treatment is a must).
  • Exercise, exercise, exercise! Physical activity helps to regulate the neurotransmitters that are dysfunctional in those with ADHD. Participation in sports can be helpful and rewarding for your child. Daily outside time, even when it’s cold should be the norm. Tell your kids to run around the house a few laps before dinnertime, it gets the wiggles out.
  • Whatever your child is good at, encourage it! Whether their forte’ is math, sports, or creating, encourage it! Without our multitasking, intelligent ADHDers, we would not have telephones, airplanes, or many of the inventions and discoveries we take for granted everyday. My above mentioned ADHD post expands on this, even listing all the famous people throughout history that have/had ADHD, check it out!

These interventions take time and effort on the part of parents. They are useful for all kids of all ages, but especially necessary for kids with ADHD. Many of these interventions are just good, effective parenting. 

If a child is in need of medication, these interventions will NOT replace the need for medicating the child. There are typically side effects of medication for most kids, and this can be worrisome to parents. Some of the side effects can be decreased appetite when med is at it’s peak, headaches, stomach aches, mood swings, and sleep issues. It’s important to figure out if the medication is actually to blame, or if there is another underlying reason for the unwanted symptoms. For example, most ADHD kids will have trouble falling asleep, it may be the ADHD or too much screen time, and not the medication. It’s also important to evaluate which is worse, the side effects or the effects of untreated ADHD?? In my professional and personal opinion, the effects of untreated ADHD can be much worse than the side effects of the medication. Trust me, I’m living the ADHD thing with my son. Look for a post on untreated ADHD soon.

Having an ADHD child takes effort, patience, and frequently a little wine. 😉 ADHD children are challenging, difficult to parent, and also rewarding. Those creative ADHD minds are awesome to watch create, absolutely fascinating sometimes. So, if you are dealing with an ADHDer, don’t forget to stop and look at the positive side of this challenge. These ADHDers are going to do amazing things for society, they just need a little TLC, and A LOT of guidance to get there.

Good luck, and regardless of the challenges…. don’t forget to ENJOY THE JOURNEY!

 

Small Dose #14- YES, We NEED to treat ADHD!!

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

“Children growing up with ADHD often face a higher risk for substance use disorders compared with the general population. New research shows that treatment with extended-release stimulants early in adolescence may reduce the risk of developing dependencies on cigarettes, alcohol, or drugs.”

-Dr. Timothy E. Wilkins, MD, Director, Center for Addiction Medicine, Child Psychiatry Services, Mass. General in Boston

 There are many risk factors  associated with non-treatment for ADHD.

A post with more information on the risks of not treating ADHD with medication to follow soon.

Learning how to navigate life’s Parenting Journey is never-ending! 😉

Effective Parenting… Important for all kids, but especially important for raising kids with ADHD!

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

Effective parenting takes time and effort, no doubt about it!!

For kids with ADHD, effective parenting is a must whether these kids are medicated or not medicated.

This information will be useful for all parents, not just those raising ADHD kids…

Does the child with Attention Deficit Hyperactivity Disorder (ADHD) need to be medicated?? Yes and No… that’s clear as mud, huh? First, it’s crucial to make sure that what you are dealing with is ADHD! Many children will present with symptoms that might appear to be ADHD, but are actually symptoms of other disorders. ADHD can present  differently for different kids. Yes, there are the classic symptoms, but not all children are as obvious as others. For diagnostic information about ADHD, check out my post, Hyperactive or Just Busy…Could your child have ADHD?

If it’s not ADHD, what else could it be? Some disorders that may present as ADHD could be anxiety, depression, lead poisoning, thyroid dysfunction, vision problems, food allergies/sensitivities, sleep apnea or something else entirely. Making sure your child has the appropriate evaluation is the first step to proper treatment.

I see many preschool age children that are brought in by their parents for behavior problems, it’s most frequently boys vs. girls. I’ve mentioned in previous posts that both boys and girls can have ADHD, but boys are diagnosed 2:1 over girls. I always say that God made boys to hunt and gather, not sit still for 8 hours. 😉 Perfect example – I saw a little boy this week for behavior problems, he is 3 years old and his mother thinks he has ADHD. The first thing I do is ask why the parent thinks the child has ADHD? Jason’s mom reported that he got in trouble in preschool A LOT, was biting other kids, was constantly in time-out, talks non-stop, and his dad has ADHD. After meeting with Jason and his mom, I think he might have ADHD, but at 3 years old I NEVER label a kid as ADHD. And, I would NEVER medicate a 3 year old for attention problems or hyperactivity; 3 yr olds are supposed to be active and have a very short attention span. If a child this young presents with problems, he needs a though neuro-psych evaluation!

