Module 5 | Parada SEN

Module 5: ADHD within Families and Relationships

When someone has ADHD, it is a family issue. It is a relationship issue. Those around them and they way they interact with each other can be affected. You don’t love them any less. It does mean there will be challenges along the way that have nothing to do with your love for each other and everything to do with the ADHD.

In this module, we will look at how ADHD can affect even the strongest of relationships. We will explore ways to build healthy, strong relationships. We’ll identify strategies that can set your child up for success not just in school but at home and in his or her world.

5.1 How Does ADHD Affect Relationships?

5.2 Prevent Tension within a Family with a Child who has ADHD

5.3 Techniques for Building Healthy Relationships for Children with ADHD

5.4 Knowing the Challenges Children with ADHD Face and Overcoming Them

5.5 Strategies for Setting Your Child Up for Success

5.6 Providing a Calm Environment to Ease Stress

Section 5.1: How Does ADHD Affect Relationships?

When someone has ADHD, it affects much more than just performance in school or at work. ADHD affects relationships in the person’s life. In fact, research has consistently found that having a loved one with ADHD is stressful and that stress can be found across relationships and across time.

Quick Fact

A diagnosis of ADHD affects the entire family.

ADHD is not just an individual issue. ADHD is a family issue. Families have to make accommodations for the person with ADHD to help maintain the stability and functionality of the family. Those accommodations can sometimes be quite extensive and intrusive. Everyone has to make allowances. No matter how much the person with ADHD is loved, this demand can create feelings of stress, frustration and even resentment among other family members who may feel overwhelmed, left out or overlooked.

Think about it like this: The family is like a child’s mobile that hangs over a crib. When it is still, it is in balance. Touch it and it moves, struggling to rebalance itself. Families are exactly the same. When a change happens in a family, things get out of balance. The family’s stability is disrupted and it struggles to regain its balance.

During this time, things can get quite tense between family members. Parent-child relationships, sibling relationships and even the parents’ marital relationship can be affected.

When a child has ADHD, especially a young child, it is the parent who takes on the lion’s share of managing the disorder. From doctor’s appointments to medication administration to school meetings, checking backpacks and more, the parent of an ADHD child is constantly in ‘management’ mode.

On top of managing the logistics of ADHD, parents may have to deal with:

Dealing with disruptive behaviors, especially on outings
Keeping the child on a schedule
Dealing with the sleep problems that ADHD kids tend to have (which tends to affect daytime behavior)
Reluctance of others to care for the child
Supervising the child, especially during unstructured time

This list could go on but you get the idea. Parents of a child who has ADHD don’t have a lot of down time to relax and recharge. They are less available to the rest of the family. Everything becomes about the ADHD. Everyone gets frustrated. Relationships can start to break down.

So, it should come as no surprise that parents of children with ADHD report considerable levels of stress in dealing with their child’s needs. The more severe the symptoms and behaviors, the greater the stress that is experienced by the parents, especially when conduct problems are present. When parents are stressed, parenting can become more inconsistent. As a result, the behavior of the children can become increasingly negative.

As the stress of the demands placed upon the parents increase, parent-child relationships can begin to break down:

Parents have to be vigilant, especially in the early days of dealing with ADHD.
Behavior problems require parental intervention. This can result in more parent-child conflicts.
More conflicts can lead to emotional distance
Time and expense of treatment may create a burden and excess worry for parents.
Parents may engage in self-blame for their child’s struggles
Parents may feel some resentment from the weight of the demands on them
Frustration or irritability may arise towards the child or with themselves
The unpredictability of behavior problems can be overwhelming and worrisome
Siblings may feel left out or ignored by parents and begin to pull away

Siblings of children with ADHD

Siblings struggle too. Because ADHD can be such a high-demand situation, parents find themselves, sometimes unknowingly, spending huge amounts of time on the child with ADHD and their needs. Other siblings receive less attention. They are sometimes referred to as ‘ghost children’. They tend to quietly go about their business – at least for a while. Over time, they may begin to adopt some of the behaviors of their sibling with ADHD because they learn these behaviors garner attention.

