076-18 CFF TOFP Special Needs ADHD Facilitator Manual v8...Late, Lost, and Unprepared: A Parents’...

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076-18 CFF TOFP Special Needs ADHD Facilitator Manual v8.indd 1 18/07/2019 16:06:59

Copyright © 2019 Care for the Family 2

Time Out for Parents – Children with Special Needs

Care for the FamilyStrengthening family life and helping those hurting because of family difficulties.

Time Out for Parents – Children with Special Needs: ADHD Facilitator Manual

Copyright 2019 Care fore the Family.All rights reserved.First published 1996.Revised and reprinted in 2019.Produced and published by Care for the Family.

Except as stated, no part of this guide may be reproduced, stored in a retrieval system or transmitted in any form or by any means – electronic, mechanical, scan, photocopy, recording or otherwise – for any purpose whatsoever, without written permission of the publisher.

Printed in the UKProduct code: TOPSNMJob no: 076-18

Contact details:Care for the FamilyTel: 029 2081 0800www.careforthefamily.org.uk

Care for the Family is a registered charity (England and Wales: 1066905; Scotland: SCO38497). A company limited by guarantee no. 3482910. Registered in England and Wales.


3Copyright © 2019 Care for the Family


Facilitator guide

Session 1 Understanding ADHD • What is ADHD?• How ADHD is diagnosed today• Sensory processing difficulties• Social, emotional, physical and

academic difficulties• How the ADHD brain works• Building self-esteem• Reflection • Focus for the week

Session 2 What is attention? • Attention deficit behaviours• Managing attention deficit• Behaviour management• School strategies• Sleep• Reflection • Focus for the week

Session 3What is hyperactivity?• Hyperactive behaviours• Managing hyperactivity• Behaviour management• Oppositional behaviour• Reflection• Focus for the week

Session 4 Impulsivity• What is impulsivity?• Impulsive behaviours• Behaviour management• Managing constant demands and anger• Treatment options for ADHD• Coping strategies for parents• Reflection

Contents





5Copyright © 2019 Care for the Family


AcknowledgementsCare for the Family is committed to developing high quality courses that acknowledge current evidence-based research. We wish to thank all those who have supported us in doing this.

DisclaimerThis course is designed to provide parents and carers with useful information and strategies that may assist them in raising a child with ADHD. It is not designed to replace the professional advice or counselling of a general practitioner, psychologist, or other professional working with children and families.

Every attempt has been made to ensure that the content of Time Out for Parents – Children with ADHD is accurate and up to date. However, Care for the Family makes no claim that the material is exhaustive and is aware that some of the opinions expressed in it may be open to debate among professionals in the field.





Contents Course overview FG3 About the courseCourse format

Theory base Facilitators should familiarise themselves with the theory notes from the website if they are unfamiliar with any of content in this manual.Download from www.careforthefamly.org.uk/facilitators.

Books and other publications FG4

Useful websites FG6

Facilitator guide


Children with ADHD


Copyright © 2019 Care for the Family


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Course overviewAbout the courseTime Out for Parents – Children with ADHD is a four-session course, designed to be delivered during, or at the end of a Time Out for Parents – Children with Special Needs course. We hope that it will be an opportunity for parents, who are bringing up children with ADHD, to support and encourage each other.

Who the course is for • Parents and carers of children aged 3 to 11 with ADHD who have

previously completed the seven-session Time Out for Parents – Children with Special Needs course or similar courses run by other agencies.

• Parents whose children have a diagnosis of ADD, ADHD, DAMP or hyperkinetic disorder.

• Parents of children identified by a professional as having hyperactivity, impulsivity or inattention who are awaiting a diagnosis. (This is particularly relevant in the present economic climate, the long waiting time for an assessment and with the current reluctance to make a full diagnosis of ADHD).

Facilitators may also use the course with parents of ADHD children on a one-to-one basis.

Course format

StructureThe course is eight hours in length and is designed to be delivered in 2-hour sessions over four weeks. The four sessions all include a short break for refreshments and relationship-building. Each session also includes take-home activities to reinforce the parents’ learning.

We recommend that you choose times to suit your participants.

SizeParts of each session will involve interaction in small discussion groups.The recommended group size is eight to twelve participants withtwo facilitators.




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Books and other publicationsUnderstanding ADHD Dr Christopher Green and Dr Kit CheeISBN: 978-0091817008

The AD/HD Handbook: A Guide for Parents and Professionals Alison Munden and Jo ArcelusISBN: 978-1853027567

How Does Your Engine Run? A Leader’s Guide to the Alert Program for Sensory Self-Regulation Mary S. Williams and Sherry ShellenbergerISBN: 978-0964304109

Helping Students Take Control of Everyday Executive Functions: The Attention Fix Paula Moraine ISBN: 978-1849058841

Step by Step Help for Children with ADHD: A Self-Help Manual for Parents Cathy Laver-Bradbury, Margaret Thompson, Anne Weeks, David Daley and Edmund J. S. Sonuga-Barke ISBN: 978-1849050708

Homework Made Simple: Tips, Tools, and Solutions for Stress-Free Homework Ann K. Dolin ISBN: 978-0971460980

Late, Lost, and Unprepared: A Parents’ Guide to Helping Children with Executive Functioning Joyce Cooper-Kahn and Laurie Dietzel ISBN: 978-1890627843

All Dogs Have ADHD Kathy Hoopmann ISBN: 978-1843106517

1-2-3 Magic: Effective Discipline for Children Age 2–12Thomas PhelanISBN: 978-1492629887




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The Red Beast: Controlling Anger in Children with Asperger’s Syndrome K.Al-Ghani ISBN 978-1843109433

Anger Managment: A Practical Guide for TeachersAdrian Faupel, Elizabeth Herrick and Peter SharpISBN: 978-1138087200

Practical Activities for Emotional Literacy (Managing Anger Book 2)Debbie Palphreyman Available free on Kindle at www.amazon.co.uk.




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Useful websitesADDISS – The National Attention Deficit Disorders Information and Support ServiceProvides information and resources about ADHD.Web: www.addiss.co.uk

ADDersProvides information and a large list of local ADHD support groups run by parents across the UK.Web: www.adders.org

Living with ADHDOffers key information, downloadable tools, hints and tips and useful contact points. Web: www.livingwithadhd.co.uk

National Resource Center on ADHDAn American site giving evidence-based information on ADHD. Web: www.help4adhd.org

NHS ChoicesProvide an overview of ADHD as well as helpful information on treatment and management tips.Web: www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd

The British Institute of Learning Disablilities (BILD)Provides news, services and information.Web: www.bild.org.uk

SEN TeacherFree special needs teaching resources. Web: www.senteacher.org/files.php

ACE Education Advice and ACE Education TrainingOffers a comprehensive range of online advice and information for parents on education issues in England only.Web: www.ace-ed.org.uk

Sensory EducationAn online store selling special needs clothing, toys, computers and software. Web: www.cheapdisabilityaids.co.uk

Contact Provides information on education, benefits and family life.Web: www.contact.org.uk


Contents Welcome and introductionWhat is ADHD?How ADHD is diagnosed todaySensory processing difficultiesSocial, emotional, physical and academic difficultiesHow the ADHD brain worksBuilding self-esteemReflection Focus for the week

Session 1: Understanding ADHD

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Children with ADHD




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Session 1: Understanding ADHD Equipment needed• Parent handbook for each parent• Name tags (R4)• Pencil or pen for each parent• Attendance sheet (R5)• Pre-course questionnaire for each parent (available from

www.careforthefamily/facilitators) • Laptop computer equipped with PowerPoint (optional)• PowerPoint slides – session 1 (optional)• Flip chart paper or A3 sheets• Marker pens• Felt-tip pens• Blu Tack

Learning outcomesAt the end of this session, parents will be able to:• Explain what ADHD is• Identify their specific concerns• Understand some of the social, academic and sensory issues• Identify ways to help boost their child’s self-esteem




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TimetableStart time Topic Time ………………… Welcome and introduction 10 minutes

………………… What is ADHD? 15 minutes

………………… How ADHD is diagnosed today 10 minutes

………………… Sensory processing difficulties 20 minutes

……………….. Break 10 minutes

……………….. Social, emotional, physical and academic difficulties 15 minutes

……………….. How the ADHD brain works 15 minutes

……………….. Building self-esteem 10 minutes

………………… Reflection 10 minutes

………………… Focus for the week 5 minutes Total time: 120 minutes




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Welcome and introduction Time to (10 mins)

Equipment needed• Name tags (R4)• Attendance sheet (R5)• Pre-course questionnaire for each parent• PowerPoint slides 1.1 to 1.5• Parent handbook• Flip chart and paper• Marker pens

Talk aboutNote: This information assumes that participants have previously attended Time Out for Parents – Children with Special Needs. If there are new parents in the group, please refer to information at the beginning of Time Out for Parents – Children with Special Needs on starting a first session about the welcome, housekeeping, group agreement and confidentiality.

Ask the parents to sign in on the attendance sheet (R5) and to complete the pre-course parent questionnaire if they have not done so already.

Welcome to this first session of Time Out for Parents – Children with ADHD. We hope it will be time well invested for you and especially for your children. Thank you for coming!

If you haven’t already covered this, remind everyone of the group agreement and emphasise that there is no need to disclose personal details, unless they are happy to do so.

What are the aims of the course?• To better understand ADHD and its effects on a child• To enable you to better manage your child’s behaviour• To increase confidence in your skills and abilities as a parent• To help the relationship between you and your child be better, or even

better, than it is now• To teach you skills to help raise your children’s self-esteem• To identify the best way to effectively discipline your child• To encourage everyone on the course to give each other mutual support• To give you the tools to help you in your relationship with your child’s

other parent or carer • To provide you with greater support where you would like it

What are your hopes for the course and what issues would you like to be covered?

Write the answers on flip chart paper so you can look back at them with the group during the last session to assess if those hopes have been met.

Explain what will be covered in the next two hours.

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What is ADHD?Time to (15 mins)

Equipment needed• PowerPoint slides 1.6 to 1.10

Talk aboutAttention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.

Children with these difficulties sometimes have a diagnosis of ‘hyperkinetic disorder’, ‘deficiency in attention motor control and perception’ (DAMP) or ‘oppositional defiant disorder’ (ODD).

There are three different types of ADHD which are referred to as ‘presentations’ based on the predominant symptom pattern for the past 6 months:

1. Predominantly inattentive presentation – diagnosed if there are 6 or more symptoms of inattention (but less than 6 symptoms of hyperactivity/impulsivity) previously known as ADD.

2. Predominantly hyperactive/impulsive presentation – diagnosed if 6 or more symptoms of hyperactivity/impulsivity (but less than 6 symptoms of inattention).

3. Combined presentation – diagnosed when there are 6 symptoms of hyperactivity/impulsivity and 6 symptoms of inattention.

Note: There maybe some members of the group who are unfamiliarwith some of the terms used. If asked, be prepared to explain what theymean. More information about this can be found in the sessionnotes at www.careforthefamily.org.uk/facilitators.

These differences in terminology can sometimes cause confusion.

What’s it like to have a child with ADHD?Parents of children with ADHD often hear people tut-tutting and making disparaging comments like, “They don’t know how to control their kids these days!”

How do you feel when you hear things like this?

Quotes from parents of children with ADHD:• “He’s impossible in the morning. He goes to his room to get ready for school,

half an hour later he’s looking out the window with one sock on.”

