Dr. Mark Bertin, a board-certified developmental behavioral pediatrician, studied at the UCLA School of Medicine and completed his training in general pediatrics at Oakland Children’s Hospital in California. Dr. Bertin is an Assistant Professor of Pediatrics at New York Medical College. Dr. Bertin is a frequent lecturer for parents, teachers and professionals on topics related to child development including autistic spectrum disorders, ADHD and parenting. Dr. Bertin is the author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child’s Attention While Minimizing Parents’ Stress. His “Child Development Central” blog can be found on the websites of Psychology Today and Education Update. His website is www.developmentaldoctor.com.
What drew you to helping parents of children with ADHD, not just their children?
It’s hard to address everything going on with ADHD if you only look at an individual who has it; it affects the whole family. Parents are often stressed, confused, or overwhelmed trying to manage children with ADHD. When they began to understand ADHD and feel more in control, everything gets better at home.
In The Family ADHD Solution you mention that if a child has been diagnosed with ADHD, there's a good chance that at least one of parents may have ADHD as well. What parenting issues are more common in a family where both the parent and the child have ADHD?
Parents of a child with ADHD have a two- to three-fold increased chance of having it themselves. Since ADHD typically affects organization, planning and life management in general, it can influence how people parent. Managing ADHD requires consistency and an emphasis on routine, which can be difficult when parents have untreated ADHD themselves. Even maintaining an emphasis on positive feedback and reward can be harder with ADHD, because of reactivity, distractibility and other symptoms.
You mention the importance of parents practicing good self-care in general, especially those whose kids have ADHD. Why is self-care so important?
When parents feel better, so do kids – one study even said that the number one predictor of stress in kids is their parents’ stress. When we’re stressed we’re more reactive, less likely to think clearly, and probably not as warm and supportive as we could be. Our kids’ needs often come first, but somewhere in the big picture we need to find the time for ourselves too. It’s sometimes a tough balance but usually worth it.
Why is an emphasis on praise and reward particularly important for children with ADHD?
Most children are motivated by positive feedback of any kind from grownups, and targeted praise and reward can help improve behavior all on their own. It’s not only that, though. Without using praise and reward we’re left with nothing but correction and punishment for changing behavior.
Children with ADHD get an incredible amount of negative feedback from parents and teachers. And they often do need some kind of redirection to stay safe or just get their schoolwork done. To maintain a sense of balance in their lives, children with ADHD need an ongoing focus on praise and success regardless of what’s going on in the bigger picture. Empty praise isn’t useful, so it can take effort. Adults may need to go out of their way to find even small successes. Praise and reward may not change everything on their own, but are still the first step in any behavior plan.
How would you answer criticisms that giving a child a reward for good behavior is just the same as bribing them?
All of us are more motivated to do things we enjoy or that give us sense of worth. With ADHD, though, when something isn’t completely exciting it is physically difficult to stay on task, for neurological reasons. Using reward to increase motivation is a nudge in the right direction, a way to keep the brain on target.
What is the practice of mindfulness, and how can it help parents of children with ADHD?
We live much of our time distracted, on autopilot. We’re doing one thing and our minds are somewhere else. We’re having dinner with the family while rehashing the fight we had at work or lost in a fearful fantasy of our child’s academic future or caught up in anger at our spouse … and meanwhile, dinner is still happening. We start arguing over schoolwork without any real focus on what we’re doing or saying, and fall back on some habit that hasn’t solved anything so far. Maybe we shut down and stop engaging, or get stuck in rumination. So instead of autopilot, mindfulness is about paying attention to our actual experience, as it happens.
Practicing mindfulness isn’t really about paying attention alone, it’s about how we live our lives. It helps us manage stress, in dealing with all the challenges of daily life. And when we’re less stressed, we make better choices, instead of simply falling back on entrenched patterns. We’re calmer and think clearer, and are at our best more often. None of mindfulness is particularly esoteric; it’s common sense. There’s so much research behind it that it’s now part of routine training for psychologists.
Mindfulness also helps in seeing a child’s experience with ADHD more fully, letting go of old assumptions about behavior and finding new ways to move forward, or finding new ways to handle particular challenges. It helps maintain some sense of calm and balance in what may otherwise feel like a storm.
In Chapter 6, "Taking Care of Yourself: Mindfulness in Action", you mention "Skillful Communication with Children". What are the hallmark features of this type of communication?
How we communicate affects how smoothly a discussion will progress. But in the middle of a stressful moment, we’re not always at our best. Maybe we’re listening to why homework hasn’t been done, but our body language shows our anger, or our tone of voice shuts our child down. Maybe we don’t really hear anything being said to us because we’ve already decided what to say next. Most of us recognize this isn’t an ideal way to have a useful discussion.
Skillful communication involves staying calm, listening before we speak and keeping track of our body language and tone of voice. We aim to respond, instead of mindlessly reacting to what’s being said. We don’t have to concede any particular point we feel strongly about or give in, or suppress what we are feeling. We don’t have to act like someone we’re not ... if you’re a sarcastic New Yorker, be a sarcastic New Yorker, as long as your child understands sarcasm. Wherever you come from, conversations are much more likely to be productive this way, even with a child who is being oppositional or difficult in some way.
In Chapter 9, "Medical Options for ADHD", you write "it is inherently unfair to expect someone with a neurologically-based disorder to overcome it through effort and willpower alone" (p. 178). Could you explain in what ways medication can help children with ADHD?
People suggest all sorts of causes, but in the end the research is clear, ADHD is a medical condition. The parts of the brain responsible for self-regulation as a whole aren’t active enough; it’s not only about inattention or impulsiveness. When used well, medications stimulate this underactive region to work more efficiently. The research regarding potential benefits is clear. They have a far greater impact on ADHD symptoms than anything else studied so far. Medications don’t fix everything on their own, but they allow someone to regulate their behavior who otherwise can’t.
You’ve said that ADHD is not about inattention, or impulsiveness, or hyperactivity, even though that’s how most people think about it. Could you explain more about that?
The symptoms that give ADHD its name are part of a much larger group of skills called ‘executive function.’ Executive function is like the brain manager, coordinating planning and organizing thoughts, as well as monitoring behavior and how we express our emotions. Practically speaking, children with ADHD have a developmental delay in some or all of these abilities. It’s not that they don’t want to do what’s being asked of them, it’s that they can’t until they’ve been taught how.
What are three things parents can do right now to help improve day-to-day living for their children with ADHD?
The first step is to understand ADHD as a deficit of executive function, which is a much broader group of skills than focus or controlling activity level. It’s like a child has an overall developmental delay in self-regulation. Seeing it that way allows parents and teachers to address what’s really going on. Children with ADHD aren’t trying to be difficult or lazy, they just don’t have the skills to do what’s being asked of them yet.
A next step is exploring all possible treatment options. We want children to catch up in their development as quickly as possible. ADHD affects all aspects of life, not only education, so children benefit from interventions at home and school. When talking about medication or alternative medicine, it’s important to seek out objective information, balancing potential risks and benefits. For most children, some combination is needed that considers medical and non-medical options, not just one quick fix.
Third, as a parent of a child with ADHD taking care of care of your child means taking care of yourself, too. If you’re completely overwhelmed, exhausted or shut down by stress, you’re probably not going to be as understanding and effective a parent as you might be otherwise. While you’re kids come first in the bigger picture, taking time to maintain your own strength and resilience helps your whole family in the long run.
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