Behavior

Emily was crying by the time the softball game ended. It wasn’t because her team had lost. It wasn’t because she was unhappy about her own playing. It wasn’t even because of anything the other team had said or done. Emily’s tears came after her dad yelled at her — in front of all her teammates — for missing the fly ball that could have saved the game. Emily is just 8 years old.

If your child has ever participated in a sport, you’ve undoubtedly met people like Emily’s dad, parents who behave inappropriately and upset their kids. These parents get so wrapped up in winning and losing or how well their own kids perform that they lose sight of what’s really important. They forget that one of the most important goals of kids’ sports is to promote a sense of good sportsmanship.

What Is Good Sportsmanship?

Good sportsmanship is when teammates, opponents, coaches, and officials treat each other with respect. Kids learn the basics of sportsmanship from the adults in their lives, especially their parents and their coaches. Kids who see adults behaving in a sportsmanlike way come to understand that the real winners in sports are those who know how to persevere and to behave with dignity — whether they win or lose a game.

Parents can help their kids understand that good sportsmanship includes both small gestures and heroic efforts. It starts with something as simple as shaking hands with opponents before a game and includes acknowledging good plays made by others and accepting bad calls gracefully.

Displaying good sportsmanship isn’t always easy: It can be tough to congratulate the opposing team after losing a close or important game. But the kids who learn how to do it will benefit in many ways.

Kids who bully or taunt others on the playing field aren’t likely to change their behavior when in the classroom or in social situations. In the same way, a child who practices good sportsmanship is likely to carry the respect and appreciation of other people into every other aspect of life.

Good Sports Are Winners

Ask first- or second-graders who won a game and they may answer, “I think it was a tie.” It’s likely the question isn’t of any real interest at that age. Kids might be more eager to talk about the hits they got or the catches they almost made.

But as they move into older and more competitive leagues, kids become more focused on winning. They often forget to have fun. Without constant reminders and good examples, they may also forget what behavior is appropriate before, during, and after a sporting event.

Kids who have coaches who care only about being in first place and say that anything goes as long as they win, pick up the message that it’s OK to be ruthless on the field. If parents constantly pressure them to play better or second-guess their every move, kids get the message that they’re only as good as their last good play — and they’ll try anything to make one.

Adults who emphasize good sportsmanship, however, see winning as just one of several goals they’d like their kids to achieve. They help young athletes take pride in their accomplishments and in their improving skills, so that the kids see themselves as winners, even if the scoreboard doesn’t show the numbers going in their favor.

The best coaches — and parents — encourage their kids to play fair, to have fun, and to concentrate on helping the team while polishing their own skills.

Fostering Good Sportsmanship

Remember the saying “Actions speak louder than words”? That’s especially true when it comes to teaching your kids the basics of good sportsmanship. Your behavior during practices and games will influence them more than any pep talk or lecture you give them.

Here are some suggestions on how to build sportsmanship in your kids:

• Unless you’re coaching your child’s team, you need to remember that you’re the parent. Shout words of encouragement, not directions, from the sidelines (there is a difference!).
• If you are your kid’s coach, don’t expect too much out of your own child. Don’t be harder on him or her than on anyone else on the team, but don’t play favorites either.
• Keep your comments positive. Don’t bad-mouth coaches, players, or game officials. If you have a serious concern about the way that games or practices are being conducted, or if you’re upset about other parents’ behavior, discuss it privately with the coach or with a league official.
• After a competition, it’s important not to dwell on who won or lost. Instead, try asking, “How did you feel you did during the game?” If your child feels weak at a particular skill, like throwing or catching, offer to work on it together before the next game.
• Applaud good plays no matter who makes them.
• Set a good example with your courteous behavior toward the parents of kids on the other team. Congratulate them when their kids win.
• Remember that it’s your kids, not you, who are playing. Don’t push them into a sport because it’s what you enjoyed. As kids get older, let them choose what sports they want to play and decide the level of commitment they want to make.
• Keep your perspective. It’s just a game. Even if the team loses every game of the season, it’s unlikely to ruin your child’s life or chances of success.
• Look for examples of good sportsmanship in professional athletes and point them out to your kids. Talk about the bad examples, too, and why they upset you.
• Finally, don’t forget to have fun. Even if your child isn’t the star, enjoy the game while you’re thinking of all the benefits your child is gaining — new skills, new friends, and attitudes that can help all through life.

Stories about athletes and steroids seem to pop up regularly in the news. Some professional baseball players, cyclists, and track stars have been accused of — and in some cases have admitted to — using steroids to give them an edge competitively.

And steroid use has trickled down to younger athletes too, who face fierce pressure to be stronger and faster, and to make it to college and professional leagues. Some research has shown that 5% of teen boys and 2.5% of teen girls have used some form of anabolic steroids.

Steroids promise bold results, but there is little proof that they deliver any such benefits. Extensive research, however, shows how they can harm developing kids — with some of these ill effects not likely to turn up until years later. And steroids are illegal, too.

It’s important to understand the facts about steroids, their side effects, and what can drive kids to try them. Being aware of the kinds of pressures kids deal with in sports can help you make sure that your child isn’t at risk.

What Are Steroids?

Drugs commonly referred to as “steroids” are classified as anabolic (or anabolic-androgenic) and corticosteroids. Corticosteroids, such as cortisone, are drugs that doctors typically prescribe to help control inflammation in the body. They’re often used to help control conditions like asthma and lupus. They’re not the same as the anabolic steroids that receive so much media attention for their use by some athletes and bodybuilders.

Anabolic steroids are synthetic hormones that can boost the body’s ability to produce muscle and prevent muscle breakdown. Some athletes take steroids in the hopes that they will improve their ability to run faster, hit farther, lift heavier weights, jump higher, or have more endurance. In the United States, it is against the law to use anabolic steroids without a prescription.

Androstenedione, or “andro,” is a kind of anabolic steroid taken by athletes who want to build muscle. But research suggests that andro taken in large doses every day can significantly increase levels of testosterone, which can lead to a number of health problems.

How Do Anabolic Steroids Work?

Anabolic steroids are drugs that resemble the chemical structure of the body’s natural sex hormone testosterone, which is made naturally by the body. Testosterone directs the body to produce or enhance male characteristics such as increased muscle mass, facial hair growth, and deepening of the voice, and is an important part of male development during puberty.

When anabolic steroids increase the levels of testosterone in the blood, they stimulate muscle tissue in the body to grow larger and stronger. However, the effects of too much testosterone circulating in the body can be harmful over time.

Dangers of Anabolic Steroids

Steroids are dangerous for two reasons: they are illegal, and they can damage a person’s health, especially if used in large doses over time. Also, the health problems caused by steroids may not appear until years after the steroids are taken.

