Behavior charts for adhd

Contents

Setting Up a Behavior Management Plan for an ADHD Child

Children who have been diagnosed with ADHD are at a much higher risk of developing noncompliant or negative behaviors than a child who does not have ADHD.

The very nature of ADHD implies that the child will have difficulty with self-control, paying attention, listening to instructions at home and school, and following directions. Some children seem to be predisposed to develop behavior problems by their temperament; however, the symptoms of ADHD—including hyperactivity, impulsivity, or inattention—seem to exacerbate these negative behaviors. Managing these negative behaviors often becomes a full-time job for parents.

Treatment for the ADHD child usually requires a comprehensive approach. It includes school support, medications if needed, parent/child education regarding ADHD and its treatment, and behavioral management techniques. Managing the negative behaviors of a child with ADHD often seems like an overwhelming and daunting task; however, such behaviors can be managed effectively with a good plan in place.

Behavior modification rewards positive behaviors and aims to decrease negative ones.

Setting Up a Behavior Modification Plan

  1. Choose a negative behavior that you want to change and a positive behavior that you would like to see start or continue. Start by choosing a behavior that your child can begin to work on immediately and that he or she realistically will be able to change. It is not very motivating for children to fail in their initial attempts. Your child will want to give up right away.

    Make sure you set specific goals. For example, you would like to see your child make the bed each day, unload the dishwasher, come to dinner on time, or get an A in math. You would like to see your child stop refusing to get out of bed in the morning, interrupting when others are speaking, refusing to complete homework, or talking back.

  2. Set up a Home Token Economy to implement your behavior management plan. A token economy is simply a contract between the child and parents. It states that if a child acts or behaves in a certain way, the parents will agree to trade tokens for a particular reward or privilege.

In setting up a token economy, focus on only a few goals at a time. Your behavior plan can be as short or as long as you want; however, I have found that more complicated plans are less likely to succeed.

Allow your child to be involved in setting up the behavior plan but don’t let yourself be manipulated. Make sure you are firm and clear regarding the behaviors you want to see started and stopped. When a child becomes part of the plan and is able to pick the rewards and the consequences he or she usually will work harder to achieve it.

For the plan to work, token values need to be high enough to be motivational. Assign each behavior a value between 1 and 25. The behaviors you really want to see changed are those that have a higher token value—and also are those that are more difficult to change. For example, you might assign a value of 5 to making the bed each morning, 10 to unloading the dishwasher, and 20 to getting out of bed on time. You would subtract tokens for negative behaviors such as interrupting others, refusing to do homework and getting poor grades.

The behavior plan is to be implemented each day. Set up a convenient time to review your child’s performance and determine how many tokens have been earned or lost. Keep a running tab on the total number of tokens and how many have been “cashed in” for privileges or rewards.

After you set up a token economy program, explain the program to your child in language he or she can understand. Be positive and tell them that you have developed a program where he or she can earn rewards or privileges for behaving in a positive way. They will probably balk at this at first—after all, they have been receiving rewards all along that they really did not have to earn.

Go over with your child the number of tokens to be given or lost for positive and negative behaviors and tell them it will be tallied each day. Explain that the tokens can be “cashed in” for privileges and explain the “cost” of each privilege and when and where the rewards or privileges can be used. Give frequent opportunities to exchange the tokens for rewards or privileges.

Rewards or privileges that I have found to be effective with children and adolescents when I have set up a behavioral plan with them and their parents are:

  • seeing a movie
  • going for ice cream
  • going to McDonald’s
  • getting to buy a new outfit
  • having friends come over
  • going out with friends
  • more time to watch television
  • more time playing video games.

The number of tokens required to receive a particular reward should vary with the reward’s importance. For example, sleeping over at a friend’s house might cost 35 tokens, whereas going to McDonald’s might cost 10 tokens. Keep the costs of the rewards low so that the child can use a reward each day.

Make sure you reinforce positive behaviors immediately. Don’t give second or third chances. Negative behaviors should result in the loss of tokens. If you give second or third chances you are weakening the behavior plan and are sabotaging yourself.

How to Keep the Program Going

  • Make sure the child is able to see their progress.
  • Modify the behavior plan if you see that your child is not meeting any of the goals. Discuss the plan with your child.
  • Educate the entire family. Answer everyone’s questions. If everyone in the family is educated about ADHD and they understand the goals, everyone is more likely to cooperate. Everyone needs to be on board. ADHD is an issue for the entire family
  • Have a backup plan if the behavior plan is not working. If goals are not being met then rework the plan.
  • Expect to achieve your goals. A positive attitude goes a long way toward achieving success.
  • If you feel ready to give up on the behavior plan, obtain outside support from mental health professionals, family, friends, and teachers. Get everyone on board with you. Nobody expects you to do this alone.
  • Approach the problem from a team perspective. Brainstorm, brainstorm, brainstorm. Everyone in the family should be involved in keeping this going. The old expression, “two heads are better than one” definitely applies here.
  • Target the most pressing problems. Avoid trying to fix too many things. You will get bogged down that way.
  • Remain consistent and do not yell.

Avoid Backsliding

There is no surer way to backslide than to get into prolonged arguments and discussions with your child over the behavior plan. Of course they are going to want to change or get rid of the behavior plan. Anything new or different usually is met with resistance.

  • Accept that your child has ADHD. It is not the end of the world. If you remain positive and calm, your child will have a much easier time changing his or her behavior. Maintain perspective.
  • Get support from everyone you can. Join a support group in your community or an online forum for parents.
  • Keep your goals in sight. Remember tomorrow is a new day and the sun will still shine. Nothing lasts forever.
  • Educate yourself about ADHD and read whenever you can. Ignorance is not bliss.
  • Practice forgiveness. Double your efforts when you feel like giving up.
  • Give the plan time to work. Remember that change takes time if it’s to be long-lasting. Nothing happens overnight.

Kara T. Tamanini is a licensed therapist who works with children and adolescents with a variety of mental disorders. Visit her website at www.kidsawarenessseries.com

Setting Up a Behavior Management Plan for an ADHD Child

Whether the child is a preschooler or a high schooler, attention deficit hyperactivity disorder (ADHD) can present some significant behavioral challenges at home and at school. Recent research shows that behavior charts offer a great resource for kids, parents, and teachers managing the symptoms of ADHD. These free printable behavior charts for kids are designed specifically to target age-appropriate goals for students with ADHD.

Kids’ Behavior Chart for Preschoolers With ADHD

For many children with ADHD, preschool offers the first opportunity for diagnosis. According to WebMD, the beginning of school routines, such as circle time, reading stories, and structured craft projects, sometimes highlight the learning differences and challenges faced by children with ADHD. Additionally, peer interactions and greater social demands may make it more difficult for children to control impulsive outbursts.

If you need help downloading the printable behavior chart template, check out these helpful tips.

Keeping It Simple

Charts can be a great way to encourage proper home and classroom behavior, but it’s important not to overwhelm young children with too many goals. This printable behavior chart for preschoolers includes only three desired behaviors:

  • “I played quietly or listened to a story.”
  • “I controlled my temper.”
  • “I did a good job listening.”

How to Use the ADHD Chart

Follow these steps to use this free printable chart in the preschool classroom or at home:

  1. Print out the chart in color. The pictures will help the child stay focused.
  2. Clearly label the child’s reward. It may also help to include a picture of the reward. Be sure to set a goal for the number of stickers required to receive the reward.
  3. For each day of the week, give the child a sticker if he or she has demonstrated the desired behavior. Provide verbal praise too.
  4. At the end of the week, check whether the child has received the appropriate number of stickers. If the child has received enough stickers, present the goal.

Free Printable Behavior Charts for Elementary Students With ADHD

When children with ADHD are in elementary school, they may exhibit a variety of ADHD symptoms, including difficulty attending and listening, frequently losing things, difficulty remaining seated or refraining from fidgeting, talking excessively and frequently interrupting other people, difficulty completing tasks, and problems controlling impulses.

Addressing Major Concerns

Since elementary-aged children are still learning to read and understand higher-level concepts, it’s best to keep behavior charts simple. This printable behavior chart for elementary-aged students with ADHD has five goals, each paired with a picture for non-readers:

How to Use the Chart

Behavior charts are easy to use. Follow these simple steps:

  1. Print out the free chart using a color printer.
  2. Discuss the reward with the child, and write it in the blank provided. Attach a photo or drawing of the reward for non-readers.
  3. Clearly communicate how many stickers the child will need to attain his or her goal.
  4. Reward the child with a sticker if he or she has demonstrated the desired behavior on a given day.
  5. Count up the stickers together at the end of the week. If the child has enough stickers, he or she receives the reward. If not, discuss how the behavior needs to change.

ADHD Behavior Charts for Middle and High School Students

The American Academy of Child and Adolescent Psychiatry reports that some children who were previously diagnosed with ADHD may no longer require treatment by late adolescence or adulthood. If they have not yet outgrown the diagnosis, these teens may show signs of disorganization, inattention, impulsiveness, and over activity. Additionally, some middle and high school students with ADHD struggle with controlling their tempers and behaving in an appropriate manner.

Raising Expectations

At this age, kids are capable of more abstract thought than they are at earlier grade levels, so charts no longer need to include pictures. Additionally, these kids are nearing adulthood and are learning to handle greater expectations regarding their behavior.

