“I Remembered Not to Forget!” How to Improve Working Memory in Children
If complex instructions or information fly easily out of your child’s mind, use these in-school and at-home tips to reduce the nagging and improve his working memory.
Working memory is the ability to hold information in mind while performing complex tasks. A young child is able to execute simple tasks — sharpen his pencil when asked — while one in middle school can remember the expectations of multiple teachers.
Since students with attention deficit disorder (ADD or ADHD) and learning disabilities often have problems with short-term memory, it is important to reduce the amount of routine information they must remember. Keeping their memory free for the key part of the task in front of them is essential.
Parents and teachers can help students with ADHD develop strategies for remembering more, and — most importantly — routinely using the strategies they came up with.
How to Improve Working Memory in Children at School
Put homework assignments in writing. Write each assignment on the blackboard in the same place every day, so that students know where to find it. Kids with ADHD may not be listening or paying attention when you give them oral instructions — and you can’t rely on them to always remember instructions.
Make checklists. One way to reduce memory demands is to provide your class with a list of the steps required to complete an assignment. The instructions should be brief.
Find out what they heard. Have students with weak working memory repeat assignment instructions and clarify any parts that they may have forgotten.
Make time at the end of class for students to write down homework in their assignment books. Make sure the kids with ADHD are doing what you’ve asked. Fun, visual reminders can also help. For an essay assignment, for instance, have each student trace her hand on a piece of paper and then write the name of one part of the essay in each finger: thesis statement, topic sentences for the first, second, and third paragraph, and conclusion.
Make eye contact with a child before giving him a classroom assignment.
Keep homework assignments on the school website up-to-date. Parents of kids with ADHD depend on this information to make sure their kids know what to do.
Speak slowly and provide information in small units. Given too much information at once, a child with weak working memory quickly loses track. She may still be working through the first few minutes of the lesson after you’ve moved on.
Make lectures interactive. To get kids with weak working memory to remember something important, structure the lecture to include responses from them. For instance, when teaching a math lesson, you might encourage students to volunteer to share what they learned about fractions, division, or whatever material was covered that day. Repeating a key point will help anchor it in their memories.
Use wild and wacky strategies. Presenting information in a typical fashion may not grab a student’s attention, but a curve ball can help grasp it for better recall later.
Use brain breaks or movement and exercise. Exercise increases blood flow to the brain and helps students think more clearly. So, rather than have students raise their hands to answer, you can have them do jumping jacks by their chairs. You can also encourage movement by letting kids walk to the water fountain for a break.
Have a routine for handing in homework assignments. Some teachers ask students to place their completed work on their desk as soon as they sit down for class — and then check off in their grade books that the homework was done. Another idea: Make handing in homework the “ticket to get out of class” at the end of the day. Stand by the door and collect it as the students leave. As you can imagine, kids will comply when the alternative is having to stay in school one minute longer.
Talk with students about what to do if they forget something. Assign — or ask students to select — a study buddy they can talk with if they’ve forgotten what they’re supposed to do for homework or can’t remember what to do in class.
Use an analog clock during lessons to help your students with time management. They will be able to keep track of how much time has passed and how much remains.
Call close attention to due dates and key concepts. Post them, refer to them frequently, and remind parents and students in notes home, newsletters, or school voicemail. For essential themes delivered when instructing, use cues like, “This is important!” It also helps to frame important information with numbers i.e. “Remember 5 things.”
Ask students to design their own “tickler systems” — ways to remind themselves of things they must remember (permission slips, lunch money, gym clothes). This could lead to a class discussion, to give students a chance to share the strategies that work for them.
How to Improve Working Memory at Home
Assign a designated place for your child to put important stuff — house keys, wallet, sports equipment. As soon as he gets home from school, make sure he puts those things where they belong. A reward for following through — or a penalty for not — will reinforce the habit of staying organized.
Create a reminder checklist to make sure your child has everything she needs to bring to school. In the beginning, watch as she goes through the checklist, to make sure she’s putting every item in her backpack. Do not repeat what’s on the list, but ask her to tell you (this helps to transfer the information from your working memory to hers). Have your child use the checklist when she finishes her homework the night before, to avoid rushing around in the morning.
Make, and use, to-do lists yourself, so that your child sees this is a lifelong coping strategy. Life is too complicated to expect kids to commit everything to memory!
Brainstorm with your child about ways he can remember important things. Can he write it on the back of his hand, program his smartphone to remind him, ask friends with better memories to prompt him?
Homework Routines to Improve Working Memory
Get permission from teachers for your child to e-mail her assignments. This is easy for kids who do homework on the computer. Some families scan the homework on a scanner and e-mail it to the teacher. This tip won’t strengthen working memory, but it’s a good coping strategy for students with weak executive function.
Reward your child for remembering. E-mail teachers once a week to make sure all the homework was handed in. Give your child five points for all homework turned in, four points for missing only one assignment, and no points if he misses more than one. Create a menu of rewards the child can earn. Allot more points for more complex assignments.
Give your child a homework routine to follow. Homework is a complex series of subtasks that must be completed in sequential order. It requires plenty of working memory. Teach your child that, in order to complete a homework assignment, he must:
- Know what the assignment is
- Record the assignment
- Bring the required materials home
- Do the homework
- Return the homework to his bookbag or backpack
- Bring the completed homework to school.
Morning Routines to Improve Working Memory
Have your child tape-record the steps of his morning routine. Listening to his own voice on playback creates less tension than your nagging him about what to do. If he forgets a step, he can just rewind the tape to figure out what he missed.
Rehearse with your child what you expect him to remember right before the situation. For example, if he needs to ask the teacher for a study guide or one-on-one help, prep him by asking, “So, what do you need to say to your teacher when you go up to her desk?”
Use digital reminders. With children in middle school, use cell phones, text messages, or instant messages to remind them of things they have to do.
