Poor impulse control can cause teens with ADHS to make poor choices – and lie about those choices. Lying stems from avoidance, denial, or a desire to skirt punishment.

But lying compounds the problem. There’s the lie, and then there’s the original problem that caused the lie.

There is something called earned trust. Through their actions, children and adolescents build on or destroy what has accumulated in a “trust bank account” with their parents. Kids think their trust bank accounts are flush with cash just because they exist. That’s not the case. Trust is earned. When a parent loses trust because a child lied, the child must earn it back, perhaps by complying with agreements or behaviors you both negotiated, for example.

When younger kids with ADHD lie, it doesn’t typically mean they’re trying to deceive you. Usually, kids lie to increase comfort in the present moment. Kids or teens may lie because they feel uncomfortable or ashamed, or in hopes of reducing stress or minimizing conflict.

[Free Download: Your 10 Toughest Discipline Problems — Solved!]

I suggest that you sit down with your child or adolescent and say, “There’s lying going on. How do we want to handle that? Let’s talk about agreements and logical consequences.”

Here’s a critical point to remember as a parent: You can’t ask for honesty and then punish it. If you say, “I want you to call me at any hour, wherever you are, and I’ll pick you up,” then you must follow through on this promise without judgement.

The ride home is not the time for lectures or to express your frustration. Refrain from telling them all the things that they’re going to lose; otherwise, they’re not going to confide in or call you again when they’re in a pickle. Instead, wait and gather your thoughts carefully. There’s nothing wrong with making your kids sweat a little bit. Then have the conversation later when everybody is calmer – and more clear-headed.

A positive response to dishonesty includes discussion and understanding; don’t shut things down with anger, guilt, blame, and shaming. When you show up with curiosity and compassion, you offer your child the opportunity to come clean and work with you on collaborative solutions to earn back your trust. This process builds connection and reduces conflict.

Parenting a Habitual Liar: Next Steps

• Read: A Survival Guide for Parents with ADHD: Strategies from Preschool to High School
• Free Download: Questions to Get Your Child Talking
• Watch: “A Parent’s Guide to Trading Defiance for Cooperation”

Sharon Saline, Psy.D., is a clinical psychologist who specializes in working with children, teens, and families living with ADHD and coexisting conditions.

As many as 62% of kids with ADHD receive a diagnosis and a prescription for medication without a recommendation for any type of parent behavior training or family therapy, according to the American Academy of Pediatrics. In a recent ADDitude survey, 57% of parents said they had participated in parent training. Of those, an astounding 93% recommended it.

Caregivers exert the greatest influence on their kids’ lives, and, let’s be honest, raising a child with ADHD can be extremely challenging. Parents may become frustrated, lose their temper, make allowances for inappropriate behaviors, or just give up in the face of relentless negative habits and attitudes. This is where parent behavior training, also called behavioral parent training (BPT), can help.

Moving from Reactivity to Proactivity

Parent training refers to a series of interventions designed to help caregivers learn effective strategies to manage their own emotions as well as their child’s behavior. The goals revolve around using positive reinforcement, setting effective boundaries, and providing scaffolding to increase positive connections, reduce negativity, and enhance a child’s successes.

This type of training helps parents learn to be proactive rather than reactive. The reactive parent responds to a child’s behaviors with threats of punishment based on intense feelings rather than logical thinking. Punishment fails to work in the long term because children with ADHD will need other options in their toolkit.

[Free Download: Your Guide to Parent Training Programs]

A good parent behavior training program can do the following:

• Teach parents real-world strategies for positive reinforcement and consistent discipline.
• Teach self-regulation, de-escalation, and calming strategies.
• Improve parent-child communication through reflective listening and accountability.
• Help parents set realistic expectations and routines based on their child’s skills and abilities.
• Replace reactive parenting with proactive strategies that rely on incentives rather than threats.

6 Popular Training Programs

The most effective parent training programs increase positive parent-child interactions by elevating the quality of attachment, the ability to communicate effectively, and the willingness to set and enforce boundaries. Here are six programs popular among families living with ADHD.

Parent-Child Interaction Therapy

Format: A therapist in an observation room watches parents interact with their child in real time. Parents wear an earpiece to receive in-the-moment parenting strategies from the therapist.

Goals:

• To help your child feel calm, confident, and secure in your relationship
• To learn how to be confident and calm in the face of your child’s most difficult behaviors

The Incredible Years

Format: Trained facilitators use video vignettes to present content and stimulate discussion. Separate programs are offered for parents of toddlers, preschoolers, and school-age children.

Goals:

• To strengthen parent-child interactions
• To foster parents’ ability to promote kids’ social and emotional development
• To reduce school dropout rates and delinquent behaviors
• To promote academic success

[Free Webinar: “The Power of Behavioral Parent Training for ADHD”]

Positive Parenting Program (Triple P)

Format: This online program is designed for two groups: parents of children ages 12 and under, and parents of children ages 10 to 16. The program provides a mix of videos, worksheets, tips, and activities that take 30 to 60 minutes to complete.

Goals:

• To set discipline guidelines
• To build parent confidence
• To raise happy children

Helping the Noncompliant Child

Format: Training sessions for parents and children ages 3 to 8. Skills are taught using active teaching methods, such as extensive demonstration, role play, and real-time practice.

Goals: To foster positive interaction by:

• Reducing parental coercive behaviors
• Giving positive attention to the child for appropriate behavior
• Setting limits and consequences

Parent Management Training

Format: Parents of children with moderate to severe behavioral difficulties work with a certified trainer online, in person, or over the phone.

Goals:

• To teach parents how to help their children cultivate positive behavior
• To learn how to effectively deal with anxiety and negative behavior

GenerationPMTO

Format: GenerationPMTO is an intervention program that is provided to individual families or parent groups, in person or via telehealth. The structure of individual training programs differs by location, both nationally and internationally.

Goals:

• To promote social skills that reduce delinquency, deviant peer associations, and mood disorders in parents and youths

Tips for Finding a Provider

Ask these key questions when interviewing a prospective therapist, coach, or program administrator:

1. What is your education in a particular parent behavior training model? Do you hold a certificate, license, or other accreditation in your field?
2. What is your training in ADHD and child development?
3. How do you monitor and support your clients’ progress?
4. What additional support is available after the program ends?

Behavioral Parent Training (BPT): Next Steps

• Free Download: 5 Ways to Improve Emotional Control at Home
• Read: How Does Behavior Therapy Work?
• Read: When Behavioral Parent Training is Working — But Tough to Maintain
• Sign Up: Parenting Class for ADHD Families

Sharon Saline, Psy.D., is a clinical psychologist and author.

Ryan Wexelblatt, LCSW, is a school social worker, camp director, and father to a son with ADHD and learning differences.

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Behavioral parent training (BPT) can be especially effective for children with ADHD and related behavioral struggles. BPT teaches caregivers the skills and strategies that can help improve their child’s behavior, self-control, and self-esteem. BPT is recommended as a first-line treatment for young children with ADHD, and starting treatment with BPT may reduce the need for ADHD medication.

BPT can help children and teens improve their ability to stay on task and control impulses at home, in school, and in social settings. It can improve the parent-child relationship and promote calm in the household.

In this webinar, you will learn:

• About behavioral parent training and why it is especially helpful for children with ADHD
• About the specific behaviors that BPT addresses
• Skills and strategies to help your child learn to manage and improve their impulse control and emotional regulation
• How BPT improves communication at home, in school and in social settings
• Why it’s important to partner with your child’s teachers and how to collaborate effectively
• How to use rewards and consequences to improve behaviors

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

ADHD Parent Training: Resources

• Sign Up: Parenting Class for ADHD Families
• Read: Train the Parent, Help the Child
• Read: How Behavioral Therapy Targets Executive Dysfunction — with Positivity and Praise
• eBook: The ADHD Positive Parenting Guide

Obtain a Certificate of Attendance

If you attended the live webinar on April 15, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Speaker

Nicole Schatz, Ph.D., is the Clinic Director with the Florida International University Center for Children and Families and a Research Associate Professor in the FIU Psychology Department. Dr. Schatz is also a licensed clinical psychologist in Florida and New York with expertise in behavioral interventions for children and adolescents with ADHD, including behavioral parent training.

