Chelmsford ADHD Support Group

Emotion Response Control & Behavioural Advice

Introduction
This section deals specifically with ADHD related issues rather than ODD (Oppositional Defiant Disorder) or CD (Conduct Disorder) which although the advice is helpful for these other co-existing conditions does not necessarily cover all the aspects of those issues.

ADHD specifically is not a bad behaviour condition however is listed and psychiatric diagnosis systems as an Emotional and Behavioural Disorder.  ADHD is an Neurological condition and although diagnosis is heavily psychiatric based the condition should be seen as a Neurodevelopmental Condition akin to ASD (Autistic Spectrum Disorder).  As previously mentioned on this website under "What is ADHD?" emotion control is a significant issues for ADHD.  It is best understood that ADHD'ers are very emotional people and struggle to appropriately control their natural responses to that emotion.  Some turn off their entire response to emotion due to their continued difficulties with the controls, especially as they get older and can often be seen to be emotionless to others because they have stopped showing emotions to the outside world.  This is as much an inappropriate emotional control as the majority of individuals who continue to fail to control negative emotions being displayed and the continued lack of ability to control how that negative outburst is displayed.

Negative emotions cross the brain much quicker than positive emotions and the delay in the prefrontal cortex reduces the ability, especially in children, to catch those emotions and control them and their response to them.  Often this continues into adulthood because they have failed to learn those controls and what is appropriate in how they are expressed etc.  We hope this section of the website will prove helpful in providing methods of how to help children with ADHD learn those controls.  As always with ADHD I believe that much of the advice can also be tailored to Adults and significantly help them to cover many aspects which they may have failed to learn as a child.

Key School and Home Advice by Dr Russell Barkley
The following advice is based on the work of Dr Russell Barkley of School Accommodations, who is one of the leading experts on ADHD and provides advice and recommendations to MIND, and is advice that all schools can and should implement for all ADHD'ers.  He points out that this advice is like a wheel chair ramp for the physically disabled.  Many teachers have asked him how quickly the children will assimilate the information and implement it themselves.  The answer he always gives is that you would never ask that question of a wheel chair ramp and like that wheel chair ramp it needs to be in place for the entire time they are in the school.

Please make sure you give a copy of the School Accommodations to your child's teacher/school to ensure they have a copy of this key information.  Of course please feel free to also recommend us and our website to them as well.

Framework
Build a framework around the individual to assist with Executive Functions, remembering that they need to be sustained indefinitely.  These are to address the key motivational deficits in ADHD.

  • Prosthetic Cues
    Use artificial prosthetic cues to substitute for working memory deficits (e.g. signs, lists, cards, charts and posters etc)
  • Prosthetic Consequences
    Provide artificial consequences in the large time gaps between actual consequences/accountability (e.g. tokens, points etc)

As previously stated, this is best to be seen as the disability ramp entering the building to enable wheelchair access.  You do not question whether it is needed to be removed after 30 days, likewise motivational structures are required long term.  They do not teach the child, they enable the child to generate the motivation that allows them to learn.

Behavioural Instructions
Many instructions given to children are behavioural related.  We recommend for all instructions that they are provided in the positive rather than the negative.  This has been shown on many occasions to be vastly beneficial.  For example a child keeps running onto the grass when they are not supposed to.  It is better to say "Stay off the grass" rather than "Don't go on the grass".

Short Term Punishments
Punishments need to cover the short term and be specific, to the point, clear as to the reason enacted and not be ongoing indefinitely or over a long period.  For example avoid banning an activity for a week, but rather ban on an hourly or half daily basis which is then re-given when it expires when the behaviour has not been corrected.  This allows the individual to realise they have control over how long the punishment lasts.  If they stop incorrect behaviour then the punishment also stops.  Of course the behaviour needs to remain ended for a set period of time to prove that it has indeed deemed as having ceased.  You don't want the opposite problem of a declaration that they have stopped to allow the activity they want to do to restart knowing full well they haven't any real intention of ceasing the behaviour but just starting the desired activity.  No one ever said this was easy but is very much tailored to your child.

Quantify and keep to Behavioural Rules
It is important for rules to those with ADHD remain static and not alter in any way.  Likewise the associated discipline promised at different stages must be enacted.  We recommend creating multiple stages for a gradual increase in the punishment so that as each stage is reached the punishment grows whilst also providing a clear basis upon which the individual can stop and the punishment will also stop.  If the child does not feel that they can change their future they will not alter their behaviour in the present.

50% of Discipline is Praise
Unfortunately when confronted with repeated behavioural issues it is easy for us parents to forget that 50% of discipline is praise and commending of good behaviour and actions.  Many people would argue that it is closer to 80% and they may well be right.  We find that much of the behavioural issues is based on low self esteem and self confidence and the individual can place themselves on a path of self destruction aiming directly at obtaining punishment to fulfill their desire of self punishment due to that low self opinion.  As parents we need to be mindful that we are building up our child into good behaviour not knocking them down to that point.  Good behaviour is the higher state, but punishing and knocking the child down into submission can result in the child believing that good behaviour is a lower state of achievement or add to their already obtained low self esteem.  If you begin feeling like parenthood reminds you too much of psychology then you're in good company.

