A Parent’s Guide to
Effective ADHD Discipline A better-behavior plan that works for even the most oppositional, defiant children ADDITUDE Strategies and Support for ADHD & LD
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ADDITUDE
Strategies and Support for ADHD & LD
A trusted source of advice and information for families touched by attention-deficit disorder— and a voice of inspiration to help people with ADHD find success at home, at school, and on the job.
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Carol Brady, Ph.D., and John Taylor, Ph.D. (Children) Edward M. Hallowell, M.D. (Life) Sandy Maynard, M.S. (Coaching) Michele Novotni, Ph.D. (Adults) Larry Silver, M.D. (Health) Ann Dolin, M.Ed., and Sandra F. Rief, M.A. (Education) administrative assistant: Madalyn Baldanzi
scientific advisory board Chairman: Larry Silver, M.D. Georgetown University Medical School Washington, DC
Russell Barkley, Ph.D. Medical University of South Carolina Charleston, SC Carol Brady, Ph.D. Baylor College of Medicine Houston, TX Thomas E. Brown, Ph.D. Yale University School of Medicine New Haven, CT William Dodson, M.D. ADHD Treatment Center Denver, CO Edward M. Hallowell, M.D. The Hallowell Center Sudbury, MA
Peter Jaksa, Ph.D. ADD Centers of America Chicago, IL Peter Jensen, M.D. Columbia University College of Physicians and Surgeons New York, NY Harold Koplewicz, M.D. New York University Medical School New York, NY Michele Novotni, Ph.D. Wayne Counseling Center Wayne, PA Roberto Olivardia, Ph.D. Harvard Medical School Boston, MA Patricia Quinn, M.D. National Center for Gender Issues and AD/HD Washington, DC
Introduction
“My seven year old swears, hits, slaps, and throws things. He doesn’t do his homework, bathe, get dressed, or clean up without a huge battle. He doesn’t care about many consequences, but will throw a fit if I take away electronics. I don’t know how much more I can take.” — Amy “Nothing works on my son. He hasn’t seen his electronics in a month and misses out on fun activities. He has no remorse. I’ve tried rewards, points, praise, consequences, and ignoring the behavior — and they all fail. I feel like a failed parent.” — Meredith Children with ADHD and oppositional defiant disorder (ODD) take insolent behavior to another level. They exhibit a pattern of angry, violent, and disruptive conduct targeted at parents, caretakers, and other authority figures. They seem to feel most comfortable in the midst of a conflict, which is upsetting and exhausting for everyone involved. But take heart. This guide aims to help parents identify what is causing misbehavior, understand why traditional discipline won’t work for angry ADHD kids, and stop your child’s lying, hitting, and meltdowns to improve quality of life for the whole family. Read on to learn about ODD, why kids misbehave, how parents can best turn around problem behavior, and what works with kids who lie, hit or melt down easily. Consult with a physician if you think your child has ODD, and seek help immediately for violent, self-harming behavior that could be dangerous.
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A Parent’s Guide to
Effective ADHD Discipline Contents What is Oppositional Defiant Dosorder?. . . . . . . . . . . . . . . . . 5 Solutions to Common Discipline Problems . . Meltdowns and Aggressive Reactions to Discipline. . Consequences and Reminders Don’t Work. . . . . . Lying and Dangerous Behavior . . . . . . . . . . . . . . Physically Aggressive Behavior. . . . . . . . . . . . . .
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Treatment For Oppositional and Defiant Behavior . Behavior Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . Family and Parent Training Programs . . . . . . . . . . . . . . . Parent-Child Interaction Therapy. . . . . . . . . . . . . . . . . . Collaborative Problem Solving. . . . . . . . . . . . . . . . . . .
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10 Rules for Parents of Defiant ADHD Kids. . . . . . . . . . . . . 24 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Parenting Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 This ebook is not intended as medical advice; consult with your doctor.
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What is Oppositional Defiant Disorder?
40 percent of children with ADHD also develop oppositional defiant disorder (ODD) — a condition that is defined by chronic aggression, frequent outbursts, and a tendency to argue, ignore requests, and purposely irritate others. Every parent of a child with attention deficit knows what it’s like to deal with behavior problems — saying no to requests, melting down over transitions, or blurting out rude words. Any child can fall into an aggressive or irritating mood from time to time. To have ODD, however, a child must show a pattern of negativistic, hostile, and defiant behavior that lasts at least six months. An oppositional, defiant child will often lose his temper, argue with adults, actively defy requests or rules set by adults, deliberately annoy people, and blame others for misbehavior. Children with ODD are often easily annoyed by others, angry, resentful, and vindictive. Consider these real-life examples:
Surveys estimate that 5% of the general population has ODD. Up to 40% of children with ADHD may have the condition.
• A 4-year-old who gleefully annoys her parents by blasting the TV at top volume as soon as she wakes up
• A 7-year-old who shouts “No” to every request and is verbally abusive • An 11-year-old who punches a hole in the wall or physically assaults his mother
Experts are unsure of why ODD and ADHD so commonly overlap, but some believe the comorbidity is tied to ADHD-related impulsivity, or is a manifestation of the frustration and emotional pain of having ADHD. Others note that flexibility, adaptability, and problem solving — all skills that help regulate emotions — are severely lacking in most people with ADHD. About half of all preschoolers diagnosed with ODD outgrow the problem by age eight. Older kids with the condition are less likely to leave it behind in adolescence. Any child that shows signs of oppositional behavior needs appropriate treatment by a psychiatrist, psychologist or therapist who is familiar with the disorder. Counseling should involve both the child and the parents on ways to cope with such behavior. If the child becomes dangerous to himself or others, hospitalization may be necessary. If it is left untreated, it can lead to conduct disorder or more serious problems.