Through her clinical work, Dr. Schatz has worked directly with parents of children with ADHD to implement behavioral parent training. Dr. Schatz has also provided clinical training and supervision in behavioral parent training to trainee clinicians. As a clinical researcher, Dr. Schatz’s program of research has emphasized the development and evaluation of behavioral interventions for children with ADHD.

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But studies suggest that we can teach kids effective skills for regulating their emotions, improving their behavior, engaging in active problem solving, and building positive relationships. How? The intervention I’ve found most helpful is dialectical behavior therapy (DBT).

“Dialectical” is simply the idea that two things that seem like opposites are true at the same time. Some examples of dialectics are: “I am independent, and I sometimes need help,” or “I’m really frustrated with you, and I love you.”

A simple approach to incorporating dialectical thinking into your parenting is to replace “but” with “and.” When you tell your child, “I know you’re angry, but you need to put your coat on,” that communicates that the first part of the sentence (the child’s side) is less important than the second half (the parents’ side). Replacing “but” with “and” communicates that both sides are equally important.

[Watch: Managing ADHD and Emotion Dysregulation with Dialectical Behavior Therapy]

Deeply Feeling Kids are “Supersensors”

When families arrive at DBT, they’ve often heard negative interpretations of their kids’ challenging behavior – and accusations that they are manipulative or spoiled. DBT asserts that, if you put a highly sensitive kid in a chronically invalidating environment, tantrums, risky behavior, and relationship problems are sure to follow. In DBT terms, a sensitive kid is an emotional “supersensor,” with reactions that are immediate, extreme, and long-lasting.

Validation is a kind of fire extinguisher for these emotional explosions. It doesn’t involve solving the child’s problems. It doesn’t mean agreeing with the child’s behaviors, thoughts or feeling. It simply involves communicating that these feelings make sense and are legitimate.

[Free Download: What Is Dialectical Behavior Therapy (DBT)?]

How to Validate Your Child’s Feelings

• Listen with awareness and avoid judgmental facial expressions.
• Reflect what your child is saying: “Math was really hard today.”
• State the unstated: “It sounds like you’re really hurt by what your friends said. Is that right?” Even an incorrect guess helps them think through their feelings.
• Communicate how their behavior makes sense given past circumstances. “I know the cafeteria is loud and overwhelming. I get why you’d be nervous about lunch today.”
• Confirm that their behavior is not unusual. “It makes sense that you were disappointed by the cast list. You worked hard preparing for that audition.”
• Cheerlead: Express belief in your child’s abilities. “It makes sense that you’re worried, and I know you are strong and up to the challenge!”

Validation is the salve for a chronically invalidating environment. It doesn’t solve the child’s problems or mean you agree with their behaviors, thoughts, or feelings. It simply communicates that they make sense and that their feelings are legitimate.

Parent Responses to Avoid

Avoid invalidating responses, which tend to exacerbate supersensors’ problematic behavior. Consider these two examples:

• During a child’s explosive episode, the caregiver says: “You’re making a spectacle of yourself!” or “You’re overreacting.” This dismisses the child’s experience.
• When a child complains that an activity is hard or boring, and doesn’t do what they said they would, caregiver says: “I don’t want to hear excuses. Do as you’re told.” This rejects the child’s efforts to communicate their feelings and oversimpliflies the process of meeting a goal.

Usually, parents or teachers say these things with good intentions, but these sentiments rarely help supersensors. These kids get the feedback that their emotions are wrong or illogical, and they start to doubt their own experience. Feeling misunderstood often turns up the dial on their distress.

Validating Deeply Feeling Kids: Next Steps

• Watch: How ADHD Amplifies Emotions
• Read: When Angry Kids Lash Out – How to Defuse Explosive Reactions
• Learn: 10 Rules for Dealing with the Explosive Child

Lauren Allerhand, Psy.D.. is co-director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at San Francisco’s Child Mind Institute.

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Dialectical behavior therapy (DBT) is an evidence-based treatment designed to help individuals who struggle with emotional dysregulation, aggression, self-harm, and other problem behaviors. DBT is an intensive, highly structured program that was originally created for adults in the 1970s and has since been adapted for children and adolescents. It can be an effective treatment for ADHD because it aids in the development of skills that support emotional regulation, problem-solving, and self-acceptance.

DBT works by helping children develop skills that decrease unwanted feelings and unhelpful behaviors, as well as skills that help them to accept difficult feelings about themselves and others without judgment. DBT patients participate in one-on-one therapy, group skills training, and/or phone coaching from their therapist. Parents learn the same skills as their children so that they can reinforce those skills outside of therapy.

In this webinar, you will learn:

• About the conditions that DBT treats in children and adolescents, and who would be a good fit for this therapy
• About DBT as a treatment model and how it works
• How DBT can support children and adolescents in managing mood, impulsivity, and anxiety
• About DBT strategies to support children in distress

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

DBT for ADHD: More Resources

• Download: What Is Dialectical Behavior Therapy (DBT)?
• Read: Overview of ADHD Therapies
• Q&A: Why Deficient Emotional Self-Regulation is Central to ADHD
• eBook: The Parents’ Guide to Raising a Teen with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on November 19, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Lauren Allerhand, Psy.D., is Co-Director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at the Child Mind Institute in the San Francisco Bay Area. She specializes in the evidence-based assessment and treatment of youth struggling with depression, anxiety, trauma, eating disorders, ADHD, and oppositional defiant disorder. She has extensive training in cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Dr. Allerhand is particularly passionate about providing DBT to improve the lives of high-risk, diagnostically complex youth who struggle with emotion dysregulation, suicidality, and self-injury.

Dr. Allerhand’s clinical practice also emphasizes supporting parents of children and teens with emotion dysregulation, oppositional behavior, or ADHD through evidence-based intervention. She has specialized trained in a DBT parenting intervention and Parent Management Training for parents of older children and teenagers. Dr. Allerhand is also certified in Parent Child Interaction Therapy (PCIT), an evidence-based intervention for families with preschool-aged children.

Listener Testimonials

“Praise to the speaker for her clarity. Excellent delivery.”

“The speaker was excellent, and the presentation outlined exactly the things I was hoping to find out about DBT. Thank you!”

“I really liked the specific examples that she provided. It was very helpful. Thank you!

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: Play Attention, inspired by NASA technology and backed by Tufts University research, offers customized plans to improve executive function, emotional regulation, and behavior through behavior therapy principles and mindfulness. Each family is assigned a personal focus coach, and our family plan provides tailored programs for both kids and parents, so everyone can thrive together. Schedule a consultation or take our ADHD test to discover how Play Attention can support your family’s cognitive, emotional, and behavioral development. Call 828-676-2240. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Use the tips below to guide you in putting this behavioral strategy into action. Remember that redirecting your attention takes time and practice to perfect. Some caregivers also work with a professional trained in effectively utilizing this parent strategy.

How to Manage Attention-Seeking Behaviors

1. Ignore the behavior if it is minor and reinforced through attention. This can include:

• whining
• arguing
• interrupting
• yelling
• being purposefully annoying

2. Do not ignore or tolerate dangerous, destructive, or unsafe behavior. Intervene to stop those behaviors immediately and implement appropriate consequences.

3. Do pay attention to other concerning behaviors. If your child is dragging their feet about brushing their teeth in the morning, for example, they’re probably not doing it to get your attention. You shouldn’t let your child avoid the task, even if they’re whining about it. (In this case, you should think about strategies to encourage your child to brush their teeth, like setting a tooth-brushing alarm, establishing specific rewards for dental hygiene, or maybe changing their toothpaste flavor.)