Although they might help build muscle, steroids can produce very serious side effects. Using steroids for a long time can negatively affect the reproductive system. In males, steroids can lead to impotence, a reduction in the amount of sperm produced in the testicles, and even reduced testicle size.

Females who use steroids may have problems with their menstrual cycles because steroids can disrupt the maturation and release of eggs from the ovaries. This disruption can cause long-term problems with fertility.

Steroids taken for an extended period of time also can cause:

• stunted growth in teens (by causing bones to mature too fast and stop growing at an early age)
• liver tumors
• abnormal enlargement of the heart muscles
• violent, aggressive behavior and mood swings
• blood lipid abnormalities that contribute to heart disease
• acne (or a worsening of acne)
• increased breast growth in males, especially teens
• irreversible stretch marks
• a heightened tendency for hair loss and male-pattern baldness
• muscle aches

Teen girls and women risk these additional side effects:

• male-type facial and body hair growth and male-pattern baldness
• deepening of the voice
• enlargement of the clitoris

Drug Testing

In addition to the health risks, kids who use steroids without prescription are breaking the law. Drug testing for all athletes has become more prevalent, and those who fail a drug test for steroids can face legal consequences, including jail time, monetary fines, exclusion from an event or team, or forfeiture of trophies or medals.

Andro use has been banned by many sports organizations, including the International Olympic Committee, the National Football League, the National Basketball Association, the National Collegiate Athletic Association, the Association of Tennis Professionals, and most high school athletic associations.

Talking to Kids About Steroids

Many pressures may drive young athletes to experiment with steroids. Although most athletes exercise hard, eat properly, and take care of their bodies to maintain optimal fitness and performance levels, athletic competition and the desire to look physically toned and fit can be fierce.

Help kids handle these pressures by:

• discussing healthy competition with them
• talking about the coaches’ and team members’ attitudes toward steroids
• knowing what kind of sports environments they compete in
• encouraging them to prepare mentally and physically for competition by eating well and getting enough rest

If you suspect your child is using steroids, watch for these warning signs:

• exaggerated mood swings
• worsening acne
• unusually greasy skin with stretch marks
• a sudden increase in muscle size

If you see any of these signs in your child, talk with your doctor.

Steroids may give kids the sense that they’re stronger and more athletic, but the consequences are too dangerous to risk. Help kids stay away from steroids by encouraging healthy eating and fitness habits that will help them feel well prepared for competition.

When steroid use among pro athletes is in the news, use that as a launching point to discuss the issue, making sure your child understands the health risks, the possibility of legal trouble, and the concept that using steroids is cheating.

Many young kids go through a stage between the ages of 2 and 5 when they stutter, repeating certain syllables, words or phrases, prolonging them, or stopping, making no sound for certain sounds and syllables. Stuttering is a form of dysfluency — an interruption in the flow of speech.

In many cases, stuttering goes away on its own by age 5; in others, it lasts longer.

There’s no cure for stuttering, but effective treatments are available and you can help your child overcome it.

What Causes Stuttering?

Experts think that a variety of factors contribute to stuttering, including:

• Genetics: About 60% of those who stutter have a close family member who stutters.
• Other speech and language problems or developmental delays.
• Differences in the brain’s processing of language: People who stutter process language in different areas of the brain. And there’s a problem with the way the brain’s messages interact with the muscles and body parts needed for speaking.
• High/increased activity level.
• Rapid rate of speech.

Early Signs of Stuttering

The first signs of stuttering tend to appear when a child is about 18-24 months old as there is a burst in vocabulary and kids are starting to put words together to form sentences. To parents, the stuttering may be upsetting and frustrating, but it is natural for kids to do some stuttering at this stage. It’s important to be as patient with your child as possible.

A child may stutter for a few weeks or several months, and the stuttering may be sporadic. Most kids who begin stuttering before the age of 5 stop without any need for interventions such as speech or language therapy.

However, if your child’s stuttering is frequent, continues to get worse, and is accompanied by body or facial movements, an evaluation by a speech-language therapist around (instead of before) age 3 is a good idea.

The School Years

Usually, stuttering drops to very low levels when kids enter elementary school and start sharpening their communication skills. A school-age child who continues to stutter is likely aware of the problem and may be embarrassed by it. Classmates and friends may draw attention to it or even tease the child.

If this happens with your child, talk to the teacher, who can address this in the classroom with the kids. The teacher also may be able to decrease the number of stressful speaking situations for your child until speech therapy begins.

When to Seek Help

If your child is 5 years old and still stuttering, talk to your doctor and, possibly, a speech-language therapist. You also may want to consult a speech therapist if:

• repetitions of whole words and phrases become excessive and consistent
• sound and syllable repetitions start happening more often
• there is an increase in the prolongations of words
• speech starts to be especially difficult or strained
• you notice increased facial tension or tightness in the speech muscles
• you notice vocal tension resulting in rising pitch or loudness
• your child tries to avoid situations that require talking
• your child changes a word for fear of stuttering
• your child has facial or body movements along with the stuttering
• you have other concerns about your child’s speech

Most schools will offer testing and appropriate therapy if you have been concerned about the stuttering for 6 months or more.

What Parents Can Do

Try these steps to help your child:

• Don’t require your child to speak precisely or correctly at all times. Allow talking to be fun and enjoyable.
• Use family meals as a conversation time. Avoid distractions such as radio or TV.
• Avoid corrections or criticisms such as “slow down,” “take your time,” or “take a deep breath.” These comments, however well-intentioned, will only make your child feel more self-conscious.
• Avoid having your child speak or read aloud when uncomfortable or when the stuttering increases. Instead, during these times encourage activities that do not require a lot of talking.
• Don’t interrupt your child or tell him or her to start over.
• Don’t tell your child to think before speaking.
• Provide a calm atmosphere in the home. Try to slow down the pace of family life.
• Speak slowly and clearly when talking to your child or others in his or her presence.
• Maintain natural eye contact with your child. Try not to look away or show signs of being upset.
• Let your child speak for himself or herself and to finish thoughts and sentences. Pause before responding to your child’s questions or comments.
• Talk slowly to your child. This takes practice! Modeling a slow rate of speech will help with your child’s fluency.

Just as you protect your kids against illnesses like measles, you can help “immunize” them against drug use by giving them the facts before they’re in a risky situation.

When kids don’t feel comfortable talking to parents, they’ll seek answers elsewhere, even if their sources are unreliable. And kids who aren’t properly informed are at greater risk of engaging in unsafe behaviors and experimenting with drugs.

Parents who are educated about the effects of drug use and learn the facts can give their kids correct information and clear up any misconceptions. You’re a role models for your kids, and your views on alcohol, tobacco, and drugs can strongly influence how they think about them. So make talking about drugs a part of your general health and safety conversations.

