Mind The Gap – Dealing with Transitions in Education

Education

Recently, I was asked to give a ten minute talk on transitions in education, and their impact on students with ADHD. Specifically, I was asked to address the transition from Primary school to high school, and from school to the tertiary education system. Both are huge topics. I promised to write about it here for those who weren’t able to attend. Here’s what I said in 10 minutes:

The first thing to remember is that any transition is challenging for anybody with ADHD. For example walking into the family home after a day at the office, awake to asleep, asleep to awake and out the door by  a certain time. These situations require re-focusing strategies and are full of  distractions.

The bigger the transition, the bigger the challenge, the wider the gap. For example, having your first baby, changing jobs, moving house – these require re-focusing AND new skillsets. Not to mention the emotions that come into play and complicate matters considerably.

In the education arena there are challenging transitions each day – the transition from one activity to the next in the classroom – from the playground to the classroom – from one classroom and teacher to the next. Then there are the big transitions mentioned above – primary to high school, and school to uni, college or TAFE. How can you help you child to negotiate these?

  1. Teach about your child first and ADHD second. Do not allow ADHD to define them. And remember that everybody’s ADHD is unique, depending on their co-existing condition, personality, etc. Help you child find and focus on his or her strengths –   they could take the VIA Strengths & Virtues quiz at:  www.authentichappiness.org
  2. Help your child learn how he or she processes information, as opposed to pigeon-holing them into a particular learning style. Processing styles are situational, so what works in the classroom need not necessarily be effective at home. Try everything when you are studying – fidget – talk – sing – listen – write.
  3. Teach you child to Pause and Plan – Russell Barkley’s work has shown that people with ADHD have impairments in the Executive Functions of their brains. ADHD is not about not Knowing – it’s about not doing what you know you should do at that point of performance. The ability to pause will help to create better choices for them.
  4. Take the load off Working Memory. Make time and plans visible. Develop routines and practise them until they are automatic.
  5. Work the system – if fidgeting helps you, find a way to fidget discreetly in the classroom. If planning an essay stops you in your tracks, allow the essay to flow freely – and write the plan afterwards.

Moving to High School:

  1. Don’t expect the worst. Many students thrive
  2. Get the timetable early if possible. Visit the school alone with your child and rehearse. Find their classrooms,  locker, the bathrooms and cafeteria. Rehearse any public transport together – and then have your child rehearse it alone.
  3. If necessary, get your child to wear the new uniform before school starts. Some children are very sensitive to fabrics against their skin
  4. Talk to the teachers & ask them to talk to you. Be a team member – not an adversary. Don’t assume they will receive any info about your child if you don’t give it to them.
  5. Establish homework routine immediately and only allow electronics as a reward.

Moving to Uni or TAFE

  1. This coincides with a Transition to adult medical services. When you are less involved with your child’s treatment, create a village of adults your child trusts.
  2. Help your child to negotiate the red tape that accompanies the start of the academic year and set up their student account
  3. Register as a student with a disability. Ensure that they are able to provide the counsellors with  the best info possible – Do encourage your child to speak to lecturers and tutors.
  4. Take advantage of the flexible learning opportunities in the tertiary system. Lectures are often recorded, enabling students to listen to them later in a distraction-free environment.
  5. Expect overwhelm and do not give up when it hits.

Internet Addiction and ADHD

internet

Although not formally documented in the DSM-5 as a medical condition, Internet Addiction and Problematic Internet Use (PIU) are the focus of several research papers in Europe and Asia. They find up to 20% of children and adolescents display problematic internet use, with up to 8% displaying signs of an addiction. Warning signs include:

  • Preoccupation with internet use. An irresistible urge to use it, and using it for longer than intended.
  • Significant consequences in social life, studies or employment due to excessive internet use.

A recent review examined possible links between PIU and ADHD (Fiona Finlay and Carrie Furnell, ADHD in Practice, Spring 2014). Internet Addiction is identified as a common co-morbidity (co-existing condition) with ADHD, along with depression, anxiety, learning difficulties and sleep disorders and others. People with internet addiction are described as having poor control over time, value of time, and time efficiency. Given that these characteristics are shared by people with ADHD, it is no surprise that internet addiction can be an ADHD-related challenge. Adding another ADHD symptom, impulsivity, into the mix, makes this problem even harder to control.

There is no recommended treatment for Internet Addiction and PIU, as it is an emerging condition. Most research focuses on treating the co-existing conditions (such as ADHD) in order to control the addiction. For example, the use of stimulant medication in children with ADHD who played video games showed a reduction in internet use and ADHD symptoms. Cognitive Behavioural Therapy (CBT) and Family Therapy have also shown some benefits.

Coaching is also a valuable tool for controlling excessive use of the internet, and it is something that I work on with most clients. Together we set internet usage goals, and put strategies in place to achieve them. Coaching comes with accountability, which makes changing habits a whole lot easier.
Here are some tips for controlling internet usage:

Children:

  • Limit the use of ‘screens’. I know that this can be tricky when computers are required for homework, but there is software to help you specify websites that can be used during homework time.
  • Use computer games and social media sites as a reward for completed homework / chores. It is a very powerful currency.
  • If students need breaks, they should be encouraged to keep a list of non-electronic activities, such a jumping on the trampoline, taking the dog for a walk, or reading.
  • Remove electronic devices at bedtime, and return them in the morning when your child is ready for school. Midnight socialising via Facebook, Skype etc, is more common than you would imagine.

Adults:

  • Use the internet as a reward for boring or challenging tasks. The prospect of a fun-filled, high stimulus activity will make it a whole lot easier to complete the dreaded housework, assignment, report, or tax return. By contrast, if you opt for the high stimulus activity first, it will make the challenging task even harder to contemplate.
  • Allocate internet times and stick to them. Build in some accountability here. If necessary, use software to limit your computer’s access to certain sites.
  • Set a timer with an alarm when you are having fun on the internet. This will prevent 3am bedtimes, and probably save your job.
  • Programme pauses. Strategies to remind you why you should stick to your internet time allocation. For example, place your alarm on the other side of the room, which will make it harder to ignore. Then, stick a post-it note on the alarm to remind you why you should honour your agreed bedtime.

If you are concerned about your internet usage, or that of your child, discuss it with your specialist. Find support with this important issue in the form of an ADHD coach, a psychologist, or a friend.

 

Try Something New For 30…….Oh Look DropBear

koala
Australia’s Famous DropBear

Recently, at a seminar, we were shown an inspiring post on TED talks. Don’t look now, but the link can be found at the end of this post. Matt Cutts challenged me, and others, to try something new for 30 days. Along with everyone else in the audience, I was immediately moved to accept his bold challenge. I resolved to give up sugar for 30 days – and to write a blog about this amazing concept (yes TED talks have that effect on me).
Matt’s challenge got me thinking. Wouldn’t it be a wonderful way for people with ADHD to change behaviours? Forget that 14 days maketh a habit stuff – never worked for anyone with ADHD that I know. 30 days seems a lot more ADHD-friendly. I immediately stepped into ADHD-Coach mode, and the following barriers to an ADHD 30 day challenge emerged:

  • In the heat of the moment, the Impulsivity of ADHD could accept ANY challenge (“Yes sure I can fly to Africa tomorrow and volunteer for 30 days. My wife is very understanding”).
  • The Inattention of ADHD could miss some finer details of the challenge. (“Cycling coast to coast in 30 days is HOW many kilometres?”)
  • The Working Memory challenges of ADHD could actually result in someone committing to a 30 day challenge – and then forgetting about it for 2 days – or 30 days for that matter.
  • The Distractibility of ADHD could make it hard to focus on a 30 day challenge (“Look DropBear”)
  • Boredom could set in and the challenge could fail to maintain its sparkle for 30 days.

So, here is my ADHD-tailored 30 day challenge. (I’m sure Matt Cutts would approve):

  • Choose something small and achievable – and write it down. Draw up a calendar / find an app that you can mark off each day.
  • Find your motivation (choose something that will make you feel good) – and make your motivation visible. Stick a picture somewhere – and add to it if you need to.
  • Set up a daily reminder. There is no guarantee that you will remember your 30 day challenge without a prompt.
  • Plan mini-celebrations – 30 days is a long time to stay motivated on a single challenge, so remember to celebrate at regular intervals, e.g. every 5 days.
  • Work with a buddy – find someone to do the challenge with you.
  • Ask for support – its always so much easier.
  • ‘Sparkelise’ your challenge when it becomes boring – people with ADHD are masters of invention. If your challenge is becoming boring, you will know how to spice it up.
  • Celebrate BIG TIME when its over – let the world know.

You can join me on my 30 day challenge on Facebook or Twitter, and we can swop notes. The accountability will make your own 30 day challenge a lot easier.

Matt’s inspiring video is here

Credential Proves My Commitment to ADHD

I am thrilled and extremely proud to say that I am the first coach in Australasia to be awarded a credential with the Professional Association of ADHD Coaches (PAAC). I can now call myself a Professional Certified ADHD Coach (PCAC).

This is in addition to the credential that I already hold with the International Coach Federation (ICF), where I have the designation of Professional Certified Coach (PCC).