• “She doesn’t seem to learn from experience.”

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• “Other children don’t seem to understand her.”

• “Other children get very irritated with him, especially when he grabs things.”

• “What I tell him goes in one ear and out the other. Can we get his hearing tested?”

• “With homework, I get nowhere unless I stand over him.”

• “She’s got such a short fuse. We have to walk on eggshells all the time.”

• “She never stops to think before barging in on someone in the bathroom.”

• “Other children tease him because they know he will always react.”

• “Nothing I do pleases him, he always wants more.”

• “If I ask him to tuck in his shirt, the shirt goes in. As he removes his hand, twice as much comes out.”

Do any of these quotes sound familiar?

It can be exhausting and very frustrating being the parent of a child with ADHD. It can also be very rewarding and our children can make us very proud.

The trouble is that we can become so exhausted and frustrated that we find it hard to be positive about them. It can be easier to sympathise if we understand why these behaviours happen.

The history of ADHD• 1845 – Heinrich Hoffman first described ADHD behaviours in a child’s

poem written for his son ‘The story of Fidgety Phillip’.

• 1987 – the American Psychiatric Association used the term attention hyperactive disorder.

• 1990 – Jean Ayers described difficulties in sensory and motor planning.

• 1990 – evidence for ADHD was presented in positron emission tomography (PET) scans.

• 1994 – The American Psychiatric Association’s Diagnostic and Statistical Manual version 4 (DSM IV) put ADHD and ODD (oppositional defiant disorder) under one heading: Attention-deficit and disruptive behaviour disorder.

• 2009 – The British Psychological Society and the Royal College of Psychiatrists, in collaboration with the National Institute for Clinical Excellence, released a set of diagnosis and treatment guidelines for ADHD.

• 2013 – the DSM V now lists ADHD under the heading of ‘Neurodevelopmental Disorders’ and is further defined by whether the symptoms are predominantly inattentive, hyperactive/impulsive, or combined.

• 2017 – the latest version of the ICD-10 now uses the term attention-deficit, hyperactivity disorder rather than hyperkinetic disorder, in line with DSM-5.

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Note: If there is time, you may wish to discuss the history of ADHD in greater detail with the group. More information on the subject can be found in the session notes at www.careforthefamily.org.uk/facilitators.

What we know about ADHD• ADHD stands for attention deficit hyperactivity disorder.

• Higher incidence in families where there is ASD.

• The exact cause of ADHD is unknown, but there are biological, genetic and environmental factors which can lead to an ‘immature nervous system’.

• ADHD is not caused by food additives, sugar or colouring. However, in some children these things can make ADHD behaviour worse.

• Children with ADHD find it hard to concentrate and have poor self-control.

• They can significantly underachieve at school.

• Children with ADHD may also have sleep difficulties or anxiety.

• ADHD affects about 2–5% of children in the UK.

• ADHD is a long-term condition which affects learning and behaviour right through the school years.

• About 60–70% will carry some of their ADHD into adulthood.

• ADHD tends to run in families. Most ADHD children have a close relative who is affected to some degree by the condition.

• ADHD mostly affects boys. Girls have it too, but it tends not to show so much and can go un-diagnosed or they may be diagnosed with shyness, depression or anxiety.

• Anyone who thinks that ADHD is caused by ‘bad parenting’ obviously hasn’t got a child with ADHD!

Not all children have all the symptoms. This means some can just have problems with poor attention, while others are mainly hyperactive.

Children and adults with an ADHD brain will have obstacles to overcome, but can live productive, healthy, happy and successful lives. The ADHD brain does not mean that a person with ADHD is inferior. On the contrary, many well-known successful individuals have lived very productive lives with ADHD including: Winston Churchill, Albert Einstein, Abraham Lincoln, Sir Richard Branson, Emma Watson, Jamie Oliver, Robbie Williams, Will Smith, Jim Carrey, Justin Timberlake, Michael Phelps, Will.i.am and Rory Bremnar.

There are no magic solutions to the problems of parenting a child with ADHD, however our aim for these sessions is that you will understand more about the condition and share some ways of coping with it.

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Life with a child with ADHD can be frustrating and overwhelming, but as a parent or carer there is actually a lot you can to do help your child meet their daily challenges and channel their energy into positive areas.

The better you understand your child, the better you will be able to manage their behaviour.

ADHD behavioursADHD is a behavioural disorder which often becomes obvious in early childhood. ADHD behaviours are due to underlying problems of poor attention, hyperactivity and impulsivity. Children with ADHD may also have poor learning and socialising skills.

Many children, especially under-fives, are inattentive and restless. This does not necessarily mean they are suffering from ADHD. The inattention or hyperactivity only becomes a problem when they are exaggerated, compared with other children of the same age, and when they affect the child’s school, social and family life.

According to NICE (National Institute for Clinical Excellence), the symptoms of ADHD can be broken down into the following categories:

Attention deficit behaviours• Inattention – unable to concentrate for very long or finish a task,

disorganised, often losing things, easily distracted and forgetful, unable to listen when people are talking.

Hyperactive impulsive behaviours• Hyperactivity – fidgety and unable to sit still, restless (children may be

running or climbing much of the time), talking constantly, noisy, having difficulty doing quiet activities.

• Impulsiveness – speaking without thinking about the consequences, interrupting other people, unable to wait or take their turn in games or in a queue, and interrupt people in conversation.

Additionally there will be varying degrees of sensory, social, emotional, physical and academic difficulties.

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How ADHD is diagnosed today Time to (10 mins)


Talk about

Note: There will be parents on this course whose child is waiting for an assessment. They may be struggling to get professionals to take notice of their concerns. Allow for a short discussion for people to express their frustrations if appropriate.

Ask the group if any are awaiting assessment or are unsure if their child has ADHD.

If you think that your child’s restless or inattentive behaviour is very different from other children their age, consider raising your concerns with your child’s teacher, their school’s special educational needs co-ordinator (SENCO) or GP.

Your GP can’t formally diagnose ADHD, but they can discuss your concerns. They will ask when the difficulties started, how they affect your child’s day to day life and if there is a family history of ADHD.

If your GP thinks your child may have ADHD, they may first suggest a waiting period of 10 weeks – to see if your child’s symptoms improve, stay the same or get worse before referring them to a specialist for a formal assessment. This could be a child psychiatrist or a paediatrician. Some children also need specialised tests by a clinical or educational psychologist a learning disability specialist, social worker or occupational therapist.

A diagnosis is made by observing the child, recognising patterns of behaviour, and obtaining reports of their behaviour at home and at school.

There are three types of ADHD:

1. Predominantly inattentive – child has six or more symptoms of inattentiveness

2. Predominantly hyperactive/impulsive – child has six or more symptoms of hyperactivity and impulsiveness

3. Combined – child has six or more of inattentiveness and six or more of hyperactivity/impulsiveness

The disorder can be classified as mild, moderate, or severe or in ‘partial remission’ if the diagnostic criteria are not currently met.

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We will look at these symptoms in detail as we move into this course.

They must also have:• been displaying symptoms continuously for at least six months• started to show symptoms before the age of 12• been showing symptoms in at least two different settings – for example,

at home and at school• symptoms that make their lives considerably more difficult on a social,

academic or occupational level• symptoms that aren’t just part of a developmental disorder or difficult

phase, and aren’t better accounted for by another condition

Getting an assessment for a child with ADHD in the UK is not easy so it is important that you:• gather as much information and evidence as you can • keep a diary of the difficulties you observe at home• ask the school for written reports on behaviours observed at school• make lists of the particular incidents – what happened and where

This course is designed to help you to do this.

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Sensory processing difficultiesTime to (20 mins)


Note: If parents have attended an ASD course, some of this material will have been covered there.

Slide 1.14Talk aboutMany children with ADHD have difficulties processing sensory input from their eyes (visual), ears (auditory), skin (touch), nose and mouth (smell and taste) the inner ear (vestibular) and sensors in our joints and muscles (proprioception).

When sensory processing works well we know where our body is in space, can avoid obstacles and uncomfortable or stressful things, and maintain or increase feelings of comfort or pleasure.

A child may be extra-sensitive or under-sensitive to certain sensory input. If they are extra-sensitive they will find sensations uncomfortable or painful and avoid them. If they are under-sensitive they may not register a sensation and may crave input into those senses.

• Some may dislike loud noises and avoid bright lights, certain tastes and textures while others may crave these sensations.

• One child may find the feeling of clothes intensely irritating and dislike being touched, while another may appear to have little awareness of touch or pain.

• Some may have very poor co-ordination and balance, while another may appear fearless in their search for movement activities.

ActivityTick the negative behaviours which apply to your child.

Under-sensitive Appears not to hear what you are saying or puzzled about where a

sound is coming from Seems destructive in search of sound Doesn’t notice when people come into the room Enjoys bright flashing lights

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Might not be aware that their face or hands are dirty May not be aware that they have been touched Enjoys eating spicy, strong flavours Props head or leans when standing Seeks all kinds of movement Loves to climb

Oversensitive Dislikes loud noises, such as fireworks and thunder Very sensitive towards sounds which are unheard by others such as

the humming of a refrigerator, clocks ticking, or fans Problems sleeping or a very light sleeper Dislikes bright lights,such as, camera flashes, bright sun and

strobe lights Hates having hair washed or brushed Overreacts to small cuts, or insect bites Dislikes labels in clothes or sensitive to certain ‘itchy’ fabrics Avoids tart or bitter foods Dislikes strong perfume or scented detergent Avoids movement and especially swings or slides

It is helpful to realise that with children with sensory processing difficulties they are not ‘being awkward’ and they need understanding and help in finding ways of coping with unpleasant or confusing sensations.

What might help?Ask the parents to get into small groups to discuss possible strategies to help with sensory issues.

Here are some ideas:• Provide a calm place to crash, hang out, and relax after a long day at school. • A thick-cushioned pad or beanbag, a soft, soothing light and a weighted

blanket to place over their chest.• A box for your child to use before, during, or after homework, containing

a weighted lap pad, a soft, squeezable rubber ball, and any other fun stuff you can think of.

• Provide headphones for your child to wear during noisy outings such as supermarkets or other busy places.

• For the tactile-sensitive child, try finger-painting activities, shaving cream in the bath or let the child paint themselves with child-friendly body paint and then scrub it off.

• After a bath or shower, give your child a rubdown to calm them down.• Cut off labels from the inside of clothing or buy tops and pants without

them. Allow them to wear underclothes and pyjamas inside out.

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• For oral sensitivities, give your child sugarless gum to chew or thick milk shakes to suck up through a straw. Try sucking an ice cube prior to eating a less pleasant food to desensitise the mouth.

• Give a crunchy snack to exercise the jaw muscles. Carrot or celery sticks, apple slices, or an ice pop work well.

• Prepare foods that a child dislikes in new ways. If the texture of cooked peas is unbearable, mash them and put them in stews or a meatloaf.

• Give lots of opportunities for swinging or rocking activities to stimulate the sensory nervous system, which has a normalising and calming effect on the brain.

• Jumping on a trampoline or swimming are helpful for those with a poor sense of space or balance.

BreakTime to (10 mins)

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Social, emotional, physical and academic difficulties

Time to (15 mins)

Equipment needed• PowerPoint slide 1.17• Pens

Talk about ADHD can show itself in different behaviours depending on the child’s age, setting (school, home, playground etc) and even motivation (for example, when doing an activity or something a child likes).

