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DON'T TEACH YOUR CHILD TO MISBEHAVE!
Here is a pattern that is easy to fall into and which is associated with increasing misbehavior and non-compliance. You ask or tell your child to do something like pick up his toys. Your child ignores you and keeps on playing. You repeat your request and your child ignores you again. You get angry and intensify your demand; your child gets angry in response and starts to tantrum. After a few more cycles of this you are both good and angry. To keep things from exploding, you drop your demand, send your child away, and pick up the toys yourself because "it's not worth all the hassle and aggravation" trying to make your child do it. Most parents have been through something like this, and with children who have ADHD and are also oppositional, this is a distressingly frequent occurrence. Unfortunately, what a child learns from this type of exchange is that if they just hang in there and persist in being defiant, they will eventually get their way. What happens, therefore, is that your child's disobedience is actually being REWARDED. This can really result in things going downhill because your child is being taught that defiance actually pays off. This is why it is important to chose your battles carefully. Once you demand something of your child, BE SURE TO FOLLOW THROUGH WITH IT. If your child persists in being defiant, try using the graded series of consequences as discussed above. Your child needs to see that you mean business, and that there is ABSOLUTELY NO PAYOFF for being disobedient. "This type of behavioral approach sounds like something that would be useful with all children. Is there anything different about using this approach with a child who has ADHD?" Using a combination of special time, positive reinforcement, and negative consequences to encourage good behavior is, of course, a technique that can be useful with all children. Although the basic principles are similar for children with and without ADHD, factors specific to ADHD generally require certain modifications to be made. Several of these important modifications are:
* Children with ADHD generally require more frequent feedback about how they are doing in meeting the parent (or teacher's) expectations. o Research has consistently demonstrated that children with ADHD perform better when they are given frequent feedback about their performance. Thus, if the behavior you are targeting is "following directions", it is better to provide your child with feedback about how well they are following directions every hour, rather than doing this once at the end of the day. The actual time interval is something to experiment with; the important point is that a child with ADHD needs frequent feedback for behavioral programs to be effective.
* Children with ADHD do better with short term goals than long term goals. o This follows from the above. Along with more frequent feedback, children with ADHD generally require shorter intervals between the opportunity to earn rewards. For example, promising a weekend reward for good behavior during the week may be too far in the future to function as an effective motivator for a child with ADHD. Daily rewards, or even more frequent opportunity to earn privileges, will often be necessary. Providing a child with points or "tokens" for good behavior that can be used to purchase more tangible rewards (e.g. TV time; Nintendo time; getting to rent a video) can be useful because they can be frequently and easily dispensed, and have value because of their connection to desired activities and objects.
* Children with ADHD require more frequent reminders about what is expected of them and what they can earn for meeting those expectations. o For this approach to be effective, it needs to occupy a prominent place in a child's mind. Children who forget what their behavior goals are and what they are trying to earn by achieving those goals are unlikely to be successful. For a child with ADHD, frequent reminders about the goals and rewards are important. This can be done in the context of providing feedback on how the child is doing.
* Children with ADHD often require frequent changes in the program to remain interested in it. o Those of you who have already tried various behavior plans may be well aware of this. It is not uncommon for a child to get off to a great start and then lose interest in earning any rewards. The best way to combat this is to try change the program to keep it feeling "new". This can be done by changing the rewards (e.g. one day the reward to be earned in TV time, the next day it is getting to stay up an extra half hour, ect.) If your using tokens, changing the actual token can also be helpful. For example, one week pennies might be used, the next week marbles, the next week stickers, ect. Obviously, this all depends on the age of the child and what his or her interests happen to be. It certainly takes plenty of hard work and creativity on parents' part. "What kinds of behaviors can be addressed with this type of approach?" In theory, virtually any type of behavior can be targeted using a behavioral treatment approach. For example, primary ADHD symptoms such as not completing tasks can be targeted by providing rewards for task completion. Symptoms such as interrupting and talking out of turn can be targeted in similar ways. Associated difficulties such as deliberate non-compliance, aggression, ect. can also be targeted in a behavioral treatment plan. Regardless of what behavior is being targeted it is essential to be sure that:
* the child understands what is being expect of him or her;
* the expectation is reasonable and something the child is capable of doing;
* the child understands what rewards can be earned by meeting the expectation;
* the child understands what the negative consequences will be for not meeting the expectation;
* you follow through with what you say you are going to do;
REMEMBER, DON'T TRY TO TAKE ON TO MANY THINGS AT ONCE AND TRY TO SET THINGS UP SO THE CHILD HAS A GOOD CHANCE TO EXPERIENCE SOME EARLY SUCCESS. DON'T EXPECT OR REQUIRE PERFECTION. EVEN A SMALL IMPROVEMENT IS STILL AN IMPROVEMENT. "I don't think this will work because it's impossible to enforce consequences with my child. Trying to enforce a punishment just makes him angrier." Unfortunately, things can get to this point. Even in these situations, however, sometimes one parent has more success than the other. For children with ADHD who are also oppositional, fathers often seem to have greater success than mothers. If this is the case, one approach is for mom to calmly and firmly attempt to induce compliance from the child and to be clear about what the consequences for continued non-compliance will be. If the child refuses to comply, make it clear that when dad gets home they will need to do what is being demanded and that the consequences will be enforced at that time. PLUS, an additional negative consequence will also be administered. By refusing to listen to mom, therefore, they are not getting out of what they don't want to do, but only delaying the inevitable. In fact, by not listening to mom, they will actually be making things worse. The intent here is to keep mom from getting into an unsuccessful and escalating battle with the child while making it clear to the child that there is no pay off for not listening to mom. For this approach to work, cooperation between parents and support for each otherís efforts is essential. "What if neither parent can get their child to comply?" This is sometimes the case. If both parents are unable to induce compliance from their child, and their best efforts are not successful, consultation with an experienced child mental health professional is essential. The longer behavioral difficulties persist the harder they are to change and it is critical to stop an escalating cycle of misbehavior as quickly as possible. The ideas discussed above are intended to provide parents with a general overview of a behavioral approach to improving children's behavior. In many cases, consultation with an experienced child mental health professional will increase the success that parents experience with this approach.
About the author: Dr. David Rabiner is a clinical child psychologist who specializes in the evaluation and treatment of children with ADHD. He teaches and conducts research at Duke University. Dr. Rabiner's research on children's social development has appeared in leading national and international journals and has been presented at numerous conferences. He has also served as a consultant on two federally funded grants involving ADHD. To visit Dr. Rabiner's Web site, click http://www.helpforadd.com/
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