Rummaging through an old box of holiday decorations, I found a photograph that evoked a Christmas memory. The photo shows our twin boys crying in unison with unrestrained toddler terror, sitting on Santa’s knees, surrounded by brothers, sisters, dogs, elves and giant candy canes. It was just a warning of what was to come.
I was already tired from a night on-call and a full day at the office before Christmas Eve. My wife had added decorating, buying, wrapping and mailing gifts, and attending school and church performances to her everyday chores of preparing meals, cleaning, errand running, and caring for our six children and me. As the night unfolded after opening gifts at our in-laws' house, I found myself struggling to attach the wheels on the red Little Tikes Cozy Coupe while she was stuffing stockings. I suddenly saw the flash of a pajama leg streaking across the stair landing. Investigating, I found all the children in the same bedroom in various stages of consciousness and agitation from the frenetic energy of their brother with attention-deficit/hyperactivity disorder racing in excited circles around them and talking a mile a minute.
After carting everyone back to their beds, I was able to calm him down enough for us both to go to sleep for a while. Despite repeated instructions to not go downstairs until the clock showed 7 a.m., he appeared at our bedroom every hour through the long night to ask us whether it was time yet. Although the next 24 hours are still hazy, I remember wrapping paper everywhere, laughing and crying, a fistfight and a bloody nose. I also dimly recall a dangerously tilted Christmas tree with half the lights out, burned cinnamon rolls, angry words, slammed doors and a really bad headache that lasted the whole day.
ADHD can throw any family off track, especially during the holidays -- even experienced parents like me, a behavioral pediatrician, and my wife, a pediatric ICU nurse. The excitement and anticipation in the air during the Christmas season will almost always stimulate the hyperactive, inattentive and impulsive symptoms of children with ADHD, like it did with my son. Things can quickly get out of control.
As the holidays continued over the years, we found that one solution within parental control was the development of a timetable of specific tasks to help manage transitions and minimize meltdowns. The key is to establish vacation routines for taking medication, going to bed, eating breakfast, controlling electronics use and returning to school.
Here is a checklist of suggestions to help your family cope with ADHD effects during the holidays.
1. MEDICATION: If your child is taking medication, you may want to consider continuing to give the regular dose at least close to the same time every day. This strategy eliminates the possibility of headaches, stomachaches or the unsettling sensation of rapid heartbeat, which can occur when medication is missed and later restarted. ADHD affects life at home as well as school.
2. WAKE-UP TIME: During the holidays, many children sleep later thanks to more physically active days and relaxed bedtimes. It is best to keep your child on a daily wake-up time within one or two hours of their regular school alarm time. Unless they are young and usually take a nap during the day, snoozing other than at regular bedtimes should not be allowed.
3. BREAKFAST: A regular high-calorie, protein-rich breakfast at home ensures that the child gets crucial calories needed to avoid mood changes because of blood sugar shifts. Also, if they are taking medication in the morning, breakfast is important because the stimulants cause appetites to wane around lunchtime. Weight loss, afternoon headaches and stomachaches triggered by blood sugar shifts can be avoided if your child is in the habit of eating breakfast at home every day. Additionally, the early-morning hunger pangs help arouse your child for the scheduled wake-up time.
4. SLEEP: A bedtime regimen should be followed that includes a quick snack to maintain weight and the elimination of all electronics (games, computers, YouTube, phones, etc.). If needed, a low dose (3-5 mg) of melatonin can be given around one hour before bedtime. This natural hormone peaks in the late evening in everyone to ease the transition into sleep, even if no signs of sleepiness are noticed. Higher doses may actually interfere with normal sleep patterns. Sleeping pills of any kind should hardly ever be given to children with or without ADHD.
5. MORE SLEEP: Research has shown that light interferes with sleep onset, the most common problem for children and adolescents with ADHD. A darkened room works best, in addition to eliminating the fluorescent screens of television or handheld electronics. Although the TV seems to be the most commonly used sleep aid, it is a troublesome trade-off for parents. The changes in contrast and volume interrupt sleep stages, triggering late-night awakenings when the TV or game is mysteriously turned back on, the refrigerator door is opened, or appearances are made in the parent’s bedroom. Sound machines, white-noise phone apps or fans are a better substitute, according to your child’s choice. Establishing and maintaining a good night’s sleep is essential. No amount of medication, special educational strategies, or behavior modification of rewards and consequences will work if the child is exhausted and irritable because of sleep deprivation. Persistent ADHD insomnia in adults can wreak havoc on jobs and relationships.
6. COMMUNICATE WITH THE SCHOOL: The end of the year marks the halfway point of the school year. This is a key time to arrange a parent-teacher conference. Teacher Vanderbilt Assessment follow-up forms, a psychological assessment tool for ADHD symptoms, provide a scale to rate attention and hyperactivity, performance in academics, organization, assignment completions, interactions with classmates, and disruptive behavior. This conference also encourages communication between parents and teachers about the educational strengths and weaknesses of your child. Plans to implement and evaluate strategies to manage learning or behavior problems should be made. Classroom success depends on the child, the personality and attitude of the teacher and classmates, and the challenging curriculum and social changes that predictably occur in the transitions to third grade, middle school and high school. It is the responsibility of the parent to commit the time and effort to establish a cooperative, communicative relationship with every teacher every year.
There is a happy ending to our story: Over time, with a lot of love and trial and error, things did come together for our family. Keeping up these routines during the holidays can deliver the best present of all — a happy and semi-peaceful holiday season and a new year with a little less blood, sweat and tears.
James M. Lewis is a professor of pediatrics at the Joan C. Edwards School of Medicine at Marshall University and is a practicing physician seeing more than 150 new ADHD patients annually.