If your child has been diagnosed with Attention Deficit Hyperactivity Disorder, you may be wondering what form of treatment to use. Usually, medication and/or behavior management are recommended.
Neither medication alone nor behavior management alone gives consistent long-term results. Medication alone does not help children with ADHD a great deal in their social and academic functioning. Behavioral therapy may be needed to tackle ADHD-related behavior problems.
Behavior therapy alone often doesn’t give the benefits as when used with medication. This may be partly because effective behavior-management programs are difficult to implement. They require ongoing efforts and cooperation over long periods of time by the children, parents, and teachers if they are to work. But when combined, medication and behavior management offer the greatest chance for long-term successful management of behavior.
What Is Behavior Management?
Behavior management refers to a variety of techniques that are designed to change or eliminate undesirable behaviors and increase wanted behaviors through the use of rewards, skills training, and adjusting the child’s environment.
Before you begin a behavior-management program for your child, you will want to identify specific behaviors that need changing. Be sure to choose behaviors that can be changed rather than personality traits, which are relatively stable. Try to set realistic expectations and target just a few behaviors to work on at one time. For example, if your child has difficulty staying seated in class, you may not be able to get the child to stay seated for a whole class period, but less activity may be acceptable. Also, other techniques may be used to help the child adjust his or her behavior.
Behavior-management programs are hard to carry through on unless parents are well prepared mentally and emotionally. If both the mother and father are helping to raise the child, they must be willing to work together, to be consistent, and to help each other. Be sure you understand what will be expected of you and what results you can expect to have.
Parent Training: Behavior Therapy at Home
Parents trying to raise a child with ADHD often get locked into patterns of interacting that increase the chance that their child will not comply, including frequent negative exchanges between parent and child. This has a harmful effect on the entire family. Parent training teaches parents behavior-management techniques that they can implement at home. It teaches parents to focus not just on the child but on family interactions as well, thereby helping parents unlock themselves from destructive patterns.
How can you get parent training? Several books are available that outline different approaches to developing effective skills to manage children’s behavior (see list on next page). Parents may also learn techniques through one-on-one counseling with a behavior therapist, such as a psychologist, psychiatrist, or a social worker. A third option is to attend a class that teaches parenting skills in a structured program. Such classes may be found at community centers, schools, child-care centers, or hospital-based clinics and doctors’ offices.
What Techniques Can I Use?
Breaking the Noncompliance Cycle
Does the following scenario sound familiar? You tell your child to do something and your child either ignores the command or refuses to do it. You repeat the command, and the child continues to refuse. This may occur several more times. The parent may then threaten the child once or several times, which may or may not get the desired result. In anger and frustration the parent may punish the child. The child has succeeded in avoiding the task at hand and has gotten a lot of parental attention, so he is likely to try this tactic again.
The goal of parent training is to prevent parents from getting stuck in this pattern. To accomplish this goal, parents must understand why children misbehave and some basic principles of child management.
Giving Positive Attention
The parent learns to “catch the child being good” while trying to ignore, as much as possible, the behaviors to eliminate. The child’s frequent demands for attention will decrease as parents learn to be aware of times when the child’s behavior is appropriate and to give him or her attention at those times.
Using Assertive Communication
Basically, “Say what you mean and mean what you say.” Make eye contact with the child and give your command in a firm voice. Don’t ask the child to follow a command. Follow-through your direction with immediate supervision of the child’s behavior. Do not plead or argue with the child or resort to name-calling or labeling of behavior.
Don’t give too many commands at once. Try giving only one specific instruction at a time. If a task is complicated, break it down into smaller steps and give only one step at a time.
Praise and positive reinforcement alone are not always enough to change the behavior of a child who frequently doesn’t comply with your direction. However, concrete rewards and incentives can provide motivation for the child to behave appropriately. You may offer a special activity, such as a movie or favorite outing when a specific goal is reached.
Time out involves isolating the child in a “time-out chair” or corner of a room that has nothing fun to offer or any kind of reward. Time out should be imposed only for a few serious misbehaviors and should be kept short (two to five minutes for younger children). Time out is hard to use with older children unless it has been done consistently since the child was small.
For children old enough to have jobs around the home it may be helpful to make up a chore card for each job. On a three-by-five card, list the basic steps needed to correctly do the job. Then when you want your child to do a chore, just hand him or her the card. You might also indicate on the card how long it should take to do the chore properly. Setting a timer may keep a youngster “on task.”
Support From Other ADHD Parents
Parents can find understanding and acceptance as well as suggestions for handling difficult situations at ADHD support group meetings. Learning effective behavior-management skills requires long-term effort and hard work. Progress may seem to come slowly. Seeking out support from other parents may help keep you on track when all seems hopeless. To find an ADHD support group, call your local Children Services Board, school system, or other youth-serving agency.