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February 24, 2016

What Is ADHD, Part III

Written by Dr. John Carosso

Okay, this is the final segment of this blog series on ADHD. We started out with a discussion of what causes ADHD (disturbance of the prefrontal lobe) and the negative impact on executive functioning. We then moved into specific strategies to enhance executive functioning, and some more general interventions to make day-to-day activities go smoother. Finally, in this third segment, here are more helpful tips and suggestions I trust you'll find to be helpful:

Teach your child not to interrupt your activities

Prior to the event during which you may be interrupted, give clear directive of expectations, give a structured fun task for the child, and praise throughout. Fade praise over time. Special praise at the end of the event. Can be used for a phone conversation, preparing a meal, having a conversation with a friend...

Home token system

Provides opportunity to provide tangible reinforcement that can be cashed-in for privileges. It can then cost tokens to play video-games, watch TV, going to movie… (list the privileges and post). Make a list of chores and tasks and how much each will earn. Be mindful of the cost for privileges (if cost too much, then system loses appeal, but don’t make it too easy). Make a token-bank to store the chips/tokens. One to three chips can be earned for most tasks. Use a point system for older kids.

Punish misbehavior constructively

Do not use criticism or excessive punishment. Do not pester or become overly emotional. Children with ADHD have lack of understanding of time and they live in the ‘now’, not in the future. Consequently, they don’t appreciate how their behavior can impact the future of any relationship. Using the token system, you can ‘fine’ child by taking away tokens. However, don’t begin taking-away tokens until after using the token system for a few weeks. Do not fine too harshly, or system will lose effectiveness. Use 3/1 rule; fine once for every 3 allocations of tokens.


Remove to quiet area. Pick one or two behaviors. Do not give attention when in T.O. Give command, count to 3, if directive not completed, give one warning for time-out, count again then to T.O. if still not complying. Use gentle physical prompting. When quiet (one minute per age) can be released if agree to carry-out what was initially refused. Praise upon completion of task. Token is only given if task is done upon initial request. Fine child if child leaves time-out. Time-out to room can be used.

Public places

Keep your child busy and occupied with fun activities. Use these same methods in stores, other’s homes, and other public places. Establish a plan. Use positive attention, praise, clear expectations, clear instruction, use of tokens and other incentives, regular specific praise throughout the outing, use of time-out as needed. Punishment can be in public, or upon returning home. Find potential time-out area in the public place. Give tokens periodically throughout the trip with lavish praise.

Okay, there ya go. Hope you found this series to be helpful. Now, it's your turn!! It would be appreciated if you would share what works for you, so I can confidentially share your ideas with those who may be having a rough time. I won't take credit for the idea, but I won't reveal your name unless you give permission. Thank you!!

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