5 Tips for Preparing Your Child for a Telemedicine Visit

In an effort to flatten the curve and reduce the transmission of COVID-19, healthcare professionals across the country are relying more heavily on telehealth. Here at Next Step 4 ADHD, we are proud to offer a variety of services through telehealth – and not just for adults. Children with ADHD don’t have to miss their sessions due to social isolation.

If your child has experience with FaceTime or Skype, he already has a good idea of what a telehealth session is like. Still, the idea of a virtual appointment can be intimidating for some children. If your child is scheduled for an upcoming virtual appointment, it’s a good idea to prepare your child ahead of time.

How to Have a Successful Telehealth Sessions

Here are 5 tips to make the transition from in-person visits to online sessions as seamless as possible.

1. Know what type of session your child is having

At Next Step 4 ADHD, your child can receive a variety of services remotely. This includes:

• New patient diagnosis
• ADHD screenings
• Medication management
• Talk therapy
• CBT
• Coaching
• Education
• Support

When you know what type of service your child is receiving, it’s easier to answer his or her questions.

Reminder: Telehealth sessions are for non-life-threatening visits. If your child is experiencing a serious mental health crisis or another emergency, call 9-1-1 or visit the closest emergency room.

2. Gather important information before the session starts

Before your appointment begins, make sure you have:

• A list of your children’s current medications
• Your child’s medical history, including allergies, weight, and any previous diagnoses
• A list of questions that your child has (if any)

Depending on what type of session your child is having, you might want to write down a list of concerning symptoms that you want to address. Be prepared to answer a variety of questions, including how the symptoms have been occurring, when the symptoms are most severe, and any other related details.

3. Find the perfect location

This is one of the most important steps to having a successful telehealth session. The ideal location is quiet, well-lit, and free from distractions. Consider setting up on the dining room table or in a den. The camera should be eye-level for your child.

If you have pets or other children, make sure they are situated elsewhere so you can focus on the session too.

4. Start with an introduction

You might have a telehealth session with a therapist or pediatrician that you’ve seen dozens of times. But if your child is seeing a new provider, you’ll start with introductions. Let your child know ahead of time if he’ll be meeting a new doctor so he can prepare mentally for the meeting. During the meeting, one of our providers will start by sharing his or her name and title. At this time, encourage your child to introduce himself too! After your child introduces himself, you’ll be asked to confirm a few details too. You’ll already have completed a treatment consent form, but you’ll still confirm your child’s name, date of birth, etc.

Tip: If your child is nervous (which is normal!), practice introductions beforehand!

5. Know your next steps

 Before your child’s telehealth session ends, make sure you understand the provider’s diagnosis, instructions, and/or advice. Keep a notepad handy so you can take notes during the session, if needed. Don’t hesitate to ask for clarification! We want to make sure your session is valuable and helpful.

Remember… We Are Here for You Too!

Working at home and doing school work at home is new to many families. During this adjustment period, it’s normal for kids to feel scared or nervous. Let your child know that we are here to help! We have created several resources and programs to help parents create learning environments at home.

•  9 Parenting Tips to Survive Isolation with Your Kids (and Maybe Enjoy It)
• Establishing a Home School Schedule for Your ADHD Child with Next Step Pediatrician Dr. Kristi Briscoe
• Motivating Your ADHD Child to Work Independently
• 8 Tips to Help Your Child with ADHD Thrive with E-Learning
• Surviving Online Learning: A Guide for Parents + Free Printables 

Questions? We’re Just a Call or Click Away

At NextStep 4 ADHD, we’re happy to provide comprehensive care for ADHD — for you and your children. If your child has ADHD, we don’t want him or her to miss out on valuable sessions. Whether you’re interested in receiving a diagnosis, therapy for your child, or other services, we are here to make sure your telehealth experience is successful. Give us a call or send us a message to request more information. 

Don’t forget to sign up for a membership so you can stay up-to-date with the latest news!

Surviving Online Learning: A Guide for Parents (Plus, Homeschool Schedule Printables)

With schools around the country closing their doors, you might be worried about how your child will manage online learning. This is a huge change for many kids and families, and children with ADHD may struggle with this new transition.  Shifting to an online school model can present new challenges for kids, including difficulty separating “home” time from “school” time.

Here at Next Step 4 ADHD, we are proud to offer support and tips to help you and your family, especially during this time of social isolation.

Keri Knight, LCSW has curated a list of several tips to help parents survive online learning with their children, so children with ADHD can adjust to online learning and thrive during this time.

6 Steps to Make Online Learning Easier

Whether you’re currently working at home or taking a break, shifting to online learning is still a big change. Thankfully, with a little planning, you can survive e-learning with your kids.

1. Name Your Expectations

First, make sure you know what is expected of your child each day. Then, make sure your child knows what the expectations are.

Teachers (and schools in general) have certain expectations for students as far as taking attendance by a certain time each day or establishing deadlines to turn in assignments, etc.  Parents should make sure that they understand what is required of the child, especially for younger kids, and then make sure the child understands what is expected of him/her. This ensures that everyone is on the same page.

