+1. What are the symptoms of ADHD?

The core symptoms of ADHD are developmentally inappropriate levels of inattention, hyperactivity and impulsivity. The disorder varies among individuals; different people exhibit behaviour that falls on different points of the ADHD spectrum, though they do have commonalities.

Symptoms of inattention, as listed in the DSM-IV, are:

• Is often forgetful in daily activities
• Is often easily distracted by extraneous stimuli
• Often has difficulty organising tasks and activities
• Often loses things necessary for tasks or activities
• Often does not seem to listen when spoken to directly
• Often has difficulty sustaining attention in tasks or activities
• Often fails to give close attention to details or makes careless mistakes in schoolwork and other activities
• Often does not follow through on instructions and fails to finish schoolwork, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions)

Symptoms of hyperactivity, as listed in the DSM-IV, are:

• Often talks excessively
• Often fidgets with hands or feet or squirms in seat
• Is often “on the go” or often acts as if “driven by a motor”
• Often has difficulty playing or engaging in leisure activities quietly
• Often leaves seat in classroom or other situations in which remaining seated is expected

Symptoms of impulsivity, as listed in the DSM-IV, are:

• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn, as well as interrupts or intrudes on conversations etc. of others

+2. What is / are the cause(s) of ADHD?

No one is certain what the key causes of ADHD/ADD are. Possible causes include:

• Genetic disposition: e.g. Children with ADHD/ADD might have a dominant right-brain, i.e. possess high creativity, but have poorer detailed analytical skills. Children with ADHD/ADD thus learn and behave differently from other children.
• Partial brain damage during gestation caused by a fall during gestation or a difficult delivery is sometimes indicated as a possible cause for ADHD/ADD.
• Inadequacy of chemicals necessary for transmission of certain messages in the brain is another cause. Ritalin and other stimulant drugs work by increasing the activity of these neurochemicals to make up for the inadequacy.
• A dietary cause of ADHD/ADD might be the excessive consumption of chocolates, sweets and high-carbohydrate foods, or an allergy to milk or other products. The latter condition may be linked to the excessive use of antibiotics, and the subsequent infestation by candida yeast.
• Farmer / Hunter theory: ADHD children’s behavior may be linked to them possessing “hunter” genes that result in their alert, active and adaptable nature. While most of the “hunter” genes have evolved into “farmer” genes about 10,000 years ago, some remnant “hunter” genes are still in existence. Majority of children have “farmer” genes that result in them being more orderly and compliant.
• Other learning disabilities that make the child lose interest and motivation such as dyslexia, dyspraxia, hearing problems, etc. result in the child being more prone to losing interest in what is being taught.

Parenting style is not the cause for the misbehavior of ADHD/ADD children; it is more difficult to teach ADHD/ADD children appropriate social skills and manners than it is to teach other children. Good parenting styles, however, can help better manage the behavior of ADHD/ADD children.

+3. Why do ADHD children "misbehave"?

• The need to “feel alive”
  • ADHD children have strong needs to “feel alive". ADHD children have this need because their sensory volume control (determined by the thalamus located at the base of the brain) is set at a very low level; they need very high and strong sensory stimulation before they can receive these inputs at a normal level.
  • ADHD children need extra-strong stimulation just to "feel alive”, thus leading to:
    • Distractibility / poor attention: This is the brain's way of opening itself up to the experience of aliveness. When nothing exciting is happening, the ADHD child will create an interesting or exciting experience (e.g. pull the pony tail of the girl in front of him) to generate the necessary stimulus to "feel alive".
    • Impulsiveness: A truly hungry person will grab for food, often ignoring the consequences. Likewise, an ADHD child with an unfilled need "to feel alive" will be driven to engage in certain socially inappropriate behaviour.
    • Restlessness / risk-taking: These are done to satisfy the basic need to "feel alive".
    • Why Ritalin works: Ritalin (a stimulant) increases the sensory volume control. ADHD children no longer need strong or high sensory inputs to receive inputs at a normal level in their brain.
• Common myths about the ADHD/ADD child are:
  • The ADHD / ADD child is lazy or not trying his best because he seems to possess the ability to pay attention or be entirely absorbed when it comes to something he loves. Truth is: If the child loves the subject, or if the teacher is very stimulating, the child’s body will automatically produce the extra neuro-chemicals needed to relay the message. The ADHD child’s naturally low neuro-chemical levels become a problem only when the task is routine/mundane (e.g. much of schoolwork, administrative work).
  • Ritalin will solve the ADHD/ADD problem. Truth is: Ritalin is just a catalyst that temporarily reduces the exhibition of ADHD/ADD symptoms.
• Other opinions about ADHD/ADD
  • ADD is a simplistic answer to the problems of a complex world.
  • ADD is a social invention to ensure the proper functioning of a society.
  • ADD is a product of a modern short-attention span society.
  • ADD is a response to boring classrooms.
  • ADD is a reflection of normal gender differences.
  • ADD is a different way of learning.
• The other side of ADHD/ADD
  • Many of the greatest inventors and divergent thinkers such as Thomas Edison and Ben Franklin exhibited traits of ADHD/ADD.
  • The ADHD/ADD child is usually of the MBTI (Myers Briggs Temperament Indicator) temperament type ENTP (Extrovert, iNtuitive, Thinking, Perceiving, instead of Introvert, Sensing, Feeling, Judging) that exhibits the following characteristics:
    • Typically active and excitable
    • Easily distracted and bored with anything remotely routine
    • Mind works so quickly that when they are asked to wait for their turn to speak, they often forget what they were going to say
    • Springs into action when inspired, but must be prodded to finish the many projects that they start
    • Immediate surroundings usually seem chaotic, messy and disorganised
    • Experts in the MBTI temperament theory believe that the ADHD behaviours are normal and dub ENTPs as inventors and entrepreneurs.
  • Most people with ADHD/ADD can focus extremely well on something they find interesting, even better than the average person can.

