Behavior therapy for attention deficit hyperactivity disorder (ADHD)

Children and teens with attention deficit hyperactivity disorder (ADHD) do not misbehave to spite their parents or other adults. Problems develop because ADHD often causes them to react impulsively and makes it difficult for them to learn and to comply with rules.

Many children with ADHD need behavior therapy to help them interact appropriately with others. Parent training in these techniques usually takes 8 to 10 counseling sessions of 1 to 2 hours per week.

Behavior therapy for children under age 18 with ADHD generally involves two basic principles:

• Encouraging good behavior through praise or rewards. Praise for good behavior should immediately follow the behavior.
• Allowing natural and logical consequences for negative behavior

Preschool-age children (5 and younger)

• Be aware of your child's need for routine and structure. Warn him or her beforehand if something out of the ordinary is expected, such as taking a different route home from the grocery store. Even small changes in a normal routine can upset your child.
• Tell your child exactly what you expect from him or her before activities or events throughout the day. For example, when you plan to go grocery shopping, make sure your child knows that he or she is going to sit in the cart or hold your hand. Also, let your child know before you go in the store specifically what items, if any, he or she will be able to pick out.
• Use a system to reward your child for positive behavior, such as token jars or sticker charts. After accumulating a certain number of tokens or stickers, plan a special activity for your child, such as going to the park.
• Use a timer to help your child anticipate a change in activities and to keep him or her on task. Set a certain amount of time for activities, such as coloring. Tell your child that when the timer goes off, that activity will be over and specify what will happen next (for example, "When the timer goes off, we will be finished coloring and then take a bath"). In addition, you can use the timer for chores, such as picking up toys. If your child finishes the task in the allotted time, you can incorporate the token or sticker reward system.
• Participate with your child in activities that build attention skills, such as puzzles, reading, or coloring.

School-age children (6 to 12 years)

• Give instructions clearly so that the child is more likely to follow through with the task. Break tasks into simple steps. This makes it easier for the child to maintain attention.
• Increase the amount of attention, praise, and privileges or rewards given to the child for obeying household rules. A token, sticker, or point system may be helpful for keeping a record of the child's good behavior.
• Anticipate where the child may misbehave (such as in stores or restaurants or in the home when visitors come by). Make a plan with the child about how to manage the situation before problem behavior occurs.
• Explain what will happen if the child misbehaves. When misbehavior occurs, follow through with the consequences as soon as possible. Your child will usually respond better with consistent reactions while in different settings, so discuss your strategies with school personnel. Consider requesting daily report cards from your child's teacher to get a sense of how he or she behaves outside of the home.
• Model good behavior. Demonstrate patience, calmness, and understanding. Avoid angry outbursts and interrupting others; pay attention while someone else is talking.

Teenagers

• Allow your child to participate in planning rules and consequences. Be willing to negotiate these rules periodically.
• Anticipate when major changes will occur, such as starting a new school. In addition, recognize other high-stress situations, such as a heavy class load or final exams. These are all times when symptoms may be more difficult to manage. Talk about what the child can expect and ways to meet the challenges successfully.
• Be consistent. Predictability reinforces expectations and will help your child develop positive behavior patterns.

When parents start a new system of limits and consequences, children tend to test those limits. It takes patience, imagination, creativity, and energy to carry out behavior management. It is important for parents to apply the techniques consistently. The program is often successful in helping a child behave appropriately and function well. However, if parents stop using the techniques, problem behavior usually returns.

Parenting programs and books may be helpful for some parents. Ask your health professional for specific recommendations.