HANDHOLDING

One of the simplest forms of behavior management is to hold the child’s hand when approaching a stimulating situation. Most ADHD children will run ahead of adults and manage to get into mischief or danger before they can be rescued. They resist being held by the hand but if you make it a policy and not a punishment they will adjust to it and accept it. It helps them, so why not employ it?

Here are two examples:

My four year old was accompanying me to social services one day. There was a glass elevator which carried patrons between three open mezzanine floors. If you know how hyperactives love to press buttons you can guess what drew my daughter into the elevator. She ran out ahead of me, entered the elevator and began pressing buttons before I could get the words "No, Kayla" out of my mouth. As the elevator door closed and she began ascending all by herself to the third floor we could see her bouncing hysterically inside the elevator. Kayla kept frantically pressing buttons and the elevator kept trying to respond to the erratic commands. Kayla was screaming the entire time and we could actually see her skin turning colors - red, purple, almost blue with fright. When the elevator finally came to rest on our floor we still could not retrieve her because she had jammed the door signals by pressing so many buttons at once. The maintenance man was summoned and a grateful but drained hyperactive little girl emerged from her temporary moving prison. We all felt so sorry for her. Poor little hummingbird really got herself in a fix that time. A stern lesson on handholding followed. It was actually my 15 year old son who had released his grip on her hand allowing her to run ahead. Just simply retaining her hand would have saved her that frightening and potentially dangerous experience.

When shopping for vacuum bags in a small vacuum cleaner shop I released Kayla's hand while signing a check. She immediately began to disassemble the nearest vacuum cleaner part by part. I verbally corrected her. She returned to my side, slipped her hand inside mine and reminded her absent-minded mother, "Please hold my hand, Mom, so I won't touch." She needed the physical restraint only my handholding could afford her. While she recognized she should not be touching she did not possess the impulse control not to. This event taught me a very important lesson about hyperactives. They often try very hard to behave but cannot do it without our help. Just as you provide diapers for a child who cannot yet control their toileting functions, you must provide external helps for children who cannot yet control their impulses.

Remember, hold a small child by the hand when in any situation where it will help them maintain socially acceptable behavior and keep them safe from harm or embarrassment. It's the kindest and wisest way to restrain a child. Do not give in to a child when they pull away. Insist they allow you to hold their hand. Some children hate the restriction of handholding, but with persistent training they tolerate it well. It is worth the effort. Fits of temper or collapsing in tow will get the child a ride in a stroller until they can cooperate.

STROLLERS

Using a small portable umbrella stroller is a very good way to manage an active and impulsive child in a public situation. The seating position in an umbrella stroller tends to keep an ADHD child more comfortable. Sitting flexed at the hips is best for counteracting the child's alerting and standing up reflexes. Umbrella strollers are also very maneuverable and take up less space. I use strollers in any situation where I know handholding alone will not be enough. Even visiting with friends at their house I know that I will tire of monitoring my son's constant exploring. I give him some time to check out his surroundings - holding his hand at all times to prevent him from destroying anything. Then I settle him into his stroller and offer him a variety of activities that I have brought with me. Books, puzzles, his favorite bag of "tools". I keep him right next to me in his stroller as I chat and visit. When he gets restless I offer him something to eat or drink, allow him to spend some time on my lap, or perhaps let someone else offer him a lap for a time. Under no circumstances do I let him down and completely free when I'm in someone else's home because I know disaster will follow. It isn't likely I would be invited to return after he pulled the drapes off the wall or stomped on the family cat! I also use strollers for outdoor situations (such as company picnics or family reunions) where my son needs a portable outdoor spot to retreat to after exhausting himself in the playground. ADHD children do not know how to rest when they are tired. In fact, many times their activity level increases as they tire. This usually ends in a meltdown unless you intervene. So when my son has had a romp, I place him in the stroller so that I can visit peacefully while he is resting nearby me. Usually an offer of some juice in his sipper cup will entice him to retire for a few minutes. This type of management is not necessary for a calmer, more self controlled three year old, but for ADHD children it's vital for their safety, social acceptance, and your sanity. Don't allow your child to be disruptive in social settings so that he receives the disdain of others. Use every opportunity to educate people who try to undermine your management techniques. You know what would happen if you turned your child loose. Most people don't. Explain calmly that your child needs some management in this setting.