Coaching is not a regulated industry, which means that anybody can call himself or herself a coach. Please be aware of that if you are looking to hire a coach for assistance with ADHD – or any aspect of your life or career. I am committed to developing ADHD coaching in Australasia with qualified, credentialled coaches, and am currently mentoring 3 coaches on the way to their own credentials. Hopefully they will be the first of many to come.

Details of my PAAC credential can be found here

My ICF credential is listed here

Kids on Speed? My thoughts

Many people have asked me over the past 10 days for my views on the Australian Broacasting Corporation’s (ABC’s) recent 3-part series about ADHD. Entitled “Kids on Speed?”, the show followed the journeys of 5 children from 4 families who had been diagnosed with ADHD. Three professionals – a psychologist, a paediatrician, and an educator worked with the children and their families over a 9 week period.

First let me say that I find no justification for the title of this show. It was stigmatising, sensationalising, and inaccurate. The SANE StigmaWatch would have taken the ABC to task if they had done something similar with schizophrenia or depression. The title, and equally stigmatizing trailer contents caused outrage amongst people with ADHD. Two consumer groups have complained that they contravened the ABC’s code of conduct, and the trailer was modified before the show as a result. It will be interesting to see what the further outcome of those complaints will be. It has come to light that the producers of the show were advised by ADHD clinicians not to use that title a year ago, but persisted with their attention-grabbing tactics.

I wish to acknowledge Michael Kohn, the paediatrican in the series. It is fair to say that Dr Kohn was the only ADHD expert involved, and the show could have been very different without his solid, authoritative, evidence-based commentary and intervention. His comments were informative, helpful, and I would have liked to hear more of him across the series. It was wonderful to see best practice medical treatment up close, and the families clearly benefited from Dr Kohn’s input. I also wish to acknowledge the fact that the behaviour management programmes put in place were of obvious benefit to all members of the family. Also, families affected with ADHD viewing the series felt that they were able to identify with much of what was going on for the series families. There was also some advantage to the testing and tutoring provided by the educational expert.

With respect however, I don’t believe that this programme showcased best practice in the education realm. While much time was spent teaching parents to modify their parenting, with good results, there was no attempt shown to educate the teachers of the children in the show. Given that children spend half of their waking hours at school, and find the school environment exceptionally challenging (Corey wasn’t even attending school), this was a glaring omission. The heartbreaking footage of Seth’s teacher stopping the entire class to stare at him while he fidgeted was aired in the first and last episode. If the teacher had been given some training on how to teach children with ADHD, she would have been empowered to show us a different scenario in episode 3, and Seth could have been a lot happier at school.

I was disappointed that the programme did not include any children with ADHD Predominantly Inattentive subtype. The children in the show had extremely challenging behavioural difficulties, which are not caused by ADHD, but this was not made clear. In a way, this programme resurrected the old stereotype of ADHD as “kids out of control”, that we worked so hard to change in the media 10 years ago. As a result, there will be more people with ADHD,  who will be overlooked and go without treatment until things get really serious for them, simply because they are not hyperactive.

Finally, I am concerned about the exposure of vulnerable families in this “hybrid of observational documentary, factual intervention and social experiment”. There are strict guidelines around the ethics of research, and the professionals (who are all researchers) treated their participants with the utmost respect. However, there were some inappropriate choices by the editing staff, which exposed very brave families more than was necessary.

If I could have 3 wishes –

  1. I would like the ABC to choose a team of ADHD experts when next they choose to feature  ADHD in a series.
  2. I would like them to listen to clinicians and consumer groups when they are notified of potentially stigmatising content.
  3. I would like them to tell the world that ADHD comes in all shapes and sizes, and that it makes the world a better place.

 

Your Most Important New Year’s Resolution Ever

bekind

Six days into 2014, and chances are you are working very hard at keeping your New Year’s resolutions. So how are they working for you? I’m guessing that some people are going just fine – no sugar / caffeine / alcohol has passed your lips – while others are already doing the self beat-up because your resolutions have unravelled.  Let’s pause for a minute and take a look at why this whole process is so difficult.

New Year’s resolutions are generally about changing habits, and habits are hard to change. Throw ADHD into the mix, and the process becomes a whole lot harder. Forget that well trotted out phrase about it taking 21 days to establish a new habit, the ADHD version can take a lot longer.  First, you need to remember the resolutions that you have made. That might sound silly to some, but believe me, someone with ADHD could be well into their day before they remember that they resolved to exercise that morning (and every morning after that). There is a whole layer of reminder systems that people without ADHD never need to worry about.

