Behavior modification for adhd
Parent Training in Behavior Management for ADHD
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Behavior therapy is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, and self-esteem. It is most effective in young children when it is delivered by parents. Experts recommend that healthcare providers refer parents of children younger than 12 years old for training in behavior therapy. For children younger than 6 years old, parent training in behavior management should be tried before prescribing ADHD medication.
When parents become trained in behavior therapy, they learn skills and strategies to help their child with ADHD succeed at school, at home, and in relationships. Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child and the family.
Parent training in behavior management is also known as parent behavior therapy, behavioral parent training, or just parent training.
What should parents look for?
If possible, families should look for a therapist who focuses on training parents. Some therapists will have training or certification in a parent training program that has been proven to work in young children with ADHD.
Therapists may also use strategies like those in proven programs1,2. The following list of questions can be used to find a therapist who uses a proven approach:
- Does this therapist
- Teach parents skills and strategies that use positive reinforcement, structure, and consistent discipline to manage their child’s behavior?
- Teach parents positive ways to interact and communicate with their child?
- Assign activities for parents to practice with their child?
- Meet regularly with the family to monitor progress and provide coaching and support?
- Re-evaluate treatment plans and remain flexible enough to adjust strategies as needed?
Learn more about finding a therapist »
New, easy-to-use, interactive web tools for children and teens to deal with thoughts and feelings in a healthy way.
What can parents expect?
Parents typically attend eight or more sessions with a therapist. Sessions may involve working with groups of parents or with one family alone. The therapist meets regularly with the parents to review their progress, provide support, and adjust strategies, as needed, to ensure improvement. Parents typically practice with their child between sessions.
Parents have the greatest influence on their young child’s behavior. Only therapy that focuses on training parents is recommended for young children with ADHD because young children are not mature enough to change their own behavior without their parents’ help. Some therapists may use play therapy or talk therapy to treat young children with ADHD. Play therapy provides a way for children to communicate their experiences and feelings through play. Talk therapy uses verbal communication between the child and a therapist to treat mental and emotional disorders. Neither of these has been proven to improve symptoms in young children with ADHD.
Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child. Ask your healthcare provider about the benefits of parent training in behavior therapy for young children with ADHD.
What can healthcare providers do?
Healthcare providers can:
- Follow the clinical practice guideline for diagnosis and treatment of ADHD in young children
- Discuss with parents the benefits of behavior therapy and why they should consider getting training.
- Identify parent training providers in their area and refer parents of young children with ADHD for training in behavior therapy before prescribing medicine.
For more information:
- Vital Signs: ADHD in young children
- Treatment patterns for young children with ADHD
For Parents and Providers:
- Finding a therapist: A guide for parents [PDF – 975 KB]
- Behavior therapy for young children with ADHD: Overview for parents [PDF – 330 KB]
- Behavior therapy for children with ADHD: Overview for parents [PDF – 795 KB]
- Behavior therapy for young children with ADHD: What healthcare providers can do [PDF – 749 KB]
- ADHD treatment options
- National Resource Center on ADHD
- Webinar series for educators working with young children with ADHD
- American Academy of Pediatrics clinical practice guideline for ADHD
For States:
- State profiles of treatment patterns for young children with ADHD
- Medicaid policy research
Parents typically attend 8-16 sessions with a therapist and learn strategies to help their child.
Sessions may involve groups or individual families.
- The therapist meets regularly with the family to monitor progress and provide support
- Between sessions, parents practice using the skills they’ve learned from the therapist
After therapy ends families continue to experience improved behavior and reduced stress.
- Positive Communication
- Positive Reinforcement
- Structure and Discipline
- Behavior therapy, given by parents teaches children to better control their own behavior, leading to improved functioning at school home and in relationships. Learning and practicing behavior therapy requires time and effort, but has lasting benefits for the child.
A Parent & Teacher Guide to ADHD Behavior Modification
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Change Your Focus, Change Results
When parents and professionals treat ADHD, typically they focus on symptom improvement first and foremost.
Often, medication is strategy #1. Yet many professionals believe that psychosocial, non-medical behavioral treatment is equally important. In fact, studies show that adult success is best predicted by three things: effective parenting skills, getting along with other children, and success at school. Many specialists argue that behavior therapy addresses all of these domains and can begin very young, before failures start to impact self-esteem.
The focus of behavior therapy is different than that of medication, which aims to eliminate symptoms. Instead, it concentrates on the ways that hyperactivity or inattention can impact academic performance, relationships with siblings, and noncompliance with adult requests. It treats for settings and domains of impairment, and hinges on strong collaboration between families, schools, mental health clinics, and primary care.
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What Is an Impairment?
