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Fall 1999 Table of Contents
Versión Español de este artículo (Spanish Version)

By James Ochoa, M.Ed., LPC, LCDC, Austin, Texas

Editor's note: Sometimes we assume that, if a child is visually impaired, this is his greatest challenge. Unfortunately, that may not be the case, especially if the child also has ADHD. Parents may think that the problems their child is having is related to his vision loss when in fact it may be related, at least in part, to the ADHD. I would like to thank James Ochoa for writing this article for SEE/HEAR. Hopefully it will help parents develop a better understanding about the importance of addressing the ADHD in their child with visual impairments. Mr. Ochoa is a psychotherapist in Austin, Texas. He has developed programs for ADHD children, adolescents and adults since 1979. He is married to his wife, Edie, whom he regards as his best friend. He has two sons, ages 4 and 8, and a beautiful Shetland sheep dog who constantly provide opportunities for his personal growth. James can be reached at (512) 918-ADHD (2343), or e-mail him at .

Parenting children with ADHD is one of the greatest challenges in a lifetime. Doing a good job of it could produce some of the most creative adults in the world.

ADHD (Attention Deficit Hyperactivity Disorder) is a condition in which children, adolescents and adults have difficulty maintaining attention, concentration, and following through on tasks. They can be hyperactive and impulsive. Research indicates that conservatively 3 - 5% of the population is affected by this genetic condition. The severity level of ADHD varies with each individual. Generally the condition is diagnosed when the effects of the symptoms significantly impair the major life areas of school, social interactions, work and home. An individual can be diagnosed as:

  • ADHD/Predominately Hyperactive, where hyperactivity and impulsivity are the major problem areas,
  • ADHD/Inattentive Type, where difficulty maintaining attention and concentration is the primary problem, or
  • ADHD/Combined Type, where an individual has significant problems in all areas.

find themselves doing and/or saying things that they never would have thought possible. As parents develop a greater understanding about parenting an ADHD child, they become better able to recognize the patterns of conflict in their relationship. This is the first step in unwinding the cycle of conflict.

Once parents recognize their own overly emotional behavior, they must learn exactly what triggers their distress. ADHD children are very perceptive and are quick to pick up on their parents' weaknesses. Parents must reach deep within themselves to remain calm and rational. Parents may need to examine their own childhood. If parents have unresolved childhood relationships with their own parents, it may be particularly difficult for them to handle similar situations with their child. They may experience greater emotional stress and overreact when their child goes through a developmental stage that caused them distress as a child. They may be emotionally blinded to see the situation for what it is.

When parents become overly emotional they lose the perspective that allows them to be effective as parents. Sadly, if this powerful struggle goes unrecognized, it often leads to an abusive situation for both the parents and the child. This is why it is so important for the parent to become aware of his or her own emotional history as a child. Once parents recognize what triggers their distress, they can develop coping skills that will help them maintain control. For example, they may elect to take a break to cool down. A more composed parent can start anew in a more functional frame of mind. They also model an effective way for the child to monitor his own behavior by taking a break just as his parents do.

Understanding ADHD

Parents can benefit from creating a more functional frame of reference for ADHD. Many professionals approach this with a neurodevelopmental perspective. They believe that each child has a unique neurological development. While there are clear developmental norms where all children are similar, genetics, personality, and environmental aspects vary extensively. For this reason each child has a unique rate of neurological development. A child's rate of development may be accelerated in some areas and delayed in others.

Dr. Mel Levine, of the University of North Carolina, takes the neurodevelopmental perspective even further. He formed the All Kinds of Minds Institute, which trains professionals to understand a child's behavior from a neurodevelopmental point of view. The adults learn about the neurodevelopmental process by interacting with children and helping them. Both adults and children learn that all children develop independently, at their own unique rate. Adults are taught to intervene effectively by highlighting a child's strengths and helping him accommodate for his weaknesses. According to Dr. Levine, there are no disorders, just differences in development. He teaches children to recognize their developmental strengths and weaknesses and to understand their individual differences.

Attention is a neurological process. Research has shown that the attention centers in the brain are located in the frontal lobe. This area of the brain has been found to be less active in individuals with ADHD than in individuals who do not have ADHD. Research in this area has focused primarily on the neurochemical processes in the frontal lobe, particularly on the neurotransmitters like Serotonin, Norepinephrine and Dopamine. We have learned that Serotonin is responsible for regulating the mood. Norepinephrine is responsible for evaluating the relationship of cause and effect which contributes to impulsive acts. Dopamine is the brain's focusing agent. It helps bring information from deep within the brain to the surface and helps the brain hold on to external stimuli.

All of these neurotransmitters contribute to an individual's ADHD, but Dopamine appears to contribute the most. Medications are used to control or lessen ADHD symptoms. It is imperative to share this information with children in a way that they can understand.

The School Home Improvement Programming Strategies (SHIPS) Project, founded by Byron Kocen, M.D., takes a more functional approach to ADHD. Research has shown that when there is a difficulty maintaining attention, a true neurological problem exists. SHIPS has taken this link one step further, maintaining that individuals with ADHD are highly creative and often very passionate about something in their lives. They are often talented and their level of interest in their creative areas surpasses that of their peers. They also have a different way of looking at life and a different way of doing things. Because children with ADHD go about life a little differently, their ideas and behaviors are frequently misunderstood. Thus, SHIPS created a different way to describe them, as individuals with "Attention Creative Difference".