This printable behavior chart includes the following age-appropriate goals:

Using a behavior chart with an adolescent struggling with ADHD requires consistency and follow-through. Use these steps to find success:

  1. Print out the free chart. You’ll need one chart for each week.
  2. Discuss the reward with the teen, and write it in the blank provided.
  3. Clearly communicate how many check marks the student will need to attain his or her goal.
  4. At the end of each day, sit down with the student and assess whether he or she met the goals. If the teen met the goals, place a check mark or sticker in the box.
  5. Count up the stickers or check marks together at the end of the week. If the teen has enough stickers, he or she receives the reward. If not, discuss how the behavior needs to change for the next week.

Things to Keep in Mind

When using behavior charts with kids who have ADHD, keep the following tips in mind:

  • Keep it simple. A chart that is too wordy may be difficult for your child to follow.
  • Decide on a reward. Choose a reward that is motivating.
  • Keep it positive. For the greatest success, the goals on the behavior chart need to be phrased in a positive manner. Stay way from words like “doesn’t” or “not.”
  • Be consistent. Consistency is the key to the success of using behavior charts. If you expect the child to follow through, you need to follow through as well.
  • Expect some push-back. Keep in mind that your child may really test you when you first begin using the behavior charts. However, the positive nature of these charts will soon win out.
  • Keep it age-appropriate. Make sure your expectations are reasonable and that you’re using a chart that’s appropriate for the child’s developmental level.

Charts Are Effective

Research suggests that behavior charts can be one of the most effective methods for handling some of the disruptive or unproductive behaviors associated with ADHD. Several recent scholarly articles and studies have shown that behavior charts are effective in extending kids’ attention spans and reducing disruptive behavior:

  • A study published by the Association for Behavior Analysis International tested the efficacy of behavior charts in managing disruptive activity in ADHD children in four classrooms. The results indicated that the charts offered a significant improvement over traditional behavior modification methods.
  • According to a study published in the Journal of Applied Behavior Analysis, behavior charts can effectively extend the amount of time a child can pay attention in the classroom setting.

Because these charts focus on the positive and are age-appropriate, children feel successful and encouraged. What’s more, controlling challenging behaviors helps ADHD students improve social and family relationships, as well as academic performance.

ADHD Weekly 2017-12-14

Join the discussion.

If your child with ADHD has become more angry or aggressive, or refuses to comply with rules and requests, you may be concerned. These behaviors may signal the emergence of a Disruptive Behavior Disorder (DBD) such as Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD), which have high rates of co-occurrence with ADHD: From 45 percent to 84 percent of children with ADHD will meet full diagnostic criteria for ODD with or without CD. In studies of clinically referred adults with ADHD, 43 percent had a lifetime history of ODD.

Because longitudinal studies have shown that DBD can lead to substance abuse or criminality, it is important to intervene early, before negative behaviors and attitudes―your child’s as well as yours and your family’s toward him or her―become firmly entrenched. The family tensions caused by a child’s disruptive behavior can create an escalating dynamic of negative behaviors; research has shown a strong link between maladaptive parenting and DBD.

What can you do?

A recent evidence-based review of treatment approaches for children with DBD conducted by researchers Jennifer Kaminski and Angelika Claussen of the Centers for Disease Control (CDC) identified six treatment method types for DBD, which in practice have been delivered under various conditions and combinations (“treatment families”). The review then ranks these treatment families into five levels of effectiveness, using a rigorous model for assessing evidence.

The results of this review can help you and your doctor find appropriate treatment, because it identifies the types of treatment―and their characteristics―that are most effective, rather than focusing on name-brands that may not be found in your location.

Understanding DBD

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), children with ODD show a pattern of developmentally inappropriate, negative, aggressive, and defiant behavior. The signs of ODD include both emotional and behavioral symptoms that persist for six months or longer:

  • Angry and irritable mood: Loses temper, is touchy or easily annoyed, or is angry and resentful
  • Argumentative and defiant behavior: Argues with adults or people in authority, actively defies or refuses to comply with adults’ requests or rules, deliberately annoys people, or blames others for his/her mistakes or misbehavior
  • Vindictiveness: Is spiteful or vindictive

CD occurs at a little later age than ODD. Approximately 30 percent of children diagnosed with ODD are later diagnosed with CD, which has a more targeted set of behaviors that consistently ignore the basic rights of others and violate social norms and rules. About 40 percent of children diagnosed with CD go on to have antisocial personality or other personality disorders. The signs and symptoms of Conduct Disorder include serious, persistent behavior problems, such as:

  • Aggression toward people and animals
  • Destruction of property
  • Deceitfulness
  • Theft
  • Serious violation of rules

Data from a 2007-2008 National Study of Children’s Health found the prevalence of DBD to be:

  • 4.6 percent (2.8 million) of children had a history of DBD
  • 3.5 percent (2.2 million) of children currently had a DBD

Those figures do not include undiagnosed cases.

The most recent National Survey of Children’s Health data from 2016 have recently been publicly released, with publications from CDC and Health Resources and Services Administration expected soon, documenting the prevalence of behavioral disorders co-occurring with ADHD.

Types of treatment for disruptive behaviors

The six types of treatment approaches identified in the review, which can be conducted in different settings or conditions, are:

  • Parent behavior therapy: In groups, individually with or without child participation, or via self-directed methods
  • Teaches the parent(s) to be more effective behavioral reinforcers

  • Focuses on strengthening the parent–child relationship so child is more motivated to behave in the way that the parent wants, and provides parents with more effective child behavior management strategies, e.g.:
  • setting and clearly communicating developmentally appropriate limits and rules,
  • selecting and enforcing effective consequences for difficult behaviors,
  • preventing misbehavior
  • Based on social learning principles: Applying or withholding positive reinforcement increases the child’s socially acceptable behaviors and decreases aggressive and oppositional behaviors.
  • Relationship-enhancing strategies
  • providing the child with positive attention
  • engaging in joint activities
  • communication skills that convey to the child that the parent understands and wants to provide for the child’s needs
  • Child behavior therapy: In groups or individually with or without parent participation
  • Therapist interacts directly with the child to teach appropriate social skills.
  • Cognitive behavioral techniques to help the child
  • identify and understand their emotions and behavioral triggers,
  • evaluate ambiguous or threatening social situations, and
  • select appropriate behavioral responses.
  • Based on social learning principles and positive reinforcement
  • Therapists may use modeling, role-plays, and behavior charts (with or without a token reward system) to teach and reinforce
  • child behaviors,
  • emotion regulation (e.g., relaxation, anger management),
  • perspective taking,
  • conflict resolution,
  • how to make friends or enter peer group activities.
  • Parent-focused therapy: In groups, individually with or without child participation
  • “Focus on parents’ emotions, attitudes, or boundaries.
  • “Client-centered” or “Emotion-focused;” targets parents’:
  • emotion awareness and regulation,
  • attitudes and perceptions about their child
  • Addresses the underlying emotional or psychological issues within the parent,
  • which translates into more positive parenting and fewer child behavior problems.
  • Specific skills taught could include:
  • emotion,
  • regulation (e.g., relaxation, anger management),
  • perspective taking,
  • empathy,
  • knowledge of and attitudes about children’s behavior.
  • Some parent-focused programs target dysfunctional family processes and structures
  • reestablish boundaries that were either too rigid or too enmeshed.
  • Child-centered play therapy: In groups or individually
  • Therapist goal is to provide:
  • close, supportive relationship for the child,
  • nondirective positive regard, warmth, and empathy,
  • help for the child to express feelings,
  • a “safe” space for the child to explore and work through negative emotions.
  • Consistently provide nurturing relationship to naturally improve child’s behavior
  • Nonbehavioral child therapy; typically doesn’t involve the parent(s)
  • Teacher Training
  • Follows behavioral principles, focused on
  • classroom/group behavior management strategies
  • making the teacher a more effective reinforcer of children’s behavior.
  • Classroom behavior management strategies can include
  • visual cues to children about their behavior (e.g., token reward systems)
  • preventive strategies (e.g., providing children with forewarnings before activity transitions).
  • May include help to teach social problem-solving skills directly to children.
  • Family problem-solving training
  • Engages the parent(s), child, and siblings in a problem-solving process to:
  • build the family’s ability to collaboratively resolve issues resulting from oppositional behavior.
  • Teaches the family how to:
  • identify unsolved problems contributing to oppositional behavior,
  • prioritize which problems most need addressing,
  • collaboratively resolve the problems.

What works?

We interviewed Steve Lee, PhD, a professor in UCLA’s Department of Psychology, who participated with Dr. Kaminski in a webinar on DBD. Dr. Lee is a member of CHADD’s Professional Advisory Board with expertise in ADHD. Dr. Lee noted that the behavioral symptom link between ADHD and DBD lies in the lack of self-regulation, which in ADHD results from impaired executive function and in DBD enables disruptive behaviors. He concurred with Dr. Kaminski on the critical importance of acting early to get a professional diagnosis when symptoms of DBD appear and persist for six months or more. He emphasized the risk of maladaptive family dynamics developing if not addressed early, and that once those dynamics take hold, they tend to cascade or snowball. It is then harder and takes longer for therapy to reverse those behaviors.

The combination of ADHD co-occurring with DBD presents challenges for clinicians, both in diagnosis as well as in treatment. Dr. Lee notes that it’s a non-additive combination: A child who is distractible and disorganized has more difficulty learning new habits. He also notes another challenge: “Hostile attribution biases,” which develop from early experiences of maltreatment or victimization. Such bias causes the child to assume negative intentions in others’ actions, which then prompts aggressive reactions in the child.

The types of therapy addressed in the CDC review are critical for successfully treating disruptive behaviors. But Dr. Lee cautions, “It will get worse during therapy before it gets better.” That’s because your child won’t know how to deal with the new conditions in the family, even though those conditions are more positive. Your child has developed his behaviors, reactions and interactions within the context of prior family and parenting dynamics, and will not be able to immediately adjust to the new reality of positive parenting. He may “test” you, trying to recreate the prior conditions in which he understood what to expect. He’ll need time to develop trust in the “new normal,” to learn new ways of behaving, and to develop new expectations and understandings of others.

“Don’t pull out of therapy. If you stop therapy too early,” Dr. Lee said, “you will communicate to your child that he isn’t worth the effort, that he is a hopeless case.”

More help for you:

The review by Dr. Kaminski and Dr. Claussen focused on children. For a review of evidence-based treatment for adolescent DBD, see Evidence-Based Psychosocial Treatments for Adolescents With Disruptive Behavior.

For a review of evidence-based treatments for ADHD, see Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder.

How have you been able to help your child who is struggling with behavioral issues?

Your child can sometimes be difficult, particularly when the impulsivity of his ADHD takes over. But lately he has been out of control—angry, irritable, argumentative, defiant. What’s going on, and what can you do about it?

Other Articles in this Edition

Disruptive Behavior in Children with ADHD

Could White Noise Help You Stay On Task?

Medication Chart for ADHD is Now Available

10 ADHD Behavior Management Strategies

Behavior management, also called behavior modification, can make parenting a child with attention deficit hyperactivity disorder (ADHD) a little easier. This approach to ADHD treatment involves rewarding and praising your child’s good behavior and discouraging unwanted or impulsive behavior with appropriate consequences.

The concept of behavior management is easy to understand, but it can be difficult for parents to implement, says Betsy Davenport, PhD, a clinical psychologist who specializes in ADHD and is in private practice in Portland, Ore. “Often parents don’t follow through.”

Here are 10 tips to establish and carry out a successful behavior management plan to help your child:

  • Define the house rules. Children with ADHD need simple rules for behavior. Define your house rules and write them down. If your child can read, post them where he or she will see them, such as on the refrigerator or over the bathroom sink. If your child is too young to read, use pictures or drawings to illustrate the house rules. Explain clearly what will happen when the rules are obeyed and when they are not. You might need to go over the rules again prior to an activity or event.
  • Give immediate rewards and consequences. Children with ADHD need more immediate feedback for their good behavior, as well as their unwanted behavior, than other children. Children without ADHD may learn from praise for their good behavior long after it occurs. “When your child has ADHD, the moment the good behavior you’re looking for occurs, you have to acknowledge it and do what you said you would when it does,” Davenport says. “Don’t expect your child with ADHD to be able to delay gratification.” The same is true for negative consequences, which can include time out, removal of privileges and removing your child from the situation.
  • Provide frequent feedback. Children with ADHD require feedback for their behavior more often than other children do, Davenport says. A good way for you to remember is to set an alarm to go off every 20 to 30 minutes. Then when it goes off, check on your child. If he is behaving well, praise or reward him exactly as promised. If not, apply the consequences you previously discussed with your child.
  • Be consistent. Consistency is key to getting an ADHD child to change negative behaviors to more positive or productive ones, Davenport says. You need to react the same way every time your child behaves in a way that you like or dislike. Also, she says, be persistent. You may want immediate results, but that’s not likely. It can take months to see significant progress.
  • Establish routines. “Kids with ADHD are terribly bored by routines, but they need them desperately,” Davenport says. Establish everyday routines for getting ready for school, doing homework, and going to bed. A routine doesn’t mean that everything has to happen at exactly the same time every day, Davenport notes. For example, your child may sleep later during the summer. But things still need to be scheduled in the same order. For instance, your child should brush her teeth before coming down for breakfast.
  • Create checklists. One way of getting your child to follow a routine is to create a checklist and mark off the steps as they are completed. “For children who are even mildly literate, I have them make their own lists,” Davenport says. For younger children, you might use pictures, such as someone brushing her teeth. “Kids like that a lot,” she adds. Checklists are helpful, Davenport says, because parents can say: “What’s next on your list?” That’s more effective for a child with ADHD than: “Go do this.”
  • Set clocks and timers. If your child has ADHD, placing clocks with alarms throughout the house may help. Then, establish times for key activities — when your child will have dinner, start homework, catch the school bus, stop watching TV, and get ready for bed — and set an alarm to signal each one. That way you don’t have to stand over your child and nag. Also, you’re clear and consistent about your child’s schedule, rather than saying, “We’ll do this in a few minutes.”
  • Create a reward system. Many times you can manage the behavior of children with ADHD with tokens, stickers, or gold stars, which the child can trade for a special reward. “Reward systems can work if the child is on board with earning them for certain behaviors,” Davenport says. However, Davenport prefers praise and acknowledgment to prizes. “If you thank your child for clearing the table and tell him how proud you are of him for doing such a good job, that’s way more powerful to him because he cares about you,” she says.
  • Focus on the positive. Emphasize the things that your child does right. For example, if she is given a multi-part task, say “good job” when she’s completed the first part. Focusing on the positive, rather than berating her for not finishing the entire task, is more effective for a child with ADHD. This helps build confidence in her abilities. But always be genuine, Davenport cautions: “Don’t practice praise inflation because your child knows that not everything he does is good.”
  • Plan for problems. Many parents of children with ADHD can predict when their child is likely to be disruptive and misbehave. If you can anticipate problems, use it to your advantage. Develop a plan for what you will do if your child misbehaves, especially in public, and share your plan with your child. Making the child aware of what may happen may lessen the likelihood that it will. If your child does misbehave, remember your plan and follow through.

A behavioral management plan can help your child with ADHD succeed if it is well thought out and enforced with consistency. Be positive and match behavior with appropriate rewards and consequences.

Parent Training in Behavior Management for ADHD

Please bookmark this to the Finding the right therapy for your child

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Behavior therapy is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, and self-esteem. It is most effective in young children when it is delivered by parents. Experts recommend that healthcare providers refer parents of children younger than 12 years old for training in behavior therapy. For children younger than 6 years old, parent training in behavior management should be tried before prescribing ADHD medicine.

When parents become trained in behavior therapy, they learn skills and strategies to help their child with ADHD succeed at school, at home, and in relationships. Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child and the family.

Did you know?

Parent training in behavior management is also known as parent behavior therapy, behavioral parent training, or just parent training.

What should parents look for?

If possible, families should look for a therapist who focuses on training parents. Some therapists will have training or certification in a parent training program that has been proven to work in young children with ADHD.

Therapists may also use strategies like those in proven programs1,2. The following list of questions can be used to find a therapist who uses a proven approach:

  • Does this therapist
    • Teach parents skills and strategies that use positive reinforcement, structure, and consistent discipline to manage their child’s behavior?
    • Teach parents positive ways to interact and communicate with their child?
    • Assign activities for parents to practice with their child?
    • Meet regularly with the family to monitor progress and provide coaching and support?
    • Re-evaluate treatment plans and remain flexible enough to adjust strategies as needed?

Learn more about finding a therapist “

What can parents expect?

Parents typically attend eight or more sessions with a therapist. Sessions may involve working with groups of parents or with one family alone. The therapist meets regularly with the parents to review their progress, provide support, and adjust strategies, as needed, to ensure improvement. Parents typically practice with their child between sessions.

Parents have the greatest influence on their young child’s behavior. Only therapy that focuses on training parents is recommended for young children with ADHD because young children are not mature enough to change their own behavior without their parents’ help. Some therapists may use play therapy or talk therapy to treat young children with ADHD. Play therapy provides a way for children to communicate their experiences and feelings through play. Talk therapy uses verbal communication between the child and a therapist to treat mental and emotional disorders. Neither of these has been proven to improve symptoms in young children with ADHD.

Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child. Ask your healthcare provider about the benefits of parent training in behavior therapy for young children with ADHD.

What can healthcare providers do?

Healthcare providers can:

  • Follow the clinical practice guideline for diagnosis and treatment of ADHD in young childrenexternal icon
  • Discuss with parents the benefits of behavior therapy and why they should consider getting training.
  • Identify parent training providers in their area and refer parents of young children with ADHD for training in behavior therapy before prescribing medicine.

For more information:

  • Vital Signs: ADHD in young children
  • Treatment patterns for young children with ADHD
For Parents and Providers:
For States:
  • State profiles of treatment patterns for young children with ADHD
  • Medicaid policy research
What parents can expect in behavior therapy

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Parents typically attend 8-16 sessions with a therapist and learn strategies to help their child. Sessions may involve groups or individual families.

  • The therapist meets regularly with the family to monitor progress and provide support
  • Between sessions, parents practice using the skills they’ve learned from the therapist

After therapy ends families continue to experience improved behavior and reduced stress.

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What parents learn when trained in behavior therapy

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  • Positive Communication
  • Positive Reinforcement
  • Structure and Discipline
  • Behavior therapy, given by parents teaches children to better control their own behavior, leading to improved functioning at school home and in relationships. Learning and practicing behavior therapy requires time and effort, but has lasting benefits for the child.

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Teaching Students with ADHD

Dealing with ADHD in the classroom? These tips for teachers can help you overcome common challenges and help kids with ADHD succeed at school.

If you’re a teacher, you know these kids: The one who stares out the window, substituting the arc of a bird in flight for her math lesson. The one who wouldn’t be able to keep his rear end in the chair if you used Krazy Glue. The one who answers the question, “What body of water played a major role in the development of the Ancient Egyptian civilization?” with “Mrs. M, do you dye your hair?”

Students who exhibit ADHD’s hallmark symptoms of inattention, hyperactivity, and impulsivity can be frustrating. You know the brainpower is there, but they just can’t seem to focus on the material you’re working hard to deliver. Plus, their behaviors take time away from instruction and disrupt the whole class.
Students with ADHD may:

  • Demand attention by talking out of turn or moving around the room.
  • Have trouble following instructions, especially when they’re presented in a list, and with operations that require ordered steps, such as long division or solving equations.
  • Often forget to write down homework assignments, do them, or bring completed work to school.
  • Often lack fine motor control, which makes note-taking difficult and handwriting a trial to read.
  • Have problems with long-term projects where there is no direct supervision.
  • Not pull their weight during group work and may even keep a group from accomplishing its task.

Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with attention deficit hyperactivity disorder (ADHD or ADD) have a hard time doing—not because they aren’t willing, but because their brains won’t let them. That doesn’t make teaching them any easier, of course.

Children and teens with ADHD often pay the price for their problems in low grades, scolding and punishment, teasing from their peers, and low self-esteem. Meanwhile, you, the teacher, feel guilty because you can’t reach the child with ADHD and wind up taking complaints from parents who feel their kids are being neglected in the classroom. But it doesn’t have to be this way. There are strategies you can employ to help students with ADHD overcome learning challenges, stay focused without disrupting others, and succeed in the classroom.

What teachers can do to help children with ADHD

So how do you teach a kid who won’t settle down and listen? The answer: with a lot of patience, creativity, and consistency. As a teacher, your role is to evaluate each child’s individual needs and strengths. Then you can develop strategies that will help students with ADHD focus, stay on task, and learn to their full capabilities.

Successful programs for children with ADHD integrate the following three components:

  1. Accommodations: what you can do to make learning easier for students with ADHD.
  2. Instruction: the methods you use in teaching.
  3. Intervention: How you head off behaviors that disrupt concentration or distract other students.

Your most effective tool, however, in helping a student with ADHD is a positive attitude. Make the student your partner by saying, “Let’s figure out ways together to help you get your work done.” Assure the student that you’ll be looking for good behavior and quality work and when you see it, reinforce it with immediate and sincere praise. Finally, look for ways to motivate a student with ADHD by offering rewards on a point or token system.

Dealing with disruptive classroom behavior

To head off behavior that takes time from other students, work out a couple of warning signals with the student who has ADHD. This can be a hand signal, an unobtrusive shoulder squeeze, or a sticky note on the student’s desk. If you have to discuss the student’s behavior, do so in private. And try to ignore mildly inappropriate behavior if it’s unintentional and isn’t distracting other students or disrupting the lesson.

Classroom accommodations for students with ADHD

As a teacher, you can make changes in the classroom to help minimize the distractions and disruptions of ADHD.

Seating

  • Seat the student with ADHD away from windows and away from the door.
  • Put the student with ADHD right in front of your desk unless that would be a distraction for the student.
  • Seats in rows, with focus on the teacher, usually work better than having students seated around tables or facing one another in other arrangements.
  • Create a quiet area free of distractions for test-taking and quiet study.

Information delivery

  • Give instructions one at a time and repeat as necessary.
  • If possible, work on the most difficult material early in the day.
  • Use visuals: charts, pictures, color coding.
  • Create outlines for note-taking that organize the information as you deliver it.

Student work

  • Create worksheets and tests with fewer items, give frequent short quizzes rather than long tests, and reduce the number of timed tests.
  • Test students with ADHD in the way they do best, such as orally or filling in blanks.
  • Divide long-term projects into segments and assign a completion goal for each segment.
  • Accept late work and give partial credit for partial work.

Organization

  • Have the student keep a master binder with a separate section for each subject, and make sure everything that goes into the notebook is put in the correct section. Color-code materials for each subject.
  • Provide a three-pocket notebook insert for homework assignments, completed homework, and “mail” to parents (permission slips, PTA flyers).
  • Make sure the student has a system for writing down assignments and important dates and uses it.
  • Allow time for the student to organize materials and assignments for home. Post steps for getting ready to go home.

Teaching techniques for students with ADHD

Teaching techniques that help students with ADHD focus and maintain their concentration on your lesson and their work can be beneficial to the entire class.

Starting a lesson

  • Signal the start of a lesson with an aural cue, such as an egg timer, a cowbell or a horn. (You can use subsequent cues to show how much time remains in a lesson.)
  • Establish eye contact with any student who has ADHD.
  • List the activities of the lesson on the board.
  • In opening the lesson, tell students what they’re going to learn and what your expectations are. Tell students exactly what materials they’ll need.

Conducting the lesson

  • Keep instructions simple and structured. Use props, charts, and other visual aids.
  • Vary the pace and include different kinds of activities. Many students with ADHD do well with competitive games or other activities that are rapid and intense.
  • Have an unobtrusive cue set up with the student who has ADHD, such as a touch on the shoulder or placing a sticky note on the student’s desk, to remind the student to stay on task.
  • Allow a student with ADHD frequent breaks and let him or her squeeze a rubber ball or tap something that doesn’t make noise as a physical outlet.
  • Try not to ask a student with ADHD perform a task or answer a question publicly that might be too difficult.

Ending the lesson

  • Summarize key points.
  • If you give an assignment, have three different students repeat it, then have the class say it in unison, and put it on the board.
  • Be specific about what to take home.

Helping the Student with ADHD in the Classroom: Strategies for Teachers

Introduction

Affecting three to five percent of the population, Attention Deficit /Hyperactivity Disorder (ADHD) is one of the most common of the childhood behavior disorders. Associated with this disorder’s core symptoms of inattention, hyperactivity and impulsivity are a variety of disruptive classroom behaviors (e.g., calling out, leaving seat, interrupting activities, etc.). Consequently, it is not surprising that these students are at risk for school failure.

Increased expectations for the use of classroom interventions for students with ADHD have been generated by Section 504 of the Vocational and Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act (IDEA) of 1997. Section 504 has been used to require the development of general education accommodation plans. These plans are designed to ensure that the student with ADHD is provided a free and appropriate education. Among the recommended components of these plans are a variety of classroom interventions (including behavior management), with a special emphasis on environmental modifications. Similarly, the recent reauthorization of IDEA, with its requirements for functional assessments, should increase the frequency with which classroom-based behavioral interventions are considered for these students.

General behavior intervention suggestions

Classroom interventions for the student with ADHD should be based upon a solid foundation of general behavior intervention principles. While students with ADHD do have a core of common problems, this group is fairly heterogeneous. Thus, instead of focusing on ADHD symptoms, management should first directly target the specific problem behavior. Next, an alternative behavior, incompatible with the problem behavior, should be selected. It is important to keep both behaviors in mind. Not only do we want to make it clear to students what behavior is unacceptable (what we don’t want them to do), but we also want to make it clear what behavior is acceptable (what we want them to do). These behaviors should be carefully defined so that the teacher will be able to accurately monitor them.

It is also important to ensure that the behavior intervention plan is based upon a careful functional assessment of behavior. Antecedents and consequences of both the problem and replacement behaviors need to be studied. Antecedents will suggest environmental changes that set up the student for success or failure. Analysis of consequences, on the other hand, will identify those environmental contingencies that serve to reinforce both desired and undesired behavior. The function of the problem behavior should guide intervention plans. For example, if the behavior is maintained by negative reinforcement (e.g., avoidance of an undesired task), then the intervention should ensure that this goal is not obtained by the problem behavior. At the same time the intervention should teach the student that the desirable behavior is a more effective way of obtaining the behavioral goal.

Environmental and instructional considerations

Task duration

To accommodate to the student’s short attention span, academic assignments should be brief and feedback regarding accuracy immediate. Longer projects should be broken up into manageable parts. Short time limits for task completion should be specified and can be enforced with timers.

Direct instruction

Attention to task is improved when the student with ADHD is engaged in teacher-directed as opposed to independent seat-work activities. Also, the teaching of note-taking strategies increases the benefits of direct instruction. Both comprehension and on-task behavior improve with the development of these skills.

Peer tutoring

Class-wide peer tutoring provides many of the instructional variables known to be important in setting up students with ADHD for success. For example, it provides frequent and immediate feedback. When combined with a token economy, peer tutoring has been found to yield dramatic academic gains.

Scheduling

Based on evidence that the on-task behavior of students with ADHD progressively worsens over the course of the day, it is suggested that academic instruction be provided in the morning. During the after-noon, when problem solving skills are especially poor, more active, nonacademic activities should be scheduled.

Novelty

Presentation of novel, interesting, highly motivating material will improve attention. For example, in-creasing the novelty and interest level of tasks through use of increased stimulation (e.g., color, shape, texture) reduces activity level, enhances attention and improves overall performance.

Structure and organization

Lessons should be carefully structured and important points clearly identified. For example, providing a lecture outline is a helpful note-taking aid that increases memory of main ideas. Students with ADHD perform better on memory tasks when material is meaningfully structured for them.

Rule reminders and visual cues

The rules given to students with ADHD must be well defined, specific and frequently reinforced through visible modes of presentation. Well-defined rules with clear consequences are essential. Relying on the student’s memory of rules is not sufficient. Visual rule reminders or cues should be placed throughout the classroom. It is also helpful if rules are reviewed before activity transitions and following school breaks. For example, token economy systems are especially effective when the rules for these programs are reviewed daily.

Auditory cues

Providing students with ADHD auditory cues that prompt appropriate classroom behavior is helpful. For example, use of a tape with tones placed at irregular intervals to remind students to monitor their on-task behavior has been found to improve arithmetic productivity.

Pacing of work

When possible, it is helpful to allow students with ADHD to set their own pace for task completion. The intensity of problematic ADHD behaviors is less when work is self paced, as compared to situations where work is paced by others.

Instructions

Because students with ADHD have difficulty following multi-step directions, it is important for instruction to be short, specific and direct. Further, to ensure understanding, it is helpful if these students are asked to rephrase directions in their own words. Additionally, teachers must be prepared to repeat directions frequently, and recognize that students often may not have paid attention to what was said.

Productive physical movement

The student with ADHD may have difficulty sitting still. Thus, productive physical movement should be planned. It is appropriate to allow the student with ADHD opportunities for controlled movement and to develop a repertoire of physical activities for the entire class such as stretch breaks. Other examples might include a trip to the office, a chance to sharpen a pencil, taking a note to another teacher, watering the plants, feeding classroom pets, or simply standing at a desk while completing classwork. Alternating seat work activities with other activities that allow for movement is essential. It is also important to keep in mind that on some days it will be more difficult for the student to sit still than on others. Thus, teachers need to be flexible and modify instructional demands accordingly.

Active vs. passive involvement

In line with the idea of providing for productive physical movement, tasks that require active (as opposed to passive) responses may help hyperactive students channel their disruptive behaviors into constructive responses. While it may be problematic for these children to sit and listen to a long lecture, teachers might find that students with ADHD can be successful participants in the same lecture when asked to help (e.g., help with audio-visual aids, write important points on the chalk board, etc.).

Distractions

Generally, research has not supported the effectiveness of complete elimination of all irrelevant stimuli from the student’s environment. However, as these students have difficulty paying attention to begin with, it is important that attractive alternatives to the task at hand be minimized. For example, activity centers, mobiles, aquariums and terrariums should not be placed within the student’s visual field.

Anticipation

Knowledge of ADHD and its primary symptoms is helpful in anticipating difficult situations. It is important to keep in mind that some situations will be more difficult for than others. For example, effortful problem solving tasks are especially problematic. These situations should be anticipated and appropriate accommodations made. When presenting a task that the teacher suspects might exceed the student’s attentional capacity, it is appropriate to reduce assignment length and emphasize quality as opposed to quantity.

Contingency management: Encouraging appropriate behavior

Although classroom environment changes can be helpful in reducing problematic behaviors and learn-ing difficulties, by themselves they are typically not sufficient. Thus, contingencies need to be available that reinforce appropriate or desired behaviors, and discourage inappropriate or undesired behaviors.

Powerful external reinforcement

First, it is important to keep in mind that the contingencies or consequences used with these students must be delivered more immediately and frequently than is typically the case. Additionally, the consequences used need to be more powerful and of a higher magnitude than is required for students without ADHD. Students with ADHD need external criteria for success and need a pay-off for increased performance. Relying on intangible rewards is not enough.

Use of both negative and positive consequences are essential when working with ADHD students. However, before negative consequences can be implemented, appropriate and rich incentives should first be developed to reinforce desired behavior. It is important to give much encouragement, praise and affection as these students are easily discouraged. When negative consequences are administered, they should be given in a fashion that does not embarrass or put down students. Also, it is important to keep in mind that the rewards used with these students lose their reinforcing power quickly and must be changed or rotated frequently.

Token economy systems

These systems are an example of a behavioral strategy proven to be helpful in improving both the academic and behavioral functioning of students with ADHD. These systems typically involved giving students tokens (e.g., poker chips) when they display appropriate behavior. These tokens are in turn ex-changed for tangible rewards or privileges at specified times.

Response-cost programs

While verbal reprimands are sufficient for some students, more powerful negative consequences, such as response-cost programs, are needed for others. These programs provide mild punishment when problem behavior is displayed. For example, a student may lose earned points or privileges when previously specified rules are broken. There is evidence that such programming decreases ADHD symptoms such as impulsivity. A specific response-cost program found to be effective with ADHD students involves giving a specific number of points at the start of each day. When a rule is broken (a problem behavior is dis-played), points are taken away. Thus, to maintain their points students must avoid breaking the rule. At the end of the period or day, students are typically allowed to exchange the points they have earned for a tangible reward or privilege.

Time-out

Removing the student from positive reinforcement, or time-out, typically involves removing the student from classroom activities. Time-out can be effective in reducing aggressive and disruptive actions in the classroom, especially when these behaviors are strengthened by peer attention. They are not helpful, however, when problem behavior is a result of the students desire to avoid school work. The time-out area should be a pleasant environment and a student should be placed in it for only a short time. Time-out is ended based upon the student’s attitude. At its conclusion a discussion of what went wrong and how to prevent the problem in the future takes place. While these procedures are effective with ADHD students, it is recommend that they be used only with the most disruptive classroom behaviors and only when there is a trained staff.

Summary

As students with ADHD are a heterogeneous group, there is no one intervention (or set of interventions) that wili improve the classroom functioning of all of these students. Thus, it is suggested that classroom modifications be tailored to the unique needs of each student. In developing these modifications it is per-haps best to begin by examining how the classroom environment might be changed to set up the student with ADHD for success. The next step is to consider the implementation of a contingency management system designed to provide external incentives for appropriate classroom behaviors. In doing so it is important to remember that behavior management programs must be consistently applied. Further, it is essential to avoid excessive use of negative consequences (such as reprimands, time-out). In all cost programs, it is important to avoid the use of unrealistic standards that result in excessive point or privilege loss. Students must experience success. In other words, it is essential that students be frequently reinforced for what we want them to do, rather than simply punished for what we do not want them to do.

Click the “References” link above to hide these references.

Sandoval, J. (1982). Hyperactive children: 12 ways to help them in the classroom. Academic Therapy, 18, 107-113.

Resources for Educators Barkley, R. A. (1 990). Attention Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment. New York: Guilford.

Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford.

DuPaul, G. J., & Stoner, G. (1994). ADHD in the schools: Assessment and intervention strategies. New York: Guilford.

Goldstein, S., & Goldstein, M. (1990). Managing attention disorders in children: A guide for practitioners. New York: Wiley.

Parker, H. (1992). The ADD hyperactivity handbook for schools. Plantation, FL: Impact Publications.

Stephen E. Brock, Ph.D., NCSP, is the Lead Psychologist for the Lodi Unified School District (Lodi, Califomia). He is also a lecturer at the University of California, Davis, and California State University, Sacramento.

(1998)

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Behavioral Intervention Techniques for Children With ADHD

Teaching Children With ADHD:
Instructional Strategies and Practices Part 9

The second major component of effective instruction for children with ADHD involves the use of behavioral interventions. Exhibiting behavior that resembles that of younger children, children with ADHD often act immaturely and have difficulty learning how to control their impulsiveness and hyperactivity. They may have problems forming friendships with other children in the class and may have difficulty thinking through the social consequences of their actions.

The purpose of behavioral interventions is to assist students in displaying the behaviors that are most conducive to their own learning and that of classmates. Well-managed classrooms prevent many disciplinary problems and provide an environment that is most favorable for learning. When a teacher’s time must be spent interacting with students whose behaviors are not focused on the lesson being presented, less time is available for assisting other students. Behavioral interventions should be viewed as an opportunity for teaching in the most effective and efficient manner, rather than as an opportunity for punishment.

EFFECTIVE BEHAVIORAL INTERVENTION TECHNIQUES

Effective teachers use a number of behavioral intervention techniques to help students learn how to control their behavior. Perhaps the most important and effective of these is verbal reinforcement of appropriate behavior. The most common form of verbal reinforcement is praise given to a student when he or she begins and completes an activity or exhibits a particular desired behavior. Simple phrases such as “good job” encourage a child to act appropriately.

Effective teachers praise children with ADHD frequently and look for a behavior to praise before, and not after, a child gets off task. The following strategies provide some guidance regarding the use of praise:

Define the appropriate behavior while giving praise.
Praise should be specific for the positive behavior displayed by the student: The comments should focus on what the student did right and should include exactly what part(s) of the student’s behavior was desirable. Rather than praising a student for not disturbing the class, for example, a teacher should praise him or her for quietly completing a math lesson on time.

Give praise immediately.
The sooner that approval is given regarding appropriate behavior, the more likely the student will repeat it.

