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When Your Grandchild Has Attention Deficit Disorder:
by Glenn Brynes, MD & Carol E. Watkins, MD

Grandparents have always had an important role in the life of a child or adolescent. When the child's parents work outside the home, a grandparent may be the daytime caregiver. In some cases, when the parent is unable to care for a child, the grandparent functions as a parent. Some grandparents live far away from their grandchildren, and may only see them a few times each year. In all of these situations, the grandparent has a special meaning to the child and can influence the child's self-esteem.

When grandparents hear that a grandchild has been diagnosed with ADHD, they may not know what to do or say. First, they should educate themselves about the different types of ADHD. ADHD (attention deficit hyperactivity disorder) is sometimes also called attention deficit disorder or ADD. ADHD has three basic features. These are:

• Inattention (distractibility, daydreaming or "spacing out")
• Physical hyperactivity (fidgetiness, running about, often switching tasks)
• Impulsivity (acting without thinking…later regretting it)

Children with Inattentive ADHD have trouble paying attention but may not show the physical hyperactivity or the impulsivity. This type is more common in girls but can be seen in boys too. Combined ADHD involves inattention along with hyperactivity and/or impulsivity. This is the classic "boy type" ADHD but some girls can show this too. These children can be creative and charming, but may require more of the parents' time and effort than other children.

ADHD is not just "bad behavior". It is a physical problem that is often inherited. Sometimes children "outgrow" or learn to manage the symptoms of ADHD as they grow up. But in many if not most cases, the condition persists into their adult life. When children are diagnosed with ADHD, it is not uncommon for their parents to recognize that they too have (or had) similar problems. Even grandparents might make similar discoveries. It helps to recognize this since symptoms of ADHD are quite often treatable in adults.

Family support is important during and after the time of the initial diagnosis. Parents may feel defensive and inadequate. They may compare themselves unfavorably to their own parents or in-laws. The nuclear family (parents and child) may experience even small remarks as judgement and react by withdrawing.

Extended family can be an important source of support, but can also be a source of tension. Grandparents and others may base their opinions on inaccurate or skewed material in the popular press. In previous generations, there was more stigma associated with mental illness and behavior disorders. If someone perceives ADHD as shameful, they don't want to think that it could appear in their family. If there were already conflicts in the extended family, the ADHD child may serve as the focal point for these simmering conflicts. Grandparents should not spank this child or tell the parents to do so. One should take special care to avoid such punishment in ADHD children because they can be impulsive. They might get the message that one can use hitting or violence to resolve conflicts. Even if gentler methods seem to take longer, they provide the child with a model of how to resolve disagreements.

Sometimes, the grandparent may see the signs of ADHD before the parents notice them. This must be approached tactfully. The grandparent should not make a diagnosis on his or her own. One might suggest discussion of the matter with the child’s pediatrician or teacher (who might recommend evaluation by a trained professional). It helps to reassure the parents that one is not making a judgement on their parenting. In other cases, it may be prudent to wait and let the parents figure it out themselves.

Childproofing may become an issue when the hyperactive ADHD child visits grandparents. Once one's children have left home, people are less likely to have childproofed houses. They may also display valuable or sentimental breakable objects on open shelves. They may have moved into a smaller home that does not have a place for children to run and play. This can present both the parents and the grandparents with a dilemma. The parents may feel on edge during the whole visit. They may feel the need to follow the child everywhere to make sure that nothing is broken. They may feel defensive about the child's behavior even if the grandparent says nothing. The grandparents may be puzzled or offended by the child's impulsive behavior and the parent's anxiety. The child may feel like the proverbial bull in a china shop.

Parents can have a more relaxing visit if they do not have to constantly worry about something being broken. There is some simple childproofing that can be done in anticipation of the active child's visit. Valuable and breakable things can be temporarily moved, or the rooms with breakables can be closed or gated off. If the grandparents have the space, a spare room can be set aside for the children. It can contain old worn furniture, children's books and some durable safe toys. If one has a yard, one can spend most of the visit outside. If these modifications are not possible, one can take the family to a park or to a "ball room." Talking while going on a walk can help the child discharge enough of their energy that they may be able to carry on a conversation. Television and videos will frequently hold the attention of even a very hyperactive child. However, they will also cut down on meaningful communication between the child and grandparents. Use videos as a last resort. The child might teach the grandparent how to play an interactive video or computer game.

When a child is having behavioral problems, misunderstandings and defensiveness are common. Often a frank, non-judgmental talk can help dispel misunderstandings. Avoid comments such as "None of my children did that." "It would go away if you disciplined them more.". In the past, many children with ADHD went undiagnosed. Some of their parents instinctively came up with their own structured behavior plans. The trick is to bring this up without being perceived as intrusive or judgmental. One might say, "You know, your husband was like that when he was a boy. He was a great kid, but sometimes it was tough. I know things are different today, and you have to figure out your own way to do things. If you ever want to know how we handled it, let me know."

Grandparents can fill an important psychological role in the child's development. The children tend to perceive the grandparent's acceptance as more unconditional. In some cases, the grandparent can be a source of advice and comfort for the parents. A child with ADHD may sometimes have more than the average amount of conflict with his or her parents. The child may feel different from his or her peers. In such situations, the grandparents may provide a loving time of respite and understanding for the child. During adolescence, the individual pulls away from parents but may still maintain closeness to the grandparents during times of family conflict.

Ultimately the most important for both parents and grandparents to do is to instill in the child a positive self-esteem and an attitude of responsibility and mastery. The entire family including the child should be encouraged to learn all they can about ADHD. With appropriate help, children can learn how to manage their own symptoms better. Even with a physical condition like ADHD, it is the child’s responsibility to learn as best he or she can to "fit in" to the world.

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