Aggression in Children and How to Handle it

Aggression- how to decrease behaviors

By Patience Domowski, LCSW

Aggression in children is really difficult. From yelling to hitting, its very disruptive and sometimes even dangerous. Especially as the child gets older it becomes more of a safety concern. A 3 yr old hitting a parent is not that big of a problem, but a 13 yr old could really hurt someone.

To solve this problem we need to figure out why it is happening. Here are some possible causes:

-Child cannot manage their emotions (needs coping strategies), gets easily angry, anxious, frustrated, etc

-Child cannot effectively communicate (hasn't developed full speech due to age or speech delay, or autism)

-Child has a mental health diagnosis (autism, bipolar, ODD, …)

-Child has observed and copied aggression from older siblings, parents, violent TV

-Child is very impulsive (can’t stop and control themselves)

-Child has discovered that this gets them what they want from others  (example: if they hit then people leave them alone, if they yell then dad gives in, etc)

-Child gets attention from their behavior (even though it is negative, some children still want this attention).

-Other reasons…

For some children there may be a combination of reasons. Sometimes the reason is easy to discover but other times it may be more complicated. Collecting data (writing down the behaviors and what happened before and after) and doing an FBA (Functional Behavior Analysis) can be helpful. Ask your child’s teacher or behavioral therapist about how to do one if it is difficult to figure out the ‘why’ for the behaviors.

To correct the behavior we want to teach the child a combination of better coping strategies and a more effective way to get what they want.

For example: if they get angry easily when their sibling takes their toy we want to teach them to calm down, and also the skill of asking for the toy nicely, or asking a parent for help. If the child wants attention then teaching the child a more appropriate way such as saying “Mom, play with me!” instead of hitting would be helpful. Also the parent should ignore the inappropriate behavior until the child does the expected response.

If the child is copying others aggressive behavior- whether in person or on TV shows/games/ etc it is important to limit this exposure. If the parents are showing aggression such as yelling and hitting children, then it's likely the child will copy this as well. If the parents can try to be more patient and handle their frustrations in a more appropriate coping way, this can greatly help the child. Parents may want to seek therapy on their own, or try anger management groups, or even medication to help, if they are really struggling with depression for example. If older siblings are exhibiting aggression it is helpful to try to get them some more help and teaching the younger child to not copy those behaviors. If the child is watching violent TV shows, movies, video games, eliminate or at least reduce the frequency the child is exposed to that. If the child resists, explain that if they reduce their aggression they can slowly return to those games/shows etc. Pay attention to the ratings on games and shows however and the child’s age.

For cursing- if it’s in conjunction with anger and aggression, use same strategies already listed to teaching better coping behaviors, but besides that mostly ignore it, or teach a silly replacement word “peanut butter jelly sticks!” The more attention you give the curse word, the more powerful they become. You can tell them not to say that word and maybe even why, and if necessary punish for it, but if you make a huge deal about it (such as yelling and lecturing) it will likely make it worse. Also make sure parents and older siblings are refraining from using those words completely. Even if parents tell child not to say a word, if they are saying it themselves, the child will still learn it and repeat it. With any behavior, parents need to model good behavior and not to do anything they would not want their child to do (for the most part). Sometimes an old fashioned ‘swear jar’ is helpful. The person that says the bad word is ‘fined’ and has to pay real money into the jar.When the jar is full some families will use it for a fun activity, sometimes the money would go to the non-swearing person, or maybe the family would donate it to a charity.

Make sure the child’s aggressive behavior is not getting them what they want. If they are hitting their sibling to get them to leave them alone, and its effective, that is going to maintain the behavior. Try to teach the sibling to respond better and quicker and teach the aggressive child to request space in a better way. If the aggressive behavior is getting them the attention or item they want from parents, parents need to try hard to not give in. Even though it makes the screaming stop now, it will just make the behavior worse the next time if you give in.

If the child has not developed appropriate speech, due to age or delays, it maybe be helpful to teach a simple hand gesture/sign language to use to communicate. Maybe a clap means ‘Can I have it?’ or a hand tap means ‘I need help’. Ask your child’s speech therapist for some ideas to figure out what will work best for your child’s speech needs.

