The joy of the holiday season can be lost when the stress of decorating, buying gifts, preparing meals and spending time with friends and relatives is added to the constant everyday responsibilities of parenting. This is especially true when the family includes a child, adolescent or adult with ADHD. The excitement and anticipation in the air will almost always stimulate the hyperactive, inattentive and impulsive symptoms of ADHD which can result in falling grades and deteriorating relationships at both school and home.
One solution within parental control is the development a timetable of specific tasks to work through the holidays with their ADHD child to manage transitions and minimize meltdowns. It is important to revise and re- establish a routine for taking medication, going to bed, eating breakfast and controlling electronics use. The best holiday gifts to keep children with ADHD on track are:
MEDICATION: Although doses will always be modified during vacations, most parents find it helpful to give medications daily to manage the symptoms and problems ADHD in daily life as well as in school. This principle is especially important for long vacation trips, sleepovers and longer stays with a distant divorced parent. If the medicine is working correctly, most children, if asked, prefer to take it every day.
WAKE UP TIME: During the holidays, daily medication is typically given a few hours later in the morning because of “sleeping in” related to more physically active days and later bedtimes. It is best to keep your child on a daily wake-up time within no more that 1 to 2 hours within their regular school alarm time. No naps should be allowed. This strategy eliminates the possibility of headaches, stomachaches or the uncomfortable sensation of rapid heartbeat that may temporarily occur when medication is missed and later restarted.
BREAKFAST: The timing of medication dosing is important to stabilize both the sleeping and eating habits of the child. A regular high-calorie, protein-rich breakfast at home ensures that the child gets important calories that can often be missed. Weight loss or early afternoon headaches and stomachaches triggered by blood sugar shifts can be avoided if the child always eats breakfast at home. The early morning hunger pangs caused by stomach acid production in anticipation of the breakfast meal can help arouse the child for the routine wake-up time.
SLEEP: A bedtime regimen that should be followed include a quick bedtime snack to maintain weight, turning off all electronics (games, computers, YouTube, phones and all electronic devices) at least one hour before bedtime. if needed, a low dose (3-5mg) of melatonin can be given at the same time. This natural hormone peaks around bedtime and will ease the transition into sleep even if there are no signs of sleepiness. Sleeping pills of any kind, including clonidine, have not been shown to be safe or effective for children with or without ADHD.
MORE SLEEP: There is strong evidence that light interferes with sleep onset, the most common sleep disorder for children and adolescents with ADHD. A darkened room works best along with the elimination of the screens of television or hand-held electronics. Although the TV is the most commonly used sleep aid, it can be a troublesome tradeoff for parents. The changes in contrast and volume interrupts sleep stages causing the child to awaken more often through the night to turn the TV back on, change the channel, call for their mother or head for the refrigerator. Sound machines on phone apps or fans are a better substitute. Establishing and maintaining a good night’s sleep is essential. No amount of medication, special educational strategies or behavior modification plans incorporating rewards and consequences will work if the child is sleeping in class.
COMMUNICATE WITH THE SCHOOL: The end of the year marks only the half-way point of the school year and is a key time for a parent teacher conference. Teacher Vanderbilt Forms are available from the NICHQ website which provide a scale for the teacher to rate attention and hyperactivity, performance in academics, organization, assignment completions, interactions with classmates and disruptive behavior. A list of medication side effects including overdose reactions is also provided.
MORE SCHOOL: This conference also encourages communication between parents and teachers about the educational strengths and weaknesses of the child. Plans to implement and periodically evaluated strategies to work around learning or behavior problems can be made. Classroom success depends not only on the child but on the personality and attitude of the teacher and students but also on the challenging curriculum and social changes that predictably occur in transitions to 3rd grade, middle school and high school.
Keeping up these routines during the holidays can deliver the best present of all – a happy and peaceful holiday season and the promise of a better new year!
James M. Lewis, MD is a Professor of Pediatrics at the Joan C. Edwards School of Medicine and is also a practicing physician seeing over 150 new ADHD patients annually. He has also managed ADHD within his own family. Dr. Lewis is the author of Making Sense of ADHD: Overcoming The Unique Conditions and The Complexity of Coexisting Conditions.