Keep external distractions to a minimum — turn off the TV or turn down the volume if you want your child’s full attention when you’re saying something important.
Follow through. Children with weak working memory will indicate that they did something — put their homework in their backpack, say — when you ask, but will proceed to forget. Until the child gets used to taking action when prompted, check on him to make sure he did what he told you.
**Article from ADDitude
6 Things You Didn’t Know About the ADHD Brain
Two top ADHD experts explain how the attention deficit brain works — and, in some cases, why it doesn’t always work at its best.
How do stimulants work in the ADHD brain?
Stimulation is an easily measured feature of the first-line stimulant medications, but it is not clear that stimulation is how and why they work for attention deficit disorder (ADHD or ADD). There are 43 medications currently available that stimulate in the same way that amphetamine and methylphenidate do, but only three of those medications make ADHD better. The rest make it worse. Just being a stimulant is not enough to make a medication work in an ADHD brain.
A PET scan study was done monitoring a specially prepared solution of methylphenidate to see where it wound up in the human brain. Everyone expected that it would go to somewhere in the fronto-parietal cortex, or to some area that was rich in adrenaline or dopamine nerves. It didn’t. Instead, it was actively pulled out of the blood and concentrated in only one area at the exact center of the brain called the corpus striatum.
The striatum has no adrenaline or dopamine activity. The striatum is your executive assistant. It scans all of your thoughts, feelings, and experiences and sends the one most important thing up to your cortex for you to think about. Everything else is handled behind the scenes.
The current theory of ADHD is that the striatum works 99 percent as well as it does in neurotypical brains. Rather than sending only one important thing to the frontal cortex, it sends five or six things, with no particular significance attached to any one of them. This is what it is like to have untreated ADHD — five things rumbling about in your head for no apparent reason. The ADHD medications help the striatum work the way it was meant to. —William Dodson, M.D.
Are stimulants safe for the ADHD brain?
Many years ago, people had unfounded fears about the long-term effects on the brain of taking stimulant-class medications every day for a lifetime. We know the answer. The first data come from the use of stimulants for the treatment of a sleep disorder called narcolepsy. Reviews of people who have taken the same medications that are used to treat ADHD every day for 40 to 50 years did not find a single long-term problem. The longest study of ADHD is the Milwaukee Study, now about 28 years old. Thus far, all of the risk of ADHD has been associated with not treating the condition with medication, not with medication treatment itself. —William Dodson, MD
Why don’t methylphenidate or amphetamine work for me or my child?
Through the years, it has been recognized that the right molecule at the right dose for the unique individual child or adult should have dramatic benefits, with essentially no side effects. However, many parents found that their child did not tolerate or benefit from taking the two stimulant medications, methylphenidate (Ritalin, Concerta, and so on) and amphetamine (Adderall, Vyvanse, and so on). We now know why.
It turns out that the dosage ranges approved by the FDA for the first-line stimulant medications work for only about half of patients. Between six to eight percent of people get their optimal response at doses lower than the lowest doses manufactured. If these patients start at the very lowest dose available, they are already overdosed and experience the Zombie syndrome (emotional blunting, lethargy) or the Starbuck’s syndrome (being too revved up, having a rapid heart rate, becoming irritable). The patients do fine when they take lower doses.
Conversely, about 40 percent of people get their optimal response at doses higher than the highest strengths approved by the FDA. They try medication, but they don’t get to a dose that gives them dramatic benefits. The recognition of a wider range of optimal doses has resulted in better medication response for up to half of patients. —William Dodson, M.D.
Why does the ADHD brain lose interest in tasks?
PET imaging studies of brains in people diagnosed with ADHD demonstrate that chemicals that activate reward-recognizing circuits in the brain tend to bind on significantly fewer receptor sites in people with ADHD than do those in a healthy comparison group. These and other imaging studies may help explain why people with ADHD tend to be less able than their peers to anticipate pleasure or register satisfaction with tasks for which the payoff is delayed. An important effect is that they have great difficulty in activating themselves to get started on tasks that are not especially interesting to them and in sustaining motivation to complete tasks for which the rewards are not imminently available. —Thomas E. Brown, Ph.D., from his book Smart But Stuck
Why is the ADHD brain often swamped by emotion?
There are two primary ways in which emotions play a critical role in the chronic difficulties of people with ADHD. Both are related to working memory impairments—the person’s limited capacity to keep in mind and use multiple bits of emotion-laden information at the same time. Sometimes the working memory impairments of the ADHD brain allow a momentary emotion to become too strong; the person is flooded with one emotion and unable to attend to other emotions, facts, and memories relevant to that memory.
At other times, the working memory impairments of ADHD leave the person with insufficient sensitivity to the importance of a particular emotion because he or she hasn’t kept other relevant information sufficiently in mind, or factored it into his or her assessment of the situation. —Thomas. E. Brown, Ph.D., from his book Smart But Stuck
Why doesn’t the ADHD brain always make the connection?
The networks that carry information related to emotion and other aspects of brain functioning tend to be somewhat more limited in individuals with ADHD compared to most others. Years ago, most scientists thought that impairments of ADHD were due primarily to problems within specific regions of the brain, particularly the prefrontal cortex. New technologies, however, have shown that some of the impairments of people with ADHD may be more related to networks of fibers that support interactive communication between various regions of the brain. One type of communication between brain regions occurs via connections referred to as “white matter.” Imaging studies have shown abnormalities in the structure of white matter in brains of children, adolescents, and adults with ADHD.
