How Behavioral Therapy Targets Executive Dysfunction — with Positivity and Praise
ADHD is not an excuse. But it is the neurological basis for so many of your child’s greatest executive dysfunctions — challenges that impact behavior on a daily basis. Responding to bad behavior with neurotypical parenting techniques is counterproductive because it ignores the root problem — which is why so many families use these strategies from behavioral parent training.
It is not your fault. Your child’s ADHD was not caused — or worsened — by your parenting. But you are the best person (and maybe the only one) to teach him the skills he needs to thrive because — despite the anger, frustration and impulsivity — your child really does want to please you.
This is the core premise behind behavior parent training (BPT), an evidence-based therapy that focuses squarely on addressing executive dysfunctions (the hallmarks of ADHD) in a way that corrects the core problems underlying bad behavior.
Behavior Parent Training for ADHD
How and why does BPT work for children with attention deficit hyperactivity disorder (ADHD or ADD)? It is a different approach to parenting that prioritizes positivity and finding the ‘right fit’ for your child — in other words, the parenting approach that gets your child to respond.
Developing that ‘right fit’ is important when it comes to keeping a child on track; children who find it with their caregivers are much less likely to experience severe, negative long-term outcomes. BPT recognizes that, and it also recognizes that the best fit for a neurotypical child is rarely the same as that for a child with ADHD. Different brains require different parenting strategies.
For example, some neurotypical children may shift their behavior to avoid or end punishment. Punitive measures like grounding, however, rarely work for kids with ADHD. They respond better to positive dopamine charges than they do to negative ones. Consider your favorite boss and why you liked working for them. They were probably inspiring and allowed you to choose what your day looked like. They likely praised when you made good choices and didn’t harp too much on your mistakes. Just as you strove to wow that boss, your kids are going to work harder for you when you decrease the reprimands and increase the positive feelings.
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The core tenets of BPT for parents look like this:
- Improved behavior is a byproduct of a healthy parent-child relationship
- Children respond best to increased positive attention and reinforcement
- Children respond worst to harsh and inconsistent parenting
- Progress is made by focusing on one desired behavior at a time (and ignoring other behaviors purposely for a time)
- Change happens incrementally
- Raising a child with ADHD is taxing, and parents need help, too
How Behavior Parent Training Strengthens Executive Functioning
ADHD is a deficit of executive function. It causes children (and adults) to lose lots of things — including their temper, their homework, their track of time, and their self-confidence. To understand that these deficits are not willful, but rather neurological, is important. To further know how to help your child with ADHD overcome these deficits is life changing.
BPT provides insight into these difficulties and offers specific strategies for responding in a way that helps your child understand what you want and learn appropriate behavior in the process. This approach takes practice and consistency — but the payoff is real. Following these strategies will help your child feel better about himself and help you feel more in control of your parenting.
ADHD Challenge #1: Working Memory Deficits
The inability to take something and hold it in memory and then do something with that information later in a way that’s appropriate.
The Problem: Slow, Nagging, Frustrating Mornings
Q: “My child takes forever to get ready in the morning and I have to follow him around reminding him to focus and move quickly to the next task. This is exhausting and stressful every single morning.”
BPT Strategy #1: Create Checklists and Schedules
It’s really important for kids to understand what’s coming next and what’s expected of them. Use checklists and visual schedules to create some structure that allows your child to take ownership of his or her obligations, so it’s not just you having to nag and reinforce and nag and reinforce.
For younger kids, make simple drawings or find images of each task on the Internet (toothbrush, hair brush, clothing) and tape them on the wall near the bathroom sink. Seeing each part of the morning routine will encourage them to independently complete the task, and provide the opportunity for your child to demonstrate that they can. Remember kids want to please their parents.
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BPT Strategy #2: Give Simple Commands and Recognize Progress
Multi-step commands tax the working memory of a child with ADHD.
BPT teaches parents that commands stated simply are the most effective. Telling your child to clean up the clutter near the front door will likely be met with confusion. Instead, use one-step commands that are very specific, such as: Please pick up your shoes. Good job. Now please put your shoes in your cubby. Great.
Breaking down the task into that level of specificity helps your child understand cause and effect in a way that enables him to make the connection “Ah, when I listen, and I follow through, my parents are happy with me.”