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Signs and Symptoms of ODD in Children Children with ODD are usually not physically aggressive but rather thwart, obstruct, frustrate, demean, and resist anyone in a position of authority (parents, teachers, coaches, police, etc.). They purposefully bother and irritate others. At least four of the following symptoms must be present consistently for six months or longer to merit an ODD diagnosis:
• Argues with adults • Actively defies or refuses to comply with adults’ requests or rules • Deliberately annoys people • Blames others for his or her mistakes or misbehavior • Easily annoyed by others • Angry and resentful • Spiteful or vindictive There are two types of ODD. The childhood version is present from an early age, and can make these children very difficult to raise. The second type is adolescent-onset ODD. Once normal and loving children become impossible to live with. Home and school become places of almost constant conflict.
Diagnosing ODD To diagnose ODD accurately, physicians usually screen your child to rule out anxiety, depression, and bipolar disorder, which can all cause ODDlike behaviors. These behaviors are only “symptoms” if they occur more frequently than is typically observed in individuals of comparable age and developmental level, and if they cause clinically significant impairment in social, academic, or occupational functioning. Diagnosis is time consuming because multiple sources of information must be assessed. Kids with ODD never take responsibility for their behavior and the effect they have on everyone around them. They see “the problem” as being the fault of anyone but themselves. It usually takes a highly qualified physician to determine whether problems at school, or home are being caused by ODD. The strain of dealing with ODD affects the entire family, especially marital relationships. Fortunately, effective therapies exist for reigning in even the most defiant child. It won’t be easy, but it can be done — typically with the help of specialized psychotherapy, parent training programs, and a phy-
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It’s hard to know whether a child is normally defiant or has ODD. Consult a therapist trained in childhood behavioral problems.
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sician to supervise treatment. The first step is working to understand why children misbehave, and why traditional discipline doesn’t work.
Why Kids Misbehave Experts in defiant behavior point to two dominant reasons for misbehavior. 1. The expectation that bad behavior will help the child obtain something he wants. Children often throw a tantrum because they know that, if they act out long enough, parents will relent and buy them that lollipop or let them play video games longer. It doesn’t have to work every time, but if it works even five percent of the time, kids learn that defiance can lead to success. For this type of behavior, routines and clear consequences can help.
2. The existence of a problem that a child doesn’t have the skills to solve. Kids with ADHD face emotional-control challenges. When confronted with a difficulty, they have a limited tolerance for frustration, which can lead to startling outbursts or prolonged meltdowns. They are overwhelmed by their emotions, and need help regulating them, though they seldom welcome the assistance. This type of defiance rejects parental authority. Parents need to think about what expectation a child is struggling to meet, and help them find a solution to that root cause.
Children with ODD sometimes revel in conflict; parents must learn to stop taking the bait.
In addition to these primary motivations, children also act out for the following reasons.
3. The rules are different at home, at school, at grandma’s house, and at the baby sitter’s house. Kids might act out just to test the limits and see what they can get away with in different circumstances. Children with ADHD need structure and routine to keep behavior in check. They often feel off-balance, and like they are struggling to catch up in life. Consistent, familiar behavioral expectations and consequences can help them feel safe and secure — less stressed out — because they know what to anticipate. What follows more relaxed kids is a more relaxed and efficient home with fewer outbursts.
4. The rules aren’t clear, or don’t make any sense. Family rules for behavior should be agreed upon by both parents, and explained clearly in a way kids can undestand. Children need to know why a rule is in place – for everyone’s well being and safety. Make sure you’re specific about what constitutes good and bad behavior. For example, if you say, “No running on the stairs,” you can’t punish a child for scooting down them on his bottom. Instead, make the rule, “Walk down the stairs.” Then, post the rules in a public spot.
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5. When children are hungry, bored, or overtired, they are likely to break down and misbehave. To avoid tantrums and teary outbursts, note when your child is having temper flare-ups, and try to figure out what’s really causing the issue. Did they skip lunch? Did they stay up too late last night? Then put a routine in place that avoids the trouble area, and fills that unmet need. If kids act out when they are bored, bring entertainment when you know there will be downtime. If hunger is a trigger, make sure that regular snacks are part of your daily schedule.
6. They are asserting their independence. When younger children start to learn new skills, they want to do more things on their own. This means trying to take control over areas that parents used to dictate, like when to brush their teeth, what to eat, and when to go to sleep. To avoid showdowns, give children options to choose from throughout the day. This helps them feel in control in a positive way, without needing to rebel. Rebellious teens may intentionally break rules to demonstrate that parents can’t regulate their behavior. Try making the family structure more democratic so teens feel like they are heard, and then create a contract where you each agree to fulfill certain responsibilities.
7. They are trying to grab your attention. Children will often act out when you are focusing your energies elsewhere. Maybe you are on the phone, or visiting with a friend. That’s the moment that your child decides to hit his little brother. The motivation behind it is attention-seeking. To avoid outbursts of this nature, get in the habit of providing your child with positive attention. When kids learn they will be acknowledged more for being a little angel, they just might try to act that way more often.
Consistency in the way you treat your child— how you set rules and convey expectations— is key to managing ODD.