[Get This Free Download: Your Guide to Ending Confrontations and Defiance]

4. Don’t ignore your child outright. While ignoring some behaviors, you’re also waiting for the opportunity to give attention to the behavior you want to see. Meet the desired behavior with positive attention as soon as you see it. Say something like, “Thank you for waiting so calmly as I finish up dinner.”

5. Watch your non-verbal communication. There are plenty of ways you can inadvertently give attention to behaviors. Be mindful of facial expressions, eye rolls, huffs and puffs, crossed arms, stances, and other forms of attention. (This takes lots of practice!)

6. Should you explain to your child why you’re ignoring them? It’s not necessary, but this approach can be effective, provided you are mindful of your tone. Consider using “when-then” statements to encourage the behavior you want to see. Don’t say, “I’m not responding to you because you’re whining. That’s not how we talk to each other.” Say, “When you ask me nicely, then I will answer your question.”

7. Expect the behavior to get worse before it improves. When you withdraw your attention from a behavior that used to get your attention, the problem behavior will often get worse before it gets better. (We call this phenomenon an “extinction burst.”) Everyone at home should be prepared for these behaviors to escalate and to continue to ignore them — provided they are not dangerous.

[Read: How to Leverage Video Game Psychology to Improve Your Child’s Behavior]

8. Be consistent. It is important to make sure that all of a child’s caregivers can clearly define the problem behavior and are on board with the plan to ignore it. Consistently ignoring the problem behavior, while praising the positive behavior that you want to see, will yield the best results.

Attention-Seeking Behaviors and ADHD: Next Steps

• Download: 50 Discipline Tips for Kids with ADHD
• Read: Your Child Is Sending You Signals. Are You Ignoring Them?
• Read: How to Manage Your Child’s Toughest Behavioral Problems

The content for this article was derived from the ADDitude webinar titled, “Parenting Styles That Work for Neurodivergent Children” [Video Replay & Podcast #481] with Caroline Mendel, PsyD, which was broadcast on November 29, 2023.

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Intense children exhibit intense, often problematic, behavior with a frequency and severity that impacts everyone. Exhausted parents field regular phone calls from school administrators, frustrated teachers feel punishment (or leaving the profession) is their only option, and medical professionals assume medication is the only approach that truly works. No one benefits, certainly not the child.

Enter the Nurtured Heart Approach, a parent behavior training program developed from therapist Howard Glasser’s work with the most challenging and intense children. School and treatment centers report that it not only positively transforms “difficult” behaviors, but the Nurtured Heart Approach benefits all children by enabling and teaching adults how to channel their intensity into great qualities of character and leadership.

In this webinar, you will:

• Understand the dynamics of intense children and how to inspire success and greatness
• Understand why, despite sincere intention, conventional methods of parenting, education, and treatment often backfire with intense and challenging children
• Learn a methodology for inspiring success that is more powerful and encompassing than traditional approaches
• Understand how to uphold a great level of limits and accountability while avoiding the traps that make consequences backfire

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on Positive Parenting and ADHD

• Download: Questions to Get Your Child Talking
• Read: “My Child Resists Everything! Will He Ever Open Up to New Experiences?”
• Read: Positive Charge: How to Reinforce Good Behavior

Obtain a Certificate of Attendance

If you attended the live webinar on March 29, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Creator of the Nurtured Heart Approach, Howard Glasser works in family treatment, clinical studies, and educational leadership. His formal studies, along with direct experience with the most intense and challenging children, form the basis of this approach. He has been referred to as one of the most influential persons working to reduce children’s reliance on psychiatric medications.

Howard is the author of 15 books, including Transforming the Difficult Child, a longstanding bestseller on intense and challenging children. (#CommissionsEarned)

Howard teaches Nurtured Heart Approach Certification Training Intensives at the Nurtured Heart Institute, the University of Arizona’s Integrative Medicine Program, and at the Zuckerman School of Public Health.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“As a heart-centered practitioner, I appreciated this approach!”

“Glasser got to the core of the parent-child relationship in such a beautiful and compelling way.”

“Excellent presentation. I was affirmed in some of my current practices with my 5th & 6th grade classroom & want to explore this approach further!”

“Thank you! So rich and helpful.”

“Thank you, Howard was fantastic. Lots to think about, and to redirect the focus is something I’m going to try starting now! Inner wealth… I love this idea.”

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Targeting and addressing impulsive behavior in early adolescence may help to prevent the development of antisocial personality disorder (APD) and alcohol use disorders (AUD), according to an article published in the Journal of Adolescent Mental Health. However, interventions for impulsivity after age 13 or 14 may not stop the cascade of problem behaviors developing into APD and AUD¹.

The study set out to test the behavioral disinhibition model (BDM), which posits that impulsivity in early adolescence leads to substance use and antisocial behavior and that, in turn, substance use and antisocial behavior beget AUD and APD, respectively. The researchers found that early adolescent impulsivity directly predicted middle and late adolescent antisocial behavior and alcohol use.

Past middle adolescence (roughly ages 14 to 16), however, impulsive behavior did not correlate with antisocial behavior or alcohol use or with the development of APD and AUD. Only antisocial behavior and substance use were associated with a greater risk of APD and AUD in middle and late adolescence.

Researchers relied on data from the Philadelphia Trajectory Study, which comprised yearly interviews with a cohort of 364 ethnically and socioeconomically diverse youths aged 10-12 between 2004 and 2010. A final interview was conducted in 2012.

The authors’ findings validate the BDM and present novel clinical recommendations for preventing and treating adolescent alcohol use and antisocial behavior. The findings suggest that early adolescent impulsive behavior should be a target for intervention to prevent future issues arising from impulsivity. In middle to late adolescents, however, the focus should be on treating alcohol use and antisocial behavior instead of impulsivity to prevent APD and AUD.

Sources

¹Defoe, I. N., Khurana, A., Betancourt, L. M., Hurt, H., & Romer, D. (2022). Cascades From Early Adolescent Impulsivity to Late Adolescent Antisocial Personality Disorder and Alcohol Use Disorder. Journal of Adolescent Health. Elsevier BV. https://doi.org/10.1016/j.jadohealth.2022.06.007

Serious disparities in health care for African American and Latinx children with ADHD are well documented. As rates for ADHD diagnosis increase across the population, a growing body of literature highlights barriers to ADHD diagnosis and treatment – from the clinical level to systemic factors – that disproportionately impact children and adolescents of color. These inequities have created and deepened societal divides that put Black and Latinx children at greater risk of poor educational outcomes.

Sufficiently addressing disparities in care starts with an understanding of why racial and ethnic imbalances matter, the roots of these inequities, and their consequences for overall health and well-being. Pediatric clinicians can further work to reduce ADHD stigma and improve equity in ADHD care by providing culturally relevant care, and by applying treatments to meet the specific needs of children in African American and Latinx families.

Health Equity: Why It Matters for ADHD Care

Early childhood experiences and environmental influences can have a profound impact on developmental trajectories and eventual health outcomes. We can observe this through the school-to-prison pipeline, where Black students can suffer severe consequences for behaviors associated with and triggered by their symptoms.

The School-to-Prison Pipeline

This model describes how schools’ harsh disciplinary reactions to behavioral concerns, including zero-tolerance policies, can push children out of the educational system and into the juvenile justice system. Talking back to a teacher, as an example, can be interpreted as a form of intimidation, possibly leading to suspension, expulsion, or even arrest for a behavior that should result in a trip to the principal’s office at worst.