Such abnormalities may explain some of the difficulties these individuals have — keeping one thing in mind while doing something else. One study has shown that methylphenidate, used to treat ADHD, can normalize the connectivity limitations in the motivation and reward networks of children with ADHD when they are performing some assigned tasks. —Thomas E. Brown, Ph.D., from his book Smart But Stuck
Courtesy of ADDitude magazine
How You’re Treating ADHD Today
There are more treatment options available for ADHD than ever before. Which ones are people using, and are they finding them effective? We wanted to find out the answers, so we asked you, our readers, in an exclusive ADDitude survey. What we discovered from the more than 4,000 responses challenges our assumptions about how people are actually treating their ADHD in 2017.
By Devon Frye, Anni Layne Rodgers
ADHD is a complex and nuanced condition, with symptoms varying widely from distractibility to excessive activity and many points in between. The average treatment plan, it seems, is correspondingly complex.
A recent survey of more than 4,000 ADDitude readers shows us that adults and parents treating ADHD typically try multiple treatment options and continue to tinker with the overall plan years, or decades, after being diagnosed. No single medication, therapy, or dietary and supplement regimen works for all individuals with ADHD. What’s more, the treatments that our readers told us work best aren’t always the ones recommended by their doctors or used by the most people.
Getting to the right treatment plan is complicated and affected by economics, geography, and access to information. Survey respondents also suggest that ADHD treatment plans may be shaped by factors like insurance coverage, lifestyle changes, budgets, and side effects.
“Everyone with ADHD is different — reacts to different treatment modalities differently, reacts differently to drugs,” one mother wrote in the survey. “For some, it’s straightforward. For others — like us — it is frustrating, at best.”
The trial and error of treatment feels like “a full-time job,” our readers said. ADHD medications, many of which are controlled substances, often require multiple doctor’s visits, frequent refills, and expensive copays — “and that’s with insurance,” one parent wrote. Non-medication options, like coaching or neurofeedback, are not available outside of many metropolitan areas — and if they are, they’re often not covered by insurance, leading respondents to “not try things because we couldn’t afford to.”
Patients also reported having to research comprehensive treatment plans on their own, and this is not easy. For the most part, respondents received little expert information about treatment options beyond medication, which was recommended by 92 percent of our respondents’ medical professionals.
For example, the American Academy of Pediatrics (AAP) recommends behavior therapy paired with medication for all children with ADHD over the age of six. Yet fewer than one-third of the ADDitude caregivers surveyed said their doctors prescribed behavior therapy. According to the survey, 59 percent of children with ADHD are not receiving this recommended form of treatment.
Similarly, exercise was rated as “extremely” or “very” effective by roughly half of the respondents who use this treatment. Yet only 13 percent of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37 percent of all respondents said physical activity was part of their treatment plan.
In the end, despite combining medication and lifestyle changes, researching and self-funding treatments not covered by insurance, and continually revisiting their treatment plans, overall satisfaction rates were low. Indeed, only 30 percent of caregivers called their child’s treatment plan “extremely” or “very” effective. Likewise, just 44 percent of adults surveyed were satisfied with their ADHD treatment. Here, we will analyze the survey data for reasons why this is true, and look for a better way forward.
ADHD Treatment Snapshot
Percent of Survey Respondents Currently Using Each Therapy
|Vitamins, Minerals, or Supplements||36%||41%|
|Cognitive Behavioral Therapy (CBT)||—||19%|
|Behavioral Therapy/Parent-Training Classes||10%||—|
|Neurofeedback with a Clinician||5%||3%|
|Home-Based Brain Training||3%||2%|
ADHD Treatment Ratings
Percent of Survey Respondents Who Rated Each Therapy Extremely or Very Effective
|Vitamins, Minerals, or Supplements||12%||15%|
|Cognitive Behavioral Therapy (CBT)||—||41%|
|Behavioral Therapy/Parent-Training Classes||33%||—|
|Neurofeedback with a Clinician||30%||42%|
|Home-Based Brain Training||22%||14%|
About the Survey
In August 2017, we sent the “My ADHD Treatment Plan” survey to a group of ADDitude newsletter subscribers. Among the 4,425 respondents, 2,495 were parents reporting on a child, and 1,563 were adults focused on their own treatment. Boys comprised 74 percent of the children, while 75 percent of the adults reporting on their treatment plans were women. Subjects ranged in age from four to older than 65; most children were diagnosed between the ages of five and eight, while 44 percent of adults were diagnosed after the age of 40.
The survey (and a follow-up) documented readers’ history with and attitudes toward 10 ADHD treatments: medication, vitamins and supplements, neurofeedback, home-based brain training, coaching or counseling, cognitive behavioral therapy, parent training, exercise, diet and nutrition plans, and mindful meditation.
Find complete information about the survey and the resulting data at https://www.additudemag.com/2017-adhd-treatment-survey-findings/
Exercise. Behavior training classes. ADHD coaching and counseling. These are the treatments rated most effective by caregivers and adults with ADHD, according to our survey. All three — plus meditation, neurofeedback, and CBT — ranked higher than did medication for efficacy. Yet, despite the middling effectiveness rating for medication — and the occasional glowing review — our respondents used it far more than any other treatment. Why? Convenience factored heavily — particularly when considering the time commitment associated with therapy or lifestyle changes. But medication’s main advantage may be the tangible, immediate changes it can bring — and for those struggling with symptoms on a daily basis, any concrete improvement can feel like a lifesaver.
That said, finding the most effective medication with the fewest side effects was not usually a quick or easy process. Most survey respondents tried a number of medications before finding one that worked — 2.7 medications, on average, for caregivers; 3.5 for adults. You must be “patient and willing to go through trial and error,” wrote an adult who tried Ritalin, Adderall, and Evekeo before settling on Vyvanse. “Once you find it, it will do so much in improving symptoms.”
