PDF Summary:12 Principles for Raising a Child with ADHD, by Russell A. Barkley

In 12 Principles for Raising a Child with ADHD, psychiatrist Russell A. Barkley offers a compassionate and comprehensive guide for parenting children with attention deficit hyperactivity disorder (ADHD). He aims to help caregivers understand ADHD as a neurodevelopmental condition that impacts self-regulation and executive function, rather than a simple lack of willpower.

Barkley advocates approaching ADHD through a "disability lens," emphasizing accommodations and positive reinforcement over punishment. He provides practical strategies for developing executive skills, managing behavior, problem-solving, and creating an environment conducive to a child's unique needs. The book promotes a mindful, structured, and nurturing approach to parenting children with ADHD.

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Other Perspectives

• There are various interpretations and applications of mindfulness, and not all may be suitable or effective for improving awareness and attunement to a child's reality, especially if the child's needs are complex or require a different approach.
• Letting go of frustration is beneficial, but it is also important to acknowledge and address the root causes of that frustration to create a healthy environment for both the parent and the child.
• Concentrating on how a child should act is not inherently negative; it can be a reflection of a parent's desire to instill good values and social norms, which are essential for the child's success in society.
• Some individuals may find that mindfulness techniques are not compatible with their personal beliefs or coping strategies, and thus may not derive the same benefits from the practice.
• There is a risk that an overemphasis on unconditional presence could lead to permissive parenting, where a lack of guidance and feedback might hinder a child's ability to learn from their actions and develop self-discipline.

Model Self-Understanding and Self-Reflection for Your Kids

Barkley encourages us to consciously engage and stay aware while interacting with our kids. He advises us to practice mindful meditation, first to prepare for those interactions and then to carry out the actual interaction in a mindful manner. To start, choose a time to meditate undisturbed—such as when your ADHD child is asleep or in class. Barkley notes that using a reclining or seated position, closing his eyes, and taking a few deep breaths can help him relax. Then he does a scan of his body—observing what each of his body parts feels like and trying to relax each one—and then does the same with what's going on around him. At this stage, he chooses a focal point for his attention, such as his breathing, and returns to that focal point whenever distracting thoughts arise. Barkley recommends doing this practice daily for at least a quarter of an hour to twenty minutes.

Barkley believes that being mindful with our children is equally important as being mindful when we're alone. He suggests starting with special play times, setting aside at least 15-20 minutes to interact with your kid without any other kids or distractions—no screens! When your kid is choosing the activity and running the show, avoid questioning them, making comments, or trying to teach. Instead, simply be present with her, paying attention and sometimes narrating her activities. Express positive feelings (“I love spending time with you this way”) and offer brief, sincere praise for actions you see ("You're creating that drawing very neatly!"). It's also important to show your appreciation by gently touching your kid with a hug, a pat, or an affectionate squeeze. This type of special playtime, done a few times weekly, helps your child feel noticed, valued, and loved simply for being herself, not just for doing something well. You’re also demonstrating to her what mindful interaction looks like, providing a model she can learn from.

Barkley also wants us to extend mindful attending to times when our ADHD child is occupied by some activity without our constant supervision. When he's playing in his room or reading, seek him out and briefly acknowledge your appreciation by narrating his appropriate behavior. ("You're staying in your room and playing calmly!") These small instances of praise and affection strengthen both your relationship and your child's self-esteem.

