The most effective treatment includes both Specially Targeted Parenting and medication. I realize that many parents abhor the idea of medicating their children and this is fine, particularly at the preschool age. If you want to try to treat your AD/HD child without medication, however, it is critical that you employ Specially Targeted Parenting techniques. Medication, however, rarely works by itself. Remember that pills don't give skills.
The use of medication requires the involvement of a prescribing practitioner. Be certain that you feel comfortable with this health care provider (a nurse practitioner, pediatrician, family physician, child and family psychiatrist, etc.). The initial medication will most likely be either an amphetamine (Dexedrine, Dextrostat, Dexedrine Spansules, Adderall, etc.) or methylphenidate (e.g., Methylin, Ritalin, Metadate ER, Methylin ER, Ritalin SR, Concerta). Both types of medication and some others have an equal chance of helping. Therefore, the choice is somewhat arbitrary though some clinicians prefer one medication over another. Knowing that there are several medications to try, you should work closely with your clinician until you find one that works best for your child's specific physiology. You will begin with the lowest possible dose, and move up gradually until you and your child observe, feel, and see a difference.
Specially Targeted Parenting is a four-step process. The first step involves reading about AD/HD until you no longer blame yourself or your child for the condition. Get rid of the guilt! Think of AD/HD as a condition that requires correction, like discovering your child needs glasses to correct bad vision, a hearing aid to correct poor hearing, or insulin to counteract diabetes. You should prepare for the need for lifelong treatment and support for your child. In addition, since AD/HD is so genetically prevalent, you may want to identify the "genetic donor" and get the appropriate help for that parent or relative.
The second step involves being meticulous and consistent about good health habits for your child. It is essential to stress good nutrition, good sleep habits and ample exercise. AD/HD children do horribly during the day when they eat low protein, high sugar foods, when they haven't slept enough the night before, or when they don't get a regular daily dose of permitted high action motor activity. Additionally, AD/HD children do not adapt well to rapid, unscheduled, unprepared changes—particularly when their day is somewhat chaotic and doesn't follow their predictable routine. Prepare for all changes with plenty of anticipatory explanations. If it is possible to avoid changes to your child's routine, do so.
The third step is to re-read Chapter 4 (Principle #2), since this is the most critical principle for you and your AD/HD child's health and sanity. Use your "one-liner" to stay disengaged emotionally. Delay giving consequences until calm. Make sure both parents carry through on all assigned consequences. Consistently apply the behavioral management techniques you learned with Principle #2 at home and make sure they are applied in the preschool classroom. Try hard to avoid any type of physical punishment for your child's misdeeds. Require that he explain to you "why I did this and what I learned" before he is allowed leave his "time out." Practice forgiveness, patience, and praise. The number of "praise words" you use should be equal to or greater than the number of "discipline words." Remember AD/HD kids tend to have other great characteristics. They tend to be open and warm, have strong verbal skills, be very creative, spontaneous, intuitive, resilient, persistent, have good humor and energy, and have a strong long-term memory.
Principle #1 is also critical. Parenting a child with AD/HD requires a great deal of parent accommodation and must include devoting a considerable amount of attention and time. Your child's symptoms will diminish dramatically if she feels safe, secure, and predictable in her place in the world.
The fourth step is to utilize Principle #3 as effectively as possible, particularly helping your child with his social skills. Primary among this is something I call Affect Attunement. AD/HD kids are often unaware of how others perceive them, including their peers. Therefore, it is essential to keep him based in reality. Your child with AD/HD will fall behind others his age in being able to read others' moods and behaviors correctly. He will misinterpret clues and body language. You must repeatedly (plan to do this for the rest of his childhood) provide social feedback and correction. For example, you will need to have regular interchanges with your child that go something like, "Honey, when you screamed/ grabbed/blurted out just now, how did your friend feel? How did he act? By looking at how he reacted to you, what do you think he was thinking?" Help your child to learn to express his feelings even though he won't necessarily get his way after doing so. When you ask him how he feels, help him learn to respond by saying, "I feel (mad, sad, bad, glad)." Then say back to him, "Thank you for sharing your feelings with me" and follow this with a hug.
AD/HD is a serious condition with serious ramifications. Never underestimate its impact in being able to wreak havoc upon your family if left untreated. Always keep in mind, though, that your AD/HD preschooler is not at fault for her condition. Help her and your parenting partner understand it is not your child's fault that she lacks inhibition, reflection, or self-regulation. Remind yourself that your child is easily distractible and impulsive because she was born with this condition. At the same time, all of you have a responsibility to work toward correcting her symptoms with the help of her relatives, her health care providers, her teachers, and others. If all of you work hard at it, you can lessen the effects of AD/HD.
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