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ADHD in Children Health Center

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Preschoolers on Drugs

Not all hyperactive kids need to be medicated.

A New Approach

Based on his research at Massachusetts General, Greene's strategy involves two steps. The first step is for parents to identify and avoid situations that habitually frustrate their child. For example, a kid who becomes over-stimulated in the supermarket can be left at home with a babysitter.

The second step is for parents to teach the child to accept a compromise when his demands can't be granted immediately. A child can be given permission to sleep over at a friend's house on the weekend, instead of during the week when homework needs to be completed.

Prioritizing for Parents

In addition, Greene says parents need to prioritize their demands, and he suggests using a system of "baskets" A, B, and C. Parents should put behaviors that relate to a child's health and safety (such as wearing a helmet when bicycling) in a nonnegotiable Basket A. These rules are important to enforce even if the child becomes angry and out of control.

Behaviors that are desirable (such as eating a variety of foods) but are not worth daily mealtime tantrums can be put in Basket C and assigned a lower priority for enforcement.

And in Basket B parents can put behaviors that are important but not essential and that can be negotiated with a compromise. For instance, a child who doesn't want to come into the house might be allowed to play outside for an extra 15 minutes.

Greene says that while these kids may want to obey, they lack critical skills such as flexibility and problem solving that would allow them to comply. With his techniques, parents can reduce the demands on their children and intervene before the kids become irrational.

"I have to sell this approach on a daily basis to skeptical parents," Greene acknowledges. "It seems simplistic but it really works."

Nicholas Hill's mother agrees. A year after starting to follow Greene's techniques, Nicholas, now 8, is a calmer, happier, more confident child. Although he remains on some medications, the doses have been dramatically reduced. "The negative mood over the whole household has lifted," says Hill.

As she talks on her kitchen telephone, she watches Nicholas dash out the back door and chase his brother up a tree. "At one time that would have been an 'A,' but now it's a 'C,' " she says. "I've learned."

Rochelle Jones is a freelance writer based in New York.

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