Here are some behavior management tools to help children with ADHD manage their behavior both at home and in school.

Over my 17 years of clinical experience, I have found it very useful to distill eight general principles that serve as touchstones in the daily behavior management of ADHD children. From these, parents and teachers have deduced what particular methods might work for their ADHD children, often proving to be quite inventive in the procedures they create. These general principles stem from the recent conceptualization of ADHD as a biological deficit in persistence of effort, inhibition, and motivation.

If ADHD involves a reduced sensitivity to behavioral consequences, such as rewards and punishments, as current theorists believe, then certain rules of managing behavior would be predictable from these theories. To date, such principles have proven very useful in designing both home and classroom management programs for ADHD children. Practitioners and educators should always bear these in mind as they advise parents in the management of ADHD children or engage such direct management themselves. Follow these eight principles and it will be hard to go wrong in designing management programs:

1. Use More Immediate Consequences

ADHD children require more immediate feedback or consequences for their behavior and activities than do normal children. Where it may seem acceptable to occasionally praise normal children but a few times a day for particularly positive behaviors they perform, ADHD children require much more frequent feedback about their prosocial or acceptable behavior than this. As Virginia Douglas and others noted long ago, ADHD children seem much more governed by immediate consequences, or moment-to-moment changes in contingencies. I have also noted elsewhere that ADHD children seem less rule-governed in daily situations and more contingency shaped (controlled by the momentary consequences) than their normal peers. This is particularly so where parents are attempting to systematically change the negative behaviors of ADHD children to more positive or productive ones. This feedback must be clear, specific, and occur as close in time after the behavior that is the target of change as circumstances permit, if it is to be maximally effective in developing and maintaining positive behaviors in ADHD children.

The feedback can be in the form of praise or compliments, but if so, should state expressly what the child did that is viewed as positive. It can also be in the form of physical affection or even rewards, such as extra privileges or occasionally a food treat. More often, when the ADHD child's behavior must be altered more quickly, artificial reward programs like token, point, or chip systems may need to be systematically introduced and maintained for several months. Regardless of the nature of the feedback, the more immediately it can be provided, the more effective it will be for ADHD children.

2. Use a Greater Frequency of Consequences

ADHD children will require these behavioral consequences more frequently than do normal children. Thus, although responding immediately is important, caregivers of ADHD children must also respond more often than do those of normal children in letting ADHD children know how they are doing. Admittedly, if this is done too often, it can get irritating and intrusive in ADHD children's daily activities. Although this can also become tiring for caregivers as well, they should be counseled to try to increase their frequency of feedback and consequences to their ADHD children.

One means of doing this is to have the parent or teacher place small stickers with smiley faces on them around the house in locations where the children frequently look each day. Some examples might be in the corner of bathroom mirrors, on the edge of the face of a kitchen clock, on the inside of a refrigerator, on a bread box, and on the back and front doors. Whenever caregivers sight a sticker, they are to comment at that very moment on what they like that their ADHD child is doing. Another way for parents or teachers to achieve this goal might involve simply setting a cooking timer for brief and varied intervals throughout the day. When it rings, this is a reminder to the parents to find ADHD children and let them know how they are doing. If behaving well, then the children should be praised and even rewarded. If violating rules, then a reprimand or mild punishment may be required.

Another device that can be used to train parents to give frequent feedback initially is called the MotivAider. This is a small, vibrating box with a built-in digital timer that can be programmed to go off at various times throughout the day, say, every 20 minutes. (For more information, call ADD Warehouse, 800-233-9273.) The caregiver wears the small device on a belt or in a pocket. Whenever it vibrates, this is a cue for the parents to provide feedback to their ADHD child. This method has the added advantage of being less obvious to the child as a prompt for parental or teacher reward, and therefore the praise prompted by the device may appear to the child as more sincere or genuine. We have used this device in current kindergarten research classes for ADHD children with great success and cooperation by our teachers. In any case, the important point is to act quickly and frequently in giving feedback to ADHD children.

3. Employ More Salient Consequences

ADHD children require more salient or powerful consequences than do normal children to motivate them to perform work, follow rules, or behave well. Since ADHD may involve a reduced sensitivity to rewards and other consequences, it makes sense that larger, more important, or salient rewards may have to be used with ADHD children. This also explains why verbal positive comments or praise are rarely sufficient, alone, to motivate ADHD children to behave well.

In addition to such praise, caregivers will often have to provide more substantial consequences, such as physical affection, privileges, special snacks or treats, tokens or points, material rewards like small toys or collectible items, and even, occasionally, money, as back-up consequences to motivate ADHD children to work or continue following important rules. This may, at first, seem to violate the common wisdom that children should not be materially rewarded too often, lest it come to replace the more intrinsic rewards that an act or activity provides, thereby maintaining interest in continuing to perform the activity. Such intrinsic rewards might be the pleasure of reading, the desire to please one's parents and friends, the pride of mastering a job or new activity, or the esteem of one's peers for playing a game well. But these forms of reinforcement or reward are not as likely to govern the behavior of ADHD children and consistently motivate them to behave well, inhibit their behavior, and persist in their work, since ADHD children are probably less sensitive to these forms of reward as sources of motivation. Therefore, the nature of their disability dictates that larger, more significant, and sometimes more material consequences may need to be used to develop and maintain positive behaviors, at least initially, in ADHD children.