For kids who don’t have good coping strategies have them write up a list (or draw) several things they can do when they are angry and then hang the list in a well-trafficked area in the home (living room or kitchen is usually good). The list should be visible because when someone is angry they are not going to go searching for a paper in a drawer to figure out what to do. The strategies can include deep breathing, walking away/ignoring, asking parents for help, doing something fun to distract yourself, and remembering to ask nicely for things. There are many coping strategy lists that can be found online. The key is to find which ones work best for your child and to have your child identify these as well. The more the child is involved in identifying the strategies the more likely the child will use them.  Also have the child act out the appropriate coping strategy when they are in a good mood, as a role play, or after they made a poor choice to reenact making a better choice.

Try giving a reward to the child for using a strategy. For example if the child takes a deep breath instead of hitting mom, or stops screaming by deciding to go chill out in their room, give them a piece of candy, access to a special toy, or extra ipad time for making a good choice. Praise your child for calming down, whether it took 10 seconds or 1 hour, immediately praise them when they are calm so they associate positive attention with calming down.

Try behavioral charts. Children are often not motivated to make a better choice internally - it’s easier for them, or not big deal for them to yell and hit versus breathe and ask nicely. But if you sweeten the deal by offering candy, toys, extra time, other privileges then they are more likely to make the better choice. Some kids will need the reinforcement reward immediately and some can wait until the end of the day or week. Think about your child’s needs and personality to figure out the immediacy of rewards. If you aren't sure how to do this seek out a behavioral therapist who is experienced in this and can help you. Once your child learns the strategies to handle their feelings more appropriately they are likely to reduce aggression and you can fade out the behavior chart, or use the rewards to target another behavior.

Sometimes if the child is so out of control and aggressive they have to be restrained. Parents can learn appropriate ways to restrain their children (ask the school, doctor, or a therapist). If the child is in danger to themselves or others it is okay to restrain them until they are calm and in control again. The police and mental health crisis workers can also be helpful in these situations. If aggression is a regular occurrence, behavioral interventions are not effective, and the behaviors are fairly severe, medication may be necessary. Talk to your child’s doctor or seek a child psychiatrist for help.

Helpful Links:

Swear Jar: https://en.wikipedia.org/wiki/Swear_jar

Child Restraining: https://www.k-state.edu/wwparent/courses/rd/toolbox/rdtool-37.html

Causes of Aggression:

https://childmind.org/article/aggression-in-children-causes/

Handling aggressive behavior:

https://www.empoweringparents.com/article/how-to-manage-aggressive-child-behavior/

Taming Aggression and Coping for parents:

http://www.parentingscience.com/aggression-in-children.html

Anger Strategies (Other helpful blog articles)

Sensory or Behavior?

Sensory vs Behavior
By Patience Domowski, LCSW

How do I know if my child’s behavior is sensory-related or a behavioral problem? Parents wonder this all the time. The simple answer is that it's often hard to tell and sometimes the reasons overlap. Often the issues can be both.

Sensory issues are sensitivities related to the senses- see, hear, feel, taste, smell. People can be over-sensitive or under-sensitive to senses. Children can be sensory- seeking: they do certain things to get certain sensory stimulation, such as excessively rubbing a soft blanket, or sensory-avoidant: they do things to avoid sensations they cannot handle, such as covering their ears for loud sounds. Some behaviors that are sensory related can also be behaviors for other reasons, which makes this so difficult to figure out. Some children are both sensory seeking and sensory avoidant for different senses.

Some behaviors you might see in a sensory-seeking child: running around and crashing into furniture/items, desires tight hugs and squeezes often, chews/sucks on toys/fingers/etc, bites/scratches/squeezes  people or furniture, likes to feel various items and objects, fabrics, textures. These behaviors are  not to get something they want from another person, like a toy, or attention, but for sensory input into their body.

Some behaviors you might see in a sensory-avoidant child include: won’t touch or eat certain textures- wet or soft items often like pudding or yogurt, screams and covers ears/eyes in certain bright lights or loud noises (may seem normal lighting or sound to a non-sensory person however, but to a sensory kid it’s overwhelming), avoids certain fabrics/clothing.