There are many interventions that I recommend for young children with behavior issues that resemble ADHD. These interventions can make a huge difference for a family, and must be consistent! These interventions take time and effort on the part of parents. They are useful for all kids of all ages, but especially necessary for kids with ADHD. Many of these interventions are just good, effective parenting:

  • Routine is unbelievably important. Doing things according to a schedule helps a child learn what to anticipate day after day. Using lists or pictures can be helpful to remind children what they are responsible for and keep them on task.
  • Make sure the rules are clear and followed consistently. If you have rules that are only enforced some of the time, the child will not know when they do or don’t have to follow the rules. This leads to frustration for the child and the parent. And, needless to say, inconsistent results!
  • Give the kids something to be responsible for…this could be helping to take care of pets, taking out the trash, or other chores around the house. This helps the child feel important, learn responsibility, and also builds self-esteem.
  • Praise and Positive Reinforcement is a must for disciplining all children, especially children with ADHD. Recognize & Praise good behavior and accomplishments. Just getting homework or small chores done can be challenging for children with attention issues.
  • Limit “screen time” – This includes all screens, such as TV, video games, computer, etc. Screen time should be limited to just 2-3 hours per day, and should be turned off at least 1 hour before bedtime. This isn’t hard to enforce during the school year because there is limited free time after school. It is a little more challenging during the Summer. Being more liberal with this rule during the summer is ok, just remember, you will see a difference in the child’s behavior; and it is essential to get back into a school routine a week or 2 before school actually starts.
  • Have a good bedtime routine with an acceptable bedtime. Kids in preschool and early elementary grades should be in bed by 7:30-8:30, upper elementary should be 8:30-9, middle school 9-9:30, and high school should be between 9-10. For more information about sleep, please see my blog, Sleep is Crucial for Healthy Development. A tired child has trouble focusing, paying attention, and retaining information. For preschool aged children, there is a significant correlation between hyperactive and impulsive behavior and short sleep duration.
  • Watch what your child is eating, 3 healthy meals and snacks are important for good brain function. Adding essential fatty acids to a child’s diet helps promote good brain function. Eliminate artificial food dyes (AFDs) from the child’s diet. AFDs have been proven to increase hyperactivity in the majority of children. A study done in Great Britain in 2006 documented that 75% of children demonstrated hyperactive behavior correlated with ingestion of AFDs and Sodium Benzoate. I have recommended this intervention to many families, and received many Thank You’s because it makes such an obvious difference in the child’s behavior. I firmly believe that AFDs should be eliminated from our food supply altogether. AFDs have been outlawed in Canada, Britain, Germany and a few other countries.
  • If your child has allergies, treat allergies with a daily allergy medication. Allergies can make ADHD worse! Allergies are a hypersensitivity, ADHD is a hypersensitive state…1+1=2, it’s that simple.
  • Exercise, exercise, exercise! Physical activity helps to regulate the neurotransmitters that are dysfunctional in those with ADHD. Tell your kids to run around the house a few laps before dinnertime, it gets the wiggles out.
  • Whatever they are good at, encourage it! Whether their forte’ is math, sports or building things, encourage it! Without our multitasking, intelligent ADHDers, we would not have telephones, airplanes, or many of the inventions and discoveries we take for granted everyday. My above mentioned ADHD post expands on this, check it out!

Do I think these interventions will keep a truly ADHD kid from needing medication? Probably not, it depends on the severity of the ADHD. If I child has mild symptoms, the above interventions may be beneficial enough to avoid the need for meds. If a child has moderate to severe ADHD, they will need medication along with the above interventions.

I can’t expresses how important these “effective parenting” interventions can be, even for those children that need medication. Medication alone will not be enough for a child with true ADHD.

I’ve had many parents come back to me and tell me how much these interventions have helped make their life better. I can tell you personally, that they do make a difference in our family. I’ve shared Joshua’s story with you, he is the definition of Inattention and Hyperactive. If you haven’t read Parenting = Biggest Rewards + Most Frustrating Job You Will EVER Have!!, check it out for a little more insight on raising Josh. Joshua literally spun in circles for many years during his early childhood prior to the elimination of AFDs from his diet. I used to refer to him as Taz, the Tasmanian Devil. After a few days with no AFDs, the spinning stopped!! It was unreal!! It turned my little Tasmanian Devil back into a sweet, funny, and interesting little boy. He was still busy, but it was obvious that he had more control over his behavior.

Children with ADHD take extra time and effort, but the extra parenting will pay off someday when they are able to accomplish their goals. The time and effort will build self-esteem, intellect, and help your child grow to be the healthy and happy person you will always be proud of.

