Live Q&A-Occupational Therapy for Children with ADHD

QUESTION 1

I have a question about kids with ADHD. In the afternoon, what are the best strategies for transitioning from school to the afternoon routine to dinner to bed.

It’s a very short space of time and I am finding it hard to find the right mix of things to do! Especially now that they’ve been out of school for so long from COVID Quarantine and are going back again!

Colette: ADHD kids flourish on routine, knowing what’s going to happen next is important. So, when coming home from school, they can be irritable and tired and hungry.

Try to get them something healthy to eat as soon as they get home. Yogurt, apple, just something to get that hunger and lethargic feeling out of the way.

Another thing: even though some kids don’t want to talk in the car or they take the bus home or whatever, but I recommend taking a minute to talk them through what’s going to happen next.

“We’re going to get home, clean out your lunch box, and then you’ll have 10 minutes to play. Then we’ll have a bath, etc. Whatever your routine is. But let them start processing that and understanding what’s happening next when they get home. If they are on a bus or carpool, greet the when they get home.

Always be friendly and ready with something nice when they get home. Then give them their space of their own but greet them with a snack and a reminder of what they should do next.

Marga: I agree totally, thank you Colette. That was the one thing I wanted to talk about was routine, a predictable routine. What you say in the car is what is going to happen at home – that’s fantastic.

I also want you to use the time in the car to really observe your child and to see what might have happened at school. Children don’t jump into the car and start telling you, ‘Oh I was bullied today’ or ‘ Somebody made me angry’ or ‘I’m feeling sad because I had a lot of struggles today.

” They don’t do that. They’re either quiet or they’ll act out. I think your observations of what space your child is in when you pick them up is really important. On that note, I think it’s important to get to school about 5 minutes early to give YOURSELF a moment to breath and get ready to shift your attention to them. They’ve been listening to instruction all day, answering questions all day.

I suggest just leave them for about 20 minutes before you’re on top of them with the next instructions: unpack your bag, bring me your dirty clothes, etc. Then you can remind them of that routine for the rest of the day and keep that part of the routine every day.

Colette: Yes, that’s important, the same routine every day.

QUESTION 2

For families who aren’t going back to school right now, the ones who are still dealing with parents working at home right now with kids in lockdown, and the routine may be different than usual. What suggestions do you have for keeping parts of the routine the same?

Colette: Whether it’s ADHD kids or neurotypical kids. Eat routine. Sleep routine. Those two are the most important things. That’s easy, no matter where you are, to keep that the same.

Wake them up at the same time in the morning. Have your morning routine the same. Have lunch at the same time. I suggest for kids transitioning back into school to start having their lunch time the same as the school lunch time to have the the internal clock at the same pace.

Then bath time, eating time, bedtime – have them the same each day.

Liz: I’ve found that, since I work from home regularly anyway, I find it has helped me even though I don’t get up and go to an office every day. I’ve kept the routines the same while we’ve been in lockdown.

I get us up at the same time, I get us dressed at the same time, even if no one is going to see me. It really has helped me and hopefully it will help others.

QUESTION 3

Anything I can do to get my 4-year-old to finish meals or ANY task for that matter at a table? He doesn’t sit still for longer than 10 minutes.

Marga: If your child is neurotypical it’s still important to have that routine. We’re going to have a meal now and we’re going to sit and finish this meal. But I find that for a four-year-old to sit still for longer than 10 minutes is sometimes a challenge, especially if they’re not that interested in the task.

If they’re not very hungry, then why would they be interested in food. So it would be a good idea to do a socially appropriate thing to give them a break. They need a little bit of a break, so why not send them into the kitchen to fetch the salt? Or ask the to grab a toy from their bedroom to show daddy what they did today.

You give them a break, and it’s socially appropriate, and they don’t get into a habit of jumping up and running away, but they do know that they can get up and do something if they need to when they’ve been asked. If your child has ADHD then it’s more difficult, and they definitely need a movement break.

Even to the point of asking them to walk 3 times around the table then sit down again and continue the meal. Again, having that routine of having meals at the same time, predictable, sitting at this table as a group – that will be much easier than sitting at a TV with no eye contact or communication with other people.

Liz: That sounds useful to those of us trying to allow our small ones to go to restaurants with us from time to time. So, letting him up to go to the restroom at some point and going to look at something so he can make it through whole meal sitting in one place.

The next two questions are related:

 

QUESTION 4

My 7-year-old son is regressing since COVID in unusual ways. He’s stimming verbally and vocally, he’s somewhat aware he’s doing it but can’t or won’t stop. He’s showing anxiety in other ways as well.

I think part of it’s because he’s not challenged at home, and I can’t provide the stimulation and challenges academically or the social stimulation that the school offers. What tips do you have for a gifted/slightly autistic child to cope with those regressive behaviors?

