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ADHD is a disorder that affects 5% to 7% of children. Children
with ADHD have problems with attention span, hyperactivity, and
impulsive behavior. ADHD is the term now used for ADD (Attention
Deficit Disorder). ADHD is more common in boys than in girls.
A normal attention span is 3 to 5 minutes per year of a child's
age. Therefore, a 2-year-old should be able to concentrate on a
particular task for at least 6 minutes, and a child entering
kindergarten should be able to concentrate for at least 15
minutes. (Note: A child's attention span while watching TV is not
an accurate measure of his or her attention span.)
If you suspect that your child has a short attention span, ask
another adult (a teacher or day care provider, for example) if
they have observed this also.
Current theory suggests that ADHD (like other learning
disabilities) is probably due to small differences in brain
chemistry and function. ADHD sometimes runs in the family. Changes
in daily routine (such as not getting enough sleep or a good
breakfast) can make the symptoms of ADHD worse. ADHD is not caused
by poor parenting.
Medicine alone is not the answer. Because ADHD is an ongoing
condition, your child also needs special interventions at home and
school to help with impulsive behaviors, work on structuring your
child's home life and improving discipline. Behavior problems can
be addressed at any time after 1 year of age. If your child also
has a poor attention span, you can do activities to help him learn
to listen and complete tasks.
Accept the fact that your child is active and energetic and
possibly always will be. The hyperactivity is not intentional.
Don't expect to eliminate the hyperactivity but merely to
bring it under reasonable control. Any criticism or other
attempt to change an energetic child into a quiet or model
child will cause more harm than good. Nothing helps a
hyperactive child more than having a tolerant, patient,
Daily outdoor activities such as running, sports, and long
walks are good outlets for excess energy. In bad weather your
child needs a room where he can play as he pleases with
minimal restrictions and supervision. Your child should not
have too many toys. This can cause him to be more easily
distracted from playing with any one toy. The toys should be
safe and relatively unbreakable. Encourage your child to play
with one toy at a time.
Although the expression of hyperactivity is allowed in these
ways, it should not be needlessly encouraged. Don't initiate
roughhousing with your child. Forbid siblings to say, "Chase
me, chase me," or to instigate other noisy play. Encouraging
hyperactive behavior can lead to its becoming your child's
main style of interacting with people.
Household routines help the hyperactive child to accept order.
Keep the times for wake-up, meals, snacks, chores, naps, and
bed as regular as possible. Try to keep your environment
relatively quiet because this encourages thinking, listening,
and reading at home. In general, leave the radio and TV off.
Predictable daily events help your child's responses become
more predictable. ADHD symptoms are made worse by sleep
deprivation and hunger. Be sure your child has an early
bedtime and a big breakfast on school days.
When a hyperactive child becomes overtired, his self-control
often breaks down and the hyperactivity becomes worse. Try to
have your child sleep or rest when he is exhausted. If he
can't seem to "turn off his motor," hold and rock him in a
For children who have trouble slowing down at bedtime, night
lights and background music are often helpful.
Except for special occasions, avoid places where hyperactivity
would be extremely inappropriate (such as churches or
restaurants). You also may wish to reduce the number of times
your child goes with you to stores and supermarkets. After
your child becomes older and develops adequate self-control at
home, he can gradually be introduced to these situations.
These children are usually difficult to manage. They need more
carefully planned discipline than the average child. Rules
should be made mainly to prevent harm to your child and to
others. Aggressive behavior, such as biting, hitting, and
pushing, should be no more accepted from the hyperactive child
than any other child. Try to stop such aggressive behaviors,
but avoid unnecessary or impossible rules. For example, don't
expect your child to keep his hands and feet still.
Hyperactive children tolerate fewer rules than the normal
child. Enforce a few clear, consistent, important rules and
add other rules at your child's pace. Avoid constant negative
comments like "Don't do this," and "Stop that." Develop a set
of hand signals and use them rather than telling your child to
calm down or slow down.
