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Old 11-15-08, 01:17 PM
Dizfriz Dizfriz is offline
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More workingwith ADHD kids

More working with ADHD kids. Part II if you prefer.

There are two concepts that are of absolute importance in learning how to deal with an ADHD child. First is the "Point of Performance" and the second is "External Consequences" also known as "Consequences in the Environment". Both are needed and when combined are the keys to helping an ADHD child.

Consider ADHD as an output disorder. In other words the kids know what to do but can't do what they know. They have, for the most part, full knowledge of what is expected for them to do and not to do. They simply cannot do these things when needed. They know they need to sit still but cannot. While they know they should not talk in class, they they cannot resist the impulse. They know they should think before they do but do before they think. They truly want to behave, want to be appreciated, want to not be in trouble, want the teachers to complement them, want their peers to admire them for their accomplishments. They want to be "Good". The problem is that they cannot make these things happen. When it comes time to do or not do what is expected of them they fail. This is part of the disorder. It is unplanned, unwanted and mostly not under the control of the child. This is ADHD.

Nagging, teaching, fussing, yelling, and telling you child time and again what you expect has little impact because you are tackling the problem on the wrong side. You are working on the input side not the output. "I told you a hundred time to put up your toys before supper!" Well the toys are not being put up. Keep on telling, maybe the hundred and sixth will work, maybe the one hundred twenty fifth. Never give up. Sounds sort of silly doesn't it but this is exactly what most parents find themselves doing. For the most part after you told them three or four times, they know. Nothing wrong with reminding but only a little.

So with this background we move on to Point of Performance.

Point of Performance

Point of Performance is probably the single most important concept in working with ADHD children. If this concept is not applied correctly then all else will fail. It is the "primary key" for successfully helping ADHD kids.

Since ADHD is considered to be an output disorder, effective work with an ADHD child must be done done on the output side, when they do or say something or fail to say or do something. This is what is termed the "Point of Performance". It is what happens "Now!"; not one hour, not fifteen minutes, not five minutes, not ten seconds later or before, but now.

All work with an ADHD child must be done as close to the "Point of Performance" as possible for it to be successful. This applies to both negative and positive consequences equally. If you want to do an exercise in futility take a four year old, see them do something and then wait ten minutes and punish. They will not have a clue about why they are in trouble and cannot connect what they did and the consequences. You can talk until the cows come home and they still will not make the connection. What they do connect is the fact that the parent is angry and they are in trouble, nothing more. Do not expect any behavior to change because it can not and will not. If you want to change behavior, you must work with the child using the Point of Performance as your guide. The closer in time you react the more likely you will see changes. The farther, the less. Plug in rewards and you will get the same.

With young children, say below age nine, you should apply your reaction within ten seconds after the event. I like one to two seconds better with immediate best. This is now you change behavior. This can stretch as the individual gets older. The concept of the Point of Performance also applies to adolescents and adults but with a somewhat extended time frame.

When working with ADHD kids, speed is the key, not the severity of the punishment nor the value of the reward. This would follow from applying the reasoning behind the Point of Performance. Once you understand this principle, you know pretty much the timing needed to work with your ADHD child. Follow it and you can see positive changes, don't and you won't. What you will see if you don't is parental fussing, yelling, griping, lots of warnings and punishments which have no impact. You will get a very frustrated parent and child and what you won't see is much in the way of positive changes. Use the Point of Performance. If you don't, you will fail and your child will fail. If you will, they can succeed.


Consequences in the Environment/External Consequences

ADHD can be described as a deficit in self regulation or self control. These kids cannot, to any real degree, tell themselves to do or not do something that is expected and follow through. It simply doesn't work. Their difficulty is in following their own internal rules as that is where the deficit is. They can, however, work with external consequences, external regulation rather than self regulation.

Expecting self control follows from the belief that the child can regulate behaviors using internalized rules. A non ADHD child can successfully use these internal feelings to help regulate their behaviors. ADHD kids, for the most part, cannot. Again, this is ADHD.

These kids really want to self regulate but they cannot do it. Again, they know what to do but cannot do what they know. Behavior regulation is dependent on having some mechanism available to provide motivation. If internal self regulation does not work, then external is what is left and it is there where we aim our efforts.

As an aside, I suggest you consider "should", "ought", and "must" as being the most useless concepts that can be used referring to the behavior of an ADHD child. "You should have known better!" "You ought to be able to do that without me reminding you!". "A six year must be able to sit in their seat at school and focus on their work like the other kids!". "Yep, they knew and they tried and it made no difference whatsoever. These kids are not being "Bad!" but are instead, being quite "normal" ADHD children.

Since a deficit of self control/self regulation is the definition we are using for ADHD, how to use this to work with these kids is the question we are addressing.

When I speak of External Consequences, I mean placing the consequences (both positive and negative) in the child's external environment. Make the consequences "real", something outside themselves they can experience. Make consequences concrete. Make them touchable, seeable, tangible results of their decisions. By something concrete and real, I mean time outs (NOW!), loss or gain of privileges given at the Point of Performance. Loss or gain of toys, games, TV, going outside, or whatever else you can come up with given at the Point of Performance. Do this and you don't need severe punishments. Toys put up for one to three days for a six year old, no video games for the same. It is the speed of the consequence not the severity. The advantage of this is that you don't have to go back and reduce the six month grounding from TV you gave after twenty warnings, a big fight, and very angry parent and child. You can easily enforce a two day loss calmly and firmly. What you don't do is use fussing, shaming, teaching and telling. For these to work, you are relying of the child to be able to use internal self regulation and it ain't gonna happen.

Do the same on rewards, they do not have to be big ones if given at the point of performance. A special treat, picking a movie, extra time on games, staying up later, again using anything you can to help the make the connection between the behavior and the positive consequence. Speed is the key.

As a note, you can shift the actual consequence to later especially with older children as long as the giving or taking away is done at the Point of Performance. Make it happen as soon as you can though. I suggest you keep in mind the general guidelines in the article on time sense. If you go past this, you will lose the impact.

As a recap: It is a simple and tragic fact that if you expect these kids to respond to self regulation and delayed consequences, they will fail. If you give them feedback at the Point of Performance and make the consequences occur in the environment, they can and often will succeed, sometimes past all expectations.

Applying the principles discussed here will give you the primary tools you need to help your child. There is a lot more to learn but but these are the main ones. Understand Point of Performance and External Consequences and you will be on the right track. Learn these, use them. This is your child.

__________________________________________________ _______

Three articles that are relevant to this post and that you might wish to read are:

The 30% rule.
http://www.addforums.com/forums/show...6&postcount=18

Time sense in ADHD children.
http://www.addforums.com/forums/show...12&postcount=1

They provide a foundation on why the principles discussed here are so essential for working with ADHD kids.

Another post "A way of working with ADHD kids" in which was presented the tool of Acknowledgements may prove to be useful. The post presents an application using the two principles discussed. If you have read the article earlier then this you might understand better why it works as well as it does. http://www.addforums.com/forums/show...77&postcount=1

__________________________________________________ _______

This is based partially on the work of Russell Barkley and on the principles of Play Therapy as explained by Virginia Axline

Much of the ADHD specific information can be found in more detail in this transcript of a Russell Barkley workshop. http://www.addforums.com/forums/show...77&postcount=1

Be aware that ADHD is a spectrum disorder and there are a range of symptoms. ADHD children will present with variations of behaviors and responses. The principles examined here will need to be crafted to fit the individual child.

I am a terrible proofreader. I tend to read in Gestalt glups and miss the individual words. Forgive any errors on my part and believe me, there will be some.

Dizfriz
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Old 11-15-08, 04:24 PM
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Re: More workingwith ADHD kids

Great info!
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Old 11-16-08, 01:30 AM
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Re: More workingwith ADHD kids

Dizfriz,

That was truly awesome.

