Children that have been diagnosed with ADHD are at a much higher risk of developing non-compliant or negative behaviors than a child that 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 (hyperactivity, impulsivity, or inattention) only seem to exacerbate these negative behaviors. Managing these negative behaviors often becomes a full-time job for their parents.
Treatment for the ADHD child will usually require a multi-faceted or multi-modal approach that is to say that the approach is comprehensive in nature. This approach includes school support, medications if needed, parent/child education of what ADHD is and its treatment, and lastly behavioral management techniques. Managing the negative behaviors of a child with ADHD often seems like an overwhelming and daunting task, however managing these behaviors by setting up a good behavior management plan is not insurmountable and can be quite effective if done correctly.
Behavior Modification, is a system of rewarding positive behaviors with the goal of increasing the frequency of their occurrence and on the opposite side is decreasing the occurrence of negative behaviors with the goal of decreasing their frequency. Most children with ADHD will benefit from a behavior plan that is clear and concise with measurable goals.
How to set up a behavior management plan:
1.) Choose a negative behavior that you want to change and a positive behavior that you would like to see start or continue. I suggest that you start by choosing a behavior that your child will be able to change and one they can start to do. It is not very motivating for a child to fail in their initial attempts. Your child will want to give up right away. (be specific in choosing the behaviors you want to see started or changed, how often you want to see it occur, and how often it will be rewarded.)
Examples of behaviors you want to see started are: your child makes the bed each day, unloading the dishwasher, comes to dinner on time, or getting an A in math. Pick a behavior that can be easily achieved at first.
Examples of behaviors you want stopped are: refuses to get out of bed in the morning, interrupts when others are speaking, refuses to complete homework, or talks back. As parents, you know the behaviors you want to see started and stopped in your child.
2.) Secondly, set up a Home Token Economy to implement your behavior management plan. Let’s start by defining what a token economy is. A token economy is simply a contract between the child and their parents that states that if a child acts or behaves in a certain way, the parents will agree to trade in 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 the more complicated the behavior plan with more target behaviors the less likely the plan will succeed. Start out small and keep it simple. Pick behaviors that you would like to see changed that are most affecting you and your child and also goals that you would like for your child to start. Allow your child to be involved in setting up the behavior plan but don’t let them manipulate you. Make sure you are firm with 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 they will usually work harder to achieve it.
Assign a token value to each behavior you want to see started and stopped. Be careful to not to try and change too many behaviors at once. Choose a value between 1 and 25 tokens. For the plan to work, the value of the token needs to be high enough to really want your child to change the particular behavior. (We all work for incentives!!) The behaviors that you really want to see changed are those that have a higher token value and also those that are more difficult to change.
Sample Behavior Chart:
Behaviors to start Token Value Su Mo Tu We Th Fr Sa
Make the bed 5
Unload the dishwasher 10
Get out of bed by 7:30 a.m. 20
Total Tokens Earned 35
Behaviors to stop Token Value Su Mo Tu We Th Fr Sa
Interrupts others 10
Refuses to do homework 15
Poor grades in school each day 15
Total Tokens Lost 40
Set up a convenient time each day to review your child’s performance for that day and determine how many tokens have been earned or lost. The behavior plan is to be implemented each day and a running tab should be kept on the amount of tokens they have and how many have been “cashed in” for privileges/rewards. For behaviors you want stopped they lose that amount of tokens or are fined and for behaviors that you want to see started or continue they received that amount of tokens. To be effective, a fine needs to be strong enough to prevent the child from displaying the behavior.
After you set up a token economy program, now you need to explain the program to your child in language they can understand. Be positive and tell them we have developed a program where he/she can earn rewards and/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 amount of tokens to be given or lost for positive and negative behaviors that will be tallied each day. Explain to them that the tokens can be “cashed in” for privileges and explain the “cost” of each privilege and when and where the rewards/privileges can be used. Give frequent opportunities to exchange the tokens for rewards or privileges. Assign a token value to each reward or privilege they want to use.
Rewards or privileges that I have found to be effective with children/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 a new outfit from the store, having friends come over, going out with friends, more time to watch television, or more time playing video games. Example of token value for rewards is as follows: sleeping over at a friend’s house=35 tokens, going to McDonald’s=10 tokens, seeing a movie=25 tokens, etc… Keep the costs of the rewards low so that they can use a reward each day. Keep track of the amount of tokens they have used and have remaining.
Make sure you reinforce positive behaviors as often as possible and give your child praise for their efforts. Positive behaviors should be reinforced immediately. Don’t give SECOND or THIRD chances. If they exhibit a negative behavior then they should lose 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, go over their behavior plan with them so they can see progress towards their goals
• Modify the behavior plan (if necessary) if you see that the behavior plan is not working and your child is not meeting any of the goals. Discuss the plan with them
• Educate the entire family. Answer everyone’s questions. If everyone in the family is educated about what ADHD is 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 back up 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 towards achieving success. If you expect to fail then of course you will!!
• If you see that you are about to “throw in the towel” and give up on the behavior plan then it is time to obtain outside support from mental health professionals, family, friends, teachers. Get everyone on board with you. Nobody expects you to do this alone and enlist outside support to help you stay on track and follow through with the goals
• 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 problem areas. Avoid trying to fix too many things. You will get bogged down that way
• Above all, remain consistent and do not yell. Get help from as many people as you can and don’t try to do this alone
Avoid Backsliding:
• There is no sure way to backslide then to start 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 is usually 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 their behavior. Keep your perspective here
• Get support from everyone you can. Join a support group in your community or a forum for parents on-line. There is nothing worse than feeling like you are alone in this
• 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
• Hope is a wonderful thing to keep us going and practice forgiveness of your child each and every day
• Double your efforts when you feel like giving up
• Give your behavior management plan time to work. Remember that change to have long lasting effects takes time. Nothing happens overnight
Kara T. Tamanini, M.S., LMHC
Author and Therapist
Founder of Kids Awareness Series
www.KidsAwarenessSeries.com
Kara T. Tamanini is a licensed therapist that works with children/adolescents on a variety of childhood mental disorders.
Kara T. Tamanini is a licensed therapist and author of KidsAwarenessSeries, a children's series of books on the childhood mental disorders. She works primarily with children/adolescents in private practice. She recently completed her second book, I Promised Not to Tell, a book on child abuse.