Behavior Therapy for ADHD

Many children with ADHD can benefit from behavior therapy to help them learn skills for interacting well with others. Parent training in these techniques most often takes several counseling sessions. Each session may be 1 to 2 hours a week.

Behavior therapy most often involves two basic principles:

• Encouraging positive actions through praise or rewards. Praise should immediately follow the action you want to see.
• Allowing natural and logical consequences when actions aren't appropriate.

Here are some things you can do to practice behavior therapy at different ages:

Preschool-age children (5 and younger)

• Be aware of your child's need for routine and structure. Even small changes in a normal routine can upset your child. Warn your child ahead of time if something that isn't expected will happen. This can be something like taking a new route home from the grocery store.
• Tell your child exactly what you expect before activities or events. Do this throughout the day. For example, when you plan to go grocery shopping, make sure your child knows that they'll need to sit in the cart or hold your hand. Also, let your child know before you go in the store which specific items, if any, they'll be able to pick out.
• Use a system to reward your child for positive actions. For example, you could try token jars or sticker charts. After reaching 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 expect a change in activities and to keep 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. Also tell your child what will happen next. For example, "When the timer goes off, we'll be finished coloring and then will take a bath." And you can use the timer for chores, such as picking up toys. If your child finishes the task in the time allowed, you can use the token or sticker reward system.
• Do activities with your child that build attention skills. Some examples of these types of activities include doing puzzles, reading, or coloring.

School-age children (6 to 12 years)

• Give clear instructions so that your child is more likely to follow through with the task. For example, break tasks into simple steps. This makes it easier for your child to maintain attention.
• Increase the attention, praise, and privileges or rewards you give your child for following household rules. A token, sticker, or point system may be helpful for keeping a record of your child's positive actions.
• Look ahead to see where your child may have problems, and make a plan to manage them. Children may have trouble in stores or restaurants. Or they may have problems at home when visitors come by. Make a plan with your child about how to manage these situations before they happen.
• Explain what will happen if your child doesn't follow the rules or plan. If they don't follow the rules or plan, calmly follow through with the agreed-upon consequences as soon as possible. Your child will usually respond better when there are consistent reactions in different settings. So talk about your approach with school staff members. Think about asking for daily report cards from your child's teacher. This will give you a sense of how your child behaves outside of the home.

Teens

• Allow your teen to help plan rules and consequences. Be willing to talk about and make changes to these rules over time.
• Look ahead to see when major changes will occur, such as starting a new school. Also, watch for other high-stress situations, such as a heavy class load or final exams. These are all times when symptoms may be harder to manage. Talk about what your teen can expect. And talk about ways to have success in these challenges.
• Be consistent. Being predictable helps your teen know what to expect and supports them in learning helpful skills for managing their actions.

When parents start a new system of limits and consequences, children may test the boundaries. With patience and consistency, these strategies can help children learn skills to manage their actions and succeed. It’s normal for challenges to come back sometimes. Sticking with the plan helps progress continue.

Parenting programs and books may be helpful for some parents. Ask your doctor or counselor for suggestions.