Behavioural Therapy

John Rogers is development officer for Parent Network
Scotland, a voluntary organisation that delivers parenting courses.
He has a background in social work, a particular interest in parent
education and support, has set up several parenting courses and is
a trainer with Mellow Parenting.

Most parents have few ways of receiving feedback as to whether
they are bringing up their children “correctly”. But parenting
education and support delivered “by parents, for parents” can make
a difference, believe organisations such as Parent Network
Scotland.

Such education can be especially important for parents whose
children have attention deficit hyperactivity disorder (ADHD).
Problems with their children’s behaviour often lead these parents
to feel they must have done something “wrong”. Many feel they are
“banging their heads against a brick wall”. And these feelings can
be exacerbated if neighbours or professionals show disapproval and
imply that better parenting might solve the problem. The behaviour
of a child with ADHD can be exasperating and wearing for parents,
who often end up stressed and depressed. Isolation makes this
effect worse.

Parents may spend a lot of the day telling their child off and
becoming angry. While they know that children with ADHD often have
short-term memory problems, it is still frustrating to have to tell
your child repeatedly not to do something. Alternatively, they may
find it difficult to continue telling off the child because they
are aware that children with ADHD have low self-esteem. But such
restraint can lead to despair about how to set limits. They may
also worry that the child commands more attention than their
siblings.

Outside the home, more problems arise. Children with ADHD find it
difficult to make and keep friends, so they can become isolated and
vulnerable to bullying. Their social and behavioural difficulties
can lead to problems in their relations with teachers and peers.
Their attention span may not fit with the demands of changing
lessons. And they may also have other learning difficulties, such
as dyslexia, which add to their problems in fulfilling their
potential.

Parents despair when their child is excluded “yet again” for
behaviour that is typical of ADHD and which the school may have
found difficult to cope with. Such exclusions can be especially
frustrating when a parent realises another school has found
positive ways of dealing with the same behaviour for another child.
Many schools struggle to meet the individual needs of children, and
a pattern of exclusions can arise.

Treatment of ADHD focuses on drugs because the condition seems to
be a disorder in brain functioning, which manifests itself as
hyperactive behaviour and difficulties in concentrating. However,
for practical purposes ADHD is best seen as a disability, which
makes it more difficult for that child to fulfil their potential.
These children need help. Their parents also need help in how best
to support their children.

Parent Network Scotland’s course, Getting through the Day (ADHD),
evolved through involvement with parents and research into the
literature. Crucially, the psychiatric services in Livingston also
supported its development. The course comprises 10 weekly sessions
and offers a forum where parents can find information about ADHD,
understand the child’s world better and enhance their repertoire of
strategies for managing their child’s behaviour. It includes
training sessions, handouts and activities to be done at home.
Three courses have been run so far. Forty parents were referred, of
whom 27 attended for one session or more. Twenty parents completed
the course, seven dropped out.

Evaluation of the courses showed that nearly all parents rated the
training very highly. Although most parents felt less stressed
after taking the course, other aspects of mental health –
confidence, assertiveness and so on – seemed to require more work
for some parents.

Where the course did seem to be particularly effective was in
enhancing listening skills. This was manifest in reported
improvements in being able to help children with their feelings,
not shouting at the children as much, seeing the child’s world more
clearly and dealing with behaviour better. Parents came up with
imaginative ways of dealing with behaviour.

For example, one parent found she was constantly remonstrating with
her six-year-old child over repeated negative behaviour. In
response to the course, she decided to try to ignore most of these
negative behaviours and “pick on” all the positive behaviours. She
also took the advice given to play more with, and talk more to, her
child, using some of the exercises that can be done at home. This
approach produced significant changes in behaviour.

Another parent described how she began to understand that her
10-year-old child would engage her in lengthy arguments, all of
which distracted from her being able to assert herself. Finding
ways to disengage from this process enabled her to assert herself
and avoid arguments.

Another parent found she could change a hitherto chaotic morning
routine into one that worked well. She looked at five-minute
“chunks” so she could see where the stress points were, and she
altered the routine. As a result chores were completed and there
were far fewer arguments.

Difficulties at bedtime were resolved by making it a game. A mother
pitched a tent in the bedroom and her son went “camping” when he
went to bed. Rather than having a battle about bedtime, her son
couldn’t wait to go to bed. This mother was well aware a new
strategy might soon be needed, but was happy with her
solution.

Most parents find that learning to listen to their children makes a
big difference. It calms things down. One parent wrote on the
evaluation form: “I hoped to get my son much calmer. I learned to
be much calmer myself.”

A 10-week course will not solve all the problems and parents
recognise that ADHD is a chronic condition which is not amenable to
a “cure”, although there may be ways a child can be helped to deal
with their disability. Continuing support is needed, and this is
being offered in Livingston through a support group which is open
to all parents, including “graduates” from the courses. We have
also encouraged some parents who have completed the course to train
as facilitators. The course has since been successfully run in
several other locations.

Many of the services for children with ADHD are aimed at the
children themselves, whereas services for parents are limited. Yet
the parents are our main caring resource. Parenting courses
represent just one segment along the service spectrum, but a vital
one.

ABSTRACT

This article describes a group intervention to help parents who
have children with ADHD. The course is based on a self-help ethos,
with peer learning an important element. The course seems to
achieve positive outcomes, including improvements in stress levels
and particularly in listening skills. A support group has been set
up to maintain the gains made. The support of the psychiatric
services was vital.

FURTHER INFORMATION

• J Barton, Hyperactive Children, The Child and Family Trust,
  1999
• Useful ADHD groups include: The ADHD Family Support Group, 1a
  High Street, Dilton Marsh, Westbury, Wiltshire BA13 4DL; national
  information and support service ADDISS at www.addiss.co.uk; Livingston
  local support group ADD-PINS at PO Box 1883, West Calder EH55
  8WB

CONTACT THE AUTHOR – E-mail johnr@pns.org.uk