Approaches in the management of general behavioural problems in children with an attention deficit disorder (ADD)
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1. It is important to remember that all children have strong and weaker points. They do not inherit only our best characteristics and it is important for parents to accept their child as a complete person and to not focus on weak points. Remember that ADD is a neurobiological condition and that certain behaviour is not under the child’s control. Quality research shows that achievement during the early school years does not necessarily lead to later success. Boys especially need to be given time to mature.
2. Parents should work at their relationships with their children and should avoid becoming just another teacher or authority figure to them. Families should develop traditions and celebrations and should try to eat together once per day. Everyone in the household should have a specific task which is his/her responsibility.
3. Be on the lookout for objects and events which draw your child’s attention and use it as an informal learning opportunity. If their interest is stimulated by, for example, a sport or by video games, get them magazines/books on these topics so that the written word can also communicate something to them.
4. It is very important to realise that children with an attention span problems also have an underactive motivation system. Encouragement from outside is often necessary. Some parents are upset by what they see as an attitude of indifference. The secret is to break down tasks into smaller sections with immediate feedback and motivation. Use an analogue watch to give children an idea of time. Important information should be clearly and prominently visible. A whiteboard calendar (erasable) is essential for homework, assignments and events. You should also provide a whiteboard on which the child can write down difficult concepts, like word problems or mind-maps.
5. Advice for younger children’s behaviour problems:
5.1 Always give short assignments in a gentle, measured tone of voice. Touch the child, make eye contact and state your expectations clearly. Give immediate feedback and don’t ask something if you cannot check to see that it has been done.
5.2 In case of specific negative behaviour that you would like to change, both parents should be in agreement on what needs to change as well as, more importantly, what positive behaviour they would like to replace it with. In general, it is better to first begin with a reward system, before bringing in punishment. Different systems can be used for rewards, like simply making positive remarks or using a point scoring system. Later, points can be deducted as punishment or systems like “time out” can be used. If tangible rewards are used, it is important that it is immediately available and that it means something to the child. For children with ADD it sometimes necessary to change the system each term to keep it interesting.
An example of a point-scoring system:
Waking up and getting dressed on time without arguing 5 points
Brush teeth 2 points
Homework (per 20 minutes) 3 points
No fighting with brother/sister
morning 3 points
night 3 points
This can then be exchanged for a special reward, e.g.
Playing outside 5 points
Going to bed half an hour later 25 points
Playing video games (30 minutes) 30 points
5.3 Misbehaviour in public places is a specific challenge for parents with young children. It is important that parents state the rules clearly before entering a public area.
“When we’re in Checkers, the rule is that you stay by my side.”
“The second rule is no crying in front of the toy shelves.”
This can be reinforced with positive feedback as soon as the area is entered. “Well done, you’re walking right next to me!”
5.4 One of the most difficult things for parents is to realise that talking and explaining are highly ineffective for modifying behaviour in younger children; therefore less explaining, pleading and persuading, and more doing!
6. Older children’s behaviour problems:
6.1 Teenagers are not a different species, but merely immature versions of themselves. It is important to be aware of things that they do right (sometimes difficult in 13 to 14 year-olds) and to give plenty of positive feedback about it.
A family-based negotiation system can help deal with problems. The steps include:
Define the problem.
Everyone in the family writes down possible solutions (without criticising).
Discuss the possible solutions and decide on the one that is most acceptable to the majority.
Create a contract (with stipulated punishments if it is broken) and let everyone sign it.
6.2 Remember to devote the most energy to managing and changing things that really matter, like school work and social interaction and to focus less on things like music, clothing and absolute neatness.
7. Some children with an oppositional disorder have immediate negative reactions to commands, refuse to acknowledge authority and blame others. They have an immature response which will sometimes respond well to a specific approach. The principles depend on the parent acknowledging the negative behaviour (without sarcasm or anger) and on the child being taught specific responses in order to be part of the solution.
A simple example:
“I can see you don’t want to do your homework today. What’s up?” This seldom leads to a response.
“Tomorrow’s homework is important, so let’s make a plan. Let’s work for twenty minutes and then you can go play outside for a bit before we start again”, or any suggestion by the parent or child that works or that defuses the situation. The response the child should learn is “I need to do my part” or “I can do it differently” or “There is more than one way to do it”.
8. At the end of the day, the parent should reflect and, for the sake of their own mental health, forgive. They should forgive their child, themselves and also other people who may have acted harshly towards the child. It is very important that unacceptable behaviour is not excused because the child has an attention span deficit, but that the disciplinary measures occur closer in time to the negative behaviour, with immediate feedback.
When a child experiences serious problems at school, measures can be attempted whereby the child gets regular feedback about his/her behaviour.
An example for a younger child is a card on the desk to which the teacher can draw his/her attention.
Raise your hand.
Don’t call out.
A learner can carry a behaviour card which each teacher can sign and give to a mentor/guardian during breaks.
It is important to not only focus on scales that evaluate attention deficit disorder, but that also those that evaluate quality-of-life, like the WFIRS-P, or scales that identify what time of day problems occur, like the D-TODS (Dundee-difficult time of day scale).
Information derived from this can guide us on where to focus with behaviour modification programmes, as well as to think about medication with a longer duration.