Things to consider:

• Can she sleep in as late as she wants?
• Will you check in with the teacher or will your child need to do that?
• What if siblings need to share the one computer? How will they work this out  based on the requirements of the school/teacher?
• How long is your child expected to sit during “school time”?  Expect that staying focused and not getting distracted while doing schoolwork from home is going to be difficult. Managing expectations can help parents not feel frustrated when things don’t go how they want them to.
• What time does your school start?

You can think of this step as creating your own “school rules.” Post your rules where everyone can see them.

2. Reach Out to Your Child’s Teacher

Communicate frequently with your child’s teacher. Don’t be afraid to reach out and ask questions. In fact, asking questions may help you overcome any obstacles quicker. Remember, this is new to teachers too so they will be happy to help you out.

3. Create a Structure

Think of a structure as a daily schedule. Whereas step 1 focused on school rules, step 3 focuses on a schedule.

If your child doesn’t have a specific schedule (from his or her teacher) to follow each day, it will be important that you create one and do your best to stick to it. We created a printable schedule to help you get started. Download the bundle here.

Tip: When creating a schedule for a child with ADHD, remember that every kid is different so their needs will be different as well.

• Include breaks in your schedule. Some children with ADHD may need more frequent breaks to move around so they can focus.
• Work in the afternoon if needed. Some children are night-owls and are more productive later in the evening than in the morning.
• Don’t neglect your morning routine. Many children may struggle to wake up and get out of bed on time. Their schedule may need to include a morning routine with lots of time to transition from sleeping to waking and then into schoolwork.
• Consider accommodations.  If your child receives accommodations at school, these may need to be replicated at home. For example, if your child receives extra time on assignments at school, you may need to add extra time into the schedule for your child to complete assignments at home too.
• Include your children in the process. Have your child help you by offering suggestions. Giving your child a say will increase his or her buy-in, and they’ll be more likely to cooperate.
• Be specific. Children with ADHD do well with structures. For independent reading time, don’t write “read a book” on the schedule. Instead, break it down. Allot 3 minutes to choose a book, 2 minutes to get into the designated reading area, and 20 minutes for the actual reading.

4. Create the Right Environment

Your child’s school environment is important.

• Find or create a workspace that is conducive to working. Workspaces can include the dining room table, the kitchen counter (if you have an island or counter with seating), a desk in the living room, a lap desk on the couch, etc. Avoid working in a playroom or bedroom (if that’s where all of your child’s toys are). Seeing the toys can be visually distracting for your child.
• Eliminate distractions and clear any clutter. If your child is working on the table or counter, remove anything unrelated to school during school hours.
• Stay consistent. Having one place where they go to work each time can help increase their focus and trains their brain to know that when they’re sitting at their spot then it’s time to work. 

Not being in a classroom setting can make it more difficult to focus and easier to get distracted. You may need to make things external, concrete, and tangible. For example, you could print out readings, try to use a physical textbook if possible (versus an e-book), write out their daily assignments on a checklist and post it on the wall for them to see.

5. Don’t Forget to Schedule Breaks

Work in regular breaks and move around after completing an assignment. Not only is this good for the body, it’s good for the brain too!

How many breaks you need to schedule will be vary. Every kid is different. You can even ask your child to guess how long they think they can sit down to complete an assignment. If they think they can sit for 20 minutes, then set a timer for 15 (just under what they think they can do). When the timer goes off, take a quick break (get a drink of water, go to the bathroom, etc.) and then come back and set the timer to work for another 15 minutes.

Another strategy is to take shorter, 2-minute breaks. During these mini breaks, have your child run in place, do jumping jacks or push-ups, or run outside to the mailbox and back. This gets the oxygen flowing and can help the brain to focus and can help with restlessness.

6. Establish a System

Once you have your rules and schedule established, you’ll need to create a system. A system ties everything together into one streamlined process. Each family’s system will look different, and that’s okay!

Systems can include:

• Making lists
• Creating folders for each subject on the computer (and storing all website links in each bookmarked folder on your computer)
• Using timers or other extra reminders to turn in assignments
• Using visible reminders with Post-It notes 

Download Our Free Tools and Resources: Checklist + Schedule Bundle 

As you embark on your online journey with your kids, don’t forget to download our Home School Schedule Template Packet.

What’s in the bundle?

Included in the Home School Schedule Template bundle are printable checklists and schedules.

Questions? We’re Just a Call or Click Away

At NextStep 4 ADHD, we’re happy to provide comprehensive care for ADHD — for you and your children. If your child has ADHD, we are happy to help YOU get the resources and education you need to make the your child’s school environment a successful one. Whether you’re interested in online 1:1 coaching, therapy for your child, or other services, we are here to guide you with your next steps.  Give us a call or send us a message to request more information. 

Don’t forget to sign up for a membership so you can stay up-to-date with the latest news!

8 Tips to Help Your Child with ADHD Thrive with E-Learning

As the pandemic continues to makes its mark across the country, business and schools continue to adapt. Some have returned to in-person operations (with restrictions), some continue to operate remotely, and some fall into a hybrid of the two. For schools, this means making necessary changes to in-person schooling. Some school districts have mandated virtual school for at least part of the year. This means a great number of children are learning at home with e-learning. Although these efforts are good (in an effort to slow the spread of the disease), e-learning can come with a learning curve if you’ve never had to do it. Children with ADHD may struggle with a few new challenges, such as avoiding the distractions of their toys and games.