Another group of survey respondents (16 percent of caregivers; 18 percent of adults) reported that they had used medication in the past but had stopped taking it altogether. This decision was usually because of persistent side effects. Among the most common were:
- Loss of appetite: experienced by 58 percent of children and 35 percent of adults surveyed
- Irritability: experienced by 34 percent of children and 24 percent of adults surveyed
- Sleep disturbances: experienced by 28 percent of children and 23 percent of adults surveyed
The Medication Decision
Parents too often face criticism for “jumping on the medication bandwagon.” In reality, only 14 percent of caregivers said they viewed medication as the “first-line” treatment for their child’s ADHD symptoms; an equal number said medication was their “last resort” — and an additional 20 percent said they tried other treatment options before deciding to pursue medication.
“It’s not that I don’t think the other treatments will work at all,” one parent wrote. “It’s that we think medication will have quicker results, work better, and [work] more consistently.” Medication has “worked wonders” for her daughter for 14 years, she wrote.
Adults were generally far less reluctant to try medication, and more likely to view it in a more positive light. About a third of adults saw medication as their “first-line” treatment; less than 5 percent said it was their last resort. Only 9 percent said they tried something else before trying medication, and 51 percent see medication as life-changing. “I don’t know how I survived without it all of these years,” wrote one person. “It’s like someone switched on a light.”
Those who turned quickly to medication frequently cited its “ease” and immediacy — a doctor’s prescription was easily filled and any effects (positive or negative) were usually noticeable right away. “I wanted to get my son’s symptoms under control quickly,” said one caregiver. “Medication seemed like a good first-line attack for that.”
Others said they were at their wits’ ends. “Getting [my daughter] to do anything was a struggle,” wrote one parent. “I took her to a psychologist who suggested medication. I was 100 percent on board — I would say I was desperate to find something to work.”
Other parents said they changed their minds about medication because other treatments failed to ameliorate symptoms. One caregiver, who reported trying vitamins, behavior therapy, and neurofeedback before settling on medication, said: “I don’t want to give him medicine to make him feel ‘normal’ — but he cannot function without it.” Some parents never feel at ease with their decision. “It terrifies me,” one parent wrote. “I only give it to him during school — no weekends or summer.”
“Before meds, our bad days outnumbered our good,” one parent wrote. “On meds, our good days outnumber the bad.”
How Common and Popular Is ADHD Medication?
|Average # Meds Tried||2.7||3.5|
|We thought of medication as a “first-line” treatment||14%||34%|
|We thought of medication as a “last resort”||14%||5%|
|Medication has been a life-changer||45%||51%|
|Medication has some positives and some negatives||44%||45%|
|Medication is just part of a treatment plan||41%||21%|
Vitamins and Supplements
Vitamins, minerals, and supplements were the most popular non-medication treatment among our survey respondents, 47 percent of whom said they had tried at least one. Of that group, fish oil was the top choice (used by 77 percent), followed by magnesium and vitamin B6. Yet only 17 percent of people said their doctors had recommended supplements.
Despite their relative popularity, vitamins ranked as the least effective treatment for children and the second least effective for adults. More than a third of caregivers and adults called them “not very” or “not at all” effective. When it came to fish oil, in particular, adults complained of having to take “huge” doses to see any benefits, and parents struggled to get kids to swallow large capsules or to get beyond the “fishy” taste. Many parents stopped this treatment, in part, because they could not find a formulation that worked and/or they could not tell whether it was helping. “The fish oil did help my son,” one parent wrote, but, “he got tired of the taste of both of the kinds we tried and didn’t want to take them anymore.”
High-quality fish oil, like other supplements, can be expensive, respondents said. “I didn’t see much bang for the buck with this treatment — and it was a lot of bucks,” wrote one man in his 30s. The high costs made him abandon the treatment quickly — an experience echoed by others.
Top Non-Medication Treatments Used for ADHD Symptoms
|Vitamins, Minerals or Supplements||36%||41%|
Top Vitamins, Minerals, and Supplements Used to Treat ADHD Symptoms
The following numbers represent the percentage of people using each specific treatment among the subset of survey respondents who said they are using vitamins, minerals, or supplements.
Top Diet/Nutrition Strategies Used to Treat ADHD Symptoms
The following numbers represent the percentage of people using each specific treatment among the subset of survey respondents who said they are diet and nutrition strategies.
|Decreasing/eliminating artificial colors/dyes||70%||53%|
|Decreasing/eliminating artificial flavors||51%||48%|
Top Reasons Why Non-Medication ADHD Treatments Were Not Tried
|Not covered by insurance/high cost||29%||28%|
|Hard to find professionals||24%||25%|
|Wasn’t aware of other treatments||11%||22%|
|Medication alone works well enough||10%||20%|
Exercise ranked as the most effective ADHD treatment among both caregivers and adults — 49 percent and 56 percent of whom gave it high marks, respectively. That is not a surprise. Research shows that exercise elevates dopamine and norepinephrine levels in the brain, thus boosting focus, self-control, and mood. Despite the solid science and high satisfaction levels, however, our survey shows that only 37 percent of children and adults with ADHD are managing their symptoms with daily exercise.
The respondents who exercise said they do so to benefit their general health, not just their ADHD symptoms. But its mood-boosting and sleep-inducing effects, in particular, were popular. “Exercise allows me to drain my brain,” said one adult. “When I leave the gym, my brain is happy, content, and not going in all different directions.” Parents, too, notice behavior improvements associated with exercise. One mother reported, “I can tell by his behavior when my son does not get enough active outdoor time.”
The AAP recommends behavior therapy as the first-line treatment for children younger than six, and using it in conjunction with medication for older children — and 41 percent of our survey respondents had completed a parent-training course. Those who did liked that it gave them more “tools” as parents and, due to the group setting of many programs, the realization that they were not alone.
Still, why did less than half of the caregivers we surveyed use this AAP-recommended treatment? One-third reported difficulty finding a practitioner in their area; another 34 percent were deterred by inadequate insurance coverage or a high out-of-pocket cost. Only 9 percent said that they didn’t seek behavior therapy because they felt it wasn’t needed.
