Kids with ADHD who do NOT respond to reward systems?

[Sylith]

My son is 7. He shows the inattentive and impulsive aspects of ADHD, not so much the hyperactivity. He has a lot of other personality "quirks" but doesn't seem to fit into any other diagnosis at this time. He is also intellectually gifted. He is such a sweet boy with a good heart, and I know he very much wants to be able to make good choices, but it is just extra, super hard for him.

The behavioral interventions which have been recommended again and again revolve around point systems and sticker charts and reward systems. His teachers and his dad and I all agree that these do not work well for him. He is enthusiastic in theory but they do not seem to motivate him "in the moment" enough to be able to stay focused. He loves praise, but it is not enough to make any consistent improvement in his behavior. His days are already highly structured and predictable. We take shortcuts for him, like letting him go to sleep in his clean, next-day's clothes instead of wearing pajamas, so that we don't have to fight that particular battle every day.

What else can I do for him, behaviorally? Am I missing anything? Our days are often so frustrating and exhausting. Every little thing seems to take forever. I repeat myself over and over until I realize I am yelling. His dad has less patience than I do, and is constantly escalating into power struggles with him.

I want to be able to experience a positive relationship with my smart, loving, generous, gregarious little boy.

[NightOwlwithowlet]

How did my son get to your house? Seriously, we tried the sticker system when he was in kindergarten last year and it completely back fired. He cried every time he didn't get a sticker, it was hard. We tried medication which helped a lot, but in the end decided the side effects were not worth it.

What worked for my son was diet changes; he's on milk (casein) free, gluten limited, additive, dye free diet. He takes fish oil, good quality daily vitamin, and a magnesium supplement.

He sees a counselor twice a month and Dh and I meet with her too. She gives all of us coping strategies and helps give DH and I realistic expectations for DS's behavior. For example it's realistic for us to expect him to be quiet and stay in his seat through a movie, it is not realistic for us to expect him to be perfectly still. We also need to provide him with tools to help him (a squeeze ball, gum to chew, and lots of exercise before we go).

I do make sure I have his attention when I talk to him. I touch his shoulder and crouch down so he is looking at me. He has to repeat back what I say.
We try to keep things simple, coat, shoes, back pack go in the same place every day. I try to vary our routine (we home school) so he doesn't get bored. But, re-reading your post it sounds like you have that covered with predictable routines.

Have you tried a written schedule of thing that need to be done? We do this with cleaning his room and school work. He checks each item off and if he loses track, he can refer back to the list. It removes me from the argument, I remind him to look at the list. It took a while, but he'll ask me to write a list for what he needs to do for other activities. He's gained self confidence and that has helped with his self control.

He takes a martial arts class three days a week, which has been very helpful.
We use the same language(self control, respect, responsibility) at home they use in class. My husband takes classes with him and it has helped them bond. It is something just between them, it has helped immensely as DH isn't very patient .

The other thing I do is wait. I'll say, "When you are ready to listen," and just wait until he focuses on me. I have to repeat myself several times on occasion, but after several weeks, he has gotten much better. He will stop moving and look right at me on the 1st or 2nd request. Then I ask "Are you ready?" and I go over whatever I need him to do. He repeats it back to me.
It seems to be working fairly well.

All these things together have made life more livable. I'm rarely angry or frustrated any more. I still yell once or twice a week, but he usually reminds me to use self control. My son is a lot less frustrated and feels much better about himself.

[RiverTam]

I have no idea if this will work, but it might be worth a try. Both gifted kids and ADHD kids have later development of executive functioning than other kids. They're very bad at decision making, impulse control and planning. It does develop in them, but it develops later. On average, they're about 18 months to two years behind other kids in this area.

In adults who have a brain injury and poor executive functioning, therapists often recommend the development of lists that break tasks down step by step. What if you gave him step by step breakdowns of what he is supposed to be doing and put them where he could see them? Some of the ADHD kids I know use checklists for school settings.

It might be a whole bunch of lists posted in different places.

