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Practical Strategies for Parenting ADHD

Wish you could just roll with the ADHD in your family?

Need practical strategies to deal with the day to day parenting of a child with ADHD? Sign up today for this FREE learning series from BC Children's Hospital.

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“I can’t thank you enough for this. I have not found many resources as practical as this. I can
honestly say that I am sad to complete the videos because I have found the information so
helpful and I feel such a sense of support by watching them.”
– Rolling with ADHD Participant

What is Rolling with ADHD?

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Raising a child is one of the hardest jobs out there. Parenting a child with ADHD is even tougher. We often tell parents that they need a ‘black belt’ in parenting when they have a child with ADHD. That is why we decided to bring together psychologists from the ADHD Clinic at BC Children’s Hospital and caregivers to provide you with support.

Rolling with ADHD is an eight module series that covers practical tools and strategies for caregivers of children with ADHD. This series has been adapted from the long standing in-person program at BC Children’s Hospital, and  includes what research show really works for kids and families living with ADHD.

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“I really enjoyed the module format. It was visually easy to follow.
It was great to gain insight into my child’s behaviors and to know what is normal for children with ADHD.
This has helped improve our relationship with our child. We are much more positive.
Thank you very much for this helpful resource!
– Rolling with ADHD Participant

This series is for you if:

  • You have a child with ADHD between the ages of 6 and 12.
  • You want to reduce conflicts about daily routines.
  • You want to understand how to make your parenting more effective.
  • You want to work with your child, not against them.
  • You want to help support your child’s successes.


“This is an amazing resource, and I have already recommended it to many parents.
I wish I had found it sooner.
– Rolling with ADHD Participant

How It Works

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Directions-InfographicV2
Ignoring-InfographicV2
Workbook
Incentives-Infographic
self regulation-InfographicV2
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Sign up for the course! Click the ‘Register’ button below to register for the course. You will receive access to the full eight-module course.

Short and impactful content – we know you’re busy!  Each module includes 15-20 minute video with activities to help you remember the key information and to think about how to apply the strategies to your family.

Focus on real life – You’ll be invited to reflect on how you have been approaching different issues with your children and how to start making adjustments.

Absolute Privacy – You’ll have a safe, secure space to interact as little or as much as you want with the course material.

Our unique learning system allows you to create notes, make reflections and journal your progress in total privacy. The program also provides you with downloadable resources and a window into how other parents are approaching the everyday issues you face. You are not alone!

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“Thank you for a concise, practical and credible course.
There is so much information out there – credible and not – that it can be overwhelming, so I was quite grateful for this.
– Rolling with ADHD Participant

Your Guides:

Dr. Candice Murray,
Registered Psychologist

Dr. Candice Murray is a registered psychologist who practices in the area of ADHD. She is the former Director of the Provincial ADHD Program at BC Children’s Hospital and is a Clinical Instructor in the Department of Psychiatry at the University of British Columbia. …read more

Dr. Daphné Dokis
Registered Psychologist

Dr. Daphné Dokis is a Registered Psychologist who works with children, adolescents and their families In the ADHD Clinic and in her private practice. Over the past 10 years, Dr. Dokis has developed expertise supporting families with ADHD and other challenging behaviours. …read more

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Thank You!

Made possible by the generosity of the Lu Family

Rolling with ADHD logo

Dr. Murray works in the ADHD Clinic at B.C Children’s Hospital and in private practice. Dr. Murray has published research articles and reviews on ADHD. She is frequently an invited guest speaker at provincial and national conferences on ADHD.  Dr. Murray lives in Vancouver, B.C with her husband, two children, and two cats. The program is much less effective with cats than children.

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She has greatly benefitted from practicing those tools on her family first… although she’s not sure yet if they appreciate it!

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Schizophrenia:
Many SGAs are indicated as a first line therapy for schizophrenia in adolescents and for the positive symptoms of psychotic disorders in general. SGAs treat active psychosis as well as decrease relapses if remission from active symptoms is achieved.

