Children who have been diagnosed with ADHD are at a much higher risk of developing noncompliant or negative behaviors than a child who does not have ADHD.
The very nature of ADHD implies that the child will have difficulty with self-control, paying attention, listening to instructions at home and school, and following directions. Some children seem to be predisposed to develop behavior problems by their temperament; however, the symptoms of ADHDincluding hyperactivity, impulsivity, or inattentionseem to exacerbate these negative behaviors. Managing these negative behaviors often becomes a full-time job for parents.
Treatment for the ADHD child usually requires a comprehensive approach. It includes school support, medications if needed, parent/child education regarding ADHD and its treatment, and behavioral management techniques. Managing the negative behaviors of a child with ADHD often seems like an overwhelming and daunting task; however, such behaviors can be managed effectively with a good plan in place.
Behavior modification rewards positive behaviors and aims to decrease negative ones.
Setting Up a Behavior Modification Plan
- Choose a negative behavior that you want to change and a positive behavior that you would like to see start or continue. Start by choosing a behavior that your child can begin to work on immediately and that he or she realistically will be able to change. It is not very motivating for children to fail in their initial attempts. Your child will want to give up right away.
Make sure you set specific goals. For example, you would like to see your child make the bed each day, unload the dishwasher, come to dinner on time, or get an A in math. You would like to see your child stop refusing to get out of bed in the morning, interrupting when others are speaking, refusing to complete homework, or talking back.
- Set up a Home Token Economy to implement your behavior management plan. A token economy is simply a contract between the child and parents. It states that if a child acts or behaves in a certain way, the parents will agree to trade tokens for a particular reward or privilege.
In setting up a token economy, focus on only a few goals at a time. Your behavior plan can be as short or as long as you want; however, I have found that more complicated plans are less likely to succeed.
Allow your child to be involved in setting up the behavior plan but don’t let yourself be manipulated. Make sure you are firm and clear regarding the behaviors you want to see started and stopped. When a child becomes part of the plan and is able to pick the rewards and the consequences he or she usually will work harder to achieve it.
For the plan to work, token values need to be high enough to be motivational. Assign each behavior a value between 1 and 25. The behaviors you really want to see changed are those that have a higher token valueand also are those that are more difficult to change. For example, you might assign a value of 5 to making the bed each morning, 10 to unloading the dishwasher, and 20 to getting out of bed on time. You would subtract tokens for negative behaviors such as interrupting others, refusing to do homework and getting poor grades.
The behavior plan is to be implemented each day. Set up a convenient time to review your child’s performance and determine how many tokens have been earned or lost. Keep a running tab on the total number of tokens and how many have been “cashed in” for privileges or rewards.
After you set up a token economy program, explain the program to your child in language he or she can understand. Be positive and tell them that you have developed a program where he or she can earn rewards or privileges for behaving in a positive way. They will probably balk at this at firstafter all, they have been receiving rewards all along that they really did not have to earn.
Go over with your child the number of tokens to be given or lost for positive and negative behaviors and tell them it will be tallied each day. Explain that the tokens can be “cashed in” for privileges and explain the “cost” of each privilege and when and where the rewards or privileges can be used. Give frequent opportunities to exchange the tokens for rewards or privileges.
Rewards or privileges that I have found to be effective with children and adolescents when I have set up a behavioral plan with them and their parents are:
- seeing a movie
- going for ice cream
- going to McDonald’s
- getting to buy a new outfit
- having friends come over
- going out with friends
- more time to watch television
- more time playing video games.
The number of tokens required to receive a particular reward should vary with the reward’s importance. For example, sleeping over at a friend’s house might cost 35 tokens, whereas going to McDonald’s might cost 10 tokens. Keep the costs of the rewards low so that the child can use a reward each day.
Make sure you reinforce positive behaviors immediately. Don’t give second or third chances. Negative behaviors should result in the loss of tokens. If you give second or third chances you are weakening the behavior plan and are sabotaging yourself.
How to Keep the Program Going
- Make sure the child is able to see their progress.
- Modify the behavior plan if you see that your child is not meeting any of the goals. Discuss the plan with your child.
- Educate the entire family. Answer everyone’s questions. If everyone in the family is educated about ADHD and they understand the goals, everyone is more likely to cooperate. Everyone needs to be on board. ADHD is an issue for the entire family
- Have a backup plan if the behavior plan is not working. If goals are not being met then rework the plan.
- Expect to achieve your goals. A positive attitude goes a long way toward achieving success.
- If you feel ready to give up on the behavior plan, obtain outside support from mental health professionals, family, friends, and teachers. Get everyone on board with you. Nobody expects you to do this alone.
- Approach the problem from a team perspective. Brainstorm, brainstorm, brainstorm. Everyone in the family should be involved in keeping this going. The old expression, “two heads are better than one” definitely applies here.
- Target the most pressing problems. Avoid trying to fix too many things. You will get bogged down that way.
- Remain consistent and do not yell.
There is no surer way to backslide than to get into prolonged arguments and discussions with your child over the behavior plan. Of course they are going to want to change or get rid of the behavior plan. Anything new or different usually is met with resistance.
- Accept that your child has ADHD. It is not the end of the world. If you remain positive and calm, your child will have a much easier time changing his or her behavior. Maintain perspective.
- Get support from everyone you can. Join a support group in your community or an online forum for parents.
- Keep your goals in sight. Remember tomorrow is a new day and the sun will still shine. Nothing lasts forever.
- Educate yourself about ADHD and read whenever you can. Ignorance is not bliss.
- Practice forgiveness. Double your efforts when you feel like giving up.
- Give the plan time to work. Remember that change takes time if it’s to be long-lasting. Nothing happens overnight.
Kara T. Tamanini is a licensed therapist who works with children and adolescents with a variety of mental disorders. Visit her website at www.kidsawarenessseries.com