Research into siblings and their reactions to having a sibling with ADHD has not been well-studied. However, one savvy researcher decided to go straight to the kids. Here’s what he found:

Disruptive behaviors were the most significant problem identified by the siblings
They described their family life as chaotic, conflicted and exhausting
Having a sibling with ADHD means never knowing what to expect
They did not feel that things would get better

Both the sibling relationships and their relationship with their parents were negatively impacted. They reported:

Feeling victimized by their sibling’s behaviors and feeling unsafe at times
Feeling their parents minimized the seriousness of the aggression and attributed it to sibling rivalry
Feeling unprotected, like they were easy targets because parents were exhausted or overwhelmed
Feeling resentful of the situation, of their sibling’s behavior and of their parents’ response

Siblings also reported having to take on the role of caretaker of their sibling. They expressed sorrow for the situation and longing for stability and peace. It’s hard to have good relationships with these dynamics.

Marital Relationship

Having a child with ADHD can impact the parents’ relationship too. Excessive time demands can leave little time for the marital relationship. Parents may differ on how to handle situations. Over time, communication breaks down and sometimes, ADHD becomes the primary topic of conversation. By then, resentment and estrangement can set in.

Section 5.2: Prevent Tension within a Family with a Child who has ADHD

The good news is that there is a lot you can do to reduce or even prevent tension in the family. The key is to normalize ADHD as a routine part of how you ‘do family’. ADHD doesn’t have to control your world. ADHD doesn’t have to take center stage.

What does it mean to normalize something? Normalizing means to learn to see concerns or problems not as a catastrophe but as normal life difficulties. Stuff we all have to deal with. Normalizing helps people to become less upset or bothered by their problems and see that they are not alone.

The fact is, ADHD is a part of your family now. It is what it is. Every family has something they deal with. And, most importantly, you have each other.

So what can you do to not let ADHD control your world and damage your family? A lot. Families living with ADHD share similarities with families who live with the chronic illness of a loved one. ADHD doesn’t just ‘go away’ with some medicine. It can improve, sometimes dramatically. Still, the long-term management of it requires accommodations and some changes in the way you ‘do family’. The good news is that all of the accommodations and emotional stress doesn’t have to impair family functioning. In fact, families can adjust and learn how to not just survive but thrive in the new normal.

The following suggestions are not necessarily another ‘to-do’ list for you, the parent. Rather, this is a set of suggestions and situations to be aware of and use as your family needs them.

Call ADHD Out By Name - Once the diagnosis is made, it’s important to share that information with the rest of the family. They’ve been living with ADHD for a while but weren’t properly introduced. What you’ve all been experiencing now has a name. Let them know what this means and how it relates what they’ve experienced with their loved one. Encourage positive and constructive discussion. Ask and answer questions.

Find Ways to Support Each Other – Support means different things to different people. How you support your child with ADHD may be completely different to how you support your other children. How you support your children will be different to how you might support a spouse.

Also consider, how do you want someone to support you?

Every member of the family needs support of some kind. Share your needs with them. Be observant. Ask them.

They may not know how to answer immediately but listen to what they’re saying…and not saying. They may reveal clues as to what they’re needing from others.

Support can take many forms. Some examples might include:

Practical hands-on help or assistance
Someone to talk to or use as a sounding board to hash out a problem
Listening to understand and not simply respond
Opportunity to handle a situation on their own knowing you have their back
Letting someone know they’ve done a good job with a hard situation
And a thousand other ways…

Seek Outside Support

Sometimes we need support from someone from outside of the family – someone who doesn’t live the same day-to-day we do. Social support is vital to our well-being whether we live with a chronic issue or not. Outside support might be a trusted friend or even a support group. We all need that sense of knowing help is there if we need it.

Communicate Beyond the Issue

When a family is dealing with a loved one’s challenges, it is so easy for that issue to dominate the conversations. Over time, it can become the way you talk to each other and it can stifle communication. Of course, talk about what you need to. Be sure that ADHD does not become the focus of every conversation. It is only one aspect of your family. There is so much more to talk about.

Practice Good Self-care

It’s important for everyone to take care of themselves too. Take time to do things that are relaxing and fun. Allow each other to take some alone time to play, relax, meditate or do those things they find pleasurable. Also, make time for family with activities that are focused around relaxing and enjoying time together. Wellness for individuals and families is all about balance.

Make Special Time For Each Other

A lot of attention will be paid to your child with ADHD especially in the beginning. It’s easy to overlook the time that your other children or spouse may be needing. Make time for them. One-on-one time can reinforce relationship bonds and increase feelings of being loved and valued.

When ADHD becomes part of your family, some things will change. Life won’t be exactly as it was before. Your family will be seeking its new balance – its new normal. The goal is to find ways to incorporate these changes into your world that work for your family.

Sometimes, no matter how hard you try, your family may struggle with all that is changing. That’s ok – help is available. Family or marital therapy can help you all learn how to deal with the new realities and find ways to communicate and support each other in ways that work.

