Adhd Self Esteem issues and defiant behavior

This week, I'd like to ask our ADDults the same question. If you'd like to share your thoughts with us please email them to me at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a>

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This issue also contains the first column from David Rabiner Ph.D. He has taken the questions that readers submitted and answered those he felt had the most to offer to our subscribers as a whole. If you a question you would like David Rabiner to consider for his column please send it to me at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a> and I'll forward them on to David Rabiner.

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Another reminder to sign up at addhelp@mindspr9ing.com. if you're interested in previewing Dr. Dave's Newsletter which will keep us all informed and up to date on all the new research that is taking place in the world of ADD/ADHD.

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Be on the look out for the update on the website to go up on or before July 19th. Lots of new information including info on St. Johns Wort, new conference information and a link for our Single Addults to a new online singles community that offers relationship coaching, forums and opportunities to chat with other adults no matter what time of the day or night you find yourself on the internet. This is just a trial link to see if this service can be helpful to our Addults so be sure to send me your feedback, positive or negative so I can make an informed decision as to whether or not the services they provide are helpful.

Thanks to the generosity of Max James and Alternatives for Families we have a wonderful, chance in a life time opportunity.

Imagine what benefits you could gain if you had the ability, to talk voice with up to 500 other readers, to talk about Advocacy, Alternatives, Medication, Parenting, ADHD, OCD, ODD etc? All from the comfort of your home? The benefits, I feel are limitless. With the possibility of guest speakers and the chance to speak with other readers who share some of the same experiences that we all have, through a conference call for the price of a long distance call. Imagine the support and sharing that we could take place!

Max James and Alternatives for Families has genoursly offered to donate to us, the ADHD community the ability to connect via telephone and brainstorm, share and support one another the very same way that large corporations conduct business. The only cost to you would be the long distance charge to your phone bill.

If you feel that this is something that you would not only benefit from but would also participate in, please let me know. If there is enough interest and enough readers willing to participate then this will become a reality. Max James has left it up to us to decide how we want this to work and I for one can not thank Max James and Alternatives for Families enough for making this generous offer.

Please email me at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a> and give me your feedback on this wonderful opportunity.

As this is the first time the question and answer column has appeared in Brandi's newsletter, I thought it would be a good idea to briefly introduce myself to all of you. My name is David Rabiner, and I am a child psychologist living in Durham, NC. I teach in the psychology department at UNC-Greensboro, and practice in conjunction with a group of pediatricians. I am married and have two daughters.

As a child psychologist, I have worked with many children and parents who came in because of ADHD and the difficulties that often go along with it. Working with ADHD children and their families has become a special interest of mine that I try to combine in my clinical and academic work. I am looking forward to responding to your questions in the months ahead and appreciate Brandi's giving me the opportunity to do so.

Let me apologize in advance for being unable to respond to everyone's' questions individually. I hope to have the time this would require in the near future, but at the moment, I am unable to do so. Because I cannot respond to each question individually, I will try to address questions that touch on issues I hope will be relevant to many of you.

It is also important to add that although I hope this column is informative, it is not intended to substitute for professional medical advice. Ideas you find here may be useful to discuss with your child's doctor, but are not intended to substitute for his or her recommendations. Now, let's get to the questions...

Many questions this month dealt with problems that often accompany ADHD. Thus, several readers asked about the difficulties their child was having making friends; several asked about antisocial behavior and whether ODD (i.e. Oppositional Defiant Disorder) and ADHD were the same thing; there were also questions about sleep problems, the relationship between ADHD and self-esteem, and problems with anger control.

All these questions deal with the very important issue about the relationship between ADHD and other difficulties. It is important to remember that the core symptoms used to diagnose ADHD are inattention, hyperactivity, and impulsivity. When you look carefully at the specific diagnostic criteria you will not see any mention of defiant behavior, problems making friends, poor self esteem, sleep difficulties, etc.

Although these other problems are not used to diagnose ADHD, however, they often occur in children with ADHD. Thus, many children with ADHD develop problems with oppositional behavior, making friends, self-esteem, and anger control. Other children with ADHD, however, do not develop these associated problems. This is very important, as these associated difficulties often create more severe problems for children and parents than the core ADHD symptoms themselves. Let's look specifically at several of these associated problems.

