What is behavior therapy?
It is non-medical approach used in treating children with Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder is known as behavior therapy or behavior management. Behavior therapy is based on several simple and sensible notions about what leads children to behave in socially appropriate ways. One reason is that children generally want to please their parents and feel good about them when their parent is proud of them. When the relationship between parent and child is basically positive, this is a very important source of motivation. A second reason that children behave appropriately is to obtain positive consequences for doing so (i.e. privileges or rewards). Finally, children will behave appropriately to avoid the negative consequences that follow inappropriate behavior.
What are the goals of behavior therapy?
The goals of behavior therapy are to increase the frequency of desirable behavior by increasing the child's interest in pleasing parents and by providing positive consequences when the child behaves.
Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs. This is a simplified, but not unreasonable view, of what behavior therapy is all about.
How to design behavior plan?
Designing a good behavior plan and implementing it effectively is not easy, and parents may often require professional assistance to do this successfully. Although the specifics of a good plan will vary from child to child and from parent to parent, there are several general principles that are important to keep in mind:
1. Be very clear about what behavior is expected of your child in order to earn the reward and make sure your child's understands this. For example, "Listening to what I say" would be too vague; "Picking up your toys and putting them away the first time I ask" is more specific.
2. Make sure that the expectation you have for your child is reasonable - do not set you and your child up for failure by having expectations that are not appropriate for your child's age. It is always a good idea to reflect on what you expect from your child and consider whether your expectations are reasonable. For example, punishing a 5 year old for being unable to sit quietly at the dinner table for an hour will generally create problems because most 5 year olds simply cannot do this. For children with Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder, behavioral expectations need to take this into account in addition to the child's age.
3. Don't try to work on too many different things at one time. It is generally better to focus on a couple of things that are really important rather than taking on everything at once. Choose your battles carefully and selectively!
4. Let your child participate in choosing the types of rewards he or she can earn. Children are generally more invested in this type of program when they have some input in its design. Try to create the feeling that this is something that you are doing with your child rather than something you are doing to your child.
5. Design the program so your child has a good chance to experience some initial success. It is important that the child experience some initial success in order to maintain and enhance their motivation. As their behavior improves, you can gradually raise the criterion required to earn rewards.
6. Be sure to provide lots of social rewards (e.g. praise) in addition to the more tangible rewards that can be earned. This is a great way to increase your childish desire to please you and to increase the amount of positive feelings between you and your child.
7. Be consistent.
For this approach to succeed you have to apply it consistently. Using the program one day but not the next, or failing to provide rewards when they are earned, is a sure fire way to keep this from being helpful.
Behavioral approach for children with ADHD:
Using a combination of special time, positive reinforcement, and negative consequences to encourage good behavior is, of course, a technique that can be useful with all children. Although the basic principles are similar for children with and without ADHD/ADD, factors specific to ADHD/ADD generally require certain modifications to be made. Several of these important modifications are:
1. Children with ADHD/ADD generally require more frequent feedback about how they are doing in meeting the parent (or teacher's) expectations.
Research has consistently demonstrated that children with Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder perform better when they are given frequent feedback about their performance. Thus, if the behavior you are targeting is "following directions", it is better to provide your child with feedback about how well they are following directions every hour, rather than doing this once at the end of the day. The actual time interval is something to experiment with; the important point is that a child with ADHD/ADD needs frequent feedback for behavioral programs to be effective.
2. Children with ADHD/ADD do better with short term goals than long term goals
This follows from the above. Along with more frequent feedback, children with ADHD/ADD generally require shorter intervals between the opportunities to earn rewards. For example, promising a weekend reward for good behavior during the week may be too far in the future to function as an effective motivator for a child with Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder. Daily rewards, or even more frequent opportunity to earn privileges, will often be necessary. Providing a child with points or "tokens" for good behavior that can be used to purchase more tangible rewards (e.g. TV time; Nintendo time; getting to rent a video) can be useful because they can be frequently and easily dispensed, and have value because of their connection to desired activities and objects.
3. Children with ADHD/ADD require more frequent reminders about what is expected of them and what they can earn for meeting those expectations.
For this approach to be effective, it needs to occupy a prominent place in a child's mind. Children who forget what their behavior goals are and what they are trying to earn by achieving those goals are unlikely to be successful. For a child with ADHD/ADD, frequent reminders about the goals and rewards are important. This can be done in the context of providing feedback on how the child is doing.
4. Children with ADHD/ADD often require frequent changes in the program to remain interested in it.
Those of you who have already tried various behavior plans may be well aware of this. It is not uncommon for a child to get off to a great start and then lose interest in earning any rewards. The best way to combat this is to try change the program to keep it feeling "new". This can be done by changing the rewards (e.g. one day the reward to be earned in TV time, the next day it is getting to stay up an extra half hour, etc.) If you’re using tokens, changing the actual token can also be helpful. For example, one week pennies might be used, the next week marbles, the next week stickers, etc. Obviously, this all depends on the age of the child and what his or her interests happen to be. It certainly takes plenty of hard work and creativity on parents' part.
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