Ask the Experts

Safety Comes First

Expert tips to help parents avoid some common risks to their ADHD children.

When it comes to child safety, make sure to look both ways and cross at the light
When it comes to child safety, make sure to look both ways and cross at the light

Little children fall and scrape their knees or bump their heads. Big kids drive too fast, and get into accidents-or experiment with drugs or alcohol. They… well, it doesn’t pay to spend too much time pondering all the risks youngsters face.

Suffice it to say that childhood and adolescence can be risky-especially if your child has ADHD. The risk increases in summertime, when kids spend more time outdoors-beyond their parents’ supervision.

Not long ago, a mother called me to say that her 10-year-old son, a patient of mine, had vanished. It was 7:00 p.m., getting dark, and Billy was nowhere to be found. She was frantic. I suggested that she call the police. At 8:00 p.m., she called back. Billy had been found, safe, at a nearby creek. He was surprised to see the police and could not understand why his mother was upset.

Billy explained that he had been unable to find a friend after dinner, and so had decided to go frog-catching. Asked why he did not tell his mother where he was going, he said simply, “I forgot.” Of course, forgetfulness was not the problem. The problem was that Billy’s ADHD medication had worn off around 6:00 p.m. He had headed for the creek on impulse.

I share this story not to scare you, but to remind you of the fact that ADHD makes kids vulnerable.

Remember, ADHD is a neurological disorder, resulting from a deficiency of specific neurotransmitters within the brain. By correcting this deficiency, medication goes a long way toward curbing impulsivity, distractibility, and hyperactivity. But, as Billy’s case illustrates, parents must be especially vigilant at those times of day when a child’s symptoms may not be fully controlled: early in the morning (before the first dose kicks in) and at the end of the day (when the last dose has worn off).

Be especially careful if your child takes a break from meds on weekends or vacations.

Of course, medication alone is not enough to protect your child. You must be alert to the dangers ADHD kids face, and provide an extra measure of structure and supervision. Here are the biggest causes of accidental injury-and strategies you can use to protect your child:

Cuts, scrapes, bruises, and broken bones

Hyperactivity might cause a young child to jump on the furniture, or run around the house without looking, maybe bumping into someone or running headlong into a sharp corner. He might climb on counters or bookshelves without thinking about how to get down. Inattention might cause your daughter to be heedless of danger.

Impulsivity is often the biggest threat. It makes your child fearless-climbing high into trees, jumping from the top of the jungle gym, and so on. It might cause your child to dash into the street or, like Billy, to wander off without telling you where he’s going.

Do your best to anticipate potential problems in all settings: home, street, playground, friends’ houses, and so on. Make sure that your child’s free play is supervised at all times by a parent, teacher, or older sibling. Don’t count on your child or teen with ADHD to remember what not to do. Someone has to remind him or her often that it is not okay to swim in the quarry or ride a bike too fast down a hill. If your child is visiting a friend’s house, be sure that a responsible grownup is there to supervise.

Put an end to your son’s jumping or running sooner than you might with another child. When walking outside, hold your child’s hand, and walk on the side that’s closer to the street. (Or simply put your child in a wagon.) Be ready to grab your daughter should she try to dart off in a mall. Yelling “stop” might not work.

If your child plays sports, make sure that standard safety rules and equipment are used. As for bike riding, set limits on where your child can ride, how fast he can go, and what tricks he can perform.

You must know at all times where your child is, what he or she is doing, and with whom. If he says, “Butt out!,” don’t back down. Hold the line on safety.

Accidental poisoning

Children with ADHD love to explore. Between their normal curiosity and their impulsive nature, they are at risk for accidental poisoning. Keep all medications, cleaning materials, bug killers, garden supplies, and so on locked up or out of reach.

Automobile accidents

Studies show that people with ADHD are less skilled than others at steering a vehicle and more likely to speed and to ignore traffic signals. Studies also show that they are more likely to be involved in accidents, including those that result in injury.

If your teenager has started driving, I urge you to learn as much as possible about his habits behind the wheel. Spend time with him in the car. Does he seem inattentive? Does she fiddle with the radio, talk on her cell phone, drive too fast, or change lanes recklessly? Ask others what they have observed. Do they say that your child shows off while driving, or that he expresses road rage?

You may have to set rules about how many young people can ride with him. You might need to forbid listening to the radio in the car. You might even require your youngster to take additional driving instruction.

Don’t be afraid to take away the keys until you’re sure your teen is ready to drive safely. Saving his life is by far more important than anything he says to you or threatens to do.

Smoking and drug abuse

Teens with ADHD are more likely than other teens to start smoking. In fact, 25 percent of these kids start before the age of 15. So it’s smart to start warning about the dangers of tobacco and other drugs around the age of 12.

All adolescents are at risk for experimenting with marijuana and other illicit drugs. Yet study after study has shown that adolescents with ADHD who receive appropriate treatment, and who are successful at school and with peers, are no more likely to abuse drugs or alcohol than other kids. The message here is clear.

Sexual activity

The combination of low self-esteem, lack of success with peers, and impulsivity can lead adolescents to exhibit poor judgment regarding sexuality.

One long-term study showed that adolescents with ADHD have more sexual partners and are more likely to contact a sexually transmitted disease. They also have more unplanned pregnancies.

Most parents are careful about what their teens do with their friends on weekends. But with more parents working outside the home, many teens are unsupervised during the after-school hours-3:00 to 6:00 p.m., Monday through Friday. Not surprisingly, this is when they are most likely to have sex, abuse alcohol or drugs, or engage in other risky behaviors. Do you know where your teen is after school?

In parting, let me remind you that many of these risks pose a threat to adults with ADHD, as well. Impulsivity can lead to a personal, financial, professional, or legal crisis. If you observe that you or your partner does not drive safely – or is having trouble with gambling, substance abuse, sexual addiction, or other problems-acknowledge the difficulty and get help.

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