4. Start Incentives Before Punishments

It is critical to avoid the all-too-common drift toward using punishment first to suppress unwanted behavior. Caregivers must be frequently reminded of the rule positives before negatives in instituting behavior-change programs. This rule simply means that when an undesirable or negative behavior is to be targeted for change in an ADHD child, a caregiver should first redefine the behavior problem into its desirable or positive alternative. This will instinctively lead to watching for that positive behavior, and praising and rewarding it when seen. Only after this new behavior has been rewarded consistently for at least one week should parents or teachers be advised to begin punishing the undesired opposite behavior. Even then, they must be cautioned to use only mild punishment and to do so consistently but selectively, only for the occurrence of this particular negative behavior--not for everything else the child may be doing wrong. Mild punishment, when used in conjunction with an incentive program, and when kept in balance such that only one punishment is being dispensed for every two to three instances of praise and reward, can be a powerful means of effecting behavior change.

5. Strive for Consistency

Just stating the rule to caregivers is not sufficient, however; defining the term is what is important. Consistency means three important things.

First, caregivers need to be consistent over time. This means that the manner in which they react to a behavior they are striving to change today is how they should seek to respond to it each time it occurs over the next few days and weeks. Inconsistency, unpredictability, and capriciousness in this respect is one of the greatest contributors to failing in a behavior-change program with an ADHD child. An important corollary of this rule is not to give up too soon when you are just starting a behavior-change program. It has taken months to years for an ADHD child's behavior to fall into this pattern. Common sense dictates that it isn't going to change overnight. Don't lose hope or give up just because a new method of management does not produce immediate or dramatic results. Behavior modification can be like medication, it can take time before a therapeutic effect is noticeable. Try a behavior-change program for at least a week or two before deciding it isn't working.

Second, consistency also means to respond in the same fashion across different places and settings. Parents working with ADHD children too frequently respond to behaviors one way at home but an entirely different way in public places, like stores and restaurants, or at others' homes. They should try to avoid this. The ADHD child needs to know that the rules and consequences expected to occur at home will also apply, whenever possible, away from home.

And, third, consistency means that each parent should strive to manage behavior in as similar a fashion as possible to the other parent. Granted there will always be differences in parenting styles between mothers and fathers. However, it should not be the case that one parent punishes an ADHD child for a certain act of misconduct, while the other overlooks reacting to it entirely, or actually rewards its occurrence.

6. Plan for Problem Situations and Transitions

Often times, caregivers of ADHD children, particularly those children who are also defiant, find themselves frequently faced with difficult, disruptive, or noncompliant behavior. These situations arise not just at home, but frequently in public places, such as stores, restaurants, churches, and others' homes, and even in school. When they occur, caregivers can become flustered, bewildered, and frustrated, and may be unable to think quickly as to how best to handle such problems. These feelings are often combined with a sense of anxiety and humiliation when these child behavior problems arise in front of others, especially strangers in public settings.

In interviewing many caregivers of ADHD children, I have often been struck by their ability, when pressed to do so, to predict ahead of time where their children are likely to disrupt and misbehave. Yet, many simply have not put this information to good use in preparing for such problems to arise again. That is why we teach parents to anticipate problems, consider ahead of time how best to deal with them, develop their plan, share it with the child just beforehand, and then use the plan should a problem arise. People may find it hard to believe that merely sharing the plan with the child before entering a potential problem setting greatly reduces the odds that behavior problems will arise. But it does.

By following four simple steps before entering any problem setting, caregivers can improve the management of ADHD children.

• Stop just before beginning the potential problem situation.
• Review two or three rules that the child often has trouble following in that situation; then ask the child to repeat these simple rules back. For instance, they can be rules like "Stand close, Don't touch, and Don't beg" for a young ADHD child about to enter a store with a parent.
• Review with the child what rewards they may be able to earn if they obey the rules and behave well. These rewards can be chips or points that are part of their home or school token system, a special treat or privilege to enjoy later, such as some additional time to play, watch TV, or even, on occasion, the purchase of a small treat or toy while in the store at the end of the trip.
• Review the punishment that may have to be used with the child. Typically, these involve loss of points nor fines, the loss of a privilege later in the day, or, if necessary, time out in the situation. Whichever punishment is used, the key to effec- tive management of a child is the quickness or immediacy of responding with the consequence when the problem arises, as noted earlier.

Now once these four steps have been followed, the caregiver and child may enter the potential problem context, and the caregiver immediately begins to give the child frequent feedback and occasional rewards or tokens for good behavior.

7. Keep a Disability Perspective

At times, when faced with a difficult to manage ADHD child, caregivers lose all perspective on the immediate problem, become enraged, angered, embarrassed, or at the very least, frustrated, when management does not work. Often, they may even argue with the child about the issue, as another child or sibling might do. This is ineffective, looks silly, and may even encourage continued confrontation by the child on future such occasions. Teach caregivers to remember at all times, they are the adult; they are this child's teacher and coach. If either of them is to keep their wits about them, it clearly has to be the adult. Losing their cool won't help, will likely make the problem worse, and will often lead to considerable guilt once they recover their senses.

Therefore, they must try to maintain psychological distance from the child's disruptive behavior, if necessary pretending that they are a stranger who has just happened upon this encounter between caregiver and ADHD child. In addition, they should not allow their sense of self-worth and dignity to become derived from whether or not they "win" this argument or encounter with the child. Counsel them to strive to stay calm if possible, maintain a sense of humor about the problem, and by all means try to follow the other seven principles in responding to the child. Sometimes this may even require caregivers to disengage from the encounter for a moment by walking away and gathering their wits as they regain control over their feelings. Above all, they must not personalize the problem encounter with the child. Advise them to remember that they are dealing with a handicapped child! ADHD children cannot always help behaving in the ways that they do; the caregivers can.

8. Practice Forgiveness

This is the most important but often the most difficult guideline to implement consistently in daily life.

