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Ask The Doctor: Early Morning Challenges With ADHD

By NAPS,
North American Precis Syndicate .

New York , NY .
Photo: NAPS

Dr. Ann Childress (NAPS)

(NAPSI)—ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity.1 For people with ADHD, these behaviors are more severe, occur more often, and interfere with or reduce the quality of how they function socially, at school, or in a job.2

Does your child with ADHD struggle in the morning?

Does your child with ADHD barely complete basic daily tasks, such as getting dressed, brushing teeth or simply eating breakfast? If so, you are not alone. In a survey of 200 parents with children diagnosed with ADHD, more than 90 percent felt that ADHD symptoms negatively impacted their early morning routine.3

For families with children affected by ADHD, the early morning routine is challenging at best, chaotic at worst. Problems can impact every member of the family and set a negative tone for the rest the day. Dr. Ann Childress, a Child and Adolescent Psychiatrist at Center for Psychiatry and Behavioral Medicine, Inc. has many patients—and families—who struggle every morning simply to get out the door. Here are some of the most common questions she receives from these families—and her responses.

Why does my child with ADHD have so much difficulty in the morning?

The early morning routine can be especially challenging for people with ADHD. Getting ready for the day requires ongoing focus and depends upon our ability to remember and manage multi-step information, a capacity psychologists call working memory. Both children and adults with ADHD struggle with deficits in focus and/or working memory.3,4

Getting ready for the day also requires us to finish many complex activities in a short time, such as completing a hygiene routine, making and eating breakfast, or packing a backpack, all before the school bus pulls up or the car pool arrives. Research shows that, when compared with typical peers, people with ADHD find it harder to gauge the passage of time—and thus find it more difficult to complete these early morning activities on time.5

My child takes medication for ADHD that usually works. Why are mornings still so hard?

For individuals who rely on a stimulant medication to help them during the day, the early morning can still represent an ADHD blind spot. What does this mean? Most stimulant medications are taken in the morning with breakfast and they may take some time to work (anywhere from 30 minutes to two hours).6 Thus ADHD patients will not necessarily experience the benefits of ordinary stimulant medication in the early morning hours, making the morning routine one of the most difficult parts of the day for the patient-and for his or her loved ones.

My entire family has been negatively affected by one member’s early morning ADHD symptoms. What can I do to help?

Parents and caregivers can use behavioral strategies to improve specific behaviors that may prevent children from getting ready in the morning. Tactics to help children complete morning activities may include the following, either alone or in combination:

• Setting multiple alarms to encourage timely completion of different tasks

• Using behavior charts and incentive programs

• Creating and using sequencing charts to outline the steps of critical activities

• Utilizing checklists.

Some families choose to alter how they administer stimulant medications. In these cases, one parent or caregiver will wake and dose the child in the wee hours, approximately two hours prior to the family’s usual wakeup time. Next, the parent will encourage the child to go back to sleep, hoping the medication will take effect before breakfast.7 However, this routine often proves disruptive for both parent and child, both of whom may have difficulty returning to sleep.?

If you think ADHD has an impact on your mornings, consider taking a quiz at theADHDmorningquiz.com. The interactive quiz helps identify ADHD symptoms that make the morning routine a challenge. You’ll also be given access to a Doctor Discussion Guide to help start the conversation about mornings with ADHD.

Tips for Managing ADHD in the Morning

• Be a morning realist. Setting unrealistic goals can set you up for failure. Being realistic about the early morning routine and adding a little more time to get things done will benefit the entire family.

• Alarms aren’t just for waking up. Set ‘as you go’ alarms to make sure you’re not running overtime on each task. Remember to be practical about how long things may take.

Talking to Your Doctor

Once you’ve made the appointment with your doctor, start writing down what you want to discuss about your mornings with ADHD. Here are some suggestions from the Doctor Discussion Guide that you’ll find when you take theADHDmorningquiz.com:

• Describe any challenges during the early morning routine.

• How do these difficulties affect the rest of the day?

• What specific ADHD symptoms are a problem in the early morning?

• What actions have you taken to try to make mornings go more smoothly? How have those helped (if at all)?

• Would it be helpful to have an ADHD medication that works when you wake up?

To learn more about morning challenges with ADHD, please visit www.adhdmorning.com.

clicktotweet “ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. If you think ADHD affects you, consider taking a quiz at theADHDmorningquiz.com that helps identify symptoms. http://bit.ly/2MBsMFB

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Editors’ Note: October is Attention Deficit Hyperactivity Disorder (ADHD) Awareness month.

1. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington (D.C.): American Psychiatric Publishing, 2013

2. Attention-Deficit/Hyperactivity Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

3. Sallee FR. Early Morning Functioning in Stimulant-Treated Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, and its Impact on Caregivers. J Child Adolescent Psychopharmacology. 2015

4. Faraone S, Hammerness PG and TE Wilens. Reliability and validity of the before-school functioning scale in children with ADHD. J Atten Disord 2015 [epub ahead of print].

5. Taylor M, Houghton S and K Durkin. Getting children with attention deficit hyperactivity disorder to school on time: Mothers’ perspectives. J Fam Issues 2008;29:918−943.

6. Dalsgaard S, Leckman JF, Mortensen PB, et al. Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. Lancet 2015;2:702−709.

7. Childress AC. Expert Opinion Pharmacotherapy. 2016; 17:1171-1178

On the Net:North American Precis Syndicate, Inc.(NAPSI)





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