Sleep Hygiene Improves Sleep Quality for Children with ADHD.

A recent study (Bessey, Coulombe & Corkum, ADHD Report, May 2013)  found that a large number of children have poor sleep hygiene. Poor sleep hygiene can be responsible for poor sleep, and poor sleep can cause ADHD symptoms to become more severe.  The study found that Improving sleep hygiene not only improved sleep in children, but also improved their daytime functioning. Further, the behavioural strategies required to implement good sleep hygiene practices are highly compatible with behavioural interventions to help parents manage ADHD in their home. Rather than viewing sleep hygiene as an additional and separate intervention, sleep hygiene may be best considered as an extension of these strategies to promote sleep at night. If your child is having difficulty sleeping, ask your doctor for help with sleep hygiene.

The study  recommends the following ABC of Sleeping:

	Concept	Details & recommendations.
A	Age-appropriate	Children should go to bed and wake up at times that ensure they receive an age-appropriate amount of sleep. (See table below)
B	Bedtimes	Seat bedtimes and wake times, as well as morning & evening routines assist good sleep. Children should not go to bed later than 9pm.
C	Consistency	Bedtimes & wake-times should be consistent – even on weekends (no more than 30-60 minute difference between weeknights & weekends).
S	Schedule	In addition to bedtimes, children should have consistency through their day, including times for homework & activities
L	Location	Bedroom should be conducive to relaxation – quiet, dark & cool. Bed should only be used for sleeping (do not use bedroom for time out)..
E	No electronics in bedroom before bed	Children should not be using electronics 30-60 mins before going to bed, and they should not have electronic items in the bedroom while sleeping
E	Exercise & diet	Physical activity during the day important for good sleep, but not too close to bed time. Cool down period before bedtime. Eliminate caffeine. No big meals close to bedtime.
P	Positivity	Have a positive attitude towards sleep, and do not tackle frustrating problems close to bedtime
I	Independence falling asleep	Independence is encourage at bedtime. If children get out of bed, parents need to return them to their room
N	Needs met during day	Needs of the child should be met throughout the day – (emotional and physical).
G	Great Sleep

Age-Appropriate Sleep Times

Age	Sleep Needs
Newborn (0 to 2 months)	12 – 18 hours
Infants (3 to 11 months)	14 – 15 hours
Toddlers (1 – 3 years)	12 – 14 hours
Preschoolers (3-5 years)	11 – 13 hours
School-age children (5-10 years)	10 – 11 hours
Older children (10 – 17 years)	8.5 – 9.25 hours
Adults	7 – 9 hours

The Focus Formula

"I have such trouble getting started on a task, and then I have trouble stopping. The only easy bit is the middle." 

The frustration expressed by my client is something that I hear often. Perhaps you can relate? - The hardest part of doing something is actually getting started. There could be several reasons for this challenge. First, as a Big-Picture, Global thinker you may find it hard to break jobs down into chunks, and establish an entry point. Secondly, if the task is difficult or boring, you could find yourself engaging in all manner of procrastination. And the list goes on. This four-point plan has proved to be very useful with many of my clients. I call it the Focus Formula.

1. Plan

If the thought of planning makes you shudder, you're not alone. Read my previous blog post on planning. For the purpose of the Focus Formula, you need to be specific about what you will be doing. Set aside some time and commit to using it for the task. Then, decide what part of the task you will work on. For example, instead of planning to "do your tax tomorrow", identify what you need to start with and when you will do it: "I will get all of my receipts out of the shoebox and sort them into categories tomorrow at 11."

2. Set Up

In order to make the assigned time productive, you need to set the task up independently from doing it. Get the shoebox of receipts out and put it on your desk. Ask yourself what else you will need to sort them. Will you need a pen and paper to make notes, for example? Have everything ready, and then walk away from the desk. Even a 10 minute break for a cup of tea will suffice. Keeping the Set Up separate prevents it from becoming a long-winded procrastination tool.

3. Sprint

ADHD brains are generally good sprinters. The thought of spending 5 hours on a tax return will fill them with dread. But they can blitz a 30 minute sprint. So make a deal with your brain - that you will give it a break in 30 minutes. Then get to work. After 30 minutes you have 2 options. You may find that you have hit the Focus Zone, and would like to keep working. If that it the case, keep at it. The Focus Formula has succeeded. However, if your brain demands the break as promised, you need to honour that. But before you walk away from the task, there is one more step:

4. Brain Dump

I have discussed the Brain Dump in some detail in a previous blog post. Essentially, it is an valuable tool to use when you are stopping partway through a task. If you walk away from incomplete work, the chances are that it will feel like starting all over again when you return. And you could hit the same brick wall. So take the time to make a note of what you need to do next. In doing so, you are creating the next entry point. When you return to the task, it will be easier to get started on your next 30 minute sprint.

