Tool 6-1: Improve Concentration
Tool 6-2: Tame Hyperactivity and Impulsivity
BACKGROUND: Poor concentration is the hallmark of the inattentive and combined types of ADHD. Not being able to pay attention is a significant factor in poor academic success, poor task completion, failure to learn, as well as low self-esteem, anxiety and depression. This tool provides strategies to help children and teens improve their concentration and help them be more successful in all areas of their life.
SKILL BUILDING: Explain and teach the following techniques to your clients and/or their parents to help them focus and reduce distractibility.
Environment: Guide clients and parents to set up a distraction- free homework space. Encourage them to simplify the stuff in the client’s bedroom and to limit distraction from the TV, computers, tablets, phones and traffic from other family members. See Chapter 22 School and ADHD for information on how to request a distraction-free environment at school.
Headphones or Earbuds: Wearing headphones while doing a task can reduce distractibility. They can be used with or without music to block out sound. Make sure the music is not grabbing their attention but rather providing a sound screen to filter out ambient noise. Avoid listening to a radio station with commercials designed to get your attention. See Tool 9-3 Headphones for a case example where headphones helped a client get her homework done.
Determine Attention Span: Teach older children and teens to recognize the length of time they can hold their attention to tasks. They can set a timer when they start a project or homework and notice how much time has passed as soon as they realize they are distracted. Then encourage them to divide tasks into chunks that do not exceed this time and use an alarm to alert them to take a short break.
Alarms and Timers: Encourage clients to use tools such as alarms and timers to help stay on task. Set an alarm to sound every 15 minutes while doing homework to remind them to re-focus on their homework if their attention has wandered. Set a timer for a few minutes ahead of when they need to have something done or to leave for an appointment. Set an alarm to remind them to do something such as start homework, feed the dog or get ready for bed. Here’s a great resource: http://www.timetimer.com
Distractibility Delay: Teach clients to write down distractions when they emerge as opposed to impulsively acting on them.
Mindfulness Skills: Teach clients mindfulness skills that teach their brain to stay focused such as:
• Mindfulness of Intention for ADHD: See Tool 11-3
• Mindfulness of Tasks: See Tool 11-6
• Meditation for Concentration: See Tool 11-10
• Core Practice: See Tool 11-11
• Mindfulness Glitter Bottle Core Practice: See Tool 11-12
Neurofeedback: Teach parents about the benefits of using neurofeedback to improve concentration. See Chapter 10 Neurofeedback.
Complementary Therapies: Explain the benefits of therapies discussed in Section VII.
Sleep: Poor sleep can negatively impact concentration. Use Chapter 21 Assess and Improve Sleep to help clients improve their sleep.
Zinc and Ferritin: Zinc and ferritin are sometimes deficient in clients with ADHD (Brown, Gerbarg, 2012) and (ADDA, 2011). If these are low, supplements may improve attention and cognitive deficits. Encourage clients to have their levels tested. See Section IX Nutrition for the ADHD Brain for more details.
RESOURCES: Visit go.pesi.com/ADHDworkbook for Handout 6A on How to Improve Concentration.
INTEGRATION: Encourage clients and their parents to incorporate these techniques one by one and see which ones make a difference in the client’s ability to concentrate and stay on task. Explain that thriving with ADHD requires a multi-faceted solution and the long term inclusion of skills and techniques. How are they staying organized and addressing the various options for improving concentration?
BACKGROUND: Hyperactivity and impulsivity are the hallmark symptoms of the hyperactive/impulsive type of ADHD. Children and teens with hyperactivity move constantly and often have trouble sitting still. They may annoy their classmates or their family with their fidgeting, constant motion and unconscious noises. They interrupt others, have trouble waiting for their turn and do things without thinking. This tool provides techniques and strategies to calm down and reduce the hyperactivity and impulsivity and to help the child or teen gain some control over it.
SKILL BUILDING: Tools for reducing hyperactivity and impulsivity aim first to increase self-awareness and body awareness, then to practice self-control and physical calming. Review the following options for reducing hyperactivity with clients and parents.
Mindfulness Skills: Use these mindfulness skills to improve body awareness, self-regulation and calming.
• Mindful Movement: See Tool 11-9
• Body Scan for Children and Teens: See Tool 11-7
• Balancing Chips: See Tool 11-8
• Mindfulness Glitter Bottle: See Tool 11-12
• Bring Attention To The Present Moment: See Tool 11-14
• Core Practice: See Tool 11-11
Neurofeedback: Use neurofeedback to decrease hyperactivity and improve impulse control. See Chapter 10.
Sensory Integration: Clients with sensory processing issues often look like they have hyperactivity. Use Tool 14-1 Sensory Integration Therapy to explore this further with the client and their parent.
Food: Although the research on the effects of food on hyperactivity is not consistent, food sensitivities can be a significant contributor for some clients. When my own daughter was young she became out of control with hyperactivity when she had certain food dyes, sugar or milk. (I guess she didn’t read those studies.) Refer to Chapter 19 and use the Food/Symptom Diary on Handout 19-1-2 to help clients find out if food is a factor for them.
Mineral Deficiency: Several studies have shown a reduction in hyperactivity and impulsivity with zinc supplementation (Bilici et al., 2004). Others show a correlation between hyperactivity and magnesium deficiency (Starobrat-Hermelin, 1997). See Tool 20-1 Common Mineral and Fatty Acid Deficiencies for more information on this and encourage the client’s parents to have levels tested.
Movement: Make sure the client is getting lots of exercise and opportunities for movement. Movement has been shown to have a positive effect on the brain (Hillman, 2014) and (Hoza, 2014). Make sure the teacher is not keeping the client in from recess to finish work. They will concentrate better if they get outside and play. See Chapter 15 Movement to Optimize Brain Function.
Impulse control: Children with ADHD often do things without thinking about the consequences. I teach my clients to close their eyes and picture a traffic light with red, yellow and green lights. I tell them that when they first think of doing something or saying something, to stop long enough to picture the traffic light with the red light on. Then while they cautiously consider the consequences of what they are about the say or do, picture the light turning yellow. Then when they make a good choice, they can turn the light green and go ahead and do or say it – or not—whichever was the better choice. This gives them time to stop, think and make a good choice. It only takes a few seconds. There is power in this process.
Another option is to teach your client to consider how they would feel if someone said or did to them what they are about to do or say to someone else. Helping them imagine what others might feel helps them learn empathy. It will help them manage their impulse control and improve their social skills.
Use role play to help clients increase their awareness of how their impulsive behavior impacts others and to practice less impulsive behaviors.
Complementary Therapies: Explain the complementary therapies discussed in Section VII to help parents with other options for decreasing hyperactivity.
Games: Play games that encourage self-control and patience. See Handout 4-3 on Play Therapy.
RESOURCES: Visit go.pesi.com/ADHDworkbook for Handout 6B on How to Reduce Hyperactivity.
INTEGRATION: Explore each of these strategies with the client and their parent. Be prepared to employ a structured process for addressing all of these things. Avoid depending on the parent to do this unless they are obviously very organized. Keep in mind, there is a 75% chance that the client inherited their ADHD from one of their parents.