Phase 1:

Understanding Child Behavior and Parenting Practices

Overview of Phase 1

We designed “Phase I: Understanding Child Behavior and Parenting Practices” to help you identify strengths and problem areas in your family. It also provides you with resources that are available to help you and your family.

Sometimes, finding solutions to personal or family problems is very challenging. This guide asks you to think about your family’s strengths and the problems in your family that you would like to change.

If you have already met with a provider to assist with finding solutions to these problems, you may have completed some forms and an interview. These items will help the provider learn more about you and your family.

If you have not yet met with a provider or you simply don’t have one, then your treatment plan and use of this manual will most likely be self-directed.

Either way, this manual may help you reach your goals and learn some skills in the process.

This phase has 3 topics:

Learning About Defiance and ADHD
A magnifying glass

Distinguish defiance from ADHD symptoms and read what other parents have asked about ADHD.

Jump to "Learning About Defiance and ADHD"
Deciding on Treatment Options
A tablet

What treatment would work best for you and your family?

Jump to "Deciding on Treatment Options"
Identifying Parenting Styles
Three adults, one with an arrow overhead

Learn about parenting styles and their pros and cons.

Jump to "Identifying Parenting Styles"

How to Best Succeed During this Program

The success of this program depends on the effort put forth by you and your family. If you are working with a provider, therapy sessions are very helpful and you and your family should attend them. When you are not in sessions, use this manual to help review and reinforce what you and your family have learned. This will ensure you and your family’s most successful course of treatment.

We provide several handouts that go along with this manual. Some handouts may also be given to you by your provider. Handouts are a helpful way to learn, summarize, and work with material discussed in treatment sessions.

If You are in a Crisis

Here are a few crisis services you may contact in case of an emergency.

National Resources

National Suicide Prevention Lifeline

Available 24 hours a day, 7 days a week
1-800-273-8255

National Domestic Violence Hotline

Available 24 hours a day, 7 days a week
1-800-799-7233

ChildHelp National Child Abuse Hotline

Available 24 hours a day, 7 days a week
1-800-422-4453

National Alliance on Mental Illness Helpline

Available 10am-6pm Eastern time, Monday-Friday
1-800-950-6264

If you are in immediate danger, call 911!

Local Resources

Ask your provider to help you identify local resources that may be helpful for you and your family.

In general, it would be good to learn about local community mental health agencies, private practitioners who serve children and families, and a local crisis center if you happen to need one. You can write those names and their contact information here.

Learning About Defiance and ADHD

Please read through the material below that addresses symptoms of oppositional behavior, inattention, and hyperactivity/impulsivity as well as the FAQs about these diagnoses and think about how it applies to you and your family. You will notice that some of the behaviors are similar. Once you have read the material, write down any questions you have to share with your provider during your next session.

Oppositional Defiant Behaviors

  • often loses temper
  • often argues with adults
  • often ignores or refuses to obey adults’ requests or rules
  • often purposely annoys people
  • often blames others for mistakes
  • is often touchy or easily annoyed by others
  • is often angry, resentful, spiteful, or cruel
Defiance

ADHD Behaviors

Inattention

  • has a hard time sustaining attention
  • does not seem to listen when spoken to directly
  • has a hard time organizing tasks and activities
  • is easily distracted
  • is forgetful in daily activities
Inattention

Hyperactivity

  • fidgets with hands or feet or squirms in seat
  • is often “on the go” or acts as if “driven by a motor”
  • talks excessively
Hyperactivity

Impulsivity

  • blurts out answers before questions are completed
  • has a hard time awaiting turn
  • often interrupts or intrudes on others
Impulsivity

Frequently Asked Questions abotu ODD

How common is ODD in children?

There are wide estimates of prevalence rates (1 to 11 percent). In childhood, boys are more likely than girls to have ODD; gender disparity diminishes by adolescence.

Is it just a made-up condition to label "bad" children?

All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two- to three-year-olds and early adolescents. (AACAP, Facts for Families).

However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life. When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD).

Is it temporary? Do kids grow out of ODD?

It’s normal to hope that your child will grow out of ODD, but ODD won’t go away by itself. Your child needs professional diagnosis and treatment early on. This will help your child develop the skills he needs to make and keep friends, get and keep a job, and build a support network later in life.

How could it affect my child's future?

Childhood ODD is associated with future problems. Children with ODD are at greater risk for substance abuse, cigarette smoking, anxiety, depression, antisocial behavior, and performance problems both now and later in life.

What causes ODD?

ODD has been linked in some research to parenting issues, child temperament, and/or traumatic experiences.

Can ODD be treated?

ODD is treatable. Research has shown behavioral treatments (like DOCC) can be helpful.

Will my child have to take medication?

Medication is not part of treatment for ODD. However, if your child has a co-occurring diagnosis of ADHD, medication may be recommended.

