Parent-training programs are a common, well-researched, and efficacious treatment for ADHD. Some examples include Cunningham’s Community Parent Education (COPE), Eyberg’s Parent-Child Interaction Therapy (PCIT), and Barkley’s Parent Training Program. These parent-training programs have all been subject to research and are widely used. The methods and rationales associated with parent training programs are usually very similar: they endeavor to teach parents how to shape their child’s behavior with appropriate behavioral management techniques.
The majority of parent-training programs include psychoeducational sessions. In these sessions, parents are provided with information about ADHD (e.g., prognosis, course, and etiology). These sessions may be supplemented with handouts, books, or videotapes. Providing parents with information about ADHD improves their perceptions of their children and may improve treatment outcomes.
In addition to the general overview of ADHD, parents are also taught the basic principles of behavioral modification. Attending skills are also a critically important component of these programs. Attending skills refer to a process in which the parent listens, provides positive attention, and ignores mild undesirable behaviors exhibited by the child. Frequently these attending skills are practiced in a low-stress, play-based setting. Attending skills represent the cornerstone of behavioral modification; however, by themselves these skills will not effectively shape the target behaviors. Therefore, parent training focuses on several other aspects of parenting. Often parents are required to completely change the manner by which they interact with their children. This is because many parents appear to overfocus on undesirable behaviors and neglect to acknowledge when desirable behaviors occur. Parent training teaches parents to listen more effectively, shift the focus of attention from undesirable to desirable behavior, consider developmental variables, and issue frequent positive reinforcement.
The success or lack thereof associated with any parenting intervention is predicated upon the quality of the parent-child relationship. Parents are often encouraged to examine the quality of the relationship they have with their children and to identify conditions that negatively impact their relationship. Parents begin to explore the relationship between their children’s behavior problems and their own reactions when the children misbehave. For example, a parent may unintentionally reinforce an undesirable behavior; this often occurs when parents attend primarily to undesirable behavior and overutilize punishment. During this critically important phase, ineffective parenting practices are identified and replaced with more efficacious methods.
Skilled use of reinforcement is quintessential to successful behavioral change. There are several prerequisites to the implementation of a reinforcement system. First, the parent must identify, define, and communicate behaviors in clear, specific, and measurable terms. Furthermore, whenever possible, the goals should be articulated with positive language and focus on the behavior that the child will exhibit, rather than what the child will cease to exhibit. A special type of reinforcement is praise. Parents learn that if they want to modify their child’s behavior through praise, they should use specific-labeled praise. This means the parent makes sure that the child knows exactly why he or she is being praised. So instead of saying “You’re a big boy,” the parent learns to say, “You got up and got dressed all by yourself. Thank you for helping. You are such a big boy.”
The second technique, punishment, must be implemented judiciously, and parents should always remember that reinforcement results in more enduring behavior change. In parent training (and behavior modification programs), a specific form of punishment called response cost is also used to shape behavior. Response cost refers to the removal of some privilege when the child exhibits an unwanted behavior. So, a child may lose his or her video game privileges for the evening if he or she chooses to neglect the dishes. Again, it is critically important that parents implement punishment strategies with caution. Unfortunately, if parents want to stop a behavior quickly, the use of punishment is the fastest way to do so, but that change tends to be short-lived. Long-term behavior change occurs best with reinforcement.
Another effective behavioral intervention, time-out, is conceptually similar to response cost. While response cost results in the removal of a privilege, time-out results in the removal of positive reinforcement. Like response cost, time-outs should be utilized sparingly. Some researchers suggest that time-outs be limited to as few as two predetermined noncompliance behaviors. Similarly, the location and amount of time spent in timeout for a given offense should be predetermined. Children should be required to correct the behavior that actuated the time-out; in addition, the child should be rewarded for positive behavior. While a common rule of thumb for the length of time to keep a child in time-out is 1 minute for each year of age, research suggests that time-out achieves maximal impact for children in 3 to 5 minutes, regardless of their age.
The token economy represents another popular technique, which utilizes both reinforcement and response cost. As with the other techniques, the focus of the token economy should be on positive behavior
A complete explanation of the token economy would exceed the scope of this entry, so only basic principles will be addressed.
Token economies are often used when the child requires frequent reinforcement. A list of target behaviors—following the guidelines relative to positive reinforcement—is generated. These behaviors should be clear, concrete, and measurable. Next, parents, teachers, or helping professionals issue tokens (usually plastic chips) or points (recorded in a notebook or calendar) when the child exhibits desirable behavior. The tokens or points are taken away when the child engages in undesirable behaviors. After a predetermined period of time, the child is allowed to exchange tokens or points for a privilege (e.g., extra time playing video games) or some other reinforcing product (e.g., comic book, candy bar).
Mr. Bobby L Porter, Founder-CEO BLP2 Family Network Center for Disabilities
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