Behavior Treatment for ADHD

While the benefits of stimulant medications have been well documented, there are cases where children are either unable to use the medicine or the parents would like to try an alternate method. This is a prime situation to consider behavior treatment plans.

These plans target the behaviors that are disruptive or need to be changed and develop a plan to alter them or replace them with the desired behaviors. The options for behavior plans vary widely, as they are tailored to meet the needs of the individual child. Behavior plans are not simply pulled out of a file and put into action; they require background and thorough insight of what is causing the behaviors and the best ways to change them. You can work with your pediatrician, school team, or other support network to develop a plan for your child.

Developing a Behavior Treatment Plan

Step 1: Background History

The first step in developing a behavior plan is to gather all the necessary information to develop a complete overview of the child, the difficulties, and possible causes. This is often done through observations, interviews, medical history review, and testing. The school psychologist or other qualified professional is an excellent resource and will usually be the individual completing this documentation. It is not up to the parent to gather all of this information; however, they will be asked to participate in the process.

Step 2: Identify the Behaviors

After the information has been gathered and a complete history is available, target behaviors will be identified. Completing a table similar to the one below will help to identify which behaviors need to be targeted in the behavior plan.

• Behavior: List the behaviors that you want to target in the order of priority. The behavior that you want to treat the most should be first, followed by the next most important, etc. For example: 1) Running into the street, 2) Yelling out, 3) Grabbing toys, 4) …
• Description: Describe exactly what is happening with each behavior — be as specific as possible.
• Frequency: Determine approximately how often the behavior occurs. Does it happen several times a day, daily, weekly, occasionally, or rarely?
• Severity: Determine the level of severity on a scale from 1-5, with 1 being a mild problem and 5 being life threatening.

Step 3: Develop Strategies

After it is understood what is causing the behaviors (from the background information gathering and chart above), you will work with the psychologist to develop strategies to change those behaviors. These strategies may be things that you do at home with your child, that the teacher implements in the classroom, or that others apply to the other activities in your child’s life — whatever is needed to make the necessary changes. It is important to remember that this is not a challenge that you face alone. When working to change the behaviors of an ADHD child, everyone who works with your child on a regular basis should be kept up to date on your treatment plans. This allows your child to receive consistent feedback and expectations in all areas.

There are several components to developing strategies that work:

• Specialized strategies for certain situations (home, school, extracurricular, etc.)
• Specific individuals assigned to implement these strategies (teacher, parent, coach, etc.)
• General strategies that apply to behaviors that are present across the board
• A system to monitor the effectiveness of the strategies
• Replacement behaviors (What will the child be taught to do in place of the behavior you are taking away?)
• Positive and negative consequences are predetermined and a system is developed to make the child aware of these consequences

Step 4: Assessment

When you are establishing your goals and strategies, include a way to measure if they are effective. For example, if interrupting is a targeted problem, keep a tally chart to show the number of times the child interrupts each day. Over time, you should see a decrease in the number of interruptions. If not, it provides the documentation to make the necessary changes. Just like with any treatment plan, it is important to periodically review the procedures and look at the effects. Determine what is working well and what areas of the behavior plan may need to be changed. This can be done anytime there appears to be a problem or a change is needed; but even if the plan is running smoothly, periodic reviews should be in place.

Guarantee Success

In theory, pretty much any type of behavior can be targeted with behavior treatment. However, to ensure that your plan will be successful, it is essential that:

• Adults understand how to properly implement the plan
• The child understands what is expected of him or her
• The child is capable of doing what is expected
• The child understands how he or she can earn rewards by meeting the expectation
• The child understands what the negative consequences are for not meeting the expectation
• The adults implementing the plan follow through with their part.

Start slow and allow your child to experience the feeling of success. Setting both short-term and long-term goals provides milestones along the way to show progress and encourages both you and your child. It is also important to celebrate the small improvements you see in your child and work your way up to the larger ones. Keep in mind that changing behavior is not something that is accomplished quickly. Take the time needed to cement these new behaviors into your child’s behavioral patterns and you will reap the rewards for many years to come.