Module 11: Review, Wrap Up, and Planning for the Future

Attention-deficit/hyperactivity disorder is a chronic condition, requiring ongoing use of behavioral skills learned in this program. Without the support of a therapist, it may be difficult for parents to use these skills consistently. The more that these skills become automatic, the more benefits parents and children will experience. A goal of this module is help parents to think about and prepare for how to apply the principles and strategies presented in this program to possible future issues they encounter with their child and personally. It is important to anticipate and catch problems early, so that parents can engage these tools before problems escalate. Another goal is to ensure that parents have, by now, realized the value of self-care so they can create a supportive, consistent environment for their children. Ongoing monitoring of their mood, parenting, and child behavior will help parents to recognize signs that it is time to seek additional professional help.

Module 9: Emotion Coaching

In Module 9, parents are introduced to their important role in helping their children with attention-deficit/hyperactivity disorder (ADHD) learn to regulate strong emotions. Parents are the child’s first teachers for how to regulate emotions and serve the role of “external regulator” for their children. Children with ADHD are more sensitive to their environments and look to their parents for signs of how to react to a situation or stressor. The goal is for parents to stay calm and collected, modeling effective emotion regulation for their child during periods of stress. When parents learn to be “emotion coaches,” they are more likely to consider the child’s emotions without judgment and decrease critical or invalidating responses. By serving as the child’s “emotion coach” (noticing, tolerating and labeling the child’s emotion), the child learns “emotion language” so that acting out in response to emotions is not necessary to express how they are feeling.

Module 3: Maintaining a Consistent Schedule and Time Management

In Module 3, parents learn to develop and maintain a consistent household schedule and daily routines for their child and themselves. All children benefit from consistency, but children with attention-deficit/hyperactivity disorder (ADHD) can be especially reactive when their environment is unpredictable or chaotic. External structure can scaffold the child with ADHD’s own sense of organization. In many families, parents of children with ADHD struggle with executive function or attention difficulties themselves. Teaching parents to implement a consistent daily schedule and to more effectively manage their time can reduce the parental stress that can contribute to harsh or negative parenting and poor parent–child relationship. In this module, you will work with parents on the basics of scheduling and time management, with the goal of creating a more organized and harmonious household.

Module 10: Home Point Systems

When parents have tried everything and their child is still struggling with compliance, routines, and other serious behaviors, you can suggest a more intensive point/token system. The rationale for this type of system is that children with attention-deficit/hyperactivity disorder (ADHD) respond better to frequent, immediate rewards over delayed rewards. The overall goal of the home point/token system is to make the expected behaviors very explicit and to provide more frequent rewards or consequences contingent on an explicit set of behaviors, using a more structured system of reinforcement. For a system like this to work effectively, it must be implemented consistently across caregivers, which is challenging for many parents. Keeping the system simple and straightforward tends to work best, especially as parents are first learning the principles. It may also be helpful to begin by focusing on one time of day to acclimate parents to the system, later expanding to other times of the day.

Module 7: Time Out and Privilege Removal

In Module 7, parents learn to use time out from positive reinforcement to help their child improve their ability to follow directions and house rules. Children with attention-deficit/hyperactivity disorder (ADHD) benefit from parents who consistently following through with a consequence for noncompliance and rule-breaking to reduce misbehavior. Time out is effective when used in the presence of a secure relationship and where opportunities for connection and positive reinforcement are consistently available in the home environment. Inappropriate behaviors are more likely to happen again when directions and rules are not enforced consistently: misbehavior continues to have positive consequences. Children with ADHD benefit from the structure, consistency, and predictability of the time out consequence to reduce problem behaviors. In fact, time out is thought to help children learn to self-regulate. Parents need to be prepared to manage their own emotional experience and their child’s reaction to execute time out correctly and experience the full benefits of time out.

Module 6: Assertiveness, Effective Commands, and House Rules

In Module 6, parents learn about assertiveness and how to apply assertiveness skills to improve communication with others. An assertive (or authoritative) parenting style, characterized by giving effective commands and setting house rules, provides both nurturance and structure. The assertive parent follows through with healthy boundaries in a calm and effective manner. Parents also need to use assertiveness skills when they communicate with their child’s school, their partner/co-parent, and extended family members. In addition, parents’ success with self-care requires asserting their own needs (e.g., saying “no” to additional obligations), following through with needed changes, and challenging the beliefs (thoughts) about holding others accountable or asking for help. Given the large influence of social interactions on mood, assertiveness skills can have significant benefits for a parent’s overall interpersonal functioning across domains of family and work.

Module 4: Praise and Changing Your Thinking to Feel Better

During Module 4, parents learn to praise their child to increase appropriate and desirable behaviors. They also learn that their own automatic thoughts about their child, parenting, and self can influence how they feel and behave. By learning common thinking errors and how to challenge them, parents develop an important skill that can help them with emotion regulation and improved mood, which can in turn affect their parenting. Parents will also be able to increase their sense of control by learning the thoughts-feelings-behaviors connection. Although parents cannot always control a situation, they can learn to respond in new ways. Toward this end, specific strategies for increasing helpful and constructive thinking and decreasing negative or unhelpful thinking (particularly in relation to their parenting and child) will be taught in this module. As parents establish new ways of thinking, different feelings and actions will follow.

Module 2: Special Time and Pleasant Activities Scheduling

During Module 2, parents increase pleasant activities with their child and on their own. Parents of children with attention-deficit/hyperactivity disorder (ADHD) often get caught in the cycle of giving more corrective/negative feedback than positive feedback. This negative feedback loop can impact the parent–child relationship, the child’s behavior, and the parent’s mood. By the time they seek treatment, parents often say that they find it hard to enjoy time with their child. You will instill hope that, by using “Special Time,” the parent can begin to enjoy time with their child again and ultimately improve their relationship. In addition, parent participation in scheduled pleasant activities (away from their child and work/family demands) is emphasized as necessary to effectively parent a challenging child. Over the course of the program, one overarching goal is to help parents prioritize their self-care, for the sake of their own mental health and their family’s well-being.

Module 8: Working Effectively with the Schools

In Module 8, parents learn the importance of advocating for their children’s educational needs by developing and maintaining a collaborative working relationship with the school. The most effective outcomes come when parent(s) and school collaboratively work together toward the common goal of helping the child succeed. To be the most effective advocate for the child, parents must understand their educational rights. Parents should also be familiar with evidence-based strategies for addressing academic productivity and behavior management in the classroom (e.g., Daily Report Card [DRC]) so that they know what to ask for. Some parents will need support to appropriately assert themselves in this context, refraining from being either too passive or too aggressive. Other parents will need support with keeping organized records of their children’s psychological evaluations, records, and report cards, which is essential as they prepare for school (IEP, 504 Plan) meetings.

Module 1: Psychoeducation and Theoretical Foundations

In Module 1, parents learn the theoretical foundations for the program. This is a time to build rapport, learn more about the child’s specific problems, identify treatment goals, and instill hope. Parents learn about two foundational models in Module 1: the ABC model of child behavior and the transactional model of attention-deficit/hyperactivity disorder (ADHD) and families. The difficulties that children with ADHD experience can contribute to parent stress and/or negative reactions to their child. Parents may feel frustrated, stressed, worried, and/or sad about their child’s behavior. Some parents may blame themselves or feel they’re not doing a good job. On the other hand, the degree to which a parent is responsive and sensitive can help or hinder temperamentally at-risk infants and young children in terms of the later development of ADHD-related problems. Teaching parents effective ways to respond to their child can have important implications for the child’s ongoing adjustment.