Here at Next Step 4 ADHD, we are proud to offer support and tips to help your children thrive, especially when facing new situations.

Psychological Associate Monica Clark has curated a list of several tips to help your child with ADHD experience an enriching e-learning experience.

Use These Tips to Help Your Child with ADHD Thrive with E-Learning

1. Maintain schedules and routines

Children with ADHD need structure and predictability to thrive. Maintaining their routines will increase chances for success. This means maintaining bedtime routines and sleep schedules, wake up times and morning routines, and meal schedules. Morning routine should be as similar as possible to routines when your child would be going to school (i.e. encourage your child to wake up, eat breakfast, and complete morning hygiene, including changing out of pajamas). This will signal to your child that it is time to be ready for the day. Meal times, especially lunch and snacks, should be consistent with when your child would eat at school.

Maintenance of routines will also decrease difficulties when your child inevitably transitions back to school.

2. Continue all medications

While your child is not in the school environment, they are still in a learning environment. It is important to maintain medication schedules as though your child was in school.

3. Provide some control

Learning from home provides your child with an opportunity to have a greater amount of control over their day and learning environment. Provide your child with a list of tasks and assignments that must be completed during the day and allow them to choose which order they will complete them in. Encourage your child to alternate preferred subjects with less preferred subjects. Provide your child with a schedule of the school day and have them note in which hour of the day they will complete each assignment. This will decrease arguments between you and your child related to order of assignments while providing your child with structure and predictability in their day.

Tip: Provide both 10-minute and 5-minute warnings when it is time to transition from one task to another.

4. Remember to include structured enrichment activities during the day

When attending school, children engage in a structured enrichment activity almost daily, such as P.E., art, or music. Including this in your child’s schedule will provide them with a much-needed release in their day. You can find fun arts and crafts activities, free musical instruction, or physical exercises online. Some museums are even offering virtual tours. (Check out the National Museum of Natural History tours here.)

Other ideas: Walking in your neighborhood for a bug or scavenger hunt, taking a bike ride, or going to the park to shoot basketball, kick a soccer ball, or other such activity would also be beneficial.

5. Provide a clean, distraction-free environment

Children should have a designated location to complete schoolwork. Work environment should have a desk or table that is free of clutter and distractions. Have your child’s books, papers, and other needed items stacked and organized neatly in the same room.

Hint: Having the items in the same room, but not within an arm’s length provides your child with much needed movement breaks during the day without encouraging long and distraction-prone trips to other rooms.

6. Encourage movement and breaks

Encourage your child to take a 5-minute break at the end of each hour. Encourage expenditure of excess energy during these breaks by engaging in a fun activity with your child, such as:

• Dancing to their favorite song
• Having a jump rope competition
• Racing around the yard

Longer breaks of approximately 15 minutes should occur twice during the day. During these longer breaks, children should be encouraged to play outside or, if weather does not permit outside play time, encourage your child to engage in high-energy activities, as described above. Do not allow screen time during breaks.

7. Don’t stress about fidgeting

Research has shown that children with ADHD learn and focus better when allowed to fidget or squirm in their seats. This behavior is often problematic and redirected in the classroom because it presents distractions and creates learning challenges for other students. With learning from home, you can allow your child the freedom to fidget and squirm as much as needed as long as they are focused and completing their work. This may actually enhance their ability to learn and be more accurate in their responses. You may find that fidget spinners or other tools are useful.

8. Remember, your child is anxious too

While being faced with the challenge of becoming a teacher for your child is anxiety-provoking, please remember that your child is anxious too. When children with ADHD are anxious, it may lead to a worsening of ADHD symptoms, including:

• Poor focus
• Difficulties completing tasks
• Restlessness
• Impulsivity

Emotional meltdowns are also common.

Using positive parenting strategies may help your child to combat some of these difficulties. Praise your child and help them to see what they are doing right rather than focusing only on what they are doing wrong. Setting up a rewards-based system, such as a points or sticker chart, where your child can earn rewards for completion of desired activities or behaviors may also be beneficial.

Remember that rewards for positive or desired behavior are more effective at managing behavior than consequences and punishment for problem behaviors.

Questions? We’re Just a Click Away

If your child is struggling with the symptoms of ADHD, we offer telehealth sessions so you can continue to get the care you need. Give us a call or send us a message to request more information.

Don’t forget that you can also request an appointment right here.

9 Parenting Tips to Survive and Maybe Even Enjoy Social Isolation With Your Children

9 Strategies for Helping Your Child Thrive While They Are Out of School

Lower your expectations. 

Close your eyes and picture what is most important to you as you consider these few weeks.  Whether in terms of behavior or learning goals, keeping our goals in perspective might help you not get lost in the little power struggles that truly do not matter.  

Practice encouragement. 

This means to comment on effort, even if the effort is minimal or sporadic or even imaginary (e.g., when your child accidentally does something helpful).  Say thanks for what your child does with the hope that they will do more of it simply because they know they can — and that it feels good to be capable. 

Encouragement is highly effective in motivating kids to both sustain and increase their effort in the long run.

Relationships and cooperation go hand in hand. 

