When a child has attention-deficit hyperactivity disorder (ADHD), parents have the power to change behavior. And that goes far beyond using medications.
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“The gold standard for treating ADHD combines what goes on inside the skin — including medications, which are highly effective — with what takes place outside the skin,” says Center for Pediatric Behavioral Health Director Michael Manos, PhD.
For external factors, parents can make the biggest difference. “When we talk about behavior and ADHD, parents can be the agents of change,” Dr. Manos says.
Here are just a few ways to get started:
1. Praise positive effort
In the landmark MTA study of ADHD, children made the most progress when parents stopped using harsh, punitive measures to control behavior. “Punishment rarely, if ever, teaches new behavior,” Dr. Manos says. “It only teaches what not to do, rather than what to do.”
Strike a balance in your feedback to children, such as making four positive comments for every negative comment, he suggests. When being positive, praise effort rather than simply trying to boost self-esteem by telling your child how smart she is or how wonderful he is. Comments that praise ability may often be detrimental.
A message such as, “You really worked hard on that,” goes much farther toward teaching new ways of attacking difficult problems.
2. Create reward systems
At home, keep a consistent, predictable schedule from day to day. Use reminders, such as a sign on the bathroom mirror with icons or words spelling out a bedtime routine, for example.
Rewards systems often help, Dr. Manos says. For example, keep 21 marbles in a jar representing three positive behaviors for each day of the week. Each time a child meets a goal, move a marble into a different jar.
“Make it a game. Give reinforcing rewards for different numbers of marbles. Emphasize privileges or fun activities rather than just giving your child a toy,” he advises.
3. Enlist other change agents
“You can’t always be the one directing your child’s attention,” Dr. Manos says. Others who work with your child can be powerful change agents, too.
Tutors, for example — especially those experienced in working with children who have ADHD — do two simple but effective things: give the child immediate feedback, and show the child what to do next.
Adds Hilary Alexander, MEd, LPCC, Program Director of the ADHD Summer Treatment Program, “Delegating the homework routine to an outside member of the family can decrease conflict during homework time.”
4. Simplify the setting
At home, keep things orderly. Much like having a regular routine, having an orderly environment can make it easier to direct a child’s attention.
“This doesn’t mean you have to maintain a barren environment, free of distractions — just keep things orderly and predictable,” Dr. Manos says.
As for the classroom setting, talk to teachers about what works best for your child. Some children benefit from being seated up front, for example, while others need extra time to finish classwork.
5. Practice patience
When working one-on-one with your child, be focused and patient. “Think of organization, goal-setting and sustained attention as skills rather than traits,” advises Ms. Alexander. “Skills can improve when practiced with an effective, supportive coach.”
In schoolwork, offer immediate feedback on performance to reinforce what your child gets right. Correct wrong answers but keep lecturing to a minimum.
If your child does five math problems and gets them all correct, note their efforts and move on to the next five. If they get one wrong, explain the error and move on to a similar problem. “Don’t let your children practice mistakes; help them practice success,” says Dr. Manos.
“There’s a koan — a meditation statement — that many parents find useful,” he adds. “Having a child with ADHD is like climbing a mountain that doesn’t have a summit. You never get to the top, so you have to fall in love with climbing.”