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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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