No child starts treatment for ADHD because their parent is sitting in bed at night reading an article about the Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms of ADHD.
Kids come in for treatment because the teacher calls the parents and says, "You need to come in for a conference. I'm having difficulty with your child in school." Or because things aren't going well at home with daily chores or sibling fights or getting into trouble around the neighborhood. The impairment is the difficulty that mediates the long-term outcome, or child’s success, so it’s what should be targeted in treatment.
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Treatments to Avoid
These treatments and interventions are commonly used with children following an ADHD diagnosis, but they are not proven to be effective:
- Elimination diets
- Biofeedback/neural therapy/attention (EEG) training
- Allergy treatments
- Chiropractics
- Perceptual or motor training/sensory integration training
- Treatment for balance problems
- Occupational therapy
- Dietary supplements (megavitamins, blue-green algae)
[Free Resource: 4 Parent-Child Therapies for Better Behavior]
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Which Treatment is Best?
The only therapies that are proven effective for treating ADHD are behavior therapy/modification, stimulant medication, or a combination of the two.
It works best to start with behavior therapy, and then see if you need to add medication as a supplement if behavior therapy doesn’t totally fix functioning issues. If needed, medication should be very gradually to find the lowest possible dose that works.
Since ADHD is a chronic issue, the most important thing parents and teachers can do is learn how to consistently implement strategies to manage children’s behavior. Medication has short-term effects, but not long-term effects. It doesn’t change the parts of the brain that make children learn better, it just makes kids more able to sit still and do seat work.
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How to Evaluate Impairment
The first step in starting a behavior modification program is to complete an assessment of daily impairment and adaptive skills. This is the most fundamental aspect of initial evaluation; it determines the target areas of treatment, and sets a baseline for ongoing assessment to evaluate treatment response.
Brief teacher and parent rating scales are sufficient to indicate if ADHD is a problem. Parents and teachers use the impairment rating scale (IRS) to describe what they see as the child's primary problems in narrative format. Raters then rate how the child's symptoms have affected each of the following domains:
- relationship with peers/siblings
- relationship with parents or teachers,
- his or her academic progress,
- your classroom/family in general
- his or her self-esteem, and
- overall problem/need for treatment
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Parent Intervention
The behavioral approach focuses on parenting skills, the child's behavior, and family relationships. Parents learn skills, like how to pay positive attention to your child when she's doing what you like, and how to modify the techniques as necessary.
The A, B, Cs of behavior modification for parents are: Modify Antecedents (things that happen before behaviors, e.
g., a request of a child), Behaviors (the thing the child does in response that parents want to change), and Consequences (things that happen after the behavior e.g., the response to disobedience).
It's not trying to teach children to think differently, but rather teaching parents how to use their attention and positive consequences to shape the child's behavior and reinforce things they want the child to do more of, and gentle negative consequences to help the child learn.
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Parenting Skills Programs
The most common way to learn these skills is through group-based, weekly sessions with a therapist (8-16 sessions). Parents are taught a technique, go home and implement what they learned, and discuss progress, problem-solve, and learn a new technique each week.
Then, sessions often fade to monthly or quarterly once behavior is under control.
Interventions need to be feasible and palatable for families so they can be maintained in the long run. Programs teach skills like rewards systems, and how to give proper commands. Improvement is often gradual, and there should be a plan in place if the child backslides, especially during major developmental transitions like entering middle school.
["None of Us Were Trained How to Be Good Parents"]
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Teacher Skills Training
Behavioral intervention in schools can only happen if teachers focus on good classroom management practices, academic performance, and peer relationships.
Teacher training is widely available in school-wide programs that train all staff and administrators, or in a consultant model — beginning with initial weekly sessions with a therapist or school psychologist, then contact fades as teachers learn the skills to use with children with ADHD during school hours.
Typically, teachers need 2 to 10 hours of training. The behavioral techniques should integrate with school-based programs like IEPs and 504 plans, and be available to all relevant staff.
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Daily Report Card
The one thing that’s absolutely essential for kids with ADHD is a daily report card. It’s a tool for ongoing monitoring of a child's progress, and can be used to titrate the appropriate dose of meds if necessary.
A parent or therapist works with the school to determine the child's goals — what will make the child function better in the classroom, the major things that need to be reduced in terms of problems or academic work. Then, together they set up a simple system for the teacher to evaluate how a child is doing periodically throughout the day, give the child feedback, and provide a note home. Parents follow up at home with rewards for the child having a good day at school.
This tool is necessary because kids with ADHD need specific feedback for their behavior more frequently than once a week. It costs little, and takes little teacher time, but is effective in changing kids' behavior at school. Once the daily report cards are set up, they reduce the amount of time teachers must spend dealing with the child’s problematic behaviors, and provide a tool for ongoing monitoring of the child’s progress.
