Community Education Service

in collaboration with
Child & Adolescent Mental Health

Parenting Inattentive/Hyperactive
Children and Youth

Funding generously provided by Encana

Corporation and the Alberta Children’s
Hospital Foundation

Outline
1. What is Attention Deficit/Hyperactivity
Disorder (AD/HD)?
- Possible Causes
- Characteristics
- Diagnostic Criteria
- Additional Criteria

2. Related Problems

3. Treatment Options

Outline
4. Strategies
- Social Skills Strategies
- Basic Strategies
- Specific Strategies

5. Good things about having AD/HD

6. Community Resources

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What is Attention Deficit/Hyperactivity Disorder
(AD/HD)?

AD/HD is:
{ Complex neurobiological condition
{ AD/HD is the most common psychiatric disorder for
children
{ Affects between 5 – 12% of school age children
{ 8 – 10% of males and 3 - 4% of females under 18
years have AD/HD
{ Males outnumber females (3:1 to 6:1)
{ Not caused by poor parenting

Possible Causes of AD/HD?

{ Brain function (i.e. neurology)
- altered brain messenger substances
(neurotransmitters)
- under activity and/or reduced blood flow in the
frontal area of the brain
{ Heredity and genetics
{ Brain injury
{ The role of environment

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 Characteristics
1) Predominantly Inattention

2) Predominantly Impulsivity/ Hyperactivity

3) Combined Type

Diagnostic Criteria
1) Inattention
{ Careless mistakes { Poor sustained mental
{ Poor sustained effort
attention { Loses things
{ Poor listening { Easily distracted
{ Lack of follow through { Forgetful
and task completion { 6 out of 9 symptoms
{ Disorganized need to be present (for
6 months)

Diagnostic Criteria
2) Hyperactivity/Impulsivity
{ Fidgets/ squirms
{ Leaves seat
{ Runs/climbs a lot
{ Can’t play quietly
{ “On the go”
{ Talks excessively
{ Blurts out answers
{ Difficulty waiting
{ Interrupts/intrudes
{ 6 out of 9 symptoms
need to be present (for
6 months)

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 Diagnostic Criteria
3) Combined Type
{ Combines criteria of both 1 and 2

Additional Criteria
{ Symptoms present before age 7
{ Symptoms present in 2 or more settings (at home,
school, or work)
{ Significant difficulties in social, academic, and
occupational functioning
{ Symptoms do not occur exclusively during the
course of PDD, Schizophrenia, or another psychotic
disorder and are not accounted for by other
disorders (mood disorder, anxiety disorder,
dissociative disorder, a personality disorder, or a
physical condition).

Related Problems

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 Related Problems
{ Learning Disabilities (Nonverbal Learning Disorder)
{ Oppositional Defiant Disorder
{ Conduct Disorder
{ Tic Disorder (e.g. Tourette’s Syndrome)
{ Mood/Anxiety Disorder (Depression and Bi-Polar)
{ Substance Use and Abuse
{ Other (Asperger’s, Sensory Integration)

Treatment Options

Treatment Options
{ Child, parent, and teacher education about this
disorder
{ Behavior modification
{ Parent training
{ Family Therapy
{ Anger Management & Social Skills Training
{ Stimulant medication/Non-stimulant medications
- Ritalin, Dexedrine, Strattera

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 Treatment Options
Medication

{ Two types of medications used are stimulants and

non-stimulants
{ A combination of therapy and medication is the
most successful treatment
{ Parents and families are encouraged to talk to their
physician and other healthcare professionals to
gather information to make a decision around
treatment.

Treatment Options
Methylphenidate Amphetamines Atomoxetine
(Stimulant) (Stimulant) (Non-Stimulant)

Methylphenidate IR Adderall ER® Strattera®

(Ritalin®)
Methylphenidate SR Adderall XR®
(Ritalin®)

Methylphenidate ER Dexedrine IR®

(Concerta®)

Methylphenidate CR Dexedrine SR ®
(Biphentin®)

Treatment Options
{ Adaptations to the student’s educational
program/environment
{ Close positive home/school communication and
cooperation is critical
{ Social skills training (individual or group)

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 Treatment Options
Alternative Therapies

{ Vitamins/dietary supplements: including these in your

child’s diet to reduce symptoms of AD/HD
{ Elimination diets: removing certain additives and food
from your child’s diet for a given period of time if you
think they may be affecting their behaviour
{ Biofeedback: a stress reducing technique used to
control certain body responses (ie. heart rate, muscle
tension). It can help children/adolescents with ADHD
to normalize brain wave patterns.