Suppose you tell your child to go to his room and put away his toys. Ten minutes later you find that he is back there playing instead. How come? If your child went back intending to put the toys away, but quickly got caught up in playing with a real neat toy, his/her "non-compliance" is not necessarily intentional and may represent the distractibility and difficulty completing takes that is characteristic of ADHD. If, however, your child argued about having to pick up the toys, and basically refused to do it, the non-compliance is deliberate and willful, and is no longer attributable to ADHD per se.

Although most mental health professionals do not believe that family factors or parenting influence the development of ADHD, interaction patterns between parents and children can influence the development of oppositional behavior. Because of the unique challenges that children with ADHD can present, such patterns are more likely to develop between parents and a child with ADHD. Discipline practices that often work fine with other children may not work. Parents can become frustrated, and find themselves in frequent arguments with their child. An escalation of oppositional behavior frequently ensues.

It is generally agreed that such problems are best addressed by learning the specific parenting techniques and strategies that are often helpful and necessary to deal with the challenges a child with ADHD can present. To review this in detail is not possible, but basically, what is involved is developing a structured and consistent framework of rewards and consequences to reduce oppositional behavior and increase socially appropriate behavior. You can find an excellent discussion of this approach in a book titled Taking Charge of ADHD by Dr. Russell Barkley. I'm sure that many of you are well aware of this approach, and know that it involves lots of hard work but that the results can be worth it.

The point I want to stress is that it is very important not to confuse extreme oppositional behavior with ADHD. I have seen many parents who thought that if their child was receiving medication for ADHD, and yet still had behavior problems, there wasn't anything else to do. Physicians may inadvertently contribute to this misimpression by focusing exclusively on medication as a treatment option. Stimulant medication helps primarily with the core symptoms of inattention, hyperactivity, and impulsivity. Sometimes, it also yields a reduction in angry and oppositional behavior. If your child displays important problems with oppositional and defiant behavior after receiving stimulant medication, however, additional types of treatment are necessary. Your child's physician may prescribe an additional medication to try and address such behavior problems. In such cases, however, most child psychologists would argue that it is essential for parents to consult with someone who can help them design and implement a good behavior plan. I think this is really critical.

Unfortunately, many children with ADHD have difficulty making and keeping friends. The behaviors that are irritating and annoying to adults (e.g. interrupting, impulsiveness, etc.) can be irritating to peers as well, and leads many children with ADHD to be disliked. Being rejected by peers can be a painful experience that can lead to the development of emotional problems (e.g. reduced self esteem, depressed mood). Also, children without friends often gravitate towards other children on the periphery of the peer group, and can become involved with peers who are heading for trouble.

What can help with these social difficulties and what can parents do? First, there is some evidence which suggests that the medication generally used to treat ADHD can also improve the social relations for many children. This is probably because when medication reduces the symptoms of inattention, hyperactivity, and impulsivity, a child with ADHD is less likely to engage in behaviors that peers find irritating.

Many children with ADHD, however, may not have developed the "social skills" that are necessary to make friends and get along with others. The type of treatment that is designed to address this problem most directly is called "social skills training". The idea behind social skills training is that children can be taught the skills they need to get along better with peers. For example, a counselor might work with a child to teach him/her how to: enter groups of other kids without barging in; how to be a good conversation partner; how to solve problems or conflicts that come with other kids, etc. In many schools, the guidance counselor conducts groups to help children learn these friendship making skills. It is thus a good idea to inquire about the availability of such a group at your child's school. In some communities, a child psychologist may also conduct such groups for children.

Another way parents can help in this area is to provide supervised peer activities for their child. If you know that your child's friendships tend to break down because he or she gets into frequent conflicts when play is unsupervised, you may need to take an active supervisory role to help things go well. A parent's presence can help keep such conflict from occurring, or from escalating to the point that it disrupts the relationship should it occur. When you are there to observe the conflict, it can provide an excellent opportunity to help your child learn more appropriate compromise and negotiation skills. Reviewing with your child what he or she needs to remember to be a "good friend" prior to the get together (e.g. sharing, taking turns, listening to your friend's ideas) and then trying to discuss how or she did with these things afterwards can be quite helpful. As always, it's important to be positive in these discussions and to find things to praise. This is another area where consulting with a mental health professional to help focus on specific issues relevant to your child can be quite helpful. Your efforts here are very important as helping your child develop and sustain even a single good friend can make a tremendously important difference in his or her life.

