The Importance Of Positive Directions For ADHD

Dr. Sam Goldstein

In last month’s article I revisited the issue of incompetence rather than non-compliance as an explanation for the problems experienced by children with ADHD. With this rationale in mind, parents’ mindset must be to manage the environment to reduce problems while building in opportunities for children to gain much needed skill in the area of self-control. The key step in this process is to provide children with positive directions. This step assists parents and educators in determining whether punishment, management or skill building is the most appropriate intervention at the time.

Research literature dealing with directing others has focused on alpha and beta commands. Beta commands are often unclear (e.g., do that), whereas alpha commands are clear (e.g., go stand by the door). Alpha and beta commands can be provided with a start or stop direction. Start and stop beta commands are equally ineffective (e.g., stop that or start that). Stop alpha commands tell the child what not to do but leave a wide range of other possibilities open (e.g., stop pushing your sister… so the child now kicks his sister!). Start alpha commands by which children are very clearly directed to what they should be doing are favored. However, human nature appears to direct all of us to point out that which we do not like. When a child exhibits an aversive behavior, most parents respond by directing the child to stop doing it. A focus on what is to be stopped as opposed to what is to be started may not be an issue for most children because the majority of the time they are capable of meeting parental expectations. Children with ADHD, however, frequently do not meet parental and teacher expectations and may then receive a steady diet of negative directions. This does little to help the child understand what is expected.

Consider for example a child with his feet on the wall. The parent directs the child by saying “take your feet of the wall.” This is a stop alpha direction. The child is not being told what to do. This leaves a range of all other behavioral possibilities available. The child may take his feet off the wall and place them on the coffee table. The child has complied with the parental request but is now doing something else that is aversive and may increase parental anger. The problem escalates. The parent then directs the child to take his feet off the coffee table only to have the child place his feet on the bookcase. Keep in mind that children with ADHD are more likely to attend to commands that are given in a straightforward declarative manner than those delivered as a question, demand or request. Instructions should be delivered without distractions and supervised. Parents should make eye contact, praise behavior, resist habitual criticism and as Dr. Michael Gordon has noted, consider the “blind man technique.” In this technique the description of the behavior that the child just performed and what the child is to do next should be understandable to a blind man present in the room.

When I work with parents of children whose problems with ADHD cause significant difficulty at home we spend quite a bit of time making certain that parents are offering positive directions in the form of start alpha commands. Although this sounds like an easy task, tell your children what you want instead of what you don’t want, it is not. Most parents report that old habits are difficult to change. Many parents find themselves focusing on what is to be stopped without considering the nature of their actions. Again, the purpose of a positive direction is to help parents and teachers think about what they do and how they interact with their children. A good rule is for parents and teachers to ask themselves “what do I want to see the child doing instead of what he is doing right now.”

Alpha commands can be used to help make the distinction between incompetent and non-compliant behavior. Remember, non-compliant behavior should be punished consistently, predictably and quickly. The child should be returned to the situation to comply. If the child is directed to place his feet on the floor and does not comply within a brief period this has nothing to do with ADHD but rather reflects non-compliance. It is at that point that punishment will prove beneficial in the long run and increase compliance when directions are given. Further, once a request is made follow through is essential. If a request is made and follow through is not forthcoming children will learn to ignore commands.

Finally, the need for repeated successful trials cannot be over-emphasized. Parents play a critical role in helping children with ADHD foster and develop self-control. Given their limited self-control, parents must be prepared to serve as an external control system for their children on a long-term basis.