+4. Will ADHD children outgrow their problems?

• Some children with ADHD/ADD do mature in ways that cause their ADHD/ADD symptoms to diminish or disappear:
  • Up to 1/3 of ADHD/ADD children outgrow the disorder or would have developed relevant strategies to cope with their ADHD/ADD problems. ADHD/ADD persons usually cope better as adults if they had proper management when they were younger.
  • For about 1/3 of the ADHD/ADD children, the hyperactivity may be replaced by restlessness, but problems with impulsiveness, inattention and disorganisation remain.
  • However, about 1/3 will continue to have most of the ADHD/ADD symptoms as adults.
• ADHD/ADD adults who were not properly managed in their childhood are at high risk of engaging in anti-social behaviour and/or drug/alcohol abuse.
• ADHD/ADD characteristics (such as high energy level, intensity, and affinity for stimulating environments) can be assets if positively channelled. Many successful businessmen have ADHD/ ADD characteristics.
• Individuals with ADHD may succeed as inventors, writers, artists, designers, businessmen, or in stimulating professions such as fire safety, law enforcement or the military.

+5. How can I help the ADHD child improve his attention or concentration?

• Train longer attention span by slowly increasing the duration of lessons from 15 minutes to 20, 25 and so on, with 5 to 15-minute breaks in between. ADHD children have very weak concentration "muscles" that are very difficult to develop. However, as with muscles, frequent use will result in stronger muscles while over-use may result in muscle damage. Thus, steady and gradual training is required.
• Some ADHD/ADD children have extremely good attention span for things that interest them. They overcome their attention problem by hyper-focusing on the activities they are interested in. Some ADHD children also subsequently develop obsessive-compulsive behaviour in order to overcome their attention problem.
• The ADHD child's interests often do not include homework and academic classes unless these are intrinsically stimulating enough to cross his higher threshold of the need to “feel alive”. A lesson might be more stimulating and interesting when its purpose is for the students to learn something new, as opposed to merely passing examinations (which typically involves rote learning).
• Build stimulus into your teaching / revision methods: intersperse high and low interest activities, intersperse listening with hands-on activities, use lots of visuals (e.g. concept maps), mnemonic learning strategies, games, competitions, summaries etc.
• Teach the ADHD/ADD child how to use attention highlighters (circle key words, underline text, draw connecting lines and vertical guiding lines etc.) and summaries (lists, notes) effectively.
• Some parents provide their ADHD children with coffee, chicken essence, Effalex (or other Omega-3, 6, 9 oils), Zan (a mix of herbs) and Ritalin to improve attention span. Ritalin is of course the strongest of these items, but care should be taken to observe possible side effects such weight loss and possible "explosive" behaviour.
• Adequate sleep is another factor that may help to increase attention span.
• Heavy physical activities and exercise also help improve concentration but this lasts for only about two hours. Regular outdoor exercise is always beneficial to the well-being of any child and could be particularly helpful for the ADHD child who experiences problems getting to sleep.
• Colourful items and things that move also help to improve the attention span of the ADHD/ADD child by arousing his interest; multi-media teaching aids on the computer are thus suitable for the ADHD/ADD child.
• Improving an ADHD/ADD child’s listening skills may also help to improve his attention span. Some "sound" therapy (e.g. Tomatis method) focus on using sound to improve the sensory integration skills of the ADHD/ADD child. Sensory integration therapy involving muscle movements may also help ADHD/ADD children overcome their problems with motor co-ordination, organisation, over / under-activity, over / under-sensitivity to touch, sounds, movements, and delays in speech, language or academic achievement.
• Background music might also help to improve the attention span of the ADHD/ADD child. Music keeps the right brain occupied while the left brain focuses on detailed and analytical work, which requires a lot of attention.
• Proper nutrition, together with supplements such as multi-vitamins, chicken essence, fish and flaxseed oils etc., also help some children with ADHD/ADD improve their attention span. This is especially useful if the child's ability to pay attention is adversely affected by nutrition-related problems.
• Reduce the amount of cakes, soft-drinks, chocolates, sweets, etc. for ADHD/ADD children, as these items may cause the child to have mood swings.
• Teach your ADHD/ADD child how to relax (e.g. through progressive relaxation techniques, meditation, music, tai chi, etc.).

+6. How can I better handle the impulsive behaviour of the ADHD child?