Depression:
SGAs are not indicated for treatment of depression in adolescents unless a psychotic depression was present. For a depression without psychotic symptoms, first line treatment is an SSRI antidepressant. The potential side effects of SGAs and lack of clinical evidence supporting efficacy of SGAs in depression in adolescents without psychotic symptoms are both reasons SGAs would not be prescribed for this condition.

Bipolar Disorder:
Some SGAs are indicated for treatment of bipolar disorder in adolescents. They stabilize mood as well as treat psychotic symptoms associated with mania. SGAs can be used alone or in combination with mood stabilizers to treat bipolar disorder. Often they are used in combination with mood stabilizers especially to stabilize mania in its initial phase as the mood stabilizers are titrated up.

ADHD:
SGAs are not indicated to treat ADHD. They are sometimes used in conjunction with expert consultation for off-label, preferably third-line use, for short-term treatment for significant irritability and explosive emotions/behaviours while stabilizing on first-line and/or second-line treatment. First-line treatment for ADHD includes monotherapy with long acting stimulants; second-line treatment includes short-acting stimulants, atomoxetine, or guanfacine XR (alone or in combination with long-acting stimulants). Third-line treatments include clonidine (monotherapy or in combination with stimulants), bupropion or noradrenergic tricyclic antidepressants. Comorbidities should be treated with first-line treatments specific to the individual condition.

Eating Disorders (AN, BN, ARFID):
SGAs are primarily prescribed for symptom management in severe eating disorders in children and adolescents. There are mixed results for enduring effects on weight restoration and any potential benefits are balanced with the well-established risks. For treatment of AN, there are limited positive open-label studies with the use of olanzapine. Quetiapine and aripiprazole have even fewer studies with mild benefit noted at times. Risperidone does not have evidence for use in AN. Olanzapine has limited positive reports for use in ARFID. Use of SSRIs, specifically fluoxetine, has the most evidence for bulimia nervosa, in which high doses are demonstrated to reduce purging behaviour. There are risks for increased binging with SGAs in BN. SGAs are sometimes used off-label to help with emotional and behavioral regulation or depression and anxiety symptoms, but experts should be consulted prior to initiating treatment. Comorbidities should be treated with first line agents (NOTE: bupropion is contraindicated in eating disorders secondary to increased seizure risk).

1. Weight gain management guidelines:

Situation 1:

Normal weight gain associated with growth and development

Recommendation: Repeat weight measurement at next scheduled screen. Provide information on the importance of lifestyle for decreasing risk of weight gain.

 

 

Situation 2:

Significant weight gain noted, especially within first three months of medication use and/or child is overweight, obese or has pre-existing metabolic conditions prior to starting SGA treatment

Recommendation:

1.Lifestyle intervention

Second generation antipsychotic medication use in children and youth is associated with weight gain and metabolic complications. It is therefore strongly recommended that patients receive counselling (nutrition, lifestyle and exercise) at the initiation of therapy regardless of baseline body mass index. This is particularly important in a child who is overweight, obese or has existing metabolic symptoms prior to treatment with a second generation antipsychotic medication.

2. Re-evaluate use of SGA to minimize weight gain

Consider the following questions:

  • Is the lowest effect dose being used? In particular, higher doses of risperidone and olanzapine have been associated with greater weight gain in children.
  • Can an alternative SGA be prescribed that has a lower side effect profile for weight gain?
  • Is the patient taking other medications that also cause weight gain? If yes, can they be stopped, reduced or altered?

1. Abnormal prolactin management guidelines:

Elevations in prolactin levels may be associated with signs and symptoms such as gynecomastia, galactorrhea, infertility, menstrual irregularities, oligomenorrhea, amenorrhea, sexual dysfunction, decreased libido, acne and hirsutism in females. However, hyperprolactinemia may be asymptomatic in some individuals, particularly in prepubertal children.

Situation 1:

Normal Prolactin

Recommendation: Repeat prolactin measurement at next scheduled screen.

Situation 2:

Abnormal Prolactin

Recommendation: Re-evaluate use of SGA:

  1. Is the lowest effective dose of the SGA being used?
  2. Can the SGA be switched to a prolactin-sparing agent, which can result in return to normal levels of prolactin within weeks?

