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How to make rewards and consequences effective for the ADHD child

Posted May 28 2011 10:15pm

Do ADHD children have such poor impulse control that they can’t control their behavior? Believe it or not, the answer is no. Although kids and teens with ADHD have a really hard time reigning in their impulses, control is not absent. Once you believe that your child can’t help himself, you are short changing and limiting his potential.

Think for a moment about all the habits which are ingrained. Out of habit the other day, I dialed my husband’s phone number when I meant to dial my mom’s. When my husband answered the phone, I was startled. Some routines are so frequent that I do them absent mindedly – like when I dialed his number instead of my mom’s. The act of dialing triggered my action. All of us are creatures of habit. We go on auto-pilot when something is so familiar we could almost do it in our sleep. Basically, it is habit and circumstance that makes children repeat behaviors.

Behavior therapy is designed to extinguish unwanted behaviors, and reinforce positive behaviors. It works with everyone on the planet. Depending on an individual’s frame of reference , they will do whatever has a desired outcome. It is very unusual for someone to do something that has no personal benefit.

Children with ADHD are no different in this than the rest of us. The problem is that their frame of reference is slightly different, and the benefit is not always obvious. I asked my son’s therapist a direct question the other day regarding this issue. Although I already knew the answer, I wanted to hear the opinion of a highly trained specialist of behavior disorders . My question was very specific “why do these children continue to misbehave and break rules even though they are suspended, receive severe consequences or are punished?” Her brief response was “They get something out of it”.

What did she mean by that? The answer is simple. If a child’s experience with caregivers – parents, teachers, guardians – does not lead them to feel that good behavior has good benefits such as positive self-esteem and praise and high regard and attention from the caregivers, then they find other methods to get attention. Also, if interacting with parents and others is stressful and negative in any way, they may seek time out or consequences as a refuge. For example, if a child has to constantly answer to a caregiver or thinks that every interaction is going to result in criticism and/or unhappiness, they may fuel the fire of contention and end up with a consequence and sent to their room. Once in the room, they are free from criticism and stress and expectations.

As parents, we all strive to do our best for our children. But let’s face it. They can be difficult and cranky and surly and oppositional . Children don’t understand all the rules that adults expect them to follow. And sometimes the rules seem unfair. It truly helps to try and think about your child's perspective when dealing with your child with ADHD.

I hear from moms who say their child is not influenced by rewards or punishments. These moms say their child doesn’t care. Or they say that their child is too impulsive and can’t control their behavior. The truth is that rewards and consequences will work when implemented consistently, correctly, appropriately and in a timely manner.

Remember I said that everyone is motivated by benefit? The key is in finding what benefits the child. Also, please remember what I said about absent minded patterns. Families tend to develop patterns. In my house, my son knows that if he promises good behavior, he is more likely to get what he wants from me than from my husband. He and his dad often lock horns. And when they lock horns, my son can dig in his heels and refuse to cooperate. When interaction patterns persist, behavior can’t change. So the first thing that needs to be done in developing a good reward/consequences plan, is to make sure your child feels good about interacting with you – or his teacher – or with anyone else he has a relationship with. Old patterns need to be changed.

I always tell my clients to step back and see their behavior from their child’s perspective. If your child screams and throws and hits, and you respond by stopping what you’re doing and screaming at him, or bribing him to stop, you just reinforced the bad behavior. In the first instance, you gave him attention, and in the second you gave a reward. You might think that when he stopped, he understood that it shouldn’t happen again. Uh – uh. The interaction taught him that you can be manipulated by his bad behavior.

Please be aware that when attention is negative, a child may seek to perpetuate it. Children crave attention, even if it’s in the form of punishment. That’s why children who are abused will want to return to the abuser if taken away.

Another important part of making rewards or consequences work is that they have to be timely and appropriate. Especially with a child with ADHD, who has difficulty with waiting, you can’t give a punishment at the end of the day for something that happened in the morning. The consequence needs to be meaningful as well. For example, if a teen breaks his curfew, grounding him isn’t the answer. Rather, you should tell him that he needs to come home two hours earlier for the next few nights. Grounding him will make him resentful, whereas curtailing his evening will teach him to be more aware of rules.

For rewards and consequences to be effective, everyone has to follow through. Teachers, coaches, and others interacting with your child need to be consistent and implement whatever program has been established by you. Try to reduce potential conflict by making comments which are neutral . If you have to criticize, make a positive statement before giving the criticism. Find out which rewards and which consequences are meaningful to your child. Make them timely and appropriate to the situation. You also have to make them realistic. Start with rewards which you know your child is capable of earning. No one will work at something unless they believe they can succeed. Success helps to build self-esteem .

Everyone feels good about winning. When you help your child to feel like they are a winner, ADHD and all, they will want to perpetuate the feeling. Using rewards which are meaningful and attainable, and consequences which are timely and appropriate, can help them to be their best. Rewards and consequences can be effective with the ADHD child. I think you will be happily surprised when you see how well they can work.

Nancy Konigsberg is a pediatric occupational therapist and child development specialist with more than 16 years experience. She has a six year old son recently diagnosed with ADHD. Nancy has a blog called Milestone Mom which discusses ADHD and a variety of other developmental disorders. In it you can find disorder specific information and symptoms along with exercise treatment and therapy techniques. Readers from all over the world can write to Nancy and get suggestions tailored to their individual situations.
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