Children with ADHD: Symptoms vs. Misbehaviors
It is a question every parent asks: How do I know the difference between ADHD symptoms and simple misbehaviors?
It is confusing. Suppose you walk into the living room to find your child bouncing on the sofa or running through the house like an out of control rocket. Is this hyperactivity, combined with impulsiveness? Is this simply a child misbehaving? If you punish your child for jumping on the sofa, are you punishing him for having ADHD? Or, if you don't punish him are you fostering a belief that he can use ADHD as an excuse for misbehaving?
In simple terms, it doesn't matter. Inappropriate behavior needs to have consequences. Children with ADHD need to learn, just as children without ADHD do, that jumping on the sofa is wrong and is unacceptable (unless, of course, in your house jumping on the sofa is okay.) They need to learn to control the impulse to jump and find other ways to manage their hyperactivity, like going outside to play, putting on music and dancing or jumping up and down on the floor, not the couch.
But, as parents of children with ADHD, we know that nothing about ADHD is simple. There is no one answer and since each child with ADHD is different, there is no right or wrong answer. Dr. Kenny Handelman, in a blog post, "Is it ADHD or a Behavior Problem," says, "So the short answer is whenever there is a question is this behavior? Or is this ADHD? The answer is it's both." Dr. Handelman suggests looking at each situation as a combination of behavior and ADHD, for example, if a child doesn't come when called for dinner, what symptoms of ADHD may have caused your child to ignore you? Was it the difficulty in transitioning from one task to another? Was it hyperfocus; he was so intent on what he was doing that he had a hard time breaking away or didn't realize that 15 minutes had gone by since you called him? Was it distraction; he was coming when you called but became distracted along the way?
As you can see, there are two forces coming together. There is the underlying symptom of ADHD, the difficulty transitioning, the hyperfocus or the distraction and there is the behavior that resulted from the ADHD. When you use ADHD as an excuse, you accept that because of the ADHD, your son could not control his behavior. You believe you need to accept his behavior because of the ADHD. When you accept ADHD as an explanation, you use behavioral strategies and set rewards and consequences for behaviors, thereby giving your child responsibility for his actions.
To help a child transition from one activity or task to another, we have suggested in the past that parents use schedules or periodic warnings. For example, using the above example, a parent lets the child know that he has 15 minutes until dinner, then reminds him again at 10 minutes and 5 minutes. This gives the child time to adjust to the next task or activity and gives him time to finish what he is doing first. By using this type of approach, a parent is acknowledging the symptoms of ADHD that are contributing to the behavior but at the same time teaching a child how to compensate for these symptoms and still follow the rules of the house.
So, when parents wonder whether any behavior may be a result of ADHD or is simply misbehavior, parents can use two steps:
1) Identify the underlying symptom of ADHD that may be causing the behavior. Keeping a daily log can help you see if there are patterns of when ADHD symptoms are most troublesome. For example, if your child takes medication, do you see ADHD symptoms interfering with behavior as the medication begins wearing off? Do you see a higher level of ADHD symptoms just before dinner, when your child is hungry or shortly before bedtime when your child is tired? Keeping track of symptoms helps you discuss what is going on with your child's doctor and work on a more effective treatment plan.
2) Set up a behavior modification program, with rewards and consequences, to help teach your child more appropriate behaviors. For example, in the example of not coming to dinner when called, a parent can give warnings at 15, 10 and 5 minutes before dinner. You can give your child a reward of extra time on the computer, watching a show he enjoys or some small reward if he shows up at the dinner table, on time. You can institute consequences, "You will not be able to watch your favorite show tonight because even though I gave you warnings, you still did not come down for dinner."
By using these methods, you accept ADHD symptoms as a cause of behaviors but instead of using them as an excuse, you use them as an explanation and teach your child self-management to help him cope with symptoms, even when you are not around.
You might also be interested in:
"Is it ADHD or a Behavior Problem?" 2006, Dr. Kenny Handelman, ADD/ADHD Blog
"Tips for Helping Your Child with Transitions," 2009, May 27, Merely Me, ADHDCentral.com