Preschool to Age 7

Before you get nervous about talking to young kids, take heart. You’ve probably already laid the groundwork for a discussion. For instance, whenever you give a fever medicine or an antibiotic to your child, you can discuss why and when these medicines should be given. This is also a time when your child is likely to pay attention to your behavior and guidance.

Take advantage of “teachable moments” now. If you see a character in a movie or on TV with a cigarette, talk about smoking, nicotine addiction, and what smoking does to a person’s body. This can lead into a discussion about other drugs and how they could cause harm.

Keep the tone of these discussions calm and use terms that your child can understand. Be specific about the effects of the drugs: how they make a person feel, the risk of overdose, and the other long-term damage they can cause. To give your kids these facts, you might have to do a little research.

Ages 8 to 12

As your kids grow older, you can begin talks with them by asking them what they think about drugs. By asking the questions in a nonjudgmental, open-ended way, you’re more likely to get an honest response.

Remember to show your kids that you’re listening and really paying attention to their concerns and questions.

Kids this age usually are still willing to talk openly to their parents about touchy subjects. Starting a dialogue now helps keep the door open as kids get older and are less inclined to share their thoughts and feelings.

Even if your questions don’t immediately result in a discussion, you’ll get your kids thinking about the issue. Show them that you’re willing to discuss the topic and hear what they have to say. Then, they might be more willing to come to you for help in the future.

News, such as steroid use in professional sports, can be springboards for casual conversations about current events. Use these discussions to give your kids information about the risks of drugs.

Ages 13 to 17

Kids this age are likely to know other kids who use alcohol or drugs, and to have friends who drive. Many are still willing to express their thoughts or concerns with parents about it. They may ask you more specific questions about drugs.

Use these conversations not only to understand your child’s thoughts and feelings, but also to talk about the dangers of driving under the influence of drugs or alcohol. Talk about the legal issues — jail time and fines — and the possibility that they or someone else might be killed or seriously injured.

Consider making a written or verbal contract on the rules about going out or using the car. You can promise to pick your kids up at any time (even 2 a.m.!), no questions asked, if they call you when the person responsible for driving has been drinking or using drugs.

The contract also can detail other situations: For example, if you find out that someone drank or used drugs in your car while your son or daughter was behind the wheel, you may want to suspend driving privileges for 6 months. By discussing all of this with your kids from the start, you eliminate surprises and make your expectations clear.

Laying Good Groundwork

No parent, child, or family is immune to the effects of drugs. Any kid can end up in trouble, even those who have made an effort to avoid it and even when they have been given the proper guidance from their parents.

However, certain groups of kids may be more likely to use drugs than others. Kids who have friends who use drugs are likely to try drugs themselves. Those feeling socially isolated for whatever reason may turn to drugs.

So it’s important to know your child’s friends — and their parents. Be involved in your children’s lives. If your child’s school runs an anti-drug program, get involved. You might learn something! Pay attention to how your kids are feeling and let them know that you’re available and willing to listen in a nonjudgmental way. Recognize when your kids are going through difficult times so that you can provide the support they need or seek additional care if it’s needed.

Role-playing can help your child develop strategies to turn down drugs if they are offered. Act out possible scenarios they may encounter. Helping them construct phrases and responses to say no prepares them to know how to respond before they are even in that situation.

A warm, open family environment — where kids can talk about their feelings, where their achievements are praised, and where their self-esteem is boosted — encourages kids to come forward with their questions and concerns. When censored in their own homes, kids go elsewhere to find support and answers to their most important questions.

Make talking and having conversations with your kids a regular part of your day. Finding time to do things you enjoy together as a family helps everyone stay connected and maintain open communication.

If you are looking for more resources for yourself or your child, be sure to also talk to your doctor.

Parents expect temper tantrums from 2- and 3-year-olds. But angry outbursts don’t necessarily stop after the toddler years. Older kids sometimes have trouble handling anger and frustration, too.

Some kids only lose their cool once in a while, but others seem to have a harder time when things don’t go their way. Kids who tend to have strong reactions by nature will need more help from parents to manage their tempers.

Controlling outbursts can be difficult for kids — and helping them learn to do so is a tough job for the parents who love them. Try to be patient and positive, and know that these skills take time to develop and that just about every child can improve with the right coaching.

A Parent’s Role

Managing kids can be a challenge. Some days keeping the peace while keeping your cool seems impossible. But whether you’re reacting to an occasional temper flare-up or a pattern of outbursts, managing your own anger when things get heated will make it easier to teach kids to do the same.

To help tame a temper, try to be your child’s ally — you’re both rooting for your child to triumph over the temper that keeps leading to trouble.

While your own patience may be frayed by angry outbursts, opposition, defiance, arguing, and talking back, it’s during these episodes that you need your patience most. Of course you feel angry, but what counts is how you handle that.

Reacting to kids’ meltdowns with yelling and outbursts of your own will only teach them to do the same (and actually is associated with an increase in children’s negative behaviors). But keeping your cool and calmly working through a frustrating situation lets you show — and teach — appropriate ways to handle anger and frustration.

Let’s say you hear your kids fighting over a toy in the other room. You have ignored it, hoping that they would work it out themselves. But the arguing turns into screaming and soon you hear doors slamming, the thump of hitting, and crying. You decide to get involved before someone gets really hurt.

By the time you arrive at the scene of the fight, you may be at the end of your own rope. After all, the sound of screaming is upsetting, and you may be frustrated that your kids aren’t sharing or trying to get along. (And you know that this toy they’re fighting over is going to be lost, broken, or ignored before long anyway!)

So what’s the best way for you to react? With your own self-control intact. Teaching by example is your most powerful tool. Speak calmly, clearly, and firmly — not with anger, blame, harsh criticisms, threats, or putdowns.

Of course, that’s easier said than done. But remember that you’re trying to teach your kids how to handle anger. If you yell or threaten, you’ll model and ingrain the exact kinds of behavior you want to discourage. Your kids will see that you’re so angry and unable to control your own temper that you can’t help but scream — and that won’t help them learn not to scream.

What You Can Do

Regulating emotions and managing behavior are skills that develop slowly over time during childhood. Just like any other skills, your kids will need to learn and practice them, with your help.

If it’s unusual for your child to have a tantrum, when one does happen, clearly but calmly review the rules. Saying something like “I know you’re upset, but no yelling and no name-calling, please” might be all your child needs to hear to regain composure. Then patiently give an instruction, like “tell me what you’re upset about” or “please apologize to your brother for calling him that name.” In this way, you’re guiding your child back to acceptable behavior and encouraging self-control.

Also, tell your child what will happen if he or she doesn’t calm down — for example, “If you don’t calm down, you need to go to your room until you’re able to stop screaming.”

