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Way to go: positive reinforcement programs for your child with attention deficit/hyperactivity disorder (ADD/ADHD). (ask the doctor).

There are many undesirable behaviors that you may want to decrease in your child. However, it is often better to try to find a way to increase a desirable behavior that may be an alternative to the undesirable behavior. For example, you may want to decrease the time that your child takes in resisting sitting down and doing homework. Another way to look at this is to increase the desirable behavior of sticking to a schedule and therefore sitting down to do the homework in a specified amount of time.


Reinforcement is something that is designed to increase behavior. There are two types of reinforcement: Positive and Negative. Positive reinforcement increases behavior when you add or give something following the behavior. Negative reinforcement increases behavior when you take something away following the behavior.


The first step in setting up a positive reinforcement system involves defining the targeted behaviors.


I. Whenever possible, try to define the behavior in positive terms. (see chart below)

II. Narrow your range of focus Be selective in identifying your target behaviors. Trying to change too many behaviors at one time is likely to fail. When selecting target behavior(s) think of the importance in terms of the following factors:

* Functional level--Where is the child in terms of behavior? What is the child able to do? If your goal is to be able to enjoy going out to a restaurant but one of your child's behaviors is the inability to stay seated at a table for more than five minutes, then changing the behavior must begin at that level

* Importance of that functional level--Prioritize according to your values. Does the behavior interfere with goals set for the child? You have decided that you want your child to have more academic success therefore it is important to get the child to focus. Therefore, sitting quietly in class

* Quality of life--Whose quality of life are you trying to improve? Will changing this behavior alter life positively? If your child wants to participate in team sports but their behavior is affecting involvement with others, changing the behavior is important for the child's success. If you see academic success as an important goal, but your child would rather spend time involved in sports, your goal will be harder to accomplish because there will be a conflict.

* Practical issues--Factors such as time and ability to monitor behavior should be taken into consideration when targeting a behavior to change. For example, if the behavior you choose to improve or change occurs mostly in school, you will not be able to monitor it directly.

* Detail--Be very specific when defining the behavior. This may involve breaking larger behaviors into smaller parts and working on them one at a time.

III. The target behavior has to be measurable

The behavior has to be something you can truly assess in terms of change. This may involve the number of times something occurs or the amount of time something lasts or the frequency of it.

* Measuring Behavior--In order to see changes in behavior(s) you need to have a clear sense of the baseline, or what is "normal" for your child. How often does the behavior occur now? How often would you like it to occur?


In selecting reinforcements, use what already motivates your child. This does not have to be a material thing, but can be time on a preferred activity. Be aware that what motivates children one day may not motivate them the next.

You may want to have a variety of reinforcement available. For example, selecting from a bowl of activities, or a point system that earns different prizes. When possible, have your child play a role in selecting the reinforcements.


Different age levels require different systems. Younger children work best with systems that furnish a very short delay between the behavior and the reinforcement. As a child ages, the reinforcement system can become more complex, with longer delays between behavior and reinforcement.

Try to get your child to make a "contract" to try the system. The greater the child's involvement in setting up the system and affirming efforts to comply, the more likely it will be for the system to succeed.

For all ages, pair the reinforcement with positive verbal feedback. This is the route to internalization. You want your child to take pride in his or her accomplishments. It is this internal sense pride that will carry the behavior forward in the future.


Be patient and give your system a fair trial. Identify a "review day" to assess your system. If it is not working, do some trouble shooting. What factors are interfering? Were you being realistic in the target number of behaviors needed to earn the reinforcement?

If it is working, continue the system for another period of time and if needed, alter the system. Wait to gain success in one behavior before targeting another.


ANTECEDENTS: What led up to the behavior? What was the situation or context in which the behavior occurred?

BEHAVIOR: What is the behavior? Specify exactly what behavior occurred.

CONSEQUENCES: What happened in response to the behavior? What was the response of you or others to the behavior?

Positive reinforcement systems target behavior through positive consequences aimed at increasing the desirable behavior. Remember to examine the the antecedents of a behavior as sometimes the context needs to be altered for the behavior to change.


These are just some basic tools for structuring a reinforcement program. You and your child may be able to find new tools to help you accomplish your goals together. Be sure to approach the positive reinforcement program with a positive attitude and make it a fun and successful experience for your child.


Think about your child's likes and dislikes and use what already motivates your child. Make a list of five things your child likes and a list of five activities he or she enjoys. A reinforcement does not have to be a "prize." It could be time playing a game with you, time on the computer, a trip to the library, etc. Remember that what motivates a child one day may not do the trick next week. You may want to put together a "treasure box" for variety, or provide other methods of choice. Be practical--reinforcements are meant to motivate and do not have to be expensive or elaborate.

Here are some examples of to re-defining the undesirable
behaviors in terms of desirable behavior:


Nail Biting Lets nails grow; Keeps fingers out of mouth

Fidgets Stays still in chair for 10 minutes

Talks on and on Keeps focused on one topic long enough
 to express a thought or need

Disorganized Remembers to bring homework home

Breaking down behaviors into their component parts and
re-defining them in positive terms is often helpful.

Behavior Sub-behaviors Re-definition
 (broken down into specific (the desirable behavior)

Always on a) Fidgets Stay still in chair for
the go 10 minutes
 b) Gets out of chair five
 times in 10 minutes

Ask the Doctor addresses issues of concern to our readers. Parents should review any suggestions made in this column with the appropriate professionals. Mention of specific products or medications illustrate suggestions and are not endorsements of any specific products. Send questions to: Ask the Doctor, EXCEPTIONAL PARENT, 65 East Route 4, River Edge, NJ 07661; Fax: (201) 489-0074; or E-mail:

This article is based on Dr. Marron's presentation at the Northern New Jersey Maternal/Child Health Consortium conference "ADHD: Maximizing Potential," Woodcliff Lake, NJ, May 17, 2002.

Jeanne A. Marron, PhD, is a clinical psychologist and has been an instructor, clinician and researcher for more than 18 years. She is also the clinical supervisor for the Asperger's yndrome Program.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Marron, Jeanne A.
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Jul 1, 2002
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