Pavlov makes it seem easy. Ring a bell and the dog drools.
In my personal experience trying to condition my son's behavior has been nothing but easy.
We've tried paper behavior charts, different size rewards from little toys to trips to disney. We've tried whiteboards and picture charts, and lastly this week we tried an online version of a behavior system...adhdnanny.com. Of all the chart systems we've tried this one seemed to have the largest appeal to our son because it is in a "club penguin" type setup where he can cash in points for rewards online. However, 2 weeks in we are already slacking...are we lazy? or does the novelty or effect wear off? Sometimes I wonder who needs the training him or me?
So why do we keep on trying? Most of the research about how best to manage ADHD suggests that "multimodal" treatment - a combination of medication management and behavioral therapy is most effective (although this is controversial at this point). Most of this data comes from the National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA). In the initial study a combination of behavioral therapy and medication outperformed medication alone on several behavioral rating scales. However, on follow up studies the advantage of behavioral therapy is less clear - the picture is confused by the difficult of keeping up with the behavioral therapy. Even when state of the art behavioral treatment was provided to families at NO CHARGE, almost 40% of families were unable and/or unwilling to fully take advantage of it. In the study the behavioral treatment included parent training, child-focused treatment, and a school-based intervention.
Parent training involved 27 group sessions and 8 individual sessions per family. The focus was on teaching parents specific behavioral strategies to deal with the challenges that children with ADHD often present. The child-focused treatment was a summer treatment program that children attended for 8 weeks, 5 days a week, during the summer. This program employed intensive behavioral interventions that were administered by counselors/aides who were supervised by the therapists conducting the parent training. The basic model was one in which children were able to earn various rewards based on their ability to follow well- defined rules and meet certain behavioral expectations. Social skills training and specialized academic instruction was also provided.
The school-based treatment had 2 components: 10 to 16 sessions of biweekly teacher consultation focused on classroom behavior management strategies, and 12 weeks of a part-time paraprofessional aide who worked directly in the classroom with the child. Throughout the school year, a Daily Report Card was used to link the child's behavior at school to consequences at home. The Daily Report Card was a 1-page teacher-completed ratings of the the child's success on specific behaviors. This was brought home daily by the child to be reviewed by parents with rewards for a successful day provided as indicated.
Whoaa! Who on earth could implement or sustain that type of behavioral program? Our longest stretch with a simple behavioral chart has lasted 2 weeks tops. Some days I wonder why keep trying, we will never come close to the ideal behavioral plan outlined by the MTA study. However, every time we start and stop we do see short term improvements so I will continue to look for the nirvana of behavioral plans/charts/chips we can stick to.... if anyone out there has the answer please post below :)
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