When relationships are in a rut, it is near impossible to get children to cooperate and do what we ask of them.  Spending time with your kids playing games, reading, talking, doing puzzles, even occasionally playing video games can do a lot to build connections and grow their willingness to listen and comply with what we ask of them. 

Beware of rewards and bribes. 

Extrinsic motivators (such as rewards) are not effective in the long run. Instead, teach kids to focus on doing things because of intrinsic motivation. Intrinsic motivation is what causes a person to do something because it is fun or personally rewarding. For example, a child may sweep the floor and feel a sense of accomplishment. That feeling (the instrinsic motivation) helps encourage a child to help out around the house.  

Listen and make sure your child knows you are listening. 

Being heard is important for all of us.  If your child is upset or frustrated, state that you understand his or her concerns.

Be specific: “I understand that you are upset that it is time to turn off the TV and come to dinner” or “I understand that you are upset that your brother is in your space and distracting you.” 

Simply feeling heard can often go a long way in preventing negative behaviors.  

Beware of praise. 

Praise teaches kids to do things our way and sometimes leaves them feeling that they are either “good” or “bad” or “capable” or “incapable”.  Instead of praise, focus on encouragement. Encouragement focuses on effort —however small the effort is — and meets kids where they are. This encourages a willingness to try and fail … and ultimately grow.  All we can ask for, as parents, is a willingness in our children to do what we ask them to do willingly and with the willingness to learn and grow. 

Work with your children to create routines and plan for these weeks ahead. 

Maybe every day will be the same, and your children strive on predictability and structure.  Maybe you want to add some flexibility. 

The goal should simply be to allow your children to make some choices and then help them stick to whatever routine or agreement is made.  

Be kind and firm. 

Remember that we as parents get the opportunity to model the behavior we most desire in our children.  If we are kind, they are more likely to be kind.  If we are patient, they are more likely to be patient.  If we sit down instead of arguing with them, they are much less likely to act out and become frustrated or upset.  

Remember that as we parent our children it is important to provide lots of opportunities for success AKA “do overs.”  

If your child yells at you or is disrespectful, remember that if you yell and act like it is the end of the world, then your child will be unlikely to feel capable of acting any other way.  If we instead respond with love and understanding without yelling ourselves, then your child may be willing to try again when calm. 

Remember that one of the goals of parenting is to teach kids more effective strategies to deal with disappointment and life.  You can do your child a huge service if you allow them a safe, loving environment to learn how to respectfully disagree and negotiate effectively.  Simply by learning strategies to effectively be heard while also learning that they will not always get their way (and that the way they respond  to that impacts their future) is truly a wonderful gift that parents can give their children.

There Might Be Rough Patches… But That’s Okay

One of the best things we can do for our children is to show them that we as parents make mistakes too. Model a willingness to make changes and take a minute to learn ourselves … for the greater good.  When parents are willing to be “imperfect” and allow themselves to be vulnerable with their children (by acknowledging their part in whatever disagreement or struggle), kids learn that they, too, can take responsibility for their part without shame or fear and hopefully can begin working on actual solutions that can lead to much more peace and productivity.  

What Am I Doing With My Kids?

About Dr. Kristi Briscoe

Does Your Child Have ADHD? Here Are 4 Surprising ADHD Symtpoms in Kids

Attention deficit hyperactivity disorder — most often referred to simply as ADHD —  is a mental health condition characterized by a combination of inattention, hyperactivity, and impulsiveness. ADHD affects over 9% of American children, according to the Centers for Disease Control and Prevention — that’s roughly 6 million children. About 4 million of those children are between the ages of 6 and 11.

ADHD affects more boys than girls (12.9% versus 5.6%), and difficulty paying attention in school is a prominent symptom, but it’s not the only symptom of ADHD in kids. [1] The condition may affect children in many different ways, which may make it difficult for parents to spot the signs of ADHD, especially in younger children. 

Undiagnosed and untreated ADHD can negatively affect your child’s quality of life, especially his or her school performance. That’s why our health care professionals at NextStep 4 ADHD recommend you visit us as soon as you spot the signs or symptoms of ADHD in your child. 

Continue reading to learn more about the common symptoms of ADHD in children — and how we can help.

What is ADHD?

ADHD is a neurodevelopmental disorder that affects your child’s ability to focus and control impulses. [2] ADHD is not a lack of willpower to focus on the task at hand; instead, most experts believe the development of ADHD may be  influenced by a child’s genes, the presence of toxins in his or her environment, brain injuries as well as subtle nuances in the hardwiring of his or her brain. [3]

Common Symptoms of ADHD in Kids

Children with ADHD are known for fidgeting or demonstrating disruptive behavior in school, but these are just two signs of ADHD. ADHD symptoms all fall under three categories:

1. Inattention: These symptoms are related to the inability to maintain focus on a specific task.
2. Hyperactivity: These symptoms are characterized by excess movements.
3. Impulsivity: These are hasty actions that are performed without forethought.

