Dr. Mark Bertin is a developmental pediatrician and the author of The Family ADHD Solution(opens in a new window). He attended UCLA School of Medicine, trained in general pediatrics at Children’s Hospital Oakland, and completed fellowship at Albert Einstein School of Medicine. Dr. Bertin is an assistant professor of pediatrics at New York Medical College, on the editorial board for Common Sense Media, and on faculty for the Windward Teacher Training Institute. He also leads mindfulness based stress reduction classes, frequently for parents.
Up to forty percent of children with ADHD demonstrate oppositional behaviors, and that’s not counting the general non-compliance often associated with executive function deficits. Anything from difficulty shifting attention away from engaging activities (which leads to requests not really being registered) to poor working memory (which leads to requests being quickly forgotten) gets easily misinterpreted as ‘oppositional.’ Yet regardless of the underlying cause it is typically parents, not children, who most effectively foster behavioral change. To most effectively manage oppositional behaviors with children with ADHD, parents can implement various strategic interventions while also monitoring the influence of their own adult response on any given situation. Here are some tips to help manage oppositional behaviors when they arise.
Practice the skill of noticing yourself lost in mental distraction. Return your attention to your actual experience, moment by moment, as often as needed. Notice when you’re off in thoughts, planning, or ruminations over the past, or when remaining mentally enmeshed in a recent situation. At dinner, if you’re still annoyed about how the morning went, you’re going to miss the fact that your child has moved on and wants to hang out.
Focus your attention on your actual experience with your children. Most days, some small experience that is pleasant and enjoyable will happen. Some moments may be challenging, but many are not. Enjoy them — and make sure to focus your attention on the experience, and on your child, throughout. If there is a successful behavior to praise, praise it before anything else has happened.
Create time for your child each day. Whatever it takes, carve out some time daily for your child. Let them pick the activity, and follow their lead as much as possible. If you have more than one child you may need to alternate days, allowing each child to get your full attention for however much time you can reasonably carve out.
Monitor your own behavior. Monitor your own habits and emotional reactions around behavior management (link to communication). If you escalate and yell or spank a child, you temporarily gain control but also teach that the loudest voice, or the heaviest hand, wins a confrontation. When you feel yourself agitated or overwhelmed, pause and focus on several breaths. Return your attention to the acute reality of the situation — and then choose a response.
Practice pausing before making requests. What do you anticipate asking? How accurately can you describe what you really want to happen? Would it be possible to offer it as a choice — do you want dinner now or in fifteen minutes? Is your request important, or could you let it slide? Notice how you are holding yourself, and imagine the tone of voice you would like to use.
Begin behavior modification by emphasizing appropriate behaviors. Start by noticing and praising the specific behaviors you want to promote. Then, create reward plans that emphasize success by rewarding the opposite of problem behaviors.
Consistently uphold limits and rules. Children quickly learn to take advantage if the limits you set are not actually followed. If pushing back gets them what they want, they will often take advantage. Set as few limits as possible, but firmly uphold the ones you deem most important.
Respond immediately to misbehavior. Consequences are most effective when immediate. In the midst of enforcing discipline, there is little point in discussion. That can wait until later. Similarly, you can praise and reward positive behaviors immediately as much as possible too.
When a behavioral plan isn’t working, reexamine the plan. Does your plan account for your child’s true abilities, right now? One common reason systems fail is when a child doesn’t have a certain skill yet. If a child with ADHD lacks the ability to notice time and organize their homework, they may appear oppositional without some kind of plan that helps them manage — they may not be doing their work because they can’t, not because they won’t.
You lead the way. Without conceding anything about who is ‘right’ or ‘wrong,’ parents influence the overall dynamic. Children typically don’t have the long-term perspective to know how to break a cycle of oppositional behavior. Change more commonly comes from behavioral plans implemented by adults, starting with an emphasis on praise and reward and adapted frequently over time. This does not imply that oppositional behaviors are a parent’s ‘fault’; it does mean that parents are more likely to address the situation skillfully than children.
Seek expert help. When oppositional behaviors occur in a child with ADHD, try your best, but keep in mind you’re probably not trained to manage them. You’re a parent, not a behavioral management super-genius. Maybe you’ve read a book that felt useful but you still don’t have a handle on everything. That’s entirely to be expected and not surprising. When you feel stuck, reach out to someone with the clinical training to help.
Topic:
ADHD