All children can behave in the ways described here, but a child with ADHD has symptoms most of the time that can seriously affect their everyday life. They may also be clumsy, unable to sleep, have temper tantrums and mood swings, and find it hard to socialise and make friends.

ADHD is not a psychological condition. However, having ADHD can cause children to develop emotional problems. Some psychological approaches to the management of ADHD, such as social skills and cognitive behavioural training, can be very helpful.

ActivityAsk the parents and carers to get into groups of three or four and tick the behaviours which apply to their child. Then in their groups discuss the behaviours they find most difficult.

Here are a few of the most common behaviours. Tick the ones which apply to your child.

Social difficulties Wants to ‘be in charge’ Is prone to temper tantrums Is impatient with other children Wanting to take over when others are too slow Speaks without thinking of the consequences Finds it hard to keep friends Acts much younger than their chronological age (for example, an

8-year-old may prefer playing with a 5 or 6-year-old) Acts ‘silly’ in a group Intrudes into other’s spaces Has difficulty reading social cues Doesn’t notice other people’s reactions to their behaviour

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Emotional difficulties Is moody and unpredictable Has emotions that are near the surface – for example, they are quick

to get angry or upset Is hard to please Has difficulty backing off in an argument Is not aware of others’ feelings Has difficulty reading facial expressions and body language Is negative and oppositional Is demanding of attention Goes on and on about a certain subject Suffers from low self-esteem

Physical difficulties Is unable to sit still – constantly on the move Fiddles constantly Clumsy and awkward in their movements Difficulty doing two activities at the same time Has sleeping difficulties (requires less sleep or sleeps lightly) Has difficulty with fine motor skills (for example, handwriting) Has difficulty with gross motor skills (for example, coordination) Very high tolerance for pain

Academic difficulties Is unable to concentrate for any length of time Has difficulty in finishing a task Is distracted by other sights, sounds or activity in the classroom Struggles to follow instructions – may not have heard or forgot Is disorganised – loses school books, kit etc.

Not all children with ADHD have all the symptoms. This means some can just have problems with poor attention, while others are mainly hyperactive.




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How the ADHD brain worksTime to (15 mins)

Equipment needed• PowerPoint slides 1.18 to 1.21• Flip chart paper• Marker pens

Talk aboutThere is ongoing research into the various parts of the brain that control the sensory system, the motor responses and the complex interaction of thoughts, actions and language.

Neuroscientists are uncovering the neural mechanisms that underlie ADHD. It would appear that there are abnormalities in different parts of the brain of the person diagnosed with ADHD, although environmental and genetic factors also play their part.

It is estimated that there are about 100 billion nerve cells inside our brain.

These nerve cells need to talk to each other to send messages to the rest of the body. They are connected to each other by a tiny gap called a synapse (bridge). Chemicals called neurotransmitters are needed to pass messages from one cell to another.

The theory is that those with ADHD have lower amounts of these chemicals leading to reduced attention, poor planning, hyperactivity and acting without thinking. This theory seems to be supported by the fact that stimulants work by increasing dopamine levels.

There is a specific part of our brain which sorts out incoming messages and information from all our senses. This filter decides which pieces of information are important and which are not.

For instance, right at this moment, your brain is filtering out lots of information about your surroundings, for example, smells, pictures on the wall and noises from outside, so you are not aware of them.

Another part of the brain is responsible for emotional reactions to events that occur. This information is sent to the frontal lobe to plan a response.

If you have ADHD, your brain doesn’t filter information properly. This makes it hard to concentrate and easy to get distracted.

The decision-making part of the ADHD brain doesn’t send the message quickly enough to stop inappropriate behaviour. This leads to lack of behaviour inhibition.

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ActivityDivide the parents into four groups. Give each group a sheet of flip chart paper, a marker pen and one topic – social, emotional, physical, or academic.

Then ask them to discuss and write down how they can help a child with these difficulties. After approximately 10 minutes ask each group to briefly share some of their ideas.

Display the suggestions up on the wall, allowing the parents time to walk around and read and discuss what is written on each sheet.

IdeasIf the following suggestions haven’t been made, add them in now.

Social • Model good behaviour to the child. • Explain social rules to them. • Be a ‘friend’ to your child and help them understand how you feel when

they try to control a game. • Use role play.

Emotional • Talk about emotions with them. • Help them put their emotions into words rather than behaviour.• Help them to use colours or numbers 1–10 to describe how they feel.• Praise and encourage them whenever they behave well.

Physical• Timetable in times for energetic activity followed by times of quiet.• Train them from a young age to sit at the table while eating.• Arrange for them to sleep in the quietest room and cut out background

noises at night.• Try using a heavy blanket at night or during the day to calm them.• Practice handwriting patterns at home.• Teach them to look at their body for bumps and bruises.

Academic• Talk to teachers about the child’s difficulties.• Ask if they can have something to fiddle with to help with concentration,

for example, a lump of Blu Tack.• Ask if the child can sit near the front in a quiet area of the class.• Start each day with a well-organised school bag.• Encourage them to use a diary.




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Talk aboutThe principle choice for parents of ADHD children is to either:• Accept the condition • Come to terms with specific difficulties that won’t change and work

round them• Help the child feel a valued member of the family

Or:

• Make no allowances• Be critical and hostile• Deal with them more and more forcefully

Giving children support, understanding and a sense of belonging requires huge amounts of patience.

A phrase which some parents find useful is:“God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

Accepting the things we can’t change means understanding what they are in the first place.

A parent who understands ADHD can make the necessary changes in life-style to be able to accommodate their child’s needs.

Children with ADHD often have very low self-esteem and they need us to be ‘on their side’.

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Building self-esteemTime to (10 mins)

Equipment neededPowerPoint slides 1.22 to 1.23Flip chart paper Marker pens

Talk about

Why might a child with ADHD have low self-esteem?

Write any suggestions on the flip chart if there is time.

Ideas• Falling out with friends• Getting constantly told off • Missing information• Losing things• Feeling stupid

How we can help to boost our child’s self-esteem:• Create an emotional climate of warmth, unconditional love, support,

tolerance, forgiveness and kindness • Be their greatest fan • Don’t “obsess” about their difficulties• Involve them in decisions relating to them• Let them know their opinions matter• Avoid discussing their needs with others in their hearing • Look for things to praise and praise as much as you can• Help them feel loved and valued for who they are (not for what they achieve)• Praise them for ‘being’ not just for ‘doing’

20

Slide 1.22

Slide 1.23




1.21

ReflectionTime to (10 mins)


Talk aboutDuring this session we’ve covered a lot of material together.

• We have started to understand what ADHD is and how the ADHD brain works.

• We have thought about what it is like to have a child with ADHD and the behaviours that are associated with the condition.

• We have looked at how ADHD is diagnosed.

• We have considered sensory processing difficulties in a child with ADHD.

• We have considered some of the social, emotional, physical and academic difficulties that a child with ADHD will have and thought about some ways we can help.

• We thought about the choice we have as parents either to accept or reject our child’s condition and how this will affect the way we deal with their behaviour.

• We thought about the importance of building up our child’s self-esteem.

What one thing are you taking away from today? (For example, many parents say how they appreciate just being able to chat with each other.)

Note: You start. Keep it short and simple. Say it’s OK to pass.

On page 21 in the parent handbook there is space for the parents to write down their reflections on the session.

Note: You may want to ask them to complete this at home, to give you their feedback verbally, or to fill it in during the session if there is time.

1521

Slide 1.24

Slide 1.25




1.22

At the end of the session, I’ve learnt that:

As a result, I intend to:

I would like to learn more about:




1.23

Focus for the weekTime to (5 mins)


Build up your child’s self-esteem.

Make a list of ten things you love about your child and share it with them.

1 6

2 7

3 8

4 9

5 10

Keep a record of every negative thing you say to your child this week and try to make sure that you say at least as many positive things to them.

Next week we will look at attention deficit behaviour and strategies to help manage this.

Thank you for coming and see you next time.

22

Slide 1.26

Slide 1.27




1.24


Contents Introduction and reviewWhat is attention?Attention deficit behavioursManaging attention deficitBehaviour managementSchool strategiesSleepReflection Focus for the week

Session 2: Attention deficit

2


Children with ADHD




2.2




2.3

Session 2: Attention deficitEquipment needed• Parent handbook for each parent• Name tags (R4)• Pencil or pen for each parent• Attendance sheet (R5)• Laptop computer equipped with PowerPoint (optional)• PowerPoint slides – session 2 (optional)• Flip chart paper or A3 sheets• Marker pen• Felt-tip pens• Blu Tack• Cards with activity scenarios (optional)

Learning outcomesAt the end of this session, parents will be able to:• Understand better what is involved in paying attention• Identify ways to help their child at home and at school• Identify ways of managing attention deficit behaviours• Understand some of the issues surrounding ADHD and sleep




2.4

TimetableStart time Topic Time ………………… Introduction and review 10 minutes

………………… What is attention? 5 minutes

………………… Attention deficit behaviours 30 minutes

………………… Managing attention deficit 10 minutes

………………… Break 10 minutes

………………… Behaviour management 20 minutes ………………… School strategies 10 minutes

………………… Sleep 10 minutes

………………… Reflection 10 minutes

………………… Focus for the week 5 minutes

Total time 120 minutes




2.5

Introduction and reviewTime to (10 mins)


Talk aboutWelcome everyone back.

Remind everyone of the group agreement.

Summarise the last session:• We started to understand what ADHD is and how the ADHD brain works.• We thought about what it is like to have a child with ADHD and the

behaviours that are associated with the condition.• We considered some of the sensory, social, emotional and academic

difficulties that a child with ADHD will have and thought about some ways we can help.

• We thought about the choice we have as parents either to accept or reject our child’s condition and how this will affect the way we deal with our child’s behaviour.

• We thought about the importance of building up our child’s self-esteem.

How did you get on with your focus for the week?Were you able to list ten things you love about your child and did you share these with them? What was their reaction?Did you make a note of how many positive and negative things you said to your child?

ActivityAsk the parents to get into pairs and share with each other one of the things they love about their child and what they did during the week to build up their child’s self-esteem.

Children learn about themselves and develop a self-image based mainly on the way in which adults treat them, talk with them and react to them. This is why it is so important to focus on the positives whenever possible and to build up their self-esteem.


This week we will be looking at attention deficit and the difficulties our children have with holding attention. We will think about ways to recognise and minimise their difficulties, and how we can help the school to support our children. We will also discuss sleep difficulties.

Slide 2.1

Slide 2.2




2.6

What is attention?Time to (5 mins)

Equipment needed• PowerPoint slide 2.3

Talk aboutAttention is what allows people to identify and take in information. It is the first step in the learning process that occurs in the brain. Attention is like a funnel that lets us select and take in useful information. Once the information is there, the brain makes sense of it and stores it.

The attention process has three parts:

1. Being alert • Be awake and well rested• Be aware of our surroundings• Be ready to take in information

2. Selecting and sustaining• Choose what to pay attention to• Continuing to pay attention to it

3. Shifting focus• Shift attention from a distraction back to the task in hand• In problem solving the ability to shift focus when we see a mistake and

change the way we approach a situation• Able to move on from a thought or an activity to do something new

Nobody can completely ignore distractions. For example, a loud noise will catch everyone’s attention but most of us are able to shift our attention to the noise and then quickly shift back to whatever we were doing.