Below is a sample of common symptoms that may affect children with ADHD:

• Becoming easily distracted during tasks, including school work 
• Skipping the fine details, especially in the directions for homework or school projects
• Difficulty maintaining focus when speaking with others or holding conversations with teachers; inability to repeat back what you just said 
• Self-focused behaviors such as interrupting the teacher
• Inability to wait for his or her turn in line or while playing a game
• Emotional symptoms, including increased outbursts (that are not age-appropriate) or increased temper tantrums
• Inability to sit still, including wiggling, fidgeting
• Difficulty playing quietly
• Increased careless mistakes on homework or schoolwork, not related to laziness
• Disorganization, including a messy desk at home or school 
• Forgetfulness, including misplacing homework or favorite toys

4 Surprising Symptoms of ADHD in Kids

In addition to the above symptoms, ADHD can present itself in more surprising ways, symptoms that may — at first — seem unrelated to ADHD. These include bedwetting and daytime wetting, time blindness, and meltdowns.

Bedwetting and daytime accidents

While it’s normal for a child to have an occasional accident, daytime accidents are 4.7 times higher in children with ADHD. [4]  

Time blindness

Time blindness is more than just poor management of time. This can manifest in many ways. A child may seem surprised and upset when it’s time to leave the park, even after a 5-minute warning. Time blindness can also affect a child’s ability to finish tests during the allotted time at school. It’s not that your child is ignoring you; he or she may not just perceive the passage of time in the same way as a neurotypical student.

Meltdowns

Unlike a temper tantrum, a meltdown doesn’t seem to cease if a child gets what he was asking for. A meltdown is how your child reacts to feeling overwhelmed. Sensory overload can even trigger a flight-or-fight response, which leads to yelling, uncontrollable crying, and even lashing out towards you or others. It can be very difficult to calm down a child in this state.

Poor social skills

Untreated ADHD can have profound effects on a child’s school and social life. Because untreated ADHD can make it difficult for a child to read social cues, he or she may struggle to produce quality work and form meaningful relationships with classmates. 

When to Worry about ADHD Symptoms in Kids

Daydreaming and even fidgeting can be normal experiences for kids, but if your child regularly experiences these symptoms — at home and school — it may be beneficial to schedule an evaluation for your child. 

Remember, ADHD is treatable! 

Holistic Treatment Options for Children with ADHD

If you notice any of these symptoms of ADHD in your children, don’t hesitate to reach out to the experienced team of psychiatrists, pediatricians, psychologists, therapists, coaches and healthcare professionals at Next Step 4 ADHD. Working with a  coach or therapist can help things like time management, reducing the frequency of meltdowns, and improving social skills.

We treat ADHD with a holistic, 5-tier approach and provide:

• Assessment
• Education
• Coaching
• Support
• Medication, if needed

Regardless of what age your child is, treatment can help provide the relief your child needs. 

Questions? We’re Just a Call or Click Away

At NextStep 4 ADHD, we’re happy to provide comprehensive care for ADHD — and you don’t have to wait weeks for an appointment. If you’re struggling with the symptoms of ADHD, visit one of our convenient Kentucky offices in Louisville and Lexington. Call the location of your choice, or send us a message to request more information. 

You can also request an appointment easily here.

References:

1. What Is ADHD?, www.psychiatry.org/patients-families/adhd/what-is-adhd.
2. “Data and Statistics About ADHD.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 Oct. 2019.
3. “Attention-Deficit/Hyperactivity Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services.
4. Tajima-Pozo, Kazuhiro, et al. “Treating Enuresis in a Patient with ADHD: Application of a Novel Behavioural Modification Therapy.” BMJ Case Reports, BMJ Publishing Group, 10 June 2014.

Parenting a Child with ADHD: 5 Tips for Peaceful Bedtime Routines

Bedtime can be one of the most challenging times for parents of children with ADHD. Evidence suggests that sleep problems are more common in children with ADHD. Parents frequently report problems, such as trouble falling asleep, anxiety and difficulty relaxing at bedtime, feeling unrefreshed after sleep, difficulty waking in the morning, and nightmares. Chronic insufficient sleep leads to children becoming overtired and a worsening of ADHD symptoms, including increased hyperactivity, impulsivity, aggression, and mood swings. As parents, there are several techniques that can be implemented to help decrease problematic sleep.

That’s why the ADHD coaches at NextStep 4 ADHD are happy to help parents navigate the challenges of raising a child with ADHD. From providing educational resources to sharing practical tips, our ADHD coaches are with you every step of the parenting journey.

In the meantime, continue reading to learn more about sleep and how the quality of sleep affects children living with ADHD.

Why Good Sleep Matters

Good sleep is more than just logging enough hours. A good night’s sleep refers to both the quality of sleep and the quantity of sleep.

Getting enough sleep plays a critical role in:

• Balancing your child’s mood
• Improved immune function [1]
• Energizing your child (physically and mentally)
• Reducing cortisol levels (the stress hormone)
• Cellular growth and repair
• Improved memory [2]
• Reduced risk of depression [3]
• Reduced risk of childhood obesity [4]
• Improved athletic performance [5]

Even though sleep is crucial for mental and physical well-being, it isn’t always easy to get kids to want to get to bed on time. Some kids may feel like bedtime forces them to miss out on exciting parts of the evening, but here are five tips to make this transition easier:

5 Tips for Making Bedtime Easier

Create consistent sleep-wake routines.