If continued treatment with the current SGA is essential for the patient’s psychiatric illness, consult with a specialist regarding further management of the hyperprolactinemia. There are potential long-term effects of hyperprolactinemia, particularly osteoporosis, even in asymptomatic patients. This is concerning given the importance of bone mineral accrual through adolescence with peak bone mass occurring in late adolescence.

If there are clinical concerns, consider specialist consultation for further investigation regarding other causes of hyperprolactinemia and/or amenorrhea.

2. Abnormal lipid fasting profile – triglycerides management guidelines:

B. Fasting lipid profile — Triglycerides

Situation 1:

Normal TG < 1.5 mmol/L

Recommendation: Repeat TG measurement at next scheduled screen.

Situation 2:

Normal TG ≥ 1.5 mmol/L

Recommendation: Re-evaluate use of SGA to minimize weight. Consider cognitive/behavioural lifestyle intervention aimed at weight loss. Consider consultation with specialist if TG ≥ 5 mmol/L for possible medical therapy.

1. Weight gain management guidelines:

Situation 1:

Normal weight gain associated with growth and development

Recommendation: Repeat weight measurement at next scheduled screen. Provide information on the importance of lifestyle for decreasing risk of weight gain.

 

 

Situation 2:

Significant weight gain noted, especially within first three months of medication use and/or child is overweight, obese or has pre-existing metabolic conditions prior to starting SGA treatment

Recommendation:

1.Lifestyle intervention

Second generation antipsychotic medication use in children and youth is associated with weight gain and metabolic complications. It is therefore strongly recommended that patients receive counselling (nutrition, lifestyle and exercise) at the initiation of therapy regardless of baseline body mass index. This is particularly important in a child who is overweight, obese or has existing metabolic symptoms prior to treatment with a second generation antipsychotic medication.

2. Re-evaluate use of SGA to minimize weight gain

Consider the following questions:

  • Is the lowest effect dose being used? In particular, higher doses of risperidone and olanzapine have been associated with greater weight gain in children.
  • Can an alternative SGA be prescribed that has a lower side effect profile for weight gain?
  • Is the patient taking other medications that also cause weight gain? If yes, can they be stopped, reduced or altered?

2. Fasting plasma glucose and insulin complications management guidelines:

Situation 1:

Normal FPG = FPG < 6.1 mmol/L

Recommendation: Repeat FPG check at next scheduled screen. If the fasting insulin is above the upper limit of normal for the assay being used, consider an oral glucose tolerance test (OGTT) and specialist consultation. For those individuals with an FPG value of 5.6 to 6.0 mmol/L, consider an OGTT.

Situation 2:

Impaired FPG = 6.1 to 6.9 mmol/L

Recommendation: Consider OGTT and specialist consultation if abnormal. Consider metformin in consultation with a specialist.

Situation 3:

Abnormal FPG = FPG ≥ 7 mmol/L

Recommendation: Consult with specialist for the management of diabetes.

Situation 1:

Normal weight gain associated with growth and development

Recommendation: Repeat weight measurement at next scheduled screen. Provide information on the importance of lifestyle for decreasing risk of weight gain.

 

 

Situation 2:

Significant weight gain noted, especially within first three months of medication use and/or child is overweight, obese or has pre-existing metabolic conditions prior to starting SGA treatment

Recommendation:

1.Lifestyle intervention

Second generation antipsychotic medication use in children and youth is associated with weight gain and metabolic complications. It is therefore strongly recommended that patients receive counselling (nutrition, lifestyle and exercise) at the initiation of therapy regardless of baseline body mass index. This is particularly important in a child who is overweight, obese or has existing metabolic symptoms prior to treatment with a second generation antipsychotic medication.

2. Re-evaluate use of SGA to minimize weight gain

Consider the following questions:

  • Can the medication be stopped? Give strong consideration if severe side effects are encountered.
  • Is the lowest effect dose being used? In particular, higher doses of risperidone and olanzapine have been associated with greater weight gain in children.
  • Can an alternative SGA be prescribed that has a lower side effect profile for weight gain?
  • Is the patient taking other medications that also cause weight gain? If yes, can they be stopped, reduced or altered?