Parenting a Child with ADHD

Defiant behavior is often linked to ADHD, particularly in children whose symptoms are primarily hyperactive. Impulsivity may result in reckless or seemingly aggressive behaviors, while emotional dysregulation and an inability to rein in anger may be another root cause of defiance. In some cases, children with ADHD also qualify for a diagnosis of oppositional defiant disorder, or ODD, a condition characterized by a persistent pattern of negative, antagonistic behavior. Harsh discipline rarely works for these children; instead, practicing compassion and focusing on skill-building are the strategies most often recommended by experts.

Children with ADHD, like others, benefit from fair and consistent discipline. Experts recommend an approach that focuses on setting clear expectations, employing natural consequences—and making sure consequences are enforced consistently—and praising positive behaviors. It’s also best to avoid punishing children for behaviors that are out of their control and to discuss problematic behaviors with children to better understand their motivation. Behavior that seems to be defiant, for instance, may actually stem from frustration or anxiety; addressing the feelings that are behind the behavior will likely help mitigate outbursts in the future.

There are pros and cons to using formal reward systems—such as sticker charts—to motivate a child to behave. On the one hand, many parents have found that sticker charts or other reward systems do help their child reduce problematic behaviors; this is especially likely when the goals of the sticker chart are achievable, specific, and measured over the short term. On the other hand, some parents worry that using rewards to encourage good behavior is akin to bribery—and some have found that it cultivates a negative, “what’s in it for me” attitude among children. Whether to use a sticker chart or other formal reward system is a personal decision; other, less structured rewards—such as a surprise outing after a week of good behavior or a few words of genuine praise—may be enough to motivate children without diminishing their intrinsic motivation to behave appropriately.

Unfortunately, some children with ADHD may struggle to make and keep friends—often due to aggressive or hyperactive behavior, emotional outbursts, or the seeming inability to stay focused on a game or conversation. To help a child develop social skills, parents should gently but explicitly explain appropriate behavior—perhaps role-playing situations where the child often slips up, such as when she’s losing at a game—offer praise when the child succeeds, and focus on individual friendships rather than trying to force a child to fit in to a larger group. Keeping playdates short, before frustration or hyperactivity set in, can also help children end social interactions on a positive note and build up their social reputation.

It’s common—and totally OK—for a child with ADHD to primarily form friendships with younger children. Since ADHD is a developmental delay, they may find that younger friends are closer to their own maturity level. Additionally, younger friends may allow a child with ADHD to feel like the leader, which they may not experience in other domains—particularly if they struggle socially with same-age peers.

While experts continue to debate whether excessive video game use can truly be considered an “addiction,” it’s undeniable that many children with ADHD exhibit problematic behavior when it comes to video games. Video games are designed to be engaging and provide immediate rewards; children with ADHD may hyperfocus on them—even to the point where they become seemingly oblivious to the world around them—and may be more prone to become irritable or angry when told to stop playing. Some children may also prefer video games to other activities, like sports or schoolwork, particularly if those are areas in which they struggle. If your child plays video games for hours each day, has little interest in other activities, or becomes enraged or inconsolable when limits are set, it’s likely that she has developed a problematic relationship with gaming that should be addressed.

Rather than setting overly harsh rules on video game playing or taking away the games altogether—both of which can lead to conflict and resentment—parents may be better served by a more balanced approach. Allowing a certain amount of playing, while also making sure that their child is engaging in other activities like exercise, creative play, or reading, will minimize tension and allow children to reap some of the potential benefits of video gaming. If rules are set around gameplay, be consistent about enforcing them.

Trouble making friends, struggles at school, or constantly being scolded for “bad” behavior can wreak havoc on the self-esteem of a child with ADHD. It can be devastating for parents to hear their child say negative things about themselves or come to believe that they are incapable of success. While low self-esteem is a common—and reversible—side effect of ADHD, it’s critical for parents to be on the lookout for signs of depression as well, as persistent low self-esteem and feelings of worthlessness may be signs of a problem that extends beyond ADHD and may require additional intervention.

Parents can help cultivate self-esteem by offering real, genuine praise when a child succeeds; it’s also beneficial to encourage her to pursue her interests in order to find domains in which she excels. A child who likes to doodle, for instance, may become a talented artist, while a child drawn to cooking may feel his confidence grow as he learns to master more complicated recipes. Gradually increasing her autonomy, and making sure that she learns critical skills as she grows, can also help increase her sense of competence and self-assuredness. Making sure your child has strong relationships—whether with family members, same-age peers, or trusted adults—can go a long way toward building lasting self-esteem.

Children with ADHD can excel at any sport (or other activity), particularly if they’re highly interested in it and intrinsically motivated to participate. For children who are unsure what sport they’d like to try, however, or who have struggled with activities in the past, parents may find that individual sports—like swimming, tennis, or martial arts—are ideal for allowing children to get the benefits of exercise while mitigating the social challenges that come with team sports.

Some research suggests that as many as 70 percent of children with ADHD have clinical sleep disturbances—including difficulty falling asleep, waking up frequently during the night, or waking up too early in the morning. Children may also resist going to bed in the first place, becoming defiant or upset at bedtime. To counteract sleep problems, parents should establish a consistent bedtime routine and create a soothing sleep environment with minimal distractions. They should make sure their child gets regular exercise and eats a healthy diet, both of which can greatly improve sleep. If sleep problems are severe, parents may wish to try melatonin supplements. Keep in mind that stimulant medications may disrupt sleep, especially if a dose is taken later in the day; if you suspect this may be the culprit for your child’s poor sleep, talk to your doctor about reducing the dose or changing the dosing schedule.