Ample data shows that Black students are more likely than are white students to be placed in this school-to-prison pipeline. In fact, they are suspended and expelled three times more often than are white students.¹ And when students are suspended or expelled for behavior, they’re almost three times more likely to be in contact with the juvenile justice system in the following year.²

[Click to Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children]

Black children are also disciplined at higher rates for certain behaviors than are white students. According to an analysis of a Seattle school district over one year³:

• 52 percent of students suspended for disruptive behavior were Black, compared to 24 percent who were white
• For interference with school authority, 56 percent of students suspended were Black, versus 6 percent who were white
• For disobedience, 44 percent of students suspended were Black students, compared to 25 percent who were white

Certain populations are even more at risk. Black boys are three times more likely to be suspended than are white boys; Black girls are six times more likely to be suspended from school than are white girls.⁴

Research also shows a disproportionate use of suspensions and expulsions for children with disabilities, even at the preschool level. According to the Center for American Progress ⁵, preschool students with behavioral problems represent about 4 percent of all preschoolers, but make up 70 percent of children who have had a suspension or expulsion. The same report found that preschoolers with ADHD, who comprise just 2 percent of the preschool student population, made up 53 percent of preschool suspensions and expulsion. Harsh discipline for behavioral concerns at this early age is particularly problematic, since children at the highest risk for this type of discipline – Black children, Latinx children, low-income students, and children with disabilities – are also more likely to experience multiple adverse childhood experiences, which may manifest as the behaviors for which they are routinely punished.

[Childhood Trauma and ADHD: A Complete Overview & Clinical Guidance]

ADHD, African American Youth, and Incarceration

Studies have found significant rates of ADHD among incarcerated populations. One meta-analysis estimates that 25 percent of the incarcerated population has ADHD, with the prevalence increasing to 30 percent among incarcerated juveniles.⁶

Given what we know about the school-to-prison pipeline, could it be that ADHD, which can affect school behavior, increases the odds of incarceration for African American youth and adults?

The authors of 2014 publication⁷ hypothesized that ADHD symptoms would be commonly interpreted as school behavioral problems in African American children, which would then be associated with negative teacher ratings and lower standardized test scores. This, in turn, would predict more suspensions, expulsions, and juvenile arrests, which would then predict arrest in adulthood. In the end, the study’s findings were largely consistent with the hypothesis.

Harsh discipline approaches, of course, lead to other adverse consequences. Nearly half of high school students with three or more suspensions will drop out of school.⁸ Today, African American children, despite comprising 16 percent of the youth population, represent 44 percent of youth in juvenile facilities. And as of 2015, Black youth are more than five times as likely to be detained or incarcerated compared to white youth.⁹

Health Equity: Improving ADHD Care

Behavioral Parent Training

Given the severe consequences for school behavior problems at school, particularly among Black children, one way to improve equity in ADHD care is through behavioral parent training (BPT) – specifically to meet the needs of African American families.

Why focus on BPT? Studies have shown that combination treatment of ADHD with BPT and ADHD medication, is most important for children in low socio-economic households, particularly for those who are African American or Latinx.¹⁰

Despite parent training being an important component of a child’s treatment program, it is not a service that is readily accessible in many clinical settings, or widely provided in primary care. But even with access, another important challenge is providing BPT in a way that maximizes parent engagement.

Parenting Styles

Understanding diverse parenting styles is a prerequisite to discussing parent training among Black families. Parenting styles have been described in three broad categories, which have been found to differ among families by race and ethnicity:

• Authoritarian parenting, where parents have high behavioral expectations and often utilize more punitive disciplinary strategies
• Permissive parenting, where parents have few demands or behavioral expectations, limits, or restrictions
• Authoritative parenting, defined as a balance between the appropriate behavioral expectations and responsiveness to the child. Much of parent training for ADHD focuses on strategies that emphasize this parenting style (like praising compliant behaviors and ignoring negative ones), which is thought to be the most effective form of parenting in terms of positive child behavioral outcomes.

Researchers have found, on average, that African American parents are more likely than white parents to use an authoritarian parenting style. Historical and sociopolitical contexts can help explain the functional significance of this type of parenting. By understanding these contexts, clinicians can adjust and adapt the content of behavioral training to meet the needs of Black families.

Parenting in African American Families

This historical context of African American parenting starts in slavery, through Jim Crow, and the civil rights movement, through present day. And through all of this history, to our current societal realities, African American parents are faced with the challenges of preparing their black children to endure racism and unfair treatment.

Historically, children made up a substantial portion of enslaved Africans in the U.S. Of the 12.5 million Africans trafficked to the U.S. before 1865, nearly a quarter were children. These children were subjugated to all of the horrors of slavery, including brutal violence, separation from family, sexual assault, and trauma. Parents who were slaves had no authority over their own children, and, in many cases, had to watch them suffer abuse from slavers and overseers, or see them sold away.^{11 12}

When slavery ended, the injustices facing young Black children persisted. Thus, African American parents continued to teach their children how to show complete reverence and compliance to white people in public, as any deviation from the white definition of “appropriate behavior” from a Black child could lead to severe consequences.^{11 12} One of the most notorious examples of this is the case of Emmett Till, who was lynched in Mississippi in 1955 at age 14 after a white woman falsely accused him of whistling at her. She later admitted that she lied, but for the perceived sleight, Till was kidnapped, brutally beaten, and murdered.

This trend continues to the present day with Black youth killed by police officers. Tamir Rice, of Ohio, was 12 years old in 2014, when he was shot and killed for playing with a toy gun in a park; Laquan McDonald was shot and killed at 17 by Chicago police as he walked away from officers in 2014; Kwame Jones was 17 when he was shot by police at a traffic stop in Jacksonville, Florida, in 2020. These are just a few of too many examples.

Adjusting Behavioral Parent Training

Given historical contexts for Black parenting, BPT programs must be adjusted and adapted to better engage these families. This may be achieved with the following strategies, among others:

• Providing scenarios and videos to which parents can connect and relate
• Using providers who have similar lived experiences to encourage and facilitate participation
• Changing wording and delivery of strategies; overcoming language barriers
• Providing courses in local neighborhoods with other parents that have similar lived experiences; using mobile options and online tools
• Understanding racial socialization, or teaching children how to effectively cope with racism

These changes can significantly improve the BPT experience for Black parents. I can personally attest to this, having undergone parent training with my husband for our twin boys with ADHD some years ago. Though I, as a pediatrician, intellectually understood the concepts of BPT, it wasn’t until the instructor in class showed a video of a Black mother using BPT techniques on her daughter that I emotionally understood.

Health Equity: Other Disparities in ADHD Care

Clinicians also need to understand how these additional factors lead to inequity in ADHD care from diagnosis to treatment:

• Diagnosis and medication rates: A number of studies have found that Black and Latinx children, when compared to white children, are less likely to receive a diagnosis of ADHD and to take a medication for ADHD.^{13 14} Black and Latinx children are also more likely to discontinue medication and disengage from treatment compared to white children. ¹⁵
• Racism and discrimination: Black and Latinx children who report perceived racial and ethnic discrimination are more likely to have symptoms of ADHD, mood disorders, and other mental health conditions compared to white children.¹⁶
• Trust: Black parents have lower trust in their providers than do white parents.¹⁷ They are less likely to have racial concordance, and therefore a shared lived experience, with their provider, which is part of a larger pattern of distrust in the healthcare system due to a legacy of racial discrimination.

Health Equity: Conclusions

Childhood experiences and influences — like racism, poverty, and other stressors — greatly shape developmental trajectories and potential health outcomes in adulthood. Inadequate intervention for ADHD in Black and Latinx children is multifactorial – the result of low levels of trust in medical providers due to historical trauma, coupled with health disparities, including in diagnosis and treatment, and less access to care. Furthermore, inadequate treatment for ADHD behaviors in children of color will and can result in serious consequences at school that have an overall negative impact on their health and wellbeing. This is why it is crucial for clinicians to provide early and adequate intervention for ADHD in these children.

