Parenting Techniques for Parents of Children with ADHD

By Dr. Erin Kardel, NeuroScience

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 11 percent of school-age children. ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. These symptoms typically persist into adulthood, and, without identification and proper treatment, those who have ADHD can face school problems, family stress and disruption, depression, relationship problems, substance abuse, delinquency, accidental injuries, and job failure.

There is no single test that can be used to diagnose a child with ADHD. Sometimes a child’s pediatrician can make a diagnosis, or sometimes the child will be referred to a mental health specialist, such as a clinical psychologist, to make a diagnosis.

Although ADHD cannot be “cured,” children with ADHD can receive treatment to learn to effectively manage their symptoms in order to improve success in academics, social situations, and other domains. Symptoms of ADHD are most effectively managed with a combination of medication (most commonly stimulants) and behavioral therapy.

While medication may seem like the simplest and most commonly prescribed treatment option, guidelines provided by both the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry suggest that the best treatment results occur when medication and behavior therapy are used together. The guidelines also state that for children with mild to moderate ADHD symptoms, it may be best to try behavior therapy before the use of medication.

Behavior therapy is based on the notion that children generally want to please their parents and feel good about themselves when their parent is proud of them. Children are also often motivated to behave appropriately when they are rewarded for good behavior and face negative consequences for inappropriate behavior.

Behavior therapy relies on these basic motivations and generally consists of three methods:

Develop a Deeper Emotional Connection with the Child
Often, the parent/child relationship can become strained and fraught with conflict in response to the frustration caused by ADHD symptoms. The good times between a parent and a child can dwindle to almost nothing, which often causes the child to lose his desire to please his parents.

In many situations, the first step in behavioral treatment is to increase the positive feelings between parent and child. One helpful way to do this is for the parent to set aside a small amount (even just 30 minutes) of “special time” each day to focus on connecting with the child in a positive way.

Using Positive Reinforcement to Encourage Good Behavior
Another way that parents can build positive behaviors for children with ADHD is to “catch their child being good.” Research suggests that the most effective ratio of positives to negatives when working with children is 5 positives for every 1 negative.

Parents can practice increasing their use of specific, labeled praise when their children engage in positive, prosocial behaviors. This can simply mean noticing when a child is doing something the parent wants to encourage (e.g., playing quietly) and commenting on it (“You’re doing such a great job playing quietly, I really appreciate it”).

When children see that their parents notice and appreciate their efforts at behaving well, it often increases their desire to do so. Providing concrete privileges or rewards for appropriate behavior (such as small prizes) is another form of positive reinforcement.

Using Negative Consequences to Reduce Misbehavior
Telling a child ahead of time, that they will lose certain privileges if they engage in inappropriate behavior can also lead to a reduction in that behavior. However, for this technique to work, it is very important that the parent follows through with the stated negative consequence; the child needs to see that the parent will be consistent and that there is absolutely no payoff for misbehavior.

It is also important not to overdo negative consequences; children can get discouraged if they are used too frequently or if they are too intense or long in duration based on the misbehavior, which can result in it becoming an ineffective therapy option.

While these behavioral therapies would be useful with all children, some things to keep in mind include:

• Children with ADHD generally require more frequent feedback about how they are doing in meeting their parent’s expectations;
• Children with ADHD do better when there is a shorter interval between the good behavior and the reward (small daily rewards are often more effective than a larger reward that won’t materialize for a few days);
• Children with ADHD require more frequent reminders about what is expected of them and what they can earn for meeting those expectations;
• Children with ADHD benefit most from simple, effective commands rather than multi-step or long-winded commands;
• Children with ADHD often require frequent changes in the reward system to remain interested in it.

Because ADHD does persist across the lifespan, many adults often also benefit from behavioral therapy to address symptoms of ADHD. For adults, behavior treatment for ADHD often involves building skills for time management, prioritizing and initiating tasks, overcoming emotional obstacles, setting up and maintaining an organizational system, and using self-contingencies to increase engagement in tasks that require sustained attention. NeuroScience, Inc. is currently enrolling adults in a group designed to build and reinforce these skills in the context of a supportive group environment.

Also, NeuroScience, Inc. offers an individual treatment called ACTIVATE, which is a computerized cognitive training and assessment program designed for children and adults with ADHD.

To learn more about individual behavior therapy options for children, adolescents, and adults with ADHD, please contact NeuroScience, Inc. at (703) 787-9090.