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Reinforcement for Children with ADD

Reinforcement is defined as anything that increases the strength of a behavior. If your child does something that pleases you and you praise her for it, she does it again. The more powerful the reinforcer, the more likely the behavior will occur again. People respond to different types of reinforcers; for example, some of us respond to pay, others to food, and still others to a single "thank you." Nevertheless, there are some general guidelines that should be used when delivering reinforcement. The first thing you need to know is to start simply. The hierarchy of reinforcement is listed below.

1. Praise (verbal and nonverbal)

2. Praise coupled with activities

3. Praise coupled with tangible rewards

4. Token economy systems

Step one is to use praise. Too often parents think that reinforcement requires that they give their child expensive toys or gifts every time she does something appropriate. Although some types of tangible reward may be necessary for some children with ADD, one of the most effective ways to increase appropriate attending behavior is to praise (verbally and nonverbally) your child after she engages in appropriate behaviors.

Early research findings in this area provided parents with a simple dictum: "Catch them when they're good." It was clear that the more parents commented on their child's positive behavior, the more the child displayed the behavior. It sounds so simple, but it's not. Parents may be so attuned to focusing on negative behavior that they find the shift in focus very difficult. Some parents may find it awkward praising their children for appropriate behaviors. Some parents feel especially uncomfortable when praising their child outside of the home. Why, they wonder, do they have to praise desired behavior, when other parents don't? And moreover, others look at them in disbelief. We can only say that it has been demonstrated to be effective. The professional literature and our experiences indicate that initially it is awkward and, at times, uncomfortable to be so effusive in your praise. Yet, when you start receiving results, it becomes worth it. A step-by-step guide to delivering praise is as follows:

1. Make a list of all appropriate behaviors your child engages in, no matter how simple they appear to be. Take nothing for granted. The easiest way to do this is to write down during a typical day every appropriate behavior from the time your child awakens until she goes to sleep. If both parents are available, both should make lists. Do this independently of each other. You'd be surprised how much each of you misses.

2. Every time your child displays the targeted behavior, say and/or do something positive. Try to vary your comments so that you are not continually saying, "Good." It's helpful if you can be specific in your praise. For example, "I like the way you got ready for school this morning; you really made me proud." Smiles, winks, and hugs should also be used frequently.

3. Praise should be delivered only after your child displays the appropriate behavior. You are trying to establish a link between the behavior and the consequence. If you praise her when she is engaging in inappropriate behaviors, you will increase them, which is exactly the opposite of what you are attempting to do.

4. Praise should be delivered very often in the beginning of a behavioral program. This continuous reinforcement serves to strengthen a behavior. As the behavior occurs more often, you can gradually reduce praise.

5. Praise should be delivered immediately after the behavior occurs in the beginning stages. Every time a positive behavior occurs, praise should be given. Over time you will be able to reduce the frequency of praise, but not until the behavior has been clearly established.

6. Praise should be genuine. Most parents we know are truly pleased when their child engages in appropriate behavior. Their praise merely reflects this. If you use praise in an artificial manner, children will see through it.

7. If you find it difficult to give praise, try some of these tips:

   1. Post signs around the house (especially in the cupboards in the kitchen) to serve as reminders. (Example: Don't forget to let Adam know how much you appreciate his "eating behavior.")

   2. Tape record segments of the day and play them back, in order to monitor your rate of praise.

   3. Buy a wrist golf counter and record your behavior each day. Try to increase it by ten percent daily.

   4. Put a piece of adhesive tape on your wrist and make a mark each time you praise your child.

Praise will not be effective for every behavior associated with ADD. You may need to use additional reinforcers. What it will do, however, is reduce many minor disruptive behaviors and highlight those behaviors that may need additional reinforcement. Without this clarity, every behavior takes on the same value. After a while physically abusing one's siblings becomes as important as not being ready when the school bus arrives. Even when praise alone is ineffective, it should not be abandoned. You merely couple praise with the additional reinforcers noted above.

The next step in the hierarchy is praise coupled with activities. These activities should be ones readily available in your home; you should not have to go out and buy lavish rewards. Merely write down all the activities your child finds pleasurable. Every time she engages in the appropriate behavior, she has "earned" the activity. These should be somewhat simple activities, such as being read to, watching TV, playing ball, playing a board game. Essentially, children learn that first they do something that you want them to do, then they receive something they want.

Parents find this procedure to be very effective. You are not using threats ("Remember, if you want to play ball..."). Rather, you are allowing them to "earn" privileges when they engage in appropriate behaviors. Once again, this may not be effective for all behaviors. If this does not work, proceed to the next step in the hierarchy.