Further Advice
The following advice is based on our own experience and tried and tested methods of parents in our support group they have found helpful.  Much of it is closely linked with the before mentioned advice and is specific to parents and home environments.

Valid Emotions
Remember often the emotional response is from a valid emotion and that their response is the action which is inappropriate in type or extent.  It is therefore important to tackle the cause of the negative emotions to reduce the emotional response or help prevent the recurrence of the emotion at a later date.  Also providing examples and coaching the child in appropriate ways of expressing their emotions will always pay in dividends.

Expectations Based on Age
As mentioned under our What is ADHD?" section the ADHD brain develops at a different rate to the average person in society. This is not necessarily a negative thing and has been shown to have many positive aspects; however we believe that many problems often occur for the ADHD'er due to being forced to fit in the educational mold. Expectations of parents are also based on the wider society and we believe many of the problems faced by parents is due to this expectation and that parenting needs to be based on the child's own developmental needs.

The ADHD child's development of rule sets and adhering to rule sets spoken and unspoken from teachers, parents and society is behind on average by 3 years.  The intelligence and ability of the child is however equal to or often greater than their peers and this can often cause a contradiction with their rule set and control system delay.  This often causes parents frustration and in turn aggravates the situation.  We recommend that parents reduce their expectations of their children adhering to rule sets and self controls to that expected of children on average 3 years younger.  This should not be purely in expectation but also reflected in preparation and execution of events and activities.  As above this includes controlling the child's expectation, reinforcing/reminding of rules and expectations of them whilst the activity takes place and also the parents own overview and management of the activity.

Token System Advice
Token systems can be fantastic but the problem often is how they are implemented and run as to why they can often be ineffective.  We would recommend considering the following advice:

It is important that parents explain to children that things like bed, food & water etc are basic rights; however that the nice things in life are not basic rights but are actually rewards.   These are things such as playing computer games, spending time with parents in activities, go out with friends and much more are those daily rewards which make life enjoyable.  Today many children view a lot of what they do as "their right" and so the only option available to parents is punishment (withdrawal of access).

With ADHD the token/sticker system is described as needing to change regularly however in most situations this change refers to the rewards and punishment aspects of the system rather than the methodology.  Often the method can remain for a much longer period if the reward and punishment system is dynamic and regularly updated.  Likewise the child's inclusion in the creation of the rewards and punishment is ideal as they then own the rewards and punishment system.  The change can therefore be natural in which the child elects new additions to both the rewards and punishments.  Ineffective rewards and punishments need to be removed and new ones added.  A catalogue of such rewards from which the child can exchange tokens/stickers for a reward is beneficial.  Below is just an example of what you could consider setting up:

Example:
You could setup a token system in which the child earns tokens at school for good behaviour and hard work.  This can be awarded by the teachers or parents can award themselves based on teacher feedback.  They could receive tokens for each hour of good behaviour achieved and many other aspects.  The child could earn 10-20 tokens during the day and a further 10-20 tokens at home in the evening.  Of course punishment can be not receiving a token for the given hour in which the poor emotional response or bad behaviour occurred.  However it can also include more severe and short term punishments which cease when the behaviour is corrected.  This for example  could be a delay in token exchange by 15 minutes, or be more severe depending on the behaviour and what the child themselves responds too.

The catalogue of rewards can be created with each reward having a different value of tokens for which it is exchanged.  Many of the rewards need to be received in the "here and now" and experienced immediately or within reasonable period of the token exchange.   The catalogue can be built up of lots of small short term rewards and some larger long term rewards.  For example lots of 10 tokens/sticker rewards such as 15, 30 or 60 minutes on the games console, packets of sweets (which don't contain any known problem chemicals).  You can then have a couple of 100 , 250 and 500 token options, such as trips to ice skating, ten pin bowling, adventure play grounds or other events.  Don't expect the child to save tokens for a later event however the opportunity to be able to do so can be important as they grow up and learn the need for planning for the future and seeing greater rewards if they save up.  We would recommend the majority of changes being to the smaller rewards, and only change the long term larger rewards if they show no interest in the idea of those activities.  Of course a parent can announce a special bonus token which earns a large reward even if the child does not save up which can only go to boost the child's self esteem and prevent them getting despondent and belief that larger rewards are outside of their reach.

Summary
The advice on this page is actually mostly common sense but society today can make parents feel that implementing these things as somehow making their child look deficient however we strongly believe the issue is with the expectation of the wider society and parents should have the confidence to implement what they know is needed for their child and not to worry how society may view their parenting skills.

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Meetings:

Our next Support Meeting is on:
Tues 13th May 2014 @ 7pm

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Wed 28th May 2014 @ 7pm


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