Next, there is the boredom factor. Sticking to a New Year’s resolution may become even more challenging for people with ADHD if there is no stimulation attached. For example, nice long walks could effectively improve fitness for some, but they could be torturously boring for people with ADHD, who may need to engage a kick-ass personal trainer, or sign up for an extreme sport. Finding the right strategy is vital when you have ADHD.

Finally, there is the ADHD need for rewards. The ADHD brain has to work much harder to get certain things done – particularly if they are difficult or boring. As a result, there needs to be more motivation. Have a specific, immediate reward planned for when your brain asks: “What’s in it for me?”

Does this all sound like a “Get out of Gaol Free” card? Well it’s not. This merely provides an explanation – supplies some of the reasons why changing habits can be so hard for people with ADHD. I witness people with ADHD making massive changes in their lives all the time, as an ADHD coach. Because I know how challenging the process can be, I am able to guide them through their challenges, and to CELEBRATE their successes with them.

And that’s where self-compassion comes in. People with ADHD don’t forgive themselves for their mistakes, and often spend a lot of time brooding about them. This prevents them from focusing on their goals.

I have a suggestion for next time your New Year’s resolutions hit a bump in the road. Instead of serving yourself a supersized portion of self-criticism, take it off the menu. Replace it with SELF-COMPASSION, and sample it every day, until you get to like the taste. It will help you to achieve your goals. So, practising self-compassion could be the most important New Year’s Resolution you ever make.

Proof that ADHD is under-diagnosed

A common bit of hysteria that regularly screams from Australian newspapers is that ADHD is over-diagnosed and over-medicated. The media would have you believe that we are popping stimulant medications at alarming rates. Because Western Australia is a leading state in the diagnosis and treatment of ADHD, our rates of prescription for ADHD medications have often been higher than other Australian states. This caused a government department to ESTIMATE in 2002 that 4.2% of WA children were taking stimulant medication. Such a figure would have been quite in line with the international prevalence rate of ADHD, which is 4-7% for children, and 4% for adults. However, it was deemed inappropriate, and led to a parliamentary inquiry into the diagnosis and treatment of ADHD in the state.

One outcome of that inquiry was the annual auditing of ADHD prescription rates in Western Australia. Yes – we count every stimulant pill we take. In fact, before anyone can be given a prescription for stimulant medication, they have to sign a consent from – granting the government permission to collect this data.

As a result of this careful counting we now know that the highest prescription rate of ADHD medication in Western Australian children was 1.56% (in 2004). The grossly inaccurate estimate of 4.2% assumed that 82% of medications were being prescribed for children. However, the audits have consistently shown that around 50% of ADHD medications are prescribed for children, and 50% for adults. Sadly, despite these figures being available on government websites, the media have chosen not to rectify the public misconception that ADHD is over-diagnosed and over-medicated. They have even allowed some to claim that the rates have been reduced from 4.2%.

The Western Australian Health Department has today released the report detailing stimulant prescription rates in 2012. It informs us that 1.24% of children are prescribed stimulant medication, and 0.53% of adults. If I could perform a miracle, I would have the media inform the public that, according to the NHMRC, this is a very small portion of the 4-7% of Australian children who have the symptoms. I would also have them inform the public that the NHMRC acknowledges the prevalence rate of ADHD in adults is 4.4%, proving that ADHD is seriously under-treated in adults as well. Finally, I would have them tell the world that ADHD is a serious condition if left untreated. As the NHMRC says, “ADHD is associated with a range of adverse outcomes including educational, social, emotional and behavioural problems during childhood, and subsequent mental health, relationship, occupational, substance, abuse antisocial, and offending problems in adult life. The flow-on effects of ADHD can have a significant impact on families, schools, workplaces and the community.”

Just Add Music

notes

All around the world parents are pulling their hair out every morning as they attempt to get their children dressed, fed and ready for school. These are some of the comments I hear:

“I send him to his room to get dressed. On the way he sees the cat, and then I’ve lost him.”

“She can stand in the middle of her room for 10 minutes and daydream – just daydream.”

“Just as we’re getting into the car she remembers that she’s dressed in the wrong uniform – It’s Sports Day Mum !!!!”

“I manage to wave goodbye with a big sigh of relief. As he heads to the bus stop I head to the kitchen – to find his lunch has been left behind”

I know you’re nodding as you read this. We’ve all experienced ADHD morning mayhem. One of my gorgeous teenage clients recently introduced music into her morning, and significantly reduced the collective family angst. Before I tell you her secret, let’s take a closer look at the situation.