“It’s hard to find the proper counselor,” one parent wrote. “Many don’t take insurance, and the time commitment to bring him made therapy very inconvenient.” One parent wrote of a 90-minute car trip to take her child to a therapist each week; another wrote that insurance covered only five sessions — and paying for more out of pocket was unaffordable.
In addition, effectiveness “entirely depends on the program and the support given to parents,” wrote the mother of a teen. That thought was held by others: Behavioral therapy was primarily positive (33 percent rated it “extremely/very” effective) — when it was available — but an ADHD-specific program is critical to success.
Treatment Is a Journey
Our survey results indicate that ADHD treatment is neither streamlined nor satisfying for most families and individuals. Most of our respondents conducted their own treatment research, cast wide nets, and combined multiple strategies — and, even then, felt satisfied less than half the time. Many described the process as “a moving target” or “a work in progress” — even if their journey began years or decades earlier.
While some respondents did report satisfaction with their treatment plan, many reported that the process can seem arbitrary, complicated, and overwhelming — in large part because treatment almost never comprises just one modality. Though caregivers and adults face no shortage of options, each has its own upsides and drawbacks.
Diet and Nutrition
More than a quarter of respondents have used dietary changes to address ADHD symptoms (with higher rates in those who had never tried medication). Decreasing or eliminating sugar was the most popular choice, followed by eliminating artificial dyes and increasing protein.
Many caregivers reported struggling to make dietary changes stick. “We tried working with a nutritionist, but our child simply wouldn’t follow the diet,” wrote one parent. “She tends to eat carbs and sweets, and wouldn’t realize how often she strayed from the diet.”
Mindfulness is used by 35 percent of adults with ADHD, but just 13 percent of children. The satisfaction rate among adults who use meditation is high, with 42 percent rating it as highly effective. Many cited mood boosts, improved executive functioning, and decreased anxiety as benefits of this therapy.
“Meditation is a critical part to starting the day!” wrote one adult. “Taking a few moments to ground yourself before your ADHD brain races off works wonders.”
Coaching & Counseling
Twenty-six percent of caregivers and 21 percent of adults reported experience with ADHD coaching or counseling. For adults, this was the second most effective treatment; more than 48 percent rated it as “extremely” or “very” effective. Caregivers also viewed it generally positively, with more than a third rating it highly.
However, “Finding the right personality is key,” said one parent. “And my daughter doesn’t always want to follow the coach’s advice.”
Brain Training and Neurofeedback
Very few respondents use neurofeedback and home-based brain training (5 percent or less in both populations), with slightly higher rates in parents and adults who had never medicated.
Neurofeedback was rated well by 30 percent of parents and 42 percent of adults — meaning that, while it was barely used, it ranked higher in effectiveness than several more popular treatments. Still, among parents and adults as a whole, home-based brain training wasn’t well reviewed: just 22 percent of parents and 14 percent of adults rated it highly, and one called it “just a glorified video game.”
Complex PTSD: Trauma, Learning, and Behavior in the Classroom
By Fabiana Franco, Ph.D.
~ 5 min read
Complex post-traumatic stress disorder (CPTSD) occurs with repeated ongoing exposure to traumatic events. Often CPTSD is a result of early traumatic relationships with caregivers. In this article we consider the effects of early traumatic relationships on learning.
Many children with a history of trauma have trouble with learning in the classroom and do not perform as well as their peers. The connection between early interpersonal trauma and learning is particularly relevant when considering the ability to maintain attention and concentration. Often, early traumatic relationships impair more than emotion regulation abilities. Cognitive capacities are also deeply affected since the ability to focus and concentrate is largely dependent upon emotion regulation.
Early attachment relationships and learning
Early relationships have a direct impact on cognitive, social and emotional development. This is because an infant/child who is raised in a safe and supportive environment has ample opportunity for exploration as well as the availability of comfort from a trusted caregiver.
One of the ways infants learn is through play and exploration of their environment. When thinking about this stage of development it is crucial to understand that an infant’s biological system is not mature enough to calm itself in times of fear or upset. This is why young children and infants reach for a trusted adult when they feel fear or uncertainty. In a secure relationship, opportunities abound for curiosity and exploration. At the same time, the infant is protected from unhealthy levels of stress, when he/she needs comfort, it is available.
Attachment researchers call this phenomenon a “secure base” in which the caregiver encourages the child to lay, with providing safety and security for the infant when needed. Exploratory play coupled with protection provide an optimal environment for learning. Researchers have noted traumatized infants tend to spend less time in exploratory play (Hoffman, Marvin, Cooper & Powell, 2006).
Let’s imagine a young child in a playground. She is less than a year old and not quite walking on her own yet. With mom nearby she can explore, perhaps by playing in the sandbox and learning how her toy car moves differently over sand in comparison to the kitchen floor at home. She is learning important information about the world. While she plays while she is keeping an eye on mom, making sure she is near. If anything happens to cause fear, perhaps a big dog strays onto the playground, a predictable scenario plays out. The child begins to cry, afraid of the dog. Mom is here to help. She picks up her infant and soothes her distress, walks away from the animal, and relatively soon, the infant is calm again.
In a traumatic relationship, mom may not recognize she needs to help her child. She may not be afraid of dogs and does not understand the infant’s reaction. She may decide to let the infant learn about dogs without her help. Perhaps the child gets bit by the dog or is allowed to scream frantically while the big, unfamiliar animal investigates her, and still mom does not react in an appropriate calming way. She may let her child learn the dog is safe (or not safe) without getting involved. Alternatively, she may escalate the situation with her own fear of dogs and scare the child even more.
