Behavior Therapy, Part 2
A plan that works
When you understand that your child can't get it all right all the time, you're ready to shape her therapy. To this end, Weiss suggests asking yourself the following three questions:
- What do I want my child to do that she isn't doing?
- How can I relay my instructions in a visual format (so I won't have to tell her what to do)?
- What would make it worthwhile for her to do it (i.e., something more powerful than what's on her radar screen at the moment she's engaged in inappropriate behavior)?
Set the wheels in motion at a time that demands routine — morning, when it's time to get up and dress, mealtime, or bedtime. With an older child, homework time is another option. To fulfill the visual-format component, provide a checklist of selected tasks (for a preschooler, try a picture checklist). This gives your child a reminder of what she's supposed to do and when, and relieves you of the task of constantly delivering it. It also offers a child more control over her actions, and cuts down on parental nagging (which children with ADHD tend to tune out as background noise — especially when they're overwhelmed).
If she achieves what's on the list, reinforce her positive actions with a reward. It doesn't have to be expensive. For a younger child, it might be stickers or an ice-cream cone; for a teenager, it could be extra phone or car privileges.
In his book, ADHD: The Great Misdiagnosis, pediatrician Julian Stuart Haber, M.D., explains a method he's used effectively in his practice. It involves pointing out the annoying behavior, stating the expected behavior, complimenting the improved behavior, then rewarding it. Says Dr. Haber: "If a child constantly interrupted you while talking on the telephone or with other people, you would say, 'That's interrupting. Now let's practice waiting,' without becoming angry and without otherwise responding to the child. When he waits for a few seconds or minutes, you respond by saying, 'That's very good. Now you're practicing waiting.' After a few times, offer to treat him to a milkshake. When he asks why, respond, 'Because you've done such a good job practicing waiting.'"
Bear in mind that many children with ADHD have trouble transferring what they've mastered from one setting to another. So while you may get your child to be patient when you're on the phone, he may not be able to keep from interrupting someone on the phone at your sister's house. That's why your role as your child's advocate is ongoing.
To make sure he's applying good home behaviors in school, you'll need to clue his teacher in on what you're practicing. If you've taught your son to ask "Can I join in?" before he steps into a game, pass that information along to his teacher. Another way to keep him on track is to make note cards (visual cues) to keep on his school desk. This traveling checklist might remind him to "raise your hand before you ask a question," or "write down the homework assignment before you leave the classroom." Ask his teacher to check things off his list as he completes them.
How to get ready
Parents are a lot less likely to get exasperated and give up if they see results. But when you're in the thick of it, it's all too easy to forget that even baby steps indicate that you're getting somewhere. This is one of the biggest obstacles parents face in sticking with a behavior therapy program, says Karen Miller, M.D., assistant professor of pediatrics at the Center for Children with Special Needs at Tufts-New England Medical Center in Boston. That's why she believes parents greatly benefit from professional coaching before they get started. Although many behavior modifications are common-sense parenting techniques, most parents need support to learn these skills and use them consistently. Parent training, whether individual or group-based, helps moms and dads stay with their goals even if they don't see a change for several weeks — the amount of time it typically takes for progress to begin. If parents habitually toss out a plan too soon, children learn to wait it out, perceptively realizing that they can get away with not sticking to new rules for just the time it takes the folks to throw in the towel.
The involvement of a neutral person, such as a coach, also helps to alleviate tension between partners who disagree on which behaviors to tackle — and how. Dr. Miller prefers group-based parent therapy because "it has the added benefit of helping parents feel less alone and less blamed for their kids' difficulties. They hear real-life tips from other people struggling with the same issues, learn how to make a behavior plan, and report back on how it's working. It's great stress management for them as well."
Every child is different, and it's impossible to predict what will work in any given situation. But creating a realistic behavioral plan that you can chart, getting coaching for yourself, and keeping up with your kid's performance at home and away are all fundamentally important to behavior therapy. The golden rule for every parent is to stop asking your child "why?" If kids with ADHD could answer that question, the condition wouldn't exist. Instead, live in the solution, which should include thoughtful behavior therapy. That's when you'll be on the road to your child's healing — and his and your happiness.