Children with attention issues can have problems with any or all of these parts which will affect their ability to learn. They can also get ‘stuck’ in what they are doing or thinking about. While they are doing this, they are not processing other information and will struggle to tune in to what is going on.

25

Slide 2.3




2.7

Attention deficit behavioursTime to (30 mins)

Equipment needed• PowerPoint slides 2.4 to 2.5• Flip chart paper• Marker pens

ActivityAsk the parents to get into small groups of 3 or 4.

Here are some attention deficit behaviours. Tick those which apply to your child.

Inattention Works poorly without one-to-one supervision Has difficulty regrouping after distraction Day-dreams Fails to give attention to details in school work Flits from task to task Has inconsistent work output Is easily distracted Seems not to listen when spoken to directly Gets over-focussed on one part and misses the big picture

Poor short-term memory Forgets instructions Loses focus, doesn’t finish tasks Reads, but does not remember Has difficulty with mental arithmetic – makes ‘careless’ mistakes Has difficulty remembering what was at the top of a paragraph by the

time they have finished reading it Has difficulty memorising tables or lists Loses concentration often during lengthy tasks

Disorganisation Forgets homework books Misjudges time Often loses things Procrastinates (tries to put things off) Has poor prioritisation Moves from one uncompleted activity to another

26

Slide 2.4




2.8

Fails to complete routine jobs without supervision Varies in performance from one day to another Has poor planning when approaching a task

Ask the parents to discuss the following questions in their groups.

Did you realise these behaviours were part of ADHD?Which behaviours do you find the hardest to manage?

Talk aboutMany children with attention issues want to focus on the ‘right’ thing. But their brains may have trouble picking out what that right thing is.

Even if they can pick out what’s important, they may not be able to sustain attention for a meaningful amount of time.

They can get ‘stuck’ in what they are doing or thinking about. While they are doing this, they will struggle to tune in to what is going on.

The mechanism that lets them focus attention, maintain attention and shift attention easily and quickly away from distractions is ‘sticky’ in children with attention issues.

At school they look as if they are not concentrating, or appear forgetful and disorganised.

At home they find it hard to settle to a task, even when it is something they have been looking forward to.

Children with attention deficit are easily distracted both in school tasks and in play activities.

A child with attention deficit may stay focused on a loud noise long after their classmates have returned their attention to the teacher. By the time they tune back in, they may have missed important information.

Many children with ADHD are oblivious to the trail of mess they leave behind! If the person looking after a child with ADHD is particularly tidy and organised, it can make dealing with this even harder for them!

What stops your child from being able to give their attention to a task?What factors have you noticed in your child?

Write down the parents’ responses on a sheet of flip chart paper.




2.9

Ideas• They are distracted by what other people are doing.• They have difficulty in blocking out noises around them.• They are confused by too many pictures on the walls.• They think their own thoughts which block out what others are saying –

only hearing half the conversation.

“Children who suffer from attention deficit usually have normal or above normal intelligence. They possess the potential to learn, but the immature chemical and metabolic system in their brain means they often have little control over their symptoms. They may try very hard to do the right thing, but struggle because they don’t have the self-control to manage things other people usually take for granted.”Kids, Families and Chaos: Living with Attention Deficit Disorder, Dr Harry Nash, Ed. Med Publishers, S.A., 1994.

Note: If parents have children who have not yet been diagnosed, the DSM V classification below will help them identify if they should be pushing for this with professionals.

For a diagnosis of ADHD predominantly inattentive presentation:Diagnosed if six or more symptoms of inattention listed below (but less than six symptoms of hyperactivity/impulsivity) have persisted for six months.

1. Often fails to give close attention to detail or makes careless mistakes in schoolwork, work or other activities.

2. Often has difficulty sustaining attention in tasks or play activities.3. Often does not seem to listen when spoken to directly.4. Often does not follow through on instructions and fails to finish

schoolwork or chores (not due to failure to understand).5. Often has difficulty organising tasks and activities.6. Often avoids, dislikes or is reluctant to engage in tasks that require

sustained mental effort (such as schoolwork or homework).7. Often loses things necessary for tasks or activities (e.g. toys, school

assignments, pencils, books or tools).8. Is easily distracted by extraneous stimuli.9. Is often forgetful in daily activities.

Slide 2.5




2.10

Managing attention deficitTime to (10 mins)

Equipment needed• PowerPoint slides 2.6 to 2.7• Cards with activity scenarios (optional)

Talk aboutUnfortunately there is no magic solution when it comes to parenting a child with ADHD (or parenting any child for that matter!).

Parents of children with ADHD can feel guilty and responsible, but remember – you did not cause your child’s condition.

Focus on the positive: You can help, encourage and support your child now that you both know what the problem is.

ActivitySplit the parents up into three small groups and give each group a scenario to discuss and then feed back to the whole group.

What can you do to help the child in these scenarios?

Scenario 1:Jack is aged 8. He always forgets something he needs to take to school and then gets into trouble with his teacher.

Ideas• Make a checklist for Jack to tick off (this could be in the form of pictures).• Get his kit ready with him the night before.• Make sure he gets up in plenty of time.

Scenario 2:Noah is aged 13. Every time his gran asks him to get washed and changed for bed, he goes up to get started but ends up being distracted by something.

Ideas• Make Noah a checklist for him to tick off.• Make sure everything he needs is already in the bathroom.• Have an agreed time by which he has to be in his bedroom and not

come out.

Scenario 3:Katie is aged 11. Her mum needs her to help with some of the household chores, but Katie is so bad at following verbal instructions that her mum ends up not asking Katie to do anything.

Slide 2.6




2.11

Ideas• Use a chart to schedule one chore each day and give appropriate rewards.• Have a routine so that chores are always done at the same time each day.• Incorporate the completion of chores into the ‘house rules’ which are

agreed by Katie and her mum.


Slide 2.7




2.12

Behaviour managementTime to (20 mins)


Talk about

Note: As these sessions are designed for parents of children with ADHD who have already attended Time Out for Parents – Children with Special Needs, these basic principles will have been covered and you may want to refer to session 5 of that course.

We have to remember that our children are first of all, children. The fact that they suffer from ADHD is second. They are the same as all children: wanting attention, needing to push boundaries or wanting their own way.

Let’s remind ourselves of some of the basic principles for behaviour management which are the same for any child and some additional suggestions for children with attention deficit.

The trick is to adapt these strategies to deal with the specific challenges of ADHD.

Routines• Routines give a sense of security.• Make a chart of which activities happen when. Keep one at home,

and a copy for your child to carry with them as a reminder when they are at school.

• Remind them each morning of what they will be doing that day.• Set a homework routine to help them with their schoolwork.• Give advance warning about changes in routine.• Plan what will happen if an activity is unexpectedly rescheduled or cancelled

so that your child knows what to do if their usual routine is changed.• Introduce competition into the routines: e.g. play races to see who can

get dressed first.

Consistent rules• Make firm clear rules when everyone is calm – not in the heat of the battle! • Have a set of household rules that are accepted by everyone in the family.• Try to keep the same rules and routines especially on school days.• Put a ‘no entry’ or ‘please knock’ sign on doors your child is not allowed

to go.

28

Slide 2.8

Slide 2.9




2.13

• Have a ‘take off-put away’ rule for coats, shoes, school kit etc.• Visual signs like egg timers can help the child focus.• Tell your child what you want them to do, rather than what not to do.• Children with ADHD have a strong sense of fairness (‘You said!’,

‘Yesterday you let me!’) so consistency is vital.

Give clear commands • Make sure you have their full attention by turning off the TV or radio and

looking them in the eye.• Speak clearly without shouting.• Check they’ve understand what is being asked of them.• Encourage them to repeat the instructions in order to avoid the “But you

said…” conversation.• Be specific with requests (e.g. “pick up your clothes and put them away

in the wardrobe” rather than “clear up this mess, your room is a tip!”).• Count down from 10 to indicate the time the child has to comply.

Physical exercise• Exercise can enhance a child’s focus and organisational skills.• Hand-eye coordination is fantastic for engaging the body and brain.• Play a game of toss and catch with a ball. • Have your child toss with the right hand and catch with the left. • If you have space, set up a Ping-Pong table.• Use exercise prior to a task requiring concentration and not before bedtime!

Be super organised!• Straight after school help them search their pockets and school bag for

notes from the school and homework instructions.• Make a list of the equipment or materials that they need for each day,

and gather these together the night before. • Put them by the front door (maybe in your child’s school bag) so your

child will see them and be less likely to leave them behind.• Keep a copy of the lesson and homework timetables in a prominent

place at home, such as on the fridge door.• Help your child structure their homework projects before they begin.• Your child probably has poor short term memory so be patient with them.

Have you tried putting any of these into practice at home? How helpful were they?

These strategies are important because when they are carried out they help prevent or minimise more challenging behaviour.

Parents with children who have ADHD sometimes worry that they are giving them too much help, and that they should be encouraging their children to be more responsible.

30




2.14

If a child has ADHD, the likelihood is that they will never be able to remember things like other people. However, they can use strategies such as having checklists and learn planning skills which will help them for the rest of their lives.

What are people’s reactions likely to be to your child’s deficit in attention, both at home and at school?

• It is natural for people to feel irritation, frustration, critical and angry – especially when they do not know your child’s diagnosis.

• This is because ADHD is a ‘hidden’ disability.• Parents do have to accept the necessity to explain their child’s needs

to others.• They also need to develop a thick skin against others’ criticism.

ActivityAsk the parent to get into pairs and discuss the following:

• What is the attitude of your child’s school towards their behaviour?

• How can you help the school understand your child’s needs better?




2.15

School strategiesTime to (10 mins)


Talk aboutADHD can cause problems with many everyday classroom activities, such as understanding texts, planning written work, logical thinking, carrying out multi-part instructions and written and verbal expression.

Children with ADHD often have poor concentration, and problems with memory and communication.

Schools have a legal duty towards children with special needs, which can include those with ADHD. They can carry out assessments and provide useful information for the doctor about how your child is behaving, learning and socialising at school.

This helps to build up a fuller picture so that the best treatment plan can be put into place for your child.

It is easy for the relationship with the school to become confrontational but it will be best for your child if you can work together and share insights and ways of dealing with your child’s behaviour.

What is the attitude of your child’s school towards their behaviour?How can you help the school understand your child’s needs better?

Note: Allow parents some time to talk about their difficulties. Don’t minimise them.

You may want to remind parents of the positive-negative-positive sandwich method covered in session 6 of the Time Out for Parents - Children with Special Needs course.

It is important for the school to accept that the child cannot help themselves, their behaviour is not prompted by naughtiness.

Make sure that the teacher is aware that your child has been diagnosed with ADHD, if they do not already know. They can be an invaluable ally in helping to monitor and manage your child’s ADHD.

Children with ADHD need predictability, structure, short work periods, more individual instruction and positive reinforcement.

They should also be given a safe place to go and a sign or card they can show to the teacher when they feel they are beginning to get upset or anxious.

