Behaviour Modification for ADHD

Introduction

Behaviour modification for children with ADHD is a structured, evidence-based approach focusing on changing the environment and reinforcement to improve functioning. For children under 6 years of age, experts recommend that ADHD be treated with behaviour therapy first, before trying medication. For older children, the best treatment is often a combination of behaviour therapy and medication. But Behaviour therapy is the recommended treatment for ADHD in children under 6 years of age.

Because behaviour modification depends on consistency, it is rarely done by a therapist working alone with a child. Instead, it is a collaboration between the parents, the school, and the therapist. It involves:

Parent Training: Parents learn how to set clear expectations, use effective commands, and provide immediate, consistent consequences. Parent training in behaviour management is used to help change problem behaviours by building parenting skills, improving the relationship between parents and their child with ADHD, and helping children manage their own behaviours. Young children with ADHD often find themselves scolded or punished much more than they are praised, so a clear way to earn positive attention from the most important people in their lives can be a big motivator.

Teacher Interventions include
1. Positive Reinforcement & Rewards: token reward systems
2. Environmental Modification: Create a quiet, clutter-free workspace, limit distractions (TV, devices) during work, and allow movement breaks if it helps focus.
3. School-Based Interventions: Utilize daily report cards to track behaviour (e.g., staying on task, following rules) and provide feedback to parents for home reinforcement.

Key Strategies for ADHD Behaviour Modification

There are a variety of interventions that have been shown to reduce, or have shown promise for reducing, hyperactive behaviour, including:
1. Contingency Management
2. Daily Behaviour Report Cards (DBRC)
3. Functional Behavioural Assessment
4. Parent Training
5. Self-Management
6. Task Modification

Essential Elements of Contingency Management

Contingency management is a type of behavioural therapy in which individuals are ‘reinforced’, or rewarded, for evidence of positive behavioural change.

Contingency management for hyperactivity involves shaping the child’s existing behaviour and providing opportunities for the new, desired behaviour to become internalised. Behavioural intervention strategies such as token economies, point systems, verbal praise, response cost; timeout from peers, reinforcers, attention, or privileges; varying amounts and frequency of teacher attention; verbal reprimands; and removal of praise. The goal of contingency management is to decrease the child’s activity levels that negatively impact learning by reshaping the environment to reinforce or eliminate behaviours.

Key Strategies for ADHD Behaviour Modification

Daily Behaviour Report Cards (DBRC) are used to record a child’s behaviour each day. The goal in implementing a DBRCs strategy is to change behaviour by providing systematic feedback on performance and progress to children and parents, followed by appropriate reinforcement. The result is increased attention (or decreased inattention) during specific tasks and conditions. The teacher selects a goal that can be: to complete the task; not interrupt; stay in the seat. Student gets a check mark or a star for each behaviour; and is rewarded by end of the day.

Functional Behavioural Assessment (FBA) is part of the observation data collected by the therapist with inputs from the teacher. The FBA is best administered by the behaviour therapist or school psychologist.

1. Parent Training: Raising a child with hyperactivity can place a lot of stress on the family. Home is the first and IDEAL place to begin modifying behaviour. Parents may need help from a psychologist or counsellor to learn how to deal with a child who never sits still, has difficulty making friends or struggles with schoolwork.

2. Self-Management is very important for children as they must learn to internalise the skills that have been taught in order to self-regulate independently. Children with ADHD struggle with executive functioning skills, which are – Time management, organisation, and goal setting. Explicit teaching is needed. Students are taught to use checklists and a planner to schedule their projects and meet deadlines. Specific skills like studying, memorising, note-taking, and doing assignments on time can all be addressed.

3. Task Modification: Increase the interest level of an activity to maintain attention. Use visual tasks with hands-on activities.

Creating the Behaviour Plan

Select a behaviour to target. There may be many problematic behaviours, but choose only one behaviour to start.
Define the child’s behaviour in operational terms. For example, instead of saying, “Mohan is hyperactive”, say, “Mohan will remain seated at his desk for 5 minutes during the reading task”.
Identify who will record baseline data on the frequency (i.e., how often) and/or severity (i.e., how much) of the hyperactivity.
Record the length of time the child remains seated, the amount of time the child waits before blurting out an answer, and so on. Consider the child’s preference for reinforcers. For example, if the child enjoys computer games, computer time can be earned or lost. Consider graphing or charting progress, depending on the age, developmental level, and interest of the child.
Once you have all the baseline data, you can set behavioural goals. Typically, the goal would be to increase the amount of time spent on task or decrease the amount of off-task behaviour during a specific interval.
If age appropriate, review the goals with the child or have the child participate in goal setting. Review the rules with the child for providing reinforcers and ensure that the child understands them by asking him or her to repeat them back.

Effective Behaviour Intervention Plan

Use baseline data to create behavioural goals. In the case of hyperactive children, the goal usually is: to increase on-task behaviour or to decrease off-task behaviour.

Token systems are typically more effective once basic behavioural goals have been met, and the tokens can be used to maintain the behaviour.

Provide the reinforcer to the child when he or she meets the goal. Do not provide the reinforcer if the goal is not met.
Previously earned reinforcers, such as tokens, may be taken away when a goal is not met.

Collect and examine data during the use of contingency management. You should expect to see large changes in behaviour in a few days. If you do not, reconsider the implementation. Ensure reinforcement opportunities are consistent and not missed.

Remain aware of the potential for satiation or boredom with a reinforcer, such as filling up on candy or getting tired of listening to music. After consistent effects are established, thin and fade the schedule of reinforcement to become more unpredictable so that the child is not overdependent on rewards to obtain appropriate behaviour.

Implement the Plan

Behaviour modification programs require a lot of investment of time, patience and energy on the part of both schools and parents. RESULTS, HOWEVER, ARE WORTH THE INVESTED TIME and effort.

Video – Behaviour Modification for ADHD

Teacher Resource Document – Behaviour Modification for ADHD