Disciplining a Child With ADHD

What parents need to know about effective child discipline for children with ADHD.


RaeLyn Murphy of Milwaukee called her firstborn son Josh "Houdini."

"He could outwit any childproof lock," she recalls. "When he was 4, he got the door open in his day-care center and told all the kids, ‘Come on, we're free, let's go!'"

His behavior, combined with a strong family history of attention deficit disorders, led specialists to diagnose Josh with ADHD at age 4 in 1990.

And Murphy spent most of Josh's childhood trying to develop the right kind of discipline strategy for him -- one that would be effective for a child with ADHD and also fair toward her younger two children.

Extra Tactics

Should parents use different tactics to discipline a child with ADHD? Surprisingly, the answer is no, says Steven L. Pastyrnak, PhD, division chief of pediatric psychology at the Helen DeVos Children's Hospital in Michigan.

"ADHD is a challenge, not necessarily an excuse for kids," he says. "We need to be more aware of how the ADHD impacts their ability to listen, follow through on tasks, and control their impulses. However, having ADHD does not take away the expectation that they will improve in these areas."

That doesn't mean that parents might not have to be a little more flexible in their expectations of a child with ADHD. "Kids with ADHD are more likely to struggle with what they hear and process in the moment and what they remember even a few moments later," Pastyrnak says. "These are the types of kids who can remember details of a family vacation from many years ago but forget to pick up their socks just a few seconds after they were told. Broken plates, hungry pets, and lost homework is common and even to be expected with kids (or adults) with ADHD."

So parents shouldn't necessarily use different approaches with a child who has ADHD. Instead, they should just understand that a disciplinary lesson that may take a child who doesn't have ADHD 10 repetitions to learn may take 20, or 30, or 50 for a child who has ADHD.

"Where discipline also tends to differ is in the frequency and consistency needed for kids with ADHD," Pastyrnak says. "I sometimes tell parents that parenting a child with ADHD is like parenting a child times five."

 

Does Time-out Work?

Murphy eventually gave up on using time-outs with Josh. "I'd put him down, he'd get up," she says. "I'd put him down again, he'd get up again -- over and over. I'd get angry and then we were battling over putting him in time-out, and neither one of us could remember why he'd gone in time-out in the first place."

Carla Counts Allan, PhD, director of psychological services at the ADHD Specialty Clinic at Children's Mercy Hospitals and Clinics in Kansas City, Mo., outlines a time-out strategy that she says works effectively with all kids -- whether or not they have ADHD -- when used consistently.

•     Contrast time-out with time-in. That means that if you put your child in time-out for hitting his sister, you should have been praising him earlier for playing well with his sister, and should praise him afterward for having a good attitude. "If there isn't a big difference between time-out and time-in, kids don't understand the consequences," Allan says.

•     Keep time-outs brief and consistent with the infraction. "Long time-outs can start a battle of wills," she says. "For younger children, 1-2 minutes is plenty. A minute per year of age is more an upper limit for time-out, but for preschoolers, sometimes a 30-second or one-minute time-out is plenty if they show me quiet feet, quiet hands, and quiet mouth."

•     Remain calm. If you tell the child to go to time-out and he ignores you, add one minute to his time-out. If he doesn't go again, add another minute. But if he ignores you a third time, don't pick him up and drag him to time-out -- that just escalates things. "Instead, impose a consequence that means a lot, such as no video games for the rest of the day," Allan says. "Deliver that consequence calmly and don't talk about it further. Even if he says, ‘I'll listen, I'll go into time-out now,' don't give in then!"

•     Practice time-outs. Ask your child to pretend that he hit his sister, and that he is sent to time-out. "'If you go willingly when I tell you to, you earn a point on a behavior chart and earn privileges,'" she says. "Have them practice going to time-out without putting up a fight."

Practice Makes a Little Closer to Perfect

Practicing time-outs goes along with another general discipline strategy for kids with ADHD (or any child): teaching them the skills they need to succeed before they have a problem.

For example, all kids need some sort of a schedule or guidance to help them keep up with chores, homework, and other expectations. Kids with ADHD, Pastyrnak says, can't be expected to "just get it" from verbal instructions. Instead, they often respond better to a visual schedule that they can follow.

Reward systems work well for kids with ADHD, but they too may need to be tweaked slightly. "For example, one expectation might be to play appropriately with his sister," says Mark Bertin, MD, a developmental pediatrician and assistant professor of pediatrics at New York Medical College and the author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child's Attention and Minimizing Parental Stress.

"It's probably not realistic to set that expectation for an entire day," Bertin says. "If they mess up in the morning, you've lost the whole day."

Instead, break the day up into thirds and grant points for good behavior in the morning, the afternoon, and the evening.

 

Adjust Expectations

You can't change everything at once in children with ADHD, Bertin says.

"Choose a few big things that you want to work on, and put other things aside for now. Don't wrestle as much with the stuff you're not working on yet."

That was something Murphy learned. "You need to pick your battles -- but when you do pick one, stay with it and be consistent."

She developed a four-point strategy she called CARE, which echoes much of what ADHD experts say about disciplining such children:

1. Clear away distractions and things that cause inappropriate behaviors.

2. Allow your child to choose an appropriate activity.

3. Redirect into a more appropriate activity when things are not running smoothly. Offer them something they can do, rather than just telling them what they can't do. For instance, "You can't hit your sister, but you can whack these pillows."

4. Exit. When things are out of hand and you know you can't do anything but fight an uphill battle -- get out. Go to the park or to an indoor play center. Don't fight with your children.

It seemed to work with Josh, who's now a successful and happy 25-year-old. "I focus on positive parenting," says Murphy, who wrote a book, Gifted With ADD, about what she's learned. "If he knows you're on his side most of the time, when you pick the battle, he knows there's a problem."

 

 

Gina Shaw - WebMD