When commands are bunched together, it makes a lot harder for them to succeed, and it gives you fewer opportunities to praise them. Hearing frequent praise helps children with ADHD feel confident, which is very important.
BPT Strategy #3: Slow Down
Resist the urge to issue rapid-fire commands. Due to the slow processing speeds associated with ADHD, I recommend waiting at least 10 seconds (slowly count to yourself: 1 Mississippi, 2 Mississippi…) before re-issuing the same command. Doing this may feel long to you but it gives your child time to process what you’ve said.
To ensure that your child understands what you’ve asked, make eye contact and stand close to him before issuing commands. Then assess for understanding. You can ask him if he understands what you’ve asked and wait for his response.
BPT Strategy #4: Praise Progress, Not Perfection
Imagine you’re a kid with ADHD who’s trying really hard that day and you’re listening when mom asks you to pick up your shoes, go up to your room, and get dressed. If you have working memory issues, you might be able to get through the first two steps. But if your parents find you doing something else instead of the third step, you’ll likely be scolded. And that, on the whole, does not help kids or motivate them to do things a little differently next time.
Most kids with ADHD are reprimanded by the adults in their lives — chastised or given negative feedback about something they’ve done — frequently throughout each day. Add this up, and it becomes pretty clear pretty quickly that by the time they’re adolescents they’ve heard a whole lot more disappointment than encouragement.
ADHD Challenge #2: Poor Response Inhibition
Poor response inhibition is the ability to keep yourself from doing something you know is not appropriate.
The Problem: Aggressive Response to Frustration
Q: “My child gets frustrated easily and lashes out — hitting or yelling or both — at family members, even when we’re trying to help.”
BPT Strategy #1: Practice the Preferred Behavior
BPT teaches parents to use reinforced practice of prosocial behavior. This means teaching your child how to do something better or different to replace that hitting behavior, and then reinforcing that with practice.
Reinforced practice means having your child practice the preferred behavior in various parts of the house under various circumstances, and using little rewards to reinforce that. A younger child might receive a Skittle every time he uses the words “Will you share with me?” or “Mom, I need your help,” instead of hitting. Getting in the reps, just as you would lifting weights, is necessary in order for the newly-acquired skill to become automatic.
BPT Strategy #2: Use Praise Strategically
Look for ways to increase praise or catch your child doing good. If your four-year-old typically hits his sister after they’ve been playing for five minutes, try interrupting the play before it goes south. Come in and praise them for playing nicely at the three-minute mark. “Hey, I love how well you guys are sharing toys. That’s great.” The point is to catch them doing good instead so that that behavior, the one that you want, increases.
ADHD Challenge #3: Delay Aversion
Waiting — for either reward or punishment — is painful or even impossible with ADHD.
The Problem: Rewards Do Not Motivate Good Behavior
Q: “We promised my child a new bike if she earns mostly As on her next report card, but she is totally unmotivated by this reward and her grades are suffering.”
BPT Strategy #1: Offer Incremental Rewards
This is not a problem of motivation, but of delay aversion — and BPT teaches parents how to change the reward schedule and increase the frequency of rewards to boost their effectiveness. In this example, think about how to break up the steps involved in getting good grades and how to measure those steps in a way that will allow your child to earn incremental rewards.
For example, if you want to improve their homework completion time, you could focus on that every night instead. For every assignment that your child completes within this period of time, he earns the ability to pick a fun activity after the homework is done.
By increasing the frequency of rewards, you are also increasing your child’s ability to experience success. Kids with ADHD will almost always choose a much smaller reward for much smaller effort now rather than bigger effort over a longer period of time for a bigger reward later. So, we want to use that to our advantage and provide some more frequent feedback about how they are performing.
BPT Strategy #2: Use Timers to Divide Up Long Tasks
Parents can also help improve delay aversion by using timers that chunk work into smaller bits. If the whole homework routine, which lasts an hour, is too painful for your child, set the timer for 10 minutes of active work and then let him take a short break or earn a small piece of a reward for later.