Attentional differences do become a "deficit" and a "disorder" for ADHD children when they are asked to complete tasks which seem boring, routine or monotonous. This is especially true when tasks require excessive attention to detail with little room for flexibility. The SHIPS Project works to reframe the "deficit" and "disorder" by building on the child's individual creative strengths and talents. It teaches parents to work with their ADHD child to develop systems and routines to help monitor the details in all areas of their lives. This results in a much more successful parenting relationship and a happier, emotionally healthy child.

Parental Intervention

The behavior of an ADHD child is one area that requires considerable energy and involvement on the part of the parent. Children with ADHD respond to the world, and to their parents, differently. They are often able to see through the situation and manipulate the outcome because they are very smart, creative, and quick to perceive parental weaknesses. Disciplining the ADHD child requires quick thinking, creative parents. Parents are encouraged to learn as much as they can about ADHD so they can monitor their child's behavior and creatively intervene when there are differences.

Problem Solving Techniques

All children need to feel as if they have some control over their lives. This is especially true of children with ADHD because they often feel as if they have no control over their internal environment. Involving an ADHD child in the discipline process gives him a sense of control. Involving the child in the problem solving process makes him feel as if he has a stake in the outcome. It often encourages him to access his creativity to find solutions to the problem.

When problems arise, as they so often do with attentional children, parents must intervene to redirect inappropriate behaviors. The best strategy is to help the child monitor his own behavior to prevent a problem before it occurs. If that fails, the parents must creatively work with the child to solve the problem. This requires the parent to remain calm in a time of frustration. It's important to remember that the attentional child looks at the world from a different point of view and may not see his behavior as a problem.

Identify the problem

Frequently the parent's first task is to help the child identify the problem with his behavior. Let him retell the event in his own words. Be careful not to subject him to your feelings or opinions; this can make him feel powerless. Ask him to state the problem in his own words. Listen to him intently, being careful not to interrupt, and encourage him to find a way to communicate clearly. After the child finishes explaining the problem, you can help by clarifying misperceptions.

Brainstorm possible solutions

After identifying the problem, the next step is to begin finding a solution. Brainstorming possible solutions with your child is the ideal place to begin. In this step it is important to identify as many solutions as possible, even some that may appear quite outlandish. Later in the process you will evaluate them, but for now just throw out ideas. Write them down. Try not to discourage his participation by being critical of his ideas either verbally or through body language.

Evaluate the solutions

After brainstorming, ask your child to help evaluate all of the solutions. Assist the child to see the whole picture and how each solution will affect it. Be careful not to make light of any solution offered by your child and be as flexible as possible. You do not want to discourage his participation in the future. Work together to eliminate suggested solutions that won't work. Your child may feel discouraged if you cross off more of his ideas than yours. So, when you are generating possible solutions, you may want to put some silly solutions into the mix so some of your solutions can be crossed through as well.

Since your child will be held accountable for whatever solution is decided upon, it will help if he feels as if he has some say in the process. Even if your child arrives at a solution that is different from yours, if it will work without damaging property or endangering anyone, give it serious consideration. After coming to agreement on the solution, write it down. Praise your child for helping you solve the problem and ask him to commit to the solution.

Behavior Management Systems

The use of positive reinforcement with ADHD children can be the most effective part of any program. Children with ADHD receive so much negative feedback that positive feedback is always needed - the more the better. One treatment center required that a positive statement be given every 15 seconds in a group of eight to ten ADHD children. An ADHD psychologist used to say that if you don't go to bed tired of giving your child positive statements, then you have not given him enough. It is more likely you are tired from criticizing and redirecting behaviors. Positive reinforcement should be the essential part of every system for an ADHD child.

Children with ADHD often respond well to a reward system, especially when they are involved in the process. These systems can be very simple or very complex. Generally speaking, the severity of behaviors you want to extinguish will determine the degree of complexity needed in the reward system.

The most important rule is to involve the child. Focus on and explain the behaviors you want to see. Do not put emphasis on the behaviors you do not want to see. Use a positive tone of voice when you identify behaviors that you would like to see. It is best not to address more than three behaviors at a time.

There are three key factors in successful parental intervention to keep in mind when designing a behavior management system:

  1. First and foremost, keep it simple. If your child appears to be frustrated or becomes oppositional, it may mean that your behavior management system is too complicated.
  2. Tell your child exactly what is expected of him, using words or pictures to provide an example of the outcome you would like to see.
  3. If you are attempting to create a certain behavior, let him help decide what the behavior should be. For example, if you are targeting the behavior of keeping his room clean, it might help to give him some control over where the trophies, toys, and so forth should be kept.

Behavior management systems usually work well with ADHD children if the reward motivates him. Find out such things as what he would like to spend his money on or whom he would like to spend time with. This will give you clues about possible rewards.

When your child achieves the targeted behavior it is tallied. Younger children under 7 years old usually respond better to getting a chip or sticker. Children older than 7 years tend to respond better to a point system. When they have acquired a specific number of chips or points, they will receive the reward. The reward system will probably need to be used for six or seven weeks, until the desired behavior has been established. Taper the system down slowly after it is no longer needed. Keep in mind, however, that you may need to pull it out again two or three times a year, depending on the needs of the family.

Although parenting ADHD children is a complicated process, the rewards are numerous. The joy of seeing an ADHD child develop to his full capacity and grow into a successful adult is every parent's wish.

The vigor with which many individuals with ADHD live their life is phenomenal. They grasp life by the horns and ride it, never letting a moment pass that they can fully experience. The shutting down effect that the media, uneducated adults and peers has on individuals with ADHD is heartbreaking. I urge you to join in the effort to create a new understanding of these individuals so they can live happy, full, creative, and successful lives.