Praise coupled with tangible reinforcement may be necessary for some children with ADD, especially younger children and those with more severe deficits. As noted above, praise should be continued and coupled with a tangible reinforcement immediately after the behavior occurs. Try to think of all the tangible rewards your child likes. These can be stickers, pencils, pads, food, or any small item your child enjoys. Use only small amounts. Try to spread the rewards throughout the day. In many cases, parents benefit at this point from consultation with a professional who is well-versed in applied behavior-analysis techniques. The use of tangibles needs to be closely monitored.

It may also be appropriate to implement a token economy system - that is, a system whereby your child earns points, stars, tokens, and similar items that can be traded in at a later date for specified reinforcements. Some children and adolescents benefit from the use of contracts - that is, when a parent and child develop an agreement specifying what each must do. These contracts are not impossible to carry out on your own, but we believe it is wise to consult a professional. Once you have developed the skills necessary to carry out such programs, you will begin to see changes in your child's behavior. And you are more apt to develop such skills under the guidance of a professional. Some parents may have a hard time coming up with potential reinforcers for their children. Below is a list developed by Dr. R. Vance Hall of the University of Kansas, which we have modified. While it is not exhaustive, it does provide parents with a good start.

Potential Reinforcers for Preschoolers

Social Reinforcers
Verbal

1. Specific praise.

2. Indirect praise (telling someone else how good they are).

3. Suggested words or phrases: "Yes." "Great." "That's right." "That's fine." "Good." "Uh-huh." "Keep going." "O.K." "All right." "Pretty." "Doing better." "I like that." "Good job." "I'm pleased." "I'm proud of you." "Show us how." "You're polite." "Thank you." "I'm glad to see you." "It makes me happy when you...." "I like the way you...." "Do that again for me."

Physical
Hugs. Kisses. Smiles. Eye contact. Tickle. Wink. Handshake. Touch. Toss into the air or whirl around. Piggyback ride. Pat on the back. Chuckling/cheering. Jumping up and down. Tweaking nose.

Material Reinforcers
Toys/balloons. Books/puzzles/magazines. Snacks of favorite food. Pennies for bank.

Activity Reinforcers
Taking a trip to a park, zoo, library (any special outing). Going to work with Dad or Mom. Playing with friends. Listening to stories or songs/singing songs. Playing on swingset or in sandbox. Spending the night with Grandma/Grandpa or favorite adult. Having opportunity to feed pet. Rocking. Playing a game/playing catch with parent/having a friend over to play or eat. Enjoying finger play. Taking a picture of how good they are while they are (a) sitting on a potty, (b) displaying good table manners, (c) going to bed. Talking into a tape recorder/listening to records. Going out for a meal, snack, or movie. Playing with dough or clay. Finger painting/coloring. Blowing bubbles. Helping mom or dad. Spending more time in bathtub, or not having to take a bath (also bubble bath). Riding in car or on bicycle with adult/riding tricycle. Getting extended bedtime or skipping nap. Watching TV. Going outside (day or night). Helping hold baby/give baby bath. Swimming/being pulled in a wagon/swinging. Carrying purse or attache case for adult. Displaying art work. Playing with toys. Using telephone to tell of success. Taking special ride on escalator or elevator. Helping cook a meal or choosing the menu. Helping water grass, flowers, or helping plant a garden. Camping out in the backyard.

Token Reinforcers
Stars on a chart, backed by material and activity reinforcers listed above.

Potential Reinforcers for Elementary Children (Ages 5-11) at Home
Social Reinforcers
Verbal

1. Specific praise.

2. Indirect praise (telling someone else about what they did or accomplished).

3. Suggested words and phrases: "Yes." "O.K.!" "Neat." "Good." "Great." "Delightful." "Brilliant." "Swell." "Fine answer." "That's right." "Beautiful." "Exciting." "Positively." "Go ahead." "Yeah." "All right." "Correct." "Marvelous." "Nifty." "Excellent." "Perfect." "How true." "Absolutely." "Exactly." "Cool." "Outstanding." "Go on." "Good response." "Wonderful job." "Fantastic." "Absolutely." "Of course!" "Fabulous." "That's clever." "I'm pleased." "Thank you." "I'm glad you're here." "It makes me happy when you...." "You perform well...." "I'm so proud of you for...." "You do so well at...." "We think a lot of you when...." "That put you tops on our list." "That shows a great deal of work." "That's a nice expression." "That's interesting." "That was very thoughtful." "Show me how to do that." "You're doing better." "I like that." "This is the best yet." "You were polite to..." "No one could have done it better." "Let's put this somewhere special." "Show this to your father/mother."

Physical
Hugs/squeeze. Kisses. Handshake. Wink. "O.K." gesture with thumb. Pat on the back. A teasing gesture. Eye contact.

