Even those with the best parenting skills deteriorate when they’re up against the day-to-day stress of ADD kids, and intervention with the parents and family is crucial to a healthy outcome for these children. Having an ADD child or teenager is often extremely stressful on a family system. Siblings are often embarrassed by the child’s behavior, and parents often feel guilty for struggling so much with these children. One of the most helpful things I have done for these families is to lead a weekly parent education and support group. When I help parents become more effective with these children, the entire household does better.
Before undertaking parent training, it is important to screen parents and other siblings for ADD. Untreated ADD in parents or siblings sabotages treatment. Untreated ADD parents are often unable to follow through on their homework. Untreated siblings often disrupt the progress of the child or teen in treatment.
Here is a summary of the important points from the parenting course:
Perhaps the biggest roadblock to effective discipline of ADD children and teens is guilt. Too often parents allow guilt to get in their way and render them totally ineffective in dealing with the difficult child.
Here is the guilt cycle that often perpetuates bad behavior.
PARENT EXPLODES
(because they can’t take the bad behavior anymore)
PARENT FEELS GUILT
(because they overreacted or were excessively harsh)
PARENT ALLOWS THE CHILD TO GET AWAY WITH MISBEHAVIOR
(because of their guilt over the explosion toward the child)
PARENT FEELS TENSION BUILDING UP
(because they are not effectively dealing with the misbehavior)
PARENT EXPLODES
(and the cycle starts all over again)
It’s very important when dealing with the ADD child to break the guilt cycle. The best way to do this is by dealing with difficult behavior whenever it occurs and not allowing the tension to build up in you to the point where you explode.
Retraining difficult behavior patterns is an essential part of the treatment for ADD. As I’ve mentioned, having this disorder causes faulty learning in many areas of life. For example, many children with ADD are repeatedly given the message that they’re stupid (i.e., by parent or teacher complaints, being teased by other children). Too often, they begin to believe they really are stupid. As such, they stop doing their work, believing it is too hard for them.
Behaviorally, many children, teens, and adults learn to get other people upset with their difficult behavior. They learn, on a purely unconscious and biological level, that when there is turmoil between people, it stimulates their brain, making them feel more alert and awake. They do not know this on a conscious level and would, in fact, deny that they ever do it. But when you watch these people with their parents or in social situations, their behavior seems goal-directed toward turmoil. After listening to hundreds of mothers, I’m convinced that this is a technique to treat underlying brain deactivation with turmoil, as an alcoholic may treat underlying restlessness or anxiety with alcohol.
Retraining behavior patterns or behavior modification involves several clear steps:
Step One: Define the desired and undesirable behaviors specifically.
Step Two: Establish a baseline period.
Step Three: Communicate the rules and expectations clearly.
Step Four: Reward desired behavior.
Step Five: Give clear, unemotional consequences for the negative behavior.
Define the desired and undesirable behaviors specifically. Before you can shape behavior, it is critical to clearly know what behaviors you want and what behaviors you don’t want. Examples of desirable behaviors might include doing what parents say the first time or doing homework before going out to play. Hitting another person and talking back are examples of undesirable behaviors.
Establish a baseline period of how often either negative or positive behavior occurs. Take some time (a week to a month) to keep a log on how many times a behavior occurs. For example, if the desired behavior is getting homework done before a child or teen goes out of the house, keep a log on how many times that actually occurs during the baseline period. Doing this will allow you to know whether or not your interventions are effective.
Communicate rules and expectations clearly. Establishing clear, written rules and expectations is the next step in effective behavior modification. These rules need to give direction for the child’s behavior. When the child knows what is expected, he or she is much more likely to be able to give it. Too often, parents believe that children should know how to act without the rules being clearly communicated to them.
Another reason to have the rules written is that children respond to symbols of rules in the environment (traffic signals, posted rules at the pool, etc.). My nephew Andrew went through a time when he was three years old during which he was afraid of monsters in his room at night. Week after week, Andrew’s parents searched the room with Andrew, trying to prove to him that there were no monsters in his room. They looked under the bed, in the closet, behind the door, and under the covers. Finally, they realized that they were only making the fear worse by exploring the room for the monsters. Andrew’s mother decided that they would make a sign saying that monsters were not allowed in Andrew’s room. She and Andrew drew a picture of a monster and then drew a red circle around it with a slash across the monster. Underneath the picture they wrote NO MONSTERS ALLOWED. Amazingly, Andrew’s fear of monsters in his room vanished because he knew the sign kept them away.