31

Slide 2.10

Slide 2.11




2.16

Here are some examples of good practice that have proved valuable not only at school, but at home too:• Sit the child at the front of class away from distracting influences.• Selecting and sustaining focus will be easier if a teacher stands and talks

right in front of a child. • Sit them with a calm, well-behaved ‘role model’ who can provide support.• Use deliberate eye contact when speaking to the child.• Give directions clearly and frequently, and whenever possible, visually

(for example, timetables).• Repeat instruction to ensure that it is understood.• Be consistent, firm and fair.• Display classroom rules which are written in a positive way.• Break down each task into small component parts.• Make sure a child knows the boundaries.• Avoid long discussions about what is wrong and right in their behaviour.• Allow time out, without delay, if required.• Monitor progress regularly throughout the lesson.• Give constant feedback and rewards.

Homework:• Be aware of when your child has homework – ask their teacher for a

copy of the homework timetable.• Agree a time with your child when homework is to be done each day. • Plan for homework first and play later.• Provide a quiet, calm environment with no distractions for your child to work.• Switch off the TV, and ban interruptions from family members.• Schedule breaks and opportunities for physical exercise when doing

homework if necessary, so your child can ‘let off steam’.

32




2.17

SleepTime to (10 mins)

Equipment needed• PowerPoint slides 2.12a to 2.13

Talk aboutChildren need about nine to ten hours of sleep each night, but this is easier said than done if your child has ADHD.

Poor quality sleep and lack of sleep are big factors when it comes to alertness issues.

Sleep difficulties are very common in children with ADHD, sleep disorders include: • Insomnia• Nightmares or night terrors• Snoring and breathing problems

Simply recognising the nature and extent of the disturbances can be the first important step towards improving the situation

What difficulties have parents had with getting their child to sleep?

Lack of sleep can negatively impact on a child’s emotions, concentration and task performance, as well as affect the wider family’s quality of life.

Parents will also suffer from a lack of sleep because of the stressful evenings, bedtime challenges and interrupted nights, and this has a knock-on effect on the ability to cope with the child’s challenging behaviour, whilst causing stress among and between other family members.

Many parents of children with ADHD tend to struggle on regardless, not recognising that their sleep problems are adding to the difficulties they already face parenting a child with ADHD.

Evening routines are fraught with difficulty and bedtimes can be a nightmare.

33

Slide 2.12a

Slide 2.12b




2.18

Does anyone recognise the following scenario?

At bedtime, Danny didn’t seem able to switch off. His parents tried using all the regular routines that you’re told to do, but the slightest thing like an ambulance siren outside would throw it off. A warm bath became a water fight, a milky drink would get spilled. If they turned their attention to one of the other children, Danny would be off playing with toys or turning on the TV.

Once in bed, they made the house as dark and quiet as possible, but the slightest noise and he was out of bed with “I need a drink” or “My bed is all tangled up”. He found it impossible to switch his thoughts off and would say, “I can’t sleep because it’s all going on in my head”

Two or three times in the middle of the night he would wake his brother up to join him bouncing on his bed, or he would wake his parents up to ask questions like, “Will I be able to go to the moon one day?”

His parents were exhausted all the time, irritable with each other and longing for a break. But finding a babysitter was near impossible and the grandparents couldn’t cope with Danny’s 24/7 needs.

The symptoms of ADHD make calming bedtime routines difficult.

Top tips for a better night’s sleep:• Physical exercise every day e.g. walking, swimming, playing a team sport.• Avoid strenuous physical activity for a few hours before bedtime.• Make sure your child goes to sleep at the same time each night and gets

up at the same time each morning.• Keep the bedroom dark, quiet and at a comfortable temperature.• Avoid over-stimulating activities during the evening such as watching

television, playing a computer game or reading an exciting book.• Take all electronic and electrical equipment, such as, TV, computer,

mobile phone, etc, out of a child’s room.• Avoid giving the child a large meal a few hours before bedtime.• Cut out certain foods such as those high in sugar and those containing

food additives.• Complete a sleep diary to help identify and understand sleep problems.• Seek help from a specialist doctor.

Sleeping medication is not often used in children but sometimes your specialist may wish to discuss this with you if your child’s sleep remains a significant problem despite other management steps.

Have parents any other tips?How have they coped with their own exhaustion?

Filling in a sleep diary can help identify the times of particular difficulty for you and your child. This might uncover the main pressure points and could be useful for starting discussions with your doctor.

Slide 2.13




2.19

“Keeping track of your child’s sleep problems and patterns can help you to think about the quantity and quality of sleep your child is getting, and how this is then impacting on your family life in general. By sharing this information with your doctor, you should begin to make informed decisions regarding managing the problems.”– Dr Chris Idzikowski, Director of the Sleep Assessment and Advisory Service, www.addiss.co.uk/sleepseekersbooklet.pdf.




2.20

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34




2.21

ReflectionTime to (10 mins)



• We have learnt that people with attention deficit have difficulty being alert, selecting and sustaining attention and coping with distractions.

• We have learnt the importance of routines, consistent rules, clear commands, physical exercise and of being super-organised ourselves.

• We have also thought about how we can work with our child’s school.

• We have considered ways to help our child get a better quality night’s sleep.

What one thing are you taking away from today?







1535

Slide 2.14




2.22

Focus for the weekTime to (5 mins)


Talk aboutWrite down the attention deficit behaviours that concern you and at least two strategies you might be able to use this week to help manage them.

Attention deficit behaviours of particular concern:1

2

3

Things to try this week:1

2

3

Next week we will be looking at hyperactivity and strategies to help manage this.


36

Slide 2.15

Slide 2.16


Contents Introduction and reviewWhat is hyperactivity? Hyperactive behaviours Managing hyperactivity Behaviour management Oppositional behaviour Reflection Focus for the week

Session 3: Hyperactivity

3


Children with ADHD




3.2




3.3

Session 3: HyperactivityEquipment needed• Parent handbook for each parent• Name tags (R4)• Pencil or pen for each parent• Attendance sheet (R5) • Whiteboard, pens and eraser• Laptop computer equipped with PowerPoint (optional)• PowerPoint slides – session 3 (optional)• Flip chart paper or A3 sheets• Marker pens• Felt-tip pens• Blu Tack• Cards with activity scenarios (optional)

Learning outcomesAt the end of this session, parents will be able to:• Continue to identify how ADHD affects their own child• Have a better understanding of hyperactive behaviours• Identify ways of supporting and helping their child




3.4

TimetableStart time Topic Time ………………… Introduction and review 10 minutes ………………… What is hyperactivity 5 minutes

………………… Hyperactive behaviours 20 minutes ………………… Managing hyperactivity 15 minutes

………………… Break 10 minutes

………………… Behaviour management 30 minutes

………………… Oppositional behaviour 15 minutes ………………… Reflection 10 minutes ………………… Focus for the week 5 minutes

Total time 120 minutes




3.5

Introduction and review Time to (10 mins)

Equipment needed• Attendance sheet (R5)• PowerPoint slides 3.1 to 3.2



Summarise the last session:

• We learnt that children with attention deficit have difficulty being alert, selecting and sustaining attention and coping with distractions.

• We learnt the importance of routines, consistent rules, clear commands, physical exercise and of being super-organised ourselves.

• We thought about how we can work with our child’s school.

• We considered ways to help our child get a better quality night’s sleep.

How did you get on with your focus for the week?Were you able to try any of the strategies you thought you might be able to use after our last session?Did they help?

ActivityAsk the parents to get into pairs and share with each other how their child has been during the week, if they tried any new strategies and if they helped.


Last week we started looking at attention deficit behaviours. This week we are moving on to hyperactive behaviours.

Slide 3.1

Slide 3.2




3.6

What is hyperactivityTime to (5 mins)


Talk aboutHyperactivity is a high level of movement, restlessness, or fidgeting.

Overactive (or hyperactive) children tend to be continually ‘on the go’. They may seem loud and noisy with a continuous chatter.

They don’t just move their bodies a lot – their brains also have trouble slowing down.

Most children have moments when they have excess energy, but a child with ADHD has overactivity caused by differences in how the brain works.

The ADHD brains ‘wiring’ system takes a bit longer to get started and go. But, it also has trouble putting on the brakes to stop.

It is thought that manipulating, touching and fidgeting help organise neural pathways in the brain for better focus.

Being hyperactive doesn’t just mean zooming around the room. Children may fidget or have extra movements even when doing little things like tying their shoes, writing or playing an instrument.

The difficulty is with self-monitoring and self-regulating their behaviour which causes their hyperactive behaviour. They also have a hard time regulating their emotions, so often overreact.

For example, a child struggles to sit still during meals and rushes to leave the table without eating much at all. Half an hour later, the child is so hungry that they can’t think straight and has a melt-down.

39

Slide 3.3




3.7

Hyperactive behavioursTime to (20 mins)


Talk aboutHere are some examples of hyperactive behaviours. Tick those which apply to your child.

Intrudes into other’s conversation or work Acts silly in a crowd Makes constant demands Is constantly restless Rushes carelessly through work Runs about or climbs excessively in inappropriate situations Has difficulty putting the brakes on behaviour Often fidgets with hands, tapping their feet or squirming in seat Constantly touches or handles things in shops or at people’s homes Has an ‘over-wound spring’ Takes risks (nothing seems to frighten them and no situation is

too dangerous) Is accident-prone Has difficulty staying seated in class, at mealtimes, etc Has difficulty playing or engaging in leisure activities quietly Is ‘on the go’ most of the day Talks nonstop without noticing how others are reacting Impatient when everyone’s just ‘sitting around’

Which ones do you find the hardest to cope with?

Every child with hyperactivity will be unique and different from all the others, but they will all have some of these behaviours in common.

Although ADHD children are usually sensitive and caring, they are often socially out of tune.

They want to be popular, but don’t know how to make this happen. Instead, their behaviour loses them friends.

Having said all this, because every child with ADHD is unique, there are some who have few social difficulties and may be the ‘life and soul of the party’ and popular with peers.

40

Slide 3.4




3.8

As the brain matures, hyperactivity improves. Teenagers with ADHD can use their stronger executive skills to help control or redirect their need to be in constant motion. So while they may still have hyperactivity, the signs are less noticeable to others.

When and where is your child most likely to have hyperactive behaviour?

Encourage parents to compare notes – there may be similarities with their children that they can identify.

Note: If parents have children who have not yet been diagnosed, the DSM V classification below will help them identify if they should be pushing for this with professionals.

Symptoms of predominantly hyperactive/impulsive presentation:Diagnosed if six or more symptoms of hyperactivity/impulsivity (but less than six symptoms of inattention) have been present for six months.

Hyperactivity1. Often fidgets with or taps hands and feet, or squirms in seat2. Often leaves seat in situations when remaining seated is expected 3. Often runs and climbs in situations where it is inappropriate (in

adolescents or adults, may be limited to feeling restless)4. Often unable to play or engage in leisure activities quietly 5. Is often ‘on the go’, acting as if ‘driven by a motor’6. Often talks excessively

Impulsivity1. Often blurts out answers before a question has been completed2. Often has difficulty waiting their turn3. Often interrupts or intrudes on others

We will be considering the last three symptoms of impulsivity during our next session.

Being a parent of a child with ADHD is tough and other people’s reactions and lack of understanding only make it worse. They look and pass judgement without knowledge and blame parents for the behaviour of their children.




3.9

Managing hyperactivityTime to (15 mins)

Equipment needed• PowerPoint slides 3.5 to 3.6• Cards with activity scenarios (optional)

ActivitySplit the parents up into smaller groups and ask them to discuss the following scenarios. Ask for general feedback after about 10 minutes.

