Essential insights for parenting ADHD kids

By Dr Brendan Belsham

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition that affects around 6% of school-going children. The three core symptoms are impairments in concentration, hyperactivity and impulsivity. Despite its well-documented biological foundation, many debate about the role of the environment, especially the home environment, in the development and management of ADHD.

Parents of ADHD children often question their parenting. In clinical practice, it is common for parents to question their role in their child’s symptoms. They often seek out behavioural and other non-pharmacological approaches to treatment, either complementary or in preference to medication.

Parent management training
In preschool, non-pharmacological approaches are particularly important due to a greater risk of side effects of medication. Parent management training is an intervention, which can be employed at various stages of the child’s development but is usually most effective when implemented in the preschool years. It involves a system of positive reinforcement, which uses a token economy such as star charts and points system to reinforce appropriate behaviour.

There are many competent South African practitioners who incorporate the key aspects of parent training programs into the process of parent counselling. Several studies have shown a reduction in ADHD symptoms in pre-schoolers and an increase in maternal wellbeing with such interventions.

Expressed emotions
Central to the understanding of parenting in ADHD is the concept of expressed emotion. This refers to a measure of family relationships that quantifies the attitudes and emotions of family members towards one another, particularly a child with ADHD.

Studies using these measures have shown that in general, parents express more negative emotions towards children with an ADHD diagnosis compared to unaffected siblings. In prospective studies examining expressed emotion, higher maternal warmth is protective against later ADHD whereas intrusive or insensitive paternal behaviour is predictive of hyperactive-impulsive behaviour at school. A lack of paternal warmth is associated with later substance abuse in ADHD children.

Associations between low maternal warmth and comorbid conduct problems in children with ADHD, have been found to be moderated by variants of such risk genes, including the dopamine and serotonin transporter genes.

Lifestyle factors
Parents should facilitate several important lifestyle factors known to be key in managing ADHD. This includes managed sleep routines, regular exercise, a healthy diet and moderation with respect to electronic screen exposure. This is increasingly difficult if one or both parents have the condition themselves. The diagnosis and treatment of adult ADHD should improve parenting performance and the management of the child’s condition.

The most important aspect of a child’s early environment is the quality of relationships and the home environment. In their quest to deal with behavioural problems, parents often forget to praise and reward positive behaviour. It is important to remember that kids will be kids and some problems are common to all children of a specific age.

Life with ADHD can be very challenging for a child. By lightening up and connecting with fun activities, laughter and positive affirmations, parents can encourage the uptake of good behaviour more successfully. With a holistic treatment plan, you can start changing your relationships and family life for the better.

Visit MyADHD for the most up-to-date articles on ADHD and how to rise above the challenges. The MyADHD Facebook community is also a great place to share the ups and downs of living with ADHD.

Dr Brendan Belsham is a child psychiatrist and author of What’s the fuss about ADHD?