Expert: Norm Bishop - 7/18/2008

Question
QUESTION: My son has ADHD and my husband does not want to medicate. I have to ask him 10 times to do something, then come over and physically direct him to what I want him to do.  Today, he would not do the garbage--literally said "No!  I won't do it!".  My husband wants me to do a summer school program of 3 hours a day of work--ha!  I can't even get him to pick out a book, much less read it.  I've encouraged, taken computer/t.v. away, grounded, had him write sentences, etc. with no compliance.  How can I help him....  He is insatiably distracted.  My husband wants to blame part of it on my disorganization, which I personally don't think is too bad.  Every day, wake kids up from 9 to 9:30 then start the day picking up the house then attempting to do homework.  It is an all-day event just trying to get him to do simple chores/homework.  He has just gotten so belligerent.  What can I do to help him?

ANSWER: The answer for your son is not simple.  ADHD is a condition in which the brain of the child does not work as a "normal" brain does.  Thus, when we think of ways that would impact us, it doesn't always impact the child.  

The first step is to provide your son with as much structure as is possible.  I recommend that his day be structured with an activity that he doesn't like, followed by an activity that he does like...and use that pattern all day.  Some of the activities can be choices, that's ok.  The structure has to be consistent...like:  Wake up in the morning...help you prepare breakfast and then eat it, 30 minutes of television cartoons or video game playing...reading time, say 30 minutes...followed by 30 minutes of game time with the rest of the family...etc....the fun activities are contingent upon a legitimate effort to do the things he doesn't like. Consistency means that there are consequences...like no TV, no games, no treats.

It is much easier said than done.  You an your husband need to be a TEAM...he needs to support your efforts and use similar strategies when he is in charge and vice versa.  Again, harder done!  

I would suggest that you call your local school district, ask for the Special Education Office, find out if there is an ADHD Parent Support group within your town.  That group can become invaluable to you and your husband, as you have a very tough job ahead of you and others in the same place can be of great help!

There is some good information on the website:  http://www.ldonline.com (click parent info).  That should help some.

As far as medication goes...we have just discovered that the brain patterns of a severe ADHD person are strikingly similar to brain activity in a meth users brain, so we are looking at physical changes as being necessary.  Ritalin and its derivatives are what has been most commonly used by doctors for ADHD.  There is NO connection between using this as medication and increased risk of drug abuse in the future.  About 50% of those children who take this medicine have positive results, while it is a stimulant, it seems to regulate the brain waves to more consistency.  In addition there are some environmental factors that may be huge.  The biggest is sleep and deep sleep patterns.  Children should get 8 to 10 hours of uninterrupted sleep each night.  During sleep, at least a third of that time should be in what we call REM (rapid eye movement) deep sleep.  People who don't get enough sleep have behavior patterns like you are seeing.  Watch your son's sleeping patterns...does he get 8 to 10 hours...is he easily awakened?  Does he snore deeply?  Does he wake often at night?  Does he have trouble going to sleep?  Does he awaken still tired?  All of these would indicate problems with sleep patterns and if you see them, then have your local physician order a sleep study...it may just make a huge difference.

The other factors are less consistent, but can make a huge difference.

1.  Raw Processed Sugar...everything you find in the grocery story has processed sugar in it, well, nearly.  If you read ingredients labels it will be called glucose, fructose (anything ending in ose) or corn syrup.  It is sugar, stripped of all nutritional value, which then explodes into the blood stream at 10 times the rate of unprocessed natural forms of sugar.  Again, watch to see if your son becomes more distracted when eating processed sugar...if so, reduce the amount he eats, replace the processed sugar foods with fruit, use honey to sweeten (non-pasteurized pure honey).

2.  Processed foods...these are pre-prepared in boxes, either cooked in the microwave or mixed with water (like mac and cheese).  They have been processed to include large amounts of preservatives and sugars, they are also processed very quickly in the body, giving a person a huge rush of energy for a short period of time, followed by a crash and lack of energy.  Avoid eating processed foods...cook fresh or frozen vegetables, eat fruit in its raw form, cook your own meats, create your own casseroles for scratch, and so on.

I like to do these things in a "controlled study" strategy.  First I observe sleeping patterns, attempt to change them for a month to six weeks.  If change occurs then I continue what worked.  If change didn't occur, then I abandon those efforts.  Then I control processed sugar for the same period of time.  Positive results mean continuation of what made a change.  Then I try avoiding processed foods.  I keep a journal to write everything down.  When done with all three, then I share the information with my Physician...and if none of these work, then try a medication trial, keeping the same sort of journal.  

I rambled around a bit.  If you need specific clarification then feel free to ask.

I suggested the following:  1) Find a Parent Support group with parents of other ADHD kids, 2) Attempt to structure your and your son's life as much as is possible, 3) Create a parenting plan with your husband so that you become a consistent team, 4) Observe and evaluate your child's sleep patterns, 5) Observe and evaluate your child's raw processed sugar intake, 6) Observe and evaluate you child's processed food intake...and, if nothing else works, consider medication with your physician.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your very speedy response - wow!  I appreciate your different suggestions.  We do the no refined sugar and flour, natural ingredients and few processed foods.  He's also getting adequate sleep (feels awake in the morning -- except when it's time to do chores :)What would you suggest as far as discipline?  I noticed that you stated to take away privileges, but how far do I do this?  Do I only take away the next privilege or go beyond?  What happens when he has a privilege taken away -- what does he have to motivate himself?  When I've done this in the past, he seems to say, "Why do _____ when I'm not getting a reward."  Any additional ideas?

Answer
I would set up a system, just because that is what I do.  When my kids (4) were little, I set up a system of "duties" and tied them to allowance and other privileges.  I "paid" then 5 cents for each chore assigned and they each had 5 to 8 per day...they ranged from taking out garbage to doing dishes and other small things that they could do.  Picking up their room daily was one of them.  None of them took a long time.  Homework was one for every day.  I charged for video game playing, and TV beyond their 1 per day free TV.  I made it way more systemmatic than it needed to be, but it worked very, very well.  Of course, as they got older the rate of pay became greater, and the chores became more difficult.  I guess it worked, each has graduated from college and is living independently as productive citizens.  One of my boys has an ADHD diagnosis and he was the greatest challenge, but it worked very well for him.