Kids whose temper outbursts are routine might lack the self-control necessary to deal with frustration and anger and need more help managing those emotions. These steps can help:

Help kids put it into words. If your child is in the middle of an outburst, find out what’s wrong. If necessary, use a time-out to get your child to settle down or remind him or her about house rules and expectations — “There’s no yelling or throwing stuff; please stop that right now and cool it.” Remind your child to talk to you without whining, sulking, or yelling. Once your child calms down, ask what got him or her so upset. You might say, “Use your words to tell me what’s wrong and what you’re mad about.” This helps your child put emotions into words and figure out what, if anything, needs to be done to solve the problem. However, don’t push too hard for your child to talk right then. He or she may need some time to reflect before being ready to talk.

Listen and respond. Once your child puts the feelings into words, it’s up to you to listen and say that you understand. If your child is struggling for words, offer some help: “so that made you angry,” “you must have felt frustrated,” or “that must have hurt your feelings.” Offer to help find an answer if there’s a problem to be solved, a conflict to be mended, or an apology to be made. Many times, feeling listened to and understood is all kids need to calm down. But while acknowledging your child’s feelings, make it clear that strong emotions aren’t an excuse for bad behavior. “I know you’re mad, but it’s still not OK to hit.” Then tell your child some things to try instead. Some kids really just need to be “heard” first.

Create clear ground rules and stick to them. Talk about house rules regularly so your kids know what you expect of them. Be clear about what is and what is not acceptable without using threats, accusations, or putdowns. Your kids will get the message if you make clear, simple statements about what’s off limits and explain what you do want them to do. You might say: “There’s no yelling in this house. Use your words to tell me what’s upsetting you.”

Here are some other good-behavior rules to try:

• In this family, we don’t hit, push, or shove.
• There’s no screaming allowed.
• There’s no door-slamming in our house.
• There’s no name calling.
• We don’t say mean things in this family.
• You may not throw things or break things on purpose.

Coping Strategies for Kids

Kids who’ve learned that it’s not OK to yell, hit, and throw stuff when they’re upset need other strategies for calming down when they’re angry. Offer some ideas to help them learn safe ways to get the anger out or to find other activities that can create a better mood.

Take a break from the situation. Tell your kids that it’s OK to walk away from a conflict to avoid an angry outburst. By moving to another part of the house or the backyard, a child can get some space and work on calming down.

Find a way to (safely) get the anger out. There may be no punching walls, but you can suggest some good ways for a child to vent. Doing a bunch of jumping jacks, dancing around the bedroom, or going outside and doing cartwheels are all good choices. Or your child can choose to write about or draw a picture of what is so upsetting.

Learn to shift. This one is tough for kids — and adults, too. Explain that part of calming down is moving from a really angry mood to a more in-control mood. Instead of thinking of the person or situation that caused the anger, encourage kids to think of something else to do that might bring about a better mood — like a walk around the block, a bike ride, playing a game, reading a favorite book, digging in the garden, or listening to a favorite song. Try one of these things together so you both see how doing something different can change the way a person feels.

Building a Strong Foundation

Fortunately, really angry episodes don’t happen too often for most kids. Those with temper troubles often have an active, strong-willed style and extra energy that needs to be discharged.

Try these steps during the calm times — they can prevent problems before they start by helping kids learn and practice skills needed to manage the heat of the moment:

Make sure kids get enough sleep. Sleep is very important to their well-being. The link between a lack of sleep and a child’s behavior isn’t always obvious. When adults are tired, they can be grumpy or have low energy, but kids can become hyper or disagreeable or have extremes in behavior.

Most kids’ sleep requirements fall within a predictable range of hours based on their age, but each child is a unique individual with distinct sleep needs.

Help them label emotions. Help kids get in the habit of saying what they’re feeling and why — for example, “I’m mad because I have to clean my room while my friends are playing.” Using words doesn’t get a child out of doing a chore, but having the discussion can calm the situation. You’re having a conversation instead of an argument. Praise your child for talking about it instead of slamming the door, for instance.

See that kids get a lot of physical activity. Active play can really help kids who have big tempers. Encourage outside play and sports your child likes. Karate, wrestling, and running can be especially good for kids who are trying to get their tempers under control. But any activity that gets the heart pumping can help burn off energy and stress.

Encourage kids to take control. Compare a temper to a puppy that hasn’t yet learned to behave and that’s running around all over the place getting into things. Puppies might not mean to be bad — but they need to be trained so that they can learn that there’s no eating shoes, no jumping on people or certain furniture, etc. The point is that your child’s temper — like a puppy — needs to be trained to learn when it’s OK to play, how to use all that extra energy, and how to follow rules.

Recognize successes. Many times these go unnoticed so be sure to comment on how well your child handled a difficult situation when you see positive behaviors.

Try to be flexible. Parenting can be a tiring experience, but try not to be too rigid. Hearing a constant chorus of “no” can be disheartening for kids. Sometimes, of course, “no” is absolutely the only answer — “no, you can’t ride your bike without your helmet!” But other times, you might let the kids win one. For instance, if your child wants to keep the wiffle ball game going a little longer, maybe give it 15 more minutes.

Try to identify “at-risk” situations and be proactive. For example, if your child has difficulty with transitions, give warnings ahead of time. Similarly, if your kids have trouble turning off the television when asked, be clear how long they can watch TV or play video games and then set a 5-minute warning timer. Be sure to enforce the agreement.

As anyone who’s been really angry knows, following sensible advice can be tough when emotions run high. Give your kids responsibility for getting under control, but be there to remind them how to do it.

Most kids can learn to get better at handling anger and frustration. But if your child often gets into fights and arguments with friends, siblings, and adults, additional help might be needed. Talk with the other adults in your child’s life — teachers, school counselors, and coaches might be able to help, and your child’s doctor can recommend a counselor or psychologist.

It can be shocking and upsetting to learn that your child has gotten in trouble for picking on others or been labeled a bully.

As difficult as it may be to process this news, it’s important to deal with it right away. Whether the bullying is physical or verbal, if it’s not stopped it can lead to more aggressive antisocial behavior and interfere with your child’s success in school and ability to form and sustain friendships.

Understanding Bullying Behavior

Kids bully for many reasons. Some bully because they feel insecure. Picking on someone who seems emotionally or physically weaker provides a feeling of being more important, popular, or in control. In other cases, kids bully because they simply don’t know that it’s unacceptable to pick on kids who are different because of size, looks, race, or religion.

In some cases bullying is a part of an ongoing pattern of defiant or aggressive behavior. These kids are likely to need help learning to manage anger and hurt, frustration, or other strong emotions. They may not have the skills they need to cooperate with others. Professional counseling often can help them learn to deal with their feelings, curb their bullying, and improve their social skills.

Some kids who bully at school and in settings with their peers are copying behavior that they see at home. Kids who are exposed to aggressive and unkind interactions in the family often learn to treat others the same way. And kids who are on the receiving end of taunting learn that bullying can translate into control over children they perceive as weak.