Written rules have power! They let children know what is expected of them in a clear way. They allow you to know when the children are following the rules and they give you a basis for reinforcing them. They keep the standards of good behavior unambiguous and serve as a touch point for clear, unemotional consequences.
Here is a set of rules that I’ve found helpful, both for my own household and for my patients’. Post them up where the family can see them every day.
TELL THE TRUTH
TREAT EACH OTHER WITH RESPECT
(which means no yelling, no hitting, no kicking, no name calling, and no putting down)
NO ARGUING WITH PARENTS
(as parents, we want and value your input and ideas, but arguing means you have made your point more than one time)
RESPECT EACH OTHER’S PROPERTY
(which means we ask permission to use something that does not belong to us)
DO WHAT MOM AND DAD SAY THE FIRST TIME
(without complaining or throwing a fit)
ASK PERMISSION BEFORE YOU GO SOMEWHERE
PUT THINGS AWAY THAT YOU TAKE OUT
LOOK FOR WAYS TO BE KIND AND HELPFUL TO EACH OTHER
These rules set the tone and “values” for the family. They clearly state that there is a line of authority at home, and that it is expected that children will follow the rules and respect their parents, their siblings, and the family’s property. These are good social expectations and teachings. When you tell someone what you expect, you’re much more likely to get it.
In establishing expectations at home, it’s often important to use visual clues, such as pictures or short printed directions. Try to minimize verbal directions since people with ADD may have trouble processing verbal input (especially in a noisy environment). Writing expectations down also has the advantage of being able to refer to it later when the ADD person denies that you ever told him about it.
Reward desired behavior. After clear expectations are given, it is essential to praise and reward the behavior that meets those expectations. When positive behavior goes unnoticed, it often ceases to exist. Most children, teens, and even adults enjoy being noticed by others. Rewards or reinforcers may take many forms. As adults, we often work for monetary gain. The more financial benefit, the harder we’ll work. But we also work for praise from our boss or spouse. Our personalities often determine the rewards we’re interested in working toward. Children are the same way—some children will work hard to comply for the verbal praise of their parents, while others need different types of rewards. Here is a list of different reinforcers.
Social rewards: verbal praise (“I really like it when you . . . “); physical affection, such as hugs or looks
Material rewards: toys, food (“Clean your room before your snack.”), little presents, or surprises
Activity rewards: sports, trips to library, park, arcade
Token rewards: star or point systems, money
Here are some simple principles in rewarding good behavior:
Many parents object to the use of reward systems when it comes to reinforcing good behavior. They say, “I’m not going to bribe my child to behave. They should do it anyway.” I respond that the definition of a bribe is to give someone something of value to encourage them to do something illegal. Behaving is not illegal! Generally, adults would not go to work if there was not some sort of payoff. It is important to think that children also work for goals and payoffs that turn them on. For difficult kids, it is often necessary to set up a token system or a point system to help keep them on track.
Here is a simple five-step “point” or “chip” system that has worked well for hundreds of parents.
1. Choose
2. Assign a point (or poker chip) value to each chore and behavior, depending on how difficult each is for the child to accomplish. If the child has a lot of trouble doing something, make it worth more points or chips than something he can do easily. Add up the possible points or chips the child can get each day if he or she has a perfect day. Also, let the child know that he or she can earn bonus points or chips for especially cooperative and pleasant behavior. Tell the child that points or chips will only be given for chores and behaviors done on the first request. If you have to repeat yourself, the child will not get any points or chips and will still have to do it.
3. Establish two lists of rewards:
4. Determine the point value necessary to redeem each reward. About half should be spent on everyday rewards. This allows a child, if they have a really good day, to save about half of their points or chips for special rewards down the line.
5. Add up the points every day. Allow the child to use his or her rewards to buy everyday privileges and keep a “savings account” for points or chips to be used later on. This works to teach them the value and need for saving.