BPT Strategy #3: Pair Short-Term and Long-Term Rewards
Use a combination of short-term and long-term rewards. A short-term reward would be, for example, earning screen time based on performance with the routine you’re targeting. But then to encourage consistency over many days, you can offer longer-term rewards like weekly ones that are delivered on the weekend. If your child met their morning routine goals on four out of the five days, for example, they would have access to XYZ on the weekend.
BPT Strategy #4: Keep Your Goals Fair — and Achievable
When setting up these behavioral programs, the goals must be fair. To do this, use baseline data to set the goals and adjust as needed. If you’re working to decrease the frequency of disrespectful language, for example, the first thing you should do is tally how many times a day you’re hearing disrespectful language before the intervention begins. You need to understand the natural frequency of this so that the goals you’re are setting are fair and within reach.
Why is this important? Because kids with ADHD can spot a fake from a mile away. So if we tell them, “You can earn this special reward if you are not disrespectful at all today,” they’re going to look at you and say, “No thank you.” If you want them to be motivated right away they have to believe the reward is within reach.
BPT Strategy #5: Make Sure Your Rewards Matter
Don’t guess about what you think might motivate your child. Instead, ask them. You can say something like “Your whole Saturday this Saturday is completely free. You can choose whatever activities that you want to do. What are they?” Keep some notes on that so you a sense of the things that they might be willing to work for in a behavior reward plan.
I also recommend using an award store — a simple stash of various rewards that you switch up every so often. Replace ones that get boring with some new ones. It’s important to make our economy in BPT look like the economy that kids really want to use where they have some choice and flexibility in it.
ADHD Challenge #4: Oppositional Defiant Behavior
The Problem: Children Will Test Limits to Measure Your Resolve
Q: “We are focusing on reinforcing good behavior with positive feedback, but how do we respond to bad behavior when it happens? We can’t just ignore the bad behavior, can we?”
BPT Strategy #1: Use Planned Ignoring
In BPT, praise and rewards are prioritized over punishment. BPT also teaches parents how to use planned ignoring. That’s a fancy way of saying you are going to choose just a few behaviors, not the most severe ones, that you completely ignore. It’s a very effective way of getting kids to stop the annoying behavior, and so all of the programs use that to some degree.
BPT Strategy #2: Dole Out Punishments Sparingly
This is important because too much punishment makes it less likely your child will work with you. They won’t want to replace those negative behaviors with the new ones that we need to see them do. When some form of punishment is warranted, most behavioral parent training programs focus on a timeout or job grounding approach.
- Timeout is what it sounds like: a timeout from positive reinforcement. Depending on the age of your kid, that can be pretty brief — as brief as it takes for them to calm themselves down. Or it could be a little bit longer — total number of minutes based on their age. Again, the goal here is to help kids understand cause and effect. If I do X, Y is what’s coming next. Consistency is important for comprehension. Kids are more likely to understand when they receive a timeout every time the bad behavior happens.
- Job grounding is a method that is effective for older kids. Job grounding essentially is a way of having kids be grounded from the things that they like to do and to instead complete a brief chore.
No matter what punishment you’re using, it needs to meet these four criteria.
- It must be fair and fit the crime
- It needs to be mild
- It needs to be delivered immediately following the undesirable behavior
- It needs to be consistent
How Can I Find a Good BPT Program?
- Effectivechildtherapy.org has a list of top-notch referral resources and questions to ask when interviewing a BPT therapist.
Your pediatrician may also be able to refer you to an effective program.
- Visit abpp.org to search for board-certified psychologists; that’s a mark of quality and a sign the psychologist is using evidence-based interventions.
- Russell Barkley’s books about parenting children with ADHD (#CommissionsEarned) are a go-to resource
- Joel Nigg has an excellent book too called Getting Ahead of ADHD (#CommissionsEarned) that addresses other aspects of parenting kids with ADHD — like the importance of sleep or diet in managing ADHD.
- The American Academy of Pediatrics has a parenting book about ADHD as well, and a new one coming out soon. And if you’re concerned about using screen time as a reward, the academy also has a really great media planner that I recommend often.
The content for this article came from Carla Counts Allan, Ph.D. webinar “The Best Kind of Discipline: How Behavioral Parent Training Can Transform Your Home Life.” That webinar is available for replay here.
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