Thank You ! Excellent Job.

tc

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(Robert)
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Old 11-17-08, 09:26 PM
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Re: More workingwith ADHD kids

An example I have with regards to the difference between INPUT and OUTPUT deficiencies:

My son was asked to write two topics on what had happened throughout that week. He successfully wrote a detailed topic on a story the teacher read to the class. He brought it up to the teacher and she said, "I need 2 topics" so he sat down. Moments later, he went up again and the teacher said, "I told you, I need to see 2 topics". He sat down again. The third time he went up again and the teacher said, "J, how come you haven't written your second topic yet? Please go finish your work." He sat down again - scribbling away. Afterschool, the children were to show the teacher their journals before leaving the class and that's when I arrived. J was the last person to show his journal to the teacher .. and so she said, "J, I have asked you 3 times to write a second topic. Why haven't you done it yet?" J: "I don't know." Teacher: "You came to my desk 3 times, J. What did I tell you to do?" J: "Write more?" Teacher: "So why haven't you written the second topic?"

.. little did she know, in the mist of all this, he was returning to his desk to write "more" about his 1st topic sentence (which would explain why it was so detailed and spilling onto a second page). He knew he needed to write 2 topics but he didn't know WHAT THAT LOOKED LIKE and how to transition from one topic to the next. It wasn't until she said, "What is your second topic going to be about.. something that has happened during the week?" J: "Assembly." Teacher: "Ok. On this page, I want you to write about the assembly we had, for homework." DING! He understood. Why? Because she explained to him what it looked like, where to write it and helped him come up with a second topic. When we came home, he wrote about the assembly within 5 minutes.

Meanwhile, he was repremanded over not "listening to instruction".

So again, thank you for your write-up. It made a lot of sense to me and a great reminder for those (including me) who've forgotten the basics.
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Old 02-27-09, 03:09 PM
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Re: More workingwith ADHD kids

Hi i am new to this I have two children girl 13yrs and boy 10yrs MY daughter is very sensitive and inattentive type. My son is the Impulsive hyperactive type. I was very concerned about my son and quietly concerned about my daughter with her the jury out as such. But my sons behaviour at home was effecting everyone especially him. ADHD runs in both sides of the family and i suspect that I also have it but never had it diagnosed.

I took my children to a pediatrician who did the relevant test and diagnosed both with ADHD which i took to the principle of the school he told me i should get a second opinion and that the department of education would not regonised that findings as it would have to be done by there department. Later I had a phycologist test them. The results were the my son was behind in his maths and english 2years behind after the school telling me he was doing good.

I then decided to get the second opinon and just had the results on my son they have said he does not have ADHD as they went to his school and observed him for 90mins and his teacher has confirmed that he doesnt think he has ADHD the same teacher who told me he was doing very well in maths and english!

There outcome is that he must be showing the same behaviour in school and home to have ADHD i am now pulling my hair out i am sure my gut is telling me that he defintely has ADHD I have done all the online test and the results all show the same ADHD i am really worried about his future, I have gone private and also use the government agency and dont know what do. Do children have to show the behaviour in different settings and if not does that really mean they dont have ADHD?????

Last edited by Lady Lark; 02-27-09 at 09:31 PM.. Reason: added paragraph breaks
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Old 02-28-09, 04:59 AM
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Re: More workingwith ADHD kids

Quote:
Originally Posted by ann Maria View Post
Hi i am new to this I have two children girl 13yrs and boy 10yrs MY daughter is very sensitive and inattentive type. My son is the Impulsive hyperactive type. I was very concerned about my son and quietly concerned about my daughter with her the jury out as such. But my sons behaviour at home was effecting everyone especially him. ADHD runs in both sides of the family and i suspect that I also have it but never had it diagnosed.

I took my children to a pediatrician who did the relevant test and diagnosed both with ADHD which i took to the principle of the school he told me i should get a second opinion and that the department of education would not regonised that findings as it would have to be done by there department. Later I had a phycologist test them. The results were the my son was behind in his maths and english 2years behind after the school telling me he was doing good.

