During the school year, a key component of behavioral parent training (BPT) is the daily report card. Early in the school year, the parents and teacher decide on certain behaviors that they want to see improved, behaviors that if changed would lessen the child’s problems in daily life. The behaviors might involve:
- Peer relations. Goals might include not interrupting other children, not teasing other children, or not fighting at recess.
- Academic work. Goals might include having all materials necessary to do tasks or completing assigned tasks and/or homework on time.
- Relationships with adults. Goals might include obeying the teacher’s directions, not talking back to the teacher, or following classroom rules.
The results you can expect
Could behavioral parent therapy be what your child needs to improve his symptoms? The answer depends on several factors, including the severity of your child’s symptoms, your own commitment to the training, and the consistency with which the rules and skills learned are implemented at home and in school. Some children need more behavior therapy, or the addition of medication, to see improvement in behavior. Studies have shown that children who have behavior therapy first can often get by on a lower dose of medication.
Your child’s behavior may get worse before it gets better. Psychologists call this phenomenon an “extinction burst.”
As your children start to realize that you are giving more attention to positive behaviors, they will shift from negative actions to positive ones. That’s the magic of behavioral parent training, and it often results in better communication and a happier parent-child relationship.
“Taking medication can produce results in 30 minutes, but the behavior returns when the medication wears off,” says William Pelham, Ph.D., chair of the Department of Psychology and director of the Center for Children and Families. “Behavior therapy is a learning process that takes time and effort, but it pays off with changes that last a lifetime. You would never hear a first-grade teacher say, “I’m going to teach everyone in the class to read in one day,’ nor can you change behavior in one day. You start small and build, but most parents find that the results are worth it.”
Medication or BPT: Which should you try first?
About 75 percent of American children diagnosed with ADHD are treated with medication and nothing else, according to the Centers for Disease Control and Prevention (CDC), even though several health organizations, including the American Academy of Pediatrics (AAP), have recommended behavior therapy as the first line of treatment for all children diagnosed with ADHD who are under age six. In children age six and older, the guidelines say that either behavior therapy or medication alone can be helpful in treating ADHD, and a combination of treatments may be best.
New research indicates that for all children with ADHD – including those age six and older – starting treatment with BPT is the best strategy. In the study, FIU researchers found that if medication, instead of BPT, is tried first and fails, it becomes much harder to treat ADHD successfully – because increasing the dose of medicine does not appear to work, and BPT is less effective when medication has been tried first.
“Parents are less committed to parent training once their kids show some improvement from medication,” says Pelham. “Medication produces a quick response, and parents are less motivated to go through the work of BPT once some symptoms improve. Increasing the dose of medication is a common strategy among doctors today, but our study showed that it doesn’t work to improve behavior in most kids. The message for parents is clear: tell your child’s doctor you want to start with behavioral parent therapy.”
Six tips for finding a BPT program that works for you.
Start by asking your pediatrician for a referral. If there is a local teaching hospital near you, call them to see if they offer behavior therapy and parent training. You can also look to ADHD parent support groups in your area for referrals.
Here are points to consider:
- Talk to the program coordinator or doctor. “If they don’t use the word ‘behavioral’ in describing the therapy, don’t go there,” says Pelham. “Other types of therapy have not been shown to be helpful for ADHD. You want a behavioral therapy program.”
- Make sure the program curriculum is “evidence-based.” This means that scientific studies have shown that the type of therapy and parent training being offered works to treat ADHD.
- Consider your child’s age. “Parent-child interaction therapy is best for kids up through six years old,” says Matthew Rouse, Ph.D., of the Child Mind Institute. “If you have an eight-year-old child, you might use parent management training or The Incredible Years or Positive Parenting Program.”
- Decide if you want to be part of a group or have one-on-one training. BPT in groups gives you the advantage of hearing different perspectives, and sometimes the best tips you get are from other parents. One-on-one training with a therapist allows you to work on the specific challenges that affect your child.
- Consider your schedule. For parent training to work, you must go to the sessions, and that’s more likely to happen if you can get there easily.
- Find out the cost. Check with your insurance company to see what they cover. Ask if the program offers any financial aid; some do. Remember that, while BPT costs may seem higher, recent research shows that, in the long run, they cost less and the benefits last longer than other therapies.
Read the ADDitude article for the full story.