All kids take lots of parenting effort and energy. Each child comes with their own unique challenges, no doubt about it. Being the parent of an ADHD kid will take more patiences, time and effort than parenting the average kid. Your efforts will pay off though, I promise!!

Whatever parenting challenges you face, I hope you always remember to ENJOY THE JOURNEY!

Sleep is Crucial for Healthy Development

/ Katie P. Tolley, RN, MSN, CPNP-PC / 3 Comments

Amount and quality of sleep impacts children in every aspect imaginable. Sleep is crucial for proper growth and development, as well as daily functioning. Sleep is essential for neural development, and even a modest decrease in adequate sleep can decrease cognitive ability. According to The Journal of Developmental and Pediatric Behavior, there is a link between preschoolers who sleep less than 10 hours a day and behavior problems.  There is a significant correlation between hyperactive and impulsive behavior and short sleep duration.

I meet many parents that don’t understand the importance of sleep. I have parents bring their kids in to be evaluated for ADHD  and one of the first things we discuss is sleep. If a child is having sleep problems, we need to help correct the sleep issues before thinking about ADHD as the problem, it could be sleep deprivation.

Some parents will tell me their child goes to bed when they get tired. REALLY?? I’m thinking this doesn’t usually go over well. This may work on rare occasions when the child goes to bed at a reasonable time and is following the bodies natural sleep signals. Most children have a natural “window” when they will exhibit signs of sleepiness; rubbing eyes, slowing of activity, etc. If the child doesn’t go to bed during this time, they have an adrenaline rush, which keeps them up for a few more hours, and way past their bedtime!

Children should be expected to sleep in their own bed, and have a good bedtime ritual and schedule from a very young age. Good sleep hygiene makes all the difference as children grow and develop into adulthood. I’m not an advocate of co-sleeping. It may work for some families, but most of the time, the kids disturb the parents, and the parents disturb the kids. I’m all for early morning cuddling, after everyone has had a good nights sleep.

Getting an inadequate amount of sleep actually leads to nighttime wakening. For a child that is having trouble sleeping through the night, it is important to make sure the child is actually getting enough sleep. When children are tired, they will actually show signs of hyperactivity and irritability rather than signs of being tired.

Are their medical reasons that a child may not sleep well?? YES!! Children with Attention Deficit Hyperactivity Disorder (ADHD) often have trouble falling asleep because they have trouble turning their brain off. When it comes to sleep and ADHD, each affects the other… ADHD can interfere with sleep, and sleep can make ADHD worse! Talk about a double edged sword…  When Josh was a baby we put him to bed with classical music for the first 2 years of his life, this worked wonders, but he decided he didn’t want it anymore when he was 2. Now, we use a “white noise” machine. If you are worried you child may have ADHD, check out my post Hyperactive or just busy…Could your child have ADHD?

Another medical problem that could interfere with adequate sleep is sleep apnea. Children that have allergies, causing swollen tonsils and adenoids, can have sleep apnea. For allergy info, check out Springtime & Sneezes…You might have allergies if… Children that  suffer from obesity are also high-risk for sleep apnea. Obesity can cause many other medical problems that I will address in a future post.

So, what can we do as parents to help our children get adequate sleep??

  • A good bedtime routine can help; bath, book, then bed is a common mantra of mine.
  • Read before bed, but read books for pleasure, or magazines, things that are of interest to the child. I love going into Joshua’s room at night and finding him asleep on top of his book! 🙂
  • Nightlights are helpful for young kids that have fears related to the dark, making it difficult for them to fall asleep.
  • NO TVs in the bedroom!! This cannot be emphasized enough, NO TV IN THE BEDROOM!!
  • Turn off all screens (TV, computer, ipod, phone texting, etc.) 1 hour before lights out.
  • a “white noise” machine, this is my kids favorite! You can get them with different sounds: rain, ocean, rain forest, waterfall, summer night, etc.

A child that doesn’t get enough sleep will be at risk for behavior problems, decreased immune function, increased irritability, inability to play independently, inability to learn from the environment, and interference with proper growth and development.  Lack of sleep can also increase a child’s risk for obesity, depression, diabetes, and cardiovascular disease.  It can also affect emotional well-being, performance, productivity, and cognitive ability. 

When I tell you about kids and sleep problems, I’m telling you not only from education but from experience. Joshua has had trouble falling asleep since he was a toddler.  Does it have anything to do with his ADHD? I’m sure it does. He could be the perfect case study of a child with proper sleep and then without.  He can be such a sweet, intelligent, polite, mannerly, inquisitive, interesting, funny guy. With no sleep, he turns into the Tasmanian devil.  He is whiny, irritable, fatigued, twirling his hair, and literally twirls in circles.  Wow, what a difference sleep can make. I have no doubt that Josh gets his sleep issues from genetics as well, I have problems with sleep sometimes too. My problems are because of a disease called fibromyalgia. Fibromyalgia severely impacts one’s sleep. Inadequate sleep makes fibromyalgia worse. Interesting how all of these medical conditions have a reciprocal impact on one’s sleep and one’s health.