Context

• Meditating without interruptions allows for deeper relaxation and concentration, which can enhance the effectiveness of the practice. This uninterrupted time helps in achieving a state of mindfulness that can be carried into daily interactions.
• Engaging in these practices can enhance the mind-body connection, leading to better awareness of one's own emotional and physical state, which is crucial for effective parenting.
• Typically, you start by lying down or sitting comfortably, then slowly direct your attention to each part of the body, starting from the toes and moving upwards, or vice versa, noticing sensations like tension, warmth, or relaxation.
• Focusing on breathing is effective because it is a constant, rhythmic process that can be easily observed and controlled. This focus can help reduce stress and increase concentration.
• The idea of returning to a focal point when distracted is a common technique in mindfulness meditation. It helps train the mind to focus and improves attention span, which can be particularly beneficial for individuals with ADHD who may struggle with maintaining focus.
• Regular mindfulness practice can lead to changes in brain regions associated with attention, emotional regulation, and self-awareness, such as the prefrontal cortex and amygdala.
• When children lead activities, they are more likely to engage in creative play and exploration, which can be beneficial for cognitive and emotional development.
• Paying attention involves actively listening to your child, which means not just hearing their words but also understanding their emotions and non-verbal cues. This can foster a sense of security and validation for the child.
• Different cultures have varying norms regarding physical touch. Understanding these differences can help ensure that expressions of affection are appropriate and well-received.
• Special playtime aligns with attachment theory, which emphasizes the importance of secure attachments in early childhood. These interactions help build a strong emotional bond between parent and child, fostering a sense of security and trust.

Developing Executive Function and Self-Regulation Skills

Encourage Mindfulness and Responsibility in Your Kids

Self-awareness, Barkley explains, is a prerequisite for becoming accountable – for making those changes that will get us to our goals and also make us more socially adapted. Barkley finds this so crucial that he devotes a whole chapter to this topic, offering us lots of ways to encourage it in our children, starting with ourselves.

Strategies to Increase Kids' Self-Assessment and Personal Evaluation

To assist your ADHD child in becoming more attentive to his thoughts, emotions, and actions, Barkley instructs us to create opportunities to model this process. For example, after an important event, you could verbally review what was successful and what wasn't. It might be a meeting with your child's teacher, or even how you handled a traffic jam or a tense moment with a coworker. To teach social awareness, you could take your child to the playground and casually narrate the scene as if you were both TV reporters observing the relationships and interactions between the children—what’s working, what isn’t, whether the kids are behaving in socially acceptable or unacceptable ways, and how you'd each handle it. You can also promote self-evaluation by gently asking your child about himself—his talents, his ability to make friends, whether he gets along with his siblings, his schoolwork, and so forth. The aim is to get him thinking about himself and whether his actions align with his goals.

Barkley recommends going further than modeling by reminding kids to conduct self-evaluation. He has found that using a cueing system to prompt self-monitoring can be successful with both children and adults, whether it's a speedometer radar sign alerting drivers that they're being tracked or a paper clip that your child's teacher drops near her desk to signal that her behavior needs to change.

Barkley recommends that we time these cues randomly for optimal effectiveness. For instance, you could configure your phone's alarm or timer function to sound at random times. You could then tell your child it's time to pause and pay attention—have your child stop whatever she's doing and think about it and report on how well she thinks it's going. Barkley also suggests that you give some consequences for failing to complete the check-in, such as a fine of tokens if you're employing a system that rewards them. With older kids, discreet cues, such as dropping a small office supply near a teen who’s not paying attention, might be less embarrassing socially. In an educational setting for older students, the timer function on smartphones or digital watches could be used to alert kids to evaluate whether they’re working. With younger children, a teacher could hold a card with a red light, large eyes, and oversized ears to tell them to focus on their work and behavior.

Barkley also describes what he calls the "turtle technique," a strategy used in school settings for students with ADHD. When the teacher says “turtle,” the child is meant to tuck in his arms and legs, move his head back and forth to survey the situation, look at his deskwork, and say aloud what he thinks he should be doing—emerging from their “shell.” If they succeed, they receive a token. Caregivers can employ this method, too.

To improve both your child’s working memory and self-awareness, you could have him “play back” a scene that involves a particular situation. This method was originally used successfully for children with autism to help them learn appropriate social interaction, but it can be helpful for any child. Barkley recommends recording a video of your child playing or interacting socially on your smartphone, watching it together soon afterward, and discussing what went well or poorly—what could they do differently next time?

Barkley also reminds us that going over the day's events can be really effective at night, starting with you modeling by discussing your own day, and then having your child talk about his. Older children might find journaling about their day more rewarding.