The content for this article was derived with permission from “Equity, Diversity, and ADHD: Achieving Equitable ADHD Care for African American and Latinx Children,” presented by Tumaini Rucker Coker, M.D., MBA, as part of the 2021 APSARD Annual Virtual Meeting.

Health Equity in ADHD Care: Next Steps

• Read: Children Left Behind
• Read: Having “The Talk” with Black Children Impacted by ADHD and Race
• Guide: Behavioral Therapy for ADHD: A Pragmatic Parent’s Guide

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Sources

¹ U.S. Department of Education Office for Civil Rights (USDEOCR). (2014). Civil rights data collection, data snapshot: School discipline. Retrieved from http://www2.ed.gov/about/of-fices/list/ocr/docs/crdc-discipline-snapshot.pdf

² Fabelo, T., Thompson, M. D., Plotkin, M., Carmichael, D., Marchbanks, M. P. III, and Booth E. A. (2011). Breaking schools’ rules: A statewide study of how school discipline relates to students’ success and juvenile justice involvement.New York , NY; College Station, TX: Council of State Governments Justice Center; Public Policy Research Institute of Texas A&M University. Retrieved from https://csgjusticecenter.org/wp-content/uploads/2020/01/Breaking_Schools_Rules_Report_Final.pdf

³ Rowe, C. (2015, June 23). Race dramatically skews discipline, even in elementary school. The Seattle Times. Retrieved from: https://www.seattletimes.com/education-lab/race-dramatically-skews-discipline-even-in-elementary-school/

⁴ Crenshaw, K., Ocen, P., Nanda, J. (2015). Black Girls Matter: Pushed Out, Overpoliced, and Underprotected. Retrieved from http://www.atlanticphilanthropies.org/app/uploads/2015/09/BlackGirlsMatter_Report.pdf

⁵ Novoa, C., Malik, R. (2018). Suspensions Are Not Support: The Disciplining of Preschoolers With Disabilities. Center for American Progress. Retrieved from https://www.americanprogress.org/issues/early-childhood/reports/2018/01/17/445041/suspensions-not-support/

⁶Young, S., Moss, D., Sedgwick, O., Fridman, M., & Hodgkins, P. (2015). A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychological medicine, 45(2), 247–258. https://doi.org/10.1017/S0033291714000762

⁷ Behnken, M. P., et. al. (2014). Linking Early ADHD to Adolescent and Early Adult Outcomes among African Americans. Journal of Criminal Justice 42(2):95–103. https://doi.org/10.1016/j.jcrimjus.2013.12.005

⁸Balfanz, Robert; byrnes, vaughan; and Fox, Joanna (2014) “Sent Home and Put Off-Track: The Antecedents, Disproportionalities, and Consequences of Being Suspended in the Ninth Grade,” Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 5 : Iss. 2 , Article 13. Available at: https://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss2/13

⁹ The Sentencing Project. (2017). Black Disparities in Youth Incarceration

¹⁰ Arnold, L. E., Elliot, M., Sachs, L., Bird, H., Kraemer, H. C., Wells, K. C., Abikoff, H. B., Comarda, A., Conners, C. K., Elliott, G. R., Greenhill, L. L., Hechtman, L., Hindshaw, S. P., Hoza, B., Jensen, P. S., March, J. S., Newcorn, J. H., Pelham, W. E., Severe, J. B., Swanson, J. M., … Wigal, T. (2003). Effects of ethnicity on treatment attendance, stimulant response/dose, and 14-month outcome in ADHD. Journal of consulting and clinical psychology, 71(4), 713–727. https://doi.org/10.1037/0022-006x.71.4.713

¹¹ Patton, S. (2017). Corporal punishment in black communities: Not an intrinsic cultural tradition but racial trauma. American Psychological Association. https://www.apa.org/pi/families/resources/newsletter/2017/04/racial-trauma

¹² Patton, S. (2017). Spare the Kids: Why Whupping Children Won’t Save Black America. Boston: Beacon Press.

¹³ Morgan, P. L., Staff, J., Hillemeier, M. M., Farkas, G., & Maczuga, S. (2013). Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade. Pediatrics, 132(1), 85–93. https://doi.org/10.1542/peds.2012-2390

¹⁴ Morgan, P. L., Hillemeier, M. M., Farkas, G., & Maczuga, S. (2014). Racial/ethnic disparities in ADHD diagnosis by kindergarten entry. Journal of child psychology and psychiatry, and allied disciplines, 55(8), 905–913. https://doi.org/10.1111/jcpp.12204

¹⁵ Pastor, P., et al. (2005). Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey. Public Health Reports. https://doi.org/10.1177/003335490512000405

¹⁶ Coker, TR et al. (2009). Perceived Racial/Ethnic Discrimination Among Fifth-Grade Students and Its Association With Mental Health. American Journal of Public Health 99, 878-884, https://doi.org/10.2105/AJPH.2008.144329

¹⁷ Moseley, KL et al.(2006). Parents’ trust in their child’s physician: Using an adapted Trust in Physician Scale. Ambul Pediatr. https://doi.org/10.1016/j.ambp.2005.08.001

What Is Your Silver Lining?

There’s no question that stay-at-home orders have caused stress, anxiety, and loneliness. But for some parents of children with ADHD, a silver lining is beginning to appear: Fewer activities, obligations, and errands means more time for game nights, family walks, and time spent just “being together.” That’s not to say behavior challenges have diminished (they haven’t) or discipline is any easier (it’s not), but sometimes focusing on the pleasant surprises can get us through a tough day.

Calm and Connected Workshop Series

In an effort to support parents at home, ADHD coach Cindy Goldrich is offering her live, interactive workshop series titled “Calm and Connected: Parenting Kids with ADHD/Executive Function Challenges.” This series is designed to help parents gain insights, tools, and strategies to manage their child’s ADHD, executive dysfunction, oppositional behavior, and other behavioral and learning challenges.

On Tuesday, May 19, at Noon and 7 pm ET, PTS Coaching will kick off the workshop series with a two-hour session titled “ADHD & Executive Function: Impact on Learning, Motivation, and Behavior.” Comment below to enter to win a free entry into this interactive session on May 19.

Enter to Win a Free Workshop Session

To win one of five free entries into the first session of the PTS Coaching “Calm and Connected” workshop series (a $55 value each), use the Comments section below to tell us: What is one positive thing you will take away from this experience of sheltering at home?

Learn more about PTS Coaching on Facebook and LinkedIn.

Deadline

Friday, May 15, 2020, at 4:59 pm EST.

Rules

Only Comments posted with a valid email address will be considered valid entries. One entry per household per day. The editors of ADDitude will select five winners at random and notify them via email on Friday, May 15, 2020.
(Official rules)

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Treating ADHD / ADD in Children and Adolescents: Solutions for Parents and Clinicians

by Gene Carroccia, Psy.D
Charles C. Thomas Publisher, Ltd; $36.95
BUY THIS BOOK (#CommissionsEarned)

Clinical psychologist Gene Carroccia lays out his six-phase “ADHD-ology” treatment model for attention deficit disorder in this book. Through evidence and experience-based suggestions, this guide provides thoughtful techniques for mitigating the parenting challenges presented by ADHD.

In addition to offering guidance for getting an accurate diagnosis, effective treatment, and academic accommodations, the book teaches parents the best practices that Carroccia has found effective for managing ADHD at home and at school.

Most useful are the chapters addressing the implementation of parental behavior management techniques. The book also addresses cost and availability, from the initial outline of diagnostic steps to the final discussions of alternative treatments. Online resources for locating such services are recommended by name, and extensive footnotes provide context for Carroccia’s advice.

Carroccia has written a thorough guidebook to the challenges faced by parents of children with ADHD. Caregivers will learn to navigate the bureaucracy surrounding effective treatment, and to change their own responses to elicit desirable behavior from their children.