If a child is screaming or running around, those are not obviously sensory related behaviors, so how do you know the difference? The way to figure it out is to try to figure out the function, or the WHY, of the behavior. Is the child running around because they are trying to get your attention? (Behavioral) Do they seem to be very hyper and struggle to sit still? (Could be Sensory) Is the child screaming to get what they want, get attention, or because other people are doing it? (Behavior) Or are they upset with no clear reason why? (Could be sensory) Would the child do the behavior if no one was in the room with them? One of the simpler ways to figure out if a behavior is for sensory purposes is if the behavior would occur without any other interaction from another person. If the child was alone in a room and would still do that behavior, it is likely sensory- because they are not trying to avoid something they don’t want to do, get attention, or get something from someone else (the other functions of behavior). [For more info on functions of behavior see my other article on this topic].

Many children do sensory-seeking behaviors that are not a major problem as most children like to run in circles, dance around, touch soft items, etc. because it feels good to them. It's only a sensory problem when the behaviors are disrupting the family or school setting, or causing distress or interference in the child’s life. To have your child diagnosed with a sensory disorder please seek an evaluation from an occupational Therapist (OT). OTs are available through Early Intervention (if your child is under age 5), the school system, or private agencies.

If the behavior is for any other reason than sensory-stimulation it's a behavioral issue, not a sensory issue. If a child is throwing a tantrum because they didn't get candy, that’s behavior. If they are melting down because the lights are too bright- that’s sensory. Sometimes it's hard to know why so trying to figure out when the behaviors occur, what set it off, and the environment is very helpful. If your child is verbal, ask them what the problem is if they can verbalize it. Sometimes taking data is helpful to see patterns and figure out what settings the behavior seems to occur in most often.

So what do we do about it? We want to treat the behavior differently based on the function (or WHY) of the behavior. If a child is screaming for attention purposes, we would likely want to ignore them and teach them a better way to get attention. But if the child is screaming to avoid a loud sound, we would want to help them protect their ears- such as providing headphones in noisy environments. If the child doesn't want to wear underwear to be difficult or in control that is much different than a child who is complaining the underwear is itchy. So once we figure out WHY the behavior is occurring, then we come up with a solution.

OTs help kids de-sensitize and meet their sensory needs in more appropriate ways. So a kid who cannot tolerate certain clothing would probably be brushed until they could tolerate it. They would have the child do sensory activities like jumping on a trampoline or crashing into cushions to meet those needs instead of grabbing people or running into walls. Behaviorally the child can be given rewards for making good choices- like using a sensory toy or strategy, such as biting a chew toy instead of mom’s arm.  We want the child to meet their needs in an appropriate way or get them to a point that they don't need that problematic behavior anymore.

Often the behaviors are both sensory and behavioral and they can feed each other, so sometimes a combined approach to treatment is helpful. Many children with ADHD, autism, and anxiety also have sensory issues. However a child can have sensory issues without a mental health diagnosis as well. Try to have your child evaluated by both a behavioral/mental health therapist and an OT to figure out the right diagnosis as that will be very helpful in coming up with a treatment plan.

Because sensory and behavior needs vary so much per child, and figuring out the function can be difficult sometimes, it is important to meet with an experienced professional to help figure out a plan specifically for your child. OTs and Behavioral Specialists/Therapists are the best professionals for this. Some Physical Therapists (PTs) can be helpful as well. Not all child therapists are familiar with sensory issues however, so find someone who knows something about sensory concerns and behavior.

• More information on Sensory Processing Disorder, including symptoms and treatment see: https://www.sensorysmarts.com/signs_of_spd.html https://www.sensorysmarts.com/sensory_diet_activities.html
• https://www.understood.org/en/learning-attention-issues/treatments-approaches/therapies/sensory-diet-treatment-what-you-need-to-know
• http://lemonlimeadventures.com/is-it-sensory-or-is-it-behavior/
• https://theanonymousot.com/2013/03/28/is-it-sensory-behavior-or-both/
• https://www.brainbalancecenters.com/blog/2014/11/sensory-meltdown-vs-temper-tantrum/
• http://suelarkey.com.au/wp-content/uploads/2015/05/Sensory_Meltdowns_vs_Behaviour_Meltdowns.pdf

Medication, Mental Health, and Children

Medication and Children’s Mental and Behavioral Health
by Patience Domowski, LCSW

Should I put my kid on medication?

