Eight Principles to Manage ADHD Children - How to Manage ADHD Children

Written by Russell A. Barkley, Ph.D.

6. Plan for Problem Situations and Transitions

Often times, caregivers of ADHD children, particularly those children who are also defiant, find themselves frequently faced with difficult, disruptive, or noncompliant behavior. These situations arise not just at home, but frequently in public places, such as stores, restaurants, churches, and others' homes, and even in school. When they occur, caregivers can become flustered, bewildered, and frustrated, and may be unable to think quickly as to how best to handle such problems. These feelings are often combined with a sense of anxiety and humiliation when these child behavior problems arise in front of others, especially strangers in public settings.

In interviewing many caregivers of ADHD children, I have often been struck by their ability, when pressed to do so, to predict ahead of time where their children are likely to disrupt and misbehave. Yet, many simply have not put this information to good use in preparing for such problems to arise again. That is why we teach parents to anticipate problems, consider ahead of time how best to deal with them, develop their plan, share it with the child just beforehand, and then use the plan should a problem arise. People may find it hard to believe that merely sharing the plan with the child before entering a potential problem setting greatly reduces the odds that behavior problems will arise. But it does.

By following four simple steps before entering any problem setting, caregivers can improve the management of ADHD children.

• Stop just before beginning the potential problem situation.
• Review two or three rules that the child often has trouble following in that situation; then ask the child to repeat these simple rules back. For instance, they can be rules like "Stand close, Don't touch, and Don't beg" for a young ADHD child about to enter a store with a parent.
• Review with the child what rewards they may be able to earn if they obey the rules and behave well. These rewards can be chips or points that are part of their home or school token system, a special treat or privilege to enjoy later, such as some additional time to play, watch TV, or even, on occasion, the purchase of a small treat or toy while in the store at the end of the trip.
• Review the punishment that may have to be used with the child. Typically, these involve loss of points nor fines, the loss of a privilege later in the day, or, if necessary, time out in the situation. Whichever punishment is used, the key to effec- tive management of a child is the quickness or immediacy of responding with the consequence when the problem arises, as noted earlier.

Now once these four steps have been followed, the caregiver and child may enter the potential problem context, and the caregiver immediately begins to give the child frequent feedback and occasional rewards or tokens for good behavior.

7. Keep a Disability Perspective

At times, when faced with a difficult to manage ADHD child, caregivers lose all perspective on the immediate problem, become enraged, angered, embarrassed, or at the very least, frustrated, when management does not work. Often, they may even argue with the child about the issue, as another child or sibling might do. This is ineffective, looks silly, and may even encourage continued confrontation by the child on future such occasions. Teach caregivers to remember at all times, they are the adult; they are this child's teacher and coach. If either of them is to keep their wits about them, it clearly has to be the adult. Losing their cool won't help, will likely make the problem worse, and will often lead to considerable guilt once they recover their senses.

Therefore, they must try to maintain psychological distance from the child's disruptive behavior, if necessary pretending that they are a stranger who has just happened upon this encounter between caregiver and ADHD child. In addition, they should not allow their sense of self-worth and dignity to become derived from whether or not they "win" this argument or encounter with the child. Counsel them to strive to stay calm if possible, maintain a sense of humor about the problem, and by all means try to follow the other seven principles in responding to the child. Sometimes this may even require caregivers to disengage from the encounter for a moment by walking away and gathering their wits as they regain control over their feelings. Above all, they must not personalize the problem encounter with the child. Advise them to remember that they are dealing with a handicapped child! ADHD children cannot always help behaving in the ways that they do; the caregivers can.