Take advantage of your child's small size and use strollers as long as possible. It's a safe and effective way to keep ADHD children restrained and yet included in social events. It prevents the tug-of-war and constant chasing that might otherwise be the case if the child is released on foot in such settings. Don't cave in to pressure from people who say things like, "Oh, let him play. He can't hurt anything here," and such platitudes. You know your child's limits and needs. Address them with confidence. If your child is too large for a small umbrella stroller, larger sized umbrella strollers can be purchased. Keep a stroller in the trunk of your car so you are never without it when you need it. Be sure it has a seatbelt that works properly.

HIGHCHAIRS

Don't overlook this excellent tool for managing hyperactive children. Most hyperactive children cannot sit at the table and eat a meal until they are much older than the average child- usually at about age five. The high chair is a perfect way to help them remain seated so that everyone can enjoy mealtime. It also makes a great "work" station for the busy toddler. We learned with our ADHD children that in order to be free to use their small muscles, the larger muscles must be disengaged. If we let the children play without intervening, they never were able to sit down and play quietly. They were only able to run amuck until they wore out entirely. By placing them in highchairs and requiring them to remain seated for 20-30 minutes, they were able to perform small muscle tasks with relative ease. Since their attention spans were so short we had a variety of activities to offer them while they were seated in the highchair. We handed them one activity at a time and required them to put it back in its container before we handed them another one. We had puzzles, beads to string, large crayons and coloring books, sorting games, playdough, and many other activities in our arsenal. High chair “work” could be offered at different times throughout the day. Putting them in their highchair in the kitchen while I fixed dinner was a perfect way to get the job done and give them some profitable "down time" as well. Placing them in a high chair and leaving them alone will not work. They still need parental presence and attention, but at least you don't have to run all over the house after them to provide it. If they spend time in their "work stations" they will also advance in their small motor skills much earlier than if left to their own devices.

If your child is ADHD don't pack up the highchair so soon. Ours used theirs until they were about five years old. We called it their "work chair" when they got old enough to be concerned about "being big". It also came in very handy when guests brought toddlers to our house! My sister had no trouble keeping average kids busy in high chairs for hours on end since she was always prepared for my children. When neighborhood kids came to her house they would beg to play in her "work chair". She had a shelf full of interesting activities labeled "Keeping Little Fingers Busy".

CARSEATS

Carseats are ideal restraining devices. They are comfortable, safe for the child, and portable. I brought one to church with us when my daughter was small. We'd set it in the pew, buckle her in, and enjoy the service while she looked quietly at books. The alternative was wrestling with her the entire time and leaving in a snit, vowing to never return to church until she was off to college. She sat in a carseat in motel rooms, when visiting homes that were not childproofed, and in any other setting where we needed some peace and she needed some restraint. She used her "quiet chair" most at home. We had not a moment of relief if she was on the move. Her random exploration was incessant and intense until age five. In order to have a meal or just some family time without continuous disruption, she had to be placed in her quiet chair. Her favorite activity in her chair was to listen to tapes on her own kiddie taperecorder. She loved the total control it afforded her. She was put out of commission as far as exploration, but she was truly in the "driver's seat" with her tape recorder. And there is nothing so valuable to an ADHD child as control! She could turn it on and off by herself. She could choose the tapes. She could adjust the volume-within limits. She usually chose to listen to the exact same tape over and over again for many weeks before changing to another one. Sitting in her carseat, listening to her tape, and sucking her pacifier was her best fix. She often fell asleep and woke up refreshed and renewed - and so did we! She actually began to ask for her quiet chair when she sensed herself spiraling out of control. She would tell me, "Mommy. I'm feeling wild." "Wild" was a term she coined for expressing her sense of feeling out of control. When she learned to identify this feeling I could ask her, "Honey, do you need some time in your chair? Are you feeling wild?" before she got into trouble and thus we were able to avert correction and exhaustion. A friend of mine taught her ADHD son to come to her when he needed her to "help you calm down". It worked. When he felt out of control he would come and tell her he needed her to "help me calm down, Mom." ADHD children usually need some help calming themselves just like they need help restraining their impulses. Find whatever works well to calm your child. At home our son would need his pacifier, blanket, and a Pooh video for his most calming scenario. In public he had to settle for the pacifier and a lap.