Physical punishment suggests to your child that physically
aggressive behavior is OK. We want to teach hyperactive
children to be less aggressive. Your child needs adult models
of control and calmness. Try to use a friendly, matter-of-fact
tone of voice when you discipline your child. If you yell,
your child will be quick to imitate you.
Punish your child for misbehavior immediately. When your child
breaks a rule, isolate him in a chair or time-out room if a
show of disapproval doesn't work. The time-out should last
about 1 minute per year of your child's age. Without a
time-out system, overall success is unlikely.
While the attention span may never be normal, it can usually
be improved. Encouraging an increased attention span and
persistence with tasks is helpful for preparing your child for
school. Increased attention span and persistence with tasks
can be taught at home. Don't wait and expect the teacher
suddenly change him. By age 5 he needs at least a 15-minute
attention span to perform adequately in school.
Set aside several brief periods each day to teach your child
listening skills by reading to him. Start with picture books,
and gradually progress to reading stories. Coloring pictures
can be encouraged and praised. Teach games to your child,
gradually increasing the difficulty by starting with building
blocks and progressing to puzzles, dominoes, card games, and
dice games. Matching pictures is an excellent way to build
your child's memory and concentration. Later, consequence
games such as checkers or tic-tac-toe can be introduced. When
your child becomes restless, stop and return for to the game
later. Praise your child for attentive behavior. This process
is slow but invaluable in preparing your child for school.
Plan to have your child do homework and other tasks that
require concentration in short blocks of time with breaks in
between. Try having your child study with low-level background
sound such as white noise or instrumental music. Do homework
and studying away from the sounds of television, radio, or
others talking but where adults can watch.
Ask neighbors that your child knows to be helpers. If your
child is labeled by some adults as a "bad" kid, it is
important that this image of your child doesn't carry over
into your home life. At home the attitude that must prevail is
that your child is a good child with excess energy. It is
extremely important that you not give up on him. Your child
must always feel loved and accepted within the family. As long
as a child has this acceptance, his self-esteem will survive.
If your child has trouble doing well in school, help him gain
a sense of success through a hobby in an area of strength.
Exposure to some of these children for 24 hours a day would
make anyone a wreck. Periodic breaks help parents to tolerate
hyper behavior. If just the father works outside the home, he
should try to look after the child when he comes home. This
not only gives his wife a deserved break but also helps him
understand better what she must contend with during the day. A
baby sitter one afternoon each week and an occasional evening
out can provide much-needed breaks for an exhausted mother.
Preschool is another helpful option. Parents need a chance to
renew themselves so that they can continue to meet their
child's extra needs.
Try to start your child in preschool by age 3 to help him
learn to organize his thoughts and develop his ability to
focus. However, you should consider enrolling your child in
kindergarten a year late (that is, at age 6 rather than 5)
because the added maturity may help him fit in better with his
Once your child enters grade school, the school is responsible
for providing appropriate programs for your child's attention
deficit disorder and any learning disability he might have.
Some standard approaches that teachers use to help children
with ADHD are smaller class size, and a isolated study space.
They may also include your child in tasks like erasing the
blackboard or passing out books (as outlets for excessive
energy). Many of these children spend part of their day with a
teacher specializing in learning disabilities who helps
improve their skills and confidence.
Seek a classroom for your child that has individual desks
rather than one where students are seated in groups at tables
or with clusters of desks.
If you think your child has ADHD and he has not been tested by
the school's special education team, you can request an
evaluation. Usually you can get the help your child needs with
schoolwork by working closely with the school staff through
parent-teacher conferences and special meetings. Your main job
is to continue to help your child improve his attention span,
self-discipline, and friendships at home.
Stimulant drugs can improve a child's ability to concentrate.
If you and your child's teacher both feel that your child's
short attention span is interfering with school performance,
discuss the use of medicine with your child's healthcare
provider. In general, medicine should not be prescribed before
school age. It should also not be prescribed until after your
child has been evaluated by a doctor, the school education
team, you have a individualized education plan (IEP) at
school, and you have followed the suggestions in this handout.
While medicine is helpful, it needs to be part of a broader
treatment plan including special education and behavioral
Call your child's healthcare provider for referral to a child
psychiatrist or psychologist if: