Dr. Steven A. Richfield, author of the Parent Coach Cards

The past several years have witnessed an explosion of research and writings regarding the daily struggles of children contending with the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Perhaps no other childhood disorder has been the subject of such a hotly contested debate over the role of medication in it's treatment. Unfortunately this controversy has grabbed the headlines to such a degree that a vital area of concern has been relatively neglected: what parenting role can benefit children with ADHD?

Regardless of whether one's child is medicated, parents of children with ADHD face plentiful challenges as they navigate their charges through the hurdles of childhood. Whether it be advocating for appropriate accommodations in the classroom, preparing their child to visit an unfamiliar place, or instilling good organizational skills, ADHD requires that parents take an active and planful role in their children's lives. The stress produced by all of this "navigational support," in addition to the typical ADHD-intensified behavior problems, can leave even the most road-tested parents in a fragile and frazzled state of mind. Accordingly, so much energy is devoted to helping make the outside world more manageable to the ADHD child that parents may find themselves on "low fuel light" when behavior problems arise at home.

Intense and recurrent episodes of noncompliance, temper tantrums, sibling rivalry, or emotional oversensitivity on the part of the ADHD child represent some of the more formidable challenges faced by parents at home. When confronted by such scenarios, parents' own problem solving skills and frustration tolerance is put to the test. In an effort to quickly extinguish the problematic episodes, some parents react in a harsh and punitive style. Other parents may unduly cater to the child's wishes. These approaches may stop troubles in the short term but do not guide children toward overcoming these problem behaviors. Ultimately, the behavior problems often intensify and the bond between parents and child is further strained by the cycle of conflict.

As a clinical psychologist who specializes in the treatment of ADHD, much of my professional time is devoted to the needs of parents who find themselves in this predicament. Upon approaching me for help, their home life feels more like a battleground of power struggles. I can easily appreciate what it must feel like since glimpses of such conflict-torn interactions are familiar to all parents. Both personal and professional experiences have been a wellspring for many of the parenting paradigms and techniques that I have developed and implemented in my clinical practice. During the past several years, I have been weaving these ideas into a cohesive model for parenting all children, but especially those with diminished self-control and social skills. I call this model Parent Coaching.

Parent Coaching is a system for skillful and proactive parental intervention. One of the underlying rationales is that parents are in the ideal position to be child behavior change agents because family life mirrors so many of the real world challenges that children face. Yet when parents are narrowly concerned with the outcome of their disciplinary efforts, and not the process by which they got there, opportunities to "coach" their child toward proper self-governed behavior are overlooked. A parent coach anticipates these situations and comes prepared to step into the coaching role. The coaching role stresses that no matter what problem is presented by the child, the parent ensures that his or her approach makes clear that both parent and child are on the same side. This is supported by a viewpoint of behavior problems as opportunities to join with the child to review the triggers of the problem, consider corrective solutions, and reinforce healthy adaptation. Children are much more likelyto accept such help if parents can approach their children's problems from a nonadversarial "coaching" position rather than an anger inducing - or anger induced - "policing" position. Coaching offers children an internal safety net of social and emotional skills to help them cope with the circumstances of their lives.

My clinical practice has served as the ideal place to listen and learn about all the "compelling encounters" that can quickly escalate to trouble for ADHD children. Common encounters include disagreements with peers, requests by authority figures, and the presence of tempting stimuli, such as drugs, risky opportunities, or the annoying behavior of others. These moments in time can serve as triggering events, activating a maladaptive reaction in the child, leading to actions and statements with lasting negative consequences. Conversely, these moments may simply pass without much significance if a child possesses the skills for self-management of potential triggers. In this case, there are no external consequences, no shattered self-esteem, and no accompanying threat to others. In fact, proper management of trying circumstances can lead to enhanced self-esteem and peer admiration. My aim is to arm parents with the tools to help their children successfully manage these encounters and empower children to use them.

Emotional self-management results from developing a repertoire of skills that children mentally retrieve when circumstances demand. This requires preparation, practice and above all, the coaching of caring and informed adults. One of the first steps is for parents to help their child identify their own personal triggers that often lead to troubling reactions. It can be helpful to speak with children about typical "triggers to trouble" or give them some examples to help them reflect upon their behaviors. Consider the following list to get things started:

CHECK OFF YOUR TRIGGERS TO TROUBLE

• Finding out that I won't be able to do something I have really been looking forward to
• Seeing other kids having fun doing something that is against the rules
• Feeling very annoyed by the behavior of another kid
  Not wanting to do something I have to do
• Being unfairly accused of something I didn't do
  Losing at a game or not performing as well at something as I think I should
• Feeling jealous about something involving another kid
  Not being able to accept the mistakes of others
• Feeling very bossed around by someone else
  Finding out that someone used something of mine without my permission
• Feeling pushed aside by a friend
• Having to switch gears from doing something fun to doing something serious
  

In addition to these examples, parents can add others to the list or invite children to offer their own personal triggers. It's okay to gently suggest certain items to your child, but be ready to withdraw an offer if your child rejects the idea. The goal is not to get your child to agree with you, but to continue to build upon his/her ability to reflect upon their behavior. Unfortunately, many parents defeat their own purpose during this fragile point in the communication process by imposing judgments of where children go wrong. Parents must also not be too quick to suggest solutions or "quick fixes" to a child. This sends the message that you don't understand how hard it is for children to change behavior patterns. Impulsive behaviors, such as hasty decisions and rash actions, are caused, in part, by children's lack of experience with rational thinking within emotionally charged situations. By discussing triggers you are beginning to help them carve out a rational thinking path that can be accessed when the stakes are high. But be prepared to do a lot of listening., not lecturing.

One of the most critical lessons I learned in working with ADHD children occurred six years ago. Ten year old Lauren, with a history of peer problems and self control deficits had just patiently listened to me offer some strategies for controlling her reactions, and quipped, "You mean, that's it, you expect me to remember everything you just said? I have ADD, you know, don't you ever give kids something to take home so that they can try to remember how to control themselves?" These comments inspired me to join with her in developing a series of strategy cards that we eventually called her Coaching Cards. Each card was devoted to a particular skill lesson and divided into two sections; the first explained when the skill was needed and the second offered a "talk-to-yourself" message that reinforced the assimilation of the skill. She then drew pictures on the opposite side of the card to portray it's contents. It wasn't long before we had come up with enough cards that could apply to just about all the children in my practice and I was making copies for them.

Six years later Lauren's "strategy cards" have evolved into Parent Coaching Cards, a set of 20 social and emotional skill building tools that are now in use in thousands of homes, schools, and childcare settings throughout the world. By blending my parenting paradigms with Lauren's need for practical, skill-based tools, the program has served as a "play book" for children and parents to refer to when the hurdles of childhood loom ahead. Although the cards are designed to be initially used by parents, in order to facilitate a coaching attitude, they remain true to Lauren's vision: they are written to appeal to a child's mind. The cards portray some of the most typical experiences of school-aged children between the ages of 6-12. The language captures their concerns for acceptance, sensitivity to failure, vulnerability to peer pressure, tendency to oppose authority, and other important developmental issues. The lessons are printed on 4" x 6" coated cards with a colorful illustration on one side and a concise self-help message on the other. They are held together with a key ring for easy use.

Although I can continue to make extensive use of the Cards in my clinical practice their availability through mail order has mostly placed the program in the hands of parents without any formal psychological training - except that which is culled from being in the parenting trenches with their children. This has generated a population of parents of ADHD children who have stepped into the coaching role without any direct professional help. The anecdotal reports I receive via e-mail suggest that children are more receptive to a parent's attempts to coach life skills if they don't feel talked down to, but sense that "coaching is a two way street." Parents contribute to this safe dialogue when they admit to their own errors, accept helpful and constructive feedback from others (including their child), and pledge to work harder at self-correction. In other words, the old standard, "I'm going to teach my child a lesson" is replaced by, "What is the lesson that both of us can be taught?"

The following vignette is an actual exchange between a child and her father that occurred soon after the parents introduced Parent Coaching Cards:

Muriel, a bright 8 year old girl , kept her negative feelings hidden from her parents until she couldn't hold them in any longer, and they erupted in temper tantrums. Her parents were perplexed about these episodes since Muriel normally behaved in an appropriate and loving manner towards both of them. After becoming familiar with the Parent Coaching approach, Muriel's father invited her to "take turns at being the coach." (This involves the parent and child picking out cards that the other person could use in specific situations.) Her father invited her to start, and Muriel began by turning to the "Quit The Clowning" card. She went on to explain, "Dad, you tell a lot of jokes that really hurt my feelings, like when you say you're going to flush me down the toilet or throw me in the garbage. I would like you to stop that." Muriel's father was surprised that his jokes hurt so deeply but he responded with the open-minded demeanor of a coach aware that he has much to learn about his daughter. "I'm really sorry that I've hurt you, but now I know so I'll try hard to quit that kind of clowning around," said the father. After they spoke some more about Muriel's hurt feelings it was time to reverse roles. Her father turned to the "Watch Out When Words Pop Out" card, and wove in a discussion of Muriel's temper tantrums. This led to an open discussion of how Muriel could work on appropriately expressing her feelings before they pile up inside and lead to tantrums.

It was a big step for Muriel to calmly assert herself with her father. She had previously viewed this type of self-expression as "being bad." But two vital elements gave her the freedom to risk this new role. Her father's open-minded attitude and the pathway afforded by the Coaching Cards provided enough reassurance for her to try it out. This pathway offered her a tangible way to give feedback to her father. The illustrations and words further supported her feelings, and allowed her to realize that this was a common situation that many people find themselves in. Once her father had responded with acceptance and taken responsibility for his own error, it was much easier for Muriel to do the same.

When the program is used in a clinical context the child may require a "therapeutic warming up" to the concept of coaching and the Coaching Cards. When parent-child conflict is particularly acute, I will invite parents into a child's appointment to model how to employ the cards in a nonthreatening, collaborative manner. With other cases, a child's willingness to respond to the cards can be cultivated through discussion of how rewards increase and punishments decrease when children are willing to be coached. If necessary, a behavior contract is drawn up that pairs the proper use of the cards with specific reinforcers.

Children spanning a wide age range have benefited from Parent Coaching Cards. Younger children, between ages five to ten, require more direct parental involvement to learn how the cards apply to real life. When appropriate parents can suggest how certain skills are depicted on television shows or encourage role play to get children accustomed to using adaptive self-talk. Children over ten-years-old may be willing and able to use the cards on a relatively autonomous basis, with perhaps a little help from parents to get them started. Ideally, the older child requires less and less coaching as they become more adept at using the skills on each of the cards. Several of my ADHD patients have been amenable to using the cards in school to aid compliance with a broader behavior management program. In these cases, the cards are often kept within a zippered pencil pouch to protect the child's privacy. When behavior problems occur teachers are encouraged to offer children the option of quietly reviewing their cards rather than face disciplinary consequences. This option often greatly curtails the need for teachers to remove children from the classroom due to chronic disruptive behavior.

One clinical example of how Parent Coaching Cards reduced parent-child conflict and promoted pro-social school behavior involves fourteen-year-old Adam. Adam had been diagnosed with ADHD at age 11 and responded well to psychostimulant treatment. As Adam entered adolescence, his parents noticed him lagging further and further behind his peers in the areas of maturity, social judgment, and "silly attention-seeking." Although his academic performance continued satisfactorily, Adam was brought for treatment to "learn to grow up." Adam also recognized that he was falling behind his peer group and antagonizing his family members with his immature escapades. But like a lot of ADHD teenagers, he lacked the skills to do anything about it. When shown the Coaching Cards, (I often drop the word "Parent" when suggesting the cards to older kids)
he was immediately relieved that I could offer him something tangible to take home and use. He wasted no time in doing so. During sessions, he reported how the cards were relied upon during the intervening week, especially "Don't Take The Bait." The cards made it much easier for him to inhibit much of the impulsive speech and behavior that proved so troublesome in his peer group and family relations. In turn, Adam could benefit more from therapy sessions since instead of "putting out fires" at home and school we could focus upon expanding and refining his social and problem solving skills in the context of his specific life circumstances.

Adam's case demonstrates how Parent Coaching Cards can provide swift therapeutic impact in the hands of a bright and motivated ADHD teen. The value of using the cards soon became so apparent to him that his parents offered little direct coaching. In keeping with the normal autonomy of adolescence, he did it on his own. If faced with a conflict with his parents, he reviewed the cards in private and thereby summoned the behavioral skills needed for resolution. His parents were especially pleased by this outcome because they no longer got trapped in the old cycle of conflict. During collateral parent counseling sessions, I suggested that if Adam began acting out his problem behaviors they should refrain from scolding and merely explain that they would continue spending time with him after he reviewed the cards. This condition significantly reduced the intensity of conflict surrounding many emotionally charged issues.


These two examples demonstrate how the employment of Parent Coaching Cards can be individualized to the needs of the child and parents. This versatility also allows different users to blend them to a particular style or location. As with other tools offered for ADHD, Parent Coaching Cards are designed to be but one component in a parents' multi-modal approach to this condition. But perhaps more than other tools, these cards hold the promise of diminishing parent-child conflict by establishing a path of collaboration and problem solving between parent and child. When the relationship between parent and child can be protected from the damage of protracted conflict, a child's efforts in the face of ADHD stand a much greater chance of success. Parents can intuitively appreciate that this protection of the parent-child bond is essential if other multi-modal treatment efforts are to provide the greatest benefit, no matter what condition a child is suffering.

Dr. Steven Richfield is a clinical psychologist who is in full-time private practice in Plymouth Meeting, PA. His practice is primarily devoted to the needs of ADHD adults and children. He has developed a child-friendly self-control/social skills building program called Parent Coaching Cards now in use in thousands of homes and schools throughout the world. He can be contacted directly for further information on Parent Coaching Cards and workshops at www.parentcoachcards.com or 610-238-4450. Mail inquiries to P. O. Box 1263 &Mac215; Blue Bell, PA &Mac215; 19422