Barkley has also found that learning mindfulness and meditation can benefit certain children with ADHD. You’re already familiar with those methods from the preceding chapter on mindful parenting; now teach them to your child.

Context

• By reviewing events, children can learn to manage their emotions better, understanding how different situations affect their feelings and reactions.
• Self-evaluation is a reflective process where individuals assess their own abilities, behaviors, and progress. It helps children with ADHD develop self-awareness and accountability, which are crucial for personal growth and achieving goals.
• Cues can be visual, auditory, or tactile. Visual cues might include signs or symbols, auditory cues could be alarms or verbal prompts, and tactile cues might involve physical objects like a stress ball.
• Random reinforcement is a principle from behavioral psychology where responses are more robustly learned when reinforcement is unpredictable. This can enhance the effectiveness of self-assessment cues.
• In educational settings, consequences for not completing check-ins can help maintain classroom order and focus, supporting both individual and group learning environments.
• The use of cues is grounded in behavioral psychology, where external prompts help individuals develop internal self-regulation skills over time.
• In addition to self-awareness, the "turtle technique" can aid in developing social skills by helping children consider the impact of their actions on others and adjust their behavior accordingly.
• The "playback" technique is rooted in the concept of video modeling, which is often used in therapeutic settings to help children observe and learn from their own behaviors. By watching themselves, children can gain insights into their actions and social cues they might have missed in the moment.
• Making this reflection a nightly routine can provide structure and predictability, which are beneficial for children with ADHD.

Monitor and Use Systems to Build Accountability

To encourage self-control in kids who have ADHD, self-awareness is only the first step. Kids then have to learn to take ownership of their actions—to become accountable. Barkley explains that children with difficulty controlling impulses, sustaining attention, and managing time will struggle to finish their objectives and commitments. For instance, chores get ignored or half-done, homework is left till the last minute, and promises are broken – not because they aren't bright enough or don’t “know better” but because their lagging executive functions aren’t up to the task of “doing better.”

Barkley reminds parents that it’s not enough to just teach social skills or ways to handle anger to a child with ADHD; these kids usually know what to do, they just don't use their knowledge. And no kid can become responsible or accountable without guidance. Caregivers must provide this, not just through general modeling but by actively holding kids accountable.

Accountability check-ins can be an effective way to encourage kids who have ADHD to complete work and stay focused on a task. For instance, if your child has math problems that she can't seem to face, have her do just five and then tell you what she did and whether she thinks she got them right. This approach gives you a chance to praise her not only for doing the work but also for being aware of how she’s doing (and being honest about it!).

Checks for accountability can apply beyond work and chores. They can aid play behavior, socializing with siblings, interactions with peers, and more. You could use a baby monitor to watch for trouble brewing when your child is playing alone. Ensure you reinforce appropriate behavior with praise, rewards, and gentle, affectionate touch.

Barkley has found that behavior report cards can help kids who have ADHD in situations where parents can’t be present to provide frequent accountability. The card lists the actions you'd like your child to take and includes a simple rating system for the supervising adult to use, such as 1-5, with 5 being “excellent” and 1 being “poor.” The behaviors are rated each 15-30 minutes during the event, such as during a social visit or an afterschool program. An effective report card incorporates incentives—points from each rating are added up at the end, and your kid can exchange them for privileges listed on a separate rewards menu.

Barkley has also found social commitments instrumental in motivating teens (and even older children). This could mean inviting a friend to work on a school project together, participating in sports or clubs alongside someone, or even having a tutor come to the house.

Context

• Self-awareness is crucial because it allows children to notice when they are veering off track, which is the first step in correcting their behavior and making more deliberate choices.
• Social skills and anger management should be integrated with other strategies, such as behavioral interventions and accountability systems, to be effective for children with ADHD.
• Developing accountability in childhood can lead to improved academic performance, better relationships, and increased independence in adulthood. It lays the foundation for a successful transition into adult responsibilities.
• Monitoring screen time and online interactions can be crucial, as children with ADHD may become easily distracted or hyper-focused on digital activities. Accountability can help them manage their time and engage in technology responsibly.
• Behavior report cards are tools designed to provide structured feedback to children with ADHD. They help track specific behaviors and offer a consistent method for evaluating progress, which is crucial for children who may struggle with self-monitoring.
• Social commitments often involve peers, and peer influence can be a powerful motivator for teens. Being part of a group or team can encourage adherence to norms and expectations, which can help improve focus and accountability.