First, each day after the children are put to bed, parents should take just a moment to review the day and forgive the children for their transgressions. Let go of the anger, resentment, disappointment, or other personally destructive emotions that have arisen that day due to the children's misconduct or disruptions. Forgive them, for they are disabled and cannot always control what they do. Do not misunderstand this essential point. It does not mean the children should not be held accountable for their misdeeds or be taught to make amends with others they have harmed, for they should. Teachers can practice this at the end of the school day, once the children have left their class. Teachers should stop, take a cleansing breath, and upon exhaling let go of the day's conflicts with the ADHD child.

Second, parents should concentrate on forgiving others that day who may have misunderstood their children's inappropriate behavior, acted in ways offensive to them and their children, or simply dismissed their children as lazy or morally bereft. Such people are often ignorant of the true nature of ADHD, typically blaming the parents and family of the ADHD child for all of the child's difficulties, when such is clearly not the case. This in no way means that parents should continue permitting others to mistreat their ADHD children or misunderstand them. Corrective action and advocacy for these children are critical to seeing that such misunderstandings or maltreatment by others does not occur again. It does mean having parents learn to go beyond the hurt, anger, and resentment such instances may have effected in the parents. This may be much less necessary for teachers who are less personally invested in the ADHD child than are parents. Even so, truly empathic teachers may also feel ashamed that they cannot control an ADHD child when in the presence of other teachers, who may deride them for their management problems. Such teachers may also need to practice this aspect of forgiveness.

Finally, caregivers must learn to practice forgiving themselves for their own mistakes in the management of ADHD children that day. ADHD children have the capacity at times to bring out the worst in adults, which frequently results in those adults feeling guilty over their own errors in handling the children's behavior. This does not mean that parents or teachers should not strive to improve their management or to evaluate how successfully they have approached and managed the child's problem behaviors. Forgiveness does not mean granting oneself license to repeatedly make the same errors without consequence. It does mean letting go of the self-deprecation, shame, humiliation, resentment, or anger that accompanies such acts of self-evaluation, replacing them with a frank evaluation of one's performance as a caregiver that day, identifying areas to improve, and making a personal commitment to strive to get it right the next day.

Forgiveness is, admittedly, a tall order for humanity. Caregivers will find this principle the hardest to adhere to, but the most fundamental of all the principles reviewed here as to the art of effective, and peaceful, management of ADHD children.

SOURCES: The ADHD Report Volume 1, Number 2, April 1993, published bimonthly by Guilford Publications, Inc.

About the author: Russell A. Barkley, Ph.D., is an internationally recognized authority on attention deficit hyperactivity disorder (ADHD) in children and adults. Dr. Barkley has specialized in ADHD for more than 30 years and is currently a Research Professor in the Department of Psychiatry at the SUNY Upstate Medical University in Syracuse, New York

Losing grip of reality can be frustrating, even scary or traumatic for Alzheimer's patients and their caregivers. Learn about auditory and visual hallucinations.

Some people with Alzheimer's may experience hallucinations or delusions, but it doesn't mean that everyone with Alzheimer's will be affected in this way and not everyone who has these problems has Alzheimer's. Here are some ways of handling these experiences.

A person with Alzheimer's may sometimes experience hallucinations. They may see, hear, smell, taste or feel things which are not really there. That's contrasted with a delusion, which is something a person thinks, something they strongly believe to be true, which is not. Because both maladies seem so real to the person experiencing them, it is often quite difficult to convince them otherwise.

The most common hallucinations are those which involve sight or hearing.

The reaction of the person with Alzheimer's to the hallucinations may vary

• They may realize that their imagination is playing tricks with them and pay no attention to the hallucination.
• They may find it difficult to decide whether or not the hallucination is real. In this case they may like you to go with them to look at the place where they thought they saw something. Or it may help if you check the room where they thought they heard voices or other noises. You can then confirm for them that nothing is there.
• As the Alzheimer's becomes more severe the person may become convinced that what they are hearing or seeing is real. They can find this very frightening. Try to let them know that, although you are not sharing their experience, you understand how very distressing it is for them. Distracting the person may help. There is absolutely no point in arguing about whether or not the things that they are seeing are real.
• Hallucinations are less likely to occur when the person is occupied or involved in what is going on around them.
• Not all hallucinations are upsetting. Sometimes it may be better to go along with the person rather than distract them. It depends on the situation.

If the hallucinations persist or the person with Alzheimer's becomes distressed by them, speak to the GP. Medication can sometimes help but, if prescribed, should be regularly reviewed by the doctor.

Visual hallucinations and Alzheimer's

Visual hallucinations are the most common type in Alzheimer's. The person may see people, animals or objects. Sometimes these involve quite complicated scenes or bizarre situations.

Such hallucinations can be the result of the person's brain misinterpreting everyday objects. They may believe, for example, that they see faces in patterns on fabrics, that pictures on posters are real people or animals, or that their reflection in the mirror is another person.

Many people with Alzheimer's who experience visual hallucinations only experience them occasionally. However, sometimes they are more persistent and troublesome.

Possible causes of visual hallucinations include:

Illness. Hallucinations can result from physical illness such as infections. They can also be side-effects of some types of medication. A doctor should be able to help rule out these possibilities.

Eyesight. Visual hallucinations may be due to poor eyesight. This cannot always be improved but you should:

• Arrange regular eye checks and encourage the person to wear their glasses if they need them
• Check that any glasses worn are clean and that the prescription is correct
• If cataracts are the cause of poor sight, discuss whether they should be removed with the GP
• Make sure that the lighting in the home is good. Changes in the brain. A person sometimes experiences hallucinations because of changes that are occurring in their brain as the Alzheimer's progresses.