Helping Kids Stop Bullying

Let your child know that bullying is unacceptable and that there will be serious consequences at home, school, and in the community if it continues.

Try to understand the reasons behind your child’s behavior. In some cases, kids bully because they have trouble managing strong emotions like anger, frustration, or insecurity. In other cases, kids haven’t learned cooperative ways to work out conflicts and understand differences.

Tactics to Try

Be sure to:

• Take bullying seriously. Make sure your kids understand that you will not tolerate bullying at home or anywhere else. Establish rules about bullying and stick to them. If you punish your child by taking away privileges, be sure it’s meaningful. For example, if your child bullies other kids via email, text messages, or a social networking site, dock phone or computer privileges for a period of time. If your child acts aggressively at home, with siblings or others, put a stop to it. Teach more appropriate (and nonviolent) ways to react, like walking away.
• Teach kids to treat others with respect and kindness. Teach your child that it is wrong to ridicule differences (e.g., race, religion, appearance, special needs, gender, economic status) and try to instill a sense of empathy for those who are different. Consider getting involved together in a community group where your child can interact with kids who are different.
• Learn about your child’s social life. Look for insight into the factors that may be influencing your child’s behavior in the school environment (or wherever the bullying is occurring). Talk with parents of your child’s friends and peers, teachers, guidance counselors, and the school principal. Do other kids bully? What about your child’s friends? What kinds of pressures do the kids face at school? Talk to your kids about those relationships and about the pressures to fit in. Get them involved in activities outside of school so that they meet and develop friendships with other kids.
• Encourage good behavior. Positive reinforcement can be more powerful than negative discipline. Catch your kids being good — and when they handle situations in ways that are constructive or positive, take notice and praise them for it.
• Set a good example. Think carefully about how you talk around your kids and how you handle conflict and problems. If you behave aggressively — toward or in front of your kids — chances are they’ll follow your example. Instead, point out positives in others, rather than negatives. And when conflicts arise in your own life, be open about the frustrations you have and how you cope with your feelings.

Starting at Home

When looking for the influences on your child’s behavior, look first at what’s happening at home. Kids who live with yelling, name-calling, putdowns, harsh criticism, or physical anger from a sibling or parent/caregiver may act that out in other settings.

It’s natural — and common — for kids to fight with their siblings at home. And unless there’s a risk of physical violence it’s wise not to get involved. But monitor the name-calling and any physical altercations and be sure to talk to each child regularly about what’s acceptable and what’s not.

It’s important to keep your own behavior in check too. Watch how you talk to your kids, and how you react to your own strong emotions when they’re around. There will be situations that warrant discipline and constructive criticism. But take care not to let that slip into name-calling and accusations. If you’re not pleased with your child’s behavior, stress that it’s the behavior that you’d like your child to change, and you have confidence that he or she can do it.

If your family is going through a stressful life event that you feel may have contributed to your child’s behavior, reach out for help from the resources at school and in your community. Guidance counselors, pastors, therapists, and your doctor can help.

Getting Help

To help a child stop bullying, talk with teachers, guidance counselors, and other school officials who can help you identify situations that lead to bullying and provide assistance.

Your doctor also might be able to help. If your child has a history of arguing, defiance, and trouble controlling anger, consider an evaluation with a therapist or behavioral health professional.

As difficult and frustrating as it can be to help kids stop bullying, remember that bad behavior won’t just stop on its own. Think about the success and happiness you want your kids to find in school, work, and relationships throughout life, and know that curbing bullying now is progress toward those goals.

When kids melt down in the middle of a crowded store, at a holiday dinner with extended family, or at home, it can be extremely frustrating. But parents can help kids learn self-control and teach them how to respond without just acting on impulse.

Teaching self-control is one of the most important things that parents can do for their kids because these skills are some of the most important for success later in life.

Helping Kids Learn Self-Control

By learning self-control, kids can make appropriate decisions and respond to stressful situations in ways that can yield positive outcomes.

For example, if you say that you’re not serving ice cream until after dinner, your child may cry, plead, or even scream in the hopes that you will give in. But with self-control, your child can understand that a temper tantrum means you’ll take away the ice cream for good and that it’s wiser to wait patiently.

Here are a few suggestions on how to help kids learn to control their behavior:

Up to Age 2

Infants and toddlers get frustrated by the large gap between the things they want to do and what they’re able to do. They often respond with temper tantrums. Try to prevent outbursts by distracting your little one with toys or other activities.

For kids reaching the 2-year-old mark, try a brief timeout in a designated area — like a kitchen chair or bottom stair — to show the consequences for outbursts and teach that it’s better to take some time alone instead of throwing a tantrum.

Ages 3 to 5

You can continue to use timeouts, but rather than setting a specific time limit, end timeouts once your child has calmed down. This helps kids improve their sense of self-control. And praise your child for not losing control in frustrating or difficult situations.

Ages 6 to 9

As kids enter school, they’re better able to understand the idea of consequences and that they can choose good or bad behavior. It may help your child to imagine a stop sign that must be obeyed and think about a situation before responding. Encourage your child to walk away from a frustrating situation for a few minutes to cool off instead of having an outburst. Praise kids when they do walk away and cool off — they’re more likely to use those skills again.

Ages 10 to 12

Older kids usually better understand their feelings. Encourage them to think about what’s causing them to lose control and then analyze it. Explain that sometimes situations that are upsetting at first don’t end up being so awful. Urge kids to take time to think before responding to a situation. Compliment them as they use their self-control skills.

Ages 13 to 17

By now kids should be able to control most of their actions. But remind teens to think about long-term consequences. Urge them to pause to evaluate upsetting situations before responding and talk through problems rather than losing control, slamming doors, or yelling. If necessary, discipline your teen by taking away certain privileges to reinforce the message that self-control is an important skill. Allow him or her to earn the privileges back by demonstrating self-control.

When Kids Are Out of Control

As difficult as it may be, resist the urge to yell when you’re disciplining your kids. Instead, be firm and matter of fact. During a child’s meltdown, stay calm and explain that yelling, throwing a tantrum, and slamming doors are unacceptable behaviors that have consequences — and say what those consequences are.

Your actions will show that tantrums won’t get kids the upper hand. For example, if your child gets upset in the grocery store after you’ve explained why you won’t buy candy, don’t give in — thus demonstrating that the tantrum was both unacceptable and ineffective.

Also, consider speaking to your child’s teachers about classroom settings and appropriate behavior expectations. Ask if problem-solving is taught or demonstrated in school.

