Kid's Health topics

Practical ways to help high-functioning young people with ADHD

G’day everyone and welcome back to another exciting instalment of Dr Megs – Paeds & Feeds!

I am actually sitting on the plane (row 23) on my way back to Brisbane after a fun weekend of conferencing with a few friends in Melbourne.  I attended an ADHD Clinical Insights Conference (which was really interesting) where delegates were from one of general or developmental paediatrics, paediatric psychiatry or adult psychiatry.  ADHD of course stands for “Attention Deficit Hyperactivity Disorder.”

So asides from the fact that I had a great night out last night drinking lovely wine and eating yummy, trendy Melbourne food with friends, I wanted to blog about a really interesting topic that was discussed at the conference.  After last week’s epic 5 page article on dyslexia (sorry about that!), it was my hope that this week there will be less writing on my part, and less reading on yours!

 

The speaker was Dr Hugh Morgan a Sydney-based general adult and adolescent psychiatrist, and the topic was about “ADHD Impairment in the High Functioning Patient.”  Credit for this information goes to Dr Morgan – this article is based on things that I learned in his lecture.

Now I know, I know – I generally don’t blog about topics that affect adults, but I really felt that this information was really relevant to my tween, teen and young adult population and for those parents out there with a child (or someone in their family) with ADHD, I learnt some really helpful everyday tips to support people with their time management skills which I hope to share with you here.

So what are we talking about here?

I have written articles about ADHD before, and for those of you who have read those articles, you would know that most people who suffer from ADHD have at least average intelligence (or cognitive function)  – meaning that often, they have good problem solving skills.  The struggle however, comes from deficits in their executive functioning.  Executive functions are those skills that we use every day to help us to function in our lives in an orderly and efficient manner: like attention, organisation, planning, working memory, control of impulsivity etc.

For those of you who haven’t read my other article on ADHD, try this link here.

So carrying on along this train of thought, it seems that young adults with ADHD have great difficulty with managing their time.  This can manifest in a number of ways. Some examples might be:

  • Always running late
  • Failing to organise workload and missing deadlines for things like homework, assignments etc
  • Getting ready for school in the morning (eg missing the bus or train)
  • Going to bed at a reasonable hour

This is not only a HUGE source of frustration for parents, but often a real cause of frustration the patient themselves!  So this lecture I attended by Dr Morgan helped me to compile a really useful and practical list of ways we can HELP young people with ADHD, who struggle to manage their time (and you know how big I am on PRACTICALITY and APPLICATION of information for parents and patients!!).

 

TOP TIPS for helping TWEENS, TEENS and YOUNG ADULTS with managing their TIME

  1. Wear a WATCH

According to Dr Morgan, many of the ADHD patients he sees that struggle with time management fail to wear a watch!  Now this is not an uncommon thing in paediatrics – many children (including my own) don’t tolerate wearing watches because they “don’t like the feeling of the band on their skin,” or it “makes them sweaty.”  Just like many things in childhood, wearing a watch can take some getting used to.  Encouraging your child to wear a watch not only helps them with time awareness, but also allows them to get a feel for how their daily routine and plans fit into a time schedule.  Point to note:  It is really important to ensure that the child who you are encouraging to wear a watch, actually knows how to tell the time!  Remember you have both analog and digital watches to choose from.

Using a smartphone INSTEAD of a watch doesn’t work in this subset of patients, because… well, they have ADHD.  Fundamentally, these kids are easily distracted and already have poor attention.  Using a phone to check the time is fraught with danger because they will easily get distracted by incoming text messages, social media (Facebook, Instagram, Twitter etc), new feeds etc etc.

Bottom line:  encourage them to wear a watch!

  1. Use a diary and develop a good daily routine

I am SUCH an advocate for using a diary and a calendar!

With young people, organisational abilities and everyday functioning (including the ability to keep track of homework, assignments and meet deadlines) is highly dependent on their working memory and conceptualisation of time.  See here for my “Top tips for Study Planning” and “How to write a Study Plan.”

Using a diary helps kids to see at a glance, what is coming up for the day/week/month and developing a good, regular and reliable daily routine, helps enormously with organisation and planning because expectations are more predictable and easier to remember if they are repetitive!

