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-Behavior Intervention A-
Be an executive

Provide structure, routines, assistive devices, external supports, and guides.

Think of the executive as the boss who creates a work environment in which all the workers know what they have to do to do their jobs appropriately. The boss also provides the necessary structure for them to do so. Performance expectations and company rules are clear. The executive supervises and directs but does not overmanage or micro-manage. Children who have difficulty with planning, thinking, organizing, concentrating, and self-monitoring need to have systems in place to guide and direct them. Parents and teachers need to be the executives in the child's life.

Examples:

• Make your expectations clear. Say, "I expect you to..."
• Try to do things at the same time every day-homework, playtime, recreation, bedtime. Post the schedule on the fridge.
• When making schedule changes, give advance warning as much as possible.
• Have simple systems for organization-where to keep possessions and needed items such as backpacks, gym clothes, pens, and so on.
• Use homework organizers, notebook organizers, day planners, weekly planners, computers, or even laptops-when called for.
• Do backpack cleaning and notebook organization once a week.

Understand that you and your child's teachers will need to provide much more direct supervision than seems necessary for the chronological age. Remember, AD/HD is a developmental disability, so these youth usually fall short of age expectations.

-Behavior Intervention B-
Develop behavior management strategies

Use positive attention, rules and consequences, and formal systems such as contracts and charts.

The main goal of all behavior management strategies is to increase the child's appropriate behavior and decrease inappropriate behavior. The best way to influence any behavior is to pay attention to it. Thus, the best way to increase a desirable behavior is to catch the child being good.

Children with AD/HD receive a tremendous amount of negative feedback. Parents and teachers need to learn to give much more positive attention and feedback. That means you have to pick your battles carefully and let a lot of nonessential stuff slide. Otherwise, increased conflict and arguments between you and your child can result.

How do you make the bulk of your interactions positive and yet still provide discipline? With thought and planning. Effective parents (and teachers) know ahead of time what behavior is acceptable and not acceptable. They know what issues they are willing to negotiate and which ones, like safety, are non-negotiable. In a nutshell: Don't sweat the small stuff, and don't ignore the good stuff no matter how small.

Much of behavior management is about changing what you do. Your house rules (or the classroom rules) need to be carefully designed. First, you want to structure them so that your child or teen will be able to meet the expectations. In other words, you don't wait for a behavior to happen or not happen. You change what happens before the behavior-head it off at the pass, so to speak. For instance, if your child constantly forgets things for school, design a system for where to put things so they get picked up on the way out the door.

Your son or daughter needs to know ahead of time what behavior is expected. He or she also needs to know what the consequences will be for behaving (following the rules) or misbehaving (breaking the rules). Consequences are given as soon as possible. Give far more positive consequences and rewards than punishment. Children who hear too much negative feedback often become oppositional or depressed. Managing behavior thoughtfully, without a lot of reaction, especially undue punishment or criticism, helps to prevent unwanted side effects of poorly managed AD/HD.

Some families need to use formal behavior management systems. These include charts or contracts. The difference between the two is simple.

Generally, contracts are used during early to mid-adolescence. In a contract, the involved parties (usually the parents and child, or teacher and student) talk about certain chores or obligations that the youth will fulfill. They draw up an agreement. The youth receives certain agreed-upon privileges or rewards for meeting the terms of the contract.

Charts are usually used for children ages 11 or younger. A chart lists behaviors that the child must display. Points are given or taken away depending on the child's behavior. Accumulated points may be traded for rewards.

If you decide to make a behavior modification chart, you may wish to follow these three simple steps.

• Make a list of problematic behaviors or ones that need improving.
• Select three to five behaviors from the list. Review the list and, with input from your child, select the behaviors to work on. Pick behaviors that occur on a daily or frequent basis, such as doing homework, going to bed on time, being respectful to all family members, or doing chores.
• Create a reward system. Assign a point value to each listed behavior. Throughout the day, give points for appropriate behavior. At the end of the day or week, your child can "cash in" points for rewards or privileges that have been agreed upon in advance.

In order for rewards to work, they must have value to the child. Since children with AD/HD tend to become disinterested in the same thing over time, the rewards usually need to be changed frequently to have value. (For more detailed information on how to design and use charts and contracts, see the suggested books and videos in Section VI. Resources.)

About punishment: Children and teens with AD/HD respond best to motivation and positive reinforcement. It is best to avoid punishment. When punishment is necessary, use it sparingly and with sensitivity. It is important that you and your child's teachers respond to the inappropriate behavior without anger and in a matter-of-fact way. Your child needs to be taught to replace inappropriate with appropriate behavior.