The Focus Formula can be used to get started on any task that is less that tantalising. Housework, paperwork, studying and many other activities can be conquered in 30 minute sprints - until you hit the Focus Zone. 

Try it out, and let me know how you go.

ADHD - The Parents' Journey - Guest Blogger Annette

As parents, the backpack we carry when our journey starts with our child can place a heavy burden on the shoulders. Some days it seems light and almost feathery, though without warning, other days it becomes so weighty it feels almost unbearable.

For me the weight of a backpack coupled with the ‘briefcase of a career’ seemed at times, to be the cause of the challenges that arose with what I thought was a wonderful, happy child.

The first occasion of my ‘talks’ arose at day care when the staff were keen to advise me daily that out of all the children my child would not take a nap. “Is he upset”? “No” was the answer. “Is he disrupting the other children?” “No”. “Is he trying to keep them awake or play with them?” “No”. I struggled to see the problem. Here was a lovely happy little 18 month old boy that seemed happy to be on the mat but just sit and play or look around at others. Not disturbing just happy to day dream but not sleep. This was mirrored at home and I was perplexed with the daily ‘tut tut’ I would receive, like it was something I was teaching him to do!

Though a pattern started to emerge.

At pre school and in Grade One the same ‘talks’ were regularly presented. Not naughty, not disruptive just won’t sit and if he does he daydreams, won’t concentrate on his work, is forgetful, won’t stay on task, doesn’t seem to listen and has difficulty understand instructions. I kept asking all along the way, “Do you think he has Autism, is he ADHD.” This was always met by a negative response and in the expert opinion of these care givers and teachers it was a behavioural problem (whatever that meant?)

 By Grade Two after one to many ‘chats’ about the negatives and few positives of our lovely little boy I trotted him off to a Psychologist. After countless weekly visits and over a thousand dollars later it was declared that there was nothing wrong with the child, must be the teachers. Again I kept asking “Could he have Autism or ADHD?” “Definitely not”, was the response. His grandparents, through the magical unconditional love that they possess declared him perfect and just too clever; they also suggested it must be the teaching practices employed these days.

By now I had shifted the blame into the ‘growing heavier by the day backpack’ and declared a self prognosis of it being my fault as a full time working mother. By Grade Three a wonderful young teacher reached in and lifted a brick from the pack. “Annette do you think Hunter might have Passive ADD?” She was anxious at presenting this suggestion but the relief was immense for me.

Here was someone who had identified through research the inattentive form of the condition, not the Predominately Hyperactive/Impulsive Sub Type that most of us relate to ADHD. A stream I had never heard of. After taking her advice I also researched the subject matter and found quickly that kids with this condition do often fall under the radar during school years. Not drawing attention to themselves with hyperactivity and strong social behaviours, these quiet souls are often labeled as lazy school workers and day dreamers.

The journey continued to be a struggle as a series of testing had to be under taken to determine the condition. Visits by the Education Psychologist (who also deemed him not to be ADHD from observations), a local Doctor (reluctant to refer him to a Specialist because there was a belief he didn’t have ADHD), to the wonderful Specialist that said “I have spent three minutes with him and I think he is but let’s try fish oil and at the same time let’s get him clinically tested before we consider any medication.”

He did, he was, and he was then offered medication.

The backpack got lighter but the emotional backlash from family and friends was at times brutal. I have since realised that if you don’t live with ADHD you can’t possibly appreciate the challenges that are presented hour by hour. Not to mention the struggles experienced by those living with ADHD. I learnt to keep my mouth shut and lean on those that were supportive and encouraging at taking a proactive approach to help my son.

My son’s medication regime is designed to assist him ‘get through the school hours’. Kicking in soon after he arrives at school and wearing off at the end of the school day. Now a teenager the medication schedule is constantly being monitored and adjusted to assist with the all important after school study that is now part of our society’s educational expectations.