Research has found some evidence to suggest that children with ADHD do not produce enough melatonin, the body’s natural hormone to aid with sleep. Without enough melatonin, a child simply may not feel sleepy at bedtime.  Some children may have delays in the timing of the release of melatonin. You can help regulate melatonin production in your child by creating consistent bedtimes and wake times — even on weekends. Because this helps to regulate the brain’s natural sleep rhythms and the release of melatonin, you’ll find that bedtimes get easier.

Establish a bedtime routine.

All children thrive on routines and structures, but children with ADHD need structure in order to function at their best. This is also true at bedtime.

One hour before bedtime:

Parents should start bedtime routines at least an hour before you desire your child to be asleep.

Children should be encouraged to:

• Take a relaxing bath (unless they bathe in the morning as part of wake-up routine)
• Brush their teeth
• Get a small drink of water
• Use the bathroom
• Get into pajamas

Two hours before bedtime:

Children with ADHD need longer, darker, and quieter bedtime routines in order to relax and prepare for sleep compared to other children. Children with ADHD benefit from quiet activities, such as reading, rather than more stimulating activities. All electronic devices, such as phones, tablets, and televisions, should be shut off at least an hour (preferably two) before bedtime. (This is because blue screens can affect the circadian rhythm.) Parents should dim the lights and encourage quiet activities. Some children benefit from reading time with their parent. Not only is this soothing, but it’s a great way to bond!

Drown out ambient noise and light.

Children with ADHD are easily distracted by extraneous noise and light, even when trying to sleep. Use of a white noise machine or a fan to drown out noise can be beneficial if regular household noises are keeping your child awake. Light in the bedroom during sleep time should be limited to a small nightlight.

Consider a weighted blanket.

Children with ADHD have higher incidences of both Restless Leg Syndrome and Periodic Limb Movement Disorder. Restless Leg Syndrome causes discomfort and leads to voluntary movement, and Periodic Limb Movement Disorder is characterized by involuntary movements of the limbs during sleep. Both are associated with poor sleep.

Additionally, some children with ADHD struggle with anxiety at bedtime. Weighted blankets may provide physical and emotional comfort by providing pressure on the body, much like a hug.

Talk to your doctor if sleep difficulties continue.

There are many supplements and medications that may be beneficial to help your child sleep.

Questions? We Are Here to Help!

At NextStep 4 ADHD, we’re happy to provide comprehensive treatment for ADHD for children.  To learn more, schedule an appointment at one of our convenient Kentucky offices in Louisville and Lexington. Call the location of your choice, or send us a message to request more information. 

Don’t forget to sign up for a membership so you can stay up-to-date with the latest news!

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/8621064
2. http://learnmem.cshlp.org/content/11/6/671
3. https://www.ncbi.nlm.nih.gov/pubmed/16259539
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2398753/
5. https://www.ncbi.nlm.nih.gov/pubmed/21731144

Traveling with a Pre-School Age Hyperactive Child Abroad

This summer my wife, Kristi Briscoe, M.D., and I brought our two boys along with us on a 10-day trip abroad to Paris and Southern France. Our oldest, “E” is seven and was very excited to see “mummies” and several other items of interest in the Louvre. “E” had never traveled abroad, but had done okay with long distance travel across U.S. in the past.

Our youngest – we will call him “H” – is four years old and really wanted to see the “big tower” (Eiffel Tower). However, we were a bit hesitant because ‘H’ is the quintessential energizer bunny. “H” does not have an OFF button, or even a PAUSE button – just FAST FORWARD and SUPER FAST FORWARD buttons that are kinda stuck in the ON setting all the time. And the more tired “H” gets the more energy he seems to get. He also suffers from ICD: otherwise known as ‘Intermittent Climbing Disorder'(humor) characterized by intermittent and unexpected episodes of climbing over railings, onto chairs, on top of tables, and other various places where children and most 2 legged creatures normally are not intended to place their legs or feet.* Needless to say we were not quite sure how this was going to work out on an oversees trip, with all the airports, airplanes, time zone changes, jet lag, metro stations, train stations, small hotel rooms, crowds, restaurants, foreign etiquette, etc.

After much deliberation and second guessing ourselves, we went ahead and decided to take both “E” and “H” along for the trip.

Ultimately, the trip was OKAY overall. If we had to do it all over again, however, I think that we might consider forgoing Paris until the youngest (“H”) was older. Personally, I think that he would have been more able to appreciate Paris if he was at least 8 years old. Although the children enjoyed going up the Eiffel Tower, seeing ‘mummies’ in the Louvre, and the playground of the Luxembourg Gardens, they did not get a whole lot out of Paris. Luckily, my family spent the majority of our time in a more rural area of Southern France (where my wife and I were completing some continuing medical education) and the children had opportunity to run and play more freely, ride bikes in the countryside,and swim in the ocean. If our time in France had been limited to Paris alone, the trip would have been a disappointment.

We did, however, use the trip to make some useful observations and can provide some useful suggestions for those considering traveling abroad with young children who struggle with hyperactivity:

Anticipate Jet Lag: Western Europe is 6 hours ahead of Eastern Standard time, so it may help to begin gradually adjusting your family’s bedtime to an earlier time beginning several weeks in advance. For the first 3-7 days after arriving to Europe and after returning to the U.S., you and your children may find it helpful to take Melatonin to assist with the transition in time zones. Note that the dosing for Melatonin for children is very different than the dosing for adults often indicated on over the counter Melatonin supplements. We recommend that you contact your pediatrician or discuss with a child psychiatrist for proper dosing instructions. Adults should likewise discuss with their medical doctor.

