Behavior Modification     

Whenever there is a discussion on the treatment of ADHD, especially for children, the term “behavior modification” will normally come up.  But less often do people explain exactly what they mean or how to go about creating an effective behavior modification program.  This is a generic term for a system that rewards appropriate and acceptable behaviors in order to encourage more of the same.  The focus of a behavior modification program is that positive reinforcement is more effective than punitive measures.

Setting up a behavior modification program takes hard work, dedication, commitment and cooperation between parents, teachers and caregivers.  The following seven steps will help you to create your own system, catered to the individual needs of your children. 

1)      Change Your Attitude

Before setting any plan into action, take some time to review how you typically react to your child.  You are going to take 1-2 weeks changing your view of your child and the situation at home.  This time will be well spent and the rewards of taking this time will pay off tremendously.  Raising a child with ADHD is exhausting, frustrating and demanding.  If many of your interactions with your child include yelling and leave you feeling exasperated, you are not alone.  Spend time listening to how you are talking with your child and try to change your perspective and focus.  Understand that children with ADHD require more monitoring and more patience than raising a non-ADHD child.  Accept that you will need to provide assistance. 

An example of this would be if you sent your child to clean their room.  Fifteen minutes later you check and it looks as if nothing has been completed.  Your first reaction may be to say something like: “You haven’t done anything, didn’t I tell you to clean up, don’t leave this room until it is done.”  But changing your perspective, you could say instead, “I see you have picked up the blocks, that is great, now I would like you to pick up the clothes and put them away.  I will be back in 5 minutes to see how you are doing.”  Return 5 minutes later.  If the clothes are picked up, compliment them and provide another instruction.  If only one piece of clothing has been picked up, say something like, “I see you have started picking up the clothes, good work, now let’s finish, I will be back in 5 minutes.”  It may take your child hours to complete a job that could have been done in 10 minutes.  However, when they are done, they will have a sense of completion and accomplishment. 

Try to use this technique as often as possible.  The more often you change how you react to your child, the easier it will become.  You will begin to see your child’s strengths, rather than focusing on their weaknesses.  Your child will also notice the difference and where they once did not seem to try, they will make more attempts at pleasing you.  This will not change overnight, however, and it may take several weeks to see the difference.

2)      Focus on One Behavior

There may be many things about your child that you want to work on improving.  They may be talking back, not completing homework, not completing chores, antagonizing brothers and sisters or not listening.  In order to make change lasting, you need to focus on one behavior at a time.  Although it is hard to ignore the rest of the behaviors, remember you are not really ignoring, but you are placing them on the back burner temporarily.  Choose the one behavior that seems to most disrupt family life (or school work). 

Once you have chosen the behavior to start with, be specific.  Decide exactly what the end result you want is, and break it down into steps, if possible.  Define your acceptable behavior.  For example, if you have chosen the behavior of completing homework and handing it in, list exactly how you are going to accomplish this and what is required.  Maybe you want your child to follow a specific schedule, such as one half hour after school to unwind, and then begin on homework.  Maybe you want them to organize their work in a certain way, so that completed homework is easy to find and hand in.  Maybe you want the teacher to check and make sure homework assignments are correctly written each day.  Create an action plan based on your child’s needs.  Target the behavior as much as possible but make sure your goals are realistic.  Try to set up the plan of action to insure successes for your child.  Write down what behavior you have chosen, what steps to take and what responsibilities you and your child will have.

3)      Pick a reward system

Rewards to not need to be monetary.  There can be a tangible reward at the end, giving your child something to work toward.  Initial rewards can be stickers, check marks on a chart, or just a “good job.”  Interim rewards can be: staying up late on the weekend or having a friend sleep over.  Place a chart on the refrigerator in order to see progress.  In the beginning, make sure your child attains goals. Compliment them on any progress, if they handed in one piece of homework but forgot the other, compliment them on handing in one and place a sticker on the chart.  If they completed all their homework, place a sticker on the chart.  No matter how small the successes, compliment them and reward them.  As you continue, make the rewards a little less frequent. 

4)      Pick a consequence

Although a behavior modification program focuses on positive reinforcement, there must also be consequences.  Make consequences appropriate for your child’s age.  If you determine the consequences beforehand, you will be able to deliver them calmly.  Consequences can be such things as: fifteen minutes early to bed, no television or no video games.  Consequences should be as immediate as possible in order for your children to connect the action and the reaction.  Time out is also an effective consequence but should be delivered without reaction.  There should be no talking allowed when in time out. 

Parents often complain that once they set up a behavioral program, certain behaviors become worse.  This is actually typical.  Children are accustomed to receiving a certain reaction from you and will attempt to get that reaction.  It may take a while for them to understand that you are no longer going to become emotional, but are serious about the new system. 

5)      Be consistent

Being consistent is the key to making any behavior modification program work.  The more consistent you are the better it will work.  It is important to discuss what you are doing with caregivers and teachers to insure that everyone is working toward the same goal. 

6)      Be Flexible with Rewards

Adding variety to your rewards will help to keep your child interested.  You can change the rewards without changing the rules.  Although the program will work exactly the same, maybe your child hands in homework all week and the reward will be to go out for ice cream this weekend.  Next weekend you might want to have a different reward, maybe renting a favorite movie.  If your children are older, they may be more interested in working toward a longer-term goal they have, such as purchasing a MP3 player.  Make sure the goal is not something they will take too long to accomplish or they will lose interest.  Try to help them find a shorter-term goal.

7)      Move On

As your child begins to master the behavior you originally began to work on, wean them off rewards for that behavior.  Then choose one additional behavior and begin again at Step 2.