While the medication allows the brain connectors to ‘switch on’ and encourage focus during these blocks of hours there is a huge gap in the emotional and social needs of a fully functioning human being. Getting ready for the day, being organised enough at school and home to be able to focus on the tasks and instructions, personal hygiene and that all important social connection we all need in our lives. Building friendships and relationships and being able to read others and their emotional needs.

In our house the gap continued to grow with the body as it morphed into a teenager. While there seemed some relief in a new high school that accepted and worked with great vigour in assisting the transition from primary to high school, things were getting emotionally strained in our normally passive home environment. Then I noticed disturbing behaviours.

Fingers picked raw from stress and anxiety, scratching of the face when being confronted – it started to scream self harm and the backpack was suddenly leaden.

After a stressful morning and in a fretful state I made a call to LADS, seeking advice for the name of a Psychiatrist that could help us. After calming me down and listening to my story this amazing woman was frank “I don’t think you need a Psychiatrist, I think your son might need a coach.” Coaching was not new to me, I had undertaken Professional Business Coaching at the height of the GFC and had gone on to learn from a couple of one on one Life Coaching sessions so the idea appealed.

We were given the contact, of whom in our own words is our ‘Family Angel’. In human form she is Dr Michele Toner, ADHD Coach.

The changes to my son and our family have been dramatic. He is now able, with strategies designed for him by Michele, to have some order and management of his personal routines, plan and manage his own study paths, and is now in the midst of learning the art of conversation and forming friendships.

The outcomes and results in a short six months? He can now get ready in the morning in a home that is ‘a screeching mother free zone’, his school grades have shot from Cs and Ds to As and Bs and his confidence in making new friends and forming stronger bonds with long time acquaintances  is going from strength to strength.

I would love to say pop a pill and go to a coach and this magic cloak will appear and all will be perfect, but it isn’t true. It needs a team, made up of family and friends, a supportive school environment and an angel of a coach. You will still need to push, then run ahead and pull - but you will get them over the life line.

Perhaps our proudest moment was just a few weeks ago when at a parent teacher night we moved from teacher to teacher to be told our son was in the top ten per cent of each subject. A first! A wonderful academic achievement and great result for all his hard work, but it didn’t seem to compare to the comments promoting what a great person he was.

“Willing to try everything, someone you can trust, always putting forward a great effort even when he might not be so good at something, and more importantly if he is good at something, helping others that might not be finding it so easy. The best sum up of the night ‘This is a wonderful young man’. What more could you ask for as a parent? The backpack was empty that night!

The Changes that My ADHD Coach has Made to My life.

 My guest blogger is Hunter, a  wonderful 15 year boy who was diagnosed with ADHD recently. Coaching has worked well for him because he has put in a huge effort to change how he operates. He also has wonderful parents, and their story will follow soon.

Before I met Michele my life was pretty turbulent. I had difficulties getting organised at home, even getting ready for school in the morning was a struggle, my grades at school were lower than I expected them to be and I was not confident socially.

The first thing Michele and I tackled was helping me get ready in the morning by suggesting an app called 30/30. The app lets you put in things that you need to do and the time that it will take, after the timer goes off you hear a noise and you must move on to the next thing. This has really helped me in the morning, because before this I used a list on the fridge. That did not work because I had to stop what I was doing and tick whatever I had done on the list off. Since I have being using 30/30 my mornings have being calmer and way less stressful and I now leave the house much happier and more organised.   

The next thing was my school grades, when I first went to see Michele my grades were Cs and Ds, but since I have being seeing Michele my grades have risen and now my grades are As and Bs. Michele taught me strategies to help me with tests and projects.  One thing she picked up was a problem I was having with maths where I could not transition between the number questions and the word questions. She suggested I try doing all of the number questions first and then I do the word questions. I used this strategy in my maths exam and did so well the school sent my parents a letter of commendation.   

Michele has also helped me with my social life. Before I saw Michele I was nervous about asking for people’s phone numbers, but now I can because of Michele. She helped me by telling me to start conversations and find out what people like and what you have in common with them.

So Michele has helped me with getting ready in the morning, my school grades and my social life.  I could not have done any of this without Michele’s help and tips. It’s really made a huge difference to my life and managing my ADD.

Hunter, age 15.

Teaching how to tell the time - ADHD Coach Perth

The following task sheet was provided by Sylvia Byers, Educational Consultant Extraordinaire.

Time is such a difficult concept for people with ADHD to grasp. This task sheet helps children to understand and use an analogue clock in a detailed series of simple steps.