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Solutions to Common Discipline Problems
The standard discipline tactics of behavior therapy often include the following:
• Rewards to encourage good behavior • Frequent reminders of behavior expectations • Consequences imposed quickly and consistently when children don’t comply
When behavior is worse than normal, a parent’s natural instinct is to tighten the rules and make discipline sterner than usual. But for angry children, cracking down isn’t always the best way to turn things around. Following are some ODD-specific solutions to common behavior problems. Problem #1: Afternoon Meltdowns Are Aggravated by Discipline “My child throws huge tantrums when he gets home from school. When I give him a consequence for acting out, he only becomes more agitated.” Solution #1: Children with ADHD experience more stress all day. They expend more energy trying to pay attention, sit still, and rein in impulsive behavior than do typical kids. Teachers might label them as aggressive, bullies, or troublemakers — and as a result, they might be punished more at school. After all of those challenges during the day, children can build up tension that releases as violent meltdowns once they’re home. Here’s how you can help your child avoid those afternoon meltdowns:
a. Demonstrate Understanding: When disciplining an angry or defiant child, it helps to remember that most misbehavior stems from these strong emotions. Kids often can’t articulate these feelings of complex frustration, so instead they express them through tantrums or defiance. Understandably, parents often react to a child’s misbehavior, and neglect to address the feelings fueling the fire. To stop a meltdown in its tracks, parents should stop and ask thoughtful questions to help a child feel understood.
b. Don’t Crack Down: Defiant children will reject and rebel against parental authority, so becoming more authoritative with punishment will not defuse the situation. Likewise, traditional parenting tech-
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“Our son frequently comments that he is a ‘slave’ in our house because we ask him to do chores, and he does not accept his teachers as his authority.” —An ADDitude reader
A Parent’s Guide to
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niques like spanking don’t help. The same children that lash out are often very emotionally hypersensitive. Physical acts of discipline can cause emotional hurt. They won’t teach the child how to behave better next time — only to fear or resent parents. c. Suspend Logic: The latest brain research helps make sense of misbehavior. When kids are in the throes of a big emotion, their “emotional” right brain is in charge. We usually respond to their outbursts with logic and reason, which are left-brain traits. The bottom line is that these opposite sides of the brain can’t work together in that moment. When you learn a specific way of acknowledging emotions, the two sides of the brain can work together. Problem #2: Simple Reminders Spark Aggression or Meltdowns “I’ve reminded my daughter to put her socks in the hamper – not on the floor – a thousand times, but then I find her on the couch, socks off, reading a magazine. When I tell her to pick them up, she freaks out.” Solution #2: Children with ADHD don’t respond to nagging. They either tune out, become distracted and forget what they are supposed to do, or respond defiantly that parents can’t tell them what to do. Instead, try techniques that involve children – giving them authority back, and partnering with them in a positive way.
ost a Behavior Chart: Explain to your child that you want to nag a. P or yell less, but she needs to meet you halfway by collaborating on a behavior chart that will serve as a reminder of behaviors that need to be done, without nagging.
b. Set Expectations: Agree on positive and negative consequences for each behavior on the chart. For example, if she puts her clothes in the hamper, she gets a star on the chart. 10 stars will earn her extra time playing a favorite game with you. A negative consequence would be going to bed 15 minutes early. This type of discipline puts the two of you on the same team. It gives you an easy way to spot good behavior and build in praise. When you have to dole out consequences, it puts the responsibility in your child’s court, since ways to avoid them were clearly outlined in your chart.
c. Police Yourself: Take it one step further and create a behavior chart for yourself. For example, keep track of when you nag. Define it as repeating a request more than twice without giving a consequence. When you catch yourself nagging, and try to stop, your child will see you make progress — and be reminded not to give up on her own challenges.
reSource Your Defiant Child: Eight Steps to Better Behavior by Russell A. Barkley Ph.D. (The Guilford Press, 2013)
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Problem #3: Consequences Don’t Work “My child doesn’t care about the consequences I set up, and doesn’t take my rules seriously.” Solution #3: If you haven’t found a punishment that works, then punishment may not be the best way to change a behavior. Some children respond better to a reward for good behavior than they do to a consequence for negative behavior. The key is determining what works best for your child.
a. Act Quickly: Consequences are the most effective when they are imposed immediately after the behavior infraction. Whether it’s withholding TV privileges, or keeping your child from attending a party, the emotional impact of a consequence is blunted if it is imposed a long time after the offense.
b. Vary Punishments: Parents need to change their punishments over time. Repetition will only make kids bored; consequences that are repeated over and over again lose their effectiveness.
c. Strike a Balance: Successful consequences should have time limits: long enough to teach a lesson, but short enough to let your child move on to something positive. Too-harsh consequences will only encourage more resentment and rebelliousness.
If your child is just not taking you seriously, there are several steps you can take to make him or her respect your rules.
d. Set the Rules Together: Important rules should be put in writing to make sure they are clear and easy to remember. If your child thinks rules are unfair, it merits a family discussion to talk out the objections. Sometimes kids misbehave simply because they resent adultimposed consequences. Kids are disrespectful because they feel like they have no say. When children are involved in the process of establishing rules, they are more likely to respect them.
e. Enforce the Rules Consistently: You can’t “forget” to enforce them, or suspend the rules if you feel guilty. Making empty threats will only undermine your credibility as the parental authority with your child.
f. Level the Playing Field: Set ground rules for the entire family. When we get angry, what’s okay, and what’s not okay? Then everyone – including parents – has to play by those rules.
g. Build Up Skills: For some kids, rewards and consequences won’t work. These are motivating mechanisms designed to pep up lagging motivation to behave better with incentives. Often ADHD and ODD kids don’t lack motivation; they lack skills to solve the problem.
