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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 medication.
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 »
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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 children
- 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.
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What parents can expect in behavior therapy
What parents can expect in behavior therapy
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.
What parents learn when trained in behavior therapy
What parents learn when trained in behavior therapy
- 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.
The fundamentals of behavior therapy for ADHD are easy to understand and implement, even without the help of a psychologist. 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.
[Take This Self-Test: Could Your Child Have Oppositional Defiant Disorder?]
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.
[Download This: Your Free ADHD Guide to Better Behavior Through Therapy]
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 professional 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 Discipline Strategies: More Carrot, Less Stick!]
ADHD Behavior Therapy: Four Good Books
Behavior Modification: What It Is And How To Do It, 8th Edition
Parenting the Strong-Willed Child: The Clinically Proven Five-Week Program for Parents of Two- to Six-Year-Olds 
Your Defiant Child, Second Edition: Eight Steps to Better Behavior
Homework Success for Children with ADHD: A Family-School Intervention Program