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Child Interventions
The behavioral and developmental approach used with children focuses on teaching academic, recreational, and social/behavioral competencies, decreasing aggression, increasing compliance, developing close friendships, improving relationships with adults, and building self-efficacy.
There are various levels of treatment: paraprofessionals, intensive treatments like 8-week summer programs, after-school sessions, and 6-hour Saturday sessions.
All of the programs use a core set of procedures that include coaching, use of examples, modeling, role-playing, feedback, rewards and consequences, and practice.
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More Resources
Instruments
- Impairment Rating Scales (Parent and Teacher)
- Disruptive Behavior Disorder Symptom Rating Scale (Parent and Teacher)
Information
- What Parents and Teachers Should Know about ADHD
- Medication Fact Sheet for Parents and Teachers
- Psychosocial Treatment Fact Sheet for Parents and Teachers
"How to Handouts"
- How to Establish a Daily Report Card
- How to Begin a Summer Treatment Program
More resources for parents: www.ccf.fiu.edu
[Train the Parent, Help the Child]
| Behavior modification Based on the article Translation - ADHD mom Changing our point of view can help our child behave properly In many discussions of the topic of ADHD, the term "behavior modification" is often used. What is meant? Behavior modification is a program that encourages positive behavior in a child in order to to achieve that such behavior has become more frequent and habitual. Putting this program into practice requires parents of careful planning, commitment, patience and interaction with all those who care about child. nine0014 1. Assess and repair your relationship Take the time to evaluate your relationship. Tensions that have been building up over time can destroy any new program. If you are used to getting annoyed and angry every time your child feels bad behaves, or if you are increasingly yelling and punishing him, but to no avail, try first gradually restore relationships. As your relationship with your child changes and you begin to see a "full half glass", you notice how your child's attitude towards you changes. The child who once had no reason to please the parent, will now try to find a way to earn your praise. 2. Choose a behavior Children with ADHD are prone to "information overload". To help them develop better habits and behaviors, you you need to select one specific behavior that you want to work on at the moment. Later, as advance your program, you can add one or two more behaviors, but only work with one at the beginning. nine0014 You may want to choose "don't snap," "don't run around the house," "don't be aggressive with your brothers," "finish homework", etc. Once you've chosen a behavior, make sure it's specific. Perhaps you should split the task into smaller parts. For example, if you want a child not to snap back, what exactly do you mean? Be specific child, what do you expect from him. Do you mean that your child does not snap with you, your spouse, his teachers, neighbors, or do you want to start with one person? What exactly do you consider to be bullying? What can your child to say instead of what usually comes out of his mouth? Write down acceptable and unacceptable phrases. nine0014 Be realistic about your goals. Make sure the goal you choose is achievable. If possible, set your child for several next successes. Create situations where you can praise your child for the way he reacted and the way he spoke. 3. Select a reward method long period of appropriate behavior. Smaller achievements can be rewarded with stickers, stars or just saying, "You did a great job. 4. Choose your response React calmly to the results. Once you allow yourself to be upset by your child's behavior, he will know what else can cause you to have this reaction. Use breaks. During the break, do not spend any conversations with the child, he should not participate in any activities or discussions. The child should be gently move away from the environment and leave alone for a few minutes. Often, once the behavior program has been set up, parents complain that the behavior is getting worse. It's in generally okay. 5. Be consistent Consistency is the key. If you do not stick to your reward system, then the child will not sufficient motivation to behave properly. If you respond inconsistently, your child will continue to misbehave, risking that this time you won't hold back. 6. Diversify You can diversify your program of behavior without changing the rules. You can change the way every day rewards. One time it might be permission to go to bed later, another time popsicles in the afternoon, the third is visiting a friend. Older children may want to work in order to have money for their own purposes. 7. Continue to work on other behaviors Once you feel your child has mastered the initial behavior, move on. Use the same the very steps to build a certain system of goals, encouragement and response. While this process is effective with all children, it seems to work especially well with children with ADHD. A behavior modification program provides the structure children with ADHD need to succeed. Besides, children with ADHD tend to have difficulty if the response to their action does not occur at the same time or soon after that. Providing immediate responses and rewards helps keep the child focused and on the right track. way. Finally, using short-term goals helps. It is much easier for a child to behave well for 15 years. minutes than throughout the day. Dividing the day into short intervals can help create desire in them. |
about.com/cs/discipline/a/behavior.htm 
Pay attention several times a day to what the child is doing well. If it is needed, create a situation for your child to behave well and praise him. Changing the Way of Expression your thoughts in conversation with your child can have a huge effect. If you sent a child to clean up his room, after 15 minutes go into the room and notice that almost nothing has been cleaned, unless you immediately indicate child that he did nothing? Try to change your point of view: praise the child for any little thing, which he has already done, and give instructions on what to do next. For example, instead of saying "You're still nothing didn't. Didn't I ask you to clean the room? What have you been doing all this time?" - you can say: "Wow, looks like you collected all the cubes that were scattered on the floor. Now let's collect the rest of the toys and put them in the box. I'll come back after 5 minutes to see how you're doing." Every 5 minutes you come back to praise and give the following instructions.