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“Everyone tells us to punish our son by taking fun things away. When we have tried in the past, they: 1) do not improve any of his behaviors 2) make him depressed, resentful and mad 3) shut him down and make him feel that we don’t get him.” —An ADDitude reader
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Then, the goal is to figure out the skill that is lagging, and give them a way to build the skill. Problem #4: I’m Like a Broken Record “To get my child to wash her hands for dinner, or put on her shoes for school, or use the bathroom before a car trip, it takes 10 minutes of constant reminders and hand holding. She just doesn’t listen — or she hears but ignores me. How can I solve this without running late for school every single day?” Solution #4: It’s All About Schedule Sometimes, kids resist following your instructions because they aren’t skilled with transitions. They don’t want to stop playing video games to come to dinner. In this case, a routine can help. Have dinner at a set time everyday so they know what time they need to start to wind down from a game. Some parents set alarms for specific times throughout the morning to keep their child moving from task to task. When the fire-truck alarm goes off, it’s time to finish up breakfast. When the old-fashioned phone alarm goes off, it’s time to put on shoes. And so on. Other families create a playlist for the morning where each song corresponds to a task like getting dressed, making the bed, or brushing teeth. The playlist is triggered by the alarm clock, and is sometimes supplemented by a visual to-do list that the child can check off while completing his morning tasks. Over time, using set routines will help build transitioning skill. Still, you may need to institute a rule that if your child comes the first time he is asked, then he gets a special treat like 15 extra minutes of game time. The rule is that when you do a hard thing, a fun thing happens.
How to Discipline a Child Who Lies Problem #5: Little Lies All the Time “My child tells little lies, even when I’ve explained how important the truth is. He does whatever he wants, and can’t understand later why I’ve punished him. How do I get through to him?” Solution #5: The impulse to tell fibs is a byproduct of ADHD, and may be helped by treating the condition as well as some additional coaching.
a. R eact with Perspective, Not Punishment: Some children tell lies because of insecurity. They concoct false stories to make themselves more likeable. Punishing insecure children can be more harmful than
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Few things damage parents’ trust as quickly or deeply as does a child’s habitual lying.
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effective. Instead, explain the downside of being caught in a lie – it may be obvious to grown-ups, but not so clear cut for children. Instead of a reprimand, give kids a way to stop lying, like taking a pause before blurting out an answer that is an exaggeration or falsehood. Remember to stay calm when your child fibs. Reacting with anger or dismay may prompt your child to tell more lies to cover her tracks.
b. Offer a Do-Over: Give kids the opportunity to reconsider the lie before doling out punishment. When you catch your child in a fib, give her another chance to respond with no consequences for the untruth. It teaches kids to second-guess the value of a lie. Then, be sure to reward kids when they are honest.
c. All Lies Are Not the Same: With young children it’s important to explain white lies, and how it’s OK to say, “Thank you for the nice present,” even if it’s not something they really wanted. Sometimes a fib can be appropriate to avoid hurting someone’s feelings. Problem #6: Escalating Lies and Dangerous Behavior “We found empty beer cans in the trunk of my son’s car. He says that he wasn’t drinking, but how can we believe him when he’s lied to us before to avoid getting in trouble?”
Lying is often a coping mechanism — a way to cover up forgetfulness, avoid punishment, or divert attention away from repeated failures.
Solution #6: Telling lies, ignoring parents’ instructions, and disregarding punishment are all typical teen behaviors. Mild rebellion is also common for preteens, who think their parents treat them unfairly. ADHD makes the situation more complicated for several reasons. ADHD can make teens focus even more on immediate gratification – hanging out with friends instead of going straight home, or texting all night instead of studying for an exam. Your teen may hear your instruction and advice, but his thoughts pull him toward what feels good in the moment, and then he lies to get you off his back.
a. Unearth the Cause: It helps to determine why lying occurs and why it keeps happening. Is it a problem at school, or with friends? Then parents can deal with the underlying academic or social skills issue. If lies are deliberate and malicious, or involve alcohol, drugs, shoplifting, or other delinquent behavior, they should be dealt with forcefully and consistently to discourage the negative behavior. Sometimes a behavioral psychologist is necessary to address the behavior quickly.
b. Learn What a Lie Looks and Sounds Like: An honest statement is typically clear and consistent. A lie often sounds sketchy and includes contradictory information. Does a story sound rehearsed? A truthful statement is spontaneous. A lie might sound stiff, like a prepared speech. What do facial expressions tell you? An honest
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person looks natural and relaxed. A person telling a lie might have a strained facial expression. What does the body language say? An honest person looks comfortable and is directly engaged in the conversation. A dishonest person may appear distant, look down at the floor, or avoid eye contact. c. Enforce Consequences Every Time: Have a heartfelt talk with teens about the serious consequences of breaking your trust, but explain how it can be repaired. Set consequences for lying, and confront lies when they occur. When you detect an untruth, demand that teens own up to the lie, show repentance, and give a sincere apology. Then enforce the consequences you have set in place consistently.