• ADHD children usually behave like children of a lower age group as their impulse control "muscle" is still quite weak compared to other children of the same age.
• One of the reasons for the impulsive behaviour, as explained by Tom Hartmann, is the ADHD child's unfilled need to "feel alive". Similar impulsive behaviour can also be observed in people suffering extreme physical hunger; it is unrealistic to expect these people to queue for their food when they have not eaten for days.
• Below is a list of possible actions to reduce the problems caused by the impulsive behaviour of ADHD children:
  • While the ADHD child is waiting for his turn, involve him in other activities (e.g. ask him some questions about the surroundings, give him a picture book, etc.)
  • Set and establish rules on answering questions (e.g. raise hands before raising question, etc.)
  • Teach him waiting skills by asking him to wait (and gradually increase this waiting time) when he demands your attention.

+7. How can I better handle the hyperactivity of the ADHD child?

• The ADHD child needs some physical activity to fulfill his basic need to "feel alive". It is thus important to expose the ADHD child to regular periods of physical activities each day to reduce the "hyperactive tension" within the child. Hence, allow the ADHD child to have some physical activity before or during the class, by e.g.:
  • Allowing a few minutes of stretching exercises before lessons begin
  • Allowing a short walk to and from the water cooler during breaks
  • Assigning him class duties such as helping to carry the books, putting up notices etc.
• While we are trying not to constrain too much of the hyperactivity of the ADHD child, we should also not encourage the ADHD child to over-exert himself on a continual basis, particularly if the activity makes him so excited that he has difficulty unwinding. Moderation is the key to handling the hyperactive ADHD child, i.e. intersperse high and low physical activities on a daily basis.

+8. How can Ritalin help the ADHD child?

• A common solution to ADHD/ADD prescribed by doctors is the use of the controlled drug Ritalin. It works as a catalyst to temporarily reduce the exhibition of ADHD/ADD symptoms as it increases the child’s naturally low sensory volume control. It thus helps the ADHD/ADD child pay attention, and control his hyperactivity and impulsiveness. Ritalin has been found to be effective for approximately 70 - 80% of ADHD children, and those not responsive to Ritalin are given Dexedrine or Cylert. The effectiveness rate for such stimulant medications is up to 96%.
• Disadvantages of using Ritalin include:
  • Loss of appetite / weight
  • Rebound effect after taking the drug, i.e. child cannot control himself after the effects of the drug has worn off
  • Cure the symptoms but not the root cause of the problems
• Ritalin is often used with behaviour management therapy to achieve maximum benefits from the therapy.
• Ritalin can be used as a catalyst to help the ADHD/ADD child learn better problem-solving skills that would be required in his adult life.
• Other alternative treatments include:
  • Herbal alternatives / health supplements such as Effalex, ZAN, ATTEND, multi-vitamins etc., which can help some ADHD/ADD children selectively [www.add-products.com]
  • EEG neuro-feedback, meditation
  • Brain gym exercises, tai chi
  • Tomatis method (using audio signals for sensory integration) [www.tomatis.com, www.tomatis.com.sg]
  • Davis correction method for dyslexic children [www.dyslexia-uk.net]
  • Sensory Integration therapy [www.sinetwork.org/whatisdsi.htm]

+9. How can I help the ADHD child cope in school?

• Get approval for extra time during examinations using a psychologist's report. Apply at least six months ahead to ensure that approval can be granted in time.
• Engage a private tutor or participate in peer tutoring at school.
• Choose classes that have a low student-teacher ratio.
• Train your ADHD child in positive self-talk e.g. “I did that well.”.
• Use word processors or computer for schoolwork.
• Consider enrolling your child into a Montessori class where he can learn things using his five senses.
• Find the best and most "interesting" teachers who can help the ADHD/ADD child develop interest in the subject being taught.
• Encourage your ADHD child to highlight & mark up his books, as well as prepare summaries of what he reads (as this is a more active form of reading).
• Use hands-on experience or real-life application in teaching wherever possible (in contrast to the mainly theoretical, semantic approach used in most classrooms).

+10. How can I teach or help the ADHD child to be better organised?

• Teach the ADHD/ADD child methods to help him better organise his things, e.g.:
  • Make use of checklists.
  • Put the same things in a designated place.
  • Colour-code his school books, files and stationery.
  • Do “work study” to determine where to put what for quick and effective retrieval.
  • Use coloured folders (or IN / WIP / OUT trays system) to keep track of pending homework, work-in-progress and completed homework.
• Break big assignments into smaller tasks, each with its own deadline.
• Use organisers, calendars, post-it notes, notice boards etc. to help keep track of things to do.
• Buy extras of essential items (keep a stock of low-priced pencils, erasers, rulers, A4-pads etc. ready at all times).
• Teach the ADHD/ADD child how to perform double-checks at critical times (e.g. before leaving a place and after completing an important task).

+11. How do I teach the ADHD child how to handle difficult or challenging situations?

• Basic problem-solving strategies:
  • Get the child to ask: "What is the problem?" and "How did this situation arise?" to identify the problem, its causes and effects as links in a chain, without assigning blame.
  • Get your child to think of three possible alternative ways of handling the situation more effectively.
  • Get your child to examine the likely consequences of each of the three possible alternatives to see if the alternative is a good or bad solution.
  • Get your child to pick the best alternative / solution.
  • Get your child to try the best alternative / solution to see if it works.
• Repeat problem-solving strategy if required. Remind yourself/your child that there are no failures – only feedback, i.e. the TOTE model (Test-Operate-Test-Exit when desired outcome is achieved).
• Teach your child to ask the right set of empowering questions, e.g.:
  • "What can I do to solve this situation / problem?", "What can I do to pre-empt similar situations / problems?"
  • Adopt a learning / “no blame” attitude. Don't ask yourself: “Why is everybody picking on me?", "Why is this happening to me?", "Why am I so stupid?", etc.