Many parents wonder this when their child is struggling with mental health issues. Is this just a ‘quick fix’? Is medication going to harm the child worse than their diagnosis already affects them? It’s a difficult decision and many parents worry about side affects, addiction, and long term necessity. Many parents have heard horror stories of kids over medicated. The stories in the media are mostly negative, and most of the information about medication that is commonly known isn’t always accurate too. So how does one make that decision?

While it’s a personal decision to be made by the parent(s), and perhaps the child, (if the child is of age to make that decision, such as a teenager), here are some helpful things to consider when trying to decide what the best course of treatment is. Consider some other options for treatment before going the medicine route, except in certain situations, to be discussed below.

Treatment Options

First, try therapy. If your child is able and at least moderately willing to attend sessions, try a behavioral therapist to help with the child’s emotional or behavioral issues. Often the coping strategies taught in sessions are sufficient, and medication is not even necessary. Children with ADHD can learn some tips and tricks to help focus, kids with anxiety can learn some coping skills to calm themselves when anxious, and parents can learn some ways to better manage their child’s behavioral symptoms and emotional distress. Most child behavioral therapists will teach the parents some ways to handle the child’s behavior including ways to help calm the child when they are angry or anxious, and some behavioral strategies such as reward charts and consequences to utilize at home. There are behavioral therapists that are in offices, some that come to the homes, and some that work in the schools. Find out what is best for your child and what is available in your community, by asking your insurance agency, pediatrician, or school guidance counselor for suggestions.

If the problem occurs at school, get help from the school. If the child’s behavior is affecting their schooling whether it’s acting up in class, panic attacks that send them to guidance frequently, or the child is unable or unwilling to complete homework, ask the school for help. The school can evaluate the child to see if they qualify for an IEP for 504. If the child meets the requirements they can get extra formal and informal supports and services from the school district.

What if therapy doesn’t work?

If therapy and school supports are not sufficient, or the child is unable to even participate in therapy or school programs due to their emotional state or extreme behaviors, then it is time to consider medication. The question as to how long to wait to see if therapy and school supports are helpful enough will vary per child, however a few months is often a good time, and asking the school and therapist about this is a good option.

For example after several months of school interventions the child is still unable to focus, has frequent anger outbursts and can’t seem to control them, or other issues, it may be time to consider another path of treatment. Or after several months of therapy the anxious or depressed child is not seeing results, they are unable to do the skills at home, or the results are very minimal, they may need medication to help them achieve the ability to try the skills learned at home or school.

Do children ever absolutely have to be on medication or aren’t candidates for therapy?

Technically no, you never ‘have’ to put your child on medication, but sometimes it is strongly advised. Not every child qualifies for or would benefit from the same types of therapies. There are different options to consider to see what best fits your child’s needs. Some children need high levels of care such as hospitalization, or residential treatment, while most only need outpatient (office-based) therapy, or home based therapy.

In some cases it may be necessary to start medication immediately, prior to implementing other treatment options. If the child is extremely suicidal, has severe panic attacks on a very frequent basis, cannot focus or sit down long enough to learn in school or participate in therapy, or their behaviors are so extreme they include aggression, inability to reason (think logically), or have dangerous behaviors such as severe aggression or impulsivity, it may be imperative to start medication before, and in conjunction with, other treatment options. Sometimes children are too affected by their symptoms to even learn coping strategies in therapy or to learn and respond to school that they need something to settle them down before they can try other options.

Can my child get off their meds or are they on it for life?

Once the child, or teen, is able to settle down, because of the medication, they are better able to learn coping strategies. Often the medication takes the edge off enough that they can think more clearly, make better decisions, and use the skills and strategies that the therapist and teachers are trying to teach them. Most professional recommend a combination of both medication and therapy to best treatment.