Quick Fact

Not sure where to find a family or marriage therapist? Some professional organizations maintain a database that is accessible to the public. Two sites to check out:

The America Association of Marriage & Family Therapists maintains a locator that includes MFT’s in the U.S., Canada and internationally.http://aamft.org/imis15/AAMFT/Content/Directories/Find_a_Therapist.aspx

UK Therapy Hub is another great option https://www.uktherapyhub.co.uk/find-a-therapist/

Section 5.3: Techniques for Building Healthy Relationships for Children with ADHD

For children with ADHD, making and sustaining relationships of all kinds is a challenge. They especially struggle with peer relationships.

Research has found that about 56% of children with ADHD have no reciprocated friendships. That percentage is nearly TWICE that of non-affected children.

Children with ADHD are more likely to be rejected by their peers even after brief contacts of minutes or a few hours.
When they do make friends, the friendships tend to be less stable and of a lower quality.
Those relationships tend to end much more frequently than those of children without ADHD.

Sibling relationships tend to be strained as well. Sibling relationships with ADHD children tend to be more conflicted and lack warmth and closeness.

So why does this happen? Why are relationships so hard for children with ADHD what can you do to help them?

For a long time, it was assumed that the behaviors commonly seen with the hyperactive type of ADHD accounted for this difficulty. After all, the disruptive, impulsive and sometimes aggressive behaviors can be pretty off-putting. Research doesn’t seem to fully support this idea though. These patterns of peer rejection are seen in children with the inattentive type of ADHD too.

They may seem to be more withdrawn or uninterested in others. They tend to stumble socially and have trouble with being mindful of others’ feelings.

But ADHD-related behaviors is only half the story. Children with ADHD struggle, with a number of social skills deficits that make relationships particularly hard.

They tend to be more ‘bossy’
They tend to break rules during games
They tend to overestimate their likeability
They tend to identify peers as friends who are not
Peers may be wary of engaging with them due to past behaviors
They tend to struggle with using the social skills they know

If you child is struggling, there are things you can do to help!

Medication and behavior management can reduce troublesome symptoms but they do not help your child learn more effective ways of coping and social interaction.

Learning more effective social skills can help your child build skills to develop and sustain relationships. It might be tempting to seek out a social skills training program, book or video.

While these contain great information, they tend to not work well for children with ADHD because they are primarily focused on teaching social skills knowledge and less on actively learning how to use them. They overly focus on teaching social skills knowledge as opposed to attending to the performance barriers that prevent these children from enacting this knowledge in the heat of the moment. Kids have a hard time remembering and applying what they’ve learned. We tend to learn by doing. Through practice, trial and error.

And you, as the parent, are your child’s primary agent of change. What you say and do with them matters.

So what can you do to help your child develop better social skills?

Talk about social skills and interactions with your child.
Gently guide your child. If you need to make a correction, avoid criticism or ridicule. Pull your child aside. Acknowledge his or her feelings before offering gentle guidance.
Model appropriate social interactions in your exchanges with others.
Future pace – talk with your child about upcoming situations and how to appropriately engage.
Focus on building 1:1 friendships. Schedule play dates with a peer. Choose something fun but not overly stimulating or overwhelming. Play dates should be short - no more than an hour or so. You want the time to end positively.
Actively supervise and guide your child as needed during play dates and other peer activities. Be aware of cues that things are turning. A quick diversion can help to get things back on track.

If you want a more structured intervention, Parental Friendship Coaching (PFC) may help. PFC is a training program for parents of children with ADHD. Parents learn to coach their children on how to get along with others by teaching social skills, using carefully planned play dates to strengthen the parent-child relationship. There are a number of parenting training programs out there.

CHADD offers a number of trainings on various topics for parents of children with ADHD. You can learn more about parent training for ADHD here: http://www.chadd.org/Training-Events.aspx

Section 5.4: Knowing the Challenges ADHD Children Face And Overcoming Them

As we’ve discussed in previous sections, children with ADHD face a number of challenges:

Academic challenges
Social challenges
Behavior challenges
Treatment challenges

Each of these presents its own set of frustrations and interventions. That’s a lot for a kid to deal with!

It is not unusual for a child with ADHD to feel bad about themselves. After all, they’ve probably been in a good bit of trouble for not paying attention, for not getting their work done, for being disruptive or unorganized…the list can go on.

They’ve probably gotten a lot more reprimands than high five’s. Over time, this can affect he way they define themnselves.