Vary the statements given as praise.
The comments used by teachers to praise appropriate behavior should vary; when students hear the same praise statement repeated over and over, it may lose its value.

Be consistent and sincere with praise.
Appropriate behavior should receive consistent praise. Consistency among teachers with respect to desired behavior is important in order to avoid confusion on the part of students with ADHD. Similarly, students will notice when teachers give insincere praise, and this insincerity will make praise less effective.

It is important to keep in mind that the most effective teachers focus their behavioral intervention strategies on praise rather than on punishment. Negative consequences may temporarily change behavior, but they rarely change attitudes and may actually increase the frequency and intensity of inappropriate behavior by rewarding misbehaving students with attention. Moreover, punishment may only teach children what not to do; it does not provide children with the skills that they need to do what is expected. Positive reinforcement produces the changes in attitudes that will shape a student’s behavior over the long term.

IN ADDITION TO VERBAL REINFORCEMENT

In addition to verbal reinforcement, the following set of generalized behavioral intervention techniques has proven helpful with students with ADHD as well:

Selectively ignore inappropriate behavior.
It is sometimes helpful for teachers to selectively ignore inappropriate behavior. This technique is particularly useful when the behavior is unintentional or unlikely to recur or is intended solely to gain the attention of teachers or classmates without disrupting the classroom or interfering with the learning of others.

Remove nuisance items.
Teachers often find that certain objects (such as rubber bands and toys) distract the attention of students with ADHD in the classroom. The removal of nuisance items is generally most effective after the student has been given the choice of putting it away immediately and then fails to do so.

Provide calming manipulatives.
While some toys and other objects can be distracting for both the students with ADHD and peers in the classroom, some children with ADHD can benefit from having access to objects that can be manipulated quietly. Manipulatives may help children gain some needed sensory input while still attending to the lesson.

Allow for “escape valve” outlets.
Permitting students with ADHD to leave class for a moment, perhaps on an errand (such as returning a book to the library), can be an effective means of settling them down and allowing them to return to the room ready to concentrate.

Activity reinforcement.
Students receive activity reinforcement when they are encouraged to perform a less desirable behavior before a preferred one.

Hurdle helping.
Teachers can offer encouragement, support, and assistance to prevent students from becoming frustrated with an assignment. This help can take many forms, from enlisting a peer for support to supplying additional materials or information.

Parent conferences.
Parents have a critical role in the education of students, and this axiom may be particularly true for those with ADHD. As such, parents must be included as partners in planning for the student’s success. Partnering with parents entails including parental input in behavioral intervention strategies, maintaining frequent communication between parents and teachers, and collaborating in monitoring the student’s progress.

Peer mediation.
Members of a student’s peer group can positively impact the behavior of students with ADHD. Many schools now have formalized peer mediation programs, in which students receive training in order to manage disputes involving their classmates.

REMINDERS OF BEHAVIOR, LEARNING EXPECTATIONS

Effective teachers also use behavioral prompts with their students. These prompts help remind students about expectations for their learning and behavior in the classroom. Three, which may be particularly helpful, are the following:

Visual cues.
Establish simple, nonintrusive visual cues to remind the child to remain on task. For example, you can point at the child while looking him or her in the eye, or you can hold out your hand, palm down, near the child.

Proximity control.
When talking to a child, move to where the child is standing or sitting. Your physical proximity to the child will help the child to focus and pay attention to what you are saying.

Hand gestures.
Use hand signals to communicate privately with a child with ADHD. For example, ask the child to raise his or her hand every time you ask a question. A closed fist can signal that the child knows the answer; an open palm can signal that he or she does not know the answer. You would call on the child to answer only when he or she makes a fist.

HELPING STUDENTS MANAGE THEIR BEHAVIOR

In some instances, children with ADHD benefit from instruction designed to help students learn how to manage their own behavior:

Social skills classes.
Teach children with ADHD appropriate social skills using a structured class. For example, you can ask the children to role-play and model different solutions to common social problems. It is critical to provide for the generalization of these skills, including structured opportunities for the children to use the social skills that they learn. Offering such classes, or experiences, to the general school population can positively affect the school climate.

Problem solving sessions.
Discuss how to resolve social conflicts. Conduct impromptu discussions with one student or with a small group of students where the conflict arises. In this setting, ask two children who are arguing about a game to discuss how to settle their differences. Encourage the children to resolve their problem by talking to each other in a supervised setting.

For many children with ADHD, functional behavioral assessments and positive behavioral interventions and supports, including behavioral contracts and management plans, tangible rewards, or token economy systems, are helpful in teaching them how to manage their own behavior. Because students’ individual needs are different, it is important for teachers, along with the family and other involved professionals, to evaluate whether these practices are appropriate for their classrooms. Examples of these techniques, along with steps to follow when using them, include the following:

Functional Behavioral Assessment (FBA).
FBA is a systematic process for describing problem behavior and identifying the environmental factors and surrounding events associated with problem behavior. The team that works closely with the child exhibiting problem behavior
(1) observes the behavior and identifies and defines its problematic characteristics,
(2) identifies which actions or events precede and follow the behavior, and
(3) determines how often the behavior occurs.
The results of the FBA should be used to develop an effective and efficient intervention and support plan. (Gable, et al., 1997)

Positive Behavioral Interventions and Supports (PBIS).
This method is an application of a behaviorally based systems approach that is grounded in research regarding behavior in the context of the settings in which it occurs. Using this method, schools, families, and communities work to design effective environments to improve behavior. The goal of PBIS is to eliminate problem behavior, to replace it with more appropriate behavior, and to increase a person’s skills and opportunities for an enhanced quality of life (Todd, Horner, Sugai, & Sprague, 1999).

Behavioral contracts and management plans.
Identify specific academic or behavioral goals for the child with ADHD, along with behavior that needs to change and strategies for responding to inappropriate behavior. Work with the child to cooperatively identify appropriate goals, such as completing homework assignments on time and obeying safety rules on the school playground. Take the time to ensure that the child agrees that his or her goals are important to master. Behavioral contracts and management plans are typically used with individual children, as opposed to entire classes, and should be prepared with input from parents.

Tangible rewards.
Use tangible rewards to reinforce appropriate behavior. These rewards can include stickers, such as “happy faces” or sports team emblems, or privileges, such as extra time on the computer or lunch with the teacher. Children should be involved in the selection of the reward. If children are invested in the reward, they are more likely to work for it.

Token economy systems.
Use token economy systems to motivate a child to achieve a goal identified in a behavioral contract (Barkley, 1990). For example, a child can earn points for each homework assignment completed on time. In some cases, students also lose points for each homework assignment not completed on time. After earning a specified number of points, the student receives a tangible reward, such as extra time on a computer or a “free” period on Friday afternoon. Token economy systems are often used for entire classrooms, as opposed to solely for individual students.

Self-management systems.
Train students to monitor and evaluate their own behavior without constant feedback from the teacher. In a typical self-management system, the teacher identifies behaviors that will be managed by a student and provides a written rating scale that includes the performance criteria for each rating. The teacher and student separately rate student behavior during an activity and compare ratings. The student earns points if the ratings match or are within one point and receives no points if ratings are more than one point apart; points are exchanged for privileges. With time, the teacher involvement is removed, and the student becomes responsible for self-monitoring (DuPaul & Stoner as cited in Shinn, Walker, & Stoner, 2002).

Go to
Part 10:
Classroom Accommodations for Children With ADHD

Teaching Children With ADHD

This ten-part series explores the three components of a successful strategy for educating children with ADHD: academic instruction, behavioral interventions, and classroom accommodations. Use the handy index below to find the specific information for which you are looking.

  • Identifying Children With ADHD
  • An Overall Strategy for the Successful Instruction of Children With ADHD
  • Successful Instruction: Introducing Lessons
  • Successful Instruction: Conducting Lessons
  • Successful Instruction: Concluding Lessons
  • Successful Instruction: Individualizing Instructional Practices — Language Arts
  • Successful Instruction: Individualizing Instructional Practices — Mathematics
  • Organizational and Study Skills Useful for Academic Instruction of Children With ADHD
  • Behavioral Intervention Techniques for Children With ADHD
  • Classroom Accommodations for Children With ADHD

ADHD in the Classroom: Helping Children Succeed in School

Children with attention-deficit/hyperactivity disorder (ADHD) experience more obstacles in their path to success than the average student. The symptoms of ADHD, such as inability to pay attention, difficulty sitting still, and difficulty controlling impulses, can make it hard for children with this diagnosis to do well in school.

To meet the needs of children with ADHD, schools may offer

  • ADHD treatments, such as behavioral classroom management or organizational training;
  • Special education services; or
  • Accommodations to lessen the effect of ADHD on their learning.

Classroom Treatment Strategies for ADHD Students

There are some school-based management strategies shown to be effective for ADHD students: behavioral classroom management and organizational training.1

Did you know?

Parents report that only about 1 in 3 children with ADHD receive behavioral classroom management.2

The behavioral classroom management approach encourages a student’s positive behaviors in the classroom, through a reward systems or a daily report card, and discourages their negative behaviors. This teacher-led approach has been shown to influence student behavior in a constructive manner, increasing academic engagement. Although tested mostly in elementary schools, behavioral classroom management has been shown to work students of all ages.1
Organizational training teaches children time management, planning skills, and ways to keep school materials organized in order to optimize student learning and reduce distractions. This management strategy has been tested with children and adolescents.1

These two management strategies require trained staff—including teachers, counselors, or school psychologists—follow a specific plan to teach and support positive behavior.