What to Do When Your Child Hits Problem #7: Physical Aggression “My child shoves people and throws things, and ignores all of my warnings to ‘keep your hands to yourself.’ This is becoming a big problem at school.” Solution #7: Practice Reflective Listening A child’s physical aggression can be extremely difficult to deal with — emotionally and physically. It’s not easy to stay calm when your child has just punched a playmate for the umpteenth time. But do your best, and rely on the same parenting techniques that work when hitting is not the issue. When your child lashes out, discipline her by demonstrating appropriate behavior — speak calmly, but firmly; don’t shout (or spank).
reSource The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children by Ross W. Greene, Ph.D. (Harper Paperbacks, 2014)
Try reflective listening, which is about understanding what your child is feeling at the moment, and then reflecting back to him in words what you imagine he is feeling. Ask yourself what feeling might be driving your child to do what he’s doing. Asking can help you get to the bottom of a behavior. Don’t try to change his thoughts with logic, reassurance, or a lecture. Reflective listening will help your child feel better and, therefore, feel like behaving better. Using reflective listening demonstrates to your child that you care. Have you ever told an angry child, “Use your words”? Often children don’t know what words to use. When your child is physically aggressive, it can help to define exactly what she did wrong, and what to do next time a similar situation arises. Let your child know that you understand how hard it is to control aggression. Listen carefully to what he says, and provide support. Ask your child what he thinks he can do to rein in aggression when something bothers him.
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Over time, reflective listening teaches children a rich and varied vocabulary for expressing their emotions, and a new understanding of why hitting is not an answer. The following steps will help you incorporate reflective listening into your parenting strategy. Here are examples of reflecting back what your angry child is feeling:
• When your child complains that Billy picked him last for his team,
instead of saying, “It’s good to be patient; at least you were still on the team,” say, “It sounds like Billy hurt your feelings and made you feel like he liked other kids better.”
• If you’re at a birthday party and your child pulls another girl’s hair when she is excluded from a game of hopscotch, instead of “Don’t just stand here, go play,” try saying, “Maybe you’re not sure if those kids want to play with you.”
Stop what you’re doing, look at your child, and listen. Sometimes our angry children are open with us about their feelings, and it’s easy to listen. But it’s also easy to get distracted. We need to look at our children to show that we are listening. It helps to make listening noises, words, and phrases, such as, “Hmmm,” “Oh,” “Really,” “Goodness.” These responses make it easier for a child to register that we are listening and that we care how they are feeling.
Reflective listening teaches children a rich and varied vocabulary for expressing their emotions, and a new understanding of why hitting is not an answer.
But what if your child won’t explain what’s wrong? You need to “listen” to his body language, facial expressions, posture, or gestures. You can tell something is bothering your child when you hear your son’s surly tone of voice, or when you notice that he doesn’t want to look you in the eye, even though you may have no idea what triggered it. These are cues for us to stop what we are doing and reflectively listen. When children don’t respond to listening, a calm, consistent consequence can be effective. ODD experts recommend the following strategy: Ask your child calmly to do something. If he doesn’t respond to you in two minutes, gently tell him, “I’m asking you a second time. Do you know what I’m asking you to do—and the consequences if you don’t? Please make a smart decision.” If you have to ask a third time, he suffers the pre-arranged consequence—no TV or video games for an hour. Use this experience to identify hot spots, or situations when your child always breaks down. Then try to avoid them when possible. Reassure your child after an aggressive episode so that your child doesn’t feel too discouraged, and remembers that you love him. If your child has become too big for a time out, or if anyone is feeling physically threatened, you need to escalate to the next level of support. You need
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therapy or coaching, a support to figure out how to get the family out of an environment where violence can breed more violence.
How to Defuse a Meltdown Problem #8: Public Tantrums Keep Us Homebound “Every time we try to have a nice, family dinner at a restaurant, our daughter creates a scene that’s so embarrassing we end up taking our food to go. Even going to the grocery store seems like an impossible feat when I know we’ll end up having a screaming, crying battle in the checkout line. How can I get her outbursts under control so we can take back our life?” Solution #8: Parents of defiant children can feel held hostage by their child’s bad behaviors, unable to go out to dinner, the movies, or anywhere for fear that their ADHD child will throw a tantrum. When your child acts up in public, use these techniques to defuse the meltdown and get on with your day.
a. Say no in a calm, matter-of-fact tone. Don’t complain that your child is always whining. Children will take this as a sign that they might get what they want if they push a little harder. Instead, say, “It’s not happening.” without lecture or explanation. That is just the way it is. Over time, kids begin to respect this tone because it is consistent. If they ask 7,000 times, the answer is still no. Children do better at managing anger when they know that their parents are in charge.
b. Set clear expectations with specific statements. Make it clear what “misbehaving” means when you’re in public. Be specific. Tell your child in advance what the consequence will be for an outburst. Discuss potential letdowns in advance, like the store not having the game you want, or having to wait at a restaurant. Then, your child will be able to plan how to react.
c. If your child still devolves into a meltdown, remind yourself that your child doesn’t get to choose your reaction. Even though you may feel embarrassed, frustrated, and resentful, you will not escalate the confrontation by yelling. Don’t take the meltdown personally. It’s about their difficulty managing intense emotions or frustrations, not you. Instead, stay calm, and pull your child into an alternate activity with you. Or, give your child a job to do, like fetching napkins and straws if you’re at a restaurant.
d. Acknowledge your child’s disappointment, and that you understand why he feels that way. It can help to think about what is going on to cause the emotional outburst, and then try to be supportive
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“Meltdowns say nothing about your parenting ability, but they do reflect the nature of ADHD.” — Michele Novotni, Ph.D.