[Get This Download: 13 Parenting Strategies for Kids with ADHD]

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

There are dozens of customized programs for the behavioral treatment of ADHD, and hundreds of books on the subject. (My research assistant counted 492.)

Here are a few behavior strategies for parents — strategies that my three decades of experience have shown will likely help you and your child.

Trust the Top Expert on Your Child: You

Not teachers. Not friends or relatives. Not the doctor. Not even other parents who have a child with ADHD. You live with your child, day after day. You know his unique potential — his energy, passions, curiosity and creativity, qualities that can get buried under distractibility, impulsiveness, and restlessness.

The best strategies for making sure your child gets what she needs to thrive will come from your own instincts, intuition, and intelligence. There are as many approaches to behavioral management as there are children, and you are the one to decide on the best approach for your child.

[Get This Free Guide to Better Behavior Through Therapy]

ADHD Is Not ‘Bad Behavior’

I have asked thousands of children on their visits to my office the same question: “If you could change one thing with a magic wish — and it can be anything at all — what would you change?” Most children wish they could make school disappear or have a recess that’s eight hours long, or get a dog, or a pony, or take a trip to the moon, or eat ice cream.

Most kids with ADHD make the same wish. And it’s not for a daily banana sundae. Nearly every one wishes that his behavior could magically improve or that he could pay attention better. And he wishes Mom and Dad wouldn’t get so upset at him anymore. Hearing this helplessness from so many children with ADHD — hearing how much they don’t want to be “bad” — I realize that kids with ADHD are asking for help for symptoms that they cannot control.

Your child is not deliberately willful, disobedient, scattered, demanding, obnoxious, aggressive, or lazy. ADHD is not a “behavior problem” or a “discipline problem.” ADHD is a neurological, genetic, nutritional, and environmental medical disorder that imbalances the brain.

Bottom line: Your child is not a bad child. You are not a bad parent. Nobody is to blame for ADHD. Therefore, assigning blame for your child’s bad behavior — and trying to correct it with criticism — is useless.

[Click to Download: Your Free Guide to Ending Confrontations and Defiance]

Rewarding Your Child for Better Behavior

Children with ADHD misbehave so often that they receive a lot of punishment, which creates hostility and resentment. Rewards work much better. In fact, kids with ADHD respond better to rewards and positive feedback than kids without the disorder, according to research.

In a recent study on this topic, neuroscientists and psychiatrists at Northwestern University compared short-term memory in 17 boys with ADHD and 17 without the condition, all of whom were asked to remember the location of objects on a computer screen. The boys got immediate results from their performance in the form of rewards (money symbols on the screen) and feedback (green or red squares on the screen).

Boys with ADHD achieved “high performance” only when they got a large reward or feedback. During the memory exercise, the researchers tracked the boys’ moment-to-moment brain activity using a real-time brain scan called a functional MRI. They found that the boys with ADHD had the most brain activity linked to short-term memory when they received large rewards.

What kind of rewards work for kids with ADHD? Anything you think will be appealing to your child: extra time playing a video game or the chance to rent a movie for the evening. Make that reward part of a verbal contract that applies to any task you want your child to do, like finishing his homework or cleaning his room. Other rewards might be physical affection, special snacks or treats, or small toys or collectible items.

Criticizing “Bad Behavior” Worsens ADHD Symptoms

A recent study, funded by the National Institutes of Mental Health, shows that criticizing your child is likely to make her symptoms worse, not better. For the study, the researchers recruited 515 families with children seven to 11 years old — 338 children with ADHD, and 127 children without.

For three years, the researchers tracked the trajectory of ADHD symptoms, using questionnaires filled out by parents, teachers, and children themselves. The results: Sustained critical parenting — a high level of harsh, negative comments about the child — was linked to ADHD symptoms that didn’t lessen over time.

How Parents Can Change Their Own “Bad Behavior”

But how do you stop yourself from being “overly critical?” How do you show your child respect rather than subjecting him to a barrage of negativity? How do you change your behavior to help your child’s behavior? The strategy I’ve used with many parents is called SAIL.

• S is for symptom. I’m sure you could make a fairly long list of ADHD-related behaviors that annoy you. Whatever the annoying behavior, don’t see it as bad behavior — see it as a symptom. Think of it this way: If your child has a runny nose, you don’t say she’s a bad child whenever she sniffles. You say she has a symptom of a medical problem, like a cold or an allergy. If your child is running uncontrollably around the house, it’s the same thing — she has a symptom of a medical problem. Without parental help, your child can no more inhibit her motor activity than she can stop her nose from running.

• A is for ADHD. After you’ve labeled the behavior a symptom, say to yourself: ADHD is a medical problem, not a behavior problem. Whatever the behavior, your child is not doing it to irritate you. Your child wants to behave. But he can’t without your help. And criticism is no help.

• I is for “It’s OK.” In the grand scheme of things — your life and the life of your child — the behavior is probably not that big a deal. Whatever your child is doing that annoys you, tell yourself, “It’s OK.”

• L is for listen. I cannot overstate the value of listening to your child. ADHD children have great strengths and talents — including the insight to help you parent them. If you tap into your child’s intuitive and creative energy, she can help you help her. The best way to do that is to listen to what your child says and to respond positively. When I meet with a child alone and listen, the child is often able to articulate the exact information his parents need. I might ask, “What do you need to help you study better?” She might tell me that she studies best in the dining room, with loud music playing. But her parents may have already decided that she should study in her bedroom without any “distractions.” What you think is best for your child may not be what is best for her.

Let your child guide you to the best possible understanding of how he interacts with the world around him, and what he needs to function at his best.

You might want to add a second L to the end of SAIL: L, for let go. You will probably have days filled with fighting, fidgeting, and so on. Resentment may build up and not go away. But for your child’s wellbeing and yours, learn to let go of anger or other destructive emotions that have arisen during the day and move on.

This advice is emphasized by ADHD expert Russell Barkley, Ph.D., in his book Taking Charge of ADHD (#CommissionsEarned). When you find yourself rehashing your child’s behavior in your mind, he recommends three minutes of mindfulness meditation. Conclude the meditation by saying, “I love you and forgive you.”

[Read This Next: Never Punish a Child for Bad Behavior Outside Their Control]

Excerpted from Finally Focused (#CommissionsEarned), by James Greenblatt, M.D., with Bill Gottlieb, CHC. Copyright 2017. Harmony Books.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

It is not your fault. Your child’s ADHD was not caused — or worsened — by your parenting. But you are the best person (and maybe the only one) to teach him the skills he needs to thrive because — despite the anger, frustration and impulsivity — your child really does want to please you.

This is the core premise behind behavior parent training (BPT), an evidence-based therapy that focuses squarely on addressing executive dysfunctions (the hallmarks of ADHD) in a way that corrects the core problems underlying bad behavior.

Behavior Parent Training for ADHD

How and why does BPT work for children with attention deficit hyperactivity disorder (ADHD or ADD)? It is a different approach to parenting that prioritizes positivity and finding the ‘right fit’ for your child — in other words, the parenting approach that gets your child to respond.

Developing that ‘right fit’ is important when it comes to keeping a child on track; children who find it with their caregivers are much less likely to experience severe, negative long-term outcomes. BPT recognizes that, and it also recognizes that the best fit for a neurotypical child is rarely the same as that for a child with ADHD. Different brains require different parenting strategies.

For example, some neurotypical children may shift their behavior to avoid or end punishment. Punitive measures like grounding, however, rarely work for kids with ADHD. They respond better to positive dopamine charges than they do to negative ones. Consider your favorite boss and why you liked working for them. They were probably inspiring and allowed you to choose what your day looked like. They likely praised when you made good choices and didn’t harp too much on your mistakes. Just as you strove to wow that boss, your kids are going to work harder for you when you decrease the reprimands and increase the positive feelings.

