q       Behavioral changes; lethargy, anorexia, disrupted sleep

q       Separation anxiety at 6 months

q       Can recall and anticipate pain after 6 months

q       Stranger anxiety at 8 months

Interventions:

q       Stay involved with day care (See Day Care Hand-Out Sheet)

q       Lots of tender loving care

q       Provide visual, auditory and motor activities

q       Promote trust

B. Toddler

Reactions:

q       Regression

q       Physical aggression, fighting, biting

q       Negativism, temper tantrums, crying

q       Withdrawal, reluctance to explore

Interventions:

q       Be firm, consistent, positive

q       Allow rituals

q       Allow choices to provide child with means of control

q       Provide mobility

C. Preschooler

Reactions:

q       Magical thinking and fantasy explanations used to explain things

q       May see separation as punishment and exhibit guilt

q       Aggressive or passive and dependent

Interventions:

q       Explain events (e.g. tell child he is going to doctor for check-up after you get off of work)

q       Let them know it’s okay to cry (let child know he can display emotion, but it won’t change outcome) (e.g. mom still has to go to work)

q       Encourage independence and initiative

q       Play with child

D. School Age

Reactions:

q       Most likely to blame self for causing separation

q       Withdrawal, silence, lack of activity, social isolation

q       Fear of loss of control from enforced dependency on secondary caregiver

Interventions:

q       Encourage industry and feelings of control by giving them useful and productive things to do

q       Encourage verbalization of feelings and needs

q       Observe for nonverbal clues which might indicate fears

q       Don’t expect child to ask for help and support - offer it

q       Give more detailed explanations

E. Adolescent

Reactions:

q       Mistrust adults

q       Restrictive environment difficult

q       Aggressive or passive, hostile and noncompliant

Interventions:

q       Establish trust

q       Involve in decisions

q       Include peers

q       Encourage information seeking

q       Support and respect individuality

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Discipline (To teach a follower)

This word comes from the same root word as disciple and means to teach. Discipline does not mean to punish. To teach, one must learn how to give effective commands to a child. This requires that you:

q       Be aware of a child’s abilities at various stages of development.

q       Give clear commands in the child’s own language. Always include who, what, when, and where. A child’s concept of when may include counting, i.e., “1-2-3. “

q       Reinforce your requests appropriately and consistently. The worst punishment for a child is to ignore him - have him to go to his room or stand in a corner or sit in a chair for a brief interval - never more than one minute per year of age up to 5 minutes. Light spankings, which scare rather than hurt may be needed to teach the child to go to his room or sit in the chair as a punishment.

q       The best reward for a child is your love and acceptance. Give it lavishly and appropriately. Catch them being good.

 

Use Praise

q       Praising is a gift; when a parent empathizes with his or her child, praise always works.

q       Provide clear, simple, positive messages.

 

Provide Positive Attention By:

q       Turning toward your child.

q       Establishing eye contact.

q       Pleasantly delivering verbal and physical praise, (i.e. a pat on the back, a smile, a hug). Providing immediate reinforcement when possible.

q       Don’t make praise a negative by saying something like "That’s good; now, why couldn’t you have done that before."

 

 What to Praise:

q       When the child does what the parent asks.

q       When the child makes an attempt to do what the parent asks.

q       Age appropriate play and task performance.

q       Plays appropriately with brother, sisters, friends.

q       Positive verbal interaction.

q       Positive responses to others—made on child’s own initiative

q       In the absence of negative, undesirable habits and behavior

 

BEHAVIOR INVENTORY SHEET---TAKE STOCK OF WHAT YOUR CHILD DOES

Under each category name five behaviors of your child that:

 

You like (and want to see more of)	You don’t like (but do not wish to punish)	You find intolerable

 

To manage these behaviors it is best to:

Pay Attention to the behavior You Like, Ignore the behavior You don’t like and, Set Limits for Behavior you find intolerable.

The most successful tool in modifying behavior is praise; give it especially when the child is doing something you like. For those minor episodes of misbehavior, ignore the behavior. You’re not withholding your love when you withhold your attention and expression of your love.