+12. How I can better manage the social problems encountered by the ADHD child?

• Incidental teaching of social skills:
  • A lesson starts when a poor social skill is observed.
  • Ask the child how he could have done it differently, and guide him into generating alternatives if necessary (rather than giving him the alternative).
• Social Skill Autopsy (for more difficult social skill-related problems):
  • Step 1: Discuss what the child did
  • Step 2: Discuss what happened when the child did it
  • Step 3: Discuss whether the outcome is positive or negative
  • Step 4: Discuss what the child should do next time
• Allow the ADHD/ADD child to play with younger children if he feels more comfortable with that; he could develop valuable social skills from interactions with younger children.

+13. How can I help the ADHD child who is being bullied in school?

• ADHD children are usually bullied in school for the following reasons:
  • Their peers and teachers do not accept their “strange” behaviour.
  • Their “social rankings” are lower than other students, especially when constantly pinpointed by teachers for their “wrong-doings”.
• How parents can help:
  • Speak with the school teacher(s) (especially the form teacher) to find out more about what is happening in class.
  • Explain to the child the possible reason(s) why bullies are targeting him, and what he should or should not do in school.
  • Teach the child what he could do when he encounters a bully by role-playing with him.
  • Get the teachers' assistance in appointing model students to watch out for the weaker students. (See Q26 on what teachers can do.)
  • Be your child's advocate; do not rest until the school takes proper actions to stop the bullying. Get as much evidence as you can – witnesses, injuries etc. Record the dates and details of incidents, backed by medical certificates / psychologist's reports if necessary. If speaking to the teachers does not work, meet with the principal. It is the school's responsibility to ensure a safe learning environment for every child.

+14. How can I help the ADHD child cope with his class work and homework?

• Allow the child to have regular breaks when doing homework (e.g. a 10-minutes break after 30 minutes of homework).
• Encourage the ADHD/ADD child to have fixed and suitable routines for homework.
• Encourage the ADHD/ADD child to estimate and monitor the time required for each assignment. This helps the child to better focus on the required assignment.
• Break big assignments into smaller tasks, each with its own deadline (e.g. have two trays, do homework one page at a time, put each completed page into the tray labelled “finished” to give visual satisfaction from work done).
• Encourage your child to highlight and mark up books, and prepare summaries of what they read (as this is a more active form of reading).
• Give the ADHD child a reason for paying attention or being interested in a particular topic / subject. For example, tell them that learning addition, subtraction, multiplication and division in mathematics is useful when you need to handle monetary transactions in the real world. By stating the usefulness or purpose of learning a particular subject, the ADHD child’s interest is enhanced.

+15. How can I improve the self-esteem of the ADHD child?

• Watch your own attitude and behaviour towards your child—he sees himself through your eyes. Accept your child as he is and he will accept himself.
• Recognise your child's strengths and teach him to recognise them too, by noticing and commenting on desirable behaviour. If possible, allow him to pursue his area of strength so that he can experience success (in an outside-school situation, if success is not possible in the school context).
• Avoid “attacking” your child's character with negative labels like “naughty”, “lazy” or “stupid”. Instead, constructively address his specific undesirable / inappropriate actions.
• Give children opportunities to do and decide things for themselves. If they make mistakes, accept it as part of the learning process—there are no failures, only feedback.
• Avoid being over-protective and give the child room to make mistakes without the fear of failure.
• Teach your child how to handle criticism. Let your child know that everyone has areas for improvement, but also gauge if the person giving the criticism is exaggerating the situation. Teach your ADHD child to see things in perspective and not be too hard on himself for mistakes made. Explain to him that statements such as “Why am I so stupid / clumsy / useless?” or “Why is everybody picking on me?” or “Why does it have to be me?” are not helpful at all, and show him better alternatives.
• Teach your child to accept praises and compliments graciously and humbly.

+16. How can I teach the ADHD child to be more self-reliant and responsible?

• Realise that ADHD children are struggling to be self-reliant and responsible. Be patient and distinguish Dr Jekyll from Mr Hyde.
• Make children sit on a "repenting / reflecting / thinking bench" until they can come up with an acceptable alternative behaviour.
• Give children opportunities to do and decide things for themselves; praise creativity and originality.
• Teach good "sportsmanship", that it is nobody's fault as to who wins or loses; we just have to do our best.
• Teach your child that he writes his own "life story"—he has the power to decide what goes on in his life and what does not.
• Get adolescents to compile their "strength list" and their “areas needing improvement” list.
• Reassure late bloomers, but avoid being over-protective and give the children room to make mistakes without the fear of failure.
• Teach the child to delay gratification to prevent irresponsible obsession with immediate gratification.

+17. How can I teach the ADHD child to better handle his emotions?

• Be aware of the child's emotions.
• Recognise any emotion as a teaching opportunity.
• Validate the emotion by listening empathetically.
• Help the child to label the emotion.
• Set limits and help the child problem-solve (see Q11).

+18. How can I teach the ADHD child perseverance?

