“It was difficult to understand at first why my parenting approach had so little effect with my youngest, Suzanne, who has ADHD,” a mother writes. “I treated her the same way I treated all my other kids, but it seemed like every time I figured out how to help her change her behavior in a positive direction she’d fall back into her old habits before the week was up.""She was also a lot angrier and more defiant than her older sisters. By the time she was diagnosed with ADHD, I was at my wits’ end. Nothing I tried with her—talking, rewarding, punishing—seemed to work. It was only after I took the parent training course recommended by her pediatrician that I started to understand why my approaches were not effective and how she and I could work together to shape her behavior.”
Many parents share this mother’s dismay on discovering that their child with attention-deficit/hyperactivity disorder (ADHD) does not respond to parenting techniques they used successfully with their other children. The failure to comply with family rules or expectations can be especially upsetting because it leads others to assume that a child’s behavior is due to faulty parenting rather than a diagnosed condition. Your negative experiences with your child may convince you that she is unable to understand or to remember your instructions and therefore can never improve her behavior.
In fact, your child with ADHD is able to comprehend and retain what you tell her, just as her siblings are. But because she has difficulties with the ability to control her actions, organize her thoughts, think before she acts, or create a plan of action and follow through, she may not be able to perform in a way she knows is correct. She may understand, for example, that it is not right to interrupt you repeatedly while you are talking on the phone, or to wander away when you are talking to her, but be unable to stop herself. The way she operates may seem more like, “ready...fire...aim!”—she thinks about the rules after she has already broken them instead of before. This is why the parenting approaches that worked with your other children are often ineffective. Again, it is not that your child does not know what the appropriate behaviors are, it is just hard for her to carry them out.
At present, behavior therapy, a form of therapy taught to parents as behavioral parent training, has been proven to be reliably effective in moving children with ADHD from understanding appropriate behavior to actually functioning in more positive ways.
This form of therapy focuses on teaching parents and other caregivers specific behavior management techniques based on
- Concentrating on your child’s behaviors instead of her feelings or emotions
- Changing her behavior through providing her with new learning experiences and giving her a chance to watch you model appropriate behavior
- Emphasizing how to evaluate problem behaviors
- Having the plan carried out at home and school by you and other people in your child’s everyday life instead of in an office with a therapist
Parent training’s emphasis on ways in which adults can better manage and shape their child’s behavior differs from other approaches that focus directly on the child and are designed to change her emotional status (such as traditional psychotherapy) or patterns of thinking (such as cognitive-behavioral therapy). These latter approaches have not been found consistently helpful in the treatment of ADHD. In this section you will be introduced to the principles underlying behavior therapy for families of children with ADHD.
You will learn
- What behavior therapy consists of, who it is for, and where it is available
- Which specific parenting techniques have been found to be effective in improving children’s functioning and how they must be implemented
- How the gains achieved through behavior therapy techniques can be preserved
As you will learn, behavior therapy techniques are often taught in highly structured 8- to 12-week individual or group parent training sessions by therapists or specially trained teachers, usually consisting of one session per week. Such courses have been shown to be effective for families with ADHD because they allow for weekly feedback—letting parents ask questions and receive helpful advice from the instructor as they are learning to implement the techniques—and may offer parents the chance to share their experiences with others in similar situations. Unfortunately, while parent training is now available in many communities, it may not be in yours, or may be available but not be covered by your insurance plan. Even if this is the case, by reading the material in this section you should be able to apply many of these principles in your daily interactions with your child. You may find it even more useful to work with a child therapist or your child’s pediatrician to adapt these techniques to your own unique situation even if it is not in the exact systematic approach described here.