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Areas › Focus, starting, and ADHD › Getting assessed and diagnosed
Star charts fail with these children because the reward was never the point of the behaviour. What helps is a proper course of parent management training, taken in order, with calm limits practised until they are boring. Say plainly to parents that this is not a punishment for having parented badly. Most of them have never been told such programmes exist at all.
'had you been harsh, or hard-hearted, they would have dispersed and left you' (Quran 3:159). Heavier pressure tends to scatter people rather than reach them.
آل عمران
فَبِمَا رَحۡمَةࣲ مِّنَ ٱللَّهِ لِنتَ لَهُمۡۖ وَلَوۡ كُنتَ فَظًّا غَلِيظَ ٱلۡقَلۡبِ لَٱنفَضُّواْ مِنۡ حَوۡلِكَۖ فَٱعۡفُ عَنۡهُمۡ وَٱسۡتَغۡفِرۡ لَهُمۡ وَشَاوِرۡهُمۡ فِي ٱلۡأَمۡرِۖ فَإِذَا عَزَمۡتَ فَتَوَكَّلۡ عَلَى ٱللَّهِۚ إِنَّ ٱللَّهَ يُحِبُّ ٱلۡمُتَوَكِّلِينَ
By an act of mercy from God, you [Prophet] were gentle in your dealings with them- had you been harsh, or hard-hearted, they would have dispersed and left you- so pardon them and ask forgiveness for them. Consult with them about matters, then, when you have decided on a course of action, put your trust in God: God loves those who put their trust in Him
Qur’an 3:159read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A nationally representative United States survey found public understanding of children's mental health problems, and of where to go for help with them, to be uneven. That helps explain how long families go without practical direction. It describes what the public knew rather than testing any programme, so take it as a reason to be explicit with parents about their options rather than as evidence for one option over another.
Pescosolido BA, Jensen PS, Martin JK, Perry BL, Olafsdottir S, Fettes D. (2008). Public knowledge and assessment of child mental health problems: findings from the National Stigma Study-Children.. Journal of the American Academy of Child and Adolescent Psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
If the behaviour is about control rather than reward, adding more reward or more loss just feeds the argument.
If there is any suggestion of harm at home, that comes first and follows its own safeguarding route.
Ask what they think this will cost them in effort, then say what you think. People rarely give up because a strategy failed. They give up because it turned out to be harder than anyone had told them.
When a child with attention difficulties is also at war with every instruction, that pairing is worth taking to someone early rather than waiting to see whether it settles.
Where a relative has taken ADHD medication, take the details: who they are to your patient, what they were given, what it did, and what was tried and dropped. Then put it in the referral letter.