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of the challenge. Is it because she is hungry? Tired? Then, shift the energy of a conversation to something positive, like doing the activity tomorrow after she finishes her homework. Or try making recovering from the meltdown a game by saying, “Let’s see how fast you can calm down, so we can get on with the rest of our day.”
e. If you’re at home, suggest physical strategies like punching a pillow, or squeezing a ball. Alternatively, have your child pretend she is holding a remote, and ask her to press the button that turns down her emotions. Be a role model, and show your child how you deal with disappointment.
f. Equip other adults. When you are engaging in group activities where another adult is in control, you might want to give others a heads up. Say, “Sometimes my child becomes extremely upset when things don’t go his way. A few kind words usually calm him down. If this happens a lot, please let me know so that I can talk to him at home.” Try to help your child with damage control when an outburst occurs with other children, to repair the relationship.
If your child has frequent meltdowns that aren’t responsive to interventions, don’t wait until you are at your wit’s end. Work with a professional to improve the chances of avoiding them.
“The stress of parenting a child with ADHD is heavy enough, without adding constant discord and yelling.” — Penny Williams
What to Do When You Meltdown Problem #9: My Child Loves to Create Conflict “My daughter with ODD is always seeking conflict. How do I avoid engaging when my child is being oppositional?” Solution #9: When parents are drawn in to arguments, it only fuels the ODD fire. It is hard for a parent to remain calm when a child is verbally abusing her, but it’s crucial not to overreact. Yelling or spanking may worsen a child’s oppositional behaviors. Stay calm and emotionally neutral amid your child’s defiance. Oppositional kids have radar for adult hostility. If they pick up on your anger, they’re going to match it — or worse. Put your own emotions and wishes aside temporarily. When we try to deal with angry children, we often get upset. We find ourselves getting angry when our child behaves defiantly, or feeling anxious or guilty because we wish they weren’t feeling so bad. The problem is that our strong feelings can cloud our thinking and lead us to react impulsively, not take time to use each interaction to help our children.
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Before you do or say something, calm yourself down. Here’s a tool that has helped a lot of parents accomplish that: Visualize yourself scooping up your anger, worry, or disappointment with both hands and placing that uncomfortable emotion at the side of the room. Picturing yourself doing it can clear your mind. Your feeling will still be there, waiting for you, if you want it back later.
reSource The Defiant Child, by Douglas Riley, Ph.D. (Taylor Trade Publishing, 1997)
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Treatment for Oppositional and Defiant Behavior
When parenting and discipline strategies fail, ODD-specific therapies can be a saving grace for families of defiant children. Step One: Make sure your child’s ADHD is under control. Typically, a doctor will prescribe ADHD medication, which can sometimes help with ODD symptoms. For more severe cases, a family therapist who is trained to deal with childhood behavior problems can help. Make sure to ask physicians if they have worked with children who have ODD and what methods they prefer. If a child’s behavior is dangerous to himself or others, seek immediate medical help from a trained professional. Step Two: Evaluate your child for related conditions. A therapist can screen your child for other conditions including anxiety, depression, and bipolar disorder — each of which can cause oppositional behavior. Therapists may recommend additional behavior therapy for children, to help them cope with difficult situations, as well as parent management or family training — the treatment of choice for ODD.
The treatment of choice for ODD is parent-management training. Parents are taught to change their reactions to a child’s behavior — good and bad.
Step Three: Consider behavior therapy and family training, which involve using well-defined rewards and praise for cooperation, and consequences for misbehavior. These programs can fill in the gaps when a child’s ADHD symptoms are under control, but defiance is still a problem. They can help reshape family dynamics to break the cycle of more extreme behavioral issues like violence. Read on below for more specific information about the therapy and training programs that work best with oppositional, defiant children.
Behavior Therapy Behavior therapy is a series of techniques meant to improve parenting skills and a child’s behavior; it fills in the behavior gaps that medication can’t address. It gives kids positive alternative behaviors to replace defiant ones. The American Psychological Association recommends this as the first line of treatment for kids with ADHD under five years of age. In fact, it works best when it is started early in a child’s life, when parent-child interactions aren’t ingrained and are easier to change.
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Successfully implementing behavior therapy at home is hard work. It means changing the way you and your child interact, and maintaining those changes over time. Improvements may not be apparent for weeks or months. But, it will be worth it when a child’s behavior changes for the long term. All behavior therapy programs operate on the same premise: parents and other adults in the child’s life set clear expectations for their child’s behavior. They praise and reward positive behavior and discourage negative behavior. This establishes predictability and routines, and increases the positive attention directed at your child. A behavior therapy regimen can be developed by a pediatrician, school psychologist, or another mental health worker. Grandparents, teachers, nannies, and other adults who spend time with your child must use the same consequences and rewards consistently. If one of them gives in to your child’s behavior, it can undermine your whole discipline program. Any effective behavior therapy should include four principles: 1. Reinforce good behavior with a reward system, like stars on a chart, or extending a special privilege like going to a movie on a Friday night. 2. Discourage negative behavior by ignoring it. Kids often use bad behavior to get attention.
Make sure all of your child’s caregivers are using the same discipline strategies.
3. Take away a privilege if the negative behavior is too serious to ignore. 4. Remove common triggers of bad behavior. Your plan should focus in on a key, narrow behavior, like no swearing, That is your top priority. Ask yourself:
• What do I want my child to do that he isn’t, or what do I want him to stop doing?
• How can I put this in a visual format so I won’t have to constantly tell her what to do?