Note: The following are suggested scenarios for you to use. Depending on the parents in your group and the children they represent, you may wish to change the names used from male to female or add a scenario of your own.

What can you do to help the child in these scenarios?

Scenario 1:Raj is aged 6. He went to a restaurant for his granddad’s 60th birthday party. They still hadn’t eaten by 1.30 p.m. and Raj began to run around the restaurant stealing food from people’s plates. When his grandma told him off, Raj kicked her.

Ideas• Take something for Raj to eat, or order ahead of time.• Ask the restaurant for something to tide him over (for example, a bread roll).• Provide him with something to do to occupy himself (for example, a

mobile phone with games).• Talk to his grandma to help her understand his difficulties.• Explain to him that if he kicks anyone there will be a consequence (which

has previously been agreed by his parents).• Ask an older child to take him for a walk.

Scenario 2:Gary is aged 9. He is very ‘wound up’ and excitable when he comes out of school every day. His mum puts him in the car then chats with her friends. Gary jumps around the car, presses the horn and hits his sister. He has been known to unwind the window and climb out. When he behaves this way his mum shouts at him and threatens to ban TV for a week, then gets in the car and drives home.

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3.10

Ideas• Take something for Gary to eat or do while his mum talks.• Allow him to run in the playground while his mum talks.• Put a timer in the car and tell him his mum will stop talking when it runs out.• Explain to him that if he hits his sister there will be a consequence

(which has been previously agreed by his parents).


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3.11

Behaviour managementTime to (30 mins)

Equipment needed• PowerPoint slides 3.7a to 3.12• Flip chart paper• Marker pens

Talk about As well as the basic principles of behaviour management:• Routines • Consistent rules • Clear commands• Physical exercise• Be super organised

We can add three more principles:• Daily activities to increase alertness and to calm• Rewarding good behaviour• Not rewarding undesirable behaviour

Daily activities to increase alertness and to calmNICE describes the ADHD child as acting as if ‘driven by a motor’.

This is a useful comparison which is often used by occupational therapists. Children with ADHD benefit from a regular programme of physical activities that provide sensory-motor input. This enables children to be energised or calmed so that they can get the most out of their day.

The child is encouraged to think about themselves as having an engine inside them rather like a car and recognise that they are able to self-regulate their engine speed.

Parents need to keep a record of those activities which they know ‘wind up’ their child and those which calm them down.

What activities wind up your child and which calm them down?

A car needs an engine to make it move.

When it is on the motorway it needs to go fast and the engine speed is high.

When it is in a busy narrow street the engine speed is low.

A car engine works best when its engine speed is just right.

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3.12

We have an engine inside us rather like a car’s.

When we are working at school or playing football our engine speed needs to be high.

It might be helpful to start your child’s day with activities such as spinning, skipping or bouncing on a trampoline to stimulate the body’s central nervous system in preparation for learning.

When we are getting ready to go to bed our engine speed needs to be low.

Activities which require heavy muscle work and deep pressure can give your child an awareness of their body in space and increases the ability to self-regulate sensory input.

ActivityAsk the parents to get into small groups of three or four and, using the flip chart paper provided, draw up a list of activities which increase and decrease their child’s engine speed.

Allow time for feedback from each group.

With this in mind, choose carefully the activities your child does at differenttimes of the day.

Talk aboutRewarding behaviour“Behaviour that is noticed increases – behaviour that is ignored decreases.”• Psychologists call this statement the ‘law of reinforcement’ to explain

that people will learn to repeat behaviours that are rewarded. • Any attention – positive or negative – can be a reward. Even a frown or a

reprimand is more rewarding than being ignored.• If a child likes what happens as a result of their behaviour, they will

repeat it.• Pay less attention to unacceptable, and more attention to acceptable

behaviour.• When the inappropriate behaviour stops, give attention immediately.

Do not ignore the behaviours that are dangerous or those that have their own reward, for example, avoiding a task.

Reward good behaviourWe all feel criticism more deeply than praise. It makes us feel so terrible that we rarely see the lesson the criticism was intended to bring. So if criticism is not a good teacher for us why do we think it will work with our children?

A conversation about strengths and plenty of praise will have a far more positive result.

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3.13

Make sure rewards come thick and fast! Children with ADHD need lots of praise when they get something right because they get a lot wrong!

Name the good behaviour when giving rewards. Rewards need to be instant and meaningful to your child, for example,• Verbal praise, for example, “Well done for hanging up your coat!”• Sweets• Cuddles and tickles• Favourite toy, video or game• Favourite meal or snack• Staying up a bit later• A trip to the park

However, some children with ADHD can’t handle praise. For them it is not rewarding. If this is the case, try to find some other way to show that you are pleased.

‘Overheard’ praise may work better, for example, letting them hear you say on the phone to grandpa, “Tom did so well today, I’m so proud of him.”

‘Descriptive praise’ may be more acceptable than ‘judgemental praise’, for example, instead of saying, “Wow! You are really good at drawing trains,” you might say, “You’ve drawn all the parts of a train I can think of.”

Spend quality time with your child doing something they enjoy.

Don’t reward undesirable behaviourRemember that noticing bad behaviour can be a reward – they would rather be hated than ignored.

Plan with other family members to notice and praise good behaviour and ignore the attention-seeking behaviour.

If you give in to difficult and undesirable behaviour (tantrums, repeated requests, etc.) then they will persist and increase.

If your child does misbehave, remember to criticise what they have done, not them as a person. Criticise the act, not the child.

Remember that the process of changing behaviour will not happen overnight; it will be a real challenge. Any behaviour strategy needs to be tried and tried again.

It is very understandable that as parents we feel inadequate, anxious and defensive. Try to remember that everyone else’s disapproval is not as important as your relationship with your child.

Don’t struggle alone. Look for a local support group where you can meet with other parents facing similar issues and swap ideas.

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3.14

Oppositional behaviourTime to (15 mins)


Talk about Around half of the children with ADHD also have oppositional behaviour and a small percentage of these will also be diagnosed with oppositional defiant disorder.

Children who are oppositional and strong willed are especially difficult to manage. These children will challenge, argue and say, “No” on principle. They see the world as a hostile place and are ready to resist its attacks and respond accordingly. Many will give their parents a terrible time but be charming to other people.

Would anyone like to share their experience of their child’s oppositional behaviour and how they dealt with it?

Tips for dealing with oppositional behaviour:• Always avoid head-on confrontations.• Avoid reasoning and lengthy debates.• Use cool, calm responses.• Be prepared to give a little ground.• Remember your child does care – they are just too stubborn to admit

they are wrong and need help.• Give choices to help avoid a battle of wills. This will help them to feel

involved in the decisions that affect them.• Let them feel they have a say, for example, “Well, there are two ways we

can handle this, but you decide which is best for you.”• Choices can also be linked with consequences, for example, “Will you

come off the computer after this game or shall I switch it off now?”• Use, “Thank you” rather than “Please”, for example, “Put your shoes on

thank you” rather than, “Please put on your shoes.”• Another approach is to say, “It’s time to put on your shoes.” This may

work better as “No” is not a response.• Be quick to reassure and to praise anything that is good.

To encourage cooperation, rather than ask them directly say something like, “I’m going to make some cupcakes. I’m very excited about them and they’re going to be such fun to do. You can help me if you like as I know you’re very good at mixing eggs …”

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3.15

Note: Encourage parents to share any tips they have found that help.

Thankfully, as children mature their oppositional behaviour tends to diminish.

RelaxationHyperactive children find it very hard to relax (for example, before going to sleep) and get angry quickly (for example, when they feel something is unfair or want something they can’t have). Parents can help by teaching them relaxation techniques. You can practise relaxation with your child and both get the benefit!

Ask the parents to sit comfortably and talk them through the following exercise, which should take 2–5 minutes.

There are lots of different relaxation methods. Here is one for you to try:• Find a quiet place.• Sit quietly in a comfortable position with no arms or legs crossed.• Close your eyes.• Think about letting go of the tension in all your muscles, beginning in

your feet and moving up to your face.• Keep your muscles loose.• Breathe through your nose.• Become aware of your breathing.• Imagine distracting ideas floating away on a cloud.• As you breathe out, say the word ‘calm’ to yourself. • Hold your hand on your stomach and be aware of the rate in which the

stomach goes in and out.• Breathe easily and naturally.

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3.16

Reflection Time to (10 mins)



• We have learnt that people with ADHD have difficulty in filtering out irrelevant information.

• We have considered the importance of routines, consistent rules, clear commands, rewarding good behaviour and not rewarding undesirable behaviour.

• We have tried one method of helping our child, and ourselves, relax.

What one thing are you taking away from today?







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3.17

Focus for the week Time to (5 mins)


Talk aboutWrite down the hyperactive behaviours that concern you and at least two strategies you might be able to use this week to help manage them.

Hyperactive behaviours of particular concern:1

2

3

Things to try this week: 1

2

3

Next week we will be looking at impulsive behaviours and strategies to help manage this.


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3.18




4.1

Contents Introduction and reviewWhat is impulsivity?Impulsive behavioursBehaviour managementManaging constant demands and angerTreatment options for ADHDCoping strategies for parentsReflection

Session 4: Impulsivity

4


Children with ADHD




4.2




4.3

Session 4: ImpulsivityEquipment needed• Name tags (R4)• Pencil or pen for each parent• Attendance sheet (R5) • Laptop computer equipped with PowerPoint (optional)• PowerPoint slides – session 4 (optional)• Flip chart paper or A3 sheets • Marker pens• Blu Tack• Paper• Cards with activity scenarios (optional)• Post-course questionnaires for each parent (available from

www.careforthefamily/facilitators)

Learning outcomesAt the end of this session, parents will be able to:• Continue to identify how ADHD affects their own child• Understand better the reasons behind impulsive behaviour and how to

manage it• Understand some of the issues surrounding ADHD medication and diet• Identify treatment options




4.4

TimetableStart time Topic Time ………………… Introduction and review 10 minutes …………………. What is impulsivity? 5 minutes

…………………. Impulsive behaviours 15 minutes ………………… Behaviour management 20 minutes

………………… Break 10 minutes ………………… Managing constant demands and anger 20 minutes

………………… Treatment options for ADHD 20 minutes ………………… Coping strategies for parents 10 minutes

………………… Reflection 10 minutes Total time 120 minutes




4.5

Introduction and review Time to (10 mins)

Equipment needed• PowerPoint slides 4.1 to 4.2• Flip chart and paper• Marker pens



Summarise the last session:• We learnt that people with ADHD have difficulty filtering out

irrelevant information.• We considered the importance of routines, consistent rules, clear

commands, rewarding good behaviour and not rewarding undesirable behaviour.

• We tried one method of helping our child, and ourselves, relax.

How did you get on with the focus for the week?Did you try using activities to increase and decrease your child’s engine speed?Did they help your child at all?What rewards worked best with your child?


ActivityIn pairs discuss the following:• Bearing in mind the difficulties you face as a parent of a child with

ADHD, how is it that you have coped as well as you have?• What, or who, has made your situation easier?

Write the answers on a flipchart.

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4.6

What is impulsivity?Time to (5 mins)


Talk aboutSomeone who has ADHD can be very impulsive, which means they often say or do the first thing which comes into their head.

This can make managing their behaviour very difficult, to say the least! Over-activity on its own is a relatively minor problem, but it becomes more challenging when combined with impulsivity.

Children with ADHD may be very aware that people find them difficult, but have little or no idea what to do to improve the situation.

