“No-fun-parenting” wins in ADHD treatment

Some 11 percent of U.S. children have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) by a healthcare professional, according to the Centers for Disease Control and Prevention. About two-thirds of them take a medication to treat their ADHD. Medications are effective for treatment of it, but any ADHD treatment plan has to include “behavioral interventions,” in other words, no-fun-parenting. Yes, we have to teach our kids to pay attention. How?

Kathleen M. Berchelmann, M.D.

Make time for parenting. ADHD kids need a full-time secretary—someone to give constant gentle reminders. When you are the parent of an ADHD kid, that’s your job. All these reminders take time. Double the time you think you need to ready for school or do chores. It’s usually easier and faster to pack your child’s backpack for him, rather than remind him six times to do it. But keep reminding him until you sound like a broken record. Yes, this takes twice as long as it should. But when we teach kids to pay attention, we teach self-control, a virtue that will last them a lifetime.

Tame your own anger. ADHD kids need a secretary, not a policeman. It seems reasonable to raise your voice when they drop their coat on the floor for the two hundredth time. But it’s your job to ask them nicely for the 201st time.

Get an electronic secretary. Adults with ADHD typically use smartphones as a secretary and caffeine as a stimulant. Kids with ADHD use parents for reminders and prescription stimulants. Why not let your smartphone be your child’s secretary, too? Set the smartphone alarm every day, even for things like getting ready for bed. Of note—your child does not need his own cell phone—set alarms on your cell phone or on an electronic home assistant such as Amazon Echo or Google Home.

Get a chore chart and use a reward system. Put all your kid’s daily tasks on the chart, not just chores. Include things like “hang up coat,” “brush hair,” and “stay in chair at dinner.” Chore charts won’t work without reward systems to motivate kids to actually check things off themselves. For rewards, use computer time, time with friends, or privileges like picking the family dinner.

Routine, routine, routine. Try to do as much as possible the same way each day. Talk about the schedule every morning and evening.

Don’t be afraid of medications. Most parents wouldn’t give a child with attention deficit hyperactivity disorder (ADHD) a caffeinated drink, for fear that their hyperactivity would only worsen. So why do doctors give stimulants to kids with ADHD? It seems so counterintuitive. Here’s another way of thinking about it:

Kids with ADHD are constantly self-stimulating. They wiggle, talk out of turn, and their mind doesn’t seem to turn off. Their thought processes are nonlinear. They talk while brushing their teeth and wiggling their foot at the same time. They seem to do everything except follow directions. When you give a stimulant to such a child, they no longer have such an urgent need to self-stimulate. ADHD kids usually have no problem paying attention to video games, which provide constant visual, auditory, and tactile stimulation. Reading books and following directions, however, are not stimulating activities — ADHD kids will try to get through these experiences by self-stimulating through wiggling, talking, etc.

If you give them a stimulant medication, they won’t need to self-stimulate. Stimulants are a tried-and-true treatment for ADHD. Ritalin has been used to treat ADHD since the 1960s and is still in use. Many brand-name ADHD medications such as Concerta are just long-acting/slow release formulations of Ritalin. Stimulants increase both fine- and gross-motor control as well as cognitive performance and executive function. In other words, stimulants can improve handwriting and sports performance as well as behavior and attention.

KATHLEEN M. BERCHELMANN, M.D., is a pediatrician at Mercy Hospital in St. Louis, Missouri, a member of the Catholic Medical Association, and a mother of six children ages one to 13.