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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
ADHD—including hyperactivity, impulsivity, or inattention—seem
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
1. 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.
2. 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 value—and 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
first—after 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.
Avoid Backsliding
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
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