Often kids are able to get off of medication over time, when they show progress using their strategies. Some kids are only struggling temporarily perhaps due to trauma, parent’s divorce, being bullied, or other life event, and after they have processed their feelings from these events are able to move off their medication as well. Sometimes children will be on medication for a long time however. Some children may continue to have their symptoms into adulthood. Talk to your doctor about the length and likelihood of medication for your child, as it varies per person. It may be hard for your doctor to tell you how long the child will need medication as their response to the treatment will vary.

What about side affects?

Side affects and effectiveness of medication is a real concern. Most side affects go away in a few days, and some medication works immediately (most ADHD meds) while others can take up to a month to see effectiveness (most anxiety/depression medication). If the medication is causing severe problematic side affects you should call the doctor immediately and see what they recommend. Don’t just pull your child off of certain meds that need to be tapered off, of there can be worse symptoms. If the medication isn’t working, talk to the doctor and they may increase the dose slowly, or try a different medication. They are many medications for each diagnosis, so they are several treatment options out there, not just the first one your doctor recommended. Some doctors can do genetic testing that will test the effectiveness of medication for your child and even side effects, before the child/teen even starts the medication. This may be a helpful option for some families.

Could my child become addicted to their medication?

Often parents worry about long term addiction to medication, or the child is never able to learn to live without it. While that could occur certainly, often children and teens are able to learn other coping strategies and are able to wean off the medication at some point in their lives. Also the medication should be closely monitored by the doctor to make sure no other issues are starting. People with ADHD and bipolar are far more likely to become addicted to illegal drugs than medication, as they often will ‘self medicate’ with drugs and alcohol to control their symptoms. It is much healthier to have them on legal medication that can meet their needs and is controlled by a doctor, than for them to turn to other unsafe methods to meet their needs. If the child is extremely suicidal, aggressive, or impulsive the risks of medication may outweigh the risks of non-medication due to the child’s likelihood of harming themselves or others from their symptoms.

How does medication help?

How does medication help? It fills in the chemicals in the brain that are ‘missing’ or reduced in the brain that are causing the child’s symptoms.  Often behavioral problems and mental health disorders are genetic, in that they are passed down biologically, or occur randomly in the child’s brain. It is not the parent’s fault, or the child’s fault. It just happens. Sometimes however problems can occur from environmental issues such as the child being raised in a stressful or difficult family situation, significant issues at school, a traumatic event, or significant loss. Then these situations ‘cause’ the diagnosis to some degree. Often there is a both a genetic and environmental factor that combine to cause the disorder, and fixing the brain chemicals can be done by treating with medication, and also by changing brain pathways in therapy in learning new ways to re-train or think about things differently and therefore respond, cope, in a better way.

Is there a medication for behavioral issues like ODD?

Oppositional Defiant Disorder is one diagnosis where there is not a specific medication or even category of medication for it specifically. While ADHD has a variety of meds to choose from, including stimulants, and nonstimulants, and there are numerous meds for anxiety and depression, and antipsychotics and other types of medication for certain disorders, there is not really anything specific for ODD. ODD is best treated with behavioral interventions. However if the child is experiencing depression symptoms along with their oppositional behavior, such as chronic sadness, frequent and prolonged anger outbursts, or aggression, there are medications that can address some of these issues. Medication for depression can help with these other symptoms to help the child be able to think more positively, be more flexible in thinking which can then help behavior. There are also medications for aggression and impulsivity that calm the body down to help the child stop and think and slows their impulses. If you aren’t sure if your child can be helped by medication for their behavioral issues, ask their doctor.

Who should I have prescribe the medication?

For children, often their primary care doctors, such as family doctors or pediatricians, will prescribe medications. Sometimes they will only prescribe something initially to start with and then refer you to a psychiatrist, other times they will handle the medication long term. Some pediatricians specialize or have a lot of experience handling emotional issues, or ADHD for example, and have no problem managing the medication, however others are reluctant to do so. Some children respond to the first medication and others need to have it figured out. If its more complex than just trying one medication, often pediatricians recommend to see a psychiatrist. A child psychiatrist specializes in handling medication for children and knows much more about these issues than a general physician would. They are the best option most of the time. Sometimes neurologists will handle medication for children with ADHD, and sometimes other diagnoses too.

What if my child refuses to take their medication?