In terms of emotional and cognitive development, these two infants are dealing with very different internal and external environments. Internally, the traumatized infant’s developing nervous system is exposed to ongoing heightened states of stress hormones that circulate through the developing brain and nervous system. Since the infant is left on her own to recover from a traumatic event, all of her resources are required to bring herself back to a state of balance. Researchers in the field of neuropsychology have pointed out that when an infant is required to manage its own stress without help, he or she can do nothing else (Schore, 2001). All energies are dedicated to calming the brain and body from significant stress. In this situation, valuable opportunities for social and cognitive learning are lost.
It is important to understand that all parents at some time fail to soothe their child when he/she is distressed. Healthy children do not require perfect parenting; it is the continued ongoing trauma that is detrimental to development.
Hypervigilance — The impact of early traumatic relationships in the classroom
Children raised in violent or emotionally traumatic households often develop hypervigilance to environmental cues. More than just a “common sense” response to an abusive environment, hypervigilance occurs because of the way the nervous system has organized itself in response to persistent fear and anxiety during the earliest years of development (Creeden, 2004). Hypervigilance to other’s emotional cues is adaptive when living in a threatening environment. However, hypervigilance becomes maladaptive in the classroom and impedes the child’s ability to pay attention to school work. For the traumatized child, school work may be thought of as irrelevant in an environment that requires attention dedicated to physical and emotional protection of self (Creeden, 2004).
Imagine a time when you were very upset or unsure of your physical or emotional safety. Perhaps an important relationship is threatened after a particularly heated argument and you feel you are at a loss of how to fix it. Imagine you had a violent encounter with a parent, or are dealing with sexual abuse at home. Now imagine, in this situation, trying to focus your attention on the conjugation of verbs, or long division. It is likely you would find this impossible.
What can be done?
It’s important that we understand the roots of learning and behavioral difficulties in the classroom so we can address them with therapy rather than prescribing medications (Streeck-Fischer, & van der Kolk, 2000). Some children who cannot focus in the classroom may be wrongly diagnosed and never offered the help they need.
There are effective ways to help children with past trauma in their learning environments. Adults need to understand that for a traumatized child, challenging behaviors are rooted in extreme stress, inability to manage emotion, and inadequate problem solving skills (Henry et al, 2007). In these circumstances, the child will likely respond more positively to a non-threatening learning environment. Children with traumatic histories need the opportunities to build trust and practice focusing their attention on learning rather than survival. A supportive environment will allow for safe exploration of the physical and emotional environment. This strategy applies to children of various ages. Older children also need to feel safe in the classroom and when working with adults such as teachers and other professionals. Frustrated teachers may believe children with challenging behaviors are hopeless and just not interested in learning. The teacher may insult the child, respond with sarcasm or just give up on the child. Teachers may fail to protect the child from teasing or ridicule from their peers. In this way, the teacher is also contributing to the threatening environment the child has come to expect.
New understanding, new opportunities
A shift in understanding is required for teachers and other professionals working with traumatized children in the classroom. Supportive environments can give these children a chance to modify their behavior and develop coping skills. This change in adult’s perception of why the child is unable to focus on schoolwork will hopefully lead to a change in attitude.
Even more importantly, children with trauma in their early history are in need of therapy and support. With understanding and appropriate therapeutic intervention, these children will have a much better chance at healing past trauma and developing the ability to focus, learn in the classroom and respond differently to challenging situations.
Baker, L.L. & Jaffe, P.G. (2007). Woman abuse affects our children: An educator’s guide. Developed by the English language Expert Panel for Educators, Ontario.
Creeden, K. (2004). The neurodevelopmental impact of early trauma and insecure attachment: Re-thinking our understanding and treatment of sexual behavior problems. Sexual Addiction & Compulsivity, 11, 223-247.
Henry, J., & Sloane, M., & Black-Pond, C. (2007). Neurobiology and neurodevelopmental impact of childhood traumatic stress and prenatal alcohol exposure. Language, Speech and Hearing Services in Schools, 38, 99-108.
Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers’ and preschoolers’ attachment classifications: The Circle of Security Intervention. Journal of Consulting and Clinical Psychology, 74(6), 1017-1026.
Schore, A. N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant mental health journal, 22(1‐2), 201-269.
Streeck-Fischer, A., & van der Kolk, B. A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34(6), 903-918.
How Stress Affects Children & How to Manage It
By Jennifer Paterson, ARCT
As grown-ups, we all suffer from stress at one point or another, but do your children?
Science says yes.
According to the American Psychological Association, about 20% of children report worrying a great deal. Unfortunately, parents greatly underestimate their child’s emotions. Only 3% of parents rate their child’s stress as extreme, and while 33% of kids experienced headaches in the month prior to the study, just 13% of parents thought these headaches were stress-related.
Here’s how you can help your kids manage stress.
How Stress Affects Children
Kids may experience different stresses than their parents — such as worrying about doing well in school, relationships with their siblings and peers, and their family’s financial situation — but they still experience the emotions. Mental health problems like anxiety, depression, and stress can have a detrimental impact on your child’s long-term development, especially because their brains are still developing. Stress affects biological processes, taking its toll on the brain and body.
Stress is your body’s natural response to demanding or adverse circumstances. Biologically speaking, it’s meant to help us deal with life-or-death situations. This fight-or-flight response causes a shift in hormones — including the release of cortisol and adrenaline — which elevates blood pressure and heart rate. Stress is beneficial in short-term situations, but when that stress response is always “on,” it can lead to problems. People can start to suffer from heart disease, obesity, and diabetes, not to mention mental issues like depression, fear, neediness, and the inability to learn new behaviors. This prolonged activation of the stress response is called “toxic stress.”
How to Help Your Kids Manage Stress
Adults have their own tricks for managing stress, but your kids have yet to develop the habits and discover the activities that can help reduce their worries. Put their health and development on the right track by giving them a helping hand. These following tips will get you started.