What happens if my child does not receive treatment for ODD?

It is possible that your child will do perfectly fine with no treatment. However, if left untreated, ODD may cause significant issues in both the home and school environments. Untreated ODD may also increase a child’s risk for anxiety, depression, antisocial behavior, and substance use disorders.

Frequently Asked Questions about ADHD

If your child meets the criteria for ADHD, please use this Frequently Asked Questions about ADHD handout to answer some of your questions.

Read through the following information and take note of how it applies to you and your family. Please be prepared to talk about what you read with your clinician. Discuss any questions and concerns with your clinician during your next session.

How Common is ADHD in Children?

ADHD is one of the most common chronic health conditions for school-aged children. It is the most common behavioral disorder of childhood. 4% to 12% of children in the U.S. community have ADHD and 3% to 5% of school-aged children have ADHD. Boys are about three times more likely to have ADHD than girls.

Percentage of all US children with ADHD
Percentage of school-age US children with ADHD

Is it just a made-up condition to label bad children?

ADHD is a real condition associated with real problems and impairments. Children with ADHD are more likely to have academic problems, relationship problems, and accidents than children without ADHD.

Is it just a temporary condition?

People usually don’t “grow out of it.” About 60% of children with ADHD continue to have symptoms into adulthood.

How could it affect my child’s future?

Childhood ADHD is associated with future problems. Children with ADHD are at greater risk for substance abuse, cigarette smoking, unwanted pregnancy, traffic violations and car accidents, and performance problems both now and later in life.

What causes ADHD?

ADHD is a biological disorder that runs in families. ADHD is very heritable. Children with ADHD show differences from unaffected children in brain imaging studies. The cause of ADHD is unknown. Brain imaging is usually not a useful diagnostic tool.

Can ADHD be treated?

ADHD is treatable. Research has shown behavioral treatments and medications can be helpful.

Will my child have to take medication?

MMedication is better than behavioral treatment alone for most children with ADHD. Medication alone may work as well as the combination of medication and behavioral treatments.

How well does the medication work?

ADHD medications are called stimulants. Stimulants are the backbone of treatment and will help most children with ADHD:

  • In the classroom. Stimulants have been shown to decrease interrupting, fidgetiness and finger tapping, improve attention, and increase on-task behavior.
  • At home. Stimulants can improve interactions between parents and children. They can also improve listening and on task behavior.
  • With peers. Stimulants can decrease aggressive behaviors, increase attention during sports, and improve peer rankings of treated children.

Isn’t ADHD over-diagnosed?

Many children with ADHD go untreated or are inadequately treated. While many parents are understandably concerned that stimulants are being overprescribed and that ADHD is being over-diagnosed in children, research suggests that many affected children are unrecognized and untreated.

What happens if my child does not receive treatment for ADHD?

It is possible that your child will do perfectly fine with no treatment. But many children with untreated ADHD begin to experience further challenges in school, home, and in the community that affect their family relationships, academic performance, safety, and/or social or peer relations. It would be reasonable to monitor your child’s current symptoms of ADHD and to review your preferences for how to best manage or treat them. You can discuss this further with your provider.

Deciding on Treatment Options

Now that you’ve reviewed some information about defiant behavior and ADHD, it is important to understand what treatment may work best for you and your family. In the section below, we list the possible benefits of each treatment for you and your family. Prepare to discuss these treatment approaches with your provider.

Learning about Different Treatment Approaches and Options

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) is a general treatment approach that focuses on making connections between thoughts, feelings, and behaviors and learning practical skills to change or manage thoughts, feelings, and behaviors. Both children and parents can participate in CBT. CBT is possibly the most well documented and most effective treatment approach being used today.

  • Thoughts: Our 'self-talk' (what we say to ourselves in our own mind) affects how we feel and what we do. CBT teaches people to identify and change their 'self-talk.'
  • Feelings: Sometimes feelings can be so intense that it is difficult to think clearly. CBT teaches people helpful tools to manage strong feelings.
  • Behaviors: What we do affects how we feel and what we think. CBT teaches people to try new behaviors and see how they change their thoughts and feelings.
CBT shows the relationship between thoughts, feelings, and behavior

Parent Management Training

Parent management training (PMT) is an effective therapy approach focused on helping parents understand their children’s behavior and use new tools and strategies to change these behaviors. Parents are taught to recognize how their own behaviors affect their child’s behaviors and emotions. Parents learn how to use rewards and consequences to increase children’s positive behaviors and decrease children’s negative behaviors.

Medications

Medications can be very effective in relieving certain emotional or behavioral symptoms. Currently, there are many medications found to reduce symptoms, especially for childhood ADHD. If one medication does not work, your team may recommend other medications to consider. You can discuss medication options in more detail with your provider.