And model good self-control yourself. If you’re in an irritating situation in front of your kids, tell them why you’re frustrated and then discuss potential solutions to the problem. For example, if you’ve misplaced your keys, instead of getting upset, tell your kids the keys are missing and then search for them together. If they don’t turn up, take the next constructive step (like retracing your steps when you last had the keys in-hand). Show that good emotional control and problem solving are the ways to deal with a difficult situation.

If you continue to have difficulties, ask your doctor if family counseling sessions might help.

Your toddler’s second temper tantrum of the day shows no signs of stopping, and supersonic, ear-shattering, teeth-jarring screams pierce the air. You’d run away and join the circus if only that were a real option. There must be a better way.

During the kicking-and-screaming chaos of the moment, tantrums can be downright frustrating. But instead of looking at them as disasters, treat tantrums as opportunities for education.

Why Kids Have Tantrums

Temper tantrums range from whining and crying to screaming, kicking, hitting, and breath holding. They’re equally common in boys and girls and usually happen between the ages of 1 to 3.

Some kids may have tantrums often, and others have them rarely. Tantrums are a normal part of child development. They are the way young children show they’re upset or frustrated.

Tantrums may happen when kids are tired, hungry, or uncomfortable; or because they can’t get something (for example, an object or a parent) to do what they want. Learning to deal with frustration is a skill that children gain over time.

Tantrums are common during the second year of life, a time when language skills are starting to develop. Because toddlers can’t yet say what they want, feel, or need, a frustrating experience may cause a tantrum. As language skills improve, tantrums tend to decrease.

Toddlers want independence and control over their environment — more than they may be capable of handling. This can lead to power struggles as a child thinks “I can do it myself” or “I want it, give it to me.” When kids discover that they can’t do it and can’t have everything they want, they may have a tantrum.

Avoiding Tantrums

Try to prevent tantrums from happening in the first place, whenever possible. Here are some ideas that may help:

• Give plenty of positive attention. Get in the habit of catching your child being good. Reward your little one with praise and attention for positive behavior.
• Try to give toddlers some control over little things. Offer minor choices such as “Do you want orange juice or apple juice?” or “Do you want to brush your teeth before or after taking a bath?” This way, you aren’t asking “Do you want to brush your teeth now?” — which inevitably will be answered “no.”
• Keep off-limits objects out of sight and out of reach. This makes struggles less likely. Obviously, this isn’t always possible, especially outside of the home where the environment can’t be controlled.
• Distract your child. Take advantage of your little one’s short attention span by offering something else in place of what they can’t have. Start a new activity to replace the frustrating or forbidden one. Or simply change the environment. Take your toddler outside or inside or move to a different room.
• Help kids learn new skills and succeed. Help kids learn to do things. Praise them to help them feel proud of what they can do. Also, start with something simple before moving on to more challenging tasks.
• Consider the request carefully when your child wants something. Is it outrageous? Maybe it isn’t. Choose your battles; accommodate when you can.
• Know your child’s limits. If you know your toddler is tired, it’s not the best time to go grocery shopping or try to squeeze in one more errand.

If a safety issue is involved and a toddler repeats the forbidden behavior after being told to stop, use a time-out or hold the child firmly for several minutes. Be consistent. Don’t give in on safety issues.

Tantrum Tactics

Most important, keep your cool when responding to a tantrum. Don’t complicate the problem with your own frustration or anger. Remind yourself that your job is helping your child learn to calm down. So you need to be calm, too.

Your actions set an example for your child. Hitting and spanking don’t help. And they send the message that using force and physical punishment is OK. That can result in more negative behaviors over the long run. Instead, have enough self-control for both of you.

Tantrums should be handled differently depending on why your child is upset. Sometimes, you may need to provide comfort. Other times, its best to ignore an outburst and distract your child with a new activity. If your child is tired or hungry, it’s time for a nap or a snack. If a tantrum happens after your child is refused something, stay calm and don’t give a lot of explanations for why your child can’t have what he wants. Try to find something he can have. Move on to another activity with your child.

Kids who are in danger of hurting themselves or others during a tantrum should be taken to a quiet, safe place to calm down. This also applies to tantrums in public places.

Preschoolers and older kids are more likely to use tantrums to get their way if they’ve learned that this behavior works. Once kids have started school, it’s appropriate to send them to their rooms to cool off.

Rather than setting a specific time limit, tell your child to stay in the room until he or she regains control. This is empowering — kids can affect the outcome by their own actions, and thus gain a sense of control that was lost during the tantrum. However, if the time-out is for negative behavior (such as hitting) in addition to a tantrum, set a time limit.

After the Storm

Do not reward your child’s tantrum by giving in. This will only prove to your little one that the tantrum was effective. Instead, verbally praise a child for regaining control.

Also, kids may be especially vulnerable after a tantrum when they know they’ve been less than adorable. Now (when your child is calm) is the time for a hug and reassurance that your child is loved, no matter what.

Make sure your child is getting enough sleep. With too little sleep, kids can become hyper, disagreeable, and have extremes in behavior. Getting enough sleep can dramatically reduce tantrums. Find out how much sleep is needed at your child’s age. Most kids’ sleep needs fall within a set range of hours based on their age, but each child has his or her own distinct sleep needs.

When to Call the Doctor

Talk to your doctor if:

• You often feel angry or out of control when you respond to tantrums.
• You keep giving in.
• The tantrums cause a lot of bad feelings between you and your child.
• You have questions about what you’re doing or what your child is doing.
• The tantrums become more frequent, intense, or last longer.
• Your child often hurts himself/herself or others.
• Your child seems very disagreeable, argues a lot, and hardly ever cooperates.

Your doctor also can check for any health problems that may add to the tantrums, although this is not common. Sometimes, hearing or vision problems, a chronic illness, language delays, or a learning disability can make kids more likely to have tantrums.

Remember, tantrums usually aren’t cause for concern and generally stop on their own. As kids mature, they gain self-control. They learn to cooperate, communicate, and cope with frustration. Less frustration and more control mean fewer tantrums — and happier parents.

Many parents are unsure about when to start toilet teaching or “potty training.” Not all kids are ready at the same age, so it’s important to watch your child for signs of readiness, such as stopping an activity for a few seconds or clutching his or her diaper.

Most children begin to show these signs between 18 and 24 months, although some may be ready earlier or later than that. And boys often start later and take longer to learn to use the potty than girls.

Instead of using age as a readiness indicator, look for other signs that your child may be ready to start heading for the potty, such as the ability to:

• follow simple instructions
• understand words about the toileting process
• control the muscles responsible for elimination
• verbally express a need to go
• keep a diaper dry for 2 hours or more
• get to the potty, sit on it, and then get off the potty
• pull down diapers, disposable training pants, or underpants
• show an interest in using the potty or wearing underpants

About Timing

There are some stressful or difficult times when you may want to put off starting the toilet-teaching process — when traveling, around the birth of a sibling, changing from the crib to the bed, moving to a new house, or when your child is sick (especially if diarrhea is a factor). It may be better to postpone it until your child’s environment is stable and secure.