  1. Optimise your sleep-wake cycle

You guys know me, I am always banging on about the importance of  sleep.  Sleep at any age is of utmost importance to any individual’s life and ability to function because it literally affects EVERYTHING!  Many individuals with ADHD experience sleep difficulties – whether it be with sleep onset and/or maintenance, and this has the potential to detrimentally affect

  • Learning
  • Attention and concentration
  • Task completion
  • Mood/irritability
  • Anxiety (which is a driver for avoidance and procrastination – the two best buddies of poor time management)
  • Relationships and social interactions
  • Memory and working memory
  • Immune function and general health…. The list goes on and on!

It stands to reason then that poor sleep can affect an individual’s ability to time-manage, and not in a good way.  Exactly HOW we optimise someone’s sleep-wake cycle is another article in itself, but as a quick refresher, click here for my article on NORMAL SLEEP patterns for kids of different ages, and here for my article on “Common Sleep Disorders and How to Deal with Them.”

Establishing a good bedtime routine with good sleep hygiene is probably the most important thing that you can do immediately.

For children who are on stimulant medication (like methylphenidate, lisdexamfetamine, dexamfetamine etc) – talking to your paediatrician about optimising the dose and dosing schedule of your child’s medication is really important.  Aids to establishing a good sleep routine (eg like melatonin) might be appropriate, so talking to your paediatrician about this is a good idea.

  1. Be mindful of substance (mis)use (eg marijuana, alcohol)

Well, this goes without saying.  Mind altering substances can affect… well, not surprisingly, the way your mind is supposed to work!  Thankfully this is not something that paediatricians have to deal with often, but it is definitely something to be aware of in tweens and teens as it can have a deleterious effect on many executive functions.

  1. Exercise

In many kids with ADHD, their condition has a motor-overactivity component.  Regular moderate exercise is a huge tool that can be used to advantage for obvious reasons, in the same way “brain breaks” or rest breaks when concentrating for extended periods by burning off excess energy and supporting the child’s ability to concentrate.

  1. Support establishment of autonomy and individuation

This can be really hard for some parents to do!  We frequently use the term “helicopter parent” and I must admit, that when I take my 3 year old to the park – I am one of these (I can’t help it!! He is such a loose cannon!)!

But when we are talking about teens and young adults, not allowing these kids to learn how to manage themselves, their tasks and their TIME is doing them a disservice.  Like anything, the skill of time management is learned and honed through practice, and we need to step back and allow our kids to take responsibility for themselves.

  1. University/TAFE Disability support

Talking to your school guidance officer and Special Education teachers early is a really good idea.  They can point you (and your child) in the right direction of support where and when it is needed.

  1. ADHD clinical coaching

Young people with ADHD sometimes need psychotherapy, but often they DON’T.  What they DO need is someone to teach them how to manage their time, get organised (and stay organised), problem solve in difficult situations.  In essence, the aim of ADHD Coaching is to target the deficits that the patient has in their executive functioning and help them to achieve their own personal predetermined objectives and goals.  Talk to your GP, paediatrician or psychiatrist about how you can access a service like this.

  1. Clinical psychologist intervention

A paediatric psychologist (or neuropsychologist/educational psychologist) is trained to help children (and their parents) improve skills like time management, organisation and planning, as well as being qualified to help detect and manage co-existing conditions such as anxiety and mood disturbance.  A skilled paediatric psychologist is a hugely useful allied health professional that has a lot to offer the young person with ADHD.

 

So we have managed to smash out an article in 3 pages (over a one way flight home from Melbourne!)! Woot!  Still longer than I intended but hey, at least I’m consistent!!

Now I just wanted to let you guys know that I might be a little thin on the new articles over the next 2 months.  I have a final subject to complete for my Masters of Public Health (I won’t be finishing my Masters, but I will finally be able to complete my second sub-specialty fellowship!) and I have 2 large assignments due that just have to take priority.  I’ll still post blogs about food when I can (the family still has to eat!) and we will still do “Archive Wednesday” posts on the Facebook page, but will be taking a break from new original articles until August.  If you are really interested, I could post the 2x 3000 word assignments that I have to write for uni… but I suspect that no one will want to read them 😉

Thanks for understanding and keep posting me comments – I always love to hear from you!

Till next time,

 

xxDr Megs

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