- Cognitive behavioral therapy (CBT) for adult ADHD provides concrete strategies and skills for coping with the core symptoms of ADHD (inattention, hyperactivity, impulsivity) and associated impairment in social, occupational, educational, and other domains.
- Whether your child with ADHD is young or a teen, you can show them you’re firm but fair (and fun) by doing two key things. Encourage good behavior with praise or rewards immediately.
- Social workers, psychologists, psychiatrists, or other mental health professionals provide ADHD therapy for children (see Where to Find ADD Help). These professionals use a variety of techniques in counseling the ADD child, but ADHD behavioral therapy and ADHD cognitive therapy techniques represent the most common types of ADHD therapy.
A major obstacle in accessing appropriate ADHD treatment is the limited availability of qualified therapists that provide behavioral/psychosocial services, such as parent behavior training, in many geographical areas.
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The second major component of effective instruction for children with ADHD involves the use of behavioral interventions. Exhibiting behavior that resembles that of younger children, children with ADHD often act immaturely and have difficulty learning how to control their impulsiveness and hyperactivity. They may have problems forming friendships with other children in the class and may have difficulty thinking through the social consequences of their actions.
The purpose of behavioral interventions is to assist students in displaying the behaviors that are most conducive to their own learning and that of classmates. Well-managed classrooms prevent many disciplinary problems and provide an environment that is most favorable for learning. When a teacher's time must be spent interacting with students whose behaviors are not focused on the lesson being presented, less time is available for assisting other students. Behavioral interventions should be viewed as an opportunity for teaching in the most effective and efficient manner, rather than as an opportunity for punishment.
Effective Behavioral Intervention Techniques
Effective teachers use a number of behavioral intervention techniques to help students learn how to control their behavior. Perhaps the most important and effective of these is verbal reinforcement of appropriate behavior. The most common form of verbal reinforcement is praise given to a student when he or she begins and completes an activity or exhibits a particular desired behavior. Simple phrases such as 'good job' encourage a child to act appropriately. Effective teachers praise children with ADHD frequently and look for a behavior to praise before, and not after, a child gets off task. The following strategies provide some guidance regarding the use of praise:
- Define the appropriate behavior while giving praise.
Praise should be specific for the positive behavior displayed by the student: The comments should focus on what the student did right and should include exactly what part(s) of the student's behavior was desirable. Rather than praising a student for not disturbing the class, for example, a teacher should praise him or her for quietly completing a math lesson on time.
- Give praise immediately.
The sooner that approval is given regarding appropriate behavior, the more likely the student will repeat it.
- Vary the statements given as praise.
The comments used by teachers to praise appropriate behavior should vary; when students hear the same praise statement repeated over and over, it may lose its value.
- Be consistent and sincere with praise.
Appropriate behavior should receive consistent praise. Consistency among teachers with respect to desired behavior is important in order to avoid confusion on the part of students with ADHD. Similarly, students will notice when teachers give insincere praise, and this insincerity will make praise less effective.
It is important to keep in mind that the most effective teachers focus their behavioral intervention strategies on praise rather than on punishment. Negative consequences may temporarily change behavior, but they rarely change attitudes and may actually increase the frequency and intensity of inappropriate behavior by rewarding misbehaving students with attention. Moreover, punishment may only teach children what not to do; it does not provide children with the skills that they need to do what is expected. Positive reinforcement produces the changes in attitudes that will shape a student's behavior over the long term.
In addition to verbal reinforcement, the following set of generalized behavioral intervention techniques has proven helpful with students with ADHD as well:
- Selectively ignore inappropriate behavior.
It is sometimes helpful for teachers to selectively ignore inappropriate behavior. This technique is particularly useful when the behavior is unintentional or unlikely to recur or is intended solely to gain the attention of teachers or classmates without disrupting the classroom or interfering with the learning of others.
- Remove nuisance items.
Teachers often find that certain objects (such as rubber bands and toys) distract the attention of students with ADHD in the classroom. The removal of nuisance items is generally most effective after the student has been given the choice of putting it away immediately and then fails to do so.
- Provide calming manipulatives.
While some toys and other objects can be distracting for both the students with ADHD and peers in the classroom, some children with ADHD can benefit from having access to objects that can be manipulated quietly. Manipulatives may help children gain some needed sensory input while still attending to the lesson.
- Allow for 'escape valve' outlets.
Permitting students with ADHD to leave class for a moment, perhaps on an errand (such as returning a book to the library), can be an effective means of settling them down and allowing them to return to the room ready to concentrate.
- Activity reinforcement.
Students receive activity reinforcement when they are encouraged to perform a less desirable behavior before a preferred one.
- Hurdle helping.
Teachers can offer encouragement, support, and assistance to prevent students from becoming frustrated with an assignment. This help can take many forms, from enlisting a peer for support to supplying additional materials or information.
- Parent conferences.