  People with Alzheimer's with Lewy bodies often have a mixture of the symptoms found in Alzheimer's disease and Parkinson's disease. People with this form of Alzheimer's are more likely to have persistent visual hallucinations together with stiffness and slowing of movement and marked fluctuations in their abilities. In these cases, antipsychotic medication, which is sometimes prescribed for hallucinations, can make the stiffness worse. It should, therefore, only be prescribed in small doses, if at all, and reviewed regularly.

Auditory hallucinations and Alzheimer's

These occur when the person hears voices or noises although nothing is there. As with visual hallucinations, it is important to rule out physical causes such as physical illness and the side-effects of medication. It is also worth checking the person's hearing and make sure that their hearing aid is working properly if they wear one.

One indication that the person may be experiencing auditory hallucinations is when they talk to themselves and pause, as though waiting for someone else to finish speaking before continuing. However, talking to oneself is very common - not everyone who does this is having an hallucination.

Shouting at people who are not there also suggests the possibility of hallucinations.

People are less likely to hear voices when they are talking to someone real, so company can help.

Sources:

• Jacqueline Marcell, Hallucinations and Delusions: How to Help Loved Ones Cope, July 2006.
• Alzheimer's Society - UK - Carer's Advice Sheet 520, Jan. 2000

Many children with ADHD grow into adults with ADHD, but with appropriate early treament for the attention disorder, the prognosis is good. Article also outlines ADHD and co-morbid conditions.

ADHD is a long-term, chronic condition. About half of the children with ADHD will continue to have troublesome symptoms of inattention or impulsivity as adults. However, adults are often more capable of controlling behavior and masking difficulties.

Untreated, ADHD negatively affects a child's social and educational performance and can seriously damage his or her sense of self-esteem. ADHD children have impaired relationships with their peers, and may be looked upon as social outcasts. They may be perceived as slow learners or troublemakers in the classroom. Siblings and even parents may develop resentful feelings towards the ADHD child.

Some ADHD children also develop a conduct disorder problem. For those adolescents who have both ADHD and a conduct disorder, up to 25% go on to develop antisocial personality disorder and the criminal behavior, substance abuse, and high rate of suicide attempts that are symptomatic of it. Children diagnosed with ADHD are also more likely to have a learning disorder, a mood disorder such as depression, or an anxiety disorder.

Approximately 70-80% of ADHD patients treated with stimulant medication experience significant relief from symptoms, at least in the short-term. Approximately half of ADHD children seem to "outgrow" the disorder in adolescence or early adulthood; the other half will retain some or all symptoms of ADHD as adults. With early identification and intervention, careful compliance with a treatment program, and a supportive and nurturing home and school environment, ADHD children can flourish socially and academically.

Terms:

Conduct Disorder

A behavioral and emotional disorder of childhood and adolescence. Children with a conduct disorder act inappropriately, infringe on the rights of others, and violate societal norms.

Antisocial Personality Disorder

Antisocial Personality Disorder is a condition characterized by persistent disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit and manipulation are central features of this disorder.

Oppositional Defiant Disorder

A disorder characterized by hostile, deliberately argumentative, and defiant behavior towards authority figures.

Sources:

• Merck Manual Online Medical Library (2003)
• National Institute of Health Medline (ADHD)

Pacing, fidgeting and being suspicious are common non-aggressive behaviors exhibited by Alzheimer's patients. Learn how to deal with them.

Pacing is aimless wandering, often triggered by a feeling of pain or boredom or some distraction in the environment, such as noise, smell, or temperature. There are a number of reasons why a person with dementia may pace up and down a room.

• They may be hungry or thirsty or constipated, in pain, or many simply want to use the toilet and be unable to tell you. Check on these kinds of possibilities.
• They may feel ill or they may be suffering the side-effects of certain medicines. If you suspect that this may be the case, contact the GP.
• They may be bored, or they may not be using up all their energy. Try to find appropriate activities or enjoyable forms of exercise.
• They may be upset by noisy or busy surroundings. They may stop walking up and down if they can find a quiet place to sit.
• They may be angry, distressed or anxious. Try to find out how they are feeling and show that you understand.

However, in some cases, pacing may be due to changes that have taken place in a person's brain. Try to distract them. However, if you are unable to prevent them from pacing:

• Try to find somewhere they can walk in safety without disturbing anyone else.
• Encourage the person to choose comfortable clothes and supportive shoes.
• Check their feet regularly for any redness, swellings or blisters which may need attention. Contact the GP or community nurse if you are concerned.
• Try to persuade the person to rest from time to time and offer drinks and snacks.

Fidgeting and Alzheimer's Patients

A person with Alzheimer's may fidget constantly. They may be uncomfortable, upset, bored or need more exercise. The fidgeting may be associated with the damage in the person's brain.

• Check whether the person is too hot, too cold, hungry or thirsty or whether they want to use the toilet for example.
• If they seem upset, try to find the reason and reassure them.
• Try and distract their attention with an interesting activity or involve them in some form of exercise.
• Give them something to occupy their hands such as a soft toy or worry beads, or provide a 'rummage' box containing interesting objects.

Hiding and Losing and Alzheimer's Patients

The person may deliberately hide objects to keep them safe and then forget where they are or indeed that they have hidden them at all.

• The wish to hide articles may be partly due to feelings of insecurity and a desire to hold on to the little that they still have. Try to reassure the person, however impatient you may feel.
• Do not leave important documents lying around and make sure you have a spare set of keys if they are likely to lock things away.
• Try and find out the person's hiding places so that you can tactfully help them to find 'missing' articles.

Some people may also hide food, perhaps intending to eat it later. If this is the case you may need to check hiding places regularly, and discreetly dispose of any perishable items.

Suspicion and Alzheimer's Patients

People with Alzheimer's sometimes become suspicious. They may worry that other people are taking advantage of them or intend to harm them in some way. For example, when they mislay an object, they may accuse someone of stealing from them, or they may imagine that a friendly neighbor is plotting against them. Such ideas may be partly due to failing memory or an inability to recognize people they know, and partly due to the need we all feel to make sense of what is happening around us.

• Although such attitudes can be very difficult to live with, try to avoid arguing. State calmly what you know to be true, if appropriate, and then reassure or distract.
• Explain to others who are in contact with the person that any unfounded accusations are caused by the Alzheimer's and that they should not be taken seriously.
• However, you should not automatically dismiss the person's suspicions if there is any possibility that they may be true.

Sources:

Jiska Cohen-Mansfield, Ph.D., Managing Agitation in Elderly Patients With Dementia, Geriatric Times, May/June 2001, Vol. II, Issue 3.

Zaven S. Khachaturian and Teresa Sluss Radebaugh, Alzheimer's Disease: Cause(s), Diagnosis, Treatment, and Care, 1996.

Alzheimer's Association

The more television a child watches between the ages of 1 and 3, the greater his or her likelihood of developing attention problems by age 7. So how can you control TV watching in your house?

A recently completed study at Children's Hospital and Regional Medical Center in Seattle indicated that for every hour a young child (age two or under) watched TV each day, there was a 10% increase in the chances of an attention disorder by the time this child was age seven. This is happening in a country where, according to the Kaiser Family Institute, around 65% of kids age two or under watch at least two hours of TV a day.

We have a TV culture that not only poses risks for young children, it cuts deeply into time that could be devoted to families spending quality time together.

TV is not evil. There are wonderful programs for both adults and kids. And there is a tremendous amount of garbage. One of the most important things you can do as a parent is to set limits on TV watching (and video game playing) while your kids are young. If these limits aren't set early, kids will tend to gravitate towards the garbage that's on the tube, and they'll spend precious time that could be spent more productively.

When you set limits on TV watching, you'll get some screams and howls from your kids. Don't EVER cave in on these demands, or you'll be sorry. This is your job. Set simple and very clear rules about what they can watch and when they can watch it. Have a time limit on how long they can watch. Many parents have had success with a policy of no TV during the week and a few hours allowed on the weekends.

By all means, at least have a policy of no TV until all homework has been completed. If you want a nightmare around finishing homework, allow them to watch TV before the work is done! Power struggles will naturally follow this policy. Be aware of the desire of your kids to just "watch TV." This usually means flipping channels until your kids can come across a disturbing and violent show or movie.

This is the emotional and mental health of your child that we're talking about here! The average child in this country spends about 28 hours in front of a TV or video game a week, about the amount of time they spend in school. And when a lot of garbage goes in, a lot of garbage comes out. Have the discipline to create other alternatives for your kids.

Here are some ideas:

• Start when they're young. It's a whole lot more difficult to keep TV viewing under control once they've "gotten into the habit."
• Keep the TV in the basement and don't make it a prominent part of your household. Your kids will learn that there are a lot of other things to do besides sitting in front of the screen.
• Get involved with friends and family who also would like to limit the TV influence in their families. It can be difficult when your neighbors or family members give your child free reign to watch, and there may be times when you just have to bend your limits when dealing with other families. If you can create a "community" of other families who feel the same way you do, it will make it a lot easier to "sell" the concept of limited TV to your kids.
• Limit how much TV you watch. It's a bit hypocritical to watch a lot of TV yourself while limiting TV time for your kids. It may be hard, but make some tough choices. You'll find a great amount of freedom in choosing other options for yourself, rather than being a "slave" to your weekly shows.
• Give your kids a lot of other choices to make. Expose them to sports, arts and crafts, camping, hiking, or anything else they might develop a passion for. It will help if you show a passion for the activities that you're showing them. The prevailing attitude can be, "Why would we want to be watching TV when we can be having experiences like this?"

Limiting the exposure of your kids to TV, especially at a young age, will be one of the most important decisions you make for your child.

They're counting on you-make the right choice.

Mark Brandenburg MA, CPCC, coaches men to be better fathers and husbands. He is the author of "25 Secrets of Emotionally Intelligent Fathers."

People with Alzheimer's can exhibit many challenging behaviors such as constantly following the caregiver, screaming, violence, maybe even walk around naked. Here are some tips on dealing with those behaviors.

We know that, for many people, the experience of living with dementia makes them feel extremely insecure and anxious. A person with Alzheimer's may therefore constantly follow you or call out to check where you are (trailing and checking). Memory loss and confusion about time means that a few moments may seem like hours to a person with dementia and they may only feel safe if you are nearby. This behavior can be very difficult to cope with.

• Try not to speak sharply. If you do it will only increase the person's anxiety.
• Provide something absorbing for the person to do if you are busy with something else - perhaps a pet or a familiar cuddly toy or doll.
• It may be reassuring for the person to hear you hum or sing. Or, if you are in another room, perhaps put the radio on.
• Try to make sure that you have some time to yourself.

Shouting and screaming with Alzheimer's Patients

The person may continually call out for someone or shout the same word or scream or wail over and over again. There are several possible reasons for this behavior.

• They may be in pain or ill or they may be experiencing hallucinations. If any of these possibilities seem likely, consult the GP.
• They may be lonely or distressed. If they shout out at night, a night light in the bedroom may be reassuring.
• They may be anxious about their failing memory. Try to reassure or distract them. If they are calling out for someone from their past, then talking to them about the past may be helpful.
• They may be bored. Everyone needs to be occupied, including people with dementia. Listening to music together or giving the person a gentle hand massage are just some of the things that people have found helpful.
• There may be too much noise and bustle. They may need a quieter environment.
• It may be the result of brain damage due to dementia. Ask your GP to refer the person to a specialist if you think that this is the case.

