IMPROVING ROLE PERFORMANCE
It is extremely important to give the child specific,
positive feedback when he or she meets stated expec-
tations. Doing so reinforces desired behaviors and
gives the child a sense of accomplishment. For exam-
ple, the adult might say, “You walked down the stairs
safely”or “You did a good job of asking to play with
the guitar and waited until it was your turn.”
Managing the environment helps the child to
improve his or her ability to listen, pay attention, and
complete tasks. A quiet place with minimal noise and
distraction is desirable. At school, this may be a seat
directly facing the teacher at the front of the room
and away from the distraction of a window or door.
At home, the child should have a quiet area for home-
work away from the television or radio.
SIMPLIFYING INSTRUCTIONS
Before beginning any tasks, adults must gain the
child’s full attention. It is helpful to face the child on
his or her level and use good eye contact. The adult
should tell the child what needs to be done and break
the task into smaller steps if necessary. For example,
if the child has 25 math problems, it may help to give
him or her 5 problems at a time, then 5 more when
those are completed, and so on. This approach pre-
vents overwhelming the child and provides the op-
portunity for feedback about each set of problems he
or she completes. With sedentary tasks, it is also im-
portant to allow the child to have breaks or opportu-
nities to move around.
Adults can use the same approach for tasks such
as cleaning or picking up toys. Initially the child
needs the supervision or at least the presence of the
adult. The adult can direct the child to do one portion
of the task at a time; when the child shows progress,
the adult can give only occasional reminders then
allow the child to complete the task independently.
It helps to provide specific, step-by-step directions
rather than give a general direction such as “Please
clean your room.” The adult could say, “Put your dirty
clothes in the hamper.”After this step is completed,
the adult gives another direction: “Now make the
bed.”The adult assigns specific tasks until the child
has completed the overall chore.
PROMOTING A STRUCTURED
DAILY ROUTINE
A structured daily routine is helpful. The child will
accomplish getting up, dressing, doing homework,
playing, going to bed, and so forth much more read-
ily if there is a routine time for these daily activities.
Children with ADHD do not adjust to changes read-
20 CHILD ANDADOLESCENTDISORDERS 491
ily and are less likely to meet expectations if times
for activities are arbitrary or differ from day to day.PROVIDING CLIENT AND FAMILY
EDUCATION AND SUPPORT
Including parents in planning and providing care for
the child with ADHD is important. The nurse can
teach parents the approaches described above for use
at home. Parents feel empowered and relieved to
have specific strategies that can help both them and
their child be more successful.
The nurse must listen to parents’ feelings. They
may feel frustrated, angry, or guilty and blame them-
selves or the school system for their child’s problems.
Parents need to hear that neither they nor their child
are at fault, and that techniques and school pro-
grams are available to help. Children with ADHD
qualify for special school services under the Individ-
uals with Disabilities Education Act (IDEA).
Because raising a child with ADHD can be frus-
trating and exhausting, it often helps parents to at-
tend support groups that can provide information
and encouragement from other parents with the same
problems. Parents must learn strategies to help their
child improve his or her social and academic abilities,
but they also must understand how to help rebuild
their child’s self-esteem. Most of these children have
low self-esteem because they have been labeled as
having behavior problems and have been corrected
continually by parents and teachers for not listen-
ing, not paying attention, and misbehaving. Parents
should give positive comments as much as possible
to encourage the child and acknowledge his or her
strengths. One technique to help parents to achieve
a good balance is to ask them to count the numbers
of times they praise or criticize their child each day
or for several days.
Although medication can help reduce hyper-
activity and inattention and allow the child to focus
during school, it is by no means a cure-all. The child
needs strategies and practice to improve social skills
and academic performance. Because these children
often are not diagnosed until the second or third grade,◗ CLIENT/FAMILYTEACHING FORADHD
Include parents in planning and providing care.
Refer parents to support groups.
Focus on child’s strengths as well as problems.
Teach accurate administration of medication and
possible side effects.
Inform parents that child is eligible for special
school services.