Q. I’m looking for advice on how to deal with a temperamental eight-year-old boy who can be really challenging. He can be impulsive, inattentive, disobedient and unable to accept responsibility for bad behaviour. We took him to a psychologist who said he had significant ADHD/ADD symptoms, which fits with what we were experiencing. We decided not to pursue this further as we did not want to put him on medication. But we are looking for advice on how to manage his behaviour.
A. Parenting a child who might have attention deficit hyperactivity disorder (ADHD) can bring significant challenges. Being inattentive and overactive, these children can find it harder to understand and keep rules, especially in school where the expectation is for them to sit and attend to tasks they might consider “boring”.
In addition, the tendency to be impulsive and to act without thinking can lead them to get into patterns of misbehaviour and conduct problems. To help your son, it is important to understand his special needs and what specifically makes it hard for him to behave. As well as holding him accountable for his behaviour, the more you can have a sympathetic view of his difficulties, the easier it will be to help him.
Provide special support to keep rules and routines
Children with attention problems need extra support in keeping rules, as they are often distracted and not focused. Clear, positive instructions, advance explanations, early warnings and reminders can all help. Clear, predictable routines ideally pres- ented in a visual step-by-step way can be helpful in letting a child know exactly what is expected.
Routine charts can be used to teach children new positive behaviours at challenging times such as bedtime or homework. Also, active children can really benefit from having periods of physical play and exercise in the routine (for example, 15 minutes of homework can be rewarded by going out to play football or to play on the trampoline, and so on).
Set aside play time
Due to getting into trouble more often, children with ADHD tend to receive more critical feedback from parents and other adults, and this can have consequences for their self-esteem and relationships with others. It is important to counteract this by ensuring you have regular play times when you can enjoy your son’s company and have fun together. This fun time builds your relationship and is the platform from which you can solve behaviour problems.
Provide lots of encouragement and positive feedback
Work hard to identify and cultivate activities and interests that your son is good at so he gets frequent experiences of success and make sure to praise frequently any time he behaves well. By consistently pointing out to your son what he is doing right, you will not only build his confidence but also help him learn how to behave well.
The more specific you make your praise, the more you help him learn the skills he needs. For example, you could say things like: “Good boy, you finished the whole picture – it looks great,” or “You waited your turn, that is good patience.” With children with attention problems you have to work extra hard to ensure the encouragement gets through and that they understand the positive message you are giving.
Use positive discipline
Children who are overactive and impulsive can have associated behavioural problems and these can be dealt with in much the same positive way as with other children, though you often need to be more persistent and consistent to have an impact. The key is to identify clear consequences for when rules are broken (for example, no television until homework is done) that highlight to your son that he has a choice in how he behaves.
By giving your son a chance to choose between a consequence and keeping a rule, you invite him to pause and think how to respond, which can in turn help him reduce his impulsiveness over time. There is more detailed information on using positive discipline in my book ‘Positive Parenting’
Teach problem-solving strategies
Often, impulsiveness is a significant difficulty for children with ADHD and this can get them into trouble. As a result, the long-term aim is to help children learn to stop and think before they act and to acquire better ways of resolving problems.
You can do this in advance by discussing social problems with your son, either if it comes up naturally in conversation or by reading books with him that present social situations. Then, for example, you could say: “The boy in the story wants to be the goalkeeper but his friend won’t let him. What could he do instead?”
You can then help your child come up with lots of solutions and ideas for how to act, such as waiting to take a turn, asking nicely to play, going to play with something else, and so on. By thinking of solutions in advance, children may remember to use them in the heat of the moment.
It can also help to problem-solve with children when it comes to specific issues that might arise on a day-to-day basis. Once again, the key is to help your child pause and think about the best way to act. You could ask: “How can you stay sitting longer at your desk in class?” or “What can you do when you want something away from your desk?”
Problem-solving with children with attention difficulties takes a lot of time and patience, but it is worth it as it is the best long-term way to help them learn to cope with their difficulties.
Seek assessment and support
Raising a child with ADHD is challenging and it is important to seek support. Many parents find it useful to seek a formal assessment of their child’s needs, which can lead to a range of extra supports.
For children diagnosed with ADHD, several things can help, such as gaining access to special school support and parenting programmes, as well as medication when indicated.
Gaining support can also reduce isolation, and many parents find it helpful to talk to other parents dealing with similar challenges. There are some good parent-support groups in Ireland such as hadd.ie.
Dr. John Sharry, Irish Times Newspaper, May 2013. John writes in the Irish Times Health+ every Tuesday.