The fundamentals of ADHD behavior therapy are easy to understand and implement, even without the help of a therapist.
Have you ever given your child a time-out for talking back — or a heads-up before taking him someplace that is likely to challenge his self-control? Then you already have a sense of how behavior therapy works in parenting ADHD children.
“A lot of behavior modification is just common-sense parenting,” says William Pelham, Jr., Ph.D., director of the Center for Children and Families at the State University of New York at Buffalo. “The problem is that none of us were trained how to be good parents, and none of us expected to have children who needed parents with great parenting skills and patience.”
The basic idea is to set specific rules governing your child’s behavior (nothing vague or too broad), and to enforce your rules consistently, with positive consequences for following them and negative consequences for infractions. Dr. Pelham suggests these seven strategies for better ADHD behavior:
1. Make sure your child understands the rules.
Telling a child to “do this” or to “avoid doing that” is not enough. To ensure that your child knows the rules cold, create lists and post them around the house. For example, you might draw up a list detailing the specific things your child must do to get ready for school.
Make sure the rules are worded clearly. Go over the rules to make sure he understands, and review them as necessary. Stick with the routines until your child has them down.
2. Give clear commands.
First, say your child’s name to make sure you have his attention. Then tell him exactly what you want him to do. If you’re in the checkout line at the grocery store, for instance, you might say, “Steve, stand next to me and do not touch anything.” It’s not enough to tell your child to “be good,” because he may not know what that entails. Finally, state the consequences for disobeying the command—and always follow through.
3. Don’t expect perfection.
Strike a balance between praising your child and offering criticism. A good rule of thumb is to praise your child for doing something well at least five times as often as you criticize bad behavior.
You’ll only set your child up for failure if you expect immediate and perfect results. Instead, focus on rewarding small steps—and gradually work your way toward the desired outcome.
If you notice that you are criticizing too much, lower your standards a bit. You’ll only drive yourself—and your child—crazy if you nitpick.
4. Use “when/then” statements to encourage good behavior and reward your child.
If your child asks for permission to do a desirable activity before completing his chores or assignments, say, “Yes, when you finish cleaning the garage, then you can go out with friends.” With younger children, it’s important that the rewarding activity take place immediately after the chore or assignment is completed.
5. Set up a point/token system for rewards and consequences.
One effective system for encouraging your child to comply with your commands involves a jar and a supply of marbles. Each time your child does what you ask, put a marble in the jar. Each time he doesn’t, take two marbles out of the jar. At the end of the day, he earns a small reward based on the number of marbles that remain in the jar, and then starts over again.
6. Tweak your discipline techniques as your child gets older.
Certain measures, including time-outs, may not work as well with tweens and teens as they do with younger kids. If your high-schooler breaks a rule, you might give him a five-minute chore — such as straightening up the family room—rather than a five-minute time-out.
With older children, it’s useful to negotiate the terms and rewards for good behavior. For example, your child may request access to the family car or time spent with friends if he is helpful around the house and does well at school.
7. Ask your child’s teachers to set up a similar behavioral system at school.
One of the best tools for parent-teacher cooperation is the daily report card. Meet with the teacher to determine desired classroom behaviors—“completing assignments within the designated time” or “contributing to discussion.” At the end of each school day, the teacher can fill out a quick evaluation of your child’s adherence to these behavioral goals, and send the document home with the child. Reward him for a good day at school with time to play outside or control over the car radio.
If your child is in middle school or high school, ask his guidance counselor to discuss a daily report card with all of your child’s teachers. Use pages in her assignment notebook for the daily reports.
Many parents incorporate these strategies into family life without professional assistance. If you are having trouble achieving the results you seek, consider signing up for a parent-training program. A typical program consists of two-hour sessions, in which a therapist works with parents—typically in a group setting—to give them the support and guidance they need to cultivate good behavior.
ILLUSTRATION: Orin Bliss Brecht