Behavioral Therapy for Young Children
The American Academy of Pediatrics recommends that young children (ages 2 to 5) with ADHD receive behavior therapy for treatment first before trying medication. Behavior therapy for young children is most effective when their parents learn strategies from therapists and use those strategies to manage their children’s behavior. Parents learn to create structure, reinforce good behavior, discourage negative behaviors, provide consistent discipline, and strengthen the relationship with their child through positive communication. These techniques not only help children with ADHD but also children without a diagnosis to function successfully at home and at school.
A recent study by researchers at the Centers for Disease Control and Prevention (CDC) reports that despite these guidelines, only one in two young children diagnosed with ADHD are receiving psychological services, which may include behavior therapy.
How does behavior therapy help me and my child?
The inattention and impulsivity associated with ADHD can contribute to negative interactions and behaviors in children. They may tend to misbehave and be punished more frequently than other children. This frequent punishment can have a negative effect on their self-image and cause problem behaviors to increase. Parents may find that their typical parenting strategies do not work very well. Parents can learn to manage the behavior of young children who have ADHD by receiving training in the use of behavioral techniques and work with caregivers (daycare providers, preschool teachers, and others) to help reduce these negative behaviors and interactions.
What does behavior therapy look like?
Parenting children with ADHD presents unique challenges. Children develop differently, and ADHD may present differently in each child. A professional can help parents determine when and what types of responses are appropriate for their child. It can be very difficult for parents to learn these parenting strategies just from books and websites and to implement them on their own. Parents can learn specific skills and strategies that are most effective with their children who have ADHD. The training includes practice and therapist support in applying these techniques effectively and consistently. Help from a professional can be very helpful.
Therapy for ADHD generally includes teaching parents the following skills:
- Establishing house rules, structure, and consistent routines
- Learning to provide specific praise and attention for appropriate behaviors (praising good behavior often) and not providing attention for mild, annoying but not harmful behaviors (choosing your battles)
- Using developmentally appropriate directions and commands
- Planning ahead and working with children in public places
- Using consistent and effective disciplinary strategies
For parents of young children, the training will need to be particularly sensitive to the child’s developmental level. Preschool-age children change more rapidly than older children. They are more likely to engage in tantrums and other oppositional behavior that can be normal for this developmental period. However, children with ADHD are likely to perform these behaviors with greater frequency and intensity. Again, a professional will help parents to determine at what point a behavior requires intervention and which strategies work best with each child.
Unlike older children who generally have had various social experiences and have acquired many social behaviors, learning how to get along with other children in pairs and groups is just emerging for young children. Because group situations can be challenging for young children with ADHD, behavioral parent training will help parents learn how to foster these skills. Behavioral parent training typically runs for 8–12 sessions. However, some families may require more sessions.
The therapist will train parents to consistently use effective communication and other strategies to manage their children’s behavior and strengthen their relationship with their child. Between sessions, parents use and practice what they have learned and return to the next session to discuss progress, adjust strategies as needed, and learn new skills.
Applying these skills with children with ADHD takes work on the part of parents. However, the hard work pays off. Parents who master and consistently apply these skills will see fewer behavior problems and better family functioning. Their child will have improved self-esteem and better relationships with parents, siblings, teachers, and others.
What parent management training programs are out there for parents of preschoolers?
The following parent behavioral training programs for parents of preschool-aged children that currently have enough research evidence to be described as effective:
- Helping the Noncompliant Child
- Incredible Years Parenting Program
- New Forest Parenting Programme
- Parent-Child Interaction Therapy
- Triple P (Positive Parenting Program)
According to a 2011 review by the Agency for Healthcare Research and Quality (AHRQ), behavioral parent training programs taught by trained therapists can “help parents manage their child’s problem behavior with more effective discipline strategies using rewards and nonpunitive consequences. An important aspect of each is to promote a positive and caring relationship between parents and their child.” The AHRQ review found the following common therapeutic components across the effective programs:
- help parents develop a positive relationship with their child
- help them manage negative behavior and increase positive behavior with positive discipline
For parents who do not have access to the specific programs mentioned above, seeing a therapist who focuses on the same elements may be helpful.
Centers for Disease Control and Prevention, http://www.cdc.gov/ncbddd/adhd/treatment.html, accessed 03/16/2016.
Centers for Disease Control and Prevention, Vital Signs: ADHD in Young Children, http://www.cdc.gov/vitalsigns/adhd/, accessed 05/04/2016.
Charach A, Dashti B, Carson P, et al. Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment . Comparative Effectiveness Review No. 44. AHRQ Publication No. 12-EHC003-EF. Rockville, MD. Agency for Healthcare Research and Quality. October 2011.
Zwi, M, Jones, H, Thorgaard, C, York, A, Dennis, J. (2011). Parent Training Interventions for Attention Deficit Hyperactivity Disorder (ADHD) in Children Aged 5 to 18 Years. Campbell Systematic Reviews.