Note:
For decades I have collected penguins. I now have over two thousand five hundred penguins—more than I could ever want or need. Penguins remind me of the need to shape behavior in a positive way. I used to live in Hawaii. On the island of Oahu, there is a place by the name of Sea Life Park. At Sea Life Park they had a penguin show, and the penguin’s name was Fat Freddy. Freddy could do amazing things. He could jump off a twenty-foot board, he could bowl with his nose, he could count—he even jumped through a hoop of fire. I was really taken with this penguin. I remember watching Freddy’s show with my son, Antony, who was seven at the time.
Toward the end of the show the trainer asked Freddy to go get something. Freddy went and got it and brought it right back. I was taken aback when I saw this. I thought to myself, “I ask this kid to get me something and he wants to have a discussion with me for twenty minutes and then he doesn’t want to do it. What’s the difference? I know my son is smarter than this penguin.” We went up to the trainer after the show and I asked her how she got Freddy to do all of those really neat things. The trainer looked at my son and then she looked at me and she said, “Unlike parents, whenever Freddy does anything like what I want him to do, I notice him, I give him a hug, and then I give him a fish.”
Even though my son didn’t like fish, the light really turned on in my head: Whenever he did things that I liked, I paid no attention to him at all because I’m a very busy guy. But whenever he did something I didn’t like, I gave him a ton of attention because I don’t want to raise bad kids. Well guess what I was doing: I was encouraging him to be a pain in the neck. By misbehaving he got noticed more and more by me!
So I collect penguins as a way to remind myself to notice the good things about the people in my life a lot more than the bad things about them. This is the essence of shaping behavior.
Administer clear, unemotional consequences for the negative behavior. In order for consequences to be effective, they must be used with the other steps in shaping behavior, i.e., clear expectations and positive reinforcement. Consequences by themselves change nothing, but when used in conjunction with the other steps of the program they can be very powerful in helping to parent the difficult child.
I once saw an interaction between a mother and her four-year-old son in a grocery store that turned my stomach. After the child ran off for the third time, the mother jerked him by the arm, picked him off the ground, and whacked him so hard his little body flew into the air. She then slammed him down into the cart and said, “You little brat, do what I say!” With a panicked look, he held his little arms up to hug her, at which point she turned and looked away from him. He then started to cry.
Too often parents punish children as a reaction to the anger they feel inside and when they’re out of control of themselves. This type of punishment causes the child to feel frightened and angry and the parent to feel guilty and frustrated.
It’s important to distinguish between punishment and discipline. Punishment means to inflict a penalty for wrongdoing. Discipline, from the root word disciple, means to teach or train. It’s critical that we use discipline to teach children how to be good, rather than inflict punishment when they’re not.
As I mentioned above, reinforcing good behavior is a much more effective change agent than giving consequences to bad behavior. Yet, there still are times when consequences are needed.
Here are eight components of effective discipline:
When used properly, Timeout is an extremely effective discipline technique for children two to twelve years of age. Use the following guidelines:
For teenagers, it is more effective and less humiliating to use “response cost” methods. When they break a rule or fail to comply with a request, the negative “response” costs them something important to them, such as privileges, money, phone time, going out on the weekends, etc. Make sure the consequence fits the crime. I’ve treated some teenagers who were grounded for the summer. By July they became depressed.
Make discipline a time for teaching and reshaping behavior.
Families often fall victim to undiagnosed or untreated ADD. Involving the whole family in treatment is often essential for a healthy outcome. Here are some important family treatment issues to consider.
ADD usually has genetic underpinnings. When one member has ADD, it is likely that another person may have it as well. Trying to effectively treat one family member while others in the family have untreated ADD invites frustration and failure. It is helpful to do some screening on every member of the immediate family. I have found that when parents have untreated ADD, they have trouble following through on medication schedules for their children or the parent training suggestions given as part of therapy. When a sibling goes undiagnosed, he or she often sabotages the process by his or her own conflict-seeking behavior.
Families with one or more persons with ADD often have serious communication issues. These families tend to misinterpret information, react prematurely, or have emotional outbursts over real or imagined slights. It is essential to teach families how to listen, clarify misunderstandings, and avoid mind reading. It is also essential to teach families with one or more ADD members to communicate in a clear, unemotional manner. Emotionality decreases effectiveness in communication.