• What would make it worthwhile for him to obey? Then you’ll have a single goal to work toward and measure progress against, and a reward that will work. Make sure that you allow for daily ups and downs. Just because your child did it today, doesn’t mean he/she will tomorrow. The important thing to focus on is that behavior is ever-so-gradually improving. Praise your child when he gets it right. Make sure the reward is something truly enticing.
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One father used his daughter’s desire to have her ears pierced. Each time she was correct, she could move up the date of ear-piercing by one week. Bad behavior added a week she would have to wait. Use affirmative “when/ then” statements, if your child wants a reward before performing the good behavior, say, “Yes, when you finish X, then you can go out with friends.” For younger children, the reward should take place directly after the good behavior. The goal is to incrementally teach your child new ways of behaving by focusing on and rewarding desired behaviors whenever you can. Experiencing success encourages children to do it again. Parent training can help moms and dads stay on track with their behavioral goals, so that you don’t get exasperated and give up when you don’t immediately see results. Children will sense that parents may throw in the towel, and wait it out. A neutral party, like a coach or group-based program can help alleviate tension, and help you stay the course.
The goal of parent training is to break the cycle of defiance and help parents discipline their children more effectively.
Family and Parent Training Programs The treatment of choice for defiant behavior is parent-management training. It is based on the premise that bad behavior results when children realize they can get what they want by behaving badly. Say your child throws a fit when you ask him to turn off the video game; if you give in even some of the time, he learns that he will sometimes succeed. The goal of parent training is to break this cycle, and help parents discipline children more effectively. Parents are taught to change their reactions to a child’s behavior — good and bad. They learn to show their child what they expect, and then give well-defined rewards and praise when their child behaves accordingly — or consistent consequences when they don’t. Therapists will also work with a parent and child together to solve specific challenges. Sometimes this involves ignoring minor bad behavior. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create a rewards system. Helping parents learn to praise good behavior is one of the toughest challenges therapists face. Many parents are so focused on bad behavior that they stop reinforcing positive ones. A few tips: Specify the praiseworthy behavior, be enthusiastic while not overdoing it, and finish up with a nonverbal gesture—a kiss on the cheek or a hug. The more creatively you tailor your program of rewards and punishments to your child’s specific abilities and needs, the better. Her needs change as she grows. Creativity is important, but consistency is vital to success. Consis-
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tency in the way you treat your child — setting rules, conveying expectations — is the key to cleaning up your child’s ODD act.
1. Parent-Child Interaction Therapy (PCIT) PCIT is a program that looks beyond a child’s bad behavior to examine troubled relationships — and how changing them can improve behavior. It helps parents become better at managing their child’s behavior with realtime coaching. It is best for children ages two to seven, and is offered in university-based centers and by individual therapists. The family interacts while listening to advice from therapists behind a oneway mirror. The therapist helps parents identify ways in which they are contributing to the problem, such as getting more and more agitated while your child becomes agitated. This therapy does not treat ADHD, but tries to lessen the comorbidities, like ODD, anxiety, irritation, and depression that can do the most damage to behavior. The advantage of PCIT is that the child associates these skills with her parent, not the therapist. Group programs teach the principles of PCIT to a group of up to 25 parents, and have the benefit of providing support for parents and costing less than private therapy. Three programs are: a) COPE (Community Parent Education) — taught, continuing-ed style, at night by paraprofessionals to parents of children up to adolescents
The American Academy of Child and Adolescent Psychiatry recognizes two treatments for defiant behavior — parent training and Collaborative Problem Solving (CPS).
b) Incredible Years — for parents of preschoolers, and focusing on early intervention to prevent defiant behavior from worsening
c) Positive Parenting Program — targeting teens and also providing strategies for managing marital problems caused by defiant behavior.
2. Collaborative Problem Solving This is a program created by Ross W. Greene, Ph.D. for defiant teens who are too big and strong to be put in a time out. Its principles can also help children for whom rewards and consequences don’t work. The program gives kids skills they lack – from social skills to executive-function skills – instead of using a reward-and-punishment system. The first step is to identify and understand the child’s concern about a problem (completion of homework or chores), and reassure him that the problem will be resolved by the child and the adult together. The second step is to identify the adult’s concerns about the same problem. The third step invites the child to brainstorm solutions with the adult, and to find a plan that is mutually satisfactory.
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What you learn: How to ask your child questions in a way that helps him explain what sets off his defiant behavior, plus how to share your own concerns with him and help him share his. A CPS Case Study: CPS turned around 12-year-old Armen Afarian’s behavior problems at school. When he was in middle school, Armen was sent to detention for what the teachers saw as defiant behavior during recess. The rule was that, when the bell rang, students had to freeze and hold the basketball, then walk back to class. On some days, Armen would shoot another basket after the bell rang, causing him to wind up in detention. Armen’s mom, Debra Ann, who had been through CPS therapy with her son, called a meeting with his teachers to discuss solutions to the problem. Armen said, “I do stop sometimes, because I’ve ended on an odd number of shots. If I don’t stop when the bell rings, it’s because I’m on an even number, and I can’t end anything on an even number.” “We won’t punish you, because that’s not going to change anything,” said one teacher. “How do you think we could solve this problem?” Armen answered, “Recess is 15 minutes; I could stop on an odd number if I know we’re getting close to the end of recess.”
