1. Make an accurate diagnosis –
This is the starting point of all treatment for ADD. –
2. Educate the family –
All members of the family need to learn the facts about ADD as the first step in the treatment. Many problems will take care of themselves once all family members understand what is going on.
The education process should take place with the entire family, if possible, as everybody needs to know what is going on. Each member of the family will have questions. Make sure all these questions get answered.
3. Try to change the family reputation of the person with ADD
Reputations within families, like reputations within towns or organizations, keep a person in one set or mold. Recasting within the family the reputation of the person with ADD can set up brighter expectations.
If you are expected to screw up, you probably will; if you are expected to succeed, you just might. It may be hard to believe at first, but having ADD can be more a gift than a curse.
Try to see and develop the positive aspects of the person with ADD, and try to change his family reputation to accentuate these positive aspects. Remember, this person usually brings a special something to the family, special energies, special creativity, special humor
4. Make it clear that ADD is nobody’s fault
It is not mom or dad’s fault, it is not brother or sister’s fault, it is not grandmother’s fault and it is not the fault of the person who has ADD. It is nobody’s fault.
It is extremely important this be understood and believed by all members of the family. Lingering feelings that ADD is just an excuse for irresponsible behavior or that ADD is caused by laziness will sabotage treatment.
5. Make it clear that ADD is a family issue
Unlike some medical problems, ADD touches upon everybody in the family in a daily, significant way. It affects the early morning behavior, it effects dinner table behavior, it affects vacations, and it affects quiet time.
Let each member of the family become a part of the solution, just as each member of the family has been part of the problem.
6. Pay attention to the balance of attention within the family
Try to correct any imbalance. Often, when one child has ADD, his siblings get less attention. The attention may be negative, but the child with ADD often gets more than his share of parents’ time and attention day in and day out.
This imbalance of attention can create resentment among siblings, as well as deprive them of what they need. Bear in mind that being the sibling of a child with ADD carries its own special burdens.
Siblings need a chance to voice their own concerns, worries, resentments, and fears about what is going on. Siblings need to be allowed to get angry as well as to help out.
Be careful not to let the attention in the family become so imbalanced that the one person with ADD is dominating the whole family scene, defining every event, coloring every moment, determining what can and cannot be done, controlling the show.
7. Try to avoid the big struggle
A common entanglement in families where ADD is present but not diagnosed, or diagnosed but unsuccessfully treated, the big struggle pits the child with ADD against his parents, or the adult with ADD against his spouse, in a daily struggle of wills.
The negativity that suffuses the big struggle eats away at the whole family. Just as denial and enabling can define the alcoholic family, so can the big struggle define (and consume) the ADD family.
8. Everybody in the family together negotiates a deal
Once the diagnosis is made, and once the family understands what ADD is, have everybody sit down together and negotiate a deal. To avoid the big struggle, to avoid an ongoing war, it is best to get into the habit of negotiation.
This can take a lot of work, but over time some kind of negotiated settlement can be reached. The terms of the settlement should be made explicit; at best they should be put into writing.
The terms should include concrete agreements by all parties as to what is promised, with contingency plans for meeting and not meeting the goals. Let the war end with a negotiated peace.
9. Seek help if negotiations bog down
If negotiation bogs down at home, consider seeing a family therapist, a professional who has experience in helping families listen to each other and reach consensus. Since families can be explosive it can be very helpful to have a professional around to keep the explosions under control.
10. Role playing can be helpful
Within the context of family therapy, role playing can be helpful to let members of the family show each other how they see them. Since people with ADD are very poor self-observers, watching others play them can vividly demonstrate behavior they may be unaware of rather than unwilling to change. Video can help in this regard as well.
11. Try to disengage from the big struggle
If you sense the big struggle is beginning, try to disengage from it. Try to back away. Once it has begun, it is very hard to get out of. The best way to stop it, on a day-to-day basis, is not to join it in the first place. Beware of the struggle becoming an irresistible force.
12. Give everyone in the family a chance to be heard
ADD affects everyone in the family, some silently. Try to let those, who are in silence, speak.
13. Try to break the negative process and turn it into a positive one
Applaud and encourage success when it happens. Try to get everyone pointed toward positive goals, rather than gloomily assuming the inevitability of negative outcomes.
One of the most difficult tasks a family faces in dealing with ADD is getting onto a positive track. However, once this is done, the results can be fantastic.