As I’ve mentioned many times now, ADD children, teenagers, and adults are experts at getting others to yell at them. It is essential, therefore, to teach families how to calm volatile situations. Teaching simple breathing techniques to all family members can be very valuable in calming disagreements. Also, the use of family Timeouts can be helpful when a situation starts to escalate. In family Timeouts, everyone in the family goes to a quiet part of the house for a designated period of time (ten to fifteen minutes), whenever voices are raised or someone is losing control. Of course, family Timeouts need to be set up ahead of time if they are going to work in calming difficult situations.
Guilt is an issue for many in an ADD family. Resentment, bad feelings, and anger are common in family members. However, parents, spouses, or siblings feel that they are not “supposed” to have bad feelings toward people they love. They end up burdened by feelings of guilt. These resentments are normal, given the difficulties in the family. Explaining the biological nature of ADD to family members often helps them understand the turmoil and have more compassion toward the person with ADD, while alleviating any guilt they might feel.
Embarrassment is a common feeling among ADD family members. The outrageous behavior and public displays of turmoil often lead family members to want to hide from the outside world. Siblings complain that their friends tease them at school because of their brother’s or sister’s behavior; parents are frequently subjected to disapproving looks from store clerks or other parents who have “perfect” kids. Understanding ADD helps families deal with the embarrassment.
In families with ADD, people often get a “good guy” versus “bad guy” label. Children with the disorder often find that their behavior causes them to be outcasts or “black sheep.” Whenever there is trouble, parents, unconsciously, look to them first. This “good guy” versus “bad guy” perception also applies to parents. A parent who has ADD often gets labeled by the other parent as emotional, irrational, or troubled. By doing this, the ADD parent may be stripped of his or her authority, causing resentment and turmoil. Treating the disorder in all family members who have it, along with teaching the family to share power, is essential to treating this “good guy” versus “bad guy” phenomenon.
Divorce is more common in ADD families. This may be due to many factors, such as the increased turmoil caused by ADD children or the interpersonal problems of the ADD adults. Thus, the issues of divorce, custody, and stepfamilies often need to be addressed in treatment.
Parents of an ADD child often blame each other for the problems and begin to pull apart. Who wants to work all day and then come home to a house filled with tension? Who wants to be in a battle zone all day and then have a spouse come home who doesn’t want to hear about all of the problems of the day? After a while, people get burned out and they may look elsewhere for some satisfaction in their lives. This dynamic may make them more vulnerable to becoming workaholics or having extramarital affairs.
Because of the higher divorce rate, child custody often becomes an issue. I have done many child custody evaluations in my practice. I look for the parent who is best suited to help the child have a good relationship with both parents, rather than a parent who vilifies the other one.
Stepfamily issues are also very important for many of these families. All members of the families need to be educated about ADD, its effects on families, and its treatment. A positive attitude and open communication between families are also essential to establishing a healthy situation. Considering the ADD person’s drive toward turmoil, the child or adult may unconsciously seek conflict, and stepfamilies are often more vulnerable to misunderstandings and tension.
Unfortunately, men are often the last people to admit that there are emotional or family problems. They often delay treatment, for their children or themselves, until there has been a negative effect on self-esteem or functioning. I have heard many men tell me that there is nothing wrong with their son, even though the child may have been expelled from school on numerous occasions three years in a row. A typical comment I hear is “He is just like I was when I was young, and I turned out okay.”
Why men are less likely to see emotional or family problems is the subject of many debates. Here are some possibilities:
Whatever the reason, men in ADD families need education about the disorder, and they need to be part of the treatment process if it is to have the best chance of being successful. To this end, it is important for wives, mothers, and the therapist to engage the father in a positive way, encouraging him to see his valuable role in helping the whole family heal. ADD is a family problem and needs the support of everyone to be successful.
It is ineffective (and may turn into a disaster) to blame the man or make him feel like he is the cause of all the problems. Approach him in a positive way and there is likely to be cooperation. Approach him in a negative way and there is likely to be resistance. In general, men are more competitive than women are and they need encouragement, as opposed to badgering, to be helpful. In my experience, once a resistant father becomes part of the treatment, he often takes much more responsibility for healing in the family.
When one or both partners in a marriage (or other living situation) has ADD, it is important to understand the couple dynamics and the treatment process. Here are important issues to consider: