In a single day, a child with attention-deficit/hyperactivity disorder (ADHD) may seem to receive as much negative feedback as a child without the disorder receives in an entire year. The first 10 minutes of a morning might sound like this: “Hurry up, get dressed. You’re going to miss the bus! Stop playing with your food! Pay attention! Go find your homework.” And that’s before the hyperactive child even steps foot onto a bus or into a classroom. About 5 percent of today’s school-age kids have been diagnosed with ADHD—that tallies to about one child in every classroom. Researchers also have found that teachers suspect at least another 5 percent suffer from the disorder but haven’t been diagnosed. Stimulant medications like Ritalin often are used to treat ADHD, but a new analysis of 174 studies suggests that parental skills can be just as effective as prescription pills.
THE DETAILS: The analysis, published recently in Clinical Psychology Review, looked at published and unpublished studies that used a range of methods and settings (school, home, recreation) and concluded that behavior-based methods, like focusing on behavioral triggers and improving parent-child communication, are highly effective in improving the functioning of children with ADHD. For parents looking to reduce or avoid the side effects of treating the disorder with medication, a behavioral approach is their only credible alternative, says the study’s lead author, Gregory Fabiano, Ph.D., assistant professor in the Department of Counseling, School, and Educational Psychology at the University of Buffalo in New York. “There are two approaches with evidence that research supports,” he says. “It [research] supports stimulants, like Ritalin (where there are sometimes side effects), and behavioral treatment.”
WHAT IT MEANS: ADHD medications may work, but the long list of possible side effects ranges from insomnia, anxiety, and nausea to anorexia, psychosis, heart problems, and addiction. This study suggests parents can try another approach. “It’s not rocket science,” says Fabiano, who recently received the White House’s Presidential Early Career Award for Scientists and Engineers. “Things we suggest are things that aren’t really hard to understand or do. The real trick is keeping them up every day for weeks, months, or years.”
Here are some strategies for a pill-free approach to managing ADHD:
• Teach consequences. Treating ADHD without pills requires that parents focus on two things: identifying triggers of positive and negative behavior, and setting clear expectations and rules. Making sure there are consequences for good as well as for bad behavior is key. “When the kids follow rules, make sure they get praise and reinforcements,” Fabiano suggests. “For bigger things, you can give a reward.”
• Keep commands short. Your kid may be dismissing your commands because of your delivery. To help them process orders, be clear and concise and make sure your instructions don’t have too many steps. “One-step commands for even minor activities, like getting ready for school in the morning or going to bed in the evening, can have a big payoff,” says Fabiano.
• Plan a parental powwow. To make sure behavioral methods work at home, it’s important for both parents to be on the same page. Agree on a united front when planning rewards and punishments, so your child doesn’t get mixed messages. If you’re planning to go out to eat or to the park, talk to each other about how you’ll praise your child for being good or how you’ll react to bad behavior.
• Know the rules of time-out. Research shows that time-outs do work for children with ADHD, but you have to use them at the right time. If you issue a time-out for a kid not doing her chores, for example, she’ll welcome the punishment to avoid her household duties. Use time-out only when she’s acting out while doing something enjoyable, like playing kickball.
• Know the best time for homework. As soon as your child gets home from school, make him do his homework. And make that a daily habit. Eventually the child will learn that he’ll have fun time after his work is done.
• Prepare for the worst. When you start using these new tactics, your child may resist. “Behavior gets worse before it gets better. When parents start to make changes, the kids don’t like it,” explains Fabiano. “They may act out more, but that’s usually short-lived.” Stick it out and stick to your guns, he says; your consistency leads kids to follow rules and behave better. That will help your family function better and help children feel better about themselves.
• Get support. For more details about behavioral techniques that help families manage ADHD, contact the Center for Children and Families at University of Buffalo and browse its list of agencies and support groups. Make sure you speak with your pediatrician before changing your child’s medication dosage.