Laughing and crying with Alzheimer's Patients

The person may laugh or cry uncontrollably for no apparent reason.

• This may be associated with hallucinations or delusions (seeing or hearing people or things that are not there, or believing things that are not true). If you think that this may be the case consult the GP.
• This may be due to the effects of brain damage. It is more common among people who have vascular dementia. It does not necessarily mean that the person is very sad or very happy. They may prefer you to ignore these episodes. On the other hand they may respond to reassurance.

Lack of inhibition with Dementia Patients

The person may behave in a way that other people find embarrassing due to their failing memory and general confusion. In a few cases it may be due to specific damage to the brain. Try to react calmly.

• Undressing or appearing naked in public may simply indicate that the person has forgotten when and where it is appropriate to remove their clothes. Take them somewhere private and check whether they are too hot or are uncomfortable or whether they want to use the toilet.
• Lifting a skirt or fiddling with flies may be a sign that the person wants to use the toilet.
• If a person starts to stroke their genitals in public, discourage them tactfully and try to distract their attention. If such behavior is frequent or persistent, consult the GP.
• If the person behaves rudely - for example, by insulting people or swearing or spitting - do not attempt to argue or correct them. Try to distract their attention. You can explain to other people later that their behavior is due to the dementia and is not directed at them personally.

Sources:

• National Institute on Aging, Understanding Alzheimer's Disease booklet, Aug. 2006.
• Alzheimer's Society - UK
• The Fisher Center for Alzheimer's Research Foundation

Anxiety and relationship problems such as anger, jealousy, and paranoia frequently cohabitate. All relationships have difficulties now and then, but when anxiety is an unwelcome third wheel, problems can occur more frequently. Also, those problems can have a unique nature and way of intruding. Anxiety causes thoughts, emotions, and behaviors that hurt each person and the very nature and quality of the relationship. Relationship problems and anxiety can make sense when you recognize what’s happening, which means that you can use your knowledge to reduce those issues and repair your relationship.

Before we explore anxiety and relationship issues, it’s important to note that these troubles don’t occur because anyone is “bad” or behaving negatively on purpose but because both people are reacting to the anxiety that is dominating the relationship. With this in mind, let’s look at some ways these anxiety issues affect relationships and how to fix them.

Anxiety and Relationship Problems: Overthinking

Overthinking everything is one of the hallmarks of anxiety. Worries about the past, present, and future run through someone’s mind seemingly constantly, an effect known as rumination. Negative thoughts dominate how someone thinks, and ruminating over them makes them stronger.

Negative, anxious thoughts in relationships cause worries about the relationship, what-ifs, worst-case scenarios, and dread. These manifest as jealousy, anger, distrust, and paranoia. Challenges arise when people act on these thoughts.  

Some examples of negative thoughts that contribute to anxiety and relationship problems:

• Fear of abandonment
• Beliefs that you’re not good enough for your partner because of anxiety
• Worry that your partner will find someone better
• Thoughts that you need your partner because you can’t do certain things on your own
• Thinking that you need to constantly check in with your partner

These anxious thoughts and others like them fuel anxiety and jealousy in relationships. Jealousy leads to trust issues, which can escalate to paranoia. Any of these thoughts and feelings can cause anger. All are barriers to a healthy, close relationship. Overthinking your worries and fears leads to another cause of problems: self-criticism.

Self-Criticism Contributes to Relationship Problems and Anxiety

Anxiety makes people critical of who they are, how they think, and what they do. Anxiety creates a critical inner voice that talks over everyone else. This inner critic makes someone with anxiety very hard on themselves, eroding self-esteem with its steady stream of harsh labels and negative thoughts.

This can make someone clingy, needing constant reassurance. If a partner isn’t present when needed, uncertainty, worry, suspicion, jealousy can set in. Where is the partner? What are they doing? Why aren’t they responding? Did they abandon the relationship?

Anxiety sabotages both people in the relationship by instilling self-doubt and making the anxious person turn against first themselves, then their partner. Trust issues lead to jealousy, anger and resentment. These thoughts, emotions, and beliefs lead to anxiety-driven behaviors.

Anxiety and Relationship Issues Cause Hurtful Behaviors

Distrust, jealousy, paranoia, and anger drive behaviors that increase relationship problems. Anxiety can lead to such things as:

• Constant calling and texting to check in
• Hovering to verify if someone is okay
• Continual criticism of each other
• Reacting in anger and exasperation
• Withdrawing
• Accusing
• Clinging
• Acting dependently

Some relationships are dominated by a certain theme. Anxiety and anger in relationships may be the biggest issue, with couples predominately experiencing jealousy, suspicion, and anger. Others may have a relationship that is colored by dependent, clingy behaviors. Others still have their own unique difficulties.

Whatever relationship problems are caused by anxiety, you and your partner can fix them.

Fixing Relationship Problems and Anxiety

Noticing and identifying anxiety-related issues is the first step in repairing your relationship. Learn to recognize when you’re overthinking and when feelings of suspicion, jealousy, self-doubt, or anger begin to creep in.  These are normal human emotions. They become a problem when:

• You and your partner react to them rather than pausing to think and respond more rationally
• You don’t give yourselves a chance to calm down before talking through problems, which keeps stress and anxiety high and communication difficult
• You and your partner hold onto resentment, anxious beliefs, paranoia

Being fully present with your partner, mindfully pulling your thoughts away from the anxiety running through your mind and paying attention to your partner creates a much-needed shift and reconnection. When your partner does the same, you grow together.

