BEHAVIOR THERAPY is a recommended intervention for children with ADHD. Parenting programs that use behavioral techniques typically involve supporting parents in improving child behavior by modifying antecedents (giving effective instructions, for example) and consequences (such as rewards, loss of privileges). When these parenting programs include teacher involvement, they can be even more helpful because parents and teachers are working collaboratively to support a child with ADHD.

Although such programs use evidence-based strategies, we are continually looking for ways to make interventions for ADHD better. One issue that may arise is a disconnect between knowing and doing. For instance, I may know that as part of the behavioral program, I am to give a reward for completion of the morning routine, but it can be hard to follow through. One method to bridging the knowing-doing gap may be to focus on the thoughts that can get in the way.

Self-confidence and interpretations for child behavior

Research shows that our confidence in our ability to act successfully may have an effect on whether we can actually act successfully. Some examples are beliefs like, “I feel confident in my ability to parent” or “I know that I can help this student learn.”

In addition, our explanations for someone’s actions may also influence our behavior. For instance, it can be hard to change our own behavior in using behavioral strategies when we explain a child’s misbehavior by thinking that this behavior was due to something internal to the child, that it will keep happening, and that it happens across situations. An example of this more negative interpretation is thinking, “He did not do his homework because he didn’t want to, and this will always be the case in the future and across settings.”

At the Attention, Behavior, and Cognitions Lab, we are trying to understand how we can use what we know about thoughts to empower parents and teachers to act effectively in supporting children with ADHD. One of our studies involves better understanding whether an ADHD program that not only addresses behavior management but also improves negative thoughts can be helpful.

In this program, parents and teachers discuss standard behavior management techniques and also receive ongoing support around how to actually manage the thoughts that get in the way. These are negative and hopeless thoughts like, “I can’t seem to ever get things right,” “I don’t think this behavior is going to change,” and “I’m a bad parent/teacher.” Such thoughts may occur regularly for parents and teachers of children with ADHD, especially in stressful circumstances. Thus, the program looks into how parents and teachers can use evidence-based tools to notice when these types of thoughts are occurring and then address them.

Strategies for managing negative and unhelpful thoughts

1 Prioritize self-care.

Rejuvenating activities (such as spending time with friends or exercise) can help improve our mood. Negative and unhelpful thoughts are more likely to occur when we don’t have that balance in our lives. One idea might be to schedule in these activities, so that we are not only modeling healthy self-care for our children but also reducing the likelihood that lack of self-care may influence our mood and actions.

2 Notice when negative and unhelpful thoughts are occurring.

We may be more likely to think negatively when we are feeling low in mood and/or stressed, so a change in mood or greater stress may be cues to look inward at our thoughts. On average, parents and teachers of children with ADHD, compared to those of children without ADHD, are more likely to be stressed, which may make them more vulnerable to such thoughts.

3 Challenge your thoughts.

When we have a negative thought, such as “my child is not doing his homework to annoy me,” we can try thinking about what the evidence for and against the thought is. The idea is not to immediately accept the thought as real, but to test it against what we know. For instance, I may think about what the evidence is for this thought and what the other explanations might be for his behavior. To help challenge negative thoughts, we can try thinking about what we would say to a friend who has the same thought or check in by asking trusted friends or family what they think.

4 Find a constructive path forward.

If there doesn’t seem to be much evidence for a negative thought, then we might try to think of a more balanced and helpful thought. For instance, I might think “he’s having a tough time with homework tonight, and there have been other days when he has worked on homework independently,” which may have a different effect on mood and behavior. It may also be the case that after examining the evidence, there is still a lot of support for the negative thought. A helpful next step might then be to assess the antecedents and consequences of the behavior of not doing homework. An example might be that this child is frustrated with the amount of homework, and is getting attention when he goes off -task. An appropriate strategy here might be to divide up the homework and provide short breaks that serve as rewards for completing each chunk. Since attention can be very reinforcing, these short breaks can involve getting positive parental attention.

Drawing from cognitive behavior therapy, thoughts, behavior, and feelings are interconnected. Although we don’t want to give the impression that thoughts are the only important ingredient for enhancing ADHD treatments (because we know that other critical factors such as time and resources also affect the ability to support children with ADHD), addressing potential thoughts that can get in the way may be one way of improving the use of intervention strategies for ADHD. More information on ADHD, behavior therapy, and CBT can be found in the list of additional resources.

Yuanyuan Jiang, PhD, RPsych, is an assistant professor of the school and clinical child psychology program in the department of educational psychology at the University of Alberta, and a registered psychologist at the College of Alberta Psychologists. She is director of the Attention, Behavior, and Cognitions (ABC) Lab, where she studies how attention, behavior, and cognitions interact in children, parents, and teachers, to improve assessments and interventions for children with inattentiveness and/or hyperactivity/impulsivity.

Katrina Aranas, BSc, is in her first year in the school and clinical child psychology master’s program at the University of Alberta. She completed her honors bachelor of science at the University of Toronto, Mississauga. She is interested in child psychopathology and her current research is focused on early intervention for children with ADHD.

ADDITIONAL RESOURCES

Greenberger, D., & Padesky, C. A. Mind Over Mood: Change How You Feel by Changing the Way You Think (2nd ed.). New York: Guilford Press, 2016.

Jiang, Y., Haack, L. M., Delucchi, K., Rooney, M., Hinshaw, S. P., McBurnett, K., & Pfiffner, L. J. (2018). Improved parent cognitions relate to immediate and follow-up treatment outcomes for children with ADHD-Predominantly Inattentive Presentation. Behavior Therapy, 49, 567-579. doi:10.1016/j.beth.2017.11.007

Kazdin, A. E. Parent Management Training. New York: Oxford University Press, 2011.

Pfiffner, L. J. All About ADHD: The Complete Practical Guide for Classroom Teachers (2nd ed.). New York: Scholastic Professional Books, 2011.

Pfiffner, L. J., & Haack, L. M. (2014). Behavior management for school-aged children with ADHD. Child and Adolescent Psychiatric Clinics, 23, 731-746. doi:10.1016/j.chc.2014.05.014