The American Academy of Pediatrics (AAP) recommends that the school environment, program, or placement is a part of any ADHD treatment plan. AAP also recommends teacher-administered behavior therapy as a treatment for school-aged children with ADHD. You can talk to your child’s healthcare provider and teachers about working together to support your child.

Special Education Services and Accommodations

Most children with ADHD receive some school services, such as special education services and accommodations. There are two laws that govern special services and accommodations for children with disabilities:

  • The Individuals with Disabilities Education Act (IDEA)
  • Section 504 of the Rehabilitation Act of 1973

The support a child with ADHD receives at school will depend on if they meet the eligibility requirements for one of two federal plans funded by IDEA and Section 504: an individualized education program (IEP) or a 504 Plan.

What are the main differences between the two Plans?

IEPs provide individualized special education services to meet the unique needs of the child.

A 504 Plan provides services and changes to the learning environment to meet the needs of the child as adequately as other students.3

Learn more about IEP and 504 Plans pdf iconexternal icon

Accommodations

IEP and 504 Plans can offer accommodations for students to help them manage their ADHD, including:

  • Extra time on tests;
  • Instruction and assignments tailored to the child;
  • Positive reinforcement and feedback;
  • Using technology to assist with tasks;
  • Allowing breaks or time to move around;
  • Changes to the environment to limit distraction; and
  • Extra help with staying organized.

Did you know?

Parents of children with ADHD report receiving more services through an IEP than through a 504 plan.2

There is limited information about which types of accommodations are effective for children with ADHD.3 However, there is evidence that setting clear expectations, providing immediate positive feedback, and communicating daily with parents through a daily report card can help.4

What Teachers Can Do To Help

For teachers, helping children manage their ADHD symptoms can present a challenge. Most children with ADHD are not enrolled in special education classes, but do need extra assistance on a daily basis. The National Resource Center on ADHD provides information for teachers from experts on how to help students with ADHD.external icon

Here are some tips for classroom success.

Communication

  • Give frequent feedback and attention to positive behavior;
  • Be sensitive to the influence of ADHD on emotions, such as self-esteem issues or difficulty regulating feelings;
  • Provide extra warnings before transitions and changes in routines; and
  • Understand that children with ADHD may become deeply absorbed in activities that interest them (hyper-focus) and may need extra assistance shifting their attention.
Assignments and Tasks
  • Make assignments clear—check with the student to see if they understand what they need to do;
  • Provide choices to show mastery (for example, let the student choose among written essay, oral report, online quiz, or hands-on project;
  • Make sure assignments are not long and repetitive. Shorter assignments that provide a little challenge without being too hard may work well;
  • Allow breaks—for children with ADHD, paying attention takes extra effort and can be very tiring;
  • Allow time to move and exercise;
  • Minimize distractions in the classroom; and
  • Use organizational tools, such as a homework folder, to limit the number of things the child has to track.
Develop a Plan That Fits the Child
  • Observe and talk with the student about what helps or distracts them (for example, fidget tools, limiting eye contact when listening, background music, or moving while learning can be beneficial or distracting depending on the child);
  • Communicate with parents on a regular basis; and
  • Involve the school counselor or psychologist.

Close collaboration between the school, parents, and healthcare providers will help ensure the child gets the right support.

Parent Education and Support

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources, information, and advice for parents on how to help their child. Learn more about their services.external icon

How to best advocate for your child
  • Understand your child’s diagnosis, how it impacts their education, and what can be done at home to help.
  • Understand your child’s IEP. If you have questions, don’t be afraid to ask.
  • Speak with your child’s teacher.
  • When possible, obtain written documentation from teachers, administrators, or other professionals working with your child.
  • Know your rights.
  • Play an active role in preparing your child’s IEP or 504 Plan.
  • Keep careful records, including written documentation, communication between home and school, progress reports, and evaluations.
  • Try to maintain a good working relationship with the school while being a strong advocate for your child.
  • Communicate any concerns you may have about your child’s progress or IEP or 504 Plan.
  • Encourage your child every day, and devise a system to help with homework and other school projects.5
What every parent should know
  • School support and services are regulated by laws. The U.S. Department of Education has developed a “Know your rights” letter for parents pdf iconexternal icon and a resource guide for educators pdf iconexternal icon to help educators, families, students, and other interested groups better understand how these laws apply to students with ADHD so that they can get the services and education they need to be successful.
  • Healthcare providers play an important part in collaborating with schools to help children get the special services they need. Read more about the role of healthcare providers in assisting children with special needsexternal icon.

More Information

Learn more about education services and accommodations.external icon
Learn more about how to help a child with attention and learning issues.external icon
Effective child therapy: ADHDexternal icon
The National Resource Center on ADHD.

Reference

  1. Evans S, Owens J, Bunford N. Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology 2014;43(4):527-551
  2. DuPaul GJ, Chronis-Tuscano A, Danielson ML, Visser SN. Predictors of receipt of school services in a national sample of youth with ADHD. Journal of Attention Disorders Published online December 10, 2018.
  3. Harrison JR, Bunford N, Evans SW, Owens JS. Educational accommodations for students with behavioral challenges: A systematic review of the literature. Review of Educational Research 2013;83(4):551-97.
  4. Moore DA, Russell AE, Matthews J, Ford TJ, Rogers M, Ukoumunne OC, et al. School-based interventions for attention-deficit/hyperactivity disorder: A systematic review with multiple synthesis methods. Review of Education. Published online October 18, 2018.
  5. https://chadd.org/for-parents/individuals-with-disabilities-education-act/external icon

“None of Us Were Trained How to Be Good Parents:” An ADHD Guide to Behavior Therapy

The fundamentals of behavior therapy for ADHD are easy to understand and implement, even without the help of a therapist. Have you ever given your child a time-out for talking back, for instance, or a heads-up before taking him some place that is likely to challenge his self-control? Then you already have a sense of how behavior therapy works in parenting children with ADHD.

“A lot of behavior modification is just common-sense parenting,” says William Pelham, Jr., Ph.D., director of the Center for Children and Families at the State University of New York at Buffalo. “The problem is that none of us were trained how to be good parents, and none of us expected to have children who needed parents with great parenting skills and patience.”

The basic idea of behavior therapy is to set specific rules governing your child’s behavior (nothing vague or too broad), and to enforce your rules consistently, with positive consequences for following them and negative consequences for infractions. To get started on your own, Dr. Pelham suggests these seven strategies, based on real ADHD behavior therapy techniques:

1. Make sure your child understands the rules.

Telling a child to “do this” or to “avoid doing that” is not enough. To ensure that your child knows the rules cold, create lists and post them around the house. For example, you might draw up a list detailing the specific things your child must do to get ready for school.

Make sure the rules are worded clearly. Go over the rules to make sure he understands, and review them as necessary. Stick with the routines until your child has them down — and then stick with them some more; backsliding is a common phenomenon.

2. Give clear commands.

First, say your child’s name to make sure you have his attention. Then tell him exactly what you want him to do. If you’re in the checkout line at the grocery store, for instance, you might say, “Steve, stand next to me and do not touch anything.” It’s not enough to tell your child to “be good,” because he may not know what that entails. Finally, state the consequences for disobeying the command — and always follow through.

3. Don’t expect perfection.

Strike a balance between praising your child and offering criticism. A good rule of thumb is to praise your child for doing something well at three to five times as often as you criticize bad behavior.

You’ll only set your child up for failure if you expect immediate and perfect results. Instead, focus on rewarding small steps — and gradually work your way toward the desired outcome.

If you notice that you are criticizing too much, lower your standards a bit. You’ll only drive yourself — and your child — crazy if you nitpick.

4. Use “when/then” statements to encourage good behavior and reward your child.

If your child asks for permission to do a desirable activity before completing his chores or assignments, say, “Yes, when you finish cleaning the garage, then you can go out with friends.” With younger children, it’s important that the rewarding activity take place immediately after the chore or assignment is completed.

5. Set up a point/token system for rewards and consequences.

One effective system for encouraging your child to comply with your commands involves a jar and a supply of marbles. Each time your child does what you ask, put a marble in the jar. Each time he doesn’t, take one out of the jar. At the end of the day, he earns a small reward based on the number of marbles that remain in the jar, and then starts over again.

6. Tweak your discipline techniques as your child gets older.

Certain measures, including time-outs, may not work as well with tweens and teens as they do with younger kids. If your high-schooler breaks a rule, you might give him a five-minute chore — such as straightening up the family room — rather than a five-minute time-out.

With older children, it’s useful to negotiate the terms and rewards for good behavior. For example, your child may request access to the family car or time spent with friends if he is helpful around the house and does well at school.

7. Ask your child’s teachers to set up a similar behavioral system at school.

One of the best tools for parent-teacher cooperation is the daily report card. Meet with the teacher to determine desired classroom behaviors —”completing assignments within the designated time” or “contributing to discussion.” At the end of each school day, the teacher can fill out a quick evaluation of your child’s adherence to these behavioral goals, and send the document home with the child. Reward him for a good day at school with time to play outside or control over the car radio.

