Communicating with a Child Who Has ADHD

When communicating with a child who has ADHD, they might require to have to learn self-regulation. Self-regulation is described as one’s ability to manage and control their behavior, emotions, and attention. This includes using specific skills to monitor, evaluate, and adjust for environmental demands so as to react appropriately. Let’s take a look at the following scenario:

Jessica is a 9-year-old girl who just moved to a new school. Recently, she was diagnosed with ADHD and her parents are taking steps to help her adjust to school, home, and extracurricular demands. In class, Jessica struggles with sitting still. Within minutes after sitting upright at her desk, she’s already switched to multiple positions including crouching under the table and sitting upside down with her legs waving in the air. Her teacher notices how challenging it is for her to complete assignments and tests in class. At recess, she has trouble making friends because she often interrupts conversations, gets too close to other children’s faces, and bosses others around during team games. 

Oftentimes, children with attention deficit/hyperactivity disorder (ADHD) struggle with self-regulation, and therefore working with an OT to address these issues can lead to success in everyday life. In this blog, we are going to describe two main ideas: how learning self-regulation skills can help children with ADHD and what specific strategies an OT can use to improve self-regulation. 

How does learning self- regulation skills help a child who has ADHD?

Being able to self-regulate is key to success, not only during childhood years but during adulthood as well. ADHD is a well-known neuro-developmental disorder usually diagnosed during childhood and is characterized by:

• Trouble focusing
• Impulsive behavior
• Restlessness or hyperactive movement
• Poor planning
• Disorganization
• Poor time management
• Low frustration tolerance
• Trouble with dividing attention amongst multiple tasks

Learning self-regulation skills early allows kids with ADHD time and opportunity to use and to refine their own techniques as they age. With practice and the right tools, parents, teachers, and caregivers may notice positive changes in any of the following areas:

  — Improves child’s attention and focus

The primary change that healthy self-regulation provides is increased attention and focus to daily tasks. This could include activities at home, school, sports, or other community/social gatherings. In many cases, children with ADHD struggle with finishing homework, meals, chores, hygiene tasks, and a wide array of activities because their attention is so limited or because their minds have already moved on to another (albeit irrelevant) activity. By learning how to monitor their own behavior and to tune out environmental distractions, children with ADHD can complete necessary tasks from start to finish in a timely manner. 

  — Reduces impulsivity

ADHD impairs a child’s ability to think before they speak or act, which means they may say or do something without fully understanding the consequences of their behavior. This may look like a child blurting out answers in class before raising their hand, jumping off a high-point on a playground without thinking about where or how they’re going to land, or constantly interrupting conversations as seen in Jessica’s story. Learning self-regulation skills may help a child reel in their reactions to consider the cause and effect of their choices.

  — Better emotional control

Although it’s not listed as a diagnostic marker, a fairly new but common concept in ADHD is referred to as “emotional dysregulation”. Some children with ADHD may be prone to meltdowns or outbursts due to an overwhelming reaction to their own emotions and not knowing how to cope in a typical way. These emotional outbursts wreak havoc on social participation and successful completion of activities that matter to them. The right self-regulation tools can teach a child with ADHD emotional resiliency and how to dissipate or experience difficult emotions in a healthy way.

  — Improves social skills

If a child can self-monitor their own behavior, emotions, and attention, this will pave the way for them to develop productive and positive relationships with others. A child like Jessica probably has an energetic, social, and fun-loving personality; however, it’s challenging for friends her age to appreciate her lovable traits when impulsivity, inattention, bossiness, and other potentially aggravating issues surface. Self-regulation skills can help Jessica and other children with ADHD keep challenging behaviors in check and allow for beautiful traits to shine through in order to foster long-lasting friendships. 

What specific strategies/ techniques does an occupational therapist use to improve self- regulation in children diagnosed with ADHD?

Pediatric occupational therapists (OTs) apply multiple interventions to help children with ADHD develop and maintain self-regulation skills. Here are just a handful of techniques that may help children and their parents:

 – Create structure/ routine

Develop a relatively predictable, structured day-to-day routine for your child. Depending on your child’s age and expected daily tasks, it may look a little something like this:

• Wake up, dress and morning hygiene, breakfast
• School (classes scheduled accordingly)
• Extra-curricular activities (sports, after school clubs, etc.)
• Dinner
• Homework time
• Night time hygiene routine
• T.V. or recreational time
• Bed-time routine

Although we can’t control everything and unexpected changes will occur, providing a child with ADHD with some daily structure is extremely helpful for emotional, behavioral, and attention regulation. After a while, the child can get used to carrying out their own successful routine without a parent’s or teacher’s supervision. 

  — Provide clear expectations

Let the child know what the actual short-term and long-term goals of each task are: homework assignments, chores, games, hygiene tasks, etc. Describe to them very clearly what is expected of them and what it means to FINISH the task. For example, instead of saying:

“Go take a bath.”

A child with ADHD may need a better explanation:

“Get undressed. Turn the water on. Wash your hair and your body with soap and water. Then unplug the tub drain, get out of the tub, and dry off with the towel.”

  — Break tasks into smaller steps

A child with ADHD may not have the attention span to heed multiple instructions in one sitting, just like the bathing instructions listed above. If that’s the case, start small and state one direction at a time. Issue the next instruction once the prior one is completed. Breaking tasks down into smaller steps shouldn’t be mistaken for giving children easy tasks because children with ADHD can do challenging things when given the opportunity. 

  — Encourage physical activity

Like most children, kiddos with ADHD struggle with sitting still for long periods of time (like at a desk during school hours). It’s essential to encourage children with ADHD to participate in physical exercise or activities to “get their wiggles out” or to meet desperately needed sensory-seeking needs. Examples include: dancing, jumping, running, army drills, recess time, weight-lifting, etc. Once those physical needs are met, attention regulation greatly increases for all sorts of tasks that require sitting still. 

  — Teach mindfulness/ relaxation skills

Mindfulness, kid’s yoga, Tai Chi, and other relaxation techniques are an excellent way for kids to tune into the inner workings of their own bodies while effectively blocking out unnecessary environmental distractions. Daily mindfulness and relaxation practices can improve both attention and emotional regulation, whether it’s during a good day or when a child needs to de-escalate from a potential melt down. 

  — Teach self-monitoring

An OT can help a child self-reflection techniques to help them identify when their emotions or behaviors need a tune-up. This takes time actively helping the child draw attention to themselves, helping them verbalize their feelings, and getting them to identify and make improvements when necessary. These strategies can be taught during interactions between the child and the OT, the child and their peers, or during social stories/simulations where the child can practice. For example, an OT may help Jessica self-monitor her interactions with friends at school by teaching her to actively listen, go with the natural flow of reciprocal conversation, and to politely wait her turn without interrupting others. 

  — Utilize positive reinforcement

Many kids respond well when the desired behavior is rewarded. Rather than primarily focusing on punishment for poor behavior (impulsivity, poor grades, tantruming, etc.), OTs introduce a system of positive reinforcement where a child with ADHD is recognized and rewarded (compliments, prizes, etc.) for the gains they make so the good behavior continues well into the future. 

Self-regulation skills are just a few of the essential building blocks that children with ADHD struggle with utilizing in an effective manner. Pediatric occupational therapists frequently work with children with ADHD to help them learn how to self-monitor their own behavior, emotions, and attention so that they can experience daily success for years to come. Check out The Therapy Place online to see if our services can help your child who is struggling with ADHD (or any child!) develop and succeed. https://www.therapyplacenj.com/