Time Out

Setting limits for intolerable behavior should usually involve a system of time out. When your child is having a screaming fit, first ignore him. When that is no longer possible, tell him in a calm, unemotional voice that she must go to Time Out. Isolate her in a corner, or preferably in a room for a length of time that fits the misbehavior. Use a timer, so the child won’t try to beg off. Make the timer the "bad guy" and reply to your child’s complaint that the timer has not rung! Better yet, leave the room and tell the child he may come out when the timer rings.

 

Behavior Modification with a Praise Sheet

A lot of your patience is needed to change your child’s behaviors. It is helpful to develop a Praise Sheet, so that everyone in the family, including the child, can watch his progress.

 

1. Place the sheet in a prominent family place, such as the refrigerator door.
2. Initially, select a behavior, which is relatively easy to teach, so the child can easily succeed and learn the system. After the child has learned the system add more difficult behaviors.
3. List the behavior on the Praise Sheet and concentrate only on this task during the week.
4. Place a "Smiley Face" or check mark on each day of the week on the Praise Sheet if the child successfully completes the task and praise the child for doing the task.
5. At the end of the week of "mostly" stars, give the child her reward. Negotiate with your child in advance about the reward. Usually the reward should be added time spent exclusively with a parent doing a fun activity.

   

The following example may help:

"Johnny, I want you to learn to put your balls in your toy box before bed, without a reminder. Every day you do this, I will place a gold star on your praise sheet. If you have mostly gold stars at the end of the week, your father will take you to the park on Sunday."

 

The Praise Sheet

List the target behaviors under the behavior column. List the rewards under the behavior column.

Concentrate on one task at a time and go from easy tasks to intolerable behaviors. The first line is filled in as an example. Use this sheet or devise more attractive ones of your own.

 

Behavior	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday REWARD
Balls in Toy Box at Night (Example)	J	J	J	J	J	Trip to Park with Dad

 

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What Is ADHD?

Attention-Deficit/Hyperactivity Disorder is a neurological condition related, in part, to the brain's chemistry and anatomy. ADHD manifests itself as a persistent pattern of inattention and/or hyperactivity-impulsivity that occurs more frequently and more severely than is typically observed in people at comparable levels of development. ADHD begins in childhood and can persist into adulthood as well. While some children outgrow ADHD, about 60% continue to have symptoms into adulthood.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the symptoms of ADHD fall into three categories: inattention, hyperactivity and impulsivity, and combined.

Inattentive Type

• This is diagnosed if the child has been impaired by six or more symptoms of inattention.
• Some of these symptoms include not paying attention, making careless mistakes, not listening, not finishing tasks, not following directions and being easily distracted.

Hyperactive-impulsive Type

• This is diagnosed if the child has been impaired by six or more symptoms of hyperactivity-impulsivity.
• Symptoms include fidgeting, talking excessively, running around at inappropriate times, interrupting others and having difficulty awaiting turns.

Combined Type

• This is diagnosed if the child has been impaired by six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity.

All children act in ways that could be viewed as inattentive, hyperactive, or impulsive, the core symptoms of ADHD. In fact, all of us daydream, interrupt, blurt out information, get impatient, or feel restless at times, but not all of us have ADHD.

Professionals diagnose ADHD only when a child:

• Has displayed symptomatic behaviors that are inconsistent with their development level.
• Exhibits at least six symptomatic behaviors consistently over a period of the last six months.
• Has had some symptoms since before the age of seven.
• Is impaired by these symptoms in life activities in more than one setting, in school and at home, for example.
• Has symptoms that are not better accounted for by another illness.

For more information visit http://www.strattera.com/1_3_childhood_adhd/1_3_1_1_what_is.jsp

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Diagnosing Attention Deficit Hyperactive Disorder

 

Symptoms of ADHD
 
This is a list of the symptoms that must be present, according to standards established by professionals in the field in diagnosis manual called the DSM IV. This is the recognized authority for mental diseases. However, the standards will probably be revised soon, as many "mental diseases" are rapidly being reclassified as neurological diseases, due to rapidly growing knowledge of the actual physical causes of many behavior problems.
 