QUESTION 5

The second question is about a 12-year-old who, at home during quarantine, is also making more and more noises. He likes to hum, he’s talking, he’s gotten into beat-boxing a lot and even though it’s fun, it’s kind of driving us crazy, especially my sound-sensitive daughter (18yrs) who also has ADHD. Help!?

Colette: Stimming is a way for ADHD kids or ASD kids to usually show those around them, “Listen, I’m not OK. ”Stimming is rocking, looking around, moving a lot, making noise, repetitive things that are not socially acceptable in that particular environment. These kids do that because they’re getting anxious. They’re saying, “I don’t’ know how to deal with my surroundings.

”1. One good thing to do is you can ask them, “Sit down, tell me what’s happening.” If they’re not able to tell you, then you need to assess the situation. What happened just before?

2. I have a weekly diary that I can share with the audience. Keep a diary to track stimming throughout the day. Write down what was going on at the moment, what was going on just before, and any changes in the daily routine that day. How was their sleep? How were their meals?

3. To relieve some of the anxiety and reduce the stimming at the moment it’s happening, give your child something that they can do with fine motor skill manipulation.

Small tasks that involve manipulation and concentration – LEGO blocks are the best for this. But also for young kids, hand them some cars and tell them to have a race or try to drive the car to a certain part of the house and back.

Theraputty is another fantastic tool – like Marga mentioned last week with sticking small pieces of toys inside the Theraputty and having the child stretch and pull to remove each item.

Fidget toys are popular for a reason – they are great at offering a focal point for stimming in a socially acceptable way.

Here is a link to Theraputty and other sensory toys that may help:

4. Movement breaks are obviously one of our most useful resources as well, that’s why CoordiKids spent so much time designing and recording them for kids to follow at home.

Not only does movement get the nervous energy out, but targeted movements that stimulate the midbrain are effective at emotional regulation.

The CoordiClass program is the one designed for this – just 5 minutes of quick, fun movement to relieve some of that and allow them to get back to what they were doing.

Marga: From a sensory standpoint, oral sensory input is really, really helpful with stimming. And there’s a reason. From the time we are babies, our bodies and brains are connected through oral feedback. And noise, too.

Crying, puckering the mouth, the amount of pressure and movement from nursing – we are designed to make repetitive noise to alert someone that we are under stress and in need of assistance and comfort. That’s why pacifiers work so well to calm a baby.

Now I don’t recommend giving your 7 or 12 year old a pacifier, but there are alternatives that are more appropriate and acceptable. For example, crunchy, tough-to-chew snacks. Carrots, celery, popcorn.

Those are great to give strong oral sensory input. Sucking something thick through a straw – like a milkshake or a smoothie. Or even a regular drink using one of those twisty straws with all the loops in them – they make it more difficult to suck liquid through.

An ice popsicle on a hot day that gives a fun temperature change, too. I also really like chewable jewelry – there are some called chewelry. My favorite is this really cool one that looks like a LEGO block.

Children can chew on these safely while they’re worn around their neck and always on-hand when needed. See some chewelry here:

One other resource that might help for young children is the CoordiKids: How Do You Feel? Chart

We use a chart that has different levels of emotions on it to ask kids to be specific about their feelings and emotions at-the-moment. Each one has coordinating movements or activities they can do in order to re-calibrate back to equilibrium.

We’ve put it all together, along with a guide for parents to learn how to use it effectively, and we can share it for free right now as well:

Download the How Do You Feel Chart:CoordiKids: How Do You Feel? Chart

 

QUESTION 6

What are some ways to help boost your child’s self-esteem? We just got the official ADHD diagnosis for my daughter. She’ll be 7 in November and will have to repeat kindergarten next year.

I’m trying to get her set up on any and every way possible for the new schoolyear. She doesn’t have great self-esteem and is very concerned about if people like her.

Colette: You know, it’s really important that children get in the habit of talking about themselves and hearing others talk about them in supportive ways. An exercise I recommend for all families to boost self-esteem is to spend a few minutes at the dinner table every day discussing something that we love about ourselves and love about each other.

Mix it up between things about how we look – our hair, our eyes, ‘Oh I love your great hair!” and our personality. “You’re so funny and fun to be around” or “I’m good at helping people learn new things.

”But not just the positive things, either. It’s also important to say things like, “I’m not so good at this, and I didn’t do a great job at it today, but I’m trying and that’s OK!”

That’s sometimes the most important part that we don’t get used to as kids. If all we ever hear is how wonderful we are, then anytime someone else tells us something painful to hear or we fail at something, we completely melt down or shut down.

We need that balance, and I think that’s the important part. I use some worksheets that kids can fill out while they’re waiting for dinner to be ready, too. They are simple fill-in-the-blanks to prompt them to think about these types of things that they are good at, things they enjoy, and things they’d like to try to be better at.

 

Here are Colette’s special Worksheets for you to use with your children:

Download Colette’s 2 Self-Esteem Worksheets and Weekly Diary:

CoordiKids: Self-Esteem Worksheets & Weekly Diary