Chart of activities saves the day! (Part two)

As we've recently made some changes to the activity chart, it's time for another post about it. So far it has been working very well and has proved flexible and effective both on school days, weekends, and sick days.

Bambam has been spending a lot more time playing creatively and  with his siblings, which has benefited the whole family. Eeyore is becoming a lot more involved in the games the kids play and has also finally taken up a 'big brother' role towards baby Tigger. Whether all that has anything to do with Bambam taking more of an interest as biggest brother, may be a bit of an overstatement, but I do believe it contributes.

Bambam still concentrates on the more - let's call it - boisterous sorts of play. I dare say when he plays with the Lego there is a lot more demolition than construction involved! Favourite games still involve a lot of running and screaming, but they are more 'themed' now. He will be a knight, monster, Jedi, or wizard. His gaming has become more focused. Rather than just sit for hours playing and playing, he is more aware of the limited time he has, and tends to choose his games more carefully. He goes for the ones that are more challenging and more satisfying.

Regarding the chart specifically, we've made some changes to how we work it, giving Bambam more autonomy. While before, we would choose the number at the top of each type of activities, he has asked to be allowed to set the number himself. He had been feeling stressed out when he felt he did not have enough time to complete all the activities that were numbered. As long as he keeps his day varied and his screen time limited as a result, we are happy to allow him the autonomy to plan his own time. The ultimate goal of all these parenting strategies is to raise a child up to be an autonomous well-adjusted grown-up who can plan his own day and accomplish his own goals. We're very pleased he has suggested these changes himself!

We're also going to allow him to cross out completed activities himself, rather than one of us do it. This is a test of trust. Will he cheat? We'll have to wait and see!

Go to Part one.

Chart of activities saves the day! (Part one)

Bambam has ADHD and takes Concerta to help him control his symptoms. Because of our family situation, we don't spend a lot of holidays together and that might be why I had gotten a bit out of practice in spending days with him. Due to the recent snow, we've been cooped up together on what should have been school days, and now the holiday has started, we're still stuck at home most of the time.

Kirk has all those pituitary issues, including Addison's disease as well now, so he hasn't been the most energetic of parents, and has spent perhaps a little too much time lately sitting around playing online games. I myself have not been terribly engaged with the older children while struggling with the fatigue of pregnancy and looking after a small baby. Little wonder then, that our Bambam has become increasingly focused on his favourite activities: watching telly and playing video games. 

It's typical for many (but not all!) ADHD children to prefer these activities. They are clearly boundaried by the frame of the screen and the rules are clear, consistent and patient, while the visual stimulus is fast-paced and interesting. For parents, it's always tempting to allow hours of screen-based activities because it is easier. Kirk and I are also firm believers that there is nothing inherently bad about playing video games, so we don't even feel guilty about it. What drove us to action was the increasingly negative attitude we were seeing from Bambam whenever he was asked to do anything else. One might expect a sullen "I don't want to" when asked to do chores, but we were getting mightily tired of getting a long face and some serious backtalking when ofering food, toys or outings. We ended up with a lot of angry yelling from both sides, which is never good.

We'd tried before, on several occasions to explain to Bambam that we didn't want to stop or limit his screentime so much as make sure he balanced out his day with other activities as well. This turned out to be too vague and left him feeling insecure and acting even more defiant. So last night I made a chart: 

Each column contains a type of daily activity: housework, personal hygiene, tidying, playing with others, playing outside, creative activities, playing with toys, and screentime. I laminated it so I can write on it with a whiteboard pen. At the top of each of the first seven colums I write a number to indicate how many activities out of that column he needs to do. Each completed activity gets crossed out. If, at the end of the day, he's done the required amount of 'other' things that means he's had a balanced day with a variety of activities. If we can't cross out the required number, I get to put as many crosses as are missing in the screentime column for the next day, which means he doesn't get to do that particular screen activity the next day. I also get to cross out screentime for bad behaviour.

My goal with this chart was to leave as much as possible control with Bambam. He has to do a certain number of activities from each column, but he always has a free choice which ones to do and when to do them, and can make up more if he wants to. It's not a fixed schedule. On the other hand, it gives him a list of suggestions, so he's not left at a loss as to what exactly we mean when we say: 'don't play on the computer, do something else'.

I've also tried to emphasise that the chart is a template for a varied, fun-filled day, rather than a reward system. He doesn't get rewarded with screentime for doing other activities. The screentime is there as part of a normal day, alongside the other activities.