It is not surprising that many children with ADHD develop poor self esteem or even more serious emotional problems such as depression. The academic problems, peer problems, and conflict with parents and teachers that are frequently experienced can make daily life a struggle. Imagine getting so much negative feedback day in and day out - after a while, this could have most of us feeling down. As a result, it is not uncommon for secondary emotional problems to develop in children with ADHD.

How can parents help to prevent this? Several things can be helpful. First, I think it is important that children with ADHD have a clear understanding of what ADHD is and what it means to have it. It can be very confusing and discouraging to a child to experience the struggles that ADHD can create: to have trouble finishing things despite trying; to try hard in school but do poorly; to get into trouble for things like talking out of turn or getting out of one's seat. In the absence of understanding why these things happen, some children start to feel that they must be stupid and that they can't do anything right. Providing a child with an age appropriate understanding of what ADHD is, what kinds of things it will make difficult for them, and how they can be quite successful despite this, can be very comforting. I have seen children who were taking medication for years without knowing why - imagine how confusing that can be. There are several books available that do a nice job of explaining ADHD in a way that children can understand. For example, you may want to take a look at Distant Drums, Different Drummers: A Guide for Young People with ADHD by Dr. Barbara Ingersoll. This book is intended for children between the ages of 8 and 14.

The other way to help protect the self-esteem for a child with ADHD is no different from what is important for any child. For all children, being competent and successful in the important parts of their lives are the basis for positive feelings about self. Children who do well in school generally develop positive feelings about their academic competence. Children who can make friends and get along with peers will develop positive feelings about their social competence. Getting along with parents and feeling that parents are proud of you also contributes to positive feelings about self. When these aspects of a child's life are going poorly, negative feelings about self often develop.

Having ADHD can make all these things difficult, however. It is not having ADHD, however, that is the direct cause of self esteem problems. Instead, when the symptoms of ADHD make it difficult for a child to succeed in important life areas, negative feelings about self are likely to develop.

The best way parents can prevent this from happening is to make sure that problems their child may be having in specific areas are being specifically addressed. If academics are going poorly, try and make sure your child is getting the special assistance they require. Social problems should be addressed as discussed above. Problems in the parent-child relationship that yield frequent conflict can be targeted with behavioral treatment or perhaps other types of counseling. For children struggling with poor self esteem or even depression, individual counseling can also be very helpful. Having worked with many children and parents around such issues, I realize that none of this is easy and there are no miracle solutions. Good, consistent hard work to help your child in these areas can, however, pay off.

That's all for this month. I hope you found this discussion to be useful and encourage you to send along additional questions to Brandi for next month. Also, beginning in August I'll be publishing a newsletter that will summarize the latest research findings on ADHD for parents. If you'd like to receive the initial issue along with subscription information, e-mail your request to me at addhelp@mindspring.com. I'll make sure you receive it.

David Rabiner, Phd
Licensed Psychologist
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I wanted to share this note with you that I received from Beth. Your newsletter is much appreciated- its a great mix of research-based information, parental support (its always wonderful to realize that we are not alone) and genuine empathy for the ADHD child or adult struggling to maintain a healthy self-image despite attentional difficulties. As a parent of a young daughter with ADHD-type 2, Inattention, and an experienced special educator who works with primary aged students with learning disabilities and attentional problems, I have come to the decision that the more I know about ADHD, the more I don't know. I agree very much with the statement by Dr. Rabiner regarding medication on a case by case basis with careful monitoring and a multimodal treatment program. I currently use the Taylor Medication Effectiveness Rating Scales (John Taylor, Ph.D.) which allows for observation and comments in 7 different areas of development once a child has begun pharmacological treatment. Are there other recommended measures beyond the traditional teacher narrative? I would also like to suggest that it is our responsibility as parents and educators of ADHD children to counteract the negative publicity surrounding this neurological condition with reports of positive information. The majority of the individuals I know with ADHD have incredible strengths and assets in areas that may be non-academic. I would like to see a section of your newsletter (which is very likely viewed by parents new to the overwhelming world of ADHD) dedicated to recognizing these wonderful traits.

I too think it's important to focus on the positives and the strengths that accompany the negatives of ADHD. Please share your positives and strengths with us and I'll post them in the next newsletter. Send them to me at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a>.

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That's it for this edition of ADDed Attractions. Hope you found it useful and I encourage everyone to contribute to this newsletter. If you have something you'd like to see in our newsletter, a tip you'd like to share with us, information on a Doctor or clinic you found helpful, a new support group or an existing one etc, send it along to me by the 10th of the month to <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a>

Brandi Valentine