Back to Basics - Tips for Managing Behavior in ADHD

[This article originally appeared in the April 2016 issue of Attention magazine. Copyright 2016 by CHADD. Republished with permission.]

Every day, Thomas comes home from school, walks past the hooks by the door and drops his coat on the family room floor. Then, he tosses his backpack onto the sofa and keeps right on going to get a snack or play with his Legos. No matter how many times his mother has complained, Thomas continues to leave a trail of “stuff.” as he moves through the house. Mariella argues about taking her bath every night. As soon as her mother tells her to turn off. the television to go upstairs for a bath and the nighttime routine, Mariella responds, “Just five more minutes.” Or, “Why do I have to go upstairs now? It’s not fair!” The interaction often escalates into yelling.

Devon has a hard time with his little sister, who wants to play with him and his toys whenever he is around. At two years old, she is not easily deterred by his requests to be left alone. Despite being told to find one of his parents when he needs help, Devon loses patience quickly and pushes or hits her to get her out of his way. Sound familiar?

Children with ADHD may have the same behavioral issues as their peers, but their impulse control problems and delayed development means that their troublesome behaviors tend to be more persistent. It’s important to know that most children with ADHD respond to the same basic principles of behavior management as do other kids. However, they may need more repetition and active management for a longer period of time. To be effective at changing behaviors, parents must respond with targeted interventions and patience. Patience is the hard part, but stick with the interventions described below, and you will slowly shift the parent-patience- to-child-compliance ratio in your favor!

To get the benefits, you will have to be realistic about the time and commitment involved. Think of this as a “campaign” rather than a collection of troubleshooting tips that are only used during challenging moments. So, if you’re having trouble getting your child’s behavior into shape, it’s time to go back to the basics.

1)    Define the rules. You need a set of house rules as you embark on bringing your child’s behavior more in line with your goals. Those rules should reflect what you are trying to teach your child. Start by developing the Golden Rules for your household based on your own values and priorities. For example, “All members of the family share in the work, as well as the rewards, of family life.” These golden rules will lead to your specific expectations. “Hang up your coat when you come in the door.” “Clean up behind yourself. “Complete your household chores.” If your list is a long one, pick just a few to start with. Post the list for all to review as needed.

2)    Keep it simple. When you talk with your child about the rules, keep it simple. Don’t invoke the general rule each time. On a daily basis, it’s better to say simply, “Hang up your coat.” The more your child argues, the more you should simplify your language, keeping your words calm and direct: “Coat. Now.”

3)    Tell the child what you want her to do. Help your child to focus on the desired behavior by explicitly stating what you want her to start doing. Think about this adult example. Let’s say that you have decided to eat more healthfully. In an effort to help, your companion says, “Don’t eat the chocolate cake.” Now, what are you thinking about? Chocolate cake! What if your companion says this instead: “I bought some great fruit at the farmer’s market. It’s all washed and ready in the fridge.” Offer the same clarity and positive message to your child. For example, you might say, “When it’s almost time to go upstairs for your bath, I will give you a ten-minute heads-up to get yourself prepared. Then, when I say it’s time, I’ll go upstairs with you to help you get started. If you’re upstairs before 8 o’clock, you can choose from one of those fancy bubble bath lotions.”

4)    Be explicit. Perhaps you’re used to saying, “No running around when the company gets here.” Instead, try this: “When we are in the living room, I expect you to sit with your bottom on the sofa and your feet on the floor.” Use explicit time frames, too. Instead of “Not now” or “Wait until later,” set specific time expectations. “I’m going to set the timer for fifteen minutes while I finish my work. When the timer rings, we can play a game.” Then, live by it. If you say you’ll be available in fifteen minutes and then don’t follow through, your child will learn to disregard your words.

5)    Set up an instant replay. Whenever possible, teach the behaviors and routines you are trying to develop by offering your child a chance to replay the situation. “Oops! I need you to redo that. Put your coat back on, grab your backpack and let’s try it again. This time, put your coat on the hook and bring your backpack into the kitchen.” Now you have a chance to praise your child for doing it right!

6)    Acknowledge good behavior. Remember that behavior followed by a reward is more likely to recur. So, avoid the tendency to “let sleeping dogs lie.” (This is really hard!) When things are going well, an appreciative word helps to reinforce the behavior. When you’re working on complex behaviors that involve a series of steps, pay attention to each link in the chain of behaviors you’re going for. For example, if there are ten items on the morning routine checklist, your child should be praised for whatever they complete, even if they don’t get through the whole list. “Edie, you brushed your teeth and you made it downstairs for breakfast before 7:15. I am really pleased with that. That was two of the items on your checklist. Let’s see if you can beat that tomorrow!” Focus the goal on “personal best,” rather than perfection.

7)    Give one warning. As positive as you are, consequences will sometimes be necessary when your child just can’t get it together to do the right thing. Give your child one warning to alert him that he has crossed the line and is now at risk of losing certain privileges or freedoms. A warning is a simple statement of fact. “If you throw the toy again, I will take it away from you until tomorrow.” Or, “If you continue throwing the sand you will have to get out of the sandbox for fifteen minutes.” A warning does not involve lecturing, pleading, or endless nagging.

8)    Make the consequences clear and then follow through. The consequences should generally emphasize the behavior or principle you are trying to teach, and not be so severe that they interfere with the motivation to recoup the privilege. You want the child to have a reason to do better. “I’m sorry. You blew it for the rest of the afternoon. But if you are gentle with your little brother between now and dinnertime, you can have another chance with the badminton rackets again dinner.” Follow through with the consequences! Children learn from the experience of being held to reasonable limits. As Dr. Russell Barkley stated so succinctly, “Act, don’t yack.”

9)    Validate your child’s feelings, but teach her acceptable ways to manage them. Your child needs to know that all emotions are okay, but what she does in response to her feelings is a choice. Children and teens with ADHD often struggle with this, because impulsiveness is a core symptom of the disorder. Be patient, but be clear. “I can see that you’re angry at your little brother, but it is not okay to hit him. What else could you do when he won’t leave you alone?”

10) Move on! A short debriefing is enough to emphasize what you want to teach. “I know you didn’t want your little brother to use your new toy. What could you do next time?” If your child can’t think of a good alternative, offer one or two ways he could handle the situation next time. Then, move on. “You blew it, but you’ll have another chance tomorrow.” Bite your tongue and trust that you have done your job if you have followed the plan.

Dr. Joyce Cooper-Kahn

Joyce Cooper-Kahn, PhD is a clinical psychologist at Thinking Tree Psychology specializing in direct services, consultation, and training regarding the needs of children with learning, behavioral and emotional challenges. She is coauthor of the books Late, Lost, and Unprepared: A Parent’s Guide to Helping Children with Executive Functioning (Woodbine, 2008) and Boosting Executive Skills in the Classroom: A Practical Guide for Educators (Jossey-Bass, 2013).