Poor impulse control means that parents often struggle to understand how someone so intelligent can behave so stupidly.

Reasoning doesn’t help.

Unthinking behaviour At times, it is necessary for all of us to act impulsively or unthinkingly.

Most of the time, information is sent by the body to an area in the brain called the thalamus. This acts like a switchboard which sends the data to the cerebral cortex where our thinking takes place.

The trouble is that in an emergency situation, thinking will slow up our reactions. So when immediate action is needed, the thalamus also sends the information to an area in the mid-brain called the amygdala. The amygdala does a ‘threat analysis’ and floods the cortex to stop it taking over.

Messages are then sent to our muscles to create a sudden instinctive movement and we act before we think – jumping out of the way of a falling branch or diving into the river to save a child, for example.

The problem for the person with ADHD is that the amygdala slows down the thinking function in the cortex for much of the time, producing impulsive ‘unthinking’ behaviour.

A child with impulsivity associated with ADHD uses these unthinking responses inappropriately.

ADHD children don’t mean to get into trouble; they just act with no thought of the consequences.

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4.7

Impulsive behavioursTime to (15 mins)


ActivityHere are some examples of impulsive behaviours. Tick those which apply to your child.

Speaks and acts without thinking Interrupts or intrudes on other’s conversations Is unable to wait their turn while playing Blurts out answers before questions have been completed Calls out in class Has a low frustration tolerance May appear aggressive Prefers immediate, smaller rewards rather than working for bigger,

more lasting rewards Has difficulty putting the brakes on behaviour Rushes carelessly through work Is accident-prone

Which ones to you find it hardest to cope with?

Talk aboutEvery child with impulsivity will be unique and different from all the others, but they will all have some of these behaviours in common.

Children with symptoms of impulsivity do things without thinking. They have difficulty waiting for their turn in games or in a queue, and interrupt people in conversation.

They are aware of what is right or wrong, but the right or wrongness of their action doesn’t register until just after they’ve done it. By then it is too late.

When analysing behaviour always look at the beginning, not the end. An impulsive child might get into a fight but the cause may have been a bully winding them up.

Children with ADHD are often genuinely upset at what they have done, but may be just as unthinking the next time. For example, even if they have got into trouble for hitting another child, the next time they are tempted to do it, the thinking part of their brain will not kick in quickly enough for them to remember the punishment and they will go ahead and do it anyway.

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4.8

They need parents and teachers to understand that they have this difficulty. To deal with this, they should be encouraged to say “Sorry” often. Adults need to forgive them quickly and at this point take the opportunity to talk with the child about what they can do next time to avoid the situation.

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4.9

Behaviour management Time to (20 mins)


Talk aboutAlthough we need to understand the difficulties children with ADHD have, they still need to have boundaries and discipline.

Having ADHD does not mean they can disobey you or behave inappropriately (for example, swearing or being violent).

We have considered the following behaviour management strategies:• Routines • Consistent rules • Clear commands • Physical exercise• Be super organised• Daily activities to increase alertness and to calm • Rewarding good behaviour • Not rewarding undesirable behaviour

Let’s add three more behaviour strategies to help with impulsivity:• Planning ahead• Consequences and sanctions• I-messages

Planning aheadMany problems can be avoided if you are able to plan ahead, for example, taking toys, games, books or food to keep your child occupied when going somewhere.• Plan for peace. Organise things to avoid undue stress. • Write a list of things to do and put it somewhere where it can be seen

clearly (for example, door of their room, bathroom). • Break down tasks like doing homework or sitting at the dining table into

smaller time spans, such as 15-20 minutes.• Talk about possible scenarios and discuss how they should behave.• Role play a new situation so that your child knows what will be expected.• Avoid difficult situations if possible, for example, staying too long at a party.• Give advance warnings about changes in routine. • Choose activities that have an immediate reward or consequence.• If there is an adult your child sees as an authority figure, plan to include

them in the more challenging situations.

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4.10

Use this traffic light chart with your child to plan with them how to react to unexpected events.

Stop – Something has happened

Think – How do I feel? What should I do?

Proceed – Choose the best thing to do

Note: This chart is based on ‘mindfulness’ and the S.T.O.P. acronym. S (stop or pause for a moment), T (take a deep breath) O (observe mindfully in the moment), P (proceed with relaxation and awareness). More information on this can be found in the theory notes.

Consequences and sanctionsEven though children with ADHD are very impulsive, with lots of training they eventually learn to be less so. But they don’t learn easily from consequences.

• You will need to explain the reason why a natural consequence happened and to remind them of past consequences.

• They sometimes get very angry when consequences are dished out.

• Be prepared to carry through the consequence.

• Be willing to ‘live through’ the consequences of your consequence! It will get worse before it gets better.

Consequences can still be used as a form of behaviour management, but be prepared to put in a lot of effort to make them work. Give warnings about a behaviour throughout the day. Children who are impulsive are unaware of how irritating they can be and are shocked when you explode because you can’t take any more.

The impulsiveness of a child with ADHD means they may not be able to automatically make the connection between the action and the consequence, and if so, they may take a long time to do this. So don’t rely on the fact that forgetting something for school will make them remember the next time.

Use ‘natural consequences’ sparingly.

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4.11

I-messagesI-messages are a way of expressing feelings in a clear and respectful way. They are a straightforward statement of what we think the problem is and what we want to do about it.

I-messages allow us to say what we feel without hurting others.

Often when we are angry or upset, we use language like, “You are so …” or “You always …” or “You never …”

These are called ‘you statements’ and focus on the person rather than the problem. The person feels as though they are being criticised and can feel attacked.

If your child is being rude or difficult, rather than saying, “You make me so angry!” use the three stages of I-messages which is less confrontational.

1. Describe the behaviour (remember to separate the behaviour from the child)

2. Describe the effects of the behaviour on yourself and others present 3. Describe how you feel

If we use an I-message, it shows how ‘I’ feel which is non-threatening.

It is the behaviour we dislike, not the child.

Wherever possible use ‘I’ instead of ‘you’.

For example instead of saying,“You’ve ruined the outing for all of us.” you might say, “I’m upset and sad when we all have to come home early.”

ActivityAsk the parents to get into twos or threes and discuss how you could change the following ‘you statements’ into I-messages without using the word ‘you’ anywhere in the sentence.

“You are always hurting your sister.”

“You’ve thrown your clothes on the floor again.”

‘You don’t have to shout – I’m not deaf’

“You’ve ruined a good pair of shoes.”


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4.12

Managing constant demands and anger

Time to (20 mins)

Equipment needed• PowerPoint slides 4.15 to 4.18• Paper and pens• Jar or bottle for activity• Flip chart paper• Cards with activity scenarios (optional)

Talk aboutThe words “No”, “Stop” and “Don’t touch” often appear to mean nothing to children with ADHD.

They may not have even heard what was said to them.

Once an idea gets into their mind, these children go on and on and on, past the point when any other child would have let it drop.

They nag and pester until the calmest parent is close to blowing up!

At the end of time spent with a child with ADHD, parents often feel exhausted and worn down.

We will need to learn to reframe what we say to our child to help with such situations.

As we have said before, there are no easy answers.

ADHD is an explanation of their behaviour but must never be used as an excuse.

All the basic strategies need to be used, but be prepared for them to take a lot longer to work.

If we are consistent, stand our ground and give them plenty of support, our child will eventually learn to behave the right way and fit in with society.

ActivitySplit the parents into small groups and give each group a scenario to discuss. After 10 minutes ask for feedback and write any suggestions on the flip chart.

How do you manage the child who is constantly asking for things even when you have said “No”?

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4.13

Scenario 1: What can you do to help manage this situation with Daniel?

Daniel is aged 7. He seems to be always hungry. Every evening just before dinner his mother has to cope with his constant demands.

“Can I have some bread?” “No, your dinner is nearly ready.” “Can I have a biscuit?” “No!” “Can I have an apple?” etc.

What can his mother do to try to avoid this situation every evening?

Ideas• Use a timer to let him know when supper time is due.• Allow him a small treat for every quarter of an hour that he doesn’t ask

for food.• Instead of saying “No” say “What do you think I am going to say?” • Instead of saying “No” say “What do you think might happen if you do eat

a biscuit just before dinner?”• Focus on the primary behaviour and avoid getting sidetracked by using

the ‘broken record’ technique – merely repeating the initial instruction, request or answer and not responding to any irrelevant issues (red herrings) he may try to introduce.

Scenario 2: What can you do to help manage this situation with Jackson?

Jackson has always been an overactive and impulsive boy. He is aged 11 and has a low self-esteem, perhaps made worse by the fact that his younger sister is well behaved and doing well at school. He seems to deliberately try to annoy her by taking her things, interrupting her when she is doing her homework and irritating her by poking her or singing in her ear.

What can Jackson’s parents do to help manage his behaviour?

Ideas• Give him plenty of encouragement when he does well, however small it is.• Help him to find things he is good at which his sister cannot do.• Avoid comparisons.• Give clear rules and commands about what is and is not acceptable.• Give him clear consequences if he continues to bother his sister.• Find a quiet place for his sister to work where he is not allowed.




4.14

Scenario 3:What can you do to help to manage this situation with John?

John is a very difficult, active and demanding 9-year-old. His parents are at the end of their tether. He never does what he is asked to do and they find they are constantly shouting at him: “Stop bothering the cat!”, “Turn off that music!”, “Get on with your homework!” etc. The atmosphere at home is one of constant tension.

What can John’s parents do to improve the atmosphere at home?

Ideas• Make a list of rules for the home – involve everyone in the family. At

an agreed time every day (perhaps teatime or bedtime) discuss these behaviours and praise each other for their efforts. “Well done, Daddy. You didn’t shout today!” “You tidied your room today Mary. That’s great.”

• Plan a timetable of his daily tasks. If possible, involve John in this.• Stand near to him, look at him, and tell him slowly and calmly what you

want him to do.• Reward his good behaviour and use planned ignoring for the

unacceptable behaviours.• Give him choices and consequences.• Give an immediate reward or consequence.

Talk about

The anger cyclePsychologists use the ‘anger cycle’ or ‘aggression cycle’ to describe how a person moves from a trigger into escalation of behaviour leading to an angry or aggressive outburst. This is followed by a recovery stage and a post-anger depression stage, before normal behaviour is restored.

We may be able to avert an angry outburst by our child during the escalation stage, but once it has reached a full blown ‘tantrum’ it needs to run its course.

We should put our child in a safe place and allow them to calm down alone.Any attempts to discuss or rebuke the child once the outburst has occurred will interrupt the recovery stage and they will become angry once again.

Wait until the child is quiet, and perhaps even tearful, before attempting to comfort or discuss what has happened.

Use ‘emotion labelling’. Children with ADHD often react before recognising their feelings. It helps to show genuine concern helping them find words to describe how they feel e.g. ‘I can see you are angry...’ or ‘You seem upset..’

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4.15

Anger is often a difficult emotion for children to discuss or explain. It is therefore useful to compare it with something they can easily identify such as a bottle or firework.

ActivityGive each parent five slips of paper and place a jar or bottle on the tablein front of you. Ask the parents to write on each slip of paper something that makes them angry. Once they have done this, ask them to fold the slips up and put them into the jar or bottle. If it overflows this will help to illustrate the point.

The concept of putting anger in a bottle should be an easy one for children to understand.