Buy several used carseats and station them where you need them most. Drop one off at Grandma's house. We have one by our bed so that when our family goes to bed but our son is still exploring we can plop him in his carseat next to us. He objects momentarily of course, but then usually settles in to watch TV with us or peruse his pile of picture books until he too finally falls asleep. Then we tuck him into his own bed complete with his blanket, pacifier, and stuffed Pooh. I had a friend with twin toddlers who could not get them to sleep at night because they kept interacting. I shared the carseat idea and it worked beautifully for her. At bedtime she bathed them, put them in their sleepers, buckled them into their carseats, put on a lullabye tape, and handed them their books. They could see each other but not interact physically. Before long they would drift peacefully off to sleep. She and her husband got some badly needed time alone before they tucked their darling sleeping twins into bed for the night and retired at a decent hour. Use the carseat, but use it wisely. Never make it a punishment, just a policy such as "It's time to look at books in your quiet chair now." Never leave children in carseats unattended or with nothing to do. Never leave them in carseats too long. Twenty to thirty minutes is the maximum, unless of course they fall asleep and nap in the carseat.

THE TOWER

At age three our daughter could not be confined by the usual physical boundaries. She was continuously escaping out our front door and was still exploring at random nonstop. The one thing I noticed was that if she was perched upon something she seemed to be able to respect that type of boundary. If I set her on the couch and said, "Stay on the couch and read your books, Kayla," she would catch herself when she began to get down. The height seemed to give her enough pause to check her impulse. I purchased a beautifully handcrafted wooden "tower". It was like a free standing treehouse which we placed in a corner of our livingroom. It was basically a cube about five by five by five. The top story had a two- inch thick vinyl covered pad. That platform formed a roof for the play area underneath it. There was a little ladder to climb up to the top and a door to the bottom section. The entire structure was open, rounded, smooth, safe. We put a tiny rocking chair, doll bed, toys, etc. on the bottom section and on the top we placed Kayla's tape recorder and a box of tapes as well as her favorite books. As Kayla gained a little more control of herself, the carseat was gradually replaced by time in "the tower" she called it. She could enjoy company from her little loft when we had visitors and yet remain safely out of the midst of things. If she was allowed to roam freely when company came she inevitably began her stretching and tumbling routines due to the excitement. Her stretching was a spinal stretch which she performed compulsively and repeatedly in the middle of the livingroom floor, laying on her back and bringing her legs up over her head. If she had a dress on this exposed her underpants which was not the ideal behavior in front of guests. She would also cartwheel compulsively by that age which often ended in her cartwheeling into the guests. We made every effort to curtail this activity, but unless we became very harsh with her, it would only stop momentarily and then start up again. Since we understood that she felt the need to stretch when she became excited we hated to punish her for it. During the normal course of the day we would instruct her to go outside and swing or do her stretching in her room, but when company came that amounted to punishment to her to be excluded. So the tower worked perfectly. She played happily on the top bunk and when she had the impulse to get down I could correct her gently to get back up before she hit the bottom rung of her ladder. She developed a strong affection for her tower. It was a safe and peaceful place to be where she could still feel included, yet in control of herself. I could prepare dinner with her in her tower and we could chat or sing with each other as I worked. The family could settle into reading or conversation in the livingroom without her continuous interrupting. I have photos of Kayla in her tower with headphones on listening to tapes, her pacifier in her mouth, and her favorite dolly in her arms, a rare look of calm on her face. It was very difficult for her to decide to dismantle the tower when she outgrew the need for it. When she was six we suggested it was time to put it away. Understanding its significance to her we allowed her to make the final decision. After several days she reluctantly agreed that she didn't need it anymore so we dismantled it and stored it. When we brought it out again for her younger brother she was still possessive of it! Unfortunately, the tower did not work well with our FAE son. He would climb it and jump recklessly off of the top bunk. Height was only an invitation to jump for him, whereas it had formed a physical barrier for our daughter. This is a good example of how individual each child's needs are.

