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Do genes matter in ADHD?

ADHD symbol design isolated on white backgroundA reader recently asked: How much do genes matter in ADHD? She’s getting conflicting opinions, and there’s a reason why… there’s no simple answer to that complex question.

Different techniques are used by experts to estimate genetic contributions to all sorts of human traits and problems. Also, it’s hard to determine genes of something that’s not easily or accurately measured, like ADHD – there is no blood test or x-ray or true biological markers. It’s a “clinical” diagnosis, which means, lots of guess work and weighing in and watching over time to see if a diagnosis fits or doesn’t, and ruling out lots of other reasons a child has trouble sitting still or focusing or behaving impulsively.

I reached out to a Harvard Medical School geneticist I know and asked him. He said, “The actual risk to a first degree relative has variously been reported in the 15-60% risk range, with boys, purportedly, at higher risk than girls.” What I take from this is the following. (1) No one really knows exactly how much genes play a role, hence the wide range of 15-60%, and (2) genes are only a piece, perhaps a small piece, of the ADHD puzzle.

My advice is not to think about genetics, but focus on the many environmental factors in our control that are tied to making an ADHD diagnoses:

  • Crowded classrooms
  • Pushing standardized tests
  • Sitting all day, having little movement in schools
  • No recess or breaks
  • Too much screen time
  • Food preservatives
  • Not enough sleep
  • Vision problems
  • Hearing problems
  • Not recognizing gender learning differences – which leads to mostly boys being diagnosed

The list goes on and on…

So let’s think of all the environmental changes and improvements we can make that will help ADHD not become a problem in the first place.

Please contact Dr. Rao about reproducing any material found on these pages.


Q&A – Help with Time-Aways

Question and Answers on speech bubbles

A fan asked a question after the recent post on Sibling Rivarly and using Time-Aways as a tool: What do you suggest when you march a child to their room when they are not clearly upset (ie, name-calling, being overly rude, hurting a sibling for no clear reason other than to be annoying), and they tell you they “won’t do it again” as you put them in their room? How long do they take time-away in a situation such as this, when there is no clear “waiting for the storm to calm”?

Time-aways should be as long as needed. They help lower the negative behaviors you’re trying to change. If a child says “sorry”, over and over, but keeps doing basically same negative behaviors, it means you have to lengthen the time-away. Before letting them out of their room make certain they tell you why they went in and what they will do differently. Some kids need a lengthier time-away (like a mini-grounding that can last a half hour or more). Try that, and keep calm. No lectures. Tell them they’ve made choices that got them in their rooms. Tell them you know they are smart and will figure out a way to hold back those urges. If this doesn’t work, add a consequence too. Perhaps they’ve lost a special treat that night for dessert or can’t join watching a favorite TV show or they have to go to bed 15 minutes earlier that night.

Please contact Dr. Rao about reproducing any material found on these pages.


Stopping Sib Rivalry… First, Do No Harm

Truth is, you can’t fix sib rivalry. It’s part of growing up. Surprisingly, the best thing to do when sibs fight is nothing. Don’t ever comment on the fighting and never jump in to save one child from another. As soon as parents get pulled into these perpetual mini-battles and complaints, sibs play up their victimhood. The tears start flowing. The accusations of hurt feelings and ouches skyrocket. It’s a classic parent trap you need to avoid.

Then why so much fighting? Here’s what’s really going on beneath the surface. Both sibs want your attention and want to win (that means you side with them over their brother or sister). Haven’t you realized that sib rivalry sparks as soon as you step into a room… and haven’t you noticed it’s really bad in confined spaces (like cars) where you’re stuck in the front seat like a judge listening to passionate legal arguments. So, keep in mind, your presence is a catalyst for these epoch battles. Don’t join in or try to fix them – it makes things worse.

But there are times you can’t ignore, for example, if one sib smacks the other for no justified reason or an over-the-top insult is lobbed. When this happens, march the offender immediately to their room without warning or a second chance. No lecturing… they already know what they’ve done is wrong. Remove them from family interaction for a bit (I call this a time-away in my book). And if both kids are fighting or getting under your nerves with yelling and nasty behavior, don’t try to negotiate or settle the fight or figure out who did what. You’d have run a DNA analysis like a CSI investigator to get at the bottom of it. Instead, immediately separate them, give no second chances. Give equal time-aways in separate, quiet space. And tell them this:

“I don’t know why you keep fighting and making so much unpleasantness. We don’t do that in our home. You both will have to stay separate until you figure out how to work out your differences and your disagreements better.”

Then do something nice for yourself… pat yourself on the back… knowing you avoided a classic parent trap. Then enjoy the ensuing, temporary quiet!

Please contact Dr. Rao about reproducing any material found on these pages.


Are you looking for help for your child’s behavior issues?

Question and Answers on speech bubblesMy Facebook fans often ask: How can I find someone like you but near me?

Start networking. It takes time. Ask your pediatrician, other parents, trusted teachers and day-care folks, and see if any names of good professionals pop up. You want to find someone who identifies themselves as a “behavioral” and/or “developmental” oriented therapist (preferably a Ph.D. or Psy.D. doctoral level psychologist). Make sure they aren’t all about quickly diagnosing problems and then moving your child onto medications.

Specifically, the professionals you want to meet with should work with parents and child(ren) in the office at same time. That’s makes a difference. The professional should be someone you also feel comfortable with. You should walk away from a first meeting with some tips and strategies. If not, thank them for their help and keep looking.

Please contact Dr. Rao about reproducing any material found on these pages.


Do you have a “Safety Rule”?

Question and Answers on speech bubblesOne parent asked: I have a 4.5 year old boy who has an issue with running in parking lots. It’s a game now. At first I chased him, I now have an infant and can’t run after him. This is scary and frustrating and I know I’m mishandling the situation. But I can’t let him run! I’ve tried bringing objects to entice him but they rarely work. I’ve tried not chasing him and being stern. Haha. Any suggestions to correct this after a year of this game!? 

Answer: Game of Chase isn’t for Parking Lots

As the mother of a five year old recently told me, running in parking lots is a dangerous habit many young boys need to break. Start with a 100% refusal to chase them. That’s what makes it rewarding and a game to them. The problem is they need a new habit – built on a simple phrase called “Safety Rules”.

Before you get out of the car or before you enter a parking lot … and always before you approach a street corner do this:

  1. Pause while holding their hand firmly.
  2. Get eye contact (you may have to kneel).
  3. Set the Safety Rule firmly – “You stay by my side or else you will have to hold my hand when we cross. And if you don’t listen, we go home and you lose something special, agreed?”
  4. Make them repeat it before you take a step.
  5. If they listen and follow the Safety Rule, give them lots of praise. If not, sorry to tell you that you’ll need to go back and try it again, and again if needed, until they comply.

Many years back I worked with disadvantaged inner city boys who were always bolting off. Often, I’d have to go up and down the stairs of our clinic repeating and practicing safety rules until they realized there would be no playtime until they complied. “I have all day,” I told them with a measured calm voice. “It’s your choice… We’re both missing out.”

Please contact Dr. Rao about reproducing any material found on these pages.