Anticipate that your hyperactive child may be more hyperactive as he/she adjusts to the new time zone. Lack of sleep can significantly worsen hyperactivity. He/she will also be excited with the new environment. As he/she gets caught up on sleep and adjusts to the new schedule things should improve. Just be extra patient with your child, and be careful with your own irritability – a lack of sleep on your own end may render you more irritable and less patient, especially on the first day of your arrival after a long overnight flight.

Try to get some sleep on the plane: Most flights to Europe depart the U.S. in the evening and arrive in Europe in the morning. If you can afford First Class or Business Class seats with seats that recline to complete horizontal, go for it; but most families (including us) find such accommodations cost prohibitive and need to try to find a way to sleep while sitting upright in standard coach sections of the plane. We recommend that you spend some time searching online for the various creative solutions that you can purchase online to help solve the problem of trying to sleep in upright seats.

A variety of products, ranging from forward-leaning pillows to between-seat hammocks are available. Verify with your pediatrician that the products will be safe for you child. Also, consider consulting with your pediatrician (or child-psychiatrist) and your own doctor regarding options for sleep aids that may help during the flight.

Anticipate that your child(ren) will be very tired the first day, regardless of whether or not they slept on the plane. Do not plan many activities on the day of your arrival. My family planned only one activity on our day of arrival in Paris – a leisurely 1.5 hour bus tour of the city around mid-day after dropping the bags off at the hotel. No walking. Go to bed early the evening of the first day to catch up on sleep. Melatonin may help get everyone on sync with the new time zone.

Pack Light: There is nothing worse than chasing a hyperactive child around an airport or train station while simultaneously trying to manage excessive amounts of luggage. Better to wear the same clothes several days in a row than throw out your back. Europeans don’t insist on wearing freshly washed clothes like we Americans do, but you can always wash your own clothes once you arrive if you insist.

Pack ADHD medication: If your child is taking medication for ADHD, do not forget to pack his/her medication. Place the medication in its original container from the pharmacy so you do not have any trouble with customs. Always pack your your medication and your children’s medication in your carry on and not your checked bags in the event that your luggage is delayed. And make sure to give your child his/her medication everyday. This is not a good time to have your child take a vacation from medication.

-If you are traveling to Paris or other major tourist city, do NOT focus on seeing all the tourist highlights. Dragging a hyperactive child through museums and all over a city sightseeing will prove to be a very unpleasant experience for all members of your family – including you. If you want to do the hardcore ‘tourist thing’ you should come back to the city another time without your children. You will be better off this time picking no more than ONE tourist highlight to check out on a single day, and make the ENTIRE rest of your day focused on doing activities geared strictly towards the children’s interests.

-Visit parks where the children can run freely to burn off energy. Purposely seek out playgrounds. Search out ‘children’s activities’ for the city you are exploring online and stick to activities that will keep the kids running, playing, laughing, and enjoying themselves. Do some ‘people watching’ while you keep and supervise your children. You will be pleasantly surprised to learn that you will still enjoy your time and get a taste of the atmosphere of the city and more genuine feel of the foreign culture as you play with your family alongside the local families in their ‘real’,’non-touristy’ neighborhood parks and playgrounds.

Introduce your children to foreign language and teach them about foreign culture. If you have an iPhone or Android device, consider downloading several apps months in advance of your trip that teach children some basic vocabulary of language spoken by the country they will be traveling to. Start teaching them some basic vocabulary over dinner conversation and start to teach them a few facts about foreign culture. If you do not know these facts or the language yourself, this can make for a great learning experience for your entire family to embark upon together! Your taking the first step in moving outside of your comfort zone to learn something new will be setting a good example for you child and may even open up new opportunities for them in the future.

*Intermittent Climbing Disorder is not a real medical disorder – it is only a term made up by the author of this article for the purpose of facilitating humor.

Choosing a Medical Professional to Evaluate for ADHD in a Preschooler

ADHD can be diagnosed by psychologists, family doctors, general pediatricians, developmental pediatricians and psychiatrists. Accurate diagnosis takes time (often greater than 60-90 minutes) and many medical practices are logistically unable to allow adequate time for these evaluations.

Ideally, the professional will have adequate time to perform a detailed parent and child evaluation, perform a thorough physical exam, provide ADHD information, provide recommendations and resources, make needed referrals and answer questions so that steps can be made quickly to improve future outcomes.

It is very important that treatment options be discussed with a professional who is well informed about the significant, life-long consequences of delaying ADHD diagnosis, interventions and treatment. It is also important to seek a professional who is aware of the benefits of early intervention with parent training for preschoolers with ADHD symptoms.

Many general physicians are unaware of the importance of early intervention and will recommend waiting to see if the behavior resolves “with time”, but often the behaviors are not readdressed until the following year. Few negative behaviors resolve “with time” and in many cases, the failure to start effective parenting leads to worsening behavior and more challenges at both home and school. This professional should also be aware that several other conditions can have ADHD-like symptoms like anxiety, autism spectrum disorder, sensory integration disorder, auditory processing disorder, and others.