Talk with Your Kids
The first step to helping your kids is to understand what’s bothering them and stressing them out. That way you can combat the stress at the source. For example, while 30% of kids worry about family financial difficulties, only 18% of parents believe it’s a source of their child’s stress. If you discover they’re worried about money, you can talk through your finances with them. You can even help them set up their own bank account and budget so they feel more in control. What’s more, talking to your kids shows them it’s okay to approach you about their worries so they don’t have to face them alone.
Play with Your Kids
These days, children are spending less and less time playing. According to Forbes, an increasing number of schools are reducing recess time, or cutting it completely, in order to allow more time for instruction in the classroom. That, combined with screen time, leaves many kids with physical play completely absent from their day.
The problem with this is that playtime, especially physical play, is significant in a child’s development. Not only does a lack of exercise lead to higher obesity rates and other health conditions, but it can also impact cognitive abilities, attention, problem-solving skills, and overall academic performance.
This ties back to one of your child’s biggest stressors: homework and grades. If they can’t concentrate in the classroom, it will only increase their stress. Getting outside to play comes with countless direct and indirect benefits on your child’s stress. Exercise naturally relieves stress by releasing feel-good hormones called endorphins. Along with that, children who exercise more tend to eat better, which can also have a biological effect on stress. Outdoor playtime gives them a break from their stressors and boosts productivity when they return to their responsibilities.
So what’s the key? Get outside and play with your kids. Go to the park. Go on a hike. Play tag football in the backyard or Frisbee at the park. As an added bonus, you’ll strengthen your relationship with them, which will further reduce their stress.
Enroll Your Kids in Music Lessons
Another stress-busting activity that will come with numerous benefits is to enroll your kids in music lessons. Music has a strong connection to our emotions. In one 2013 study, researchers found that music impacts the stress system and leads to faster recovery from stress. Playing and creating music acts as a kind of medicine that can help reduce blood pressure and decrease heart rate to reduce stress, depression, and anxiety.
Not only that, but learning music from a young age can have incredible benefits in academic areas. For example, music teaches children how to listen for certain sounds, which can help them in with speech, language, and reading. So enrolling your kids in music lessons isn’t just great for their stress levels; it promotes a well-rounded development, too.
You can use this concept in multiple aspects of life, even outside the classroom. Play music while cleaning or helping with homework, join community musicals together, or attend concerts with your kids.
These days, fewer and fewer kids are getting enough sleep. Part of this trend is due to an increase in screen time. Forty percent of kids have a TV or iPad in their bedroom, and 57% don’t have a regular bedtime. That leads to 60% of kids who don’t get enough sleep. The problem? Studies show that this can have a great impact on their irritability and stress.
“Enough sleep” depends on your child’s age. Toddlers need about 11 to 14 hours of sleep per day, preschoolers need 10 to 13, and school-aged kids need 9 to 11 hours of sleep per day. Your teenagers should be getting at least 8 to 10 hours of sleep every night. Be sure your kids have a scheduled bed time and understand the importance of sleep.
Need A Happiness Boost? Spend Your Money To Buy Time, Not More Stuff
August 28, 2017
Mowing the lawn can be good exercise, and is fun for some people. But others who find themselves squeezed for time might find the luxury of paying someone else to do it to be of much more value than buying more stuff.
Money can’t buy happiness, right? Well, some researchers beg to differ. They say it depends on how you spend it.
A recent study published in the Proceedings of the National Academy of Sciences (http://www.pnas.org/content/114/32/8523.full) suggests that when people spend money on time-saving services such as a house cleaner, lawn care or grocery delivery, it can make them feel a little happier. By comparison, money spent on material purchases — aka things — does not boost positive emotions the way we might expect.
Think of it as a way to buy back what has become for many Americans a scarce resource: free time. Yet, in a culture where many people are quick to buy the latest model phone, a big-screen TV or a fancy pair of shoes, those same people are often resistant to spending money on time-saving services.
“Contemplating paying somebody else to do something you’re perfectly capable of doing yourself may provoke feelings of guilt,” says Elizabeth Dunn, a professor of psychology at the University of British Columbia and an author of the study. Dunn and her colleagues had a hunch that if people spent money to hire out some of the unwanted tasks on their to-do list, they might feel more satisfied with their quality of life.
“We hypothesized that people would be happier if they spent money to buy themselves out of the things they don’t like doing,” she says.
As a test, she and her colleagues designed an experiment: First, they recruited 60 adults under the age of 70 from Vancouver, British Columbia. The researchers gave the volunteers a little cash and asked them to spend it in two different ways, on two consecutive weekends.
“On one weekend we gave them $40 and asked them to spend it in any way that would give them more free time,” Dunn explains. Participants in the study chose a variety of services — everything from meal delivery to a cleaning service to help with errands.
Then, on the other weekend, the participants got another $40 to spend on a material purchase. They could choose anything they wanted within that budget. “One person bought polo shirts,” Dunn says. “Another participant bought wine that she described as fancy.”
After each weekend purchase, the researchers called the participants and asked how they were feeling. The participants reported how much “positive emotion” they’d been experiencing and how much “negative emotion,” Dunn explains. When the study participants spent money on time-saving services, they reported more positive emotion.
“Buying yourself out of [tasks] like mowing the lawn or cleaning the bathroom — these were pretty small, mundane expenditures, and yet we see them making a difference in people’s happiness,” Dunn says. But how much happier? A separate part of the study helped to answer this question.
The same researchers surveyed a group of 6,000 people across a wide range of income brackets in the U.S., Canada and Europe. (The median household income for U.S. residents in the survey was $75,000, but the study also included working adults who made about $30,000 per year and some European millionaires.)
Respondents completed survey questions about whether they spent money each month to increase their free time by paying someone else to complete unenjoyable tasks, and if so, how much they spent. In addition, the respondents were asked to rank their own level of happiness on a 10-point scale of life satisfaction. Think of the scale as a happiness ladder with 10 rungs.
