Long before my son was diagnosed with ADHD, his preschool teachers noted his "inappropriate" manner of play. It was "not goal directed," they said; when given two dinosaurs, rather than engage them in battle with each other he would simply throw them at his classmates. Matchbox cars, Ninja Turtles, Duplo blocks, Playdough, and yes, finger paint all followed a similar trajectory.
My son was still too young at the time to have been diagnosed accurately with what turned out to be textbook ADHD, but his chaotic and aggressive manner of play was a powerful early clue. Likewise, early and continual interventions through play had a powerful impact on his ability to concentrate, focus, and follow through. It also helped him develop social skills such as cooperating, communicating, negotiating, sharing, and taking turns.
Child psychiatrists and psychologists have long used play as a therapeutic tool for children with problems such as ADHD, clinical depression, and anxiety disorders. Many children can express themselves through play when meaningful discourse is not possible. Conversely, play is an indirect way for therapists to recast children's perceptions, cognitions and behaviors. As Carol Brady, Ph.D., a Houston child psychologist, puts it: "Children communicate metaphorically through play. As a therapeutic tool, it's like giving a sugary pill instead of a bitter pill."
In a home setting, Brady believes, parents also can use play to help their children achieve impressive gains in attentional and social skills. And while the market abounds with expensive and therapeutic "toys and games specially designed to help children with ADHD," Brady says many conventional, inexpensive toys such as Go Fishing, Clue and Chinese Checkers can be just as beneficial. "It's not so much the game as how you play it," Brady says.
Here are several of the toys, games, and methods Brady recommends for parents and their ADHD children.
Ages 4-6: the power of fantasy
Four to six-year-olds enjoy fantasy toys because they allow for exploration of new experiences and feelings in a safe context. Doctor kits, stuffed animals, family and animal figures, and action or monster figures enable the children to act out roles, situations, and emotions. For children with ADHD, fantasy play is even more important.
Younger children with ADHD may feel isolated and confused because their disorder prevents them from communicating effectively their experiences, fears and concerns. They may have a problem or a story to relate, but they are too distractible to stay with the task from beginning to middle to end. Similarly, they tend to be impulsive, rather than anticipatory thinkers; that is, they act on their impulses before considering whether or not it's a good idea. That's one reason ADHD kids so often find themselves "in trouble" or without friends.
When skillfully directed by parents, fantasy play helps ADHD children learn to stay with a string of tasks long enough to bring them to a conclusion, and teaches them to consider consequences before acting. Constant practice through play enables children to transfer these skills to real life.
Parents should plan ten minute play sessions once a day — longer periods run the risk of the child falling out of attention, and the parent becoming frustrated. Using the toys as props, initiate the fantasy game by suggesting to the child, "Let's make up a story about the horses" — or about whatever fantasy figures are involved.
Fostering follow-through and completion
Continue by prompting: "Once upon a time..." and let the child start to make up and act out the story. You can even play act one of the roles in the fantasy, taking the part of one or more play figures and interacting with the child's.
While the child always directs the fantasy, the parent's role is to redirect when necessary to maintain focus. Every time the child veers of track, you can gently direct the child back to the game — for example, "I was really interested in that horsey story. Tell me what happens next."
If the child is not finished with the fantasy as the ten-minute period concludes, the parent can prompt the ending. "Oh, it's getting dark. Time for horsey to get ready to go to bed," or "The boy's mommy is calling him to come home for dinner now." Take another minute to finish the story and put away the toys.
Start with simple themes: the horse is running around the pasture, and then it's time to have a snack and go home. After a few months, you'll probably notice an improvement in your child's ability to stick with the task. At that point, you can step up the challenge gradually by making the themes increasingly more elaborate (After the snack the horses go out to find a secret treasure). You can even expand the venue of the game from the playroom floor to the whole house.
Rehearsing social behaviors and consequences
Non-ADHD kids who naturally play fantasy game from beginning to end have ample opportunity to rehearse, abandon, and try out new behaviors in this safe and sheltered context. But ADHD kids are different; without parental involvement they may not be up to this task.
Therefore, throughout the story the parent should interact in ways that encourage the child to rehearse social behaviors, experience logical consequences and eventually anticipate outcomes.
- "If the baby horse goes out without his mommy, do you think he might get lost?"
- "If the girl breaks all her toys, what will she have to play with?"
- "If the boy hits his friend, maybe the friend will get hurt and not want to play with him anymore."
Parents also can respond within the fantasy — for example, taking the part of the injured party. If the child's figure hits yours, you might say: "Ow, that hurts! I don't want to play with people who hurt me. Can you try being more gentle?" ADHD children, so used to being chastised, can be more responsive to correction when it's not directed personally at them.
The parent-child relationship benefits from this kind of play too. Says Dr. Brady, "What parents can gain along with the satisfaction that they're helping the child is time to enjoy each other, unlike most times where you're telling your kids what to do or making them do something. And its doubly rewarding because kids in this age group are so much fun and they say the cutest things."
Ages 6-10: rehearsing lifetime skills
Elementary school is a time during which children develop increasingly sophisticated social and cognitive skills that will carry them to high school and beyond. It's an especially critical period for children with ADHD; if they fall behind their peers in this domain, it sets the stage for failure in the future.
"From six to ten, most children learn how to take turns, play by the rules, pay attention to detail, strategize, handle frustration, deal with failure, and recover from disappointments," says Dr. Brady. But ADHD kids often find themselves excluded from the very peer activities such as team sports and cooperative board games that help them build these skills. Their lower frustration tolerance, shorter fuse, and difficulty staying on task can be off-putting to potential team and play mates. When ADHD children are shunned, they miss opportunities to develop socially and cognitively with their peers. This snowball affect can take years to counteract.