Simply put, behavior therapy/behavioral parent training consists of a set of practical, tested procedures designed to provide you with the strategies you need to improve family interactions and your child’s ability to manage his behavior.
Parent training is just that—a program aimed at training you, the parents, to successfully manage and shape your child’s behavior. By focusing less on the child’s emotional state and more on his actual behaviors, it attempts to turn parents into their child’s “therapist” by teaching them how to encourage and maintain positive behaviors, determine which behaviors can be actively ignored, and know when and how to set and enforce rules.
All forms of behavior therapy, including parent training, share a common set of principles and offer an array of techniques that can be combined in different ways to help increase a child’s abilities for self-regulation. A sound parent training program should help you
- Gain a better understanding of what behaviors are normal for your child.
- Learn to achieve consistent and positive interactions.
- Cut down on negative interactions, such as arguing or constantly having to repeat instructions.
- Provide appropriate consequences for your child’s behavior.
- Become more empathetic of your child’s viewpoint.
- Assist your child in improving her abilities to manage her own behaviors.
Who Benefits Most From Behavior Therapy?
In most cases, the younger your child is, the more successful a behavior therapy program is likely to be because it is easier to change negative behaviors that have not been in place for very long. (Still, even teenagers can benefit from a sound and consistent behavioral approach.) Because behavioral parent training requires sufficient verbal skills for your child to understand what you are telling her, and to discuss her present behavior patterns and the plan for behavior change, it usually is recommended for families when the child is at least preschool-aged. Children who have more serious conduct problems may need additional professional help, or a different type of help, to improve their functioning.
Behavior therapy may be most effective in some situations when it is used along with stimulant medication that allows the child to be more fully attentive to the techniques being introduced. Combining medication management with behavior therapy can, in many cases, modestly but significantly increase the chances that parents and teachers will regard a child’s behavior as comparable to that of children who do not have ADHD.
For children who have ADHD without coexisting conditions and have adequate social functioning, and few significant behavioral problems, well-planned and monitored medication management may be the best treatment option. For preschoolers, children, and youth who have ADHD complicated by oppositional symptoms, poor social functioning, and behavior problems from suboptimal or negative parenting practices, a combination of medication management and behavior therapy has been found to be the most effective treatment option. For toddlers and preschoolers with oppositional and behaviors with or without ADHD, behavioral parent training/behavioral therapy is the suggested first line of treatment.
Whether or not your child is taking medication, behavior therapy may help improve your relationship with her. Parents and children report greater satisfaction when behavior therapy is included in their overall treatment plan, and in some cases the benefits of parent training include being able to reduce the dose of stimulant medication needed to achieve targeted behavioral goals. An additional benefit of parent training is that the principles work well for all children in the family, not just for children with ADHD, and adopting a parenting approach that uses these techniques can lead to better overall family relationships.
Coexisting Conditions and Family Issues
If your child has been diagnosed with ADHD and other coexisting conditions, her pediatrician can help you determine the behavioral treatment priorities for your child based on her individual needs. For example, if your child has been diagnosed with ADHD and also has anxiety, either behavior therapy or medication management may lead to similar gains. However, children with ADHD and oppositional and defiant or conduct disorder may benefit more from treatment that combines both medication and behavior therapy rather than medication alone. Although intensive behavioral therapy is the first-line and most effective treatment for children with autism spectrum disorders, children who have ADHD symptoms in addition may need a different approach to medication management for these symptoms than children who have ADHD alone. Children with ADHD and severe depression may also require different medication management and a different type of behavioral treatment plan. The kind of parent training described in this chapter may also not be appropriate in these situations.
Ideally, at the time that your child was diagnosed with ADHD, any coexisting disorders were also identified. Keep in mind, though, that certain conditions may escape notice early on or only surface at a later time. If your child exhibits symptoms that make you suspect she has a disruptive behavior disorder, depression, or anxiety, discuss your concerns with her pediatrician. It may be necessary to reconsider her diagnosis and coexisting conditions and to change her treatment plan accordingly.
Family circumstances may also affect your ability to make gains using behavior therapy techniques. If communication among members of your family is extremely difficult; you are experiencing serious marital problems; or family members are struggling with multiple major issues, including any form of family violence, parent training may not work for you. In these circumstances, meeting with a psychotherapist for family therapy may be a more helpful strategy.
Where Can I Find a Parent Training Program?
If behavioral parent training programs exist in your community and are covered by your health insurance, your child’s pediatrician can point you toward an appropriate resource. Check to be sure that the therapist or training leader is a qualified mental health or other medical professional and that the program follows a systematic format adapted specifically for parents of children with ADHD. It can be useful to check to see if a particular behavior therapist is certified by the American Board of Professional Psychology. Your own pediatrician or mental health resource, or developmental and behavioral or mental health departments at your local children’s hospital, may be able to help you find some resources. The best programs are evidence-based—they have already been found effective through carefully conducted research. While less standardized parent training programs may be available, they are not as likely to be as helpful for families dealing with ADHD.
Some schools have been able to fund and train their teachers in the use of behavior therapy techniques. If your child’s teacher is able to participate in such courses, she and your child would probably benefit enormously. By participating in parent training with your partner and sharing behavior therapy strategies with your child’s other caregivers (including her teacher), you can help others support your child’s efforts to meet the target outcomes that you and the rest of her treatment team have identified.
If no formal parent training programs are presently available in your community, you can still apply these principles to the specifics of your own situation, and may be able to use this information to advocate for the development of these services through your child’s pediatrician, your school system, or other local agencies or support groups. Take the time to review the information that follows in this chapter, and think about the ways in which you may be able to incorporate these practices into your daily life with your child.