SECTION TWO Checklists for Parents

2.1 WHAT CHILDREN AND TEENS WITH ADHD NEED FROM PARENTS

The high degree of negative feedback and disapproval that children and teens with ADHD receive on a day-to-day basis can take its toll on their self-esteem. Parents have the most important role in providing the loving support and encouragement to enable their child to build resilience for overcoming obstacles and self-confidence needed to achieve success. Children and teens need: The unconditional love and acceptance of their families To know they are not deficient in the eyes of their parents Empathy, tolerance, and forgiveness Positive attention and feedback Support and encouragement Clear limits and structure Fair, clear, and reasonable rules and expectations Supervision and follow-through Positive rather than reactive discipline Consistency and logical, reasonable consequences Predictability of schedules and routines Reminders and prompts without nagging, screaming, criticism, or sarcasm Praise and recognition for what they are doing right To hear the words: "That was a good choice you made." "Thank you for . . ." "I'm proud of you." "I have confidence in you." "I'm here for you." To be able to let down their guard at home and express their needs, thoughts, and emotions openly To feel they have choices and options and are involved in some decision making Help in understanding and labeling their feelings ("I'm frustrated [or disappointed or worried]") To have their feelings validated by parents' active listening For parents to focus on important issues and downplay less critical ones An emphasis on their own personal best efforts and self-improvement Help with coping skills and feelings of frustration Parent guidance and coaching in appropriate behavior and skills Modeling and practicing of calm, rational, problem-solving approaches To know that it is okay to make mistakes and for parents to acknowledge when they make mistakes themselves To be able to ask for help and know parents will do what they can to provide it Buffering from unnecessary stress and frustration Preparation for changes and time to adapt and adjust Fun and humor To hear and feel how much they are loved and appreciated Escape valve outlets Numerous opportunities to develop their areas of strength (for example, in sports, music, dance, or the arts) To be able to pursue their interests and participate in extracurricular activities Special time with parents, not contingent on anything-just time to talk and have fun together, building and strengthening the relationship Help with organization, time management, and study skills Structuring of their work environment, tasks, and materials Help getting started with chores, assignments, and projects Help with planning ahead, following schedules, and keeping on target with deadlines and responsibilities Parents' involvement and close communication with the school Parents to become knowledgeable about ADHD so that they will be well equipped to manage, support, and advocate effectively on their behalf To be educated about ADHD: understanding the disorder that affects them, why various treatments and strategies help, and that there are countless highly successful adults with ADHD in every profession and walk of life

2.2 POSITIVE AND EFFECTIVE DISCIPLINE

Discipline, which means teaching responsible behavior, is a key responsibility of parenting. Here are basic guidelines for behavior management, discipline, and helping children learn appropriate, cooperative, and responsible behavior. Establish a few specific, important rules and expectations that are clear to all members of the household. Plan ahead which behaviors you will work toward increasing in your child through positive reinforcement and which unacceptable behaviors will always result in a punishment. Set limits, and let your child know you mean business. Enforce your limits with consequences that are logical, reasonable, and fair, and do so consistently. Use contingencies in establishing boundaries. This basically involves the age-old Grandma's rule: "First you eat your vegetables; then you get dessert"-for example: "As soon as you . . . , you may . . ." "Once you have . . . , you will then be able to . . ." "You have done your homework. Now you get to go play." Children with ADHD receive far more than average negative attention from parents and teachers because misbehavior captures attention. Notice and pay attention to your child when he or she is behaving appropriately. Make it a goal to catch your child "being good" at least three times more frequently than when you need to respond to misbehavior. Be specific in acknowledging and praising: "I really appreciate how you cleaned up without being reminded." "I noticed how well you were sharing and taking turns when you played with Bobby." Always reward or give positive attention to the behaviors you want to increase or continue to occur. Immediately reinforce desired behavior with a positive consequence. That means that something your child likes (praise, smiles, hugs, privileges, points or tokens earned toward a reward) follows the behavior. Children with ADHD require more external motivation than other children because their internal controls are less mature and they have trouble delaying gratification. Therefore, they need frequent, immediate, and potent rewards for their efforts. Implementing techniques such as a token economy system are effective for children with ADHD. This involves: Rewarding the child with tokens of some kind (poker chips or points, for example) for performing specific, positive behaviors. These include things they are normally expected to do, such as being ready for the school bus on time, clearing the table after dinner, feeding the dog or doing other chores, and remembering to bring home all books and the assignment calendar for homework. A menu of rewards and reinforcers is created with the child, including items and privileges such as those suggested in checklist 2.6. A point value is assigned for each of the items on the list. The child then "purchases" the reward from the tokens earned. Children tend to respond best to novelty, so change the choices of rewards frequently to maintain your child's interest. Negative consequences or punishments are also effective in changing behavior. However, be sure to use far more positives than negatives in your behavioral approach. With a token economy system, the child can also be fined by losing tokens for targeted behaviors (for example, each incident of fighting with siblings or talking back). It is crucial in such a system to ensure that the child is earning far more tokens or points than he or she is losing, or the system will not work. When punishments are required, they should be enforced as soon as possible following the misbehavior-and usually with one warning, not several. The best consequences are those that are logically related to the offense and natural results of the child's actions. Some effective punishments include: Ignoring (particularly attention-getting behaviors) Verbal reprimands Removal of privileges Response costs: receiving a "fine" or penalty such as removal of some points or tokens earned Time-out: isolation for a brief amount of time When delivering consequences, do so in a calm but firm voice. Try to avoid reacting emotionally. State the consequence without lecturing. Be direct and to the point. If using a time-out, choose a location that is boring for your child, as well as safe but away from the reinforcement of other people and activities. It should be clear to your child what behaviors will result in time-out. Typically a reasonable amount of time is one minute per year of age. Use a timer. Punishments must have a clear beginning and ending that you are able to control. When punishing, be careful to focus on the behavior that is inappropriate. Do not attack the child as "being bad" or criticize his or her character. Keep in mind that punishment is reactive: it is a response to misbehavior, but one that does not teach appropriate behaviors to replace the inappropriate ones. So at a different time, work on teaching and practicing alternative desirable behaviors with your child. For example, if your child curses when angry or lashes out by hitting, teach him or her to use another response, such as anger management and calming strategies. Anticipate and plan in advance (with your spouse) how to handle challenging behaviors. When parents are able to show a united front in their expectations and how they deal with their child's misbehaviors, it prevents incidences of the child playing one parent against the other....