“What we found is that people who spent money to buy time reported being almost one full point higher on our 10-point ladder, compared to people who did not use money to buy time,” Dunn explains. People from across the income spectrum benefited from “buying time,” she adds.
Moving up one rung on the happiness ladder may not sound like much, but the researchers say they’re very excited by their results. “Moving people up on the ladder of life satisfaction is not an easy thing to do,” Dunn says. “So, if altering slightly how people are spending their money could move them up a full rung, it’s something we really want to understand and perhaps encourage people to do.”
Emanuel Maidenberg, a clinical professor of psychiatry and bio behavioral sciences at UCLA who was not involved in the study, tells NPR he was a little surprised by the results. He says it’s an intriguing possibility to think about time-saving services as a “stress-management tool.” But there are still some unanswered questions, he says. For instance, is the boost in positive emotions sustainable, “or is it just an immediate response?” Maidenberg wonders.
The authors are “presenting enough data to justify a more careful look into this,” Maidenberg says. “It’s exciting.”
ADHD Weekly Newsletter
DWD — Driving While Distracted — is a real risk for drivers affected by ADHD. Researchers are looking for ways to reduce those risks, and medications top the list. Read on for more information, as well as non-medication tips. Keep reading for tips to make your driving safer.
ADHD & Driving? Research Points to Meds
When we first learn to drive, we pay attention to every little detail—staying in the lane, how much pressure we need on the gas or the brake pedal, the drivers around us, using our turn signals. Once we have enough practice, we tend to not think deliberately of each of these actions. The unconscious part of our brain takes over those details, freeing our minds to think about other things. But is that a good thing?
Drivers affected by ADHD have challenges with executive function. They are at greater risk of having car accidents and receiving traffic tickets for speeding or traffic violations. For teen drivers with ADHD, the risks are even greater.
earch shows that car crashes for drivers with ADHD are dramatically reduced when drivers employ medication as part of their treatment plan. But driver safety isn’t as simple as just taking your medication. What else do you need to know before you get behind the wheel?
Music, phone calls, texting, eating on the go, adjusting the temperature, videos to entertain your children – all these things can contribute to distracted driving. They take your focus off the road for brief moments or extended periods of time. Distracted driving accounts for more than half of car crashes.
It is easy to think that it’s “okay” to do something other than focus on driving. Yet, according to the National Highway Traffic Safety Administration, taking your eyes off the road for five seconds at 55 mph is like driving the length of a football field with your eyes closed.
ADHD increases risks for drivers
ADHD impairs executive function, which is critical for driving. Driving requires you to process a huge amount of visual information, anticipate the actions of other drivers, and coordinate multiple actions with your hands and feet. Multitasking automatically lowers your ability to place your full attention to a task and can even make it harder to perform the skills needed for driving. We talk more about multitasking and ADHD in Are You a Multitasker? this week.
Daniel Cox, PhD, is one of the leading researchers on the effect ADHD has on a person’s driving abilities and has been a guest expert on driving for one of our Ask the Expert webinars.
“Automobile accidents are a leading cause of death for people between ages 6 and 25,” Dr. Cox tells UVAToday for the University of Virginia. “For adults who don’t have ADHD, after age 25, the accident rate starts to decline significantly. That’s not true for those with ADHD. They are elevated during adolescence–three to four times more collisions, injuries, etc.–but the rates don’t go down, as they do for the general public, as they get older. The good news is that medications improve not only driving safety, they reduce collisions. [W]hen ADHD people are on medication, their accident rates radically drop.”
Reduce risks with medication
Researchers looked at 2.3 million drivers affected by ADHD and found the rate of car crashes was dramatically lower for drivers taking medication to help manage their ADHD symptoms. The researchers found a 38 percent lower risk of accidents for men when they were taking medication, compared to when they were not taking their medications. For women, the risk was 42 percent lower. These reductions were found across all age groups in the study.
Taking medication is not enough to prevent a crash—understanding how your symptoms may affect your driving is essential. ADHD medications have limited amounts of time when they are active in a person’s system. Discuss your symptoms and when you are normally driving with your healthcare provider to determine the best medication for you and the best time to take it.
Tips to reduce distractions
There are non-medication steps you can take that will significantly minimize distractions:
- Turn off phones and electronics before you drive. Talking on the phone and texting are obvious distractions, but even just hearing a call or other notification can be distracting. If you must make a call or check a text, pull off the road. Most states have laws against texting or using a phone in handheld mode while driving. You might not get into a crash, but you could still get a ticket.
- Use a driving app or GPS. Most use voice commands to guide you. Set it up before you drive and pull off the road to make changes.
- Keep music low or off. If music helps you while driving, choose your station, CD, or playlist and set the volume before starting the car. Do not change it or fiddle with the controls while you are driving.
- Keep videos out of sight. Make sure the video screen is out of sight and laptops or tablets are in the backseat. Motion on screen while you’re driving is difficult to ignore. Keep the volume low, or ask those watching to wear headphones.
- Don’t eat and drive. Eating while driving is a common cause for distraction and, if you drop or spill, could result in a time when your eyes will be off the road.
- Have an Easy Pass for tolls. Many highways have automatic payment systems for tolls. They have the added benefit of not needing to keep change on hand or plan ahead to pay tolls.
- Leave earlier. It’s far easier to make a mistake when you are in a hurry and easier to correct one when you have more time.
Good driving habits are possible
Driving presents multiple challenges for people affected by ADHD, but research shows medication management helps to significantly reduce the risks of a car crash across all age groups, regardless of the level of experience of the driver. Take the time to understand how your symptoms may affect your safety as a driver, and discuss medication options with your healthcare provider.
For more information:
This article appeared in ADHD Weekly on June 08, 2017.
© 2017 by Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). All Rights Reserved.