External Supports for Working Memory and Poor Sense of Time

Executive Function impairments involve much more than issues with self-awareness and responsibility. Barkley points out that ADHD also makes it difficult for children to remember what they’re supposed to accomplish, as well as understand and use time to manage their own behavior.

Use Reminders and Prompts to Ease the Memory Load for Your Kid

Working memory, Barkley explains, allows us to keep information in mind that helps us complete tasks. Children without ADHD develop this ability naturally as their brains mature. So when they're faced with, say, 20 math problems, they can rely on short-term memory to remember what the current task entails and access previously learned knowledge of how to complete it, while simultaneously ignoring competing stimuli in their environment. Barkley has found in his clinical practice that kids who have ADHD struggle more to retain information mentally while working, and their working memory is very easily erased whenever a distraction presents itself.

To address this, Barkley recommends that we offer outside reminders. While your child works on homework, for instance, make a list of the steps needed to complete the assignment and place it where she can see it. This could be read, recite, write, and review for a reading-and-writing assignment, or for math you could list the steps needed to add fractions, for example. If your kid forgets to bring materials back from school every day, tape a reminder to her backpack that lists everything that should be in it or make a checklist and have her check off each item. If he’s always running late—a manifestation of another mental process weakness, time blindness—post a "prepare for school" checklist by his room's entrance with a reminder about when the bus will arrive. Barkley says that the key is to put reminders at the exact moment and place your child will need them to complete the task at hand. He prefers these low-tech methods to trying to manage a kid who has ADHD using high-tech apps for a smartphone or tablet because these usually involve several steps that are overwhelming for a kid with ADHD, including remembering where the device is and making sure it’s charged up.

To increase the effectiveness of these reminders, especially for little kids, Barkley suggests incorporating visuals. Simple drawings of the steps needed to complete a chore—like making a bed, tidying a play area, or preparing for bedtime—can help her remember what to do and what to put away, especially if the picture sequence is posted where she'll do the task. You can add a reminder to a chore list on the fridge about what happens if the task isn't done.

Context

• Parents play a crucial role in setting up and maintaining these external reminders. Their involvement can help ensure that the reminders are used consistently and effectively, providing the necessary support for their child.
• Creating these lists can be a collaborative process between parents and children, fostering communication and understanding of the child’s specific challenges and strengths.
• Taping reminders to a backpack serves as a visual cue to help children with ADHD remember essential items they need for school, reducing the likelihood of forgetting important materials.
• Visual aids like checklists can compensate for working memory deficits by providing a concrete reference that children can repeatedly consult, reducing the cognitive load required to remember tasks.
• This psychological theory suggests that combining verbal and visual information enhances learning and memory, as the brain processes these two types of information in different ways.

Use Timers, Schedules, and Concrete Stepwise Supports

To aid your child in learning to use time effectively, Barkley advises us to employ external clocks, such as timers, schedules, and calendars, to compensate for his weak internal clock—his "nearsightedness" to the future. These tools make time physical and clear, which simplifies managing it. You could, for example, set a timer to let your child know how much time he has until he’s supposed to leave for school, start on homework, or prepare for bedtime. To help chores seem more manageable, divide them into steps that each have a time limit, and post the schedule outside his room.

Barkley also reminds us that kids with ADHD struggle to envision future events. That means they may struggle with waiting. You could, he says, reduce the distress by helping your child visually track the days leading up to a special event, like a vacation or birthday, by having him cross off each day on a calendar.

Barkley points out that these tools for time perception and working recall not only help kids perform better in the moment but are also crucial for teaching kids with ADHD the strategies they’re going to need to use to live successfully on their own as adults. Don't forget, though, that your aim isn't to turn a child with ADHD into an organized automaton; being able to relax and experiment with his environment is equally important and may even help him tap into the creativity that research shows may be associated with ADHD.