Task	Check
To say the names of the numerals from 1 to 12.
To identify the numerals 1 to 12.
To count to sixty by ones using a number line.
To recognise that the sixty numerals on a number line match up in a one-to-one correspondence with the sixty minute marks on a clockface.
To recognise that the circumference of a clockface is like a number line that is curved.
To recognise that the longer minute hand is the pointer for the ‘60” line.
To count clockwise by ones every minute mark from the zero mark on a clockface to determine the number of minutes after an hour indicated by the longer pointer.
To say “……… minutes after” the hour.
To place the numerals 1 to 12 in order on a number line and then count them aloud.
To move the numerals 1 to 12 from their number line position to their clockface position.
To read aloud all of the numerals on a clockface in a clockwise direction starting at 12.
To recognise the relationship between the placement of numerals on the “12” number line and the multiples of five on the “60” number line when both number lines are of the same length.
To map the multiples of five on the “60” number line onto the “12” number line in a counting sequence using the idea of many-to-one relation.
To keep a tally on the “12” number line the number of times one counts to sixty on the “60” number line.
To recognise that the tally counter on the “12” number line is doing the same job as the hour hand on the clockface.
To show zero minutes after the hour with the minute pointer.
To say “o’clock” when the minute hand is at the top centre position pointing to the “12” on the clockface.
To read ….:00 as o’clock.
To recognise that the minute hand (longer pointer) points to the top centre of the clockface when the clock reads ….:00.
To associate the word “o’clock” with “…:00” and the top centre position of the minute hand.
To associate hours with the numeral indicated by the shorter hour hand on the clockface.
To determine the hours indicated by the numeral that the hour hand is pointing to when the minute hand is pointing to the top centre of the clockface.
To recognise that the longer hand is always pointing to the numeral 12 when the hour hand points directly to a numeral on the clockface.
To show a designated time on the clockface: time designated will be on the hour.
To read aloud the time as indicated by the positions of the hands for the time on the hour.
To say “o’clock” when reading or referring to time on the hour.
To identify time on the hour.
To recognise that the hour hand moves slowly from one numeral to the next in relation to the movement of the minute hand.
To tell time correctly to the minute using the language “after the hour.”
To recognise that thirty minutes after the hour is the same as (is another name for) “half after the hour.”
To say “half after the hour.”
To show time on the half hour.
To identify time on the half hour.
To say minutes and hours in sequence, “thirty-one minutes after 7.”
To count by fives on the “60” number line.
To count by fives on a clockface using the numerals one to twelve as a guide.
To count multiples of five on a clockface as indicated by the numeral on the clockface to which the longer hand is pointing.
To say the minutes and hours in sequence when the minutes are multiples of five, “twenty minutes after 4” or “forty-five minutes after 11.”
To tell time to the minute using the language after the hour with facility by counting first by fives and then by ones until the position of the minute hand is reached.
To recognise that fifteen minutes after the hour is another name for a quarter after the hour, and that thirty minutes after is another name for half after the hour.
To say “quarter after the hour.”
To recognise that forty-five minutes after the hour for three-quarters after the hour.
To recognise that three-quarters after the hour is another name for a quarter before the next hour.
To recognise that another name for a quarter before the next hour is fifteen minutes before the next hour.
To recognise that forty-five minutes after one hour is another name for fifteen minutes before the next hour.
To use the language “after the hour” when referring to the number of minutes the minute hand has travelled past the numeral 12 on a clockface, and use the language “before the hour” when referring to the number of minutes the minute hand must travel to reach the number 12 again during a span of sixty minutes.
To count in a clockwise direction the number of minutes the minute hand must traverse to reach the numeral 12.
To count in a anti-clockwise direction from the numeral 12 to determine how many minutes the minute hand must travel before it will reach the numeral 12.
To tell time to the minute using the language “n minutes after the hour”, “n minutes before the hour”, ¼ after,” “1/2 after”, and “1/4 before.”
To show the correct time on a clockface in response to the language “n minutes after. N minutes before. ¼ after. ½ after. ¼ before.” When these times are spoken.
To show the correct time on a clockface in response to the written forms: “8:00, 8:16, a quarter to nine, 8:30, half after 8, 8:45, 8:53.”
To draw the hands on a clockface to show designated times.
To show time on a clockface expressed in writing.
To identify the time shown on a clockface by selecting the correct written response from a set of pictures of clocks.