Treatment Options
Alternative Therapies cont’d

{ Sensory integration training – using light, sound,

tactile stimulation to “exercise the brain”.

Note: Evidence-based research is underway on

many of these therapies and information is still
being gathered about how effective they are.

Strategies

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 Social Skills Strategies
{ Listening/Attending { Role-playing

{ Turn-taking { Modeling

{ Anger management { Relaxation training

{ Problem-solving { Communication skills

{ Cooperation training

{ Emotional regulation { Therapeutic games

Basic Strategies
{ Establish predictable { Simple and concrete
daily routines consequences that are
{ Prepare child in known to child
advance for any change { Consistency in rules and
of routine consequences over time
{ Simple concrete rules { Regular physical activity
and expectations that { Quiet wind down
are known to child

Specific Strategies
1. Accept that your child will be active and
energetic, because of the makeup of their
brain.

{ It is helpful for these children if their caregivers can

be calm and tolerant

{ Label the behavior and not the child (e.g. the child is
NOT bad)

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 Specific Strategies
2. Provide outlets for releasing extra
energy.

{ These children need daily physical activities,

involvement in sports such as running, dance,
martial arts or family playtime

Specific Strategies
3. Find activities at which your child can
succeed.

{ All children need to experience success to feel

good about themselves

Specific Strategies
4. Problem Solving - A person who has AD/HD may
have difficulties solving problems. She or he might:

o See the problem as more difficult than it truly is

o Have trouble finding solutions for the problem, or get

stuck in one way of dealing with the problem even
though it isn’t working

o Find it hard to put a plan into action.

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 Specific Strategies
Problem Solving (cont’d)

o Identify the problem

o Identify possible actions to help solve the problem

o Compare the good and bad points of the different

solutions

o Pick the best action

Specific Strategies
Problem Solving (cont’d)
o Identify the problem and potential actions to take to
help solve the problem
The Problem: ƒIdentify the problem by paying attention to how
your mood changes through the week.
ƒFocus on only one problem at a time.

People who can support me: ƒFriends, siblings, parents, other concerned
adults?

What I want to happen: ƒ What would you like the end result to be?

3 things I could do (action)
ƒ Consider things that you can do with and without
the help of someone else.
ƒ Don’t try to decide which one is best.
ƒ It’s okay if you tried something and it didn’t’
work.

Specific Strategies
Problem Solving (cont’d)
o Compare the good and bad points of the different
solutions

Action Good Points Bad Points

1.
2.
3.

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 Specific Strategies
Problem Solving (cont’d)

o Pick the best action

o Be assertive: strike a balance between what you

want and what others want, stating your own
view and listening to the views of others

Specific Strategies
5. Set small, reachable goals.

a) Choose a goal – SMART

Specific, Measurable, Agreeable, Realistic, Timeline

b) Carry out the goal

c) Evaluate the goal

d) Celebrate

Specific Strategies
Goal Setting cont’d:
a) Choose a goal for the next week, and make the goal:
o Specific: unclear goals are less likely to be carried out
and result in feelings of failure
o Measurable: develop a goal that is easy for you to
track your progress and success
o Agreeable: develop a goal that works for you and
those around you (e.g., your family)
o Realistic: goals that are too big often result in feeling
discouraged. Should be easy enough to carry out
o Scheduled: the more exact in stating your goal, the
more likely to carry it out

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 Specific Strategies
Goal Setting cont’d:
b) Carry out the goal

c) Evaluate your progress/success

d) Celebrate
o Recognize what has been accomplished
(Parents can help acknowledge the child’s
success).
o Give credit for trying to accomplish the
goal and review or revise as needed.

Specific Strategies
6. Keep home environment organized

{ It is helpful to have a regular routine and be as

consistent as possible in daily activities, such as
mealtime, homework and bedtime

{ Provide logical spaces to keep your child’s

schoolwork, toys, and clothes to reduce the
possibility of these items being lost

Specific Strategies
7. Avoid fatigue in these children

{ When they are tired, their self-control often breaks

down and their hyperactivity becomes worse

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 Specific Strategies
8. Maintain stimulation at an appropriate level

{ Some children need more quiet time

{ Some children need to be kept busy, but NOT over

stimulated

Specific Strategies
9. Prepare for formal gatherings

{ The hyperactivity can be difficult to manage in

formal settings, such as church or restaurant

{ Make sure you have something for your child to

do and rehearse your child through appropriate
behavior

{ Discuss positive and negative consequences to

redirect actions

Specific Strategies
10. Maintain firm & consistent discipline

{ Set realistic goals - pick your battles

{ Don’t ignore unsafe behavior

{ Intervene early

{ Give appropriate consequences or suggest

alternative acceptable activity

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 Specific Strategies
11. Use timely, age-appropriate consequences

