Catherine Browne, MA. BCBA, ABA Consultant at Beam ABA Services
A common desire for a lot of parents of children with ADHD is to provide the best support for their child so they can develop the skills they need to live a positive and productive life. ADHD symptoms impact social interactions, cause communication difficulties, and can lead to challenging behaviour.
For the typical developing child, communication skills and social abilities develop intuitively as they learn from the environment around them. However, for those with ADHD, while some of these skills may be present, they can struggle to use them appropriately in everyday life.
Impulsive and hyperactive behaviours can be seen in children with ADHD which can impact their academic and social progress. It can cause issues with staying on task and following instructions at home and at school. Social and communication skills are such vital areas in any child’s development that it is important to determine the best support for these children.
Research into treatments for ADHD
Medication is cited as a common treatment for those with ADHD, but studies have shown that medication, combined with behavioural therapy, has demonstrated great success in treating ADHD. This was evidenced by the landmark National Institute of Mental Health's (NIMH) Multimodal Treatment Study of Children with ADHD. NIMH found that medication therapy alone, and medication and behavioural therapy together, resulted in the greatest improvement in children's ADHD symptoms.
While medication works on a neurological level to regulate the brain, behaviour therapy addresses specific problem behaviours by teaching the child self-management and self-regulation skills. Behavioural programmes may utilise effective strategies such as: visual supports, helping arrange the environment to support the child, task organisation and management. These supports help to establish predictability and routines, and increase positive attention.
The importance of behavioural therapy for ADHD
This highlights the importance of behavioural therapy as a viable option for helping support those with ADHD and especially for younger children where stimulant medications are not recommended for those under six.
Research has shown that children with attention deficit disorder or ADHD respond positively to parent training interventions. Parent-Management Training (PMT) is one evidenced based approach which helps parents to use behavioural modification strategies to improve their child’s behaviour in the home. A lot of the strategies in PMT are based on the principles of Applied Behaviour Analysis (ABA), where positive consequences/reinforcement are given for appropriate behaviours such as task completion and specific social skill related behaviours.
Research into the effectiveness of ABA for individuals with ADHD is not as vast as the decades of research surrounding ABA and autism, however, ABA has been shown to be effective for students with ADHD in managing task-related behaviour, impulsivity, and academic responding (Bicard & Neef, 2002; Cook et al., 2014; Flood et al., 2002; Neef et al., 2001).
Reinforcement, effective prompting and adjustment of environmental contingencies have shown to improve student learning. Research has shown that problem behaviours, such as impulsivity, aggression as well as important life skills including social and self-care skills, are all behaviours that can be influenced by ABA. Using this behavioural approach, positive behaviours can be learned, negative behaviours decreased and new appropriate behaviours established.
So what are some of the things that parents can implement to help their child? Here are five key strategies:
It is important to focus on the positive things your child has done and reinforce and praise these. These may be little things like, hanging their coat up or taking their dinner plate to the sink. They might spend a lot of their day being told what they are doing wrong so it is important to find the good and acknowledge it.
Give clear instructions about the behaviour you want to see. Keep the expectation reasonable and something the child is capable of doing. Avoid vague statements like “you need to listen better” or “you need to help more”, and instead be clear about the behaviour you expect, for example, “take your homework out of your bag” or “put your toys back in the box when you have finished playing”. It is easier to follow a direction that is simple and clear.
It is important for children to see their progress on a day-to-day basis. It also allows them to achieve rewards based upon progress. The goal is for the child to complete certain tasks or expectations — whether it’s a household chore, homework, etc. — so they earn tokens or points that count towards a reward. Short-term rewards are usually more effective, such as extra computer access or a preferred snack. Positive reinforcement is always a stronger motivation for children than negative reinforcement or punishment.
These often work better for older children and teens. Involve them in drawing up the rules and the rewards for following through. Establish that you are doing this with your child rather than something you are doing to your child. Keep expectations realistic and focus on a few important things as opposed to everything all at once. It is important to maintain their motivation so keep targets manageable and achievable.
For anything to truly work and last over time, it needs to be applied consistently. Implementing agreed rules on a daily basis and providing rewards when they are earned is important for establishing positive behaviour change.
Parent-led behavioural therapy programmes
While these strategies are set out as a helpful guide for parents, it is important to acknowledge that parents often need additional support to successfully implement effective behaviour change. With the right support, parents can master and consistently apply the necessary skills leading to long term benefits for their child’s development and also the child-parent relationship.
Beam's new service, ABA Pathfinder, is a parent-led behavioural intervention which brings a BCBA certified ABA Consultant into family homes using video technology. The ABA Consultant works directly with the parent/carer, who adopts the role of an ABA tutor. The Consultant creates a person-centered ABA programme carefully tailored to the individual, identifying behaviours to reduce which are replaced with the acquisition of skills generalised across people, settings and time.
Parents/carers receive all the tools, strategies, coaching and support needed to implement an ABA programme individually designed for their child, with the Consultant having full oversight of the programme to ensure it meets its goals and is aligned with best practice clinical standards. Read more about ABA Pathfinder.
Bicard, D.F., & Neef, N.A. (2002). Effects of strategic versus tactical instructions on adaption to changing contingencies in children with adhd. Journal of Applied Behavioural Analysis, 35(4), 375-389
Cook, A., Bradley-Johnson, S., &Merle Johnson, C. (2014). Effects of white noise on off-task behaviour and academic responding for children with adhd, Journal of Applied Behaviour Analysis. 47, 160-164
Flood W.A, Wilder D.A, Flood A.L, (2002). Peer-mediated reinforcement plus prompting as treatment for off-task behaviour in children with attention deficit hyperactivity disorder. Journal of Applied Behaviour Analysis, 35, 199-204.
Kazdin, A. E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. Oxford: Oxford University Press
MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder: Multimodal Treatment Study of Children with ADHD. Archives of General Psychiatry, 56 (12), 1073-1086
Neef, N. A., Bicard, D. F., & Endo, S. (2001). Assessment of impulsivity and the development of self-control in students with attention deficit hyperactivity disorder. Journal of Applied Behaviour Analysis, 34, 397–408.