Growing Independence: Tips for Parents of Young Children

General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

Discuss your child's treatment program with appropriate school personnel.
Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.
Schools may be willing to fax completed follow-up rating scales to your doctor's office.
Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.
Ask your child how he or she feels on the medication.
Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

PDF | Print or Share

Children Love to Learn

Open and honest communication will create a lifelong closeness with your child.
Routines and responsibilities will let your child know what to expect. When a rule is broken, a natural consequence needs to follow.
As you teach your child how to be independent, you also need to teach how to be safe.
Learning how to be a good friend is an important skill you can teach your child.

Y our little one is starting to explore the world outside your home. This is exciting, but can be scary!

Children from 4 to 6 years old are:

Beginning to develop their independence and form real friendships.
Learning rules to more difficult games.
Developing important life skills.

Set Limits

When children do something against the rules, explain simply and in a few words:

That what they did was wrong
What will happen if the behavior continues

Consequences need to be logical, meaningful, and simple. For example:

If your child rides a bike without a helmet, the bike is off limits for a day or two.
When your child won't share a toy, that toy can't be used for the rest of the day.

Create and Keep Routines

Teach about rules by setting up daily routines. Children do best when they know what to expect.

In the morning:
- Use the bathroom
- Get dressed
- Have breakfast
At bedtime:
- Take a bath
- Brush teeth
- Read a story

Schedule specific times for TV, video games, and use of the computer.

When you know what your child is watching, you can avoid violence and other unacceptable content.

Limit “total screen time” to no more than 2 hours a day.

Read at bedtime.

This helps your child:

Settle down after a busy day
Learn how to read

Have meals together as much as possible.

This is a great way to spend time together and share family traditions, while also teaching good eating habits and table manners.

Take Time to Talk and Listen

Children feel important when adults take the time to talk with them. Talking often, and about many things, helps them gain self-confidence.

Ask about friendships and the activities that your child enjoys.

Talk about your own best and worst experiences.

Ask your child:

“What was the best part of today?”
“What was the hardest part of today?”

Let your child know that it's OK to have and talk about negative feelings. Share the best and hard parts of your day. This teaches your child that we all have ups and downs.

Assign Responsibility

When young children copy everyday household tasks, they are really learning how to contribute. With your support, tasks will soon be done with few reminders. As children grow older, they can begin to take on real responsibilities, such as:

Setting the table
Putting away their toys
Feeding the pets
Placing dirty clothes in a basket

Watch your child's self-esteem grow when given the chance to help out.

Encourage Independence in Dressing and Bathing

At first, this may take a little more time than helping your child get dressed or take a bath, but it is time well spent. Independence comes with practice, and with your guidance.

If you get the clothes ready the night before, the morning routine will involve only getting dressed. This way, your child can focus on just one thing.

Your child may need to be reminded of all the steps.

“In the morning, when you get up,
First, use the bathroom,
Then, take off your PJs,
And then, put on your clothes.”

Praise your child's efforts and successes:

“You did a great job getting yourself ready for school today!”

Teach Simple Rules about Safety with Adults

Keeping children safe is an important job for parents. You want your child to respect and trust others, but you also need to teach your child to be careful.

Following are some simple rules and ways that you can start a conversation with your child about different safety issues.

“If you’re not sure, ask me.”

“If an adult asks you to do something that you’re not sure is OK, always ask me first. I won't get mad at you for asking.”

“No secrets.”

“No one should ever tell you to keep a secret from me—one that might make me mad if I found out. Adults should never expect you to do this.”

“Certain body parts are private.”

“No adults (except parents, doctors, and nurses) should touch you where you normally wear a bathing suit.”

“If we get separated, find a security guard or police officer.”

“This is a very busy place. If you can't find me, find a security guard or police officer, or ask someone to help you find one. That person will help you find me.”

When you take your child to a crowded place, look around and point out the person who is there to help if you do become separated.

Help your Child Become a Good Friend

Four- to six-year-olds are learning what it means to be a friend. They will have fun times as well as arguments and hurt feelings. It can be tempting for parents to try to solve these problems themselves or by talking with the other child's parent.

Instead, guide your child to solve problems. With your help, your child can learn how to solve social problems.

1. Help your child understand the other child's point of view.

“I guess Suzie wants a turn too.”

2. Teach your child the following:

Stay calm
Do not hit, grab, or shove
Use words:
- “I get upset when you talk to me like that.”
- “I'm sad you don't want to play with me.”
- “I'm angry you took the ball from me.”

3. Stand close by and watch as the children solve their problem.

Being close by puts the children on their best behavior. This is how they begin to develop the confidence and skills to communicate honestly, calmly, and politely with others.

< Back to all behavior articles

The Text of Your Heading