If you have noted that height forms a natural physical barrier for your child, perhaps you can purchase or construct some sort of tower for your child at a safe height. Remember, hummingbirds sometimes need to perch!

SWINGING

A favorite activity for most young children is swinging. Since ADHD children need more motion than the average child it is especially satisfying for them to swing. We hung baby swings in the doorways of our home in different locations . The swings could be taken down or moved from place to place in the house so that the child was always supervised while swinging. Whenever we needed a break from the exhausting work of keeping an ADHD toddler out of trouble, we would plop them in their swing. Again, this was never punitive, but merely an optional activity for them. Playing with children in a swing is very rewarding for both parent and child. It's face to face and it's rythmic. We often sang to the children or put music tapes on while they were swinging merrily in the doorway. Sometimes they used their swings as play stations . We hung various toys on their swings so they could grab them and play as they sat suspended, effectively restrained from their ceaseless wanderings. Swinging is also very calming to the central nervous system. It is similar to rocking which most humans find comforting and calming. While your child is swinging, the vestibular system is being stimulated which enhances development of balance and coordination. Be sensitive to your child's tolerance for swinging. When he's weary of it be quick to let him down so that the child does not develop an unpleasant association with the swing.

This is true of any form of restraint mentioned here. If you allow the child to become uncomfortably restless before releasing him, you will cause the child to feel anxious about the various stations you have developed for him. This is not to be confused with insisting that the child submit to the activity initially. That is essential. After the child has spent time at the activity, the need for release or change must be promptly recognized and attended to.

These techniques are designed to manage children, not make them miserable while a caretaker is freed from duty. Balancing the needs of the child and the caretaker is a skill that is most important to acquire. Raising a child with ADHD will test most parental patience and endurance to the limits. This should press parents to become creative. It may even prompt them to seek household help. It might compel them to appeal to extended family or friends for support and respite care. But it must never cause a parent to blame a child, neglect a child, or detach emotionally from a child. If you find this happening to you, please get some professional counseling. There are qualified people who can help you meet the high demands of raising a child with ADHD. A good place to start looking for help is your local chapter of C.H.A.D.D. - a valuable support group for people dealing with all aspects of ADHD.

On a sympathetic note to parents, I can understand only too well the exhaustion and weariness that can overcome parents of children with this condition. I suffered a complete nervous breakdown when my daughter was four years old and at the peak of her difficult behaviors. I believe there were other factors that pushed me over the coping edge, but my state of mental and physical exhaustion from caring for her was a large one. I can honestly say that I hadn't had an uninterrupted thought for four years. I had not been able to read one book during that time. I was numb with grief, frustration, disappointment, and anger at my situation. Of course, it wasn't her fault that she had boundless energy and I didn't, that her mind worked at warpspeed and mine didn't. It wasn't her fault that she had a microscopic attention span and no impulse control. It wasn't her fault that she needed me every minute of every day just to keep herself connected to planet earth. Who knows what to blame for those things? Her drug addicted birth mother? Her genetics? Early bonding factors? I drove myself literally crazy trying to figure out the cause, when I needed to simply address the symptoms. After I crashed and burned I began to accept Kayla the way she was. I began to become open to parenting her differently. I became willing to become the kind of parent she needed rather than the kind of parent I thought I should be. I began to see my little hummingbird in all her beauty and wonder and let the mysteries about her remain mysteries. I started to study her. Other essential helps came my way.

