Teaching Good Behavior: Tips on How to Discipline

General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

Discuss your child's treatment program with appropriate school personnel.
Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.
Schools may be willing to fax completed follow-up rating scales to your doctor's office.
Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.
Ask your child how he or she feels on the medication.
Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

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Discipline is how Parents Teach their Children

Praise success and good tries.
Be clear and consistent about what you expect.
Listening is important; let your child finish the story before helping to solve the problem.
Praising your child for good behavior works most of the time, but you will still need to set limits.
Sometimes a time-out is needed for either you or your child.

A ll children want to be good and please their parents, but they need to learn how. Young children view the world as “good and bad” or “right and wrong”—nothing in between.

Teach your child right from wrong with words and actions. Children need to know when they do something bad and when they do something good.

Praising your child will encourage good behavior and reduce bad behavior, but part of a parent's job is to correct bad behavior.

Teach all the Steps

What seems simple, like getting dressed in the morning, has many steps for children. If your child “can’t” or “won’t” do something, it may be that your child still needs to learn the steps.

Explain the steps one at a time and then offer praise.

For example,

“Please get your clothes. They are on the bed.”
“OK, now take off your pajamas.”
“Now, put on your shirt.”
“You look very nice today. You did a good job getting dressed.”

Take time to remind your child about each step rather than doing it yourself or getting upset.

It will take longer at first, but it is well worth it! Learning new skills makes your child more confident.

Catch your Child Being Good

Watch for good behavior like listening to you, being polite, and helping others. Praise good behavior as often as possible. You can even praise a good try!

“Nice tower. Look how high you built it!”
“Good sharing. I love it when you play so nicely with your sister.”

Your love and attention are what your child needs and wants. But sometimes children learn that the way to get attention is to misbehave. Teach your child that being good is the best way to get your attention. Praise with words, but remember that a hug or a smile is often just right!

Children love to help. A good way for your child to get your attention is by helping with chores like folding laundry, setting the table, or assisting with simple repairs. Smile and say, “Thanks for your help!”

Children think they are special, and they are! Self-respect is the first step toward learning how to respect others. Children who are loved feel that they are special and learn that other people are special too. It's okay to say,

“You’re a great helper!”
“Good job!”
- When children are doing something good, let them know it by saying, “ I like it when you…”

Children Need Limits

Nobody is perfect; that's why patience is needed. When your child needs to be corrected,

Name the bad behavior.
Tell your child that the behavior needs to stop. “No hitting! That's not nice.”

While children respond best to praise for good behavior, sometimes other types of discipline are needed.

TIME-OUT—Setting limits for 2- to 5-year-olds When saying “no” is not enough, try using a time-out. It teaches your child that misbehaving is not a good way to get your attention and it stops the bad behavior. When the time-out is over, you and your child can start all over again.

Steps for giving a time-out are:

Warn your child: “If you don't stop, you’ll have a time-out.”
If your child misbehaves again, briefly explain the reason. For a 2-year-old, simply say, “No hitting.”
Have your child go to a quiet place, like the corner of a room.
Start the timer—1 minute for each year of age.

2 years old = 2 minutes
3 years old = 3 minutes
4 years old = 4 minutes
5 years old = 5 minutes

If your child leaves the time-out area,

Have your child go back.
Restart the timer.
Explain the need to “stay put” until it's over.

Other adults caring for your child (grandparents, baby-sitters, aunts, and uncles) also need to know how a time-out works.

Other Ideas

Time-outs can be used too much. Other ways to correct your child's behavior include:

Ignoring. When your child is doing something that is not dangerous to get your attention, try ignoring the behavior.
Redirecting. Sometimes children misbehave because they are bored or don't know any better. Find something else for your child to do.

Correcting a child's behavior can be hard. Talk with your pediatrician for more ideas.

Set Clear Rules

Help your child learn the rules by making them plain. “It's time for bed sweetheart. Please get in your bed now. Then we can read a story. I'm glad you got ready for bed so quickly. I love reading to you at night.”

Children will almost always test a new rule for the first few days. Hold fast; say it again and again and your child will learn the new rule. Be consistent, even when it seems like a lot of trouble!

Listen to your Child

Children are learning and experiencing many new things every day, and they want to share them. Spend time every day playing and talking with your child. Talk about the good and fun parts of the day as well as any bad or tough times.

If your child had a hard time,

Listen to the whole story. Without judging or talking about how to behave, let your child finish telling the entire story.
Find positive parts of the story to praise.
Teach better ways of behaving and responding.

Questions you can ask at dinner or bedtime include:

“Tell me about what you did today.”
“What was your favorite thing that happened today?”
“Was there anything that was hard or that you needed help with today?”

When your Child Makes you Angry

Sooner or later, all parents get frustrated. Remember that no matter how difficult your child can be, you are the most important person in your child's life.

If you feel out of control, first make sure your child is in a safe place, like a playpen, crib, or bedroom. Then take a “time-out” for yourself.

Do something that you find relaxing to help you calm down.

Have a cup of tea or coffee.
Listen to music.
Call a friend or spouse.
Read.
Meditate.

Feeling stressed out is natural and it will pass. When you are feeling better, go back to your child, hug each other, and start over again.

If your child is old enough, you can simply say, “I got really mad when you wouldn't listen. I'm feeling better now. I love you.”

When you raise your child with praise, you will both be happier. But it takes a lot of patience and time!

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