Also, while some experts recommend starting the process during summer because kids wear less clothing, but it is not a good idea to wait if your child is ready.

How Long Does It Take?

Of course, teaching a toddler to use the potty isn’t an overnight experience. The process often takes between 3 and 6 months, although it may take more or less time for some children.

And although some little ones can learn to both make it through the night without wetting or soiling themselves (or the bed) and use the potty around the same time, it may take an additional month to even years to master staying dry at night.

Potty Types

The two basic potty options are:

1. a standalone, toddler-size potty chair with a bowl that can be emptied into the toilet
2. a toddler-size seat that can be placed on top of your toilet seat that will let your child feel more secure and not fear falling in

If you choose the modified toilet seat, consider getting a stepping stool so that your child can reach the seat comfortably and feel stable and supported while having a bowel movement.

It’s usually best for boys to first learn to use the toilet sitting down before learning to pee standing up. For boys who feel awkward — or scared — about standing on a stool to pee in the toilet, a potty chair may be a better option.

Buy a training potty or seat for every bathroom in your house. You may even want to keep a potty in the trunk of your car for emergencies. When traveling long distances, be sure to take a potty seat with you and stop every 1 to 2 hours. Otherwise, it can take more time than your child may have to find a discreet location or restroom.

About Training Pants

Experts sometimes disagree about whether to use disposable training pants. Some think that they’re just bigger diapers and might make kids think it’s OK to use them like diapers, thus slowing the toilet-teaching process.

Others feel that training pants are a helpful step between diapers and underwear. Because kids’ nighttime bladder and bowel control often lags behind their daytime control, some parents like using training pants at night. Others prefer that their child use training pants when they’re out and about. Once the training pants remain dry for a few days, kids can make the switch to wearing underwear.

Ask your doctor if your child would benefit from using disposable training pants as a transitional step.

Common Problems

It’s common for a previously toilet-taught child to have some trouble using the potty during times of stress. For example, a 2- or 3-year-old dealing with a new sibling may regress (return to a previous level of development).

But if your child was previously potty trained and is having problems, talk with your doctor just to be on the safe side and to rule out things like an infection.

If your child is 3 years or older and is not yet potty trained, talk to the doctor, who can help determine the problem and offer advice to make the process easier.

Tips for Toilet Teaching

Even before your child is ready to try the potty, you can prepare your little one by teaching about the process:

• Use words to express the act of using the toilet (“pee,” “poop,” and “potty”).
• Ask your child to let you know when a diaper is wet or soiled.
• Identify behaviors (“Are you going poop?”) so that your child can learn to recognize peeing and pooping.
• Get a potty chair your child can practice sitting on. At first, your child can sit on it clothed. Then, he or she can sit on the chair with a diaper. And when ready, your child can go bare-bottomed.

If you’ve decided that your child is ready to start learning how to use the potty, these tips may help:

• Set aside some time to devote to the potty-training process.
• Don’t make your child sit on the toilet against his or her will.
• Show your child how you sit on the toilet and explain what you’re doing (because your child learns by watching you). You also can have your child sit on the potty seat and watch while you (or a sibling) use the toilet.
• Establish a routine. For example, you may want to begin toilet teaching by having your child sit on the potty after waking with a dry diaper, or 45 minutes to an hour after drinking lots of fluid. You may be able to catch your child peeing. Only put your child on the potty for a few minutes a couple of times a day, and let your child get up if he or she wants to.
• Try catching your child in the act of pooping. Children often give clear cues that they need to use the bathroom — their faces turn red, and they may grunt or squat. And many kids are regular as to the time of day they tend to have a bowel movement.
• Have your child sit on the potty within 15 to 30 minutes after meals to take advantage of the body’s natural tendency to have a bowel movement after eating (this is called the gastro-colic reflex).
• Remove a bowel movement (poop) from your child’s diaper, put it in the toilet, and tell your child that poop goes in the potty.
• Make sure your child’s wardrobe is adaptable to potty training. In other words, avoid overalls and shirts that snap in the crotch. Simple clothes are a must at this stage and kids who are potty training need to be able to undress themselves.
• Some parents like to let their child have some time during the day without a diaper. If he or she urinates without wearing a diaper, your child may be more likely to feel what’s happening and express discomfort. (But if you opt to keep your child’s bottom bare for a little while, you’ll probably need to keep the potty close by, protect your rugs and carpet, and be willing to clean up.)
• When your son is ready to start peeing standing up, have “target practice.” Show him how to stand so that he can aim his urine stream into the toilet. Some parents use things like cereal pieces as a sort of bull’s-eye for their little guys to try aiming at.
• Offer your child small rewards, such as stickers or time reading with Mommy, every time your child goes in the potty. Keep a chart to track of successes. Once your little one appears to be mastering the use of the toilet, let him or her pick out a few new pairs of big-kid underwear to wear.
• Make sure all of your child’s caregivers — including babysitters, grandparents, and childcare workers — follow the same routine and use the same names for body parts and bathroom acts. Let them know how you’re handling the issue and ask that they use the same approaches so your child won’t become confused.

Above all, be sure to praise all attempts to use the toilet, even if nothing happens. And remember that accidents will happen. It’s important not to punish potty-training children or show disappointment when they wet or soil themselves or the bed. Instead, tell your child that it was an accident and offer your support. Reassure your child that he or she is well on the way to using the potty like a big kid.

And if you’re torn about when to start the toilet-teaching process altogether, let your child be your guide. Don’t feel pressured by others (your parents, in-laws, friends, siblings, coworkers, etc.) to begin. Many parents of past generations started potty training much sooner than many parents do today. And it all depends on the child. Kids will let parents know when they’re ready.

Lisa’s son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall.

It was exhausting to parent Jack, but Lisa hadn’t been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher’s comments about his inattention and disruptive behavior in class became too frequent to ignore, Lisa took Jack to the doctor, who recommended an evaluation for attention deficit hyperactivity disorder (ADHD).

ADHD is a common behavioral disorder that affects about 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it’s not yet understood why.

Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what’s expected of them but have trouble following through because they can’t sit still, pay attention, or focus on details.

Of course, all kids (especially younger ones) act this way at times, particularly when they’re anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and happen in different settings. They hurt a child’s ability to function socially, academically, and at home.

The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.

