This question came in response to “Does He Need ADHD Medication?”
Q: What does the rest of the overall [ADHD] treatment plan consist of? What would a non-drug treatment plan consist of?
A: An overall treatment plan for ADHD includes support structures at home and school and behavior modification strategies implemented consistently and persistently.
A good plan will vary based on the biggest challenges your child is facing. But even the best plan will only be as effective as its implementation. Consistently coaching your child is not for the faint of heart. It often requires changing parenting behaviors and modifying teaching methods. Teacher and parent collaboration is critical. Even when a plan is going well, what works today may not work tomorrow. Maintain commitment, flexibility, consistency and persistence to support your child.
Four principles common to most behavioral strategies for ADHD are simplicity, structure, environmental support and positive reinforcement. Below are some examples:
SIMPLICITY: GIVE EFFECTIVE INSTRUCTIONS
Kids with ADHD have difficulty paying attention long enough to follow instructions well. Multi-step, complex or ambiguous instructions are particularly difficult. When giving instructions, follow these strategies:
Keep it simple: Use one-step instructions. Instead of telling your eight-year-old son, “Get your lunch, put on your shoes and grab your backpack before getting in the car,” give him one prompt at a time; “Get your lunch.”
Post written checklists: If you’re asking your child to do the same thing every morning, write down and post the routine. For a young child, post a picture of a tooth brush to remind him to brush his teeth. For older kids, a written checklist will do.
Establish eye contact: When giving an instruction, kneel down to your young child’s level. For all ages, make sure you have eye contact to confirm you have your child’s attention. Avoid the temptation to shout out instructions to your child as he passes you on his way up the stairs or out the door.
STRUCTURE: ESTABLISH ROUTINES
Kids with ADHD have challenges transitioning from one task to the next. Establish a structured, predictable routine to support your child’s ability to focus.
Post and follow the schedule: Post a schedule you’ve both agreed to follow. Have your child perform predictable tasks at the same time each day.
Give reminders to prepare for transitions: If your child is scheduled to relax and have a snack from 3:00-3:30 PM, at 3:20 PM remind her that she has ten minutes before starting her homework. Give her a second reminder at 3:25 PM; “Five more minutes.”
Do homework in the same place: Have your child do his homework in the same place every day to physically reinforce routines and to prevent him from delaying the start by searching for his notebook or pen.
Eliminate distractions: For kids with ADHD, siblings running through the house and noises from the TV can be especially challenging. Provide a quiet place to do homework free from distraction.
ADVOCATE FOR CLASSROOM MODIFICATIONS
With a collaborative, respectful approach, many teachers are open to making simple modifications to better support a student with ADHD. Common modifications include:
Sitting at the front of the room: Looking at a sea of classmates can be extremely stimulating and distracting. Sitting at the front of the classroom not only eliminates visual distractions, but also allows the teacher to more easily redirect your child when he’s distracted.
Sitting away from the door: For a kid with ADHD, watching the comings and goings of students walking through the door on their way to the bathroom can be infinitely more interesting than the task at hand. Ask the teacher to seat your child away from the door and from any other noisy areas of the classroom.
Providing physical prompts: When the teacher says, “Tommy, you need to pay attention,” and she has to repeat it throughout the day, not only is it taxing for her, but it can also be embarrassing for your child. Ask the teacher to try a physical prompt such as placing a hand on the child’s shoulder when he’s lost focus and needs to redirect himself.
PROVIDE A STRUCTURED CLASSROOM SETTING
Many kids with ADHD are more successful in a structured classroom that includes clear and consistent expectations, well-established routines, visual prompts and a reward system for behavior.
Explore options for schooling: If your school does not offer a structured environment, consider other options or other classrooms within the school. Just because a school or teacher was fantastic for your older daughter does not mean the same will be true for your child with ADHD.
- POSITIVE REINFORCEMENT: REWARD POSITIVE BEHAVIOR
Breaking the habit of commenting on undesired behavior can be challenging and giving constant positive reinforcement can be exhausting. But it’s hard to argue with results. Kids with ADHD thrive on markers to acknowledge their success. While getting in the car on time with his backpack may not seem like an accomplishment worth noting, for kids with ADHD, it can be a huge achievement. When a child feels good about his progress, it gives him the confidence to build on his success and overcome the next challenge, like remembering to bring home his homework folder at the end of the day.
Parents can become exhausted as they experiment with strategies and hit road blocks. Seek support for yourself and your child. Professionals and other parents facing the same challenges can lighten the burden of finding solutions. If you’re a parent who also has ADHD, you may be especially challenged and need additional support.
GO THE DISTANCE
You’re running a marathon, not a sprint. ADHD is a lifelong problem that can’t be cured. For improvements to last, strategies must be maintained over time. Develop a plan that is workable and feasible not only for elementary school, but for high school, college and beyond.