Practice self-care and couple-care. When you each do things on your own to care for yourselves and induce calm, you’re more able to interact without intense anxiety intruding. Also, creating calming rituals that you can do as a couple encourages intimacy and feelings of love and belonging.

Fixing anxiety and relationship problems takes patience, time, and practice, but it’s well worth it. Together, you can build a caring relationship based on love, trust, and support instead of anger, jealousy, and paranoia.

See Also:

Anxiety and Insecurity: How They Kill Relationships and What to Do?

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The connection between ADHD and rudeness is often baffling to people who have ADHD. They wonder why it's hard to make and keep friendships and why successful relationships are so difficult to maintain, and they are often hurt when others turn away, frustrated. Understanding why rudeness is part of ADHD can help you work to change people’s perception of you and make it easier and rewarding to be with others.

What Does ADHD Have To Do with Rudeness?

When asked about their idea of ADHD, people frequently conjure images of impulsivity, disorganization, and erratic energy, but rudeness? Yes, rudeness. Just ask anyone who lives or works with someone with ADHD.

When you examine what ADHD is, it makes perfect sense that people with it can appear rude. ADHD is a brain-based disorder involving in part the neurochemistry of the brain, the dopamine system in particular (Aguiar et al., 2010; CHADD, The Science of ADHD). The ADHD brain processes and reacts to things differently than a non-ADHD brain.

With ADHD, the brain doesn’t correctly attend to and interpret things like facial expression, tone of voice, and other non-verbal communication messages. Therefore, someone with ADHD misreads a lot of interpersonal interactions, doesn’t respond correctly, and comes off as rude.

The effects of ADHD that equate to rudeness include:

• A lack of impulse control that leads to interrupting
• Talking too much
• Abruptly walking away from a conversation.
• Not paying attention to people

ADHD and Rudeness: How You Might Appear to Others

Someone who interprets your ADHD behavior as rudeness can become irritated and frustrated. ADHD causes problems at work, school, with friends, and at home. Often, however, people with ADHD either don’t know that they’re being rude or don’t know how to fix it.

The idea of rudeness is a bit too vague. If you are wondering about your behaviors, this list can help you understand the specifics of ADHD and rudeness. People with ADHD:

• Can appear self-centered when they don’t take others’ feelings, needs, and wishes into consideration
• Send the message that they don’t think others are important when they miss deadlines, lose things, etc.
• Frequently interrupt others, showing lack of manners and disregard for the other person and his/her ideas
• Act impulsively by blurting out tactless things, saying the first thing that comes to mind rather than thinking about how their words will affect others
• Sometimes are over-energetic, coming on too strong
• Often talk too much, too loudly, and too rapidly
• Have a hard time listening attentively and tend to “space out” instead of paying attention to others
• Can have angry outbursts, which are off-putting
• Sometimes stand too close to others, violating personal space

Any one of these behaviors can cause you to appear rude. If you have had experiences with others turning away from you because they’re irritated by rudeness, don’t worry; you can change people’s opinions of you.

Changing People’s Perceptions of You and Rudeness

People with ADHD easily get down on themselves and have low self-esteem. That’s why it’s important that you see this rudeness for what it is: a behavior that isn’t your choice but instead is an effect of ADHD. Change people’s perceptions of you by adding certain social skills to your behavior.

Without further ado, here are tips to help you gain some social skills in order to change people’s opinion of you, ADHD, and rudeness.

• Don’t argue or be defensive. Telling someone you’re not rude or arguing with their feedback only reinforces rudeness. Just start using new skills, and people will notice. Think of your high school English teacher’s rule: show, don’t tell.
• Identify how you want to be. What type of person do you want to project to the world?
• Then, observe others. How are they acting? Certain behaviors are associated with specific traits, such as warmth or competence (O’Hara, 2015). Figure out how people are acting, and emulate the traits you value.
• Take the initiative to apologize if you know you did something that warrants an apology. It’s important to admit to behavior that is rude or insensitive, even if you didn’t mean to do it.
• Don’t over-apologize. Constantly apologizing will be perceived as insincere, hollow, and annoying. Remember that actions speak louder than words.
• Look for opportunities to work with or otherwise spend time with others. When you’re with them, listen carefully, ask questions or otherwise express interest, refrain from interrupting or wandering off. Act like the type of person you decided you wanted to be.

You aren’t your ADHD. Rudeness isn’t intentional, and it’s not a sign of a bad person or a person who can’t have rewarding relationships. You can have a fulfilling work and personal life. Like anything in life, you’re learning skills and adding them to your behaviors so the world sees not ADHD rudeness but the wonderful person you are.

ADHD and exams are two things that shouldn’t exist together. However, they do exist together, and quite likely they always will. You don’t have to love taking tests if you have ADHD, but you also don’t have to be stuck cursing tests, either. There are ways you can deal with tests, and take them well, despite ADHD.

Just how does ADHD affect test taking? ADHD often causes test anxiety because of the things it does to your brain during a test. If you have ADHD, you might have experienced some of these problems when trying to take an exam:

• Identifying key information
• Organizing thoughts into linear arguments (for essays)
• Poor time awareness so that you don’t pace yourself right
• Rushing and making careless mistakes
• Memory recall issues (that mind-going-blank experience)
• Distractibility
• Following directions

Anxiety and poor testing performance come from a lack of confidence in your own ability to do well on a test. People with ADHD often have a history of negative or disappointing test taking experiences, and this carries over into current situations.

Know this: ADHD doesn’t have to do with intelligence. Poor testing performance is a reflection of ADHD, not of inability. Know this, too: you can learn strategies to improve your performance on exams.

Test Taking Strategies for ADHD Students

The following strategies are a sampling of things people with ADHD do to improve their performance on exams.