At Next Step ADHD Specialty Clinic, we have Board certified physicians and doctorate level psychologists who specialize in diagnosing and treating ADHD.

Call us at 502-907-5908 or Contact us via this form to book an appointment with one of our physicians or therapists.

If you don’t get help from us, seek help from someone with significant experience and expertise in treating ADHD.

How to Manage a Hyperactive Child at an Amusement Park

Taking a hyperactive child to amusement park or on a Disney vacation can be a challenge. But it can also be quite enjoyable if you plan well, stay flexible, and maintain a healthy mindset.

This past October we had the opportunity to take our two children to Disney World in Orlando Florida. Our youngest, who is 3 years old, is quite hyperactive and considered ‘at risk’ for ADHD. So much so that, upon observing our son’s behavior, one of the Disney staff members portraying the character of Aladdin affectionately referred to him as a “little blonde monkey dressed up like a human.” Hence, in this article we will refer to our ‘little monkey’ as ‘Abu.’

You would think that, as a pediatrician and a psychiatrist, we would ‘have it together.’ We did make some reasonable preparations in advance, but over the four days of our trip we made more than our share of mistakes and learned some lessons the hard way.

Here are some tips we would like to share with you:

• Try to stay on a healthy regular schedule as much as possible. A lack of sleep can exacerbate hyperactivity and other symptoms of ADHD.
• Avoid exhausting your child. Try breaking up your visits to the park into 4-5 hour intervals with breaks to your hotel in between. If you are going to stay out late into the evening hours, take a break in the middle of the day for a long nap.
• When eating in the park, don’t expect your child to finish eating all their food during meals. They will be very excited to be in the park, and that is okay. Don’t have a ‘clean your plate’ battle with your child.
• Eat healthy food whenever possible. Try packing some healthy snacks so you can avoid sugary snacks that are sold in the park. But don’t sweat it if you child wants to indulge in some sweets for the day. Its okay to get some ice cream or chocolate. Just beware the effect of sugar in the late evening hours.
• If your child is on medication for ADHD, bring it and have your child take it as usual. This is not a day to skip medication.
• Keep yourself and your family well hydrated. If the park does not provide free water, bring your own. And remember that soda products are neither healthy nor hydrating.
• Waiting in long lines can be very difficult for a hyperactive child. Many parks, including Disney, provide special accommodations to children with more significant cases of ADHD and other disabilities – such as the ability to bypass the line. Family members, including siblings, can join their child and jump straight to the front of the line. Inquire with the park’s Guest Services regarding “Disability Access Services” (as the service is called at Disney). Disney does not currently require a note from a doctor, but other parks may and our office will be happy to provide.
• Keep your expectations realistic. Remember you are here for your child’s enjoyment, not for yourself.

If your child does get a little “wild and crazy” for a moment, have a good sense of humor about it. And have fun. We actually used our little monkey ‘Abu’ to get revenge on a couple of snotty 20-year-old girls who cut it in front of us in line by letting our little Abu run loose for a few minutes and resisting the urge to tell him to keep his hands to himself. A few head butts and elbows to the ladies’ legs and they were wishing they had not cut in front of us in line.

My child has ADHD. Could I have ADHD also?

It is not uncommon for a parent to approach me and ask me if they might have ADHD after their child has been diagnosed.

ADHD is a genetic condition. When it exists in one family member, it can oftentimes be found in siblings, parents, and even grandparents. If your child has ADHD and you seem to struggle with maintaining your attention/focus, distractibility, and/or organization, you might just have ADHD too. It may be worth investigating, as treatment can greatly improve a person’s quality of life and improve day-to-day function.

If you grew up in the 1970’s or 1980’s, symptoms of ADHD were often ignored as teachers and doctors were not screening for it. As a result, many adults have lived their lives struggling with the symptoms of ADHD without ever receiving formal treatment.

Contrary to popular opinion, people do not ‘grow out’ of ADHD. Studies have consistently demonstrated that 50-70% of cases of childhood ADHD persist into adulthood. Adults typically do not struggle with hyperactivity, but rather tend to struggle with maintaining control over their attention, being easily distracted, feel like they can never ‘get themselves together,’ seem to be chronically disorganized, and struggle with time management and drastically underestimating the time it will take to complete a task. Adults with ADHD oftentimes start numerous projects and fail to complete many of them.

Edward M. Hallowell, M.D., professor of psychiatry at Harvard University and author of the bestselling book “Driven to Distraction” points out, adults with ADHD are often driven from one exciting stimuli to another, jumping from task to task with limited ability to maintain focus on one particular task at a time.

For more information about ADHD in adults, read the book “Driven to Distraction” by Edward M. Halloween, M.D. The book is widely available in bookstores and can be purchased on Amazon.com.

If you think that you might have ADHD, use the link to access an assessment :
http://psychcentral.com/quizzes/addquiz.htm

The above link is only a questionnaire and NOT diagnostic. If you feel you may have ADHD, contact a qualified mental health professional and schedule an evaluation.

Call us at 502-907-5908 or email us to book an appointment for an ADHD evaluation.

If you don’t get help from us, seek help from someone.

Life and the future can be much brighter with treatment.