Treatment Overview

Many children with attention deficit hyperactivity disorder (ADHD) need behaviour therapy to help them interact appropriately with others. Parent and caregiver training in these techniques most often takes 8-10 counselling sessions. Each session may be 1 to 2 hours a week.

Behaviour therapy most often involves two basic principles:

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

Here are some things you can do to practice behaviour 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 behaviour.

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 colouring. 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 colouring 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. For some children, it can be helpful to let them know when a timer is about to go off. This can prevent a feeling of surprise, especially for activities they enjoy or if they are very focused. When to give the warning that a timer will go off can depend on your child and the length of the activity they are doing.

Do activities with your child that build attention skills.

Some examples of these types of activities include doing puzzles, reading, or colouring.

School-age children (6 to 12 years)

Give clear instructions so that your child is more likely to follow through with the task.

Use clear, simple language to explain expectations. Break tasks into simple steps using numbers or words such as “first” and “then” to highlight the steps and order. 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 behaviours. To make a reward more effective, involve your child in picking it.

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 any problem behaviour occurs.

Explain what will happen if your child doesn't follow the rules or plan.

When the problem behaviour occurs, follow through with the 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 regular communication from your child's teacher. This will give you a sense of how your child behaves outside of the home and can help you know what kind of mood your child will be in when they get home.

Talk with your child about behaviors at school.
When your child gets home, do not add more consequences for behaviours that have already been addressed at school. Instead, use the information you get from school staff members to talk with your child about the event, their reaction, and how they can act differently in the future.

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 reinforce what is expected. It will help your teen develop positive behaviour patterns.

Remember, when parents or caregivers start a new system of limits and consequences, children and teens tend to test those limits. It takes patience, imagination, creativity, and energy to carry out behaviour management. It's important for parents and caregivers to apply the techniques in a consistent way. The program is often successful in helping a child behave and function well. But if you stop using the techniques, problem behaviour most often returns.

Parenting programs and books may be helpful for some parents and caregivers. Ask your care provider for suggestions.