What causes hyperactivity and ADHD (attention deficit/hyperactivity disorder)? A combination of temperament, environment and parenting. The most important factors are parenting skills and resources, especially those that can help create some calm. You can learn them.
“I would suggest we can head off many cases of ADHD in the first 2 years of life,” says W. Douglas Tynan, PhD, ABPP, director of Integrated Care at the American Psychological Association. Tynan’s psychology practice served more than 55,000 kids and their families over 13 years at the Nemours Pediatrics primary care and Alfred I. duPont Hospital for Children in Delaware. I interviewed him at the recent Lown Conference in Washington, DC.
“Everyone likes to blame the parents, particularly the mothers,” Tynan acknowledges. But there are some specific skills that he has been teaching parents that make a real difference.
“For example, if you have 2 kids who are very hyperactive at age 2,” Tynan notes. “If the daycare provider and the parents are consistent and do some of the things we recommend — which intuitively lots of parents do anyway — I predict you’ll have a very active first-grader, who may never quite reach criteria for ADHD. But if the parents get caught in the coercive cycle — punishment, lots of yelling — by the time we get to first grade, that child is going to have significant problems.” We cannot prevent all cases of ADHD, but we can certainly lessen how severe these problems become by intervening early.
Meds or Skill Development?
A very good study Tynan quotes compared 2 groups of families with a hyperactive or ADHD child. One group started with behavioral therapy (incorporating the 5 rules from below). The second group started with ADHD medicine. In both groups, if the child wasn’t making enough progress then medicine (for the first group) or behavioral therapy (for the second group) was added. And how were things a year later? Both sets of families were happier and more successful in their interactions. But starting with behavioral therapy saved money — drugs are more expensive than therapy — and established skills that kids who only got the meds didn’t learn.
Tynan’s 5 “Rules” for Effective Parenting
1. Increase the amount of positive interaction time between you and and your child
The most important words you say to your child are the positive ones. A hyperactive child can cause any parent to be snappish. Try to find things your child has done well and praise him or her constantly.
Between work, school, homework and scheduled activities, families sometimes forget to play together. Here are some websites with ideas for fun (and free!) activities:
2. Establish a scheduled routine, even on weekends
Use a calendar or chart on the wall.
3. You have to have the ability to implement consequences
If your child disobeys you, don’t give him or her a pass. Make punishments small, short and reasonable.
- Take away a privilege
- Require a chore
- Time out
4. Give clear directions — be polite but direct
“Jason, please put your toys away now.” Don’t put a direct request in the form of a question, e.g., “Jason, would you put your toys away?” It’s not Jason’s choice. When you can give a choice, make it simple — 2 choices like, “Sandra, would you like to wear the red pants or the blue skirt?”
5. Follow through on the good and the bad
If you promise a reward for homework or chores, don’t put off the reward. Positive reinforcement is very important. One threat and one punishment is enough; don’t cycle up from no screen time to no Christmas gifts. Very brief negative consequences, consistently delivered, are effective. Threats of punishment are usually ineffective.
One last story from Tynan
In order to evaluate a child for ADHD, he interviewed the child’s teacher. As it happens, the regular teacher (who had started the evaluation process for ADHD for the child) was out on maternity leave. The substitute teacher was a very, very senior-aged nun, retired after 45 years of teaching.
When asked about the child’s behavior that the regular teacher had complained of, she said, “Oh yes, he swings his leg constantly. And he’s easily distracted and taps his pencil.” Was that a problem, Tynan asked. “No, I moved his seat to the end of the row so he could swing his leg easily and I put a big eraser on the end of his pencil so it would make less noise when he tapped. You should see the little stories he writes! And he’s really very good at math.”
By focusing on his great qualities and understanding his need to fidget, this substitute teacher redirected the child’s life in a positive way.
Kids don’t come with instructions, and while many parents intuitively implement some or all of these rules, most parents could use some help. Tynan recommends parent support based on the principles of “Triple P Parenting” (good for all ages) and an e-newsletter “Just in Time Parenting.”
For children under 3 who are experiencing problems, all states have federally mandated Birth to 3 programs that can provide evaluation and support. These are usually done through the local public schools and in some areas through the public health system.