{ Time out

{ Natural consequences

{ Loss of privileges

{ Physical punishment is not appropriate

Specific Strategies
12. Reward positive behaviour

{ Praise and reward your child’s efforts to pay

attention

{ Offer kind words, hugs etc. as soon as positive

behaviour is noticed

Specific Strategies
13. Help your child stay “on task”

{ Keep instructions brief

{ Offer frequent, friendly reminders

{ Use charts and checklists for homework and chores

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 Specific Strategies
14. Advocate for your child

{ “You know your child best, need to be their biggest

fan”

{ Learn as much as possible about AD/HD and how it

will affect your child at home, in school, and in
social situations

{ Help others understand their behavior.

Specific Strategies
15. Self-Care: Daily!

{ Life can never be stress free. Part of the learning

to cope with stress is coming to the realization that
one cannot solve every problem one encounters

{ Its important to take into account one’s physical

and emotional limitations, and to have reasonable
expectations about what one can handle on one’s
own and when it is time to get some help.

Self-Care Strategies
{ Express your feelings!

{ Periodically get away from it all

{ Child benefits most when adult happy and

comfortable

{ Take care of yourself

{ Nurture adult relationships

{ Join a parent support group

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 Good Things About Having
AD/HD

Good Things about Having AD/HD

{ Happy and enthusiastic { Very good with younger

{ Never boring children

{ Charming { Full of energy

{ Sees things differently { Requires less sleep

{ Great memory for things { Observant of details

that interest them { Are the first to volunteer

Good Things About Having AD/HD

{ Doesn’t usually hold { Easy to talk with

grudges { Great sense of humor

{ Risk takers - try new { Innovative

things { Spontaneous
{ Can do several things at { Creative and imaginative
one time

{ Fun to be with

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 Good Things About Having AD/HD

{ Sensitive/ compassionate

{ Loving and caring

{ Curious

{ Interested in new things

{ Candid

{ Positive of life in spite of troubles

Community Resources
{ C.H.A.D.D. 403-225-8512

{ Learning Disabilities Association 403-283-6606

{ Calgary Learning Centre 403-686-9300

{ Access Mental Health 403-943-1500

{ Health Link 403-943-LINK (5465)

Credible Websites
{ American Academy of Paediatrics
www.aap.org

{ Canadian ADHD Resource Alliance

www.caddra.ca

{ Canadian Mental Health Board

www.cmha.ca

{ C.H.A.D.D (Children and Adults with AD/HD

http://www.chadd.org/

{ Medline Plus
www.nimh.nih.gov

{ National Institute of Mental Health

www.nimh.nih.gov

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 References
Barkley, Russel A. (2005). Taking Charge of ADHD: The Complete
Authoritative Guide for Parents. New York: The Guilford Press.

Mayo Foundation for Medical Education and Research (1998 – 2008).

Retrieved July 7, 2008, from www.mayoclinic.com.

Moghadam, H. (2006). Attention Deficit – Hyperactivity Disorder.

Calgary: Detselig Enterprises Ltd.

National Institute of Mental Health (NIMH) (2008). Retrieved July 7,

2008, from www.nimh.nih.gov.

National Standard: The Authority on Integrative Medicine (n.d.).

Retrieved July 7, 2008, from
www.naturalstandard.com.hinc.lib.ucalgary.ca/.

Acknowledgements
We would like to acknowledge the contributions of the many
clinicians who participated in our Focus Groups and thus
contributed to refreshing the content of this presentation. As
well, we would like to thank the following clinicians who have
gone the ‘extra mile’ and made significant editorial and/or
content contributions to this presentation:

Susan Ponting, M.Ed., R. Psych., Mental Health Education

Specialist, Community Education Service

Lindsay Hope-Ross, M.Sc., R. Psych., Clinical Supervisor,

Healthy Minds/Healthy Children

Rekha Jabbal, B.SP, Pharmacy Clinical Practice Leader

Child and Adolescent Mental Health

Community Education Service

To register for notification or an

upcoming education session
go to: www.fcrc.sacyhn.ca

For general CES enquiries

Email: ces@sacyhn.ca
Call: 403-955-7420

Funding generously provided by Encana

Corporation and the Alberta Children’s
Hospital Foundation

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