Encourage your child to write down the things that make them angry on a piece of paper (younger children can tell you and you can write it down for them).

Put their pieces of paper into a bottle.

Discuss the consequences of bottling up angry feelings, for example, what would happen if the bottle were too full?

Talk about Another illustration of the angry outburst is the firework, but we can’t illustrate this today!

• The match used to light the firework illustrates the thing that triggers the anger.

• A firework has a fuse which can be long or short which illustrates the escalation of anger.

• The explosion of the firework illustrates the angry outburst.

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4.16

Treatment options for ADHDTime to (20 mins)


Talk about A child suffering from ADHD needs treatment in all situations where the difficulties occur. This means support and help at home, school, with friends and in the community.

All the effective behaviour treatments for ADHD involve living by routine, rewarding the good and taking a step back from confrontation.

Teachers and parents need to use behavioural management strategies such as reward charts.

At school, your child may need specific educational support and plans to help with their daily work both in the classroom and with homework. They may need help to build their confidence and develop their social skills.

It is important that there is good communication between home, school and the professionals treating the child to ensure that the ADHD symptoms are dealt with as well as possible, and that your child achieves their best potential.

Psychological therapiesSometimes it is helpful if a child attends a course of individual or group cognitive behavioural therapy (CBT) covering the following areas:• Social skills – improving relationships with their friends and other children.• Problem-solving – finding ways of coping with difficulties.• Self-regulation – developing their ability to control themselves.• Active listening skills – listening when other people are talking to them.• Emotions – learning ways to deal with and express their feelings.

Psychological interventions should always be the first line of treatment.

Have any parents experience of particular therapies or training that has helped their child?

Note: Unfortunately, despite NICE guidelines, medication is the only option some parents are offered to manage their child’s condition. Few are offered additional psychological support, training or written information about ADHD.

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4.17

ADHD and medicationDrug treatment for children and young people with ADHD should form part of a comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions. Has your child ever been offered medication? What are your feelings about it? Does anyone have a child who is helped by medication?

Note: Encourage the parents to share their feelings about medication. Has this been tried with their child and how did it affect them? You will find many parents feel very strongly about this topic.

The aim of medication is to rebalance the brain’s chemistry so that, along with therapy and education, sufferers can take control of their behaviour.

Not all children with ADHD take medication, but it can play an important role in managing moderate to severe ADHD.

Many children talk about being able to think more clearly, understand things better, concentrate, communicate and succeed at school in a way they never could before. Their improved concentration gives them the opportunity and time to learn and practise new skills. Medication works by enabling the brain to focus on what it couldn’t before.

Taking appropriate medication for ADHD can help children:• Pay attention, concentrate and remember things• Be less impulsive and hyperactive• Stay calm and be more in control• Think more clearly• Improve relationships• Make wiser choices and decisions

Talk to your child’s clinical psychologist, GP or paediatrician if you think they might benefit from medication. Bear in mind that it may not be right for your child as not all children with ADHD benefit from medication.

Note: Further information on this topic can be found in the ‘ADHD theory base and session notes’ at www.careforthefamily.org.uk/facilitators.

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4.18

ADHD and diet

Note: Many parents feel very strongly about this topic. Point out that just because something works with their child, it may not necessarily work for all.

Has anyone noticed that a particular food increases their child’s inattention or hyperactivity?Have you found anything that helps?

Talk aboutThere is some evidence about the effect of diet on some children.

Food additives and colourings have long been known to over-stimulate some of them and it is possible that children with ADHD are even more sensitive to these substances than other children.

Keep a diary of what your child eats and drinks and their behaviour afterwards.

If you notice that certain foods worsen hyperactivity, try to avoid them.

A stimulant that regularly affect children’s behaviour is sugar.

Removing these completely may be impossible, but you can take some simple measures to reduce your child’s intake of stimulants:• Use carob instead of cocoa to make chocolate-flavoured foods.• Avoid sugar highs by giving your child small quantities of sugar on a

regular basis, rather than giving them a large amount occasionally.

Make changes to diet as slowly as possible as your child may have a dependency on these foods.

It is best to discuss this with your doctor or specialist dietician.

If there seems to be a link between certain food and drink and your child’s behaviour, you should be offered an appointment with a dietitian.

Slide 4.21




4.19

Coping strategies for parentsTime to (10 mins)


Note: This session, of necessity, has focussed on managing negative behaviours. However, it is important to consider the positives that there can be with having a child with ADHD. We also look at the need for parents to look after themselves.

Talk about It’s easy to feel demoralised – but if managing ADHD was easy, there would be no need for this course.

It is the behaviour of the ADHD child that makes good parents appear poor, not poor parenting that creates the behaviour.

All mums and dads need to have ways of coping with the stresses and strains of being a parent. If your child has ADHD, coping strategies are even more important.

Anger managementIt can be very hard to keep cool when you are managing a child with ADHD. If you can, try to attend or take an online anger management course which will give you some useful strategies, and even help you to help your child.

‘Me time’‘Me time’ is vital for parents whose children have ADHD. Don’t leave it until you are too worn out to benefit from a rest. Make sure you schedule in time for yourself during the day.

SleepSleep difficulties are very common in children with ADHD. Their difficulty getting off to sleep and staying asleep means that parents’ sleep is also disturbed. Try to have a sleep during the daytime when your child is at school. Ask a family member to do a ‘night shift’ so that you can have the occasional undisturbed night.

Look after your own health.Go to your doctor if you feel depressed or unable to cope. Accept help when it is offered.

What have parents found has helped them personally to cope with their own struggles of parenting a child with ADHD?

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Slide 4.22




4.20

Support groupsBeing the parent of a child with ADHD can be lonely. Meeting with other parents who face the same challenges and understand what it’s really like can be a great help.

Note: Facilitators should try to find what agencies there are in their locality that provide support for parents and also encourage parents to share any support groups or clubs they have found for themselves or their child.

Choose your battlesParents often feel ruled by other people’s ‘shoulds’ and ‘oughts’, for example, at the meal table, when other people are looking, it is easy to find yourself thinking, “I ought to make him sit down because they’ll think I’m a useless parent.”

Forget what other people think! We can’t deal with all our child’s behaviours at once. Decide to concentrate on dealing with the behaviours you find most difficult or feel are most important. Ignore the rest for the time being – they can wait.

Thinking positivelyWe have spent much of this session thinking about the frustrations and challenges of managing children with impulsive behaviour, so it is important that we look at the other side of the coin.

Impulsive children are not all bad news. Many people with ADHD grow up to be very successful adults because they channel their extra energy well. They may have a whole range of individual skills and delightful characteristics.

If children with ADHD enjoy an activity, they will often be highly motivated to persevere and become highly skilled.

Many negative characteristics of ADHD can have a positive side.

Impulsive DecisiveDistractible Creative and open-mindedInsatiable AmbitiousPersistent Persuasive

People with ADHD will often flourish in careers that require enthusiasm, energy and open-mindedness such as acting, painting, music etc.

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Slide 4.23




4.21

Many children with ADHD have sharp observational skills.

They may have very good long–term memories.

Children with ADHD can be very caring.

If we can improve the way we view our own child, the view of everyone else who deals with them will also improve.

Being positive is also vital because poor self-esteem is a big issue for them. It’s very important for children with ADHD to know they are loved whatever, and that they find things they can achieve.

ADHD success storiesIn our first session we mentioned some well-known personalities who have ADHD.

Here are some of their comments:

Note: Read out some or all of these, depending on how much time you have.

“I’ve got all this stuff in my head at the same time and I don’t know how to stop or slow down. Music is my therapy and my straitjacket. Music brings control to my thoughts. It’s not escape – it’s just order. I’m making order out of a disorder.” Will.i.am,singer, songwriter, DJ, record producer and actor.

“It’s like having a brain like a pinball machine. I’ve got this condition that’s a right pain, I may as well get something from it, have a bit of fun …” Rory Bremnar, impressionist and comedian.

“Although ADHD was a challenge and a struggle I’m thankful that I am how I am. I look at myself everyday and I’m so proud and so happy of who I am and who I was able to become.”Michael Phelps, American swimmer, winner of 14 Olympic gold medals.

“I get hyper-focussed on things I love doing. I like having ADHD a lot, it is who I am. I’m learning to work with it and manage it so that life is less chaotic and painful for my wife and children.” Richard Bacon, television and radio presenter.

“Because I don’t have a lot of patience and focus, I’m constantly generating new ideas … constantly challenging my business and my team to accomplish more. I work really well under pressure. My ADHD is my superpower.” Sharon Vinderine, entrepreneur and company director.




4.22

”People with ADHD perform best in activities that require hyper focus, i.e. short and intense bursts of attention. They have a heightened awareness of their immediate environment. They excel in chaotic conditions and thrive under pressure. They are risk takers who can come up with creative, out-of-the box solutions. Their impulsivity, if controlled, can lead to quicker reaction times, saving precious microseconds that can mean the difference between losing or winning”.The ADHD Advantage by Dale Archer MD

In your parent handbook answer the following questions:

What are some of the things that your child does well?

How can you encourage these strengths?




4.23

Reflection Time to (10 mins)

Equipment needed• PowerPoint slides 4.24 to 4.26• Certificates of attendance• Post-course questionnaire for each parent

Remember to allow enough time for this section!

It’s a good idea to celebrate the end of the course, all that the group has achieved and the relationships that have formed. A drink and something to eat is an excellent way of doing that. If the timing works out, you could even extend the length of this session and finish off with a take-away meal.

Talk aboutThis is the end of the course and during our sessions we’ve covered a lot of material together. First of all, let’s just recap what we’ve done today.

• We have thought about behaviour management at school and looked at examples of good practice both at school and home.

• We have looked at impulsive behaviour in children with ADHD and recognised that they don’t mean to get into trouble; they just act with no thought of the consequences.

• We have considered how best to manage impulsive behaviour by adding in the strategies of planning ahead and consequences and sanctions.

• We have learnt about the anger cycle and strategies for managing and preventing constant demand and anger.

• We have looked at the treatment options that are available for ADHD.

• We have identified the positives of having a child with ADHD and have considered coping strategies we can adopt for ourselves as parents.

In session 1 we talked about what you hoped to get out of these sessions and the issues you would like to be covered. Do you think the sessions have met these goals?We also talked about the issues that concern you about your child. Have the sessions helped?What have you enjoyed most about the sessions?What is the main thing you have learnt from the sessions?Name one hope that you have for your family’s future.


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Slide 4.24

Slide 4.25




4.24

On page 70 and 71 of the parent handbook there is space for the parents to write down their reflections on this particular session and also on the whole course. These can be completed during the session if there’s time or when they have returned home.




ActivityGiving out certificates is a good way to mark the parents’ commitment and contributions.

The certificates can be downloaded from the facilitator website at www.careforthefamily.org.uk/facilitators.

Ask the parents to complete the post-course questionnaire.

Note: If they haven’t already done so following Time Out for Parents – Children with Special Needs, ask the parents to complete the ‘Keep in touch’ form in the back of their handbook.

Note: Take time to discuss with the parents any plans to meet up after the course (a meal or day out with their children, for example). If appropriate, signpost them to other sources of help and opportunity. Share contact details if the parents are happy to do so.

Slide 4.26




4.25

Reflection on the courseWhat I have enjoyed most about this course:

At the end of this course, I have learnt:



My hopes for my family for the future include:

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4.26


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