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Teaching Children with ADD to Get What They Need

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Teaching Children with ADD to Get What They NeedChildren with ADD need to learn how to meet their basic human needs--or receive payoffs--with productive, safe, and beneficial behavior, as opposed to the negative and often dangerous behavior they might typically adopt. Negative behaviors--such as bullying, arguing, disrupting in class, and more serious responses like drug or alcohol abuse, promiscuity, and criminal activity--are known as illusionary because they give the illusion of satisfying basic human needs but in fact do not. There are positive behaviors that offer the same payoffs as the illusionary behaviors. It can be helpful to show the ADD child that negative behaviors only appear to have a payoff.

Optimizing Options
Psychologists have found that children and teens who have chronic behavioral problems consistently lack the ability to identify legitimate ways to get the same payoffs that they derive from destructive activities. There is a simple test for measuring a person's tendency toward destructive thinking patterns. You begin a story but stop before the ending with the request that the person complete the story. The story might begin, "There was this boy named Johnny, and he always felt that he was different from everyone else because he was born with yellow eyes. He could have considered himself special because most people told him that his eyes were very mysterious and had a special intensity. But Johnny hated this feature about himself...

"Now complete the story."

The way the individual completes the story is rather predictive of how that person responds to challenges. The next step in the assessment is to ask the test subject to add a second ending; when that is concluded, another ending is requested; then another. A person with a healthy approach to life generally can come up with at least three different endings. This implies that the individual has the ability to find alternative behaviors to deal with challenges and stressful situations. Psychologists call this cognitive flexibility.

Children and adults who have trouble following the rules, whether at home, in school, or in society, have difficulty coming up with more than one ending. These individuals have difficulty finding socially acceptable ways to get the payoffs they want. Your job as the parent of an ADD child--or any child, for that matter--is to help the youngster learn to identify multiple acceptable options that meet his needs.

The I-OPT Approach
In my clinical practice and teaching, I have found that children can quickly learn to choose alternative behaviors with a method I call the I-OPT approach. The four steps that give this method its name are

1. Illusionary behavior
2. Objective feeling, or payoff, sought
3. Possible alternatives
4. Trial

Suppose your ADD child is angry and resentful toward a teacher. The anger and resentment qualify as illusionary behavior because they are not helping Johnny get the payoff he wants in an acceptable manner.

The first step in the I-OPT method of treatment for this negative behavior is to describe the illusionary behavior: "Johnny, you seem to be very angry with your teacher. Can you help me understand why you feel that way?" Johnny might answer, "Ms. Smith makes me so angry because she expects me to do all those math problems, and it takes me forever. She is so unfair."

If children have few coping skills (not many do), they usually react to stress and threat in one of two proactive ways: fight or flight. In the first way, they try to escape these situations by avoiding, denying, or running away--hence the word flight. In the second type, they become angry, stubborn, and hostile--hence the term fight.

The next step is to inquire about the objective feeling--the payoff--the child really seeks. "OK, Johnny, let's just pretend for a minute that you've just gotten really angry at the teacher. When you get to this point, how does it make you feel?"

Johnny might say, "I would feel good because I would get rid of my frustration and she would understand how I feel."

The next step is to have the child consider possible alternatives that would give him the desired objective feeling. For example, "OK, Johnny, so you want to feel two ways. You want to feel less frustrated and you want to feel that Ms. Smith understands you better. Besides blowing up, can you think of any other ways you could behave, and feel those things?"

Johnny gives some thought to the question. "Well, I could write her a letter and tell her, or I could just tell her how I feel."

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You can help the child find more possibilities. One idea parents can teach their children over time is to take the focus off blaming others and put the focus on their own efforts. Johnny's mother introduced the idea. She explained, "Maybe you could try something called focus techniques, which they teach in martial arts, to help you use all your powers of concentration. That way you won't have to worry about anyone but yourself. It will put you in control of your life. Doesn't that sound better than being angry all the time?"

Johnny liked the notion that these techniques were called martial arts, because he had seen these concepts acted in movies. I taught him that the first step in these approaches was to remove his emotions from the situation in order for him to focus all his intentions on strategies. He grasped an immediate understanding after some rehearsals with various scenarios, such as a bully threatening him or a person calling him names. (Youngsters are usually quicker to learn this principle than adults because youngsters' worlds are simpler.)

Once Johnny had mastered the concept, we rehearsed focusing techniques that would involve a teacher model. The next day I phoned his teacher and explained our plan to have Johnny practice this approach with her, and I also explained that Ms. Smith would be playing her part as "practice" for that day. Ms. Smith was great in her understanding; and with full knowledge that the first trial would be a practice run, they had an encounter the next day.

Johnny was excited in his first practice run with the teacher (thanks in great part to the teacher's reinforcement), and he continued to "practice" his focusing techniques, thus becoming a teacher to other students.

Not all dialogues with ADD children go as smoothly as that, but you'd be surprised how many actually do. This is a solution-based approach to destructive behavior. In summary:

• I--Consider the illusionary behavior without critique and as a method the child has chosen to achieve legitimate emotional needs.
• O--Consider the objective feelings, the payoff, the child seeks.
• P--Consider possible alternative options that would achieve the same payoff.
• T--Try them out.

As examples, some of the most frequent behaviors, feelings, and alternatives I have observed for children with ADD are listed below.

Illusionary Behavior Payoff Behavioral Alternatives

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Lying Self-esteem Achieving success through physical challenges Passive aggression Power Controlling internal dialogue and learning techniques of positive self-talk Drug Abuse Independence Learning altered states of consciousness Bullying Attention Assuming responsibility for others (for example, as a traffic supervisor)

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