I get many requests for information about how to deal with children with ADHD and aggressive (verbal and/or physical) behaviors. It happens so often that I thought I’d dedicate a post to this particular set of strategies.
When a child is dealing with the impulsivity of ADHD and aggressive feelings, we have to develop a multi-modal plan. This means we need three steps: (a) antecedent manipulations, (b) replacement behavior teaching, and (c) consequence modifications. Antecedent manipulations mean we set the environment up for success. The child will have no choices except to be successful. Replacement behavior teaching means we teach the child what to do instead of the targeted behavior. If a child is cussing, we cannot say “stop cussing”. We have to teach them what to do instead of cussing. Finally, we have to change consequences. What we have been using is not working so we have to change how we react to the student when they have any behavior. Remember, how we react when any behavior occurs (good or otherwise) determines whether or not it occurs again.
Most frequently, when I receive emails from viewers about children like this I ask them to list current interventions. Typically, I hear things like response cost, punishment, or other negative responses. These interventions have not worked and for good reason. These interventions work for 80% of the student population; however, they do not work for 20% of the population and these are the students whose behavior we are trying to modify. So here is what to do instead. This is a proactive multi-modal plan.
Proactive Strategies to set up the environment for success:
- air filled disk on his chair- sewn in so it can’t go flying across the room
- pool noodle cut into 1/5ths and threaded through elastic and hooked to his two front chair legs
- He needs to be taught how to use proprioceptive input with his feet to help him stay focused
- Put a strip of velcro (one side only) and a bathtub non-slip applique under his desk top and teach him how to fidget with that.
- This book has ideas for ADHD in it- http://behaviordoctor.org/wp-content/uploads/2014/01/2014nonmedicatedadhd.pdf – free download
I do not have a good one yet- I’m filming one for neuro-typical kids, ADHD kids etc. next week- but you can look it up on http://www.youtube.com and type in Siskin Institute and Video Self-Modeling. You’ll see one for a child with autism and a very young child. However, I have had huge success using this with all children as well.
Teach him (Antecedent modification) how to breathe to calm himself down in his calm down area. Here are the directions:
- Put your tongue behind your two front teeth
- Close your mouth
- Breathe in through your nose
- Breathe out through your nose
- Repeat this 10 times in and 10 times out
- I give the kids 20 pompons and an old Kleenex box and have them dump out all the pompons and put one in with each in and with each out- until all 20 are gone.
- I typically make this a poster to remind them using Boardmaker – because when a child is upset pictures are better. You can also make a video self-modeling video of this process to help him learn this. (It’s a replacement behavior teaching- – but it’s taught as an antecedent modification and this is what he will do when he is upset. He will learn how to calm himself down.
To teach Replacement Behavior:
- token economy-
o I’d use a velcro chart with 5 tokens that velcro onto the strip- when he gets 5 tokens he earns a 5 minute break
o He gets one token for each compliance to a request- no tokens= no breaks
- For behavior at home and school:
o Student/Teacher rating sheet – http://behaviordoctor.org/wp-content/uploads/2013/12/2014studentteacherratingsheet.pdf
- This is explained in the download and it ties home to school- child earns rewards based on behavior- no rewards except what is earned- nothing is given free
Spanking is not going to change his/her behavior- it doesn’t work on ADHD
What works best is to give him/her nothing and make him/her work to earn anything. (not like you are punishing- but like this is what you have to do to get: computer time, toy access, free play)
When you give him work to do- give him equal choices (not do this or lose recess)- you can do this math paper or this math paper, you can write with the red pencil or the blue pencil, you can sit in the red chair or the blue chair. Stand on his right side when you offer these choices. If he/she has a tantrum, make sure you keep your heart beat at 60bpm and talk in a sing song-y voice and say- “Do you want to walk to the calm down area with me or do you want to walk down to the calm down area with Mrs. Jones.” (Whomever could go with you to talk to him/her)
We have found with heart monitors that children who have aggressive behaviors (tantrums, aggression etc.) their heart rates tend to beat at 147 beats per minute. Music research tells us your heart will match the music you are listening to- I have on my website calming videos with 60 bpm music and 7 minutes of nature pictures. I would make a playlist of 60 bpm music and play it at conversation level all day long. I would also have a bunch of nature pictures in a calming area for him to go to – to calm himself down. I prefer a blue bean bag in this area (blue is a calming color)
I’ll try to add pictures to this tomorrow evening to help with identifying some of the strategies. You can see how this is a multi-modal plan that will help the student learn to have better control over their own behavior.