Often children will refuse to take medication. Sometimes it’s just that they don’t like how it tastes or feels in their mouth, other times its because they are being teased about it from siblings or peers, or they aren’t sure it will help them. Making it easier for them to swallow by putting the medication into food can help, as well as providing them education on how it can help them. Often children report they feel much better on their medication and look forward to taking it. If they are refusing to take it because they don’t think they need it, have them talk directly to their prescribing doctor and/or therapist to discuss these issues. If they are not taking it because of behavioral reasons, a simple reward system for taking their pill daily can often be the best solution.

My child’s other parent refuses to allow them to take medication

This is a common problem, especially in divorced families. Often one parent doesn’t see, or believe, the same behaviors and symptoms that the other parent witnesses. Sometimes parents have personal reasons, have heard horror stories, or have bad experiences with medication themselves that they are not open to this type of treatment. It can be helpful for that parent to participate more in the child’s therapy, school support meetings, and attend the doctor’s appointments so that parent can discuss their concerns with the doctor and others involved in the child’s treatment. It may be helpful for the child to communicate directly to the other parent if they want to take medication (often teens ask for anti-depressants for example), so it’s not just coming from the other parent. In the end however if the child is underage both parents have to agree and sign off on medication. Perhaps asking the other parent to just allow it for a trial period to see if anything improves may be a good resort. Have them take data of the behaviors or feelings before and after the medication to see the results themselves.

Personal Note

Personally, as a behavioral therapist, I often do not recommend medication right away, because most children respond pretty well to behavioral therapy, and having parents involved in therapy and willing to take the therapist’s suggestions and try them at home, is often sufficient. However sometimes there are times, as mentioned above, where medication is necessary. I recommend medication sometimes after trying therapy for a little while without a lot of progress, or in some extreme situations where it is necessary to go ahead with it sooner rather than later. I support parents’ desires to make informed decisions regarding their child’s treatment while also encouraging an open mind to other forms of treatment available. Parents are often surprised to learn that there are many other children already on medication and it makes a huge different in their child’s life. Some parents are so happy to finally see progress from something that is very simple to implement. Often the information parents have on medication is outdated, as things have changed since the ‘ritalin age’ where kids were over-diagnosed with ADHD and over-medicated with Ritalin for example. Now there are more options out there and more information. I encourage parents to research and ask questions and find a doctor that can help.

Other helpful articles and information

 http://www.aacap.org/aacap/families_and_youth/facts_for_families/FFF-Guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-I-How-Medications-Are-Used-021.aspx

http://kidshealth.org/en/kids/ritalin.html?ref=search&WT.ac=msh-p-dtop-en-search-clk
http://www.specialneeds.com/children-and-parents/general-special-needs/behavioral-problems-and-medication-kids

Using a Fidget properly

How to use a fidget toy properly
by, Patience Domowski, LCSW

Fidgets can be really helpful for kids with ADHD, Anxiety, Sensory issues, etc, however they MUST be used properly to help you stay Focused or else they will just distract you further. Here are the Fidget Rules: 

1)      It should be kept in your lap or inside your desk.

2)      You should be looking at the teacher, or focusing on your work on your desk, not looking at the fidget.

If you start to look at the fidget, are thinking about the toy instead of your class, or if the fidget becomes distracting to others around you- it is NOT being used properly and becomes a distracter instead of a helper. If that happens the teacher may take it away for a little while and then give you another chance later.

ADHD tips for parents

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD- if you don’t think its “real” just ask a parent or teacher that has a child with this diagnosis! It can be so frustrating to work with a child with ADHD because they are usually a typical child with no delays or obvious special needs but yet they tend to lack focus, have to be told to do things that are a normal routine and they are usually unorganized and forgetful. Some kids are hyper and impulsive- sometimes in girls its hyperactive talkativeness instead of physical motor activity.  

If you are seeing these symptoms have your child/student evaluated by a doctor or therapist and get some behavioral therapy. Some children may need medications (even some adults too!) but some may do fine with only behavioral interventions.

Some strategies to try to teach these skills:

·         Fun focus activities: hidden pictures, mazes, word searches, etc (trains child to concentrate on something hidden which forces their brain to ignore the external stimuli/distractions)—can find lots of these for free online!