Parents have a critical role in the education of students, and this axiom may be particularly true for those with ADHD. As such, parents must be included as partners in planning for the student's success. Partnering with parents entails including parental input in behavioral intervention strategies, maintaining frequent communication between parents and teachers, and collaborating in monitoring the student's progress.
- Peer mediation.
Members of a student's peer group can positively impact the behavior of students with ADHD. Many schools now have formalized peer mediation programs, in which students receive training in order to manage disputes involving their classmates.
Effective teachers also use behavioral prompts with their students. These prompts help remind students about expectations for their learning and behavior in the classroom. Three, which may be particularly helpful, are the following:
- Visual cues.
Establish simple, nonintrusive visual cues to remind the child to remain on task. For example, you can point at the child while looking him or her in the eye, or you can hold out your hand, palm down, near the child.
- Proximity control.
When talking to a child, move to where the child is standing or sitting. Your physical proximity to the child will help the child to focus and pay attention to what you are saying.
- Hand gestures.
Use hand signals to communicate privately with a child with ADHD. For example, ask the child to raise his or her hand every time you ask a question. A closed fist can signal that the child knows the answer; an open palm can signal that he or she does not know the answer. You would call on the child to answer only when he or she makes a fist.
In some instances, children with ADHD benefit from instruction designed to help students learn how to manage their own behavior:
Adhddialectical Behavioral Training Programs
- Social skills classes.
Teach children with ADHD appropriate social skills using a structured class. For example, you can ask the children to role-play and model different solutions to common social problems. It is critical to provide for the generalization of these skills, including structured opportunities for the children to use the social skills that they learn. Offering such classes, or experiences, to the general school population can positively affect the school climate.
- Problem solving sessions.
Discuss how to resolve social conflicts. Conduct impromptu discussions with one student or with a small group of students where the conflict arises. In this setting, ask two children who are arguing about a game to discuss how to settle their differences. Encourage the children to resolve their problem by talking to each other in a supervised setting.
For many children with ADHD, functional behavioral assessments and positive behavioral interventions and supports, including behavioral contracts and management plans, tangible rewards, or token economy systems, are helpful in teaching them how to manage their own behavior. Because students' individual needs are different, it is important for teachers, along with the family and other involved professionals, to evaluate whether these practices are appropriate for their classrooms. Examples of these techniques, along with steps to follow when using them, include the following:
Adhddialectical Behavioral Training Center
Adhddialectical Behavioral Training Program
- Functional Behavioral Assessment (FBA).
FBA is a systematic process for describing problem behavior and identifying the environmental factors and surrounding events associated with problem behavior. The team that works closely with the child exhibiting problem behavior (1) observes the behavior and identifies and defines its problematic characteristics, (2) identifies which actions or events precede and follow the behavior, and (3) determines how often the behavior occurs. The results of the FBA should be used to develop an effective and efficient intervention and support plan. (Gable, et al., 1997)
- Positive Behavioral Interventions and Supports (PBIS).
This method is an application of a behaviorally based systems approach that is grounded in research regarding behavior in the context of the settings in which it occurs. Using this method, schools, families, and communities work to design effective environments to improve behavior. The goal of PBIS is to eliminate problem behavior, to replace it with more appropriate behavior, and to increase a person's skills and opportunities for an enhanced quality of life (Todd, Horner, Sugai, & Sprague, 1999).
- Behavioral contracts and management plans.
Identify specific academic or behavioral goals for the child with ADHD, along with behavior that needs to change and strategies for responding to inappropriate behavior. Work with the child to cooperatively identify appropriate goals, such as completing homework assignments on time and obeying safety rules on the school playground. Take the time to ensure that the child agrees that his or her goals are important to master. Behavioral contracts and management plans are typically used with individual children, as opposed to entire classes, and should be prepared with input from parents.
- Tangible rewards.
Use tangible rewards to reinforce appropriate behavior. These rewards can include stickers, such as 'happy faces' or sports team emblems, or privileges, such as extra time on the computer or lunch with the teacher. Children should be involved in the selection of the reward. If children are invested in the reward, they are more likely to work for it.
- Token economy systems.
Use token economy systems to motivate a child to achieve a goal identified in a behavioral contract (Barkley, 1990). For example, a child can earn points for each homework assignment completed on time. In some cases, students also lose points for each homework assignment not completed on time. After earning a specified number of points, the student receives a tangible reward, such as extra time on a computer or a 'free' period on Friday afternoon. Token economy systems are often used for entire classrooms, as opposed to solely for individual students.
- Self-management systems.
Train students to monitor and evaluate their own behavior without constant feedback from the teacher. In a typical self-management system, the teacher identifies behaviors that will be managed by a student and provides a written rating scale that includes the performance criteria for each rating. The teacher and student separately rate student behavior during an activity and compare ratings. The student earns points if the ratings match or are within one point and receives no points if ratings are more than one point apart; points are exchanged for privileges. With time, the teacher involvement is removed, and the student becomes responsible for self-monitoring (DuPaul & Stoner as cited in Shinn, Walker, & Stoner, 2002).