[justmama]

I want to second the checklist option. Ours is a whiteboard that I can refill as the day goes on depending on our activities and structure and whether it's a weekend or a weekday. i am extremely specific. I don't write just "get dressed" or "get ready for school" because that's too broad for my daughter. I have to write "change underwear" and "bring backpack downstairs" and "take your pajamas to the hamper." She also gets weekly progress reports at school along with the teacher signing her agenda where she writes down her hoemwork. She also has to get each hoemwork assignment checked off in that agenda after finishing it at night. It has been the only way that assignments don't slip through the cracks and not get done.
She's not been diagnosed officially yet but we met the psych today for an initial intake appt and are heading back next week for testing for ADHD. She's got some severe memory issues compounding the ADHD that he says he is interested in finding more about and dealing iwth so that will add to our testing process. So we won't have official results for about 3 weeks. She's been having a lot of difficukty in school lately so we decided to go the diagnosis route instead of just finding coping mechanisms. It seems like we may need the IEP at school just to help her function.

[twilight girl]

We just took our 7.5 y.o. DD in for educational testing for a possible enrollment in the school for dyslexia/ADHD/SPD. We had a previous diagnosis of ADHD from when we were living in Costa Rica. However, the new psychologist touched on something we said in our interview (she has not met DD yet) and suggested that she would be looking at a possible misdiagnosis of ADHD, and a possible sensory integration issue or SPD.

I also have felt like DD fits the bill in many aspects of ADHD criteria, but just not quite exactly. She is very energetic, but not what I would call hyperactive. I have seen hyperactive kids, the practically vibrate. DD is just high energy (IMO). She is not inattentive or unfocused. She is easily distracted and a sensory seeker. So, all the while we've thought OK, she's ADHD, but the impulsivity is her real obstacle. She bangs into people, bear hugs hard enough that it hurts me, very physical and just too hard/rough. So, after talking with the new psychologist I've started reading about SPD, and specifically SPD misdiagnosed as ADHD.

This might be a starting place: http://www.sensory-processing-disord...checklist.html At least, here you'll get an idea how parallel the two are, but also how SPD may account for a kid who is impulsive, yet not inattentive or hyper. I don't pretend to have many answers as we are just beginning to navigate this ourselves.

Good luck to you!

[Sylith]

Thanks for responses. He definitely, definitely has issues with executive functioning. We have done lists before, but maybe they were not detailed enough. For that matter maybe my verbal instructions are not detailed enough. Hmm...

Nightowlwithowlet -- We already do a lot of the dietary stuff. I like the martial arts idea. I will try to look for something in this area that would be good for him. I do try to be sure I have his attention when talking to him, but... um, it's not as easy as it sounds with him. I am confused about the waiting... really, he eventually processes that you are waiting and comes to listen? can you tell me more about that?

Twilight girl -- My DS is *absolutely* inattentive as well as impulsive. Oh, so inattentive. LOL. But these things can co-exist or overlap in the same kid, and there might still be some things there that apply to DS.

I am glad to have some other things to try. It's tough parenting the kid who seems never to react as all those parenting books say he will...

[NightOwlwithowlet]

Originally Posted by Sylith

T
Nightowlwithowlet -- We already do a lot of the dietary stuff. I like the martial arts idea. I will try to look for something in this area that would be good for him. I do try to be sure I have his attention when talking to him, but... um, it's not as easy as it sounds with him. I am confused about the waiting... really, he eventually processes that you are waiting and comes to listen? can you tell me more about that?

I am glad to have some other things to try. It's tough parenting the kid who seems never to react as all those parenting books say he will...

It's kinda hard to explain, but I watched a friend do it with her son and it worked. It makes it his responsibility to listen, instead me making him listen. I hope that makes sense. It removes a lot of the conflict and power struggle from the interaction for me. His therapist pointed out that we are asking him to control himself, but it is clear to him that we were often frustrated and impatient with him, it was a double standard. We weren't modeling the behavior we wanted. It sounds kind of silly when I try to explain it. Sorry.....