There are things you can do before the day of the test to improve your performance on your exam, such as

• Study well in advance, for short bursts several consecutive nights before the test rather than cramming for hours the night before (How to Study When You Have ADHD: 5 ADHD Studying Tips)
• Exercise, ideally right before the test if that’s at all possible
• Eat well, putting nutrients into your body and keeping junk out
• Drink plenty of water
• Visualize yourself staying calm and doing well on the test
• Talk to your teacher to discover what material will be on the test and to ask questions you may have
• Ask for accommodations such as extra time, a different testing environment, the ability to take breaks, and more. (You might be required to have a 504 plan to receive accommodations.)

You can also do things during the test to help you manage the task of taking an exam.

• Look at the entire text before beginning. Use a highlighter (or multiple highlighters of different colors) to emphasize directions, different sections, and keywords. Exactly what you highlight will depend on the actual test.
• Carefully read the directions as you highlight them.
• Divide your test into equal segments (with your highlighter), and quickly estimate the amount of time you can spend on each section. Use a timer if it’s allowed, otherwise, pace yourself using the segments of color, making sure you’re progressing through.
• Wear earplugs if allowed to block out noises.
• Have a focus object to look at as you think and to turn your attention to when you catch yourself wandering. This can be a small object you place on your desk, your pencil, your shoe—anything to draw your attention and help you concentrate.
• Double check your answers when you finish to catch any careless mistakes.

Successful test taking with ADHD is largely about knowing what makes exams challenging for you and then developing strategies to compensate. Play around with the ideas above to see what works for you, and experiment with other strategies, too (Ten Steps for Student Success for College and Adult Students with ADHD). You’ll build a repertoire of test-taking strategies for ADHD that work.

A final thought: Keep your perspective. To avoid panicking when that test is placed in front of you, remind yourself that this is just one test. While important, it doesn’t have the power to make or break the grand scheme of your life.

Anxiety and romantic relationships are a frustrating combination. If you are in a loving relationship with someone you care about, it’s difficult to watch them struggle with anxiety. When you care about someone, it’s natural to want to help them, to make their anxiety better. Further, anxiety can become an unwelcome extra partner who tries to take over the relationship. Romantic relationships and anxiety present a triple whammy: Your partner is plagued by anxiety and its life-limiting effects; you face the challenge of wanting to help your anxiety-ridden partner, and the relationship between the two of you suffers, too.

Anxiety in dating relationships or any kind of love relationship is trying. No one wants to see a loved one suffer. Here, we’ll explore how to help a loved one with anxiety as well as examine some ways you can care for yourself, too. As miserable a combination as anxiety and romantic relationships can be, it’s possible for each partner and the relationship itself to thrive.

Anxiety and Romantic Relationships: Dos and Don’ts for Helping Your Anxious Partner

Key concepts for helping your partner reduce their anxiety can be remembered with the acronym LACE-C (pronounced “lacey).

• L: Listening
• A: Acceptance
• C: Compassion
• E: Empathy
• C: Communication

Together, these form the foundation of what you can do to help your partner with anxiety. Of course, these concepts are important in all relationships, but when anxiety is part of a romantic relationship, these principles guide healing so everyone can move forward.

Listening is a skill that helps your partner feel heard. They feel secure sharing their anxieties with you, and when they open up, you can help alleviate their fears.

Acceptance of your partner is also called unconditional positive regard, or unconditional love. Letting go of “shoulds,” rules for how you think your partner should be, how you think you should be, and how you think the relationship should be helps you live in your real world rather than in your head with troubled thoughts.

When you exist in the present moment with your partner without evaluating them or their anxiety, you’re practicing acceptance. When people feel accepted, anxiety decreases and peace and contentment increase. This is true for your partner, you, and the relationship.

Compassion involves a nonjudgmental approach to your partner when they are riddled with intense anxiety. Compassion allows you to separate your partner from their anxiety, loving the person for who they are.

Empathy is similar to compassion, but is slightly different. Empathy is being able to put yourself in your partner’s shoes and seek to understand what it would feel like to go through what they are experiencing. Empathy involves shared feelings and deep understanding.

Communication is one of the most important components of any relationship and is especially important when one partner has anxiety. When you both agree to be open and honest, you can work through almost any difficulty. The best way to know what your partner needs for anxiety support is to ask. The best way to understand your partner’s specific anxieties is to listen and allow them to tell you.

Some things that don’t help—and actually hurt—a relationship include:

• Trying to be your partner’s therapist, all day every day
• Taking your partner’s anxiety personally
• Your partner taking your communication personally
• Criticizing
• Blaming
• Impatience
• Anger
• Accusations
• Enabling
• Coddling
• Reacting rather than stopping, thinking, and responding intentionally

Anxiety and Romantic Relationships: Don’t Forget Yourself

No matter how much you love your partner, anxiety can be a huge relationship challenge. Often, the partner without anxiety takes on a lot of responsibilities: helping their partner, taking care of many household chores, shopping, parenting (if kids are involved), and being the sole source of income (if anxiety prevents the other partner from working).

Practicing self-care and loving and supporting yourself the way you do your partner is important for your own mental health and wellbeing. Some ways to do this:

• Take breaks by engaging in your own interests and hobbies
• Form your own support system (family, friends, a support group)
• See a therapist for your own needs
• Set boundaries: what you can and can’t do
• Don’t allow your partner to mistreat you. Anxiety isn’t a license for terrible treatment ("How Abusive Relationships Cause Anxiety").

Anxiety and romantic relationships may seem like a bad combination; however, a relationship in which one partner has anxiety can blossom and thrive. With mutual support and concern, anxiety will shrink out of the way.

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