A Framework for Parenting a Child with ADHD
By: Mark Bertin (2012)
Dr. Mark Bertin is a developmental pediatrician and the author of The Family ADHD Solution. He attended UCLA School of Medicine, trained in general pediatrics at Children's Hospital Oakland, and completed fellowship at Albert Einstein School of Medicine. Dr. Bertin is an assistant professor of pediatrics at New York Medical College, on the editorial board for Common Sense Media, and on faculty for the Windward Teacher Training Institute. He also leads mindfulness based stress reduction classes, frequently for parents.
- Use praise and reward.
Emphasize successes in daily life, and praise the opposite of behaviors you would like to avoid. Targeted, specific praise often modifies behavior all on its own. Some families find token economy systems, such as sticker charts for younger children and more sophisticated reward systems for older ones, motivate kids to earn small rewards as they work toward a longer-term goal. Though an emphasis on praise and reward typically does not eliminate all problem behaviors, it is a vital for maintaining a healthy perspective in parents and children alike.
- Recognize the power of routine.
Establish and maintain routines for everyday tasks around the house such as getting ready for school or completing homework. Break tasks up into small manageable steps, and have your child rely on those lists each time a task is performed. Create visual or written lists for common routines, and then steer your child back to them as often as needed. Consistent routines make households run smoother and also provide direct instruction in delayed organization and planning abilities.
- Set limits.
Children with ADHD struggle to self-regulate. Upholding limits and routines not only helps your household run smoothly but is required for building executive function and related abilities that set your child up to thrive as an adult. In and of themselves clear limits help address developmental delays in self-regulation.
- Monitor your own consistency.
Both overly punitive parenting and inconsistent parenting can exacerbate behavioral issues in ADHD. These habitual styles as parents often develop and persist without our awareness. To build flexibility in your responses, use a practice of "listen, breathe, respond," pausing and reflecting before proceeding with your next action throughout the day. Consistency among caregivers is critical as well. Involving teachers, babysitters, grandparents and other caregivers in setting expectations also supports healthy development.
- Ignore what you can ignore.
A behavioral "triage" can help families prioritize what issues must be addressed versus those that can wait. Children with ADHD can and should be held accountable for their own behavior, but not everything will resolve at once. Choose those behaviors you'd like to change first for your child, and ignore the rest as much as possible. You'll get to them, but not right now.
- Consequences should be immediate.
To be effective, consequences for poor behavior should occur almost immediately rather than being delayed for later discussion or punishment. Behaviors persist if they are useful in some way — such as getting a grown-up's attention — and decrease when they are not as helpful to a child. Possible consequences may include such responses as a loss of privileges, the removal of a favorite toy or some other meaningful object, or a time out.
- Consequences — the calm way.
While trying to discipline or control a distressing situation, you are also training children in conflict resolution. Whatever consequence you set, stick to your decision without escalation. Yelling, for example, may control the situation in the short term but teaches a child to yell back in the long term. When using time outs don't interact, don't join in discussion, and don't lecture. The time out itself is the consequence, and any discussion should follow later. Be positive when reconnecting, addressing what might be done differently next time instead of dwelling only on whatever occurred.
- Know your child.
Your child has ADHD, a biological condition that affects self-regulation, memory and many other aspects of daily life as well. Recognize your child's needs, whether organizational, behavioral or otherwise, and work to collaborate and build skills. Offer appropriate options when you can instead of making demands, remaining firm about some rules and lax when you feel comfortable. Most importantly, set expectations that acknowledge your child's ADHD as a developmental delay in executive function.
- Maintain perspective.
Problem behaviors in children with ADHD are remarkably persistent, and behavioral change requires an amazing amount of consistency and patience. Recognize and celebrate small victories along the way. Remember to take care of yourself, doing what you can to maintain your own resilience and well-being.
Adapted from "The Family ADHD Solution" by Mark Bertin M.D. Copyright © 2011 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.