1. Get an accurate diagnosis. This is the starting point of all treatment for
2. Educate the family. All members of the family need to learn the facts about
ADD as the first step in the treatment. Many problems will take care of
themselves once all family members understand what is going on. The education
process should take place with the entire family, if possible. Each member of
the family will have questions. Make sure all these questions get answered.
3. Try to change the family "reputation" of the person with ADD. Reputations
within families, like reputations within towns or organizations, keep a person
in one set or mold. Recasting within the family the reputation of the person
with ADD can set up brighter expectations. If you are expected to screw up, you
probably will; if you are expected to succeed, you just might. It may be hard
to believe at first, but having ADD can be more a gift than a curse. Try to see
and develop the positive aspects of the person with ADD, and try to change his
family reputation to accentuate these positive aspects. Remember, this person
usually brings a special something to the family--special energies, special
creativity, special humor. He (or she) usually livens up any gathering he
attends, and even when he is disruptive, it's usually exciting to have him
around. He punctures bombast and does not tolerate fools. He is irreverent and
not afraid to speak his mind. He has a lot to give, and the family, more than
any group of people, can help him reach his potential.
4. Make it clear that ADD is nobody's fault. It is not Mom's or Dad's fault. It
is not brother's or sister's fault. It is not Grandmother's fault, and it is
not the fault of the person who has ADD. It is nobody's fault. It is extremely
important that this be understood and believed by all members of the family.
Lingering feelings that ADD is just an excuse for irresponsible behavior or
that ADD is caused by laziness will sabotage treatment.
5. Also make it clear that ADD is a family issue. Unlike some medical problems,
ADD touches upon everybody in the family in a daily, significant way. It
affects early-morning behavior, it affects dinner-table behavior, it affects
vacations, and it affects quiet time. Let each member of the family become a
part of the solution, just as each member of the family has been a part of the
6. Pay attention to the "balance of attention" within the family. Try to
correct any imbalance. Often, when one child has ADD, his siblings get less
attention. The attention may be negative, but the child with ADD often gets
more than his share of parents' time and attention day in and day out. This
imbalance of attention can create resentment among siblings, as well as deprive
them of what they need. Bear in mind that being the sibling of a child with ADD
carries its own special burdens. Siblings need a chance to voice their
concerns, worries, resentments, and fears about what is going on. Siblings need
to be allowed to get angry as well as to help out. Be careful not to let the
attention in the family become so imbalanced that the person with ADD is
dominating the whole family scene, defining every event, coloring every moment,
determining what can and cannot be done, controlling the show.
7. Try to avoid the Big Struggle. A common entanglement in families where ADD
is present but not diagnosed, or diagnosed but unsuccessfully treated, the Big
Struggle pits the child with ADD against his parents, or the adult with ADD
against his spouse, in a daily struggle of wills. The negativity that suffuses
the Big Struggle eats away at the whole family. Just as denial and enabling can
define the alcoholic family, so can the Big Struggle define (and consume) the
8. Once the diagnosis is made, and once the family understands what ADD is,
have everybody sit down together and negotiate a deal. Using the principles
outlined earlier, try to negotiate your way toward a "game plan" that everyone
in the family can buy into. To avoid the family gridlock of the Big Struggle,
or to avoid an ongoing war, it is wise to get into the habit of negotiation.
This can take a lot of work, but over time negotiated settlements can usually
be reached. The terms of any settlement should be made explicit; at best they
should be put into writing so they can be referred to as needed. They should
include concrete agreements by all parties as to what is promised, with
contingency plans for meeting and not meeting the goals. Let the war end with a
9. If negotiation bogs down at home, consider seeing a family therapist, a
professional who has experience in helping families listen to each other and
reach consensus. Since families can be explosive, it can be very helpful to
have a professional around to keep the explosions under control. Also consider
buying a book to help in negotiation, such as Fisher and Ury's Getting to
10. Within the context of family therapy, role-playing can be helpful to let
members of the family show each other how they see them. Since people with ADD
are very poor self-observers, watching others play them can vividly demonstrate
behavior they may be unaware of rather than unwilling to change. Video can help
in this regard as well.
11. If you sense the Big Struggle is beginning, try to disengage from it. Try
to back away. Once it has begun, it is very hard to get out of. The best way to
stop it, on a day-to-day basis, is not to join it in the first place. Beware of
the struggle's becoming an irresistible force.