Material Reinforcers
Toys. Tricycle. Bicycle. Pets. Books. Games. Puzzles. Food. Own bedroom. Clothing. Musical Instruments. Skates/skateboard. CDs. Own TV-Radio-Stereo. Personal items such as hair dryer, own telephone.

Activity Reinforcers
Playing game with parent. Spending time with parent. Special outing. Play with friends. Reading or being read to. Overnight with relative or friend. Decorating room or home for special event. Helping parent (cook, work in yard, sew, or construct something). Feeding the baby. Extended bedtime. Shopping. Eating out. Plan a day's activities. Watching TV or listening to records. Freedom from chores. Using the telephone. Planting a garden. Taking special lessons (such as music, athletics, art). Public display of work. Party for friends. Going to hamburger stand.

Token Reinforcers (backed by reinforcers listed above)
Stars on a chart. Points. Poker chips. Allowance. Own bank account.

Material Reinforcers
Food. Choice of seat in room. Special pencil or pen. Balls, jump ropes, other playground equipment.

Potential Reinforcers for Junior High Youths (Ages 12-14) at Home
Social Reinforcers
Verbal

1. Specific praise.

2. Kidding and joking.

3. Suggested words or phrases: "Neat." "Fantastic." "Wow." "Super." "Great." "Nice." "On a scale of 1 to 10, you are an 11!" "It is a pleasure having you as a... (son or daughter)." "I'm proud of you." "I like your attitude (behavior)." "That was very thoughtful." "You just made my life easier." "You are a lot of help." "You do so well at..." "It pleases me when you..." "I like that outfit." "That's so-o-o good." "Show us how to do that." "That's better."

Physical

Smiles. Eye contact. Physical contact (only if adolescent approves). Winks.

Material Reinforcers
Favorite meal. Snack. Clothes. Books and magazines. Own phone. TV-radio. Stereo. Tapes. C.D.'s. Moped. Electric razor. Hair dryer. Curlers. Own room. Gift certificate. Guitar or other musical instruments. Money. Sports equipment. Hobby items. Own pet.

Activity Reinforcers
Participate in activities with friends. Special lessons (such as music, sports, modeling, art). Roller skating. Additional time on telephone. Playing stereo. Choosing own bedtime. Extended curfew. Staying up late. Staying overnight with friends. Time off from assigned chores. Opportunity to earn money. TV privileges. Being chairperson of a family meeting. Decorating own room. Camping out. Summer camp. Expensive haircut. Trip to amusement park. Sleeping late. Discussion with parents. School activities. Party for friends. Taking a friend out for pizza. Shopping trip (clothes). Ski trip. Bowling. Sporting events. Time with parents alone (apart from younger brothers and sisters).

Token Reinforcers
Points (backed by any reinforcer above). Money.

Potential Reinforcers for Senior High Youths (Ages 15-18) at Home
Social Reinforcers
Verbal

1. Specific praise.

2. Kidding and joking.

3. Indirect praise (telling someone else about what they did or accomplished).

4. Suggested words or phrases: "Swell." "All right." "Super." "Great." "Bravo." "Well done." "Commendable." "Delightful." "Excellent." "Likeable." "Terrific." "How true." "Good job." "That's clever." "I'm pleased." "I'm glad you're here." "That's a prize of a job." "It makes me happy when you..." "Lookin' good." "Yeah." "How beautiful." "Well thought out." "You are very sincere." "That shows thought." "This is the best yet." "Now you're really trying." "You have a good attitude." "Keep up the good work." "Your room looks so neat." "Whatever you decide is okay." "That was a good suggestion." "What is your opinion?" "What would you suggest?"

Physical

Smiles. Eye contact. Nods. Physical contact (only if adolescent approves).

Material Reinforcers
Books. Pets. Playing cards. Games. Musical instruments. Records. Tapes. Sports equipment. Tools to work on car or motorcycle. Typewriter, record player, TV. Own telephone. Clothes. Electrical equipment (for example, shaver, hair dryer, make-up mirror). Craft kits. Favorite food. Car keys. Money.

Activity Reinforcers
Leading family groups. Exempting a duty or assigned task. Cooking. Working on car or cycle. Listening to TV, stereo, tapes. Talking on the telephone. Free time with peer group. Special outing (parent pays) such as, musical group, sporting event, bowling, roller/ice skating, movie. Remodeling, redecorating room. Shopping trip. Friend staying overnight or staying with friend.

Token Reinforcers
Points (appropriate for some 14- to 15-year-olds, backed by material and/or activity reinforcers). Money.

The Reinforcement Questionnaire is helpful with selecting reinforcers.