• Teach your child to set clear objectives or have a clear vision of what he wants, i.e. "You can't get to where you want unless you know where you are going.”.
• Teach your child that successful people are those who have failed many times, and that people gain experience when they fail, as they learn important lessons of what does not work. Those who never fail are typically those who never succeed either.
• Teach your child to have positive thoughts and to be optimistic in life. Analogies such as seeing a glass of water as half-full or half-empty might help your child understand things, as well as a reminder that both the good and bad in life are natural and work in tandem.
• Teach your child to think of different ways for achieving these objectives. Encourage your child not to give up too easily. Explain to them that an aeroplane is off-course 98% of the time (partly because of external wind conditions), and the pilot has to constantly adjust the flight direction to reach the desired destination. In the same way, we have to constantly adjust our actions to achieve what we want.

+19. How can I help the ADHD child feel that he is loved?

• Extract from the book Heart of Parenting:

  • Make sure your ADHD/ADD child feels he is worthwhile and loveable so that he can grow up to be an effective and happy adult with good self-esteem.
  • Be specific in your praise and criticism. Describe the behaviour that caused the praise or criticism; also describe what could have been done to avoid the problem / criticism.
  • Allow your child to be competent and responsible. It is important for the child to feel that he can competently control everyday experiences. This will affect his future behaviour in terms of willingness to try and be persistent in achieving his goals.
  • Signs of a good parent-child relationship:
    • Child comes and ask you to carry or hold him
    • Child brings hurt feelings to you
    • Child says something that shows he knows how you feel
    • Child helps when not asked
    • Child wants to talk or be with you
  • Signs of a poor parent-child relationship:
    • Child does not send messages like those above
    • You are often angry with your child
    • Small issues become big issues
    • You talk to your child in a sarcastic, lecturing way
    • You hit your child in fits of rage
    • Your child defies you or shouts at you
  • Communicating love & acceptance:
    • Be a good listener
    • Show love by touching
      • Tell your child you love and appreciate him
    • Share your child's activities without taking over
    • Let your child do his own things without directions or criticisms
    • Learn to recognise your child's feelings. We must find clues to the feelings of our children that may be hidden in what they say or do. We must show the child we understand by communicating that understanding.
  • Sharing yourself with your child: Let the child know and experience how you feel, your thoughts and your expectations. This should be done without intending to manipulate the child by making him feel guilty or fearful. There should be no expectations that the child will act differently because of what you say.

• Make bedtime a special time for the ADHD/ADD child:

  • Develop a bed-time routine that starts 30 minutes before sleeping.
  • Encourage the ADHD/ADD child to pick his favourite book, etc.
  • Tuck them into bed and tell them that you will always love them.

+20. How can I help the ADHD child improve his handwriting?

• Use the “wheelbarrow walk”, i.e. hold the child's legs up, and with their body horizontal, have the child walk using his arms.
• Encourage them to play with monkey bars to exercise and arm and wrist muscles.
• Have the child help you to tear paper that needs to be shredded. This help the child develop better wrist and finger muscles, which are essential for good hand-writing.
• Any other exercises that help the child to improve his arm/wrist/upper back muscles (e.g. badminton, dumb-bell exercises, etc.).
• Teach the ADHD child the different shapes and sizes of the characters in the alphabet (for small and capital letters), as well as the different starting points for each character, relative to the shape of the character.
• Compare his handwriting with his previous work (not with peers' standards) and comment on any areas for improvement.

+21. How can I help the ADHD child improve his listening skills?

• Read bedtime stories to him/her.
• Get storybooks with accompanying audio tapes.
• Ask him/her to help to answer the phone at home.
• Consider enrolling your child into a Montessori class where he can learn things using five senses.
• Purchase Baroque music (which has 60 beats per minute, close to a relaxed heart-beat rate) such as Bach, Handel, Pachebel, Vivaldi for your ADHD/ADD child, to help him relax and improve his concentration.

+22. How can I communicate so that the ADHD child will listen to me?

• Extract from How to Talk so that Kids will Listen and How to Listen so that Kids will Talk:
  • Describe what you see and feel
  • Give information on what has happened
  • Write a note on what needs to be done
  • Do not command, lecture, moralize, warn, compare, prophesise or be sarcastic
  • Alternatives to punishments:
    • Point out acceptable alternatives (show child how to make amends)
    • Express disapproval for specific actions, not disapproval of the child's character
    • State your expectations
    • Give the child a choice
    • Take preventive action
    • Problem-solve together with child
  • When praising, be specific about the action that you are praising. Describe what you see and feel (e.g. “I can see that the toys are neatly kept. I like that. That is what I call being organised.”). General praises are not as effective (e.g. “Good boy, well done.”).
  • Accept and respect the child's feelings. Acknowledge and give them a word to describe their feelings. Do not deny their feelings, give advice or be philosophical.
  • Encourage autonomy in your child
    • Let child make choices
    • Show respect for his struggles
    • Don't ask too many questions
    • Don't rush to answer the child's question; prompt them for possible answers instead
    • Don't take away hope
  • Avoid labelling your child. Describe what the child has done and how you feel about the action, then help your child to generate other possible actions. Your child behaves the way he does because he lack choices at the moment.
  • Watch your non-verbal signals (tone, pitch, gestures, posture, eye pattern, etc.), as they account for 93% of total communication.

+23. What role can the father play in bringing up the ADHD child?