3. Vive Vive is an intensive family therapy program for parents of older kids with behavioral problems. It uses the principles of parent management training, but involves two separate therapists: a “mentor” for the struggling youth, and a “coach” for the parents. This technique is for families in crisis who can devote a substantial amount of time, and money. Fees can be up to $3,000 a month. The teen’s mentor will meet him or her at school or work, while the coach usually speaks with the parents by phone. Then, family sessions are conducted together in the family’s home. The mentor can help the teen with problems at school or work along with behavior, and the coach can help reduce parental stress like marital bickering. The program can help kids become more reflective about ADHD and impulsivity, and help families recognize patterns in ways of reacting to each other. Then everyone can focus on using the strategies that work positively for them.
“We liked the fact that Vive gave our son more control over his own therapy.” — Lauren, a mother in Atlanta
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10 Rules for Parents of Defiant ADHD Kids
1. Stay Positive: Rewarding good behavior can be more effective than punishing bad behavior. It can also boost self esteem when you “catch” your child behaving well, and dole out praise. Making time to plan fun activities with your child takes you out of the discipline zone, and lets you strengthen your bond in a positive way. Try making time to volunteer together. Then, when you need to discipline your child your shared experiences will make her more receptive to your authority. Treat your child as if he were already the person you’d like him to be – that will help him develop the self esteem to become that person. 2. Treat Before You Punish: Make sure you’re not disciplining children for a symptom of ADHD. Once the symptoms are under control, you will know which behaviors are punishable, and which are facets of the condition. Don’t buy into other people’s negative remarks. Your child’s mind may work differently. Behaviors that other people call “slow” or “bad” may be symptoms. 3. Use Your Words: You always tell your children to use this technique to communicate feelings, but it’s important for parents to remember, too. Hypersensitivity commonly exists alongside ADHD, so spanking can be harmful for kids. The only lesson it teaches is how to be afraid of mom or dad. Instead, be a model of how to behave when you’re upset.
“Taking a positive approach is more effective than handing out angry ultimatums.” — Kenny Handelman, Ph.D.
4. Avoid Meltdowns: Having an escape strategy for tough events like birthday parties and family events can make the difference between a public scene, and a quiet exit. The best plans make you and your child co-conspirators in on the same secret. Take him aside and say, “It’s time to be a magician and become invisible.” Then, stage your exit. 5. Act Like a Cop: When you are pulled over, the policeman doesn’t berate you or yell. He calmly asks you what you did, and then doles out punishment. ADHD children can be very sensitive to parents’ anger, and won’t understand the message of what you’re staying. Instead, stay cool headed so things stay under control. 6. Be Clear About Rules and Consequences: Parents need to explain what behavior is not allowed, and exactly what will happen if kids don’t meet
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those expectations. Then, be consistent when reinforcing the rules. Kids with ADHD need to have it all laid out so they don’t forget. But don’t be too quick to say no. A child who hears “no” as a reflexive answer to every question is apt to rebel – especially if she’s impulsive to begin with. Know when it makes more sense to take a deep breath and answer in the affirmative. 7. Play Before Punishing: Doing creative projects together can help keep kids from misbehaving. When kids do act out, give them a punishment that’s so boring they’ll never want to do it again. Then talk about what to do differently next time. 8. Know Your Child’s Patterns: Honing in on the little quirks and hypersensitivities that make your child tick can help you adjust your discipline plan. It will let you know when your child is being willfully defiant, and when emotional overwhelm has gotten the best of him. Is he seeking stimulation because he’s bored? Or is he misbehaving on purpose? Have a plan in place when you see an explosive situation coming on, like how you’ll leave a family party, and get things under control.
Visit our guide to defiant and oppositional behavior: http://additu.de/ defiant
9. Determine the True Cause: Many conditions that could cause behavior problems commonly co-occur with ADHD. Oppositional Defiant Disorder (ODD) is the second most common one. If you suspect your child might have ODD, see a pediatric psychiatrist or family therapist so you can figure out how to discipline each disorder effectively. 10. Ask Yourself If You’re Contributing: Could you have ADHD, too? It’s commonly passed through family lines, so an undiagnosed parent might have a temper that flares more often, or impulsivity that undermines discipline efforts. If you think you might have ADHD, seek a diagnosis and treatment, so you can be the best parent you can be. Parents are a child’s most influential role model, so think carefully about your own behavior.
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Further Reading 1-2-3 Magic: Effective Discipline for Children 2-12, by Thomas W. Phelan (Parentmagic, Inc., 2014) Loving Your Child is Not Enough: Positive Discipline That Works, by Nancy Samalin (Penguin Books, 1998) No-Shout, No-Tears Discipline ODD and ADHD: Parenting Your Defiant Child Parenting with Love and Logic, by Foster Cline and Jim Fay (NavPress Publishing, 2006) Screamfree Parenting: The Revolutionary Approach to Raising Your Kids by Keeping Your Cool, by Hal Edward Runkel (Harmony, 2008) Strategies for Parenting Defiant Children The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, by Ross W. Greene, Ph.D. (Harper Paperbooks, 2014) The Kazdin Method for Parenting the Defiant Child with No Pills, No Therapy, No Contest of Wills, by Dr. Alan Kazdin with Carlo Rotella (Houghton Mifflin Harcourt, 2008) Your Defiant Child: Eight Steps to Better Behavior Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship, by Russell Barkley, Ph.D. (The Guilford Press, 2013) What is Oppositional Defiant Disorder?
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Parenting Programs 1-2-3 Magic Parenting Celebrate Calm Collaborative and Proactive Solutions (CPS) Empowering Parents Impact ADHD Lives in the Balance Parenting with Love and Logic The Incredible Years The Triple P – Positive Parenting Program Vive Family Support Program
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