This morning I came downstairs to find him beating his sister with a pillow. I crossed out 'World of Warcraft' from the screentime column. I then explained to him what the new chart was for. His whole demeanour changed and he's been great all day. Jumping at the chance to clear and set the table in order to cross out another chore. Playing imaginatively all over the house and outside, with or without siblings. They dressed up, played hide-and-seek, built a fort out of cardboard boxes... He's been polite and nice and not the slightest bit defiant or aggressive.He spent barely any time at all watching screens because he's been so proudly doing other things and enjoying praise and attention because of it. I'm so glad I seem to have struck just the right chord for him and our family to have a good time together again.

Go to Part two.

How to get ADHD

I always suspected Bambam might have ADHD, or at least, that there was something about his development that  was atypical. Several parents and teachers have praised me on my persistence and success in pursuing a diagnosis and treatment for him. Perhaps I should share some of my experiences here.

When Bambam was a baby, he seemed to find it exceptionally difficult to calm down. He also did not play 'appropriately'. He had toys that stimulate different senses and are meant to elicit different responses, but he would only throw and bang. Since then, I have noticed that other babies can also, for example, investigate and concentrate quietly. Obviously this is normal for any baby and certainly, at this point, there would have been no reason to suspect a problem.

As he grew up to be a toddler and an older child, his speech seemed delayed to me and he continued to find it difficult to play with toys appropriately. Throwing balls and banging hammers is fine. But most children will build with blocks, fit puzzles, draw with pencils, roll marbles down the track. Bambam was, well, like Bambam, or Godzilla. Constantly on a rampage. At home, I soon organised toys and furniture to be safe to drop, throw, and bang into. When out, I developed an iron grip to hold his hand and it still felt like walking a cat.

He couldn't focus on anything, even if he liked doing it (with the notable exception of screen-activities, common in ADHD) I learned to break down instructions to him into very short, very small steps. Not: "get dressed", not even: "put your trousers on", but "pick up your trousers" - pause for execution - "now turn them over with the button to the front" - pause for execution - "now put your one foot into the leg"... etc. If left to himself with this for even a moment, trousers and all other clothes would be flung around the room and hanging from the light fixtures.

I must stress, he did none of this from malice. He was, and is, genuinely incapable of controlling these impulses and focusing on the task at hand. He was often surprised and even saddened by the havoc he caused, like he wasn't really there when it happened.

By this time, I felt we needed a professional opinion. What really got my goat was the difficulty at reaching the right specialists. I mentioned a problem to the health visitor, who told me to go to the GP, who referred me with no result for more than 6 months. When I inquired, it turned out we had missed an appointment with the specialist centre, because they had gotten our address wrong. So the GP had to refer us again. When we were finally seen, we were assessed by a temporary registrar paediatrician, who tried to claim that speech delay was normal in bilingual kids even when I asserted it had been a problem before our household ever became bilingual. They tried to blame his behaviour on the fact that I'd separated from my partner and had re-married and the stresses that entailed. They wrote a little report mentioning impulsiveness and hyperactivity and left it for six months.

Six months later, at the follow-up visit, the entire medical staff at the centre seemed to have been replaced. Lather, rinse, repeat.
They did suggest I attend a parenting class. I know it is part of the support that ADHD children need, but at that point it just felt I was being branded a 'bad' parent. I have trained both as a primary teacher and a childminder and volunteered as a play leader for six years, so it felt very inappropriate. I couldn't even attend the class because I couldn't get childcare for the other kids! I did look up which system they were using, and got myself the book instead, which has proved invaluable: The incredible years. 

After three entirely unproductive visits, we made an official complaint that 2 years of follow-up had yielded absolutely nothing. I pointed out that he had been described as impulsive and hyperactive in each and every report, regardless of other circumstances, and that his behaviour was the same both at home and at school. Within weeks, we actually saw the consultant paediatrician and a child psychologist and soon we also got referred to a psychiatrist who was able to confirm the diagnosis of ADHD. Then we just had a few months to wait for Bambam's sixth birthday to start ADHD medication called Concerta.

The trick to getting this far was to use the internet to interpret symptoms, being careful to discriminate between hysterical misinformation and actually medically relevant data. Then figure out exactly what you want to achieve, check the NICE guidelines http://www.nice.org.uk/CG72 and quote them at your medical professionals until they listen. Do not give in. They try to avoid getting patients 'on their books' because they are understaffed and overworked. Although they are doctors, it's perversely not in their interest to diagnose. But it was in my interest and in Bambam's interest that we found out about his ADHD, because it is perfectly treatable with specialized behaviour management and medication. The earlier it is recognized, the better.

In future posts, I'll go into some parenting tricks I've learned over the years, the benefits of treating with medication, and how to deal with ADHD in school.