ADHD: Establishing Routines

Step 3: Reinforce Routines with Incentives for Performance
In most families, the reinforcer offered the child is the absence of parental wrath. "If you do this, I won't scream and yell at you." As any experienced parent knows, that doesn't always work. The list reminds the child what he's expected to do. Now the challenge is to find something to associate with it that is so important to the child that he will use the list on a daily basis. What works as a reward may change and needs to be reviewed on a regular basis. Determining what is an effective reinforcer is key.

Jan: What incentive did Theodore have to follow his morning list? The immediate gratification of playing with LEGOs and reading books still afforded greater pleasure than did following a routine and getting out of the house, even if the new routine had reduced the volume of sound emanating from Mom and Dad. We decided that money was the incentive Theodore needed. We realized, however, that the list was too long for one reward to keep Theodore focused. At Sharon's suggestion, we split the list in half. If Theodore finished the first half by 8:00 A.M., he would receive ten cents. If he completed the second half by 8:20, he received another ten cents.

A little experience resulted in a refinement. The delay and then "hurry up and finish" syndrome particularly affected the second half of the list, so we redesigned the incentive. If he finished after the deadline, but before 8:25, he didn't get the second ten cents but he didn't lose anything either. But if he took until after 8:25, and we had to hustle him out the door by collecting his lunch box, combing his hair, etc., then he had to pay us ten cents.

Accounting for completion of the routine was the final step. I printed up multiple copies of his morning list on the computer. He kept them next to his alarm clock in his bedroom. When he finished the list, he stuffed that copy of it in an old mayonnaise jar on the kitchen counter. Every Sunday night, we added up what he had earned and that became part of his allowance. Although some children need the more immediate feedback of allowance money paid daily, for Theodore, watching the lists accumulate in the jar and getting paid on Sundays was sufficient.

The list--with monetary rewards--proved to be a surprisingly effective tool. The reward was an incentive, not a bribe. As Sharon reminded us, a bribe is payment for doing something wrong or outside the law. In this case, the incentive got him to do what we wanted, which was something he had trouble doing on his own. For the most part, we stopped nagging and yelling, and he assumed responsibility (mostly) for getting himself out the door in the morning.

Summary of Process for Establishing Routines

• Include the child in discussions whenever possible.
• Identify siuations that occur on a frequent basis.
• What do I want him to do instead of what he's doing?
  • Determine one to five things (depending on child's age) that need to be accomplished as part of that routine.
  • Discuss and decide on the number of reminders needed.
  • Determine the time frame for completing steps.
• How can I put expectations and progress in a visual format?
  • Develop documentation (chart, checklist).
• What would make it worth his while?
  • Decide on reinforcer for successful completion of retine within specified time.
  • Review steps of routine, tools (checklists, timers), and rewards with the child.