The Older Dad

The wise and older parent

ADHD: Behavioral Parenting Supported (Again) By Research

Behavioral Parenting: a key ingredient when rearing children with ADHD

Children with ADHD struggle from the earliest ages to control their actions and pay attention. They forget to turn-off the TV, to come to the table, or to clean their rooms. When homework requires their attention, children with ADHD lose track of time, skip problems, and often can’t find their assignment book.  In the past, I’ve written about positive self-esteem (http://www.psychologytoday.com/blog/the-older-dad/201102/positive-parenting-self-esteem) and siblings of children with ADHD (http://www.psychologytoday.com/blog/the-older-dad/201110/ghost-children-brothers-and-sisters-adhd-children). Now let’s turn our attention to a new study on ADHD and behavioral parenting.

When things Go Wrong:  Dr. Russell Barkley, a leading psychologist researcher in ADHD, documented how parents repeatedly reprimand their children with ADHD for not doing what they’re told. Barkley reported that, often, parents end-up learning to use angry, punitive strategies with their ADHD children.  But, this cycle of reprimands, anger and punishment usually only works in the short-term. In the long-term, this cycle can harm children’s emotional well-being, unintentionally teaching them to be aggressive. So…..what can parents do instead?

When things Go Right:  Researchers at Ohio University, led by Dr. Steven Evans (http://www.ohio.edu/research/communications/owens-evans.cfm), reviewed studies since 2007. They examined the evidence, to see what helps children and teens who have ADHD. The study, published this month in the Journal of Clinical Child and Adolescent Psychology (http://www.tandfonline.com/toc/hcap20/.VACJzFavbRo), included the finding that behavioral parent training works.  Evans' team found similar evidence to other published studies, like the one Dr. William Pelham’s team published in 2005. What’s most encouraging is how quickly behavioral parenting training can work: the study showed that, even when the behavioral parent training occured in a single session, or on the phone, chidlren still benefited.

Behavioral Parent Training: A Positive Approach

Of the various programs for behavioral parent training, the Kazdin method (http://www.apa.org/divisions/div12/rev_est/pmt_child.html), called Parent Management Training (PMT), is a well-regarded POSITIVE way for parents to change their children's behaviors. 

In PMT, parents are taught several parenting skills, including how to measure their children’s behaviors and set limits. But one of the most important parts of any behavioral parenting intervention, including PMT, is teaching parents how to focus on positive behaviors.  In PMT, those are called Positive Opposites. Dr. Kazdin, in his book Parent Management Training, says

"The notion of positive opposites underscores the different orientation of PMT, namely, the focus on developoing positive, prosocial behaviors.  Even when punishemnt is used in PMT, it is secondary to a program that focuses on positive reinforement."

Positive Opposites: When parents work to reduce oppositional behaviors from ADHD children, behavioral parenting defines what parents want from their children: the Positive Opposite. For example, if children fail to come to the table for dinner, the positive opposite would be to stop whatever else is being done, and sitting at the table. So PMT teaches parents to reward children for what Kazdin calls “minding.” The idea of behavioral parenting is not to stop a behavior, it is to replace it instead. 

Attention Rewards: PMT also teaches parents how to control attention to problem behaviors, while praising children when acting in the positive opposite way. Parents learn how to use effective, unemotional ignoring targeted at specific problem behaviors. Instead, parents use effective praise when the positive behavior occurs by not only thanking children, but also by describing the behavior while praising it ("Sue, thank you for coming to the table, that is just want I asked you to do!").  

No More Nagging:  In addition, when parents ask children with ADHD to do a positive opposite, asking more than twice is referred to as nagging—and nagging rewards, through attention, children not minding. In contrast, a reminder that there will be another chance, and then ignoring children for a brief period can often be more effective. The "no more nagging" rule breaks the cycle described by Dr. Barkley. 

Point Rewards:  PMT also provides ways to use points to reward positive opposites. The points, in turn, can be used by children to obtain things they want. Even when children don’t mind their parents, PMT uses positive strategies by reminding children that they can try again later to earn points—keeping both parents and children focused on the positive. The parents are also aided to select only items that are interesting or desirable to their children so that earning points will be motivating. 

Time-out and Other “Costs” for Problem Behavior: Of course, sometimes parents must use negative outcomes or time-out. In behavioral parenting, time-out is short, and children are praised for going to, and staying in, time-out. In PMT, time-out is not punitive; instead, it’s withholding attention until things calm down so children can try again to do the positive behavior.  Other costs, like performing an unwanted choir or removing a privilege, occur along with parents reminding their children of the positive behavior. To keep the "costs" as postivie as possible, parents learn to use calm tones rather than displaying any anger.

Positive Practice: When parents have had unpleasant experiences, they can become apprehensive even before children misbehave. Research shows that parents’ anticipatory anxiety can undermine using positive behavioral skills, even after those skills have been used well. In behavioral parenting, moms and dads learn to use the strategies by practicing, sometimes even in the very situations when problems have occurred in the past. Behavioral parenting uses role-playing and practice to both teach behavioral parenting skills and to build positive experiences that counter anticipatory anxiety. 

For children with ADHD, keeping it positive and using behavioral parenting strategies can’t be emphasized enough. Parents can see sometimes amazing outcomes when they learn behavioral parenting strategies, focus on the positive opposites, and use rewards and ignoring effectively.

Resources

http://yaleparentingcenter.yale.edu

http://alankazdin.com/the-kazdin-method-for-parenting-the-defiant-child-with-no-pills-no-therapy-no-contest-of-wills/

http://www.russellbarkley.org

http://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Behavior-Therapy-The-Specifics-of-Parent-Training.aspx

In some parts of the country, parents can enroll their children in summer camps that can rapidly lead to progress—but moms and dads go to the camp regularly too, learning behavioral parenting. For more information, see http://ccf.fiu.edu or http://ccf.buffalo.edu/STP.php 

 

Kevin D. Arnold, Ph.D., A.B.P.P., is the Director of the Center for Cognitive and Behavioral Therapy of Greater Columbus and a Clinical Faculty member in the Dept. of Psychiatry at OSU.

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