Why Your Child Refuses ADHD Help: Understanding the 6 Stages of Change
Parents and professionals offer many useful, productive, well-intentioned ADHD treatment tools. Oftentimes, though, children (and adults) refuse or dismiss the suggestions and strategies designed to help them. Why? The Transtheoretical Model helps us understand an individual’s willingness or resistance to change — and adjust accordingly.
There is no shortage of perfectly good ADHD treatment options — each one of which is absolutely useless if you try to hand it to someone with a closed fist. So, as caregivers or professionals, how do we get that fist to open?
First, remember that many people with attention deficit disorder (ADHD or ADD) struggle with executive functions such as emotion management, self-regulation, attention, time management, and the ability to reflect on efficacy — essentially, the skills that influence our ability to change. To better understand why your child or your client doesn’t utilize the ADHD treatments or coping tools you’ve offered, you must first understand:
- The Transtheoretical Model and how to determine someone’s readiness to change
- How you can actually facilitate change by meeting someone where he is
The Transtheoretical Model (TTM)
Developed from more than 35 years of scientific research, Dr. James Prochaska’s model defines the following stages of change:
- Pre-contemplation: “I can’t/won’t do this!”
When someone refuses to even consider change, your best strategy is to show him empathy and normalize the situation. Instead of driving him into an even more defensive posture, frame his challenge or frustration as understandable; this removes the stigma and helps the individual feel less overwhelmed or embarrassed. In this stage, you might say: “Of course, lots of kids love their video games, and I’m sure I would if I were your age! I’m not trying to force you to quit, just for you to play the game without the game playing you.”
- Contemplation: “I might do it, but I’m not sure when.”
Contemplators can deceptively look as if they’re on their way to making real changes. but then surprise us by suddenly quitting. Encourage them to use a decisional balance sheet: a four-stage process of weighing pros and cons (see below). This method takes into account resistance and helps shift from a default setting to conscious choice. In this stage, you might say: “I know you’re feeling mixed emotions about whether to put some structure into your gaming schedule. This chart will give you the information you need to make a good decision.”
- Preparation: “I definitely will try.”
At this stage, conviction sets in, and your child or patient decides she will make the change happen soon. Here, suggest that she experiment by just changing one small thing in preparation for the bigger change. In addition, make sure she has the right resources lined up. In this stage, you might say: “Now that you’re ready, what’s the best way to keep you on track? Would phone reminders help or scheduling the gaming for a particular time?”
- Action: “I’m doing it! I’m into it.”
Once the change has been initiated, your role as a parent or professional is simply to check in and offer time-management tools to stay on track when helpful. In this stage, you might say: “You might try an app that tracks your consistency on this awesome habit you’ve been developing. You might enjoy seeing your progress.”
- Maintenance: “I’m still doing it.”
You’ll witness a confidence and shift in image once the change becomes a regular, habitual occurrence. Be aware of and help him be aware of the normalcy of occasional backsliding. In this stage, you might say: “Nobody bats a thousand. If you miss a day, let it go and get back to the habit.”
- Bonus Stage: Graduation
Here, people “graduate” to a new self-concept in which they believe they can change anything they want. They might even help other individuals make the same change. In this stage, you might say: “Do you remember how hard it was at first to change that habit? I do. You never have to change anything unless you want to, but it’s nice to see that you can.”
- Pre-contemplation: “I can’t/won’t do this!”
Decisional Balance Sheet
STEP ONE STEP TWO Benefits and Advantages of Things Staying the Same
Helps me relax, something fun to do with my friends
Costs of Things Staying the Same
Up really late playing, hard to stop playing most of the time, don’t want to try new things or meet new people
STEP THREE STEP FOUR Costs of Things Changing
Won’t have a way to destress, hard to hang out with friends if I don’t play, I’ll be bored, it’s too expensive to go out
Benefits and Advantages of Changing
Probably get more sleep, easier to get to class on time if I don’t play in the morning, get out of my room more, could meet new people?
How to Progress Through the Stages of Change
I recommend moving through the stages of change with your child or client by taking the “I do, we do, you do” approach.
- “I do” involves modeling and showing how you would solve the problem, thinking aloud, or even giving direct instructions.
- “We do” requires taking a step back while still remaining involved. You’re checking in with questions like, “How’s that going for you?” or “What do you think the next step should be?”
- “You do” requires stepping further back and providing feedback if they’d like it and then letting them assume full responsibility.
Often, there are good reasons why our kids or clients won’t use the tools and strategies we try to hand to them. Using these respectful approaches allows people to grow and change at a pace that works for them. While more controlling tactics may yield some immediate short-term results, long-term ownership of the goals and increasing independence only occurs when a person goes through the change process on their own terms.
Michael Delman, CEO, is the founder of Beyond Booksmart, the largest executive function coaching company in the country. The information for this article was adapted from his CHADD presentation titled “Why Interventions Fail: Applying the Science of Behavior Challenge for Students and Adults with ADHD.”
Updated on June 6, 2019