• Literature on ADHD, counsellors and psychologists all consistently noted that it is the mother who senses that her child is “different”, attends talks and reads books on ADHD, and tries to advocate for her child. Fathers of ADHD children, on the other hand, often get stuck in the “denial” stage. They place the blame for the child's behaviour on their spouse's “ineffective mothering”, preferring to handle the situation with large doses of “good old fashion discipline”. This conflict between the parents puts additional stress on the ADHD child and increases his sense of insecurity. The full participation of the father is therefore a primary factor in helping the ADHD child cope.
• Fathers play important roles in bringing up children. See www.fathers.com.sg to get more information on this. Sign up for the mailing list on tips for fathering (send your request to fathers@singnet.com.sg).
• Fathers have the following important roles:
  • Fathers are often seen as the authority in the household.
  • Fathers teach the child to see the world from different perspectives.
  • Research has shown that fathers have more impact on the child than mothers in many areas, despite the fact that fathers usually spend less time with their children compared to mothers.
  • Playing with their children allows fathers to create strong parent-child bonds, as well as allow fathers to teach their children important values and beliefs. Fathers thus have a great impact on how the child views the world.
  • Boys will role-play what their fathers do.
  • Girls will learn more about men from their fathers. Their fathers largely influence their values and beliefs about men.
• There are many fathers that do not know how to play or interact with their children because they have not done so with their own fathers. One of the key missions of The Centre for Fathering [www.fathers.com.sg] is to break this vicious cycle of uninvolved fathers. Activities such as camps and field trips are organised by the Centre to help fathers build a stronger bond with their children.

+24. How can I better cope with the stress encountered in managing the ADHD child?

• 10 tips to help you manage your stress:
  • You should have realistic expectations on what your child can or cannot do.
  • You should encourage routines that help the child get his work done.
  • Simplify your life to provide your ADHD/ADD child with the time, energy and attention they need.
  • Accept your child as he is and focus on his strengths and interests.
  • Be fair, firm and consistent with your disciplinary methods.
  • Distinguish intention and action. When you encounter rebellious behaviour from your child, focus on his intentions rather than his actions.
  • Avoid allowing either you or your child to become fatigued.
  • Take your child to places where he has room to be himself (e.g. an open parks or places with carpeted floors, where he can run around and fall without getting easily hurt).
  • Take good care of your own mental and physical health, so that you would have adequate energy and patience to provide your child with the necessary guidance he needs.
  • Stop comparing your life with others and be grateful for what you have.
• You have to realise that you cannot resolve all the different problems that the ADHD child has at the same time. Instead, prioritise a few areas to work on at any point of time, and move on to other areas when current problems have been reduced (or when you have reached a stage of accepting them as they are).

+25. How do I resolve the differences between my spouse and I on the subject of raising our ADHD child?

• It is common for you and your spouse to have different opinions on raising your ADHD child. It is likely that one parent will be stricter than the other. However, parents should not focus too much on whether the other parent is too lenient or strict, but rather on ensuring that the ADHD child feels loved and cared for. Research has shown that the strictness or leniency of a child’s parents has little effect on a child’s behaviour. However, children who do not receive enough love and attention are likely to act out.
• It is important to do the following to reduce the conflicts between you and your spouse:
  • Discuss the differences in opinion in bringing up the ADHD child when the child is not around.
  • Agree on what constitutes acceptable behaviour and the consequence(s) of unacceptable behaviour.
  • Spend time together with your spouse (without the ADHD child) to strengthen your bond.
• It is common for you and your spouse to feel drained looking after the ADHD child. This is likely to make it more difficult to discuss and agree on the way to raise the ADHD child. The following are possible solutions:
  • Agree to disagree on certain areas, but present a common front to the ADHD child so that the child will not make use of the differences between his parents’ opinions to get away with certain behaviour.
  • Seek the help of an independent third party that both you and your spouse can trust to mediate on the differences (e.g. a family counsellor at Child Guidance Clinic at Health Promotion Board).
• It is not uncommon for one or both of the parents of an ADHD child to be very stubborn in his/her views, thus making it almost impossible to have any conciliatory views on bringing up the child. In such cases, the patience and perseverance of the other parent is required.
• Parents with special needs children face a higher risk of ending up in a divorce, especially when conciliatory views on bringing up the child cannot be agreed upon. Marital counselling is usually required in such a situation.
• Looking after the ADHD child is a very demanding task and parents must be careful to put in sufficient effort to sustain the relationship with their spouse. Ultimately the ADHD child will suffer more if his/her parents are not handling their conflicts well.

+26. What can teachers do to help ADHD children?

• Establish a supportive learning environment:
  • Children with ADHD could be seated in the first few rows near the teacher's desk, surrounded by five to six model students who can assist the ADHD child, and whose behaviour the ADHD child can emulate. (Model students here refer to fairly matured children who are tolerant and have good EQ skills.)
  • Emphasise that everyone has his own strengths and weaknesses, and that students should support and help each other.
  • Acknowledge the helpful attitude and positive contribution of the aforementioned model students at appropriate times.
  • Do not place students with ADHD/ADD near air conditioners or high traffic areas such as doors or windows as these will distract the ADHD/ADD child.
• Reduce the incidence of bullying in school
  • Be conscious that teachers are role models for the other students' attitude towards / treatment of children with learning difficulties. If the teacher disciplines the ADHD child with dignity, then other children will follow suit. If she highlights the ADHD child's strengths, she will raise his social standing and reduce the probability of him being bullied.
  • Be aware that children who are “different” are bully-magnets. To reduce bullying, investigate complaints against the ADHD child thoroughly before taking disciplinary measures.
  • Emphasise that bullying will not be tolerated in school and remind students of the consequences if they are caught bullying others.

• When giving instructions to students with ADHD/ADD:

  • Write homework and other important messages on a special corner of the board (or on a separate board) that is not erased until the message is no longer valid.
  • Emphasise key points by writing them on the board. This is more likely to catch the attention of a student with ADHD/ADD.
  • Try to involve various senses during lessons (e.g. the use of colourful materials). Children with ADHD enjoy hands-on experiences.
  • Keep each lesson short and inject variety to stimulate students' interests. What is useful for the ADHD child is also useful for other children.
  • Most children learn best through play. Lessons should be made as fun as possible by using creativity and real-life examples, as the ADHD child finds it difficult to learn abstract things. For example, teaching mathematics using money makes the child appreciate why we need to learn addition and subtraction, and motivates the child to learn other abstract mathematical operations.
  • ADHD children (as well as one-third of all children) are usually weak in their listening skills. Find creative ways to enhance the listening skills of children by:
    • Using multi-media teaching aids on the computer
    • Asking children to identify what they can hear in the background
    • Making wire-telephones using paper cups during science lessons
    • Getting different children to read different parts of the lesson
  • Try to have structure and routines for the different lessons.
  • State directions clearly and simply.
  • Minimise the clutter on your handouts.
  • Teach students memory aides.
  • Encourage students to solve problems with minimal teacher involvement.
  • Maintain eye contact during verbal instruction.

• When giving assignments to students with ADHD/ADD:

  • Give out one task at a time; monitor frequently.
  • Make sure that you are testing knowledge and not attention span.
  • Keep in mind that children with ADHD/ADD are easily frustrated; stress, pressure and fatigue can break down their self-control and lead to poor behaviour.
  • Require the use of an assignment notebook:
    • Write down assignment(s) on the board
    • Require students to write down assignments into a notebook
    • Get parents to sign off the assignment notebook
  • Give them more time for assignments and tests. ADHD children tend to lose focus and thus need more time than others to complete their work. Inform parents of ADHD/ADD children that they should apply for extra time for school examinations for their children at least six months before the exam to ensure approval can be obtained in time.
  • Communicate assignments clearly by being clear about the deadline and required technicalities such as number of pages, formatting, necessary materials, etc.
  • Provide a model / structure of the required assignment or project.
  • Intervene when there is a pattern of incomplete assignments. Contact parents to ensure supervision at home.
• Modifying behaviour and enhancing self-esteem:
  • Invest time and effort to build rapport with the ADHD child on a one-to-one basis. Once the groundwork is done, maintenance is easy—just a smile or nod to reinforce desired behaviour, and a shake of the head to signal inappropriate behaviour.
  • Provide supervision and discipline:
    • Remain calm, state what has gone wrong and avoid arguing with the student.
    • Describe what should have been done.
    • Pre-establish consequences for misbehaviour with the student.
    • Enforce classroom rules consistently.
    • Ensure that the discipline fits the wrongdoing, and that there is no unnecessary harshness.
    • Avoid ridicule and criticism; remember that children with ADHD/ADD have difficulty staying in control.
    • Avoid publicly reminding ADHD/ADD students to take their medicine.
  • Provide encouragement:
    • Reward more than you punish; find good behaviour to reinforce.
    • Be specific in your praises.
    • Encourage positive self-talk (e.g. “You did very well remaining in your seat today. How do you feel about that?").
• Provide proper structure and organisation:
  • Provide structure and routine for lessons.
  • Require that students use appropriate files to effectively organise their materials and schoolwork.
  • Provide a designated place in the classroom for students to turn in their work.
  • Teach students how to keep a neat desk, and build desk-cleaning time into the class schedule.
  • Encourage students to be responsible for their own belongings.
  • Encourage class discussions in which students share their ideas about keeping organised.
  • Encourage the use of a checklist.
• Making examinations more manageable for children with ADHD and other learning difficulties:
  • Do not use microprints.
  • Place comprehension passage / graphic stimulus on page facing the questions.
  • Sit ADHD child right in front of invigilator.
  • Break the examination into separate sections / booklets. ADHD children tend to be overwhelmed by the length of the entire examination paper and are unable to pace themselves to complete it on time. Breaking it into separate sections allows the child:
    • Much-needed attention breaks
    • A visual (and kinaesthetic) indication of work progress and passage of time
    • Grant the ADHD child extra time for the examination.

+27. What are some of the strengths that an ADHD child may have?

Children with ADHD / ADD are usually creative, daring and happy-go-lucky. Other strengths of the ADHD /ADD child may include:

• Kindness
• Helpfulness
• Good memory
• Artistic skills
• Good with animals
• Adventurous nature
• Good reading skills
• Good computer skills
• Good gross motor skills
• Good mathematical skills
• Enjoys outdoor activities
• Has a wide variety of interests

+28. How can a person with ADHD succeed in today's competitive world?

