Be a Behavior Detective
When my patients have this kind of problem at the end of the day, I might prescribe an extra four-hour dose at about 8 p.m. If the child's problems were the result of a lack of medication, he should now have an easier time at bedtime.
Whenever you up the medication, it's important to monitor your child's sleep. If he now seems "wired" until late at night or the extra medication is otherwise affecting his sleep, your doctor may be able to recommend an over-the-counter antihistamine (like Benadryl) to help your child get to sleep. If this doesn't help, the best bet may be to try another ADHD medication or to avoid medication after about 4 p.m.
As always, talk to the prescribing physician before altering the dose or timing of any medication.
2. Your child is being placed in situations that lack structure or adult supervision
Even the best-managed child with ADHD can have trouble in such situations. Look for ways to add structure. If trouble tends to arise as your child moves between classes at school, arrange for an adult to accompany your child. Art, music, and physical education classes are often less structured, so they can be problem areas. Ditto for field trips and playground time. Maybe trouble comes when a substitute teacher changes the routine or a baby-sitter fails to set limits.
Once you understand the reason for the problems, work out a solution. You might offer to go along on a field trip to add adult supervision, for example, or remind babysitters why it's important to follow familiar routines. (Are there any older siblings of kids you know who have ADHD? They often make great baby-sitters for ADHD kids.)
3. Your child feels anxious as a result of academic difficulties
Half of all kids with ADHD also have learning disabilities. If your child is one of these, make sure that both problems are adequately addressed. Otherwise, your child may still have trouble keeping up in school, no matter how effectively his ADHD symptoms are controlled.
Academic difficulties can impair social interactions and trigger disruptive behavior - and cause the child to avoid difficult tasks (including homework). And it's all too easy for parents and teachers to attribute these behaviors to AD/HD, when the real problem might be a learning disability.
4. Your child is troubled by emotional stress
No household is tension-free, but turmoil at home can cause emotional problems - and children are often the first to show a reaction. If you suspect that your child's problems are being caused by marital discord, financial problems, or some other trouble within the family, sit down with your spouse and discuss ways to limit the impact of stress on your child. For starters, try not to let your child witness conflict between you and your partner. If the stresses are too great, or if you and your spouse disagree on what to do, consult a therapist.
As parents, we strive to love our children unconditionally. But when your precious child turns into a little monster, parental love may quickly give way to frustration and anger. If you work to uncover the reasons for your child's misbehavior - and find a fix - you'll be the loving parent you want to be.