12. Give everyone in the family a chance to be heard. ADD affects everyone in
the family, some silently. Try to let those who are in silence speak.
13. Try to break the negative process and turn it into a positive one. Applaud
and encourage success when it happens. Try to get everyone pointed toward
positive goals, rather than gloomily assuming the inevitability of negative
outcomes. One of the most difficult tasks a family faces in dealing with ADD is
getting onto a positive track. However, once this is done, the results can be
fantastic. Use a good family therapist, a good coach, whatever--just focus on
building positive approaches to each other and to the problem.
14. Make it clear who has responsibility for what within the family. Everybody
needs to know what is expected of him or her. Everybody needs to know what the
rules are and what the consequences are.
15. As a parent, avoid the pernicious pattern of loving the child one day and
hating him the next. One day he exasperates you and you punish him and reject
him. The next day he delights you and you praise him and love him. It is true
of all children, but particularly true of those with ADD, that they can be
little demons one day and jewels of enchantment the next. Try to keep on an
even keel in response to these wide fluctuations. If you fluctuate as much as
the child, the family system becomes very turbulent and unpredictable.
16. Make time for you and your spouse to confer with each other. Try to present
a united front. The less you can be manipulated the better. Consistency helps
in the treatment of ADD.
17. Don't keep ADD a secret from the extended family. It is nothing to be
ashamed of, and the more the members of the extended family know about what is
going on, the more help they can be. In addition, it would not be unlikely for
one of them to have it and not know about it as well.
18. Try to target problem areas. Typical problem areas include study time,
morning time, bedtime, dinnertime, times of transition (leaving the house and
the like), and vacations. Once the problem area has been explicitly identified,
everyone can approach it more constructively. Negotiate with each other as to
how to make it better. Ask each other for specific suggestions.
19. Have family brainstorming sessions. When a crisis is not occurring, talk to
each other about how a problem area might be dealt with. Be willing to try
anything once to see if it works. Approach problems as a team with a positive,
20. Make use of feedback from outside sources--teachers, pediatrician,
therapist, other parents and children. Sometimes a person won't listen to or
believe something someone in the family says, but will listen to it if it comes
from the outside.
21. Try to accept ADD in the family just as you would any other condition and
normalize it in the eyes of all family members as much as possible. Accommodate
to it as you might a family member's special talents or interests like musical
ability or athletic skills whose development would affect family routines.
Accommodate to it, but try not to let it dominate your family. In times of
crisis this may not seem possible, but remember that the worst of times do not
22. ADD can drain a family. ADD can turn a family upside down and make
everybody angry at everybody else. Treatment can take a long while to be
effective. Sometimes the key to success in treatment is just to persist and to
keep a sense of humor. Although it is hard not to get discouraged if
things just seem to get worse and worse, remember that the treatment of ADD
often seems ineffective for prolonged periods. Get a second consultation, get
additional help, but don't give up.
23. Never worry alone. Try to cultivate as many supports as possible. From
pediatrician to family doctor to therapist, from support group to professional
organization to national convention, from friends to relatives to teachers and
schools, make use of whatever supports you can find. It is amazing how group
support can turn a mammoth obstacle into a solvable problem, and how it can
help you keep your perspective. You'll find yourself saying, "You mean we're
not the only family with this problem?" Even if this does not solve the
problem, it will make it feel more manageable, less strange and threatening.
Get support. Never worry alone.
24. Pay attention to boundaries and overcontrol within the family. People with
ADD often step over boundaries without meaning to. It is important that each
member of the family know and feel that he or she is an individual, and not
always subject to the collective will of the family. In addition, the presence
of ADD in the family can so threaten parents' sense of control that one or
another parent becomes a little tyrant, fanatically insisting on control over
all things all the time. Such a hypercontrolling attitude raises the tension
level within the family and makes everybody want to rebel. It also makes it
difficult for family members to develop the sense of independence they need to
have to function effectively outside the family.
25. Keep up hope. Hope is a cornerstone in the treatment of ADD. Have someone
in mind whom you can call who will hear the bad news but also be able to pick
up your spirits. Always bear in mind the positive aspects of ADD--energy,
creativity, intuition, good-heartedness--and also bear in mind that many, many
people with ADD do very well in life. When ADD seems to be sinking you and your
family, remember, things will get better.
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