Symptoms

ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors:

1. an inattentive type, with signs that include:

• trouble paying attention to details or a tendency to make careless errors in schoolwork or other activities
• difficulty staying focused on tasks or play activities
• apparent listening problems
• difficulty following instructions
• problems with organization
• avoidance or dislike of tasks that require mental effort
• tendency to lose things like toys, notebooks, or homework
• distractibility
• forgetfulness in daily activities

2. a hyperactive-impulsive type, with signs that include:

• fidgeting or squirming
• difficulty remaining seated
• excessive running or climbing
• difficulty playing quietly
• always seeming to be “on the go”
• excessive talking
• blurting out answers before hearing the full question
• difficulty waiting for a turn or in line
• problems with interrupting or intruding

3. a combined type, a combination of the other two type, is the most common

Although it can be challenging to raise kids with ADHD, it’s important to remember they aren’t “bad,” “acting out,” or being difficult on purpose. And they have difficulty controlling their behavior without medicine or behavioral therapy.

Diagnosis

Because there’s no test that can detect ADHD, a diagnosis depends on a complete evaluation. Many kids with ADHD are evaluated and treated by primary care doctors, including pediatricians and family practitioners, but may be referred to specialists like psychiatrists, psychologists, or neurologists. These specialists can help if the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, anxiety, or depression.

To be considered for a diagnosis of ADHD:

• a child must display behaviors from one of the three subtypes before age 12
• these behaviors must be more severe than in other kids the same age
• the behaviors must last for at least 6 months
• the behaviors must happen in and negatively affect at least two areas of a child’s life (such as school, home, childcare settings, or friendships)

The behaviors also must not only be linked to stress at home. Kids who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it’s important to consider whether these factors played a role when symptoms began.

First, your child’s doctor may do a physical examination and take a medical history that includes questions about any concerns and symptoms, your child’s past health, your family’s health, any medicines your child is taking, any allergies your child has, and other issues.

The doctor also may check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions (such as extreme stress, depression, and anxiety) can look like ADHD, you’ll probably fill out questionnaires to help rule them out.

You’ll be asked many questions about your child’s development and behaviors at home, school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably will be consulted, too. An educational evaluation, which usually includes a school psychologist, might be done. It’s important for everyone involved to be as honest and thorough as possible about your child’s strengths and weaknesses.

Causes of ADHD

ADHD is not caused by poor parenting, too much sugar, or vaccines.

ADHD has biological origins that aren’t yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder.

Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found.

Research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth.

Some studies have even suggested a link between excessive early television watching and future attention problems. Parents should follow the American Academy of Pediatrics’ (AAP) guidelines, which say that children under 2 years old should not have any “screen time” (TV, DVDs, videos, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television programming.

Related Problems

One of the difficulties in diagnosing ADHD is that it’s often found along with other problems. These are called coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

At least 40% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.

Mood Disorders

About 20% of kids with ADHD also experience depression. They may feel isolated, frustrated by school failures and social problems, and have low self-esteem. About 15% to 20% of kids with ADHD also have bipolar disorder, which involves rapidly changing moods, irritability, and aggression.

Anxiety Disorders

Anxiety disorders affect about 30% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.

Learning Disabilities

About half of all kids with ADHD also have a specific learning disability. The most common learning problems affect reading (dyslexia) and handwriting. Although ADHD isn’t categorized as a learning disability, its effects on concentration and attention can make it even harder for kids to do well in school.

If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.

Treating ADHD

ADHD can’t be cured, but it can be successfully managed. Your child’s doctor will work with you to develop an individualized, long-term plan. The goal is to help your child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen.

In most cases, ADHD is best treated with a combination of medicine and behavior therapy. Any good treatment plan will include close follow-up and monitoring, and your doctor might make changes along the way. Because it’s important for parents to actively participate in their child’s treatment plan, parent education is also an important part of ADHD management.

Sometimes the symptoms of ADHD become less severe as a person grows older. Hyperactivity tends to ease as kids become young adults, although the problems with organization and attention often remain. More than half of kids who have ADHD will continue to have symptoms as young adults.

Medications

Several different types of medicines can be used to treat ADHD:

• Stimulants are the best-known treatments — they’ve been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There’s currently no evidence of long-term side effects.
• Nonstimulants represent a good alternative to stimulants or are sometimes used along with a stimulant to treat ADHD. The first nonstimulant was approved for treating ADHD in 2003. They may have fewer side effects than stimulants and can last up to 24 hours.
• Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss this risk with your doctor.

Medicines can affect kids differently, and a child may respond well to one but not another. When finding the correct treatment, the doctor might try a few medicines in various doses, especially if your child is being treated for ADHD along with another disorder.

Behavioral Therapy

Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy.

This therapy attempts to change behavior patterns by:

• reorganizing a child’s home and school environment
• giving clear directions and commands
• setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones

Here are examples of behavioral strategies that may help a child with ADHD:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what’s expected throughout the day and when it’s time for homework, play, and chores.
• Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
• Avoid distractions. Turn off the TV, radio, cellphones, and computers, especially when your child is doing homework.
• Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
• Change your interactions with your child. Instead of long-winded explanations and nagging, use clear, brief directions to remind your child of responsibilities.
• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic (think baby steps rather than overnight success).
• Discipline effectively. Instead of yelling or spanking, use time-outs or loss of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior.
• Help your child discover a talent. All kids need to have successes to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.

Alternative Treatments

The only ADHD therapies proven effective in scientific studies so far are medicines and behavioral therapy. But your doctor may recommend additional treatments and interventions based on your child’s symptoms and needs. Some kids with ADHD, for example, might need special educational interventions such as tutoring and occupational therapy. Every child’s needs are different.

Other alternative therapies promoted and tried by parents include megavitamins, diet changes, allergy treatments, chiropractic treatment, attention training, visual training, and traditional one-on-one “talking” psychotherapy. However, scientific research has not found these treatments to be effective, and most have not been studied carefully, if at all.

Parents should always be wary of any therapy that promises an ADHD “cure.” If you’re interested in trying something new, speak with your doctor first.

ADHD in the Classroom

As your child’s most important advocate, you should become familiar with your child’s medical, legal, and educational rights.

Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child’s progress.

In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success:

• Avoid seating distractions. This might be as simple as seating your child near the teacher instead of near a window.
• Use a homework folder for parent-teacher communications. The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time.
• Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces.
• Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn’t call out, or waits his or her turn.
• Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and retain information.
• Supervise. Check that your child goes and comes from school with the correct books and materials. Sometimes kids are paired with a buddy to help them stay on track.
• Be sensitive to self-esteem issues. Ask the teacher to give feedback to your child in private and avoid asking your child to perform a task in public that might be too difficult.
• Involve the school counselor or psychologist. He or she can help design behavioral programs to address specific problems in the classroom.

Supporting Your Child, Yourself

Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency and need active coaching to help learn these skills.

Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training also can teach parents to respond to a child’s most trying behaviors with calm disciplining techniques. Individual or family counseling also can be helpful.

By learning as much as you can about ADHD and building partnerships with others involved in your child’s care, you’ll be a stronger advocate for your child. Take advantage of all the support and education that’s available, and you’ll help steer your child toward success.