Creating a Structured Routine for Children With ADHD

In this video, Greg Mattingly, MD, discusses creating a structured routine for children with attention-deficit/hyperactivity disorder (ADHD) and how those routines will differ between summer vacation and the school year.

In Part 2, Dr Mattingly explains positive parenting techniques, the importance of academic recovery, and ways clinicians can create successful treatment plans alongside parents.

Read the transcript:

This is Greg Mattingly, and we're here to talk about summertime. Summertime for kids with ADHD, it's fun time. It's a time for camp. It's a time for being outdoors. It's a time for spending time with family.

It's also time for get-back-to-school time. Get ready for school, start making those preparations, adjusting your medicines, and thinking about how we start the year with a good start and a fresh start.

As we all know, this has been a tough year for many of our kids with ADHD. Many of our kids have had to go through virtual learning, hybrid learning, tele-learning, in-person, out-of-person, all of the different things that have happened this past year. We've had kids in quarantine. We've had kids who had friends in quarantine.

It's never been more important to think about how do we jump-start this next year and start off with the right start. As we think about the right start for our kids with ADHD, first of all it comes down to balance. We're going to talk about balance within their social lives, balance within their emotional lives, balance within their academic lives.

When I talk to my kids, how are you doing this summer as far as making friends, how are doing as far as interacting with others, how are you doing with your family, how are you doing with your emotions, how are you doing when you look forward to the school year, one of the good things, one of the take-homes is a lot of our kids are looking forward to going back to school.

After a year of having been isolated, or not seeing their friends, or having to do things they're not used to, a lot of the kids are saying, "Listen, Dr. Mattingly. I never thought I'd say this, but I'm look forward to going back to school."

We as clinicians, as we think about jump-starting this summer, getting our kids ready for school, how do we help them to have a successful start to school? A successful start means planning ahead. In the same way when you get ready to go on a trip, you pack your bags ahead of time, we want to get our kids ready for that beginning of school.

Ready for the beginning of school's a lot of things. Number one, are your medicines working as well as they should be? Do we have the right dose? Do we have the right duration? Do we have the right blend? Are we having side effects or maybe causing problems?

Just yesterday I had a young boy doing pretty well. He said, "Yeah, Dr. Mattingly, grades are pretty good, but man, this medicine, it really messed up my stomach." I had another young kid who'd just come back from summer camp, and he talked about I did really good at summer

camp, but I'm still having a lot of anxiety. I said, "We'll talk about the anxiety. Let's talk about what you've seen."

We're going to talk about optimizing the medicines. Summertime is the right time if we're thinking about a change in medication options, maybe changing it to a new treatment option, maybe changing to a treatment that covers more of the day.

Maybe it covers some of the break-through symptoms, or maybe an option that helps with some of the comorbid symptoms that our children are facing, anxiety, mood issues, emotional issues, sleep issues, looking for the right treatment choices.

There's a time when we think about the options. I'll talk to my kids, and I'll say, "Listen. Here's the things I hear from you. You're struggling with sleep, or maybe you're struggling with anxiety, or maybe you're having some breakthrough symptoms at the end of the day. Let's talk about some of the options we could do to help cover those symptoms."

You work with your kids. You work with your family. You talk about optimizing treatment for them.

When we talk about school, it's important that we start thinking about not just medicines, but how do we start getting structure back into a kid's day. Structure means getting up at a certain time, getting our sleep cycles back where they should be, getting ourselves organized and ready for that first day of school.

For all of my kids, a week or two before they start school, I want them to start structuring their day like they're having a school day. Start getting up at the right time. Start going to bed at the right time. Get used to that daily structure that helps to get you successful.

In the same way, if you have an athlete, he'll start running laps and getting ready for the first day of soccer or the first day of basketball. We're going to do the same thing academically for our kids.

Why don't you sit down with your parents? I'd like you to read a half hour each night. In the morning over breakfast, talk to your parents about the story you read. Share that with them. Get them used to using their brain again. Get them used to the structure of that in a positive and creative way.

When we talk about structuring the school day next year for my kids, I typically like to work our way through the school day. I don't like the hardest class to be the first class. I don't like the hardest class to be the last class. What we know is kids' concentration builds as they go throughout the day, and the peak time for concentration is typically about 10 or 11 o'clock in the morning.

Start with a preferred class. Start with a class the kids look forward to. Give them something to look forward to and [inaudible 4:28] option to choose those classes. Work your way towards the harder subjects. Maybe that's math. Maybe that's English for different kids that I work with. Put those subjects around 10, 11 o'clock. That's when concentration will typically be at its peak.

At the end of the day, once again, I like ending with a preferred class. I like bookending the day, a beginning that starts off good, an ending that finishes well. Put some of the tougher classes there in that early part of the morning before you head to lunch.

Greg Mattingly, MD, is a physician and principal investigator in clinical trials for Midwest Research Group, St Charles, Missouri and a founding partner of St. Charles Psychiatric Associates, St Charles, Missouri. He earned his medical degree at Washington University, St Louis, Missouri. Dr Mattingly is board certified in adult and adolescent psychiatry and is a Diplomat of the National Board of Medical Examiners. He is an Associate Clinical Professor at Washington and has been a principal investigator in over 200 clinical trials focusing on ADHD, anxiety disorders, major depression, bipolar disorder, and schizophrenia.