I then decided to get the second opinon and just had the results on my son they have said he does not have ADHD as they went to his school and observed him for 90mins and his teacher has confirmed that he doesnt think he has ADHD the same teacher who told me he was doing very well in maths and english!

There outcome is that he must be showing the same behaviour in school and home to have ADHD i am now pulling my hair out i am sure my gut is telling me that he defintely has ADHD I have done all the online test and the results all show the same ADHD i am really worried about his future, I have gone private and also use the government agency and dont know what do. Do children have to show the behaviour in different settings and if not does that really mean they dont have ADHD?????
My 6 year old son's behaviour is different at school and at home, but nobody doubts he has adhd. Maybe your son is lucky to do well in the structured environment at school and his teachers don't get to see what he's like when his environment is less structured? (My son is the opposite: lots of acting out at school, pleasant and rather obedient at home). It took a while for us to get a correct diagnosis. Therapist were thinking in the direction of autism, but I felt that was't what was going on with him. I sympathise with you, I know how draining it can be to get the correct diagnosis.
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Old 02-28-09, 05:11 AM
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Re: More workingwith ADHD kids

I agree 100 % with you. Have you any idea what to do when a school teacher doesn't encourage, reward or punish immediately (like we do at home?). I feel my son needs a more firm and direct approach in the classroom. He often gets angry or start crying when he can't/won't do an assignment. His teacher gives him lots of attention after let's say 5 min of whining, but at that time he is too worked up to react to his teacher's words.

I tried to explain the teacher the importance of being firm and direct, but he looked at me like I was asking him to train my son like a puppy. I know he believes our approach at home is not the right one. Do you know of any articles on managing adhd behaviour at school that I could show the teachers? I wish they could see what a wonderful, talented son we really have when he receices the right guidance.
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Old 03-02-09, 06:57 PM
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Re: More workingwith ADHD kids

Quote:
Originally Posted by ann Maria View Post
There outcome is that he must be showing the same behaviour in school and home to have ADHD i am now pulling my hair out i am sure my gut is telling me that he defintely has ADHD I have done all the online test and the results all show the same ADHD i am really worried about his future, I have gone private and also use the government agency and dont know what do. Do children have to show the behaviour in different settings and if not does that really mean they dont have ADHD?????
In general, the criteria in the US is that the behaviors need to be shown in "more than one setting," not necessarily in "all" settings. In fact it is very common for kids to behave much differently in school than at home, for a variety of reasons. Kids also behave differently around different people. Having said that, we have heard from other posters from Europe that the doctors say the kids need to have the problems all the time or it is ADHD. Unfortunately the standards for diagnosis are different in different countries.
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Old 11-06-16, 10:46 AM
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Re: More workingwith ADHD kids

My grandson is 14yrs turning 15yrs in December. He has ADHD and many other psychosis that goes along with his condition. He's seeing and therapist and takes medication. Will his conditions get better with age? or it is what it is?
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Old 11-06-16, 10:50 AM
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Re: More workingwith ADHD kids

Wow that looked really Interisting but I could not physically read all of it could you please summaries it
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Old 11-06-16, 10:57 AM
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Re: More workingwith ADHD kids

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Originally Posted by Phillyr121 View Post
My grandson is 14yrs turning 15yrs in December. He has ADHD and many other psychosis that goes along with his condition. He's seeing and therapist and takes medication. Will his conditions get better with age? or it is what it is?
I think many things will get better with age and I firmly believe that a therapist - not all, but some -can bait a child into continually getting worse.

Have you started taking him to learn to drive in empty parking lots on Sunday yet? I believe that some solid bonding with you will be better than any therapist. Mentor him. Love him, show him the way.
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Old 11-06-16, 11:12 AM
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Re: More workingwith ADHD kids

[quote=Jeftheginger;1849144]Wow that looked really Interisting but I could not physically read all of it could you please summaries it[/QUOTE

Summarization would most likely be difficult given the amount of time that has passed...can you skim it?
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