[Self-Test: Oppositional Defiant Disorder in Children]

The core tenets of BPT for parents look like this:

• Improved behavior is a byproduct of a healthy parent-child relationship
• Children respond best to increased positive attention and reinforcement
• Children respond worst to harsh and inconsistent parenting
• Progress is made by focusing on one desired behavior at a time (and ignoring other behaviors purposely for a time)
• Change happens incrementally
• Raising a child with ADHD is taxing, and parents need help, too

How Behavior Parent Training Strengthens Executive Functioning

ADHD is a deficit of executive function. It causes children (and adults) to lose lots of things — including their temper, their homework, their track of time, and their self-confidence. To understand that these deficits are not willful, but rather neurological, is important. To further know how to help your child with ADHD overcome these deficits is life changing.

BPT provides insight into these difficulties and offers specific strategies for responding in a way that helps your child understand what you want and learn appropriate behavior in the process. This approach takes practice and consistency — but the payoff is real. Following these strategies will help your child feel better about himself and help you feel more in control of your parenting.

ADHD Challenge #1: Working Memory Deficits

The inability to take something and hold it in memory and then do something with that information later in a way that’s appropriate.

The Problem: Slow, Nagging, Frustrating Mornings

Q: “My child takes forever to get ready in the morning and I have to follow him around reminding him to focus and move quickly to the next task. This is exhausting and stressful every single morning.”

BPT Strategy #1: Create Checklists and Schedules

It’s really important for kids to understand what’s coming next and what’s expected of them. Use checklists and visual schedules to create some structure that allows your child to take ownership of his or her obligations, so it’s not just you having to nag and reinforce and nag and reinforce.

For younger kids, make simple drawings or find images of each task on the Internet (toothbrush, hair brush, clothing) and tape them on the wall near the bathroom sink. Seeing each part of the morning routine will encourage them to independently complete the task, and provide the opportunity for your child to demonstrate that they can. Remember kids want to please their parents.

[Your Free Guide to Parent Training Programs]

BPT Strategy #2: Give Simple Commands and Recognize Progress

Multi-step commands tax the working memory of a child with ADHD.

BPT teaches parents that commands stated simply are the most effective. Telling your child to  clean up the clutter near the front door will likely be met with confusion. Instead, use one-step commands that are very specific, such as: Please pick up your shoes. Good job. Now please put your shoes in your cubby. Great.

Breaking down the task into that level of specificity helps your child understand cause and effect in a way that enables him to make the connection “Ah, when I listen, and I follow through, my parents are happy with me.”

When commands are bunched together, it makes a lot harder for them to succeed, and it gives you fewer opportunities to praise them. Hearing frequent praise helps children with ADHD feel confident, which is very important.

BPT Strategy #3: Slow Down

Resist the urge to issue rapid-fire commands. Due to the slow processing speeds associated with ADHD, I recommend waiting at least 10 seconds (slowly count to yourself: 1 Mississippi, 2 Mississippi…) before re-issuing the same command. Doing this may feel long to you but it gives your child time to process what you’ve said.

To ensure that your child understands what you’ve asked, make eye contact and stand close to him before issuing commands. Then assess for understanding. You can ask him if he understands what you’ve asked and wait for his response.

BPT Strategy #4: Praise Progress, Not Perfection

Imagine you’re a kid with ADHD who’s trying really hard that day and you’re listening when mom asks you to pick up your shoes, go up to your room, and get dressed. If you have working memory issues, you might be able to get through the first two steps. But if your parents find you doing something else instead of the third step, you’ll likely be scolded. And that, on the whole, does not help kids or motivate them to do things a little differently next time.

Most kids with ADHD are reprimanded by the adults in their lives — chastised or given negative feedback about something they’ve done — frequently throughout each day. Add this up, and it becomes pretty clear pretty quickly that by the time they’re adolescents they’ve heard a whole lot more disappointment than encouragement.

ADHD Challenge #2: Poor Response Inhibition

Poor response inhibition is the ability to keep yourself from doing something you know is not appropriate.

The Problem: Aggressive Response to Frustration

Q: “My child gets frustrated easily and lashes out — hitting or yelling or both — at family members, even when we’re trying to help.”

BPT Strategy #1: Practice the Preferred Behavior

BPT teaches parents to use reinforced practice of prosocial behavior. This means teaching your child how to do something better or different to replace that hitting behavior, and then reinforcing that with practice.

Reinforced practice means having your child practice the preferred behavior in various parts of the house under various circumstances, and using little rewards to reinforce that. A younger child might receive a Skittle every time he uses the words “Will you share with me?” or “Mom, I need your help,” instead of hitting. Getting in the reps, just as you would lifting weights, is necessary in order for the newly-acquired skill to become automatic.

BPT Strategy #2: Use Praise Strategically

Look for ways to increase praise or catch your child doing good. If your four-year-old typically hits his sister after they’ve been playing for five minutes, try interrupting the play before it goes south. Come in and praise them for playing nicely at the three-minute mark.  “Hey, I love how well you guys are sharing toys. That’s great.” The point is to catch them doing good instead so that that behavior, the one that you want, increases.

ADHD Challenge #3: Delay Aversion

Waiting — for either reward or punishment — is painful or even impossible with ADHD.

The Problem: Rewards Do Not Motivate Good Behavior

Q: “We promised my child a new bike if she earns mostly As on her next report card, but she is totally unmotivated by this reward and her grades are suffering.”

BPT Strategy #1: Offer Incremental Rewards

This is not a problem of motivation, but of delay aversion — and BPT teaches parents how to change the reward schedule and increase the frequency of rewards to boost their effectiveness. In this example, think about how to break up the steps involved in getting good grades and how to measure those steps in a way that will allow your child to earn incremental rewards.

For example, if you want to improve their homework completion time, you could focus on that every night instead. For every assignment that your child completes within this period of time, he earns the ability to pick a fun activity after the homework is done.

By increasing the frequency of rewards, you are also increasing your child’s ability to experience success. Kids with ADHD will almost always choose a much smaller reward for much smaller effort now rather than bigger effort over a longer period of time for a bigger reward later. So, we want to use that to our advantage and provide some more frequent feedback about how they are performing.

BPT Strategy #2: Use Timers to Divide Up Long Tasks

Parents can also help improve delay aversion by using timers that chunk work into smaller bits. If the whole homework routine, which lasts an hour, is too painful for your child, set the timer for 10 minutes of active work and then let him take a short break or earn a small piece of a reward for later.

BPT Strategy #3: Pair Short-Term and Long-Term Rewards

Use a combination of short-term and long-term rewards. A short-term reward would be, for example, earning screen time based on performance with the routine you’re targeting. But then to encourage consistency over many days, you can offer longer-term rewards like weekly ones that are delivered on the weekend. If your child met their morning routine goals on four out of the five days, for example, they would have access to XYZ on the weekend.

BPT Strategy #4: Keep Your Goals Fair — and Achievable

When setting up these behavioral programs, the goals must be fair. To do this, use baseline data to set the goals and adjust as needed. If you’re working to decrease the frequency of disrespectful language, for example, the first thing you should do is tally how many times a day you’re hearing disrespectful language before the intervention begins. You need to understand the natural frequency of this so that the goals you’re are setting are fair and within reach.

Why is this important? Because kids with ADHD can spot a fake from a mile away.  So if we tell them, “You can earn this special reward if you are not disrespectful at all today,” they’re going to look at you and say, “No thank you.” If you want them to be motivated right away they have to believe the reward is within reach.

BPT Strategy #5: Make Sure Your Rewards Matter

Don’t guess about what you think might motivate your child. Instead, ask them. You can say something like “Your whole Saturday this Saturday is completely free. You can choose whatever activities that you want to do. What are they?” Keep some notes on that so you a sense of the things that they might be willing to work for in a behavior reward plan.