With the challenges that ADHD presents, it can be easy to overlook what happening on the inside. How do these outward manifestations of ADHD affect the child emotionally? What is happening in there?

Turns out, a lot is happening! For a lot of kids, living with ADHD can affect self-esteem, self-perception and self-confidence.

A number of children with ADHD have other co-occurring behavioral or emotional issues that can profoundly affect how they cope with the challenges they face. Some children with ADHD also have what are known as externalizing problems such as Oppositional Defiant Disorder (ODD). Still others have what are known as internalizing problems such as mood disorders and anxiety. These co-occurring problems can have a negative impact on self-esteem.

As things continue to spiral downward, feelings of self-worth erode.

A positive sense of self is one of the most powerful forces in coping and resiliency. Having confidence in one’s abilities and worth enables perseverance even in the face of considerable adversity.

Kids with ADHD need a strong mindset that will allow them to keep learning the skills that will help them to succeed and flourish. By developing this mindset, they will be better prepared to step out into the world prepared to pursue their goals.

So how can you prepare your child to take on the challenges while building the self-confidence and self-worth he or she needs?

1. Find what your child is good at and encourage it.

There’s nothing worse than feeling like you can’t do anything right. The truth is, everyone is good at something. Help your child find the thing that they are good at. There will be time later for trying new and challenging things. Right now, your child has enough challenge. Find what they are already good at and do more of it.

2. Catch them doing it right

Kids who are used to being in trouble are used to being reprimanded. So when they are praised, it can be surprising, even a bit jarring. Look for reasons to praise. Look for the little things and say, “Great job. I like the way you…” You want to be specific because they don’t always recognize when they’re doing something well.

3. Build their sense of belonging and empathy

Children with ADHD don’t always have good self-awareness of how they affect others. Look for ways your child can reach out and help others. It might be cleaning out a toy box to donate some toys to the thrift store. There may be an opportunity to volunteer locally. Helping others feels really good and helps a child to see how his or her actions help someone in need.

4. Start small and be patient

Learning something new is hard for everyone. When you have ADHD it can be even harder. When your child has a new task to learn, break it down into small steps. Each step is a tiny layer of success that is a motivator to take the next step. Praise along the way. Support, but allow your child to do it on his or her own. Accomplishing a task is part of the building of self-efficacy – knowing that you can start and complete something successfully. When we believe we can, we do. When we think we can’t, we don’t.

5. Look for teachable moments

Every setback is not cause for alarm and every mistake does not require a heavy consequence. Sometimes the best change agent is learning what happened and what choices could have been made to change the outcome. These are teachable moments. They happen every day and are a perfect opportunity for your child to consider alternative choices that might have made the situation turn out differently.

6. Be present

Of all the things you do for your child, there is nothing more powerful in shaping self-worth than feeling that they matter. When your child is speaking to you, listen. Give your full attention. Make eye contact. Better yet, get down on their eye level. A child is the world’s expert in reading body language. When you look at them, speak directly to them and listen to understand what they are saying, so you are conveying the message, “You are important and I am interested in what you are saying”.

If you find your child is really struggling with self-esteem issues or you suspect that there may be some depression or anxiety present, it may be time to talk with a child therapist. A therapist trained to work with children’s mental health needs can identify where the struggles are and help your child learn ways to cope with the feelings he or she may be experiencing.

Section 5.5: Strategies for Setting Your Child Up For Success

So with all that we’ve learned about children with ADHD so far, how do we put it all together to set your child up for success? It’s all about having a plan.

What we know is that ADHD kids face challenges on multiple fronts: emotional, behavioral, academic, social, familial and sometimes, physical. You need a plan that addresses these needs and monitors for changes so you can react quickly and effectively if needed.

Every child’s needs will be different but here is what a typical plan might look like:

1. Be realistic about what you see. Trust your instincts.

If you think your child is struggling way more that an average kid might, you are right to be concerned. Ask the questions about behavior, about learning, about peer relationships. If it sounds like a struggle, it might be time to reach out for help. The more children struggle, the harder it is to overcome their deficits and the emotional impact.

2. Reach out to the experts.

Seek out the best child therapists and child psychiatrists you can find. Don’t let the word ‘psychiatrist’ scare you. They are the type of medical doctor who specializes in medications for emotional and behavioral disorders.

Depending on where you are in the world, ask about their board certifications and pediatric-specific training. Ask as many questions as you need to about any recommended treatments. If you are unsure, get a second opinion. Find a team you trust and work with them so that your child can achieve his or her best level of functioning.