Medications can be effective in relieving certain emotional or behavioral symptoms

Considering Medication treatment for ADHD

If your child has not been diagnosed with ADHD, feel free to skip ahead to the section labeled "Identifying Parenting Styles."

Jump to "Identifying Parenting Styles"

If your child has been diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD), his/her medical provider may be discussing medication treatment with you and your child. This decision can be difficult for some families, so read on for additional information that may assist you in making a fully informed decision that is best for your family.

A Team Approach

Your child’s pediatric practice has a care team dedicated to supporting you in address your child’s challenging behaviors.

Your child's primary care provider will be responsible for:

  1. Prescription of any medications, including making sure that you and your child have full understanding of the medication and have all of your questions answered
  2. Monitoring for side effects and medication response

The behavioral health care manager at your child’s pediatric practice will provide clinical treatment support by:

  1. Talking with you and your child about his/her symptoms, changes, and possible side effects (if any)
  2. Making sure that you, your child’s primary care provider, and any additional needed supports are all working together

Benefits of ADHD Medications

ADHD is one of the most common chronic health conditions affecting school-aged children and the most common behavioral disorder of childhood. Prevalence has been reported to be 4% to 12% in community samples of children in the U.S., with a conservative estimate of prevalence being 3% to 5% of school-aged children. Boys are approximately three times more likely to be affected than girls. ADHD is a real condition. Children with ADHD are more likely to suffer from academic problems, relationship problems, and accidents than unaffected peers. Approximately 60% of children with ADHD continue to experience symptoms into adulthood.

ADHD is a quite treatable disorder. Medication will help most children with ADHD. In the classroom, certain medications have been shown to decrease interrupting, fidgetiness, and finger tapping, improve attention, and increase on-task behavior. At home, these medications can improve interactions between parents and children, and improve listening and on-task behavior. With peers, medications have been shown to decrease aggressive behaviors, increase attention during sports, and improve social ranking.

Readiness and Concerns

You may be 100% ready to begin medication treatment for your child’s ADHD or you may have some concerns. One way to work through those concerns is to list out the “pros” and “cons” as you see them, using a Decisional Balance Sheet. Using the chart included in the handout below, write in the Pros you see to starting a medication trial and the Pros to not agreeing to a medication trial. Then, list the Cons to agreeing to a medication trial and the Cons to not starting medication at this time. Make an ADHD consultation appointment with your child’s pediatrician to review your concerns and the Decisional Balance Sheet.

Complete Handout: Decisional Balance Sheet

Identifying Parenting Styles

Common Parenting Styles

Before you start to learn and apply additional parenting skills, a valuable exercise is to look more closely at your current parenting style and the specific practices you use. There are 3 common parenting styles – please read through each description and try to identify which style most closely resembles yours.

Authoritarian Parenting

  • Highly demanding and highly unresponsive
  • “My way or the highway”
  • Unwilling to see child’s point of view
  • Children are expected to accept parents’ decisions without question
  • Children tend to be more anxious and distant
  • Child gets little practice making good decisions
Authoritarian

Permissive Parenting

  • Very low demands on children
  • “Hands off” approach
  • Believe that children with freedom will make the right decision
  • Child gets a lot of practice making good decisions
  • Parents may be disengaged or neglectful
  • Affects child’s development in attachment, social and emotional skills, and self-esteem
  • Children often crave rules for the security that structure provides, which their home lacks
Permissive

Authoritative Parenting

  • In between authoritarian and permissive parenting
  • Reasonable demands on children
  • Express love and acceptance openly
  • Do what they feel is in the best interest of the child
  • Respect between the parent and child
  • Children show independence and cooperative behavior

Why Does Authoritative Parenting Succeed Where Permissive and Authoritarian Styles Fail?

Authoritative parents enforce rules that are not random or unreasonable. Rules are consistent, reasonable, and realistic. They may not know for sure that their choices are perfect. But they are confident that their kids can make smart decisions.

Every family is different. Effective parenting in one home may not be as effective in another household. You are the experts. You know the best fit between your parenting style and your child’s personality.

Source: Dacey, J.S., & Fiore, L.B. (2000). Your Anxious Child. San Francisco, CA: Jossey Bass.

Now that you have looked more closely at these common parenting styles, please review this worksheet to help you consider your own style. Please answer the following questions carefully/honestly to determine what parts of your parenting style you are happy with and which ones you may want to improve upon or change. If you are scheduled to meet with the behavioral health care manager in your child’s pediatric practice, be ready to review your completed form.

Complete Handout: My Parenting Styles and Practices

End of Phase 1

Congratulations! You have completed Phase 1 of this manual. Great work! If your child has been diagnosed with Attention-Deficit Hyperactivity Disorder, move on to Phase II; if not, move on to Phase III.