About time-out: When your child is misbehaving or out of control, time-out can be an effective way to manage the problem. Time-out means that your child is sent for a short period of time to a previously agreed-upon place-usually out of the main hub, like a special chair or area of a room. In general, he or she stays in time-out and must be quiet for three to five minutes. The time-out place should not be a traumatic place, such as a closet or dark basement. The purpose of time-out is to provide a cooling off place where your child can regain control.

Time-out works best with pre-adolescent kids. You can also use time-out with teens. Usually that means asking your teen to go to his or her room until he or she calms down.

-Behavior Intervention C-
Use problem solving

Develop skills in the art of negotiation, give and take, and conflict resolution through peaceful means.

Problem solving helps take the reaction out of parenting. It is results-oriented. If your child is mature enough, involve him or her in this process. Good problem solving has three parts:

• accurately defining the problem,
• coming up with workable solutions, and
• evaluating results and trying something else, if necessary.

Very often, people spend a lot of time solving the wrong problem. It's important to analyze problem areas. Pay attention to the facts and not the emotions of the situation. Brainstorm to find possible solutions. Put down all ideas that come to mind. Evaluate them. Pick the one that seems most likely to work. Go back to the drawing board if it doesn't. This approach helps to stop conflict from escalating.

For example: Suppose your child argues when you ask him or her to do a chore. While it appears as if arguing is the problem, actually that behavior might be the result of some problem with the request to do chores. Instead of focusing on the arguing, direct your attention to the chore and what that problem is. For instance, do you have a regular chore schedule? Are expectations clear? Does the child understand all the task expectations? Is there a definite time line? To some children, picking up the room means moving a couple of things out of the way.

Once you clearly define the problem, then you can brainstorm for a workable solution. Let's say your child understands all aspects of the chore, but it still doesn't get done without your nagging or threatening. Come up with a plan where the child knows exactly what to do by when. Decide if reminders will be given. Give a reward for on-time chore completion. Give a bonus if the chore is done ahead of time. Penalize the child if the chore is not done on time, but don't nag. Take action. Don't react. Make not doing the chore the child's problem and not yours.

-Behavior Intervention D-
Use good communication skills

Say what you mean in a firm, loving way. Practice listening without judgment and discussion without attack. Recognize that your child with AD/HD has trouble listening. Be brief and to the point.

Screaming, yelling, speaking through clenched teeth, stamping feet, throwing things, finger pointing, and making threats are violent forms of communication. These escalate problems, as do put-downs, sarcasm, lecturing, preaching, and name calling. When we are using good communication skills, we:

• let the speaker finish,
• concentrate on what is being said,
• show interest,
• avoid judgment,
• eliminate putdowns,
• express our agreement, and
• use praise.

Problem solving and good communication help to eliminate some of the oppositional and hostile encounters that often accompany the disorder of AD/HD.

4-Educational Interventions

One of the most critical areas in which to offer support is in the school arena. This is where most children with AD/HD experience the greatest difficulty. That is because schools require great skill in the areas where students with AD/HD are the weakest: attention, executive function, and memory. Although AD/HD does not interfere with the ability to learn, it does wreak havoc on performance. Behavior problems, which usually get the most attention, may actually be by-products of the school environment and AD/HD. These usually occur when tasks are too long, too hard, or lack interest. Many behavior problems can be avoided or lessened by adapting the school setting to fit the needs of the student.

In the school arena, AD/HD is an educational performance problem. When little or nothing is done to help children with AD/HD improve their performance, over time they will show academic achievement problems. This underachievement is not the result of an inability to learn. It is caused by the cumulative effects of missing important blocks of information and skill development that build from lesson to lesson and from one school year to the next. (It should be noted that a number of students with AD/HD also have learning disabilities, and these do interfere with the ability to learn.)

Generally, AD/HD will affect the student in one or more of the following performance areas:

• starting tasks,
• staying on task,
• completing tasks,
• making transitions,
• interacting with others,
• following through on directions,
• producing work at consistently normal levels, and/or
• organizing multi-step tasks.

Those teaching or designing programs for students with AD/HD need to pinpoint where each student's difficulties occur. Otherwise, valuable intervention resources may be spent in areas where they are not critical.

For example, one child with AD/HD may have difficulty starting a task because the directions are not clear. Another student may fully understand the directions but forget to follow all of them. Another may have difficulty making transitions and, as a result, get stuck in the space where one task ends and another begins. With the first child, intervention needs to focus upon making directions clear and in helping the child to understand those directions. The second child would need guidance to follow all the directions. The third child would need help in making transitions from one activity to another.

The sooner educational interventions begin, the better. They should be started when educational performance problems become evident and should not be delayed because the child is still holding his or her own on achievement tests. Specific suggestions for educational interventions are presented in Section III of this Briefing Paper. Other school issues, including special education, are discussed there as well.