ADHD Common Behaviors Elham Shirazi MD Child & Adolescent Psychiatrist

Many ADHD :  Act younger than they are  Are forgetful  Argue or talk back  Hard to wake up  Have a messy room  Don’t learn from discipline  Act without thinking of consequences

If you want to correct every misbehavior You will be worn out physically & emotionally !  Pick your battles carefully  Use reprimands sparingly Your teenager can learn to compensate But it will take time !

Seek Independence & Freedom 1. Encourage independence  Give as much freedom as you feel he can cope with  Give opportunities to make his decisions 2. Trust until proven not trustworthy 3. Be observant of activities & friends  Intervene when isn’t handling independence well  Take away privileges,but extend them again to give him a 2nd chance

4. Consider compromise 5. Set up win-win solution  Allowed to go to beach with friends with a parent supervision 6. Offer an attractive alternative  As interesting, with sufficient freedom  Propose an interesting activity before he has ideas of his own

Disobey / Conflict with Adults  Don’t always do as parents & teachers ask them but often, their failure is inadvertent !  Variety of reasons : Forget, don’t listen, don’t hear, immaturity, impulsivity, can’t focus on one activity, losing track of time, avoid unpleasant job  Often oblivious to rewards & punishment Conflict

Available Options 1. State rules clearly 2. Post them in writing helps 3. Develop rules jointly m ore likely to remember & comply 4. A few stated rules are better

Act Younger  Social development 30% behind peers  LLD Impaired communication skills Trouble following & remembering lengthy explanations & requests Trouble finding right words to answer quickly & organized  Want privileges of his age but may not handle them maturely

Available Options 1. Adjust expectations  To appropriate age level  Don’t take misbehavior personally 2. Ask his help in solving problems 3. Teach desired behavior 4. Impose consequence if necessary

Act Impulsive  If a thought crosses their mind, they may act on it  If they think it, they may say it more likely to say : Ready, Fire!, Aim (& Oosp !! at the end)  They often say / do things they wish they could take back  Keeping secrets terrible time  Live for moment delay gratification is difficult

Available Options 1. Anticipate problems  Buy a small gift to open before christmas  Put car keys away  Put money in saving account  Don’t tell him secrets 2. Avoid tempting to act impulsively 3. Consider medication

Difficulty Paying Attention  View the world through a wide angle lens Pay attention to every thing at once Trouble selecting what is most important  Sometimes over focus Concentrate on single activity for hours  Misleading adults He deliberately don’t pay attention ! Trying to talk with ADHD can be frustrating Are you listening to me?

Available Options 1. Make eye contact / use touch  Stand/sit in front of him (close proximity)  Place your hands on his shoulder/knee (touch)  Say his name (sound)  Avoid power struggle 2. Keep comments brief & leave  Can’t remember >2-3 things  Trouble picking important points

Available Options 3. Avoid preaching 4. Write instructions down 5. Accept his listening style  Sometimes they hear even appearing not to listen  Ignore his restlessness & accept his listening style

Forgetful / Doesn’t Do Chores 1. Make a written list 2. Use post-it notes 3. Help get started / show how to do 4. Ask what help?

Disorganized / Lose Things 1. Put name on possessions 2. Purchase less expensive things 3. Help be organized  Have specific place for belongings  Teach time management constantly 4. Serve as a couch  Give reminders about important responsibilities

Available Options 5. List steps for a clean room  Make up bed  Hang up clothes  Pick up thinges of floor  Put them in closet & vaccuum 6. Help cleaning / organization  Work with him on weekly/monthly basis  Make learning pleasant (listen to music,talk about hobbies,…) 7. Close door to messy room  You don’t have to look at the mess

Lack Of Awareness Of Time  Are often late  Difficulty guessing how long it will be take 1. Set a wristwatch alarm for key times 2. Rent or buy a beeper 3. Teach awareness of time

Difficulty Planning Ahead  Prefer to do things on the spur of moment 1. Teach planning 2. Teach time management  Including him when planning family activities  Using a weekly calendar  Estimate time required for each step

Difficult to Discipline  Don’t learn from their mistakes  Don’t make connection between behavior & consequences  Low sensitivity to rewards & punishment  Traditional punishment doesn’t work parents use harsher discipline  Many times : Genuinely sorry when doing something wrong

Available Options 1. Use positive reinforcement 2. Use logical consequences 3. Reward or punish immediately 4. Create new consequences / rewards 5. Be consistent 6. Try “Grandma’s Rule 6. Try “Grandma’s Rule “

Available Options 7. Use behavior charts 7. Use behavior charts 8. Use rewards / may include money 8. Use rewards / may include money 9. Redirect interests 9. Redirect interests 10. Give second & third chances 11. Avoid power struggles

Low Frustration Tolerance Irritability / Emotionality  Easy frustrated  Respond more emotionally  Irritable or moody  65% oppositional  Arguing over smallest issues  Never certain what mood to expect

 Defensive & angry at person correcting him  Respond to stress with angry temper outbursts  Overreact to crisis  Blame unfair action of others  Direct anger at person they love the most / they feel safest  Sensitive to criticism or disapproval  Fear of being embarrassed

Available Options 1. Use active listening 2. Be supportive Treat your teenager with respect 3. Teach problem solving skills 4. Teach anger control  He is learning from family & parents  He will model your behavior  Bragging about things he does well

Verbal Fights / Arguing Being a parent & not responding angrily is not easy Being a parent & not responding angrily is not easy 1. Ignore minor infraction 2. Walk away from conflict ( I know you are upset, but cursing is not acceptable around me, I will not stay here & listen to you talk that way. I will come back later & we will talk when you have calmed down or when you can talk without cursing ! )

Available Options 3. Give space & time to cool off Need time alone when had emotional blown-up 4. Impose a consequence 5. Adjust medication

Don’t Accept Responsibility for Actions  May blame someone/ something else for their actions  Trouble admitting they have done something wrong  Trouble saying they are sorry 1. Deal with problem behavior 2. Don’t try to assess degree of guilt or excuse

Dishonest Dishonest 1.If you know the answer, don’t ask ! 2. Don’t create opportunities to lie 3. Eliminate some punishment 4. Develop plan to solve the problem 5. Impose a consequence

Difficulty With Family Events 1. Keep outings simple 2. Reduce demands 3. Keep outings brief 4. Provide a safety release valve 5. Look for creative solutions 6. Medication may help

Difficulty Participating In Sports  Exercising is good : stress sleep better restlessness good for heart hyperactivity production of neurotransmitter  50% poor motor coordination  Poor hand-eye coordination Gross motor skills may be better

1. Play large muscle sports swimming, soccer, track, wrestling, karate 2. Play an active position that requires full attention positions which involve higher activity levels are more likely to hold attention & focus 3. Consider medication before game

Restless / Easily Bored Feeling restless complain of being bored Wants to do something constantly Wants to go somewhere constantly 1. Encourage involvement in community activities community activities physical activities, organized sports, religious groups, overnight parties, ski trips,...

2. ‍Plan interesting family outings  schedule family events that allow your teenager be active 3. Encourage hobbies & interests  discover his interests by exposing him to variety of activities  discuss options & let him pick one out 4. Make special plans for holidays

Difficulty With Family Events 1. Keep outings simple 2. Reduce demands 3. Keep outings brief 4. Provide a safety release valve 5. Look for creative solutions 6. Medication may help