What’s really happening in your child’s brain as you ask him or her to brush their teeth for the third time? In previous blogs I’ve spoken about the Executive Function deficits that occur for people with ADHD. According to Professor Thomas Brown the Executive Functions (EFs) of the brain include the ability to organise, prioritise & activate, to monitor & self-regulate actions, to control alertness, effort & processing speed, to focus, to use working memory, to shift & sustain attention, and to control emotions. Simply put, the brain is like an orchestra, with many sections doing many things. The Executive Functions are the conductor, ensuring that all the sections work together. In the ADHD brain, the conductor is asleep! So your child is unable to remember the sequence of tasks required in order to be ready for school / work. In addition, he or she has “Time Myopia” and is unable to judge how much time is needed for, or is spent on each task. And then, when time runs out and things become urgent, your child may struggle to control their emotions.

In order to complete a sequence of tasks, therefore, an external prompting system is required. This approach is highly recommended by Professor Russell Barkley, who constantly reminds us that ADHD requires intervention at the “point of performance”. There is no point in giving your children a lecture on the importance of being ready for school on time. They know that. They also know how to get ready. What they don’t know, is how to remember all the steps and complete them at the appropriate time. So what is an external prompting system and how does it work? Here are the steps:

  1. Make a list (or a picture storyboard) of what needs to be done in order
  2. Make the list highly visible to your child.
  3. Keep your child focused on their list, as opposed to individual items.
  4. Have an instant reward at the end of the list.
  5. Make time audible for your child – that’s where the music comes in.

To prevent the list being forgotten, there needs to be an external audio prompt. Many of the teenagers I work with have found the 30/30 app to be perfect for this purpose. However, others are less enthralled with this technology. It’s all about finding the right stimulus for your child. And for my client last week is was The Playlist Prompt. She carefully chose and compiled her morning playlist, with a song connected to each task. Then she explained to her family that she would be using it as a prompt, and asked her mum to remind her to switch it on by a certain time. The Playlist Prompt is working very well for her, especially with the following rules:

  1. Check the list each time a song ends
  2. Singing along is permitted, but remember that the hairbrush is not a microphone
  3. Dancing is fine, as long as it happens alongside a task – e.g. the toothbrush wiggle
  4. Be sensitive to your family’s eardrums – use headphones if necessary.

Perhaps the Playlist Prompt is something that could work for your child?

Whatever system you use, remember that this “simple” task of getting ready in the mornings is probably one of the hardest things for your child to learn. Celebrate the successful days, and encourage him or her to improve on dodgy days. Success will not occur overnight – but it will happen if you persist.

Shameful Media during ADHD Awareness Month

October is Global ADHD Awareness Month, as well as Breast Cancer Awareness Month. Both have great significance for me. I was diagnosed with breast cancer in 2010, and ADHD was the focus of my PhD, so I know a fair bit about both conditions, and their treatments. I have also observed the portrayal of each condition in the media, particularly during this important month.

The West Australian newspaper, for example, must be congratulated for excellent support of breast cancer awareness. Pink front pages, numerous educational articles, and patients’ stories have all alerted the public to the seriousness of the condition, as well as the importance of early detection and treatment. Experts are regularly consulted, and Australian oncologists are portrayed as competent, caring, cutting-edge physicians – which they are indeed. By contrast, discussions in the media about ADHD focus almost exclusively on the medications used to treat it. Experts are rarely quoted, and the views of unqualified politicians are constantly given preference. Psychiatrists and paediatricians are regarded with suspicion. There is little attempt to educate the public about the seriousness of untreated ADHD.

ADHD medication featured on the front page of the West Australian last week, as well as in the Age (Age 5 Oct). However, the alarming side effects of my cancer drugs have never received that attention. This puzzles me. Among other things, the first medication I was prescribed decreased my bone density to a point where I had to stop taking it. Possible risks associated with my current medication include Deep Vein Thrombosis, Uterine Cancer, and Blindness.

WA’s new federal MP is requesting a review of government funding for an ADHD medication (West 4 Oct). This concerns me. You see, I have made the decision to continue my cancer treatment, after a balanced, informed discussion with my expert oncologist. I would therefore hate the government to stop funding it. In the same way, people with ADHD deserve the right to make informed decisions about their treatment after discussing all options with their ADHD medical expert.

The Sydney Morning Herald also joined the chorus, with a shameful heading that described children on ADHD medication as “Zombie Kids” (SMH 5 Oct). This term has created a potential situation where children with ADHD will be even more bullied in the playground. It is time for this irresponsible, uninformed, unkind reporting to stop. Which means that it is time for the College of Physicians, the College of Psychiatrists, as well as State and Federal Health Departments, to start providing factual, reasonable, and relevant information for the public when it comes to ADHD.