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Get an accurate diagnosis. This is the
starting point of all treatment for ADD.
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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 under-stand 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.
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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 the reputation of
the person with ADD within the family 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 5 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.
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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 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.
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Also make it clear that ADD is a family
issue. Unlike some medical problems, ADD touches 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 problem.
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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 one 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.
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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 ADD family.
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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 best to
get into the habit of negotiation. This can take a lot of work, but over time
some kind of negotiated settlement can usually be reached. The terms of the
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 negotiated peace.
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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 are sometimes 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 Yes.
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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.
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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.
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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.
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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.
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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.
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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 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.
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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.
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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.
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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.
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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, can-do attitude.
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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.
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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 last forever.
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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.
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Never worry alone. Try to cultivate as many
supports as p05sible. From pediatrician to family doctor to therapist, from
support group to professional organization to national conventions, 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.
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Pay attention to boundaries and over control
within the family. People with ADD often step over boundaries without meaning
to. It is important that each member of the family know that he or she is an
individual, and not always feel under the collective will wielded by 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 hyper
controlling 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.
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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 that
things can get better.
Families
in general have tremendous power both to heal and to inflict pain. If the
family is willing to cast a new eye upon a chronically wounded member, if the
family is willing to heal him, it can do so better than all the medications,
therapies, and incantations ever devised. However, if the
family is unwilling to look differently upon one of its members, if the family
instead sneers and snorts, "Just another one of your lame excuses!
Why don't you just shape up?" then the family can undermine whatever good
treatment he may receive. Few of us ever outgrow the power of our families both
to deflate us and to fill us up. Few of us ever get past the wish for love and
approval from mother or father, sibling or kin. That wish can be used in our
favor, to support us as the wish is granted, or it can be used in our
destruction as the wish is perpetually denied.
For the family to use its considerable power to
heal, it must be willing to accept the challenge of change. All groups,
especially families, feel threatened by a change in the status quo, no matter
how bad the status quo may be. As the person with ADD seeks to change, he is
also asking his family to change with him. This is never easy. It is not the
bad family that has a hard time with change; it is all families. But with
education and information as guides, with encouragement and support as reinforcers, most families can successfully adapt. As
there is less suffering in the family system, life at home can even be fun.
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