3. Team up with the school. Get to know your special needs team.

Chances are, your child may need some special education services for accommodations, modifications or other interventions at school. Keep the lines of communication open. Don’t be quick to dismiss a new intervention. Give it time to yield results. If things aren’t improving, ask about reconvening to discuss.

4. Educate Yourself

Whether it’s a medication, a therapeutic recommendation or the special education process, take time to understand what all of these new things mean for you and your child. You want to be able to understand what is being recommended or done. You also want to know what your and your child’s rights are. You may never need to exercise them but in case a situation arises, you want to be able to be a strong, positive advocate for your child.

5. Check in often. Ask and listen to understand.

Children don’t often spontaneously tell us what they’re thinking and feeling. Check in regularly with your child. Ask about how things are going, what they’re feeling about the changes, what’s working and what’s not. Try to avoid the type of questions where you get ‘yes’ or ‘no’ answers. Instead, ask questions that require them to describe. Use these times to chat about anything and everything. These are great opportunities to offer praise and support. Listen for what they’re saying and what they’re not. Again, trust your instincts.

6. Look for opportunities for your child to grow

Your child may struggle with peer relationships or sibling relationships. Self-esteem might be problematic. Look for ways to build your child’s social skills. Plan small play dates. Plan some fun family activities that everyone can enjoy. If your child struggles with confidence, find something he likes and allow him to pursue it. Choose something he’s already interested in and has some experience with. Kids with ADHD often do better in individual sports or activities such as martial arts or dance. Contact and team sports can be overwhelming for some kids and beyond social skill level for others.

7. Make home a soft place to land

Home should be a place of comfort and support for every child. They need to know that home is stable, predictable, safe and loving. Have some structure and a schedule. Chaos can exacerbate ADHD symptoms. Model positive interaction skills and expect the same from others in the home. Practice healthy habits like getting exercise, serving healthy food, limiting screen time and maintaining personal hygiene. If sibling conflict is an issue, work on improving communication and understanding. Expect that everyone is treated respectfully. Make time for family fun.

8. Above all, be truly present.

Never underestimate how powerful this simple act is.

Section 5.6: Providing a Calm Environment to Ease Stress

As we’ve talked about in some previous sections, chaotic or ‘busy’ environments can exacerbate ADHD symptoms. Calm environments help to avoid or reduce the over-stimulation that sometimes occurs.

There are endless ways to create calm environments from restricting certain noises to creating calming areas. These ideas can be used at home or at school. You can mix and match what works for your particular child.

Quick Fact Fact

Calm spaces work equally well for kids who do not have ADHD and even sometimes for grownups. Everyone can benefit from a calmer space.

Here are some of the most commonly used strategies:

Create A Routine – Routines create stability and predictability. You know what is happening and when.
Create Quiet Spaces or Zones – Designate certain areas of the house or classroom as quiet areas for reading, doing homework or just relaxing. No electronics here. You can place ‘quiet’ items like books, puzzles or coloring books here. You can also encourage your child to go here when he or she is feeling anxious or upset as a place to calm down. This space should never be used as a punishment or time out space.
Use Soothing Colors – Color has an effect on how we feel. Some colours such as soft blues are soothing. Avoid bright colours, patterns or busy artwork.
Keep Things Organized – Clutter makes everyone feel stressed. For kids who have ADHD, clutter can make it hard to focus or stay on task. Make sure their study materials are organized. Same goes for their backpacks and bedrooms.
Help Them Prepare – Help them plan for what is coming next. For example, check and pack the book bag the night before. Lay out clothes for the next day. If a transition is coming, count them down. “Dinner will be in 10 minutes.” “We will have dinner in 5 minutes. Please start putting up.” Some kids really like visual timers. Preparing can help to avoid the meltdown when we can’t find the left shoe at 6:00 in the morning.
Designate Electronics-Free Time – Electronics can be fun but too much can be detrimental in so many ways. They can be overstimulating, distracting and even disrupt sleep. Our brains need a break.

Make Time for Outdoors – Exercise and fresh air are naturally calming and stimulate lots of feel good chemicals in the brain. Make time in the day for some outside time.
Limit Choices – Having too many choices can overwhelm a child with ADHD quickly. Instead, practice using a strategy called Forced Choice. Essentially, the child has two choices – either A or B. This limits the choices and possibility of getting overwhelmed which can lead to meltdowns.
Be A Role Model – Modelling calm behaviour is a great way to teach calm ways of behaving. Let your child see you as calm and in control. A bonus - being around calm people encourages calm in others.

Making small changes in how you do things can have a profoundly positive effect on your child.

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