Potter’s Bridge, Noblesville, IN

Making it fun..Working with kids with ADHD.

Some Fun Tips for the Attention-ally Challenged

Hi! Ever wonder why you have to repeat yourself so many times to your child?

Ever said ‘I told you to do that 5 times and still, here you sit’

Ever been disappointed in yourself for wanting to be productive, but doing something else instead?

Since I’m a therapist who has worked worked with kids and adults who could or do have some sort of a diagnosis regarding their attention, I have some thoughts about it.

Here are a few thoughts about Attention Deficit Disorder:

  1. The diagnosis can be primarily hyper, or it can be primarily inattentive.

2. I enjoy working with people who have some extra challenges and successes with their attention.

3. Since we live in a society where electronics continue to have more and more of an effect on our lives, my belief is that more and more people will continue to have issues with their attention.

“Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.index.shtml

When I am in a first meeting in a session with a person who could be diagnosed with an attention deficit type of disorder, I start with a pretty simple premise.

Therapy is fun!’ You ‘get’ to come with me and have therapy for about 45 minutes. For our first session, I meet with the child and the parents together.

During this initial session I learn about the child and their family, as well as the symptoms they note. I learn about who lives in the home(s) the child lives in, the history of symptoms, what are current symptoms, and what are the child’s strengths and skills.

I also learn if there is a history of abuse in the family.

Following that first session, I explain to the parents/adult that going forward, our session will be around 45 minutes. After the session, I will check in with the parents/adult and talk about some of the goals the child and I set during the session.

Since attention is likely to be short, I vary the activities based on the needs of the person I am talking with during the session.

I usually start with a check-in of what has been going well, and what they feel could have gone better. Once I have been updated on their goals from the previous week, we begin our therapy activities specific for the session we are having.

I give the participant a choice about what they would like to do. I usually have some sort of game, as well as some sort of activity.

I allow the participant to choose which they would like to do first.

Once they choose, we move forward with their choice.

If their choice is a game, the first time we play I introduce the game and explain the rules that are specific to therapy.

Once we have played at a previous session, I ask them if they like the rules. I give them the option to change some of the rules, which also allows me to realize which parts of the game resonate with them.

One game I find particularly effective is Uno.

There are several ways that I utilize the game. One way to play is to assign each color an emotion. An example is:

red=anger, green=happy, blue=sad, and yellow=scared

When I play the game using these emotions, we talk about identifying an emotion each time they place a card that is one of those colors.

I encourage them to tell me about a time they felt the emotion that is assigned to that color of card.

I also like to make a special rule, where if I play a ‘special’ card (Draw 2, Wild, Reverse, Skip), I get to ask them a question of my choosing.

Another option is to use each color to notice a sense. For example:

Blue=something they see

Red=something they hear

Yellow=something they can touch

Green=something they smell. I have also switched this up with something they are looking forward to

By allowing the participants to choose rules, I help them maintain some control of the session.

We work on mindfulness, so we are working on what they see, hear, smell and touch.

By talking about what they are looking forward to, this allows us an opportunity to plan for things which could be difficult for them.

For example, if they are looking forward to fireworks on the 4th of July, we can talk about what to do if they want to set off fireworks and they are either told no, or told that they have to wait.

We can plan for ways to help them be patient and avoid conflict. This also allows for me to see their own insight into struggles they may predict having.

Social Skills and learning to de-escalate are pretty common issues shared by people I meet with at during therapy sessions.

I assist the people I am working with learn to identify tough social situations, and to practice how they want to act in them.

This assistance has been helpful in helping to identify alternative ways to behave and respond, and to act differently than they have previously behaved in those tougher situations.

These are some specific, concrete skills that we work on:

One of them is to work on De-escalating. De-escalating means helping the participants and their families learn to bring down their level of emotions that they are feeling.

Here are a couple of De-escalation Techniques that I find helpful:

1. Deep breathing: in for 4, rest for 2, out for 4, rest for 2

2. Mindfulness: find an object in the room; identify what color it is. Ask some questions about the objects the participant is looking at: ‘What do you see when you look at it’ ‘What do you smell, hear, see, touch?’

3. For some participants, I teach a sequence of skills. For example:

a. Pick a color

b. Count how many things you can see that are that color

c. Count to that number, then count backwards from that number

d. Take that many deep breaths

At all times while we are working together, I work on LISTENing-participants who have a diagnosis of attention issues frequently experience people being irritated with them.

Sometimes the participants have not been listened to as they’d like to be. Many times, participants with attention issues recognize that transitions are tough for them.

I talk with the participants I am meeting with about how transitions are going for them.

Specifically, we come up with concrete ideas for how to help with transitions. Some examples are:

1. Getting ready for school-

I ask the participant some prompting questions to help get an idea of what the issue specific to their routine is for them. Some examples are:

‘What will help you wake up?’

‘Do you set an alarm?’

‘When are you likely to lose track of time?’

‘What medicines do you take, if you do take them?’

‘When are the meds helpful, and when do you not need them?’

Once we have identified some areas that cause stress for them and their family, we problem solve ideas together. We meet together with their parent/caregiver at the end of the session to put some ideas into place.

2. Homework time

Most kids with attention issues perform better with structure and breaks. Once school gets out for the day, some parents are tempted to have their children complete their homework right away.

Many times, the parents state that they are thinking that their children will enjoy being ‘free’ from responsibilities for the rest of the evenings. Other parents have multiple other tasks to complete after the homework task is finished, which could include music activities, sports practices, dinner, baths, etc.

My suggestion: give kids a break from structured activity after school.

How long this break is can be determined by both the parents and the child, depending on the needs of the family.

Some families choose to have snack time, then free time, and to start homework after dinner. Some children are in a child care setting which encourages homework time, or where homework may be more difficult to complete.

Other families prefer to set a timer, and once the timer goes off, homework time starts. This allows the break to be set for a specific amount of time.

The timer can also be helpful in morning routines.

One family I met with many years ago had a lot of frustrations around the length of time their son was showering in the morning before school.

They had tried a few things, including prompting him about when it was time to move on to shampoo, soap, etc., but this had not been successful for them.

What did work for them was setting a timer for the shower.

Once the timer went off, the child turned the shower off.

This allowed him to determine when to transition from rinsing, to soap and shampoo, to rinsing again, to being done with his shower.

It allowed him some control, and also allowed other family members who were trying to get ready at the same time to focus on their own set of tasks to get out the door in the morning.

If the timer went off and he had not completed the tasks of soaping and shampooing, then he did not do those things that morning. This routine worked for the family and the child, as the child learned to utilize the time he had fairly quickly.

Bedtime

Bedtime can be another tough transition for those with a diagnoses of an attention issue, or those who transition less well to sleeping.

Again, structure helps. Having a set bedtime, with predictable events before bedtime, helps in this area.

For instance, some families choose to either read to or allow their children to read prior to bedtime. This calming down time helps with the transition from being awake to being asleep.

I encourage families to stop screen time prior to bedtime as well.

For my own children, who love video games, we had an end time of 8pm both during the week on school nights and on weekend nights.

Their friends knew they would have to stop playing video games at 8pm if they were at our house.

This rule lasted until they were around 11 or 12 years old, and worked for our family. For some children, they may need to have their screen time end prior to that, depending on how screens affect the child’s ability to fall asleep.

These are some specific concrete ideas that have been useful for me as a therapist working with children with a diagnosis of ADHD.

The concrete ideas are helpful in providing structure, structured breaks, and success in transitioning throughout the day.

Hope you enjoyed reading it as much as I enjoyed writing it down!