Last week, 9-year-old James came into my office beaming. It was the first time I had met him and I was quite surprised at the charming, smiling boy who shook hands with me. I had met with his parents two weeks before and they had described James as angry, defiant, and constantly misbehaving, both at school and at home. He didn't turn in his homework and when his parents tried to monitor him, he'd lie and say he turned it in.
James's pediatrician had recently diagnosed him with ADHD and recommended medication, but his parents balked at the idea. They had read about the side effects of stimulant drugs and wanted to try another path. A friend had recommended family therapy.
"What's that?" I asked James, pointing to a toy he carried proudly. "It's a fidget gadget," James replied. "I won it at school because I had good behavior for a week." "Good job," I said. He told me that his teacher had set up a reward system in the classroom. Every child who had good behavior for the week got to pick a toy. This, along with the reward system and other parenting interventions I had helped his parents set up at home, had changed James' behavior in two weeks.
James was no longer angry and defiant at bedtime. He was ready for school in the morning when it was time to leave. These were the two behaviors we had targeted with a sticker chart and reward system. The reward was that four stars out of five earned him a special outing with his father on the weekend. He could choose to go out for frozen yogurt or to mini golf, or simply to the park to play catch. Often children misbehave to get the attention of their parents. Earning a special outing with a parent kills two bird with one stone—the child gets rewarded for positive behavior and also gets one-on-one time with a parent.
I had to laugh when I read Dr. Kennedy-Moore's words about reward systems for kids: "... parents get fed up with them." Yes, star charts and consistent follow-through takes time and effort. But parenting isn't always a joyride, especially with kids who are having problems. For kids who have been labeled with ADHD, ODD, or the rest of the alphabet soup of diagnoses, parents usually have to work hard to reverse the child's behavior.
With all the demands on their time, parents might well decide that star charts take too much time and turn to medication instead. But in my 25 years of experience in family therapy for severe childhood problems, consistency over a few months with a star chart and rewards always pays off.
Star charts are useful for reinforcing positive behaviors such as being ready for school on time, brushing their teeth, or having a day without incidents at school. You put a calendar on the refrigerator door or in the child's room. Every day that the child completes the desired behavior, he gets a gold star. If he gets four out of five stars on weekdays, then on weekends he gets rewarded with a treat. The treat can be a special excursion with a parent to an ice-cream shop, a small toy, having a friend over for pizza, or even being able to stay up past bedtime on a weekend night. It's good to keep the chart simple and start out by targeting one behavior that is most important to you and easy for the child to learn.
For older children and more serious problem behaviors, a "token economy," also known as a "point system," can replace the star chart. A child can gain points for positive behaviors like cleaning her room, getting her homework done without prompting, or getting ready for school on time. When a child does not do what is expected, she loses points. To earn privileges, the child must accumulate a specified number of points. For especially obnoxious behavior, the child's school may go to a point system as well.
Of course, for serious behavioral problems, star charts and rewards are not in themselves enough. They need to be combined with other strategies like calm consistent consequences for misbehavior, more structure in their day, parents' not arguing in front of the children, reclaiming the family hierarchy in which parents are in charge of their kids, not vice versa, not discussing parental stress in front of the children, and so forth. Parents can read about these strategies in my book A Disease Called Childhood.
My years of clinical experience have taught me that star charts and rewards have magical results when parents use them consistently until eventually the child internalizes the good behaviors and they become unnecessary.