Context

• By learning to use these tools, children can gain a sense of control and independence, which boosts their confidence and motivation to tackle tasks on their own.
• The use of timers can be customized to fit the individual needs of each child, such as adjusting the duration based on their attention span or the complexity of the task.
• Children with ADHD often have difficulty with executive functioning, which includes planning, organizing, and completing tasks. Breaking chores into smaller steps with time limits can help them focus on one task at a time, reducing overwhelm and increasing the likelihood of task completion.
• By visually tracking days, children can develop a sense of anticipation and learn patience. This method helps them see the passage of time concretely, which can reduce anxiety and improve their ability to wait for future events.
• Effective time management and memory skills can improve social interactions by helping individuals keep commitments and remember important details about others, fostering stronger relationships.
• Research suggests that individuals with ADHD may have enhanced divergent thinking, which is the ability to generate creative ideas by exploring many possible solutions. This can be linked to their tendency to think outside the box and make unique connections.

Teach Problem-Solving Skills Concretely, Not Just Abstractly

Barkley reminds us that play is a form of problem-solving; young children learn to take things apart (analysis) and put them back together (synthesis) with their hands. They try different mixtures to observe what occurs. Typically, this eventually evolves into mental manipulation of images and language—a child no longer has to create every outcome in reality; he can do it in his head. They can resolve issues without having to constantly use experimentation. Kids who have ADHD do not develop this capacity for internal problem-solving as quickly or as proficiently as others. When faced with a problem or request, Barkley explains, they have trouble holding information in mind to guide them, they're not good at taking things apart and then rearranging them (analysis and synthesis), and they struggle to work with abstract language.

Deconstruct Problems Into Physical, Manipulable Components

To help kids who have ADHD learn better problem-solving skills, Barkley advises us to make the problem physical—something a child can handle manually. He suggests, for instance, that we provide kids with a number line for math problems so they can literally count forward or backward to solve them. You could also use objects like marbles, Legos, or even paper clips – and then have him write down the equation he’s creating or replicate the equation on a calculator.

Barkley says that this approach can assist with language, too. If your child has to do a book report, for instance, have her read a brief section and then vocalize what’s important in that section. Then, by guiding her thought process, have her write down notes or draw an image to summarize the key ideas. Proceed to the subsequent section and repeat. It might be helpful to display the questions "Who? What? Why? Where? When? How?" nearby to prompt your child’s thinking and note-taking. Once the book is read, she can use her notes to write a brief summary, starting with what happened first. If she’s old enough to use a computer, word processing software will not only help her type and edit, but also spell-check and offer different word choices. For other problems, such as learning social skills, you can try role-playing to test out responses in a simulated situation, making it concrete and physical instead of requiring abstract contemplation.

Context

• Physical objects can serve as visual aids, helping children visualize mathematical operations and relationships, which can enhance comprehension and retention.
• A number line is a visual representation of numbers on a straight line, which helps in understanding numerical order and the concept of addition and subtraction by moving forward or backward.
• The act of writing or replicating equations reinforces memory retention, as it involves multiple senses and cognitive processes, aiding in better recall.
• This method encourages active engagement with the material, which can improve comprehension and retention. By vocalizing and summarizing, children process information more deeply.
• They provide a consistent framework that can be applied across various subjects, aiding in the development of a systematic approach to learning and comprehension.
• Recalling events in order can strengthen memory by reinforcing the natural progression of the story, which aligns with how our brains typically store and retrieve information.
• Word processing software allows for easy editing and revising of text, which can be particularly beneficial for children with ADHD who may need to make frequent changes to their work as they organize their thoughts.
• Role-playing allows children to practice social interactions in a safe and controlled environment, helping them understand social cues and appropriate responses without the pressure of real-world consequences.

Comprehensive Behavior Management and Environmental Adaptations

Reinforce Constructive Behavior Instead of Only Punishing

Barkley argues that punishment, though a part of any parent’s job, is among the least effective strategies for shaping behavior, especially when the behavior that needs changing stems from ADHD or another disorder. It’s far more effective to reinforce the good than to focus on stamping out the bad, especially when a kid doesn’t even know her actions are unacceptable.