OCCUPATIONAL THERAPY

Kayla was finally accepted into an occupational therapy home program. Our therapist visited us in our home once a week. She taught me all about Kayla's needs. She explained the reasons for many of her strange behaviors. I can't tell you how much this helped me cope. It was miraculous. Kayla began to improve in many ways. She looked forward to her therapists visit each week. She sensed that this person understood her in ways that others did not. Each week we were given a batch of fun activities to do as "homework". All of these activities addressed a specific therapeutic need in Kayla and we watched joyfully as she gained new skills and strengthened weaker ones. I strongly recommend that occupational therapy be accessed as soon as possible for ADHD children. They usually have sensory integration dysfunction and underdeveloped areas that can be painlessly improved with this approach. It is just play for the child and a wonderful support to the parents.

Initiate occupational therapy as soon as possible for your child. Check out local programs for funding if your insurance does not cover it. If you live in California, get information about the California-Hawaii Elks Program. They offer excellent in home occupational and physical therapy at no cost.

RESPITE CARE

Another big help came during my collapse. My sister began taking Kayla home with her one day a week so I could rest. It gave me a chance to catch my breath and it gave Kayla another person that could understand and absorb her tremendous energy. Another curious advantage was that someone close to me finally understood the daily challenge I faced in parenting an ADHD daughter. Her behaviors were never that difficult on a short- term basis. People I tried to confide in could not understand my struggle. My child was so beautiful, so bright, so charming. How could she be so difficult to parent? This was devastating to my confidence. I blamed myself and I felt guilty. This isolated me from other parents. Their children played happily at their feet with books while my toddler moved the furniture around the room. I found it unbearable to cope with the stress of not being understood by others. My collapse forced my sister to spend sustained time with Kayla. She would then call me exhausted and say, "Gee, now I think I know what you mean." It was a healing balm to my battered parental ego.

I strongly advise parents of ADHD children to find someone capable and loving that will devote some time to their children. All parents need relief at times, but parents of ADHD children need it more. All parents need understanding and support, but parents of ADHD children need it more. Cultivate relationships with positive, supportive people - not critical and judgmental ones. My daughter still has a special relationship with her aunt at age 12 and this has been a continued source of strength and help to me. It has also been very rewarding for my sister.

THE ACTIVITY BOX

As Kayla grew older she became more able to attend to small tasks for longer periods of time. Five minutes rather than five seconds. Yet she could not seem to direct herself from one fruitful activity to another. She would come to me and say, "Mom, I'm bored." As a child I always had more ideas cooking than I had time to act on them. I can rarely remember a bored moment. My imagination was very active whereas Kayla seemed to have no imaginative play. Her play consisted of tasks or copying tasks. We came up with the Activity Box. It was an index card box. On each card was an acceptable activity that Kayla could engage in. When she came to me every few minutes asking what to do, I would so often draw a blank. With the box I could say, "Okay. Let's pick a card from the box." This was a wonderful and exciting game to her. Never mind that she did the tasks over and over from day to day. I would think up new ones and add them in now and then. A card might say, "Kayla can wash her doll clothes in the sink and hang them up to dry outside." Of course, I had the option of switching cards discreetly if the weather did not permit doll laundry that day. I could substitute "Kayla can spray and wipe the kitchen counters off with paper towels" or "Kayla can feed the dog a biscuit" or "Kayla can put stickers in her sticker book". I could give her busy or calming activities to suit her need at the time. "Kayla can call her friend Ashley on the phone and talk for 10 minutes."

Each task was short, safe, and satisfying for her. I had control in a positive way over what she was doing. Directing her was much easier than correcting her after she had started something inappropriate or unsafe.

There are other helps that we discovered over the years. You will probably discover many of your own. I hope these few will work for you, will inspire you and encourage you in your efforts to effectively and lovingly parent your children. You will have no other challenge so important, so taxing, or so rewarding. If you are not currently parenting, perhaps you will be motivated to help some parent who is struggling to raise a challenging child. With these practical helps you could keep a child happily and safely engaged in positive play long enough for a tired parent to catch a nap or get to a doctor’s appointment or maybe even read this article!