·         Play Simon Says game to work on following directions

·         Use reward system as kids with ADHD are often motivated by rewards!

·         Do “following directions coloring pages” and activities- up to 3 step directions. For example: “color the tree orange, the flowers purple, and draw a sun in the sky”—this teaches child to remember 3 directions at once. Can use it for motor activities too like a game where you give directions and they have to try to remember all of it: “grab your jacket, two shoes, and put on your socks”.

Tiperoo: don’t give a child TOO many directions at once. If they are having a hard time just give them ONE at a time until they master that, then move on to about 3 directions at once.

·         Make Checklists! Make one for morning routine, completing any task where they forget the steps -make a list and have them check it off daily! (can pair it with a reward chart). There are many free printable checklists online or you can make your own. Use this also for chores.

·         Remove distractions, like the ipad, preferred toys, etc, from your child’s room/view in the morning. You can reward them with play time if they finish their morning routine tasks within enough time (show them a timer or clock). [See Morning routine section under Section 1]

·         Use a Timer!! They are great to teach time management skills. You can download free visual timers on phones and ipads or order a ribbon timer or other visual timer from www.timetimer.com

Tiperoo: set a timer and have them “Beat the timer” as a competive game to teach them to move quicker through getting dressed, showering, etc

·         Have them clear/clean out their backpack weekly- remove all old papers, re-organize current necessary papers. Perhaps eliminate multiple folders and keep everything in one large binder or one folder with multiple sections to make things simpler. Try color coding and clear labeling of where things go (can attach to a reward chart for keeping it organized)

·         Clearly label and organize your child’s room/toy space for them and teach them to put things where they go (follow up weekly). For example bins/drawers for each clothing, toy, papers, etc.

Tiperoo: Take a photo of what the space or task should look like and then tell your child to make it look like the picture. For example their bedroom, desk, shoes/coat area, loaded dishwasher, toy bins, etc.

·         Keep their homework work space clear of distractions (visual and audio) by keeping it quiet area, no TV in background or other people, toys, etc. Check in with child often to make sure they are on task and keep working. Timers and little reminder cards can be helpful to keep them on track too.

·         Try a “keep working slider”. Put a button or bead on a pipe cleaner/string on a card and slide it along the card as your child completes their work so they can see their progress toward being finished. You can also do this with putting velcroed cards that say “start”, “middle” “end” etc or numbers 1-5 that you keep putting in a row to complete as they work so they can see their progress as well and know how much time is left to be done!

·         Take movement breaks between things that require a long time of sitting such as walking around/jump on trampoline between homework subjects, classes at school, long car rides, sitting through church, a play, movies, etc.

·         If your child is struggling in school ask the school to evaluate your child. Then request a 504 accommodation plan (this would include things like quiet space to take tests, teachers making sure they turn in their homework, extra time for assignments, sitting close to the teacher, etc) or IEP plan (includes goals for behavior and /or academics and may include specially designed instruction where teachers would have to tailor their approach to meet your child’s needs or may need to place child in a more appropriate classroom setting). 

Timers to teach focus

There are lots of ways to teach kids to focus. One is to use a Timer (you can use a kitchen timer, watch, phone, or timer app!). Have the child play with something (preferred) for 3-5 minutes. They can't switch activities until timer goes off. If they try to leave bring them back until the timer goes off. Then they can switch activities! You can also do various other table tasks in between taking breaks such as mazes, dot to dots, coloring, worksheets, puzzles, games, etc to work on focus. Do each activity for about 5-10 minutes (depending on child's age and ability) and then take a little break

Recommended apps: "Countdown", "VisTimerFree" for iphone.