Frequent Use of a Points-Based Method to Motivate Children

Barkley has observed through his work that a reward system is a powerful way to reinforce appropriate behavior and motivate children to complete tasks. He advises using poker tokens for younger kids because they’re tangible, fun to manipulate, and easy to keep track of. With your child, write down the chores, tasks, and prosocial behaviors you'd like to encourage, and then assign point values to each one. Then make another list of privileges and rewards the child can earn by cashing in points, such as TV time, video games, playing with a special toy, or even a trip to the park. (For younger children, the system will need to be simple; with those who are older, you can use a notebook instead of chips.) Then, your kid can decide what they’re “working for.” For the system to succeed, though, you must apply it consistently to reinforce positive actions and withhold rewards for negative actions.

Context

• Consistent application of the system is crucial for effectiveness. This means regularly updating the list of tasks and rewards and ensuring that points are awarded or withheld fairly.
• Using a notebook for older children can also serve as a tool for developing organizational skills, as they learn to track their progress and set goals.
• Consistent application helps children understand the direct link between their actions and consequences, which is crucial for learning and behavior modification.

Praise, Make Contact, and Minimize Commands When Providing Feedback

Barkley stresses that you don’t have to buy an elaborate system to reward children with ADHD; simple praise and affection, offered frequently and spontaneously, are incredibly motivating to children. But he cautions parents to communicate these rewards thoughtfully, remembering that a kid with ADHD requires simple, direct feedback and more of it, instead of long, complex explanations or endless complaints. He reminds us that the executive brain of kids who have ADHD doesn’t absorb a lot of language—“It’s not an information deficit disorder!” he likes to say. Instead of talking, he advises us to get personal: Get close to your child, touch her affectionately, make eye contact, and then speak briefly and concisely, then leave with a gentle touch.

Context

• Thoughtful communication fosters a sense of trust and connection between the child and the parent. This relationship is crucial for encouraging cooperation and reducing resistance.
• Children with ADHD often struggle with processing lengthy or complex verbal instructions due to differences in attention and executive function. This means they benefit from clear, concise communication that reduces cognitive load.
• Engaging multiple senses through touch and eye contact can help maintain the child’s attention and make the interaction more memorable and impactful.

Predict and Proactively Prepare for Challenges

Because kids with ADHD struggle to use "hindsight" (knowledge from past experience) to anticipate and prepare for similar situations in the future, parents must intervene to guide them.

Identify Recurring Problems and Modify Them In Advance

Barkley advises us to identify common settings and events that typically result in misbehavior, emotional meltdowns, or other adverse consequences of having ADHD—for example, going to the supermarket or visiting relatives during holidays. Ask yourself what usually triggers a problem, whether you're out or at home. Maybe preparing for school or bedtime involves endless pleading from you and resistance from your kid—or perhaps sibling arguments are an everyday occurrence. Or maybe you know that even a short trip to pick up a birthday cake will prove challenging because waiting is very hard for kids with ADHD who aren't able to anticipate when a task will be over.

Once you recognize the situation, Barkley encourages you to brainstorm possible solutions, such as arranging childcare to shop without worry, taking your kid to the park before grocery shopping, or creating a fun chore chart that everyone can use.

Context

• Parents can benefit from keeping a journal to track patterns in behavior, identifying specific triggers that consistently lead to issues.
• Consulting with professionals such as therapists or educators can provide additional strategies and support tailored to the child's needs.

Managing Transitions: Rules, Rewards, and Penalties

To increase the odds that challenging situations will succeed, think about devising a plan for transitions that you can review with your child before entering the setting or starting the activity. This involves three steps:

1. Rules: Decide on the rules you expect your child to follow in this situation or setting. If it’s shopping, for example, these might be “stay near me”, “don’t touch anything”, and “please don't ask me to buy you anything”.

