If your child has been diagnosed with attention deficit disorder (ADHD), chances are, your physician has discussed or prescribed ADHD drugs. You may also have learned that behavioral therapy, also called behavior modification, may be helpful. As you try to figure out the best treatment for your child, bear in mind that these two therapies are not mutually exclusive options. In fact, they often work best together in solving ADHD behavior problems.
This is clearly shown by the landmark National Institute of Mental Health's (NIMH) Multimodal Treatment Study of Children with ADHD. NIMH found that medication therapy alone, and medication and behavioral therapy together, resulted in the greatest improvement in children's ADHD symptoms. In addition, the combination treatment worked best in improving ADHD-associated oppositional behaviors, as well as other areas of functioning, like interactions with parents and school.
Even if you opt for behavioral therapy alone — you've decided on a non-medical approach, your child's too young for medication, or suffers bad side effects from it — your child can learn behavior, social, and academic skills that will be useful in managing ADHD throughout his life. Most children don't get diagnosed until school age, so if you suspect your child has ADHD before then, it's nearly always helpful (and never harmful) to treat him behaviorally as though he has the condition.
It's about focus
What is behavior therapy, and how can a parent use it on its own or as a component of combined treatment? While medication works on a neurological level to regulate the brain (kids with ADHD often have irregular brain-wave levels), behavior therapy addresses specific problem behaviors by structuring time at home, establishing predictability and routines, and increasing positive attention.
This may seem like a tall order, especially to the parent whose child must be reminded every five minutes to stay focused on homework. When ADHD is present, the most basic strategies can be a huge challenge to implement on a day-to-day basis. This is why Sharon K. Weiss, author of From Chaos to Calm: Effective Parenting for Challenging Children with ADHD and Other Behavioral Problems, recommends that parents narrow their focus. Tackling too much at once will only frustrate a child who has trouble simply remembering to put on both of his shoes in the morning.
To figure out what to work on first, Weiss suggests asking yourself: What does my child need to do so that he can participate successfully in life? When you apply this litmus test, certain things will emerge as more essential than others. "The school doesn't care if the child's bed is made, but they do care if he shows up buck naked," says Weiss. While many therapists and educators talk about creating a "behavior plan," she asserts that this need not be intimidating. The plan should simply include three basic components: a narrow focus on essentials, documentation, and a commitment to note and reward improvement when it occurs.
If you identify getting to school on time as a top priority, you have a single goal to work on and easily measure progress for — progress-tracking being another important part of behavioral therapy. If your goals are too diverse (going to bed at a certain time, being dressed impeccably in the morning by 8, doing homework immediately after school, and remembering to take the trash out), you probably won't be able to notice and keep track of your child's accomplishments. "You can't tell him he needs to be downstairs at a certain time each morning and then, when he succeeds in doing that, ask him why he forgot to comb his hair," says Weiss. When success isn't noticed and complimented, a child with ADHD feels increased frustration and lower self-esteem. He probably won't achieve even one of the things you've asked of him, let alone all of them.
How to get real
Once you've chosen key behaviors to work on (say, getting to bed on time or not interrupting someone else when they're speaking), you then must be clear — and realistic — about your expectations and what you're going to look for. First, ask yourself if your child has the skills to accomplish what you ask of her. For instance, if she typically needs to be told 10 times a day not to blurt out what's on her mind when others are talking, expecting her to hold her tongue without reminders is probably not wise. Instead, set the goal to remind her a couple of times a day. Or pick a certain time of day to assess how she's doing (morning, for example), then cut her some slack if she's not performing up to par at other times.
Unlike chemically-based intervention, behavior therapy will have an up-and-down quality to it. Just because he dressed himself and was downstairs for breakfast on time and out the door for school by 8 a.m. today, doesn't mean your child will do it again tomorrow. What's important: that if prior to the behavioral therapy he was succeeding only two out of five times a week, he's now up to three. Don't hassle him the other two times.