Minimize School Morning Mayhem for ADHD Children

Experts share tips for getting your ADHD child ready for school each morning -- with a minimum of stress.

From the WebMD Archives

Getting any child up and out the door in time for school can be a trying experience, but if a child has attention deficit hyperactivity disorder (ADHD), this process can make you want to pull your hair out.

Think about all that can go wrong: The backpack may not be where it was supposed to be or the dog may have literally eaten the homework. Suddenly, a child remembers he or she is supposed to bring something special to school or flat out refuses to wear a raincoat when it's monsooning. The list is endless.

For ADHD kids, these scenarios can actually reinforce low self-esteem and negative self-talk like "I'm unorganized" or "I'm always late" or "I always forget."

Marked by impulsiveness, hyperactivity, and inattention, ADHD affects about 5% of children aged 6 to 17, according to the CDC.

"The school morning routine is one of the most difficult areas for ADHD children," says Betsy Corrin, PhD, a child psychologist at Packard Children's Hospital and the Stanford University School of Medicine. "The morning is time-pressured and involves a lot of steps. And such stressful situations don't bring out the best in many ADHD kids or their parents who often have ADHD as well," says Corrin, who runs a training group for ADHD families.

It doesn't have to be this way. Creating a step-by-step personalized action plan can help mornings go seamlessly 99% of the time, she says. And while these tips were designed for ADHD children, they can work for non-ADHD kids as well.

Step 1: Outline the Steps

"This is very individualized," Corrin says. "Lay out the steps and anchor them by time." For example, on a school morning, your child should get out of bed by 7 a.m., be dressed by 7:25 a.m., have breakfast at 7:30 a.m., pack their book bag by 7:45 and be out the door by 8 a.m. That's five steps."

Step 2: Define How Many Reminders There Will Be for Each Step

"For example, say, 'I will come in twice and that's it, and you must be out of bed by 7 a.m.,'" she says. Index cards can also help. "Hand a child an index card with each step written on it and ask them to give the card back when he or she has completed that step or task."

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Step 3: Create a Point or Reward System

ADHD children may need a little extra support because they get easily distracted and don't jump out of bed right away. "There needs to be a set amount of prompts or reminders for each step in order for your child to get a reward," Corrin tells WebMD.

If they miss the mark, simply say, "'you didn't get your point for getting out of bed, but you can still get your point for washing up,'" she says. "Give your child a point for each step they correctly meet. Tie the points to something the child is interested in." For example, some points can be redeemed for TV time, while others can be used for computer time.

"Reward-based incentives tend to be the most effective, and a point system which sets up the value or expectation for each step is very concrete," Corrin says. The consequences and rewards should be as immediate as possible and should change as the ADHD child ages.

"This system puts the appropriate level of responsibility on the ADHD child," she says. "The child does tend to wake up to the process and realize that they feel the consequences themselves."

Another advantage is that it also cuts back on some of the disruptive yelling and screaming as the onus now falls on the child, not the parent. "Parents feel less frustrated with the new structure because they don't have to panic that they alone must make this happen," Corrin says.

Step 4: Remain Calm, Cool, and Collected

When things are not going smoothly, Corrin says, "Use a steady calm voice and say, 'You know your direction and this has to be done and it's on you. Bye.'" If all else fails, "the best thing to do is walk away and disengage from the battle and say, 'We will be late today.'"

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Preparing for the School Year

Other factors that play a role in making the school mornings go smoothly start way before school does, adds Frank A. Lopez, MD, a neurodevelopmental pediatrician in Winter Park, Fla.

One issue that needs to be addressed is the practice of "drug holidays." Some parents may have opted to stop their child's ADHD medication over the summer vacation.

In these cases, Lopez says parents must discuss when and how to restart the medication with the prescribing pediatrician.

Sticking to Routines

Routine is a key part of managing ADHD children. During the lazy days of summer, routines and schedules may go out the window. To avoid mayhem when school starts, "try to keep as much of a routine as possible over the summertime," Lopez says. "All children may stay up later during the summer, but if you have a night owl, you want to start pushing the bedtime back by 15 or 30 minutes each week in the three for four weeks before the first day of school."

Encouraging Summer Study Habits

ADHD children may also get out of the habit of doing schoolwork over the summer, which can make it extra hard to get back into it when the school year starts.

Avoid this trap by making time each evening for an activity -- not a game -- that has some similar structure to school.

"The bottom line is that nothing is ever 100% foolproof, but doing these things now will make transition to back-to-school much easier for ADHD children," Lopez says.

WebMD Feature Reviewed by Brunilda Nazario, MD on July 25, 2008

Sources

SOURCES:

Betsy Corrin, PhD, child psychologist, Packard Children's Hospital and the Stanford University School of Medicine.

Frank A. Lopez, MD, neurodevelopmental pediatrician, Winter Park, Fla.

© 2008 WebMD, LLC. All rights reserved.

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