14. Use a good family therapist, a good coach, whatever
Just focus on building positive approaches to each other and to the problem.If you have not already done so, make it clear who has responsibility for what within the family. Everybody needs to know what is expected of him or her. Everybody needs to know what the rules are and what the consequences are.
15. Avoid loving your child one day and hating him the next
As a parent, avoid the pernicious pattern of loving the child one day and hating him the next. One day he exasperates you and you punish him and reject him. The next day he delights you and you praise him and love him. It is true of all children, but particularly true of those with ADD, that they can be little demons one day and jewels of enchantment the next. Try to keep some even keels in response to these wide fluctuations. If you fluctuate as much as the child, the family system becomes very turbulent and unpredictable.
16. Make the time for you and your spouse to confer with each other
You should try to present a united front. The less you can be manipulated the better. Consistency helps in the treatment of ADD.
17. Don’t keep ADD a secret from the extended family
It is nothing to be ashamed of, and the more the members of the extended family know about what is going, the more help they can be. In addition, it would not be unlikely for one of them to have it and not know about it as well.
18. Try to target problem areas
Typical problem areas include study time, morning time, bedtime, dinnertime, times of transition (leaving the house and the like) and vacations. Once the problem area has been identified, everyone can approach it more constructively. Negotiate with each other as to how to make it better. Ask each other for specific suggestions.
19. Have family brainstorming sessions
When a crisis is not occurring, talk to each other about how a problem area might be dealt with. Be willing to try anything once to see if it works. Approach problems as a team with a positive can-do attitude.
20. Make use of feedback
Make use of feedback from outside sources, teachers, pediatrician, therapist, other parents and children. Sometimes a person won’t listen to or believe something someone in the family says, but will listen to it if it comes from the outside.
21. Normalize ADD in the eyes of all family members
Try to integrate ADD into the family just as you would any other condition and normalize it in the eyes of all family members as much as possible. Try not to let it dominate your family. In times of crisis this may not seem possible, but remember that the worst of times do not last forever.
22. ADD can drain a family
ADD can turn a family upside down and make everybody angry with everybody else. Treatment can take a long while to be effective. Sometimes the key to success in treatment is just to persist and to KEEP UP A SENSE OF HUMOR.
Although it is hard not to get discouraged if things just seem to get worse and worse, remember that the treatment of ADD often seems ineffective for prolonged periods. Get a second consultation, get additional help, but don’t give up.
23. Never worry alone
Try to cultivate as many supports as possible. From pediatrician to family doctor to therapist, from support group to professional organization to national conventions, from friends to relatives to teachers and schools, make use of whatever supports you can find.
It is amazing how group support can turn a mammoth obstacle into a solvable problem, and how it can help you keep your perspective. You’ll find yourself saying, “You mean we’re not the only family with this problem?” Even if this does not solve the problem, it will make it feel more manageable, less strange and threatening. Get support. Even if it is just someone to grow gray hairs with you. Never worry alone.
24. Pay attention to boundaries and over-control within the family.
People with ADD often step over boundaries without meaning to. It is important that each member of the family knows that he or she is an individual, and not always feel under the collective will wielded by the family.
In addition, the presence of ADD in the family can so threaten parents’ sense of control that one or another parent becomes a little tyrant, frantically insisting on control over all things all the time.
Such a hyper-controlling attitude raises the tension level within the family and makes everybody want to rebel. It also makes it difficult for family members to develop the sense of independence they need to have to function effectively outside the family.
25. Keep up hope
Hope is a cornerstone in all treatment of ADD. Always have someone in mind that you can call who will hear the bad news but also be able to pick up your spirits.
Always bear in mind the positive aspects of ADD – energy, creativity, intuition, good heartedness – and also bear in mind that many, many people with ADD do very well in life. When ADD seems to be sinking you and your family, remember things will get better.
About The Author
*Edward Hallowell, MD practices child and adult psychiatry in Cambridge, MA, where he is also on the faculty of the Harvard Medical School. He consults to various schools in the area, including the Willow Hill School and the Brookwood School. He lectures around the country on topics related to attention deficit disorder, dyslexia, and other forms of learning problems, as well as on topic related to connectedness and disconnectedness within our society. Dr. Hallowell is the author, with John Ratey, MD, of two books on ADD, and as well as author of a book on the range of neurobiological disorders that occur in children and several other books as well.
ADDR Reviewed 8-22-2015 (mm)