A number of years ago I offered a metaphor to help parents accept and understand the nature of ADHD. In light of the emerging body of research reflecting the delayed development of self-control in children with ADHD, it is worth re-visiting this concept. Parents, caregivers and educators working with children with ADHD must be able to distinguish between problems that result from incompetence and those that result from non-compliance. The former must be dealt with through education and skill building. The latter is usually quite effectively dealt with through manipulation of consequences. Due to their impaired developing self-control, children with ADHD lack the capacity to effectively and efficiently govern their behavior as well as those of their chronological age and developmental level. I remind parents that one of the most common question we ask our children when a mistake is made is, “what were you thinking when you did that?” Our expectation is that faulty thinking guided the child’s behavior. However, for ADHD the better question to ask is “what weren’t you thinking when you did that?” For ADHD a problem behavior is not guided by thought. In fact, the behavior results from the inefficiency and inability to use thought to cue and self-direct.
We can all agree that a large percentage of the problems children with ADHD demonstrate results from incompetence rather than purposeful non-compliance. The child with ADHD struggles to settle into a task, lacks persistence, makes repetitive mistakes, tends to become overaroused, easily frustrated, responds impulsively and behaves restlessly. This pattern results in a wide variety of non-purposeful behaviors that are clearly disturbing to others. Yet these behaviors in many cases are not the result of planned action but just the opposite. Parents and educators must be helped to understand that over time these behaviors result in a steady diet of “quit it, stop it, cut it out, don’t do it” responses. In part this likely plays a role in the development of oppositional behavior in children with ADHD. Children with ADHD are at significant risk to perceive their social environment as restrictively controlling and dissatisfied with their performance which then leads to the child’s becoming increasingly oppositional. By successfully distinguishing between incompetent and non-compliant behavior, parents and educators can reduce negative feedback, increase compliance and success and stem the tide of the development of oppositional behavioral problems, all other factors being equal.
It is important for parents and educators to understand that if they punish a child for the symptoms and consequences of ADHD, there is a strong likelihood the child will be remorseful and promise to behave better. Unfortunately the next time the child is in that situation the impulsive need for gratification will quickly overwhelm the child’s limited capacity for self-control. Thus, the problem will re-occur. Developing an understanding of this critical issue not only helps parents and educators re-label the majority of their child’s behavioral problems as unintentional, but acts as well as a motivator in changing the way they deal with the majority of problems. I often remind parents they wouldn’t punish a child unable to read and expect that punishment would increase reading capacity. Instead the child would be educated to develop a basic foundation of reading skill. Parents and educators working with children with ADHD must be helped to understand that punishing the symptoms of ADHD alone offers little chance of changing the behavior.
Parents and teachers can effectively manage the behavioral problems children with ADHD experience by providing appropriate commands, building in success, offering incentives and providing clear, consistent punishments for non-compliance. Finally, when dealing with non-compliance it is best to minimize negative reinforcement and maximize positive reinforcement. Parents and teachers should be directed to gain the child’s attention, be specific and direct, provide eye contact, offer a start rather than stop direction, use appropriate language, offer clear commands, not argue and allow only one opportunity for non-compliance. The best way to deal with non-compliance is to make certain that you have control over consequences. Appropriate commands, management of rewards, positive directions and response cost are all effective means to do so. Next month’s article provide a set of strategies to help provide positive direction.
