Organization, Routine Key for Back to School Transition for Children With ADHD

(Part 1 of 2)

An organized workspace, medication plan, and routine, including after-school activities, are essential for students with attention-deficit/hyperactivity disorder (ADHD) to successfully transition back into school, says Andrew Cutler, MD, associate professor of psychiatry at SUNY Upstate Medical University, Syracuse, New York.

In part one of this video, Dr Cutler shares tips for clinicians on how to help the primary caregivers of parents with ADHD who are going back to the classroom either remotely or in person.

In the upcoming part two of this video, Dr Cutler explains best practices for optimizing medication and non-medication management of ADHD, screening for common comorbidities, and the importance of the doctor-caretaker relationship during this transitional time.

Read the transcript:

Hello, I'm Dr. Andrew Cutler, Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University. I'm also a researcher. I've been doing clinical trials on ADHD for over 20 years, so I've learned a few things along the way, particularly about how important back-to-school time is for children and families with ADHD.

As we know, children with ADHD have difficulty with attention and that makes it hard for planning and organization. They also have difficulty with hyperactivity and impulsivity, which means managing their behavior and having relationships can be challenging. All of these make it difficult for people with ADHD in school.

Of course, we also have the complications of the COVID-19 pandemic and we know that this past year-and-half or so has been quite a challenge and a struggle for our children and families with ADHD. We know that school has gone virtual for much of last year.

Now, with the coming year, of course, some schools may still be virtual, some may be going fully in-person, and some may have a hybrid model. It's important, first of all, of course, to check and find out what exactly you're going to be dealing with in the coming year.

In my experience, with my patients, some kids actually do very well with the virtual environment. There are less distractions and they can focus better. Some kids though have really struggled because they have a hard time staying focused. It's less engaging, less interesting, if you will.

So, you want to understand where your child is with respect to how they handle the virtual environment. Also, of course, virtually, you have less in-person interactions with others.

What are some things that we, as clinicians, can do? I think the most important thing we can do is help the primary caretakers with some tips and some ideas and suggestions. Of course, optimizing our medication and non-medication management of ADHD.

As we know, many times, kids go off their medications for the summertime, which is not something we preach, of course, but it happens. You want to make sure that these kids are getting their medications restarted and, ideally, tweaked and optimized before their school year begins.

Some of the things to help your caregivers with is to make sure that they review their child's IEP [individualized education plan] or 504 plan. Make sure it's updated and it really meets their child's needs.

If the child is going to a new school or moving up to a higher level of a new school, you want to see if they can maybe visit this new school to allay the child's anxiety and even meet the teacher, which will help familiarize the child if they're going to be in person.

You want to help them to understand how important it is to organize the home environment. They want to organize the school supplies, make sure that they get all of the things that are needed. Very often, there's a checklist from school of what school supplies you need.

Make sure that the home, especially the study environment, and the homework environment is really conducive. It should be separated from the rest of the family and the rest of the house, should be free of distractions, and should, of course, have an organizational scheme and system and a place to put things. Ideally, a desk and a chair. You don't want the kid working in bed, for instance.

Then, of course, you also want to work with them on how important it is to have a regular schedule and a routine. That means not only a schedule throughout the day but also, a bedtime and wake time routine.

It's extremely important. Kids with ADHD really need to have a proper amount of sleep. They really do better with structure, routine, and predictability. They know what's going to happen beforehand, things like that.

Help them to set up a calendar. That's a very useful tool. It can give the caregiver and the child a sense of control over things.

Also, it's very important to pay attention to breakfast and to mealtimes. You want to especially make sure that they get breakfast in them before school starts, of course, and perhaps before the medications, including stimulants, might kick in and decrease their appetite.

Now, it's important to understand, from a medical perspective, the brain, in general, uses 2 main things for fuel. That's glucose and oxygen. Glucose, of course, it's very important to eat regularly and keep that glucose going for the brain. Also, the way oxygen gets to the brain is through our bloodstream, so hydration is critically important.

What I really work with parents and caregivers on is how important it is to have the child eat regularly and, especially, hydrate them. What I often tell them is, as soon as the child gets home, give them a snack, and give them something to drink right away. That can help, sometimes, avoid that afternoon dip that you can sometimes see.

Planning for afterschool activities is also extremely important. You want to try to understand the child's interests, hobbies, their likes, and their strengths. Exercise, we know, is critically important, especially if the child has been sitting for a good part of the day.

Afterschool activities involve exercise, whether traditional sports or martial arts, or dance, gymnastics. Find out whatever they might be interested in and they might want to do. Getting involved in a club, club activities, things like that.

Also, you want to make sure that they have opportunities for peer interactions and relationships with friends and others. You might want to have them consider a tutor or other kinds of academic support for the child as well. Get that in place early.

Very importantly, as we talked about, is you want to review the medication and make sure that they understand how to take the medication, how to get it refilled, and what to do if there's a problem.

Another thing to help them with is to set goals for the coming year. While you're doing that, really make it into a positive interaction. Focus on the child's strengths. I think what happens all too often is parents and caregivers get into a mindset of pointing out the weaknesses and criticizing.

The child gets a lot of negative feedback from various sources and their self-esteem can really take a hit. You want to try to be as positive as you can and use positive reinforcement tools. Help the parent and the caregiver to understand how important that is.

Ask the parent and caregiver, "What do you like about this kid?" "What really gets you off on this kid?" "What do you think are some of their strengths?" "What are they good at?" Not necessarily what are they bad at. We already know that to some degree.

Andrew J. Cutler, MD is the Chief Medical Officer at Neuroscience Education Institute, Carlsbad, California, and a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University, Syracuse, New York. Dr Cutler is board certified in Internal Medicine by the American Board of Internal Medicine and in Psychiatry by the American Board of Psychiatry and Neurology.  He is also a Certified Physician Investigator (CPI) by the Association of Clinical Research Professionals (ACRP).

Dr Cutler has been conducting clinical research since 1993, and has been a Principal Investigator on over 400 clinical trials in a variety of CNS and medical indications, authored more than 100 peer-reviewed scientific articles and has presented more than 300 abstracts and posters at scientific meetings around the world. 

Dr Cutler is a member of the American Psychiatric Association (APA), the Florida Psychiatric Society (FPS) and the American Medical Association (AMA).