ADHD — Treatment Through Behavior Therapy

Most experts recommend using both medication and behavior therapy to treat ADHD. There are many forms of behavior therapy, but all have a common goal — to change the child's physical and social environments to help the child improve his behavior.

Under this approach, parents, teachers and other caregivers learn better ways to work with and relate to the child with ADHD. You will learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. Your child will learn better ways to control his behavior as a result.

There are three basic principles to any behavior therapy approach:

• Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.
• Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when she fails to meet a goal.
• Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child's behavior in a positive way.

Table 3 shows specific behavior therapy techniques that can be effective with children with ADHD.

Table 3. Behavior Therapy Techniques

Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child's life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions.

As the child's primary caregivers, parents play a major role in behavior therapy. Parent training is available to help you learn more about ADHD and specific, positive ways to respond to ADHD-type behaviors. This will help your child improve.

Taking care of yourself also will help your child. Being the parent of a child with ADHD can be tiring and trying. It can test the limits of even the best parents. Parent training and support groups made up of other families who are dealing with ADHD can be a great source of help. Learn stress-management techniques to help you respond calmly to your child. Seek counseling if you feel overwhelmed or hopeless.

There are steps you can take to help your child succeed in controlling his behavior. These tips can be applied to everyday life in your house and can make a big difference for your child and family:

• Keep your child on a daily schedule. Try to keep the time that your child wakes up, eats, bathes, leaves for school and goes to sleep the same each day.
• Cut down on distractions. Loud music, computer games and television can be overstimulating to your child. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Whenever possible, avoid taking your child to places that may be too stimulating, like busy shopping malls.
• Organize your house. If your child has specific and logical places to keep his schoolwork, toys and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.
• Reward positive behavior. Offer kind words, hugs or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child's efforts to pay attention.
• Set small, reachable goals. Aim for slow progress rather than instant results. Be sure that your child understands that he can take small steps toward learning to control himself.
• Help your child stay "on task." Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer frequent, friendly reminders.
• Limit choices. Help your child learn to make good decisions by giving your child only two or three options at a time.
• Find activities at which your child can succeed. All children need to experience success to feel good about themselves.
• Use calm discipline. Use consequences such as time-out, removing the child from the situation, or distraction. Sometimes it is best to simply ignore the behavior. Physical punishment, such as spanking or slapping, is not helpful. Discuss your child's behavior with him when both of you are calm.

In addition to parents and caregivers, your child's school is a key partner in providing effective behavior therapy for your child. In fact, these principles work well in the classroom for most students.

Some successful classroom management techniques may include the following:

• Keeping a set routine and schedule for activities
• Using a system of clear rewards and consequences, such as a point system or token economy (see Table 3).
• Sending daily or weekly report cards or behavior charts to parents to inform them about the child's progress
• Seating the child near the teacher
• Using small groups for activities
• Encouraging students to pause a moment before answering questions
• Keeping assignments short or breaking them into sections
• Close supervision with frequent, positive cues to stay on task

Your child's school should work with you and your pediatrician to develop strategies to assist your child in the classroom. When a child has ADHD that is severe enough to interfere with the child's ability to learn, two federal laws offer help. These laws require public schools to cover the costs of evaluating the educational needs of the affected child and providing the needed services. The laws are:

• The Individuals with Disabilities Education Act, Part B (IDEA)
• Section 504 of the Rehabilitation Act of 1973