• Successful people with ADHD/ADD have the following characteristics:
  • Are perservering
  • Are physically active
  • Are self-reliant and responsible
  • Have found way(s) to be organised
  • Possess an "I can" attitude and have good self-esteem
  • Focus on problem-solving rather than self-blame or self-pity
  • Focus on outdoor / hands-on / creative / computer jobs rather than desk-bound and theoretical paper work
• The following is a list of actions that people with ADHD/ADD have tried and found useful:
  • Make full use of your creativity.
  • To be more organised:
    • Practise being more aware of your own actions as well as what is happening around you.
    • Learn to have designated places to keep various things.
    • Create permanent reminder lists to minimise common problems encountered.
    • Buy extras of essentials
    • Develop the habit of double-checking.
    • Develop ways to organise your things/work
  • To be successful at your workplace:
    • Find mentors and role-models, especially successful people with the same ADHD/ADD problems.
    • Find ways to remember people's names (e.g. by repeating the person's name, asking the person to spell his/her name).
    • Set short term goals to help you to keep focus; break big jobs into smaller tasks, each with its own deadline
    • Use organisers and calendars to help you track things to do.
    • If possible, have an executive assistant to help you keep things more organised.
    • Remind yourself that people who have failed many times are also more successful than others in what they do.
  • To be successful in school:
    • Find the best and most "interesting" teachers who can help you develop interest in the subject being taught.
    • Highlight and mark up books, and prepare summaries of what you read (this is a more active form of reading).
    • Read the summary, title, first / last sentence / paragraph before you read the entire article.
    • Find a reason / purpose for paying attention or being interested in a particular topic/subject.
    • Choose subjects/topics that provide hands-on experiences or real-life applications (in contrast to a class that covers only theories).
  • Be physically active:
    • Exercise or enroll in a martial arts class
    • Learn physical relaxation techniques
  • Learn to use a computer.
  • Learn problem-solving skills:
    • Ask yourself the right set of empowering questions, e.g.: "What can I do to solve this problem?" or "What can I do to prevent similar problems from happening?", instead of "Why is this happening to me?", "Why am I so stupid?", etc.

+29. What types of jobs or careers are suitable for a person with ADHD?

• Jobs that provide a variety of activities, adequate autonomy and creativity freedom are suitable for people with ADHD/ADD. Outdoor, hands-on and computer-related jobs are also suitable.
• Examples of suitable jobs for people with ADD/ADHD:
  • Technical jobs involving field installation and repair of high-tech equipment
  • Sales representatives who are not office-bound
  • Scientific exploration / research
  • Computer / financial / engineering consultants
  • Entrepreneur / businessman
  • Work that requires leadership (leading by example) rather than a managerial role (managing details)
  • Fire safety, law enforcement and military where there are stimulating activities
  • Work that requires a lot of creativity (e.g. design work, writing, artistic work, advertising, etc.)
• People with ADD/ADHD should avoid the following jobs:
  • Work that requires focus on everyday details, have less autonomy, and are usually desk-bound (e.g. managerial positions, secretarial jobs, administrative work, accounting, etc.)
  • Desk-bound work that deals with abstract theory and have little direct bearing on real-life activities / application

+30. What Co-Curricular Activities (CCA) or physical activities are suitable for the ADHD child?

• ADHD children may do less well than their peers in team sports because of their behavioural characteristics (impulsiveness, hyperactivity, disorganisation, lack of social skills etc.).
• ADHD children can focus on, and do well in activities that are intrinsically stimulating to them. Hence, the key is to give them the opportunity to pursue their passion. Excelling in a CCA is one way of building up the ADHD child's self-esteem (which may have been battered by “failures” in the classroom setting).
• Depending on age, physical activities and CCAs that are suitable for ADHD children include:
  • Cycling / jogging
  • Swimming
  • Playgrounds
  • Table-tennis / Badminton / Basketball
  • Tai chi or other martial arts
  • Riding (particularly for those who love animals)
  • Social activities such as church groups or youth organisations that help develop social skills and self-esteem
  • Outdoor activities such as camping, visiting the zoo / bird park / beach / nature reserves

+31. What books are useful in helping me better manage an ADHD child?

The following books are useful reading materials for managing an ADHD child:

• ADD Success Stories and Beyond ADD by Thom Hartmann (see www.thomhartmann.com)
• The Myth of the ADD Child by Thomas Armstrong (see www.amazon.com)
• How To Talk So Kids Will Listen and Listen So Kids Will Talk by Adele Faber and Elaine Mazlish
• Beyond Ritalin by Stephen Garber, Marianne Daniels Garber & Robyn Freedman Spizman
• Quantum Learning by Bobbi Deporter & Mike Hernacki
• The Learning Gym by Erich Ballinger (see www.braingym.com)
• The Heart Of Parenting: Raising an Emotionally Intelligent Child by John Gottman & Joan DeClaire

+32. What are some useful websites that provide more information about ADHD?

Useful websites for more information on ADHD issues include:

• www.ldonline.com – Learning Disability Online
• www.chadd.com – Children and Adults with ADD
• www.addexpert.com - For ADHD/ADD newsletter
• www.add.org – ADD Association
• www.thomhartmann.com – Author for ADD Success Stories, Beyond ADD, etc.
• www.add-products.com – Herbal alternatives to Ritalin
• borntoexplore.org – Born To Explore: A different perspective of ADD
• www.fathers.com.sg – Centre for Fathering
• www.helpguide.org – Helping Children and Teens with ADD / ADHD Succeed at School