You can buy timers specifically for teaching children with ADHD or learning needs at www.timetimer.com 

ADHD tips for teachers

Impulse Control

—  Teach child to control impulses using games like Simon Says

—  Remind them to STOP and THINK

—  Raise your hand silently as a cue to raise hand if child is calling out and wait to call on them until they raise their hand (ignore them if they call out)

Reduce Distractions

—  Eliminate/avoid distractions in the room as much as possible

—  Sit ADHD child in FRONT of the class so they avoid distractions such as other students

—  Sit child so they do NOT face window, doors, highly decorated areas of the room

—  Sit away from toys and computers

—  Use a file folder “office” to block distractions

—  For tests sit in quiet section like back of room where less children are around

Keeping organized and on task

—  Many kids with ADHD cannot keep themselves regulated in If you can’t keep things regulated/organized INTERNALLY (in your head) you have to do so EXTERNALLY such as using calendars, to do lists, charts, sticky note reminders, etc

—  Help kids stay on task using Timers (www.timetimer.com),  make reminder notes, have visual schedules, mark backpack/folders with reminder notes, completion checklists, picture schedule of the day, and other visual reminders

Reward systems/motivators

—  Often children with ADHD, and ODD, and other behavior disorders (Autism, Disruptive Behavior Disorder, etc) do not have the internal motivation or desire to want to perform well, please parents/teachers, or achieve/succeed within themselves.  (Let’s face it we all have those days we’d rather play than work or learn! ) So they need EXTERNAL MOTIVATORs such as incentive/reward charts, tokens, behavior systems, earned allowance, etc. Basically find out what they want and then help them get that with doing the expected/preferred behavior.

—  Reward systems/charts should be individualized, tailored to child’s wants, needs and interests. If child is NOT interested/doesn’t want the reward, its too hard to achieve, or its not related to them, they are highly unlikely to utilize it and actually do what you are requesting.

—  Rewards DO NOT have to be Toys/Food (tangible) they can be –extra time, -special choice, -extra attention, -computer time at end of the day, -stickers, -coloring pages they enjoy, etc

—  For younger children small token/reward charts work great. Make it achievable. They should be able to earn in an hour or day if they are very young, or weekly for kids who are a little older or have achieved daily rewards already.

—  Older children should earn tickets/money/chips to cash in for prizes/rewards/ privileges

Other helpful tips

—  place child closer to front of room, sit student next to a calmer student or away from distractions, call on child often to answer questions, or repeat back information, sit child in a chair versus on the floor

—  Tap their desk/call name while teaching to get their attention

—  Have them run errands/be helper for class to get out extra energy

Remind of expected behavior and establish reasonable consequences

—  Tell children the expected behavior and the consequences if they don’t follow it – should be clear and concise. Remember if its simple they are more likely to hear it! For example “We are going to play musical chairs now. If you don’t follow the rules and get “out” when told, you can’t play the game again when we play next time” or “Now its time for art. If you splash the paint on the floor on purpose, you will have to sit out”.

Other disruptive behavior tips

—  Out of seat on carpet/crawling around:

                                -try a chair, carpet square, move away a little from the group

·         Talking to peers next to them:

- move them away from that peer, put them next to calmer/quieter kids (boy/girl/boy/girl can work)

·         Fidgeting:

- try a fidget toy to hold (if that toy becomes distracter, take it away until they focus, then return toy to them to see if that helps. If not, fidget toys won’t work. )

-Sit on a fidget seat (School’s OT consultant should have one), exercise ball, or bean bag for extra sensory input.

—  Butting in line/pushing children in line:

- put child at front or back of line, or several feet from others in line, remind of consequence “keep hands to yourself or you will have to go to back of line/lose recess/etc”

·         Have child take a walk/movement activity before having to sit for a while 

—  Wandering around/not transitioning to correct center/activity:

- small chart/list of centers to choose from. They mark off each center they complete on the list.

—  Not staying on task in the center:

                                - timer or task completion checklist

—  Waiting/transition time - fidgeting/touching others/etc:

                                -suggest a wait game or sing songs during that time

Classroom Rewards and Consequences  for everyone

—  Can be individuals earning stickers/rewards/tokens or whole class/group earns a collective prize:

For example if everyone is quiet they get extra 5 minutes recess, or if they are following directions all week, they get a special activity on Friday

—  Consequences could include sitting out of the activity, not being able to sit with a certain peer, losing a toy or other privilege, and call to parents 

Remember:

—  Be Consistent (keep rules the same)

—  Be Fair (don’t always have one child be in trouble if several are doing same behaviors)

—  Give Consequences/Follow through! (if you said it would be the consequence- then make sure it is! Child will learn from that and not keep making same mistakes!)

—  Use Rewards !! (makes everyone more happy!)