I’m looking for suggested behavior modification techniques to use with my 11 year old son who has ADHD. Over the course of the past 6 months, medication seems to have lost it’s effectiveness and ADHD behavior is becoming more problematic. My son shows real difficulty with controlling his impulses, especially blurting out. As of late, he constantly interrupts or blurts out his thoughts before considering the appropriateness of his comments. We have just returned from a holiday in DC and I observed him interjecting himself into other people’s conversations constantly. After the fact, he is often aware that his behavior was inappropriate and he is embarrassed by it, however he does not seem to be able to regulate this behavior. In school last spring, blurting out in the classroom was an issue.
He is entering middle school in another month. I would like to address this problem at home with a successful strategy that I can pass onto his teachers and support staff at school. I will be talking to his neurologist again about medication, however at our last visit in May, the neurologist indicated that he thought perhaps Sunshine had given up making an effort and was relying solely on medication as the miracle cure. He had been on a combination of Dexedrine and Wellbutrin, which seemed to work very well until February of this year, when the medication seemed to have little effect. He is currently on 54 mg Concerta and 2 mg Risperdal; this combination has never produced the same peak results as the Dexedrine and Wellbutrin.
Audrey
Re: Behavior mod for 11 yr old ADHD
My son does better on Dexadrine than he does on Concerta. That seems like a very high dose of Concerta too, my child is 12 and is on 18mg and has been on this same dosage for about a year now. When we tried 36 mg it felt like being wired up the wazoo’s. I wonder if the Concerta is too much of a good thing and if you backed down to a lower dosage he wouldn’t be as impulsive??
I would suggest therapy in pragmatics with a speech pathologist. They can conduct a small group and use a video camera so that he can see later on what he is doing by reviewing the video tape in his own private session with the SLP. This works well for the children when they see how their behavior looks and helps them in monitoring it as the SLP teaches them skills to handle themselves appropriately.
Re: Behavior mod for 11 yr old ADHD
Hi Audrey,
Are you saying your son had less of a problem with “interrupting” during conversations when his medication was working optimally? Has TS been ruled out?
Impulsivity may be part of the problem but I’m wondering if short term memory is another piece of this problem. Was the blurting out in the classroom related to answering questions, or was his talking and being disruptive, unrelated to the lesson that was being taught? Here’s why I ask: Many ADHD people have ideas flitting around in their heads, and when they are listening, it can be SO hard to hang on to what they want to ask or say until the other person is finished speaking. Your son could be trying very hard to behave appropriatedly, but at the same time feel he MUST speak before the idea just drops out. In other words, if he doesn’t say/ask it right then, he will forget it altogether.
I hope your visit to the neurologist is productive, and that the difficulty your son may be experiencing because of his ADHD is not too quickly minimized as bad behavior or over-reliance on medication. If the right medication makes him “available” to listen and learn, I’m not sure that what the doctor calls “over reliance” is necessarily a bad thing. Your son needs to get off on the right foot in middle school. Information will be coming faster and it will be more complex. If he is undermedicated, he’s not going to do as well as he could.
Check the LD in depth section of this website for more information on behavior modification, etc. JJ
You should probably post again on the Teaching ADHD board. There are a lot of mothers there very knowledgeable about ADHD.
My understanding is that certain aspects of attention are trainable. Programs such as Interactive Metronome and PACE often get good results in those areas. However, my understanding is that the impulsivity aspect of ADHD is largely not trainable, because the problem is primarily neurological in origin. In other words, I don’t think behavior modification techniques would help.
The problem of a child coming to rely entirely on meds for control of ADHD is fairly well documented. I think there are some articles that discuss this in the “LD in Depth” section of this website. This is more likely to happen when a child is prescribed meds but is not concurrently enrolled in counselling or skills training classes. It seems to be a form of “learned helplessness”, which involves complex issues of self-esteem.
If you haven’t checked it out yet, you may want to do some reading at http://www.brainplace.com. Dr. Amen has documented something like 7 different subtypes of ADHD, each of which responds favorably to different medications and supplements.
Mary