If only one toy was removed during these 5 minutes, show the child that you noticed him diligence. And even if it takes a child 3 hours to put things in order, you might be able to done in 10 minutes, in the end you will have a child in front of you who can proudly look at his room. nine0014 
Start with the behavior that has the most negative effect on your child's life and self-esteem. 
" Reward as often as possible. In the beginning, you can react to the behavior many times a day. (Note any time your child speaks to someone in a respectful manner.) Accordingly build a reward system. If you give stickers, you can start with a sticker for every 15 minutes that the child did not yell. After a certain number of stickers, he can get a more tangible reward, for example, rent a videotape or visit a friend. nine0014 
Children have learned to rely on your feedback. They are accustomed to understand and connect your response with your concern. So it's only natural that they need your reaction. Be persistent and soon the child will perceive your new reaction as the only correct one. The child will start trying to get a reward, knowing that the reaction to bad behavior no longer exists. nine0014 
By introducing variety, you will allow the child not to get bored on a new path. The rules must remain the same, but change reactions can help keep them "fresh". nine0014 
succeed. nine0014 Correction of children with attention deficit hyperactivity disorder (ADHD)
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Correction of Attention Deficit Hyperactivity Disorder
Manifestations of Attention Deficit Hyperactivity Disorder can be observed even in children in the first year of life. nine0014
Such babies are very restless, struggling to get rid of diapers, sleep little and badly, are easily excited, cry loudly and often. They have an increased muscle tone, frequent unmotivated vomiting (everything they ate is immediately back in a fountain), as well as an extremely high sensitivity to all external stimuli - noise, light, cold, heat, etc.
In the process of growing up in such children, the main triad of signs of attention deficit hyperactivity disorder (ADHD) is more and more clearly manifested: nine0014
- attention disorder;
- hyperactivity;
- impulsiveness.
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Attention impairment in children with ADHD is manifested in the inability to focus and keep attention on details, to listen to the speech addressed to them. Often it seems that the child does not understand the task, as he is not able to complete it from beginning to end. In fact, the problem lies not in the weakness of thinking, but in the inability to concentrate attention for a long time. Due to inattention, such children often lose things, schoolchildren forget notebooks, textbooks, etc. at home. nine0014
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Hyperactivity is manifested in the inability of the child to perseverance. He constantly spins, shows aimless motor activity, tries to climb somewhere, puts himself at risk, not being able to correctly assess the degree of danger and the consequences of his actions.
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The impulsiveness of a child with ADHD is manifested in the fact that he answers the question, often without even listening to it, intervenes in someone else's conversation or game, pesters others with conversations. Can take risky actions under the influence of a sudden impulse, not having time to think about the consequences. Often gets injured, spoils his own and other people's property. nine0014
The mechanisms of the pathogenesis of ADHD have not yet been clarified, but experts have no doubt that this syndrome occurs when there are disturbances in the activity of the central nervous system and requires appropriate treatment. Correction of ADHD requires persistent, methodical therapy with the participation of specialists - a neuropsychologist, a neurologist, a psychiatrist, using non-drug methods of exposure and drugs.
Drug correction, the purpose of which is to bring the processes of excitation and inhibition in the central nervous system into relative balance, is prescribed by specialists after a thorough examination of the child.
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Non-drug methods of treatment include: psychotherapy, neuropsychological, pedagogical correction, behavior modification techniques. Correction of ADHD to reduce painful manifestations also involves the provision of the following conditions:
- The training mode is gentle, with a lesson duration of no more than 30 minutes and with a minimum number of children in the class (no more than 12 people).
- Raising socially encouraged norms of behavior in a child. nine0121
- Limit or eliminate the participation of children with ADHD in crowded activities.
- Give only one task for a certain period of time (due to difficulties in concentration).
- The choice of partners for games is very important. Friends of the child should be calm and balanced.
- Psychotherapeutic work with parents of a hyperactive child:
- compliance with the daily routine; nine0121
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visual schedule;
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exercise, running, walking to expend excess energy;
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avoid overworking the child when doing homework.
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