Dear Cathi: F.O.S.T.E.R. Peace at Home with Your ADHD Child

Dear Cathi,

I am a pediatrician in Reston and I see a lot of kids with ADHD. Some of them require medication and all of them need help coping with the issues around their diagnosis. I have referred patients to your practice for help with social skills and I know you work in a very structured way over a considerable period of time with the whole family, but I wonder if you have any advice for me. Once I tell the family that their child has ADHD, it is hard to know what to say next. Obviously the parents are concerned and with a regular 15 minute appointment, I am not sure how to give them anything valuable to take away. I usually spend that whole time making sure they understand the medication piece, because I feel that has to be a priority. So in your experience, other than being sympathetic, is there something I could offer them? 

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Dr. James,

You are not alone. Many of the physicians we work with have the same problem. They have a brief amount of time to spend with their patients and want to give them something substantial to be able to manage the symptoms of whatever diagnosis they have been given. As a therapist, I appreciate you asking these kinds of questions.

Even with an optimal response to ADHD medications, challenging behaviors persist. Parents need help.  And, as you well know, there is no magic pill that cures all of the behavioral aspects of ADHD.  After 17 years of running a child and family therapy practice, I’ve developed several strategies to help parents foster a peaceful environment at home with their ADHD child.  I have created the following tool to give parents some practical strategies to help keep the peace.

F.O.S.T.E.R. 

FORECAST – Let your child know your expectations of him/her in advance of a potentially challenging situation.  Review and practice these guidelines with your child prior to the event.  In this way, you help him/her manage potential problems proactively rather than reactively.  Focus on what “TO do” rather than on what “NOT to do”.

Try Saying This:  “Before we go into the restaurant, remember our agreement. 1: Stay in your seat  2. Indoor voice  3. Eat with your mouth closed.  Got it?” 

OPTIMISM – Outside of your home, your child is likely bombarded with criticism and negativity from adults and peers alike.  For this reason, you need to actively praise your child when s/he is doing something right.  Make it a goal to spend more time paying attention to positive behavior than to negative.

Try Saying This:  “Thank you for doing what I asked the first time I asked you.” “I notice you really working hard on your homework today.” “When you and your sister get along, it makes me feel so happy.”

STRUCTURE – ADHD kids need predictability and routines.  They may not WANT structure but they NEED it.

Try Doing This: Set up consistent morning and bedtime routines to help create a peaceful environment at home.

TO THE POINT – At times you may want to express your frustrations with your ADHD child in a flurry of words and emotions.  This action will likely lead to your child ignoring you.  Instead, when you want to alter behavior, make your statements short and sweet, focused on the behavior.  Wait silently for compliance and impose an immediate consequence if your directive is not followed.

Try Saying This: “Hands and feet to self.”  Instead of this:  “How many times do I have to tell you not to hit your sister?!?”

EXPECTATION OF INNOCENCE – Remember that your ADHD child does not behave badly to make you miserable.  Knowing this will help you feel more patient and less upset with your child’s behavior.  Regardless, you will need to set clear limits with your ADHD child.

Try Thinking This: “Take a deep breath.  She’s not doing this purposely to make me mad. She is frustrated and needs some help.”

RESTRAINT– Stay as neutral as you are able.  When you are upset, your child’s behavior worsens.  Then, the problem becomes yours instead of his/hers.  Take a break if you need one.

Try Thinking This: “Andrew, you are shouting at me.  I have a hard time hearing you when you do that.  Sit on your bottom and speak more quietly so that I can hear you.”

I hope these strategies help you to maximize the time you have with your parents and give them real tools to use with their ADHD children.  If they need additional help, please feel free to give them In Step’s contact information and we will do our best to help.  Our clinicians specialize in working with children and their parents.

All the best,

Cathi Cohen