Inattention Behaviors:
1. The patient does not pay attention to details, makes careless mistakes in school work.
2. The patient has difficulty sustaining attention in tasks or play.
3. The patient does not seem to listen when spoke to directly.
4. The patient does not follow instructions and fails to finish schoolwork, chores, or duties (not due to oppositional behavior or failure to understand instructions).
5. The patient has difficulty organizing tasks and activities.
6. The patient avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork, homework).
7. The patient loses things necessary for tasks.
8. The patient is easily distracted by extraneous stimuli.
9. The patient is forgetful in daily activities.  
 
Hyperactivity/Impulsivity Behaviors:
1. The patient fidgets with hands or feet squirms in seat.
2. The patient leaves seat when remaining in seat is expected.
3. The patient runs about inappropriately or climbs excessively (or has feelings of restlessness).
4. The patient has difficulty in playing or engaging in activities quietly.
5. The patient is "on the go" or often acts if "driven by a motor".
6. The patient talks excessively.
7. The patient blurts out answers before questions are completed.
8. The patient has difficulty waiting his/her turn.
9. The patient interrupts or intrudes on others.
 
This list may not describe every patient with ADHD, but is a good starting place.

 

For accurate diagnosis the "strict criteria" further requires:

• 6 symptoms in either paragraph to diagnose Inattention and/or Hyperactivity
• Some symptoms should be present in 2 or more settings. (For example: home and school, or home and work)
• Some symptoms should occur before age 7.
   

            Many of the psychological tests were devised to decide, in an objective way, whether a child has a sufficient number of symptoms at a particular age and location. Unfortunately, these are really just someone's opinion of the patient's behavior, so they are not all that objective. Still, these tests are the best we have, until science devises an easy blood, EEG, or brain scan. These tests are actually just a list of the above ADHD symptoms, masked with some normal behaviors to improve accuracy of the test. There are several different tests given by schools and doctors. They each have their place, but cannot replace careful observation and opinions, given by an experienced parent, teacher, or doctor. The tests are named by the person or school who devised them. They are known as the Conners, the Hawthorne, and the newer Vanderbilt tests. Just remember, they are not true tests, but an attempt to see if the person answering the questions thinks the patient has the symptoms of ADHD, listed above.

 

After you have become familiar with ADD and you think your child might have some of these symptoms, you should have him evaluated by a doctor, who is experienced and trained to evaluate ADD. Your pediatrician may be the best place to start. Our pediatricians are quite familiar with ADD. We have hundreds of patients, who can tell you the benefits of proper diagnosis and management of this and other behavior problems in children. If you would like an appointment with one of our pediatricians, you may request one by phone, or by email, IF YOU REGISTER AND USE OUR SECURE EMAIL FEATURE.

 

            Before your appointment, just print out the forms below; complete the parent forms at home, so you can give it your best effort. Take the teacher forms to the teacher(s) who know your child best. Give the teachers plenty of time, as they may have several ADD kids in their classroom. We look forward to seeing you in our office!

 

Parent and Teacher Forms

 

Initial ADHD Evaluation – Teacher Form

Initial ADHD Evaluation – Parent Form

Follow-up Evaluation – Teacher Form

Follow-up Evaluation – Parent Form

 

 

Informational Websites

 

http://www.chadd.org/

With over 20,000 members and over 200 affiliates nationwide, CHADD is the leading non-profit organization serving individuals with Attention-Deficit/Hyperactivity Disorder (AD/HD).  Through collaborative leadership, advocacy, research, education, and support, CHADD provides science-based, evidence-based information about AD/HD to parents, educators, professionals, the media and the general public.

 

www.strattera.com

Strattera is the first non-stimulant medication that is FDA approved to treat ADHD in children, adolescence, and adults.

 

www.ncld.org 

National Center for Learning Disabilities

 

www.ericec.org 

Educational Resources Information Center

 

http://www.adhdinfo.com

An informational website about ADHD that discusses explanations about responsible treatment, explains facts and myths, and gives support for care givers and school personnel.

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