Sleep is important for all of us! Make it a priority for your children and it will make your parenting journey a little bit easier…Promise! 😉

Sweet Dreams and don’t forget to Enjoy the Journey!

Parenting = Biggest Rewards + Most Frustrating Job You Will EVER Have!!

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

Have you ever had one of those days that you just don’t know what to do as a parent? I’m living it right now! I thought I would share, because writing about difficult times is therapeutic, and I thought you all would like to know none of us have all the answers! 

I thought nursing school was hard – okay, kinda…. I thought getting in shape after having a baby was hard – yes, but not so bad… I thought getting my master’s was hard – very time consuming, but not as bad as I thought.

But, let me tell you – J.O.S.H.U.A. IS THE BIGGEST CHALLENGE GOD HAS EVER PRESENTED ME WITH…EVER!

Joshua is the sweetest, most intelligent, creative, cute, silly, talkative, impulsive, disruptive, unmotivated, lackadaisical kid I’ve ever encountered!!! He is doing so well intellectually and academically; but just can’t seem to keep his mouth shut, stay in his seat, or stop himself from disrupting class.

His science teacher commented on how great he did when they dissected cow eyeballs last week. He loves science! His reading level is 12th grade, rather impressive for a 4th grader. He read the entire Harry Potter series in less than 5 months when he was 8 years old. His guitar teacher talks about how creative he is. Mike said he has students that have been taking guitar lessons for over 5 years that couldn’t create and improvise music the way Josh can; he could be the next great song writer and guitarist for Phish. He gets awesome grades on his tests and projects, even earning bonus points sometimes. This is the kid that amazed the psychologist with his IQ test scores. And, lately, he’s been watching all these science shows that talk about concepts that baffle even me, such as the sixth sense, the worm holes in outer space, and galaxies far beyond our own. Yes, I’m a Proud Mom, most of the time!

Then, the dreaded email comes, as it did today… Josh was disruptive, talkative and silly in class. AAAGGGGGHHHHHH!!!!!!! There were more details, but I won’t bore you with how he got sent to the Headmaster and had to write his teacher an apology note. :-/ This kid is so smart, he thinks he can get away with acting silly, but as long as he get good grades it’s no big deal. I just don’t know what to do with him!!! (Any suggestions are welcome.) He’s already lost all toys, electronics, and only has his musical instruments and books to occupy his time as he spends the evenings for the rest of this week in his room (his dinner will go up on a tray). I am so frustrated with him!!!

I am great at helping other people with their parenting dilemmas. I have an answer for most situations, but under my own roof I’m currently stumped!  Even his teacher (who’s been teaching for well over 20 years) says she has never met a kid like him. When he is focused, he’s exceptional, creative, and does amazing work. When he doesn’t want to do something, it’s like he’s a totally different kid. Thankfully, every teacher he’s had has been just as impressed with his intelligence, just as challenged with his behavior, but has convinced me that this kid is headed for greatness… All this parenting effort and heartache will pay off! Right???

Tomorrow he will be sorry for his behavior, will act like an angel for days, and make me sorry I’ve been mad at him. This will last just long enough for me to forget what he did, and then…. well, I don’t have to tell you, do I?? He’s a boy, and boys will be boys… and boys with ADHD are even more challenging to parent!! You can check out my ADHD blog at Hyperactive or just busy…could your child have ADHD?

Parenting is one of the toughest, most rewarding, most frustrating jobs any of us will ever have. It’s hard work, but the pay offs are big!  The time you put into it pays off, and the effort you put into your parenting will make your children better people as they grow up. Go with me on this one, it’s the only hope I have at the moment. 😉

I’m convinced that God has a plan for Joshua! I’m hopeful that he will change the world someday. My current objective is to change his behavior just enough to get him there…that’s if I don’t kill him first! My answer for now is to call in all the reinforcements I can. I’ll consult with his pediatrician, psychologist, and teachers at school. Fortunately, they are all intrigued with Joshua, and will give me all the advice and support they have to offer.

I often say “God makes them cute for a reason, it’s so we don’t kill ’em!” 😉

As the title of this post states, Parenting brings the biggest rewards and the biggest challenges most of us will ever face. Through the smiles and the tears, we still have to enjoy the journey friends!! Thanks for listening. 😉

Josh and his Fender

Creating….