2. Rewards: What will your child get for good behavior? Use the system of points or tokens you've already set up, or consider rewards like ice cream after the grocery store or a trip to the park after homework.

3. Punishment: What will happen if they don't follow the rules or act out in other ways? Loss of tokens, a short timeout, or even foregoing a privilege like a sleepover with friends this weekend will all work.

Review these three components of your plan before you enter the situation and hand your child something diverting to do, such as a favorite handheld game or even a bag of granola to eat. It’s also important to offer frequent praise and rewards for good behavior while you’re in the setting or while accomplishing the task. Waiting until the end just doesn't reinforce good behavior for a child whose executive functions aren’t up to connecting the action with the delayed consequence. Barkley reminds us that a good plan also includes a few backup strategies, given that kids with ADHD might not always respond as we hope and expect, such as a quiet spot for a time-out in a public location or a quick “reward” for good behavior.

Context

• Consistent use of transition plans across different settings (home, school, public places) helps reinforce expectations and supports the child in generalizing appropriate behaviors.
• While consistency is important, rules may need to be adapted over time as the child grows and their needs change, ensuring they remain effective and supportive.
• Using a points or token system can also teach children about goal-setting, responsibility, and the value of working towards a reward, which are important life skills.
• Consequences should be age-appropriate and consider the child’s developmental stage. Younger children may need more immediate and tangible consequences, while older children might benefit from more complex systems of rewards and penalties.
• Reviewing the plan beforehand helps set clear expectations and reduces anxiety for both the child and the parent. It ensures that the child understands what is expected and what the consequences will be, which can be particularly important for children with ADHD who may struggle with impulsivity and attention.
• Frequent praise serves as positive reinforcement, which is a behavioral strategy that increases the likelihood of a behavior being repeated. This approach is particularly effective for children with ADHD, who may respond better to positive feedback than to negative consequences.
• Public settings can be overstimulating for children with ADHD, leading to sensory overload. Backup strategies can include finding quieter areas to help the child calm down.

Think About Medicating as a Supplement to Behavior Management

Barkley emphasizes that medications approved by the FDA are an effective treatment for ADHD. They've undergone extensive study, and even though they aren't a cure, they can help kids whose disorder is so severe that even the best behavior management doesn't result in substantial gains in daily functioning.

Medications Improve Executive Function and Regulating Emotions

Barkley is adamant that ADHD medications don’t just address the outward symptoms of ADHD; they improve a child’s core executive functions, from sustaining attention to inhibiting impulsive actions to managing emotions. In many cases, the combination of medication to manage the underlying neurodevelopmental deficit, along with behavioral strategies and accommodations, is the key to helping children or adolescents with ADHD succeed.

Other Perspectives

• Some experts argue that the long-term impact of ADHD medications on the developing brain is not fully understood, and caution should be exercised when prescribing these medications to children.
• Some individuals may prefer to manage their symptoms through lifestyle changes, such as diet and exercise, rather than medication.
• Medication does not teach coping skills or behavioral strategies; it merely creates a more conducive environment for learning and applying these skills, which must be taught separately.

Pair With Additional Treatments, Not Standalone

If you're thinking about medication for your child, Barkley, drawing on his many years as a clinician and researcher, advises us to be mindful of the myths that surround ADHD medications. ADHD is a legitimate condition, it has a primarily biological origin, ADHD medications are safe when used as prescribed, and they don’t turn children into drug addicts. Barkley wants us to know that ADHD medications are comparable to eyeglasses or crutches for physical problems—they can reduce the burdens that accompany a disorder and aren’t intended to replace a compassionate, supportive, informed home and school environment.

Context

• Organizations like CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) provide resources to help families understand medication safety and management.
• The effectiveness of eyeglasses depends on the correct prescription tailored to an individual's needs; ADHD medications also require careful dosage and type adjustments to suit each person.
• Factors such as prenatal exposure to toxins (e.g., alcohol, nicotine), premature birth, and low birth weight have been linked to an increased risk of developing ADHD.
• Proper dosage and regular follow-ups with healthcare providers are crucial in minimizing any potential risks associated with medication use.