I also recommend using an award store — a simple stash of various rewards that you switch up every so often. Replace ones that get boring with some new ones. It’s important to make our economy in BPT look like the economy that kids really want to use where they have some choice and flexibility in it.

ADHD Challenge #4: Oppositional Defiant Behavior

The Problem: Children Will Test Limits to Measure Your Resolve

Q: “We are focusing on reinforcing good behavior with positive feedback, but how do we respond to bad behavior when it happens? We can’t just ignore the bad behavior, can we?”

BPT Strategy #1: Use Planned Ignoring

In BPT, praise and rewards are prioritized over punishment. BPT also teaches parents how to use planned ignoring. That’s a fancy way of saying you are going to choose just a few behaviors, not the most severe ones, that you completely ignore. It’s a very effective way of getting kids to stop the annoying behavior, and so all of the programs use that to some degree.

BPT Strategy #2: Dole Out Punishments Sparingly

This is important because too much punishment makes it less likely your child will work with you. They won’t want to replace those negative behaviors with the new ones that we need to see them do. When some form of punishment is warranted, most behavioral parent training programs focus on a timeout or job grounding approach.

• Timeout is what it sounds like: a timeout from positive reinforcement. Depending on the age of your kid, that can be pretty brief — as brief as it takes for them to calm themselves down. Or it could be a little bit longer — total number of minutes based on their age. Again, the goal here is to help kids understand cause and effect. If I do X, Y is what’s coming next. Consistency is important for comprehension. Kids are more likely to understand when they receive a timeout every time the bad behavior happens.
• Job grounding is a method that is effective for older kids. Job grounding essentially is a way of having kids be grounded from the things that they like to do and to instead complete a brief chore.

No matter what punishment you’re using, it needs to meet these four criteria.

1. It must be fair and fit the crime
2. It needs to be mild
3. It needs to be delivered immediately following the undesirable behavior
4. It needs to be consistent

How Can I Find a Good BPT Program?

1. Effectivechildtherapy.org has a list of top-notch referral resources and questions to ask when interviewing a BPT therapist.
   Your pediatrician may also be able to refer you to an effective program.
2. Visit abpp.org to search for board-certified psychologists; that’s a mark of quality and a sign the psychologist is using evidence-based interventions.
3. Russell Barkley’s books about parenting children with ADHD (#CommissionsEarned) are a go-to resource
4. Joel Nigg has an excellent book too called Getting Ahead of ADHD (#CommissionsEarned) that addresses other aspects of parenting kids with ADHD — like the importance of sleep or diet in managing ADHD.
5. The American Academy of Pediatrics has a parenting book about ADHD as well, and a new one coming out soon. And if you’re concerned about using screen time as a reward, the academy also has a really great media planner that I recommend often.

The content for this article came from Carla Counts Allan, Ph.D. webinar “The Best Kind of Discipline: How Behavioral Parent Training Can Transform Your Home Life.” That webinar is available for free replay.

[Download This: ADDitude’s Guide to Better Behavior Through Therapy]

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

Q: “My son is 11, and has trouble falling asleep and then staying asleep. He has generalized anxiety disorder, ADHD, and learning disabilities. He takes melatonin to fall asleep and guanfacine to stay asleep. We limit electronics at night and we read every night. His bedroom is literally right across from ours, and when his anxiety is bad, he sleeps under his mattress, on his floor, and has duct taped the door shut. I have real concerns for his safety. He will seem fine at bed, then in the morning I see he’s stayed up for hours. Lack of sleep exacerbates his other issues. He also wets the bed frequently. He’s in therapy, but all she has said was take everything out of his room and let him sleep on the floor. We have used diffusers, fans, white noise, and a night light. I’m at a loss to help this kid sleep.”

A: “If this behavior is all anxiety based, then your son needs someone who can help him understand and talk to his anxious thoughts. To relieve his anxiety, what you need is…”

WATCH THE VIDEO BELOW FOR THE FULL ANSWER

Ryan Wexelblatt, LCSW is the facilitator of the ADHD Dude Facebook Group and YouTube channel. Ryan specializes in working with males (ages 5-22) who present with ADHD, anxiety with ADHD, and learning differences; he is the one professional in the United States who specializes in teaching social cognitive skills to boys from a male perspective.

Submit your questions about ADHD in boys here!

Behavioral parent training therapists typically lead groups of parents in 8 to 12 weekly sessions, each one of which addresses a specific skill — coaching parents through common scenarios and offering a plan for the application of new parenting techniques. Therapy may take place at home, in an office, online, or even over the phone. Prices vary based on format, frequency, and the availability of one-on-one attention, among other variables.

The most effective BPT programs increase positive parent-child interactions by elevating the quality of attachment, the ability to communicate effectively, and the ability to set and enforce boundaries. The following are several BPT programs popular among families living with attention deficit disorder (ADHD or ADD):

Parent-Child Interaction Therapy (PCIT)

http://www.pcit.org

• Price: Dependent on therapist or practice
• Format: A therapist in an observation room watches parents interact with their child in real time.
• Therapy: Parents wear an ear piece to receive in-the-moment parenting strategies from the therapist.
• Goals:
  • Make your child feel calm, confident, and secure in your relationship
  • Learn how to be confident and calm in the face of your child’s most difficult behaviors
• Duration: Can be completed within 12 to 20 sessions, though treatment is not time limited.

Incredible Years

http://www.incredibleyears.com

• Price: $750 to 1,970
• Format: Trained facilitators use video vignettes to structure content and stimulate discussion.
• Therapy: Incredible Years offers separate programs for parents of toddlers, preschoolers, and school-age children.
• Goals:
  • Strengthen parent-child interactions
  • Foster parents’ ability to promote children’s social and emotional development
  • Reduce school dropout rates and delinquent behaviors
  • Promote academic success
• Duration: 12 to 20 weekly group sessions, each one lasting 2 to 3 hours

Positive Parenting Program (Triple-P)

https://www.triplep-parenting.com/us/triple-p/

• Price: $79.95 for 12 months unlimited access
• Format: This online program is divided into two groups: parents of children aged 12 and under, and parents of children aged 10 to 16 years old.
• Therapy: The programs provide modules — a mix of videos, worksheets, tips and activities — that take 30 to 60 minutes to complete.
• Goals: Build parent confidence, raise happy children, and set discipline guidelines.

Helping the Non-Compliant Child (HNC)

http://www.cebc4cw.org/program/helping-the-noncompliant-child

• Price: around $500 in 2016
• Format: Training sessions for parents and children aged 3 to 8
• Therapy: Skills are taught using active teaching methods, such as extensive demonstration, role play, and real-time practice.
• Goals: Foster positive interaction by
  • Reducing parental coercive behaviors
  • Providing positive attention to the child for appropriate behavior
  • Setting limits and consequences
• Duration: 60- to 90-minute sessions once or twice a week for 8 to 10 weeks

Parent Management Training (PMT)

https://www.parentmanagementtraininginstitute.com

• Price: Sliding scale, call 203-848-7169 for more information about fees
• Format: Parents of children with moderate to severe behavioral difficulties work with a certified trainer online, in person, or over the phone.
• Therapy: Training covers how to effectively deal with anxiety and negative behavior, and how to increase positive behavior from your child.
• Goals: Teach parents how to help their children cultivate positive behavior
• Duration: Weekly 45- to 50-minute sessions. PMT also offers intensive training sessions lasting 2 to 4 hours — in person or over WebEx.

Parent Management Training-Oregon Model (PMT-O)

https://www.generationpmto.org

• Price: Varies depending on location of practice.
• Format: This intervention program is provided to individual families, parent groups, and through telehealth delivery.
• Therapy: The structure of individual training programs differ by location, both nationally and internationally.
• Goals: Promote social skills that reduce delinquency, deviant peer associations, and mood disorders in parents and youths.
• Duration: Training duration varies based on implementation site