If your child is in middle school or high school, ask his guidance counselor to discuss a weekly report card with all of your child’s teachers. Use pages in her assignment notebook for these regular reports.

Many parents incorporate these strategies into family life without professional assistance. If you are having trouble achieving the results you seek, consider signing up for a parent-training program or seeking family therapy. A typical program consists of two-hour sessions, in which a therapist works with parents — typically in a group setting — to give them the support and guidance they need to cultivate good behavior. Online parenting programs also are available to offer structured information and support.

ADHD Behavior Therapy: Four Good Books

Behavior Modification: What It Is And How To Do It, 8th Edition, by Garry Martin and Joseph Pear (Prentice Hall)

Homework Success for Children with ADHD: A Family-School Intervention Program, by Thomas J. Power, James L. Karustis, and Dina F. Habboushe (Guilford)

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Updated on January 26, 2020

Treatment for Children with ADHD

Patience is key with behavioral therapy, since people with ADHD are notoriously variable in their symptoms. One day, your child may behave beautifully, and the next, fall back into old patterns. Sometimes it may seem as if the training is not working. However, over time, behavioral treatment does improve the symptoms of ADHD.

Social skills training

Because kids with attention deficit disorder often have difficulty with simple social interactions and struggle with low self-esteem, another type of treatment that can help is social skills training. Normally conducted in a group setting, social skills training is led by a therapist who demonstrates appropriate behaviors and then has the children practice repeating them. A social skills group teaches children how to “read” others’ reactions and how to behave more acceptably. The social skills group should also work on transferring these new skills to the real world.

For a social skills group near you, ask for a referral from your school psychologist or a local mental health clinic.

Tips for supporting your child’s ADHD treatment

Children with ADHD often have trouble translating what they’ve learned from one setting to another. For instance, they may have learned how to control impulsive outbursts at school, but impatiently interrupt others at home.

In order to encourage positive change in all settings, children with ADHD need consistency. It is important that parents of children with ADHD learn how to apply behavioral therapy techniques at home. Children with ADHD are more likely to succeed in completing tasks when the tasks occur in predictable patterns and in predictable places, so that they know what to expect and what they are supposed to do.

Follow a routine. It is important to set a time and a place for everything to help a child with ADHD understand and meet expectations. Establish simple and predictable rituals for meals, homework, play, and bed.

Use clocks and timers. Consider placing clocks throughout the house, with a big one in your child’s bedroom. Allow plenty of time for what your child needs to do, such as homework or getting ready in the morning.

Simplify your child’s schedule. Avoiding idle time is a good idea, but a child with ADHD may become even more distracted and “wound up” if there are too many after-school activities.

Create a quiet place. Make sure your child has a quiet, private space of his or her own. A porch or bedroom can work well—as long as it’s not the same place as the child goes for a time-out.

Set an example for good organization. Set up your home in an organized way. Make sure your child knows that everything has its place. Role-model neatness and organization as much as possible.

The importance of praise

As you establish a consistent structure and routine, keep in mind that children with ADHD often receive criticism. Be on the lookout for good behavior—and praise it. Praise is especially important for children who have ADHD because they typically get so little of it. A smile, positive comment, or other reward from you can improve your child’s attention, concentration, and impulse control. Do your best to focus on giving positive praise for appropriate behavior and task completion, while giving as few negative responses as possible to inappropriate behavior or poor task performance. Reward your child for small achievements—these will lead to bigger successes down the road.

Cognitive behavioural therapy (CBT) involves self-instructional training administered in a group or individual basis, to help the individual with ADHD to develop a more planned and reflective approach to thinking and behaving, including social interactions.1 It can also help individuals adopt a more reflective, systematic and goal-oriented approach to everyday tasks, activities and problem solving, including academic functioning.2

Results from a randomised controlled trial of a CBT group in adolescents with ADHD (n=119; aged 15–21 years) receiving pharmacological therapy with methylphenidate or atomoxetine showed that:3

  • Patients who received CBT showed significantly reduced symptoms of ADHD compared with the control group on the Clinical Global Impression Self-Report Scale (p<0.001) and the Clinical Global Impression Clinician-Report Scale (p<0.001).3
  • Patients who received CBT showed a significant reduction in functional impairment compared with the control group on the Global Assessment of Functioning (p<0.001) and the Weiss Functional Impairment Rating Scale Parent Version (p<0.05).3

CBT in combination with pharmacological treatment may reduce the symptoms of ADHD in adolescents.3

In a 6-month study of two internet-based CBT modular programmes in adults with ADHD (n=45), 48% of whom were receiving pharmacological therapy, participants were assigned to one of the following:4

  • Self-help internet-based CBT
  • Self-help internet-based CBT plus weekly group therapy sessions
  • Wait list (control group).

Modules covered topics including behaviour analysis, mindfulness and acceptance, time management, gauging attention span, reducing distractors, organisation and planning, problem solving, behaviour activation, cognitive restructuring and anger control training.4

Patients who received internet-based CBT had a significant reduction in ADHD symptoms compared with the wait-list control patients at post-treatment (Figure).4

Figure: Results from a 6-month study of two internet-based CBT modular programmes in adults with ADHD (n=45). Figure developed using information from Pettersson R et al. J Atten Disord 2017; 21: 508-521.4

A randomised, controlled trial has explored the effectiveness of group-based CBT in adults who were already receiving medication for ADHD (n=86).5 Therapy included three core modules, focusing on:5

  1. Psychoeducation about ADHD, and training on organisation and planning, including problem-solving.
  2. Skills to reduce distractibility, such as techniques to time the length of one’s attention span.
  3. Cognitive restructuring, involving learning to think more adaptively in situations that cause distress.

Twelve 50-minute sessions of CBT significantly reduced ADHD symptom scores compared with relaxation and educational support, with responders continuing to maintain benefit over a 12-month follow-up period.5

Other group-based approaches to CBT have also been associated with symptomatic improvements in adults with ADHD.

  • In a study of 29 adults with ADHD, 10–11 weekly sessions of cognitive–behaviourally oriented psychological group rehabilitation reduced self-reported ADHD symptoms.6
  • Two studies assessing an 8- or 12-week programme of meta-cognitive therapy to target executive self-management skills in 30 and 88 adults with ADHD, respectively, reported reduced symptoms of inattention and improved executive functioning.7,8

The authors concluded that CBT for the treatment of adult ADHD showed comparable effect sizes with behavioural treatments in children with ADHD. The authors recommended that further research should be conducted to identify empirically supported principles of treatment-related change for adults with ADHD.9

Figure: Self-reported symptoms of ADHD for treatment versus control. Reproduced with kind permission from Knouse LE et al. J Consult Clin Psychol 2017; 85: 737-750.9

There is also some evidence to support the use of CBT approaches in children with ADHD. In a randomised study of boys aged 7–13 years with ADHD (n=25), CBT improved parent perception of hyperactivity in the home and child-rated self-esteem, compared with a supportive therapy control group.10

Some evidence suggests that CBT may enhance activity in neural structures typically affected by ADHD, in a similar manner to treatment with methylphenidate.11 Similarly, data from another small imaging study suggested that CBT may increase grey matter volume in structures typically characterised by volume reduction in ADHD patients, versus an ADHD control group, and that these increases may be associated with attentional performance.12 However, this research is in its infancy and further investigation is warranted.

  1. Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
  2. Prevatt F, Yelland S. An empirical evaluation of ADHD coaching in college students. J Atten Disord 2015; 19: 666-677.
  3. Vidal R, Castells J, Richarte V, et al. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015; 54: 275-282.
  4. Pettersson R, Söderström S, Edlund-Söderström K, et al. Internet-based cognitive behavioral therapy for adults with ADHD in outpatient psychiatric care: a randomized trial. J Atten Disord 2017; 21: 508-521.
  5. Safren SA, Sprich S, Mimiaga MJ, et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA 2010; 304: 875-880.
  6. Virta M, Vedenpaa A, Gronroos N, et al. Adults with ADHD benefit from cognitive-behaviorally oriented group rehabilitation: a study of 29 participants. J Atten Disord 2008; 12: 218-226.
  7. Solanto MV, Marks DJ, Mitchell KJ, et al. Development of a new psychosocial treatment for adult ADHD. J Atten Disord 2008; 11: 728-736.
  8. Solanto MV, Marks DJ, Wasserstein J, et al. Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry 2010; 167: 958-968.
  9. Knouse LE, et al. Meta-analysis of cognitive-behavioural treatments for adult ADHD. J Consult Clin Psychol 2017; 85: 737-750.
  10. Fehlings DL. Attention deficit hyperactivity disorder: does cognitive behavioral therapy improve home behavior? J Dev Behav Pediatr 1991; 12: 223-228.
  11. Hoekzema E, Carmona S, Tremols V, et al. Enhanced neural activity in frontal and cerebellar circuits after cognitive training in children with attention-deficit/hyperactivity disorder. Hum Brain Mapp 2010; 31: 1942-1950.
  12. Hoekzema E, Carmona S, Ramos-Quiroga JA, et al. Training-induced neuroanatomical plasticity in ADHD: a tensor-based morphometric study. Hum Brain Mapp 2011; 32: 1741-1749.

Date of preparation: March 2019; Job code: INTSP/C-ANPROM/NBU/16/0049c

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