ADHD child needs praise, consistency

From Tots to Teens

February 18, 1997|By Dr. Modena Wilson and Dr. Alain Joffe | Dr. Modena Wilson and Dr. Alain Joffe,SPECIAL TO THE SUN

I have a 7-year-old grandson with ADHD. He is very hyperactive and on medicine for it. Your column about how families can disagree over punishing a child with ADHD made me cry. I don't want to make my grandson miserable, but I do have to admit we have had many arguments about him. Can you say more about how to discipline a child with ADHD?

The basic principles of discipline for children with ADHD -- attention deficit hyperactivity disorder -- are the same as for other children. They need lots of love; adults they can depend upon who are consistent in their expectations and rules; praise for the things they do right even if those are small; and short, reasonable punishment -- like timeout -- for important mistakes. However, because children with ADHD by definition have short attention spans and are quite active, they can sometimes challenge the most well-intentioned parents and grandparents. They are quite likely to forget parental instructions, become distracted, fail to finish tasks, act on impulse rather than reason, make noise and move around.

It may seem as though a child with ADHD is deliberately sabotaging a well-ordered household, and he may be told directly or in subtle ways, and come to believe, that he is bad. He is not. Because of the way his brain works, he is likely to need more structure, guidance, understanding and perhaps even forgiveness than most children without ADHD. Here are some concrete suggestions families tell us have been useful from the many we have heard, read and tried.

First, be kind to yourself, so you will have patience. Get plenty of rest and exercise, so you will feel good and be able to be calm.

Build your child's life around a simple and dependable routine. It may be helpful to show it on a chart or calendar. Schedule frequent breaks for him during which movement is not only condoned, but encouraged. All children benefit from exercise, and children who are hyperactive cannot be expected to sit still for long periods. When there is a choice to be made, keep it simple for him. You might say, "Do you want to wear your red or your blue shirt?" rather than, "Which shirt do you want to wear?"

Make certain he has positive time with each parent each day. A friend of ours, Dr. Barbara Howard, calls this "special time" and suggests it be labeled as such for the child. During that time, the parent plays with the child at an activity of the child's choosing. Special time does not need to take place at the same time every day or be longer than 10 or 15 minutes, but when it occurs, make certain the child has the parent's undivided and uninterrupted attention. All through the day, remember to show him you like him in unspoken ways like smiles, pats and brief hugs.

Also, it is important all day long to notice all the good things he does. Comment on them so he gets positive attention. Children learn to repeat the things that bring them attention. With any child you can find good things, even if they are small and brief. You may have to begin with bright spots that would be taken for granted in most situations. "Johnny, what a wonderful job you are doing of putting on your other shoe without me even asking." If you show him what he can feel good about, he will do it more often. When you do need to give him directions, be clear and simple.

Although we tend to think of discipline as punishment, all the positive measures mentioned above are discipline, too, and should in fact be the biggest part of how a child's behavior is molded.

However, there will be times when punishment is used. We urge parents to put a great deal of thought into what "crimes" will be punished and how. We believe punishment should be reserved for the few behaviors that are truly harmful or unacceptable and that punishment does not need to involve physical force. If there are things he is doing that are merely annoying, ignore them. If there are behaviors that must be changed, don't try to do everything at once. Pick out one or two of the most important things, and make clear rules about them.

Make a plan so all adults will react the same way when rules are broken. In other words, be consistent. Tell him clearly what the rules are. When they are broken, react immediately but calmly. Simply say to him, "What is the rule about that?" and put him in timeout -- a chair in a quiet and boring corner is a good place. Set the timer for a few minutes -- one minute per year of age is the usual number, but a hyperactive child might not be able to comply that long. When the timer goes off, he may get up. Discuss the rule again briefly, and let it go at that. When the punishment is over, let it be truly over. Don't keep reminding him of his bad behavior. Do remember to praise him, however, when he follows the rule.

In the end, your grandson most needs to know that you and his parents love and accept him, even though his behavior lapses. If you are disagreeing about him, do it calmly and out of his presence. After all, adults should be models of good behavior themselves!

Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

Pub Date: 2/18/97

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