The single most useful shift in parenting a child with ADHD is to stop working on the child and start working on the conditions. That sounds like a slogan and it has a concrete meaning: almost everything with good evidence behind it changes the environment, the timing or the way an instruction is delivered, and almost nothing changes the child’s motivation, because the motivation was rarely the problem.
This article is about what happens between seven in the morning and bedtime. If you are still at the stage of working out whether to seek an assessment, our guide to ADHD in children covers what that process involves and what is offered at the end of it.
Why ordinary instructions do not land
Because most household instructions are delivered in the one format this brain handles worst: at a distance, mid-activity, and several at a time.
“Shoes on, we’re leaving in five minutes, and bring your reading folder” is three instructions, one time estimate and no acknowledgement, shouted from a different room at a child who is currently doing something absorbing. A child without ADHD queues that and executes it imperfectly. A child with ADHD frequently does not register it as having happened at all, which is why the honest answer to “did you hear me?” is often no.
The mechanical version of the fix takes about fifteen seconds longer and removes a surprising share of the daily conflict:
- Go into the room. Do not call from elsewhere.
- Wait for the current activity to reach a pause, or end it deliberately with a warning.
- Get eye contact before saying anything that matters.
- Say one action, not three.
- Have them say it back.
Parents who change nothing else routinely report that a large fraction of what they had been reading as defiance was delivery failure. That is not the whole problem, and it is the cheapest part of it to fix. [dsm-adhd-parenting]
What behavioural parent training does, and what it does not
Behavioural parent training is the intervention with the best evidence for what parents can do, and it is recommended as a first line for younger children before medication is considered. [nice-ng87-parenting] It is worth being precise about what the trials actually found, because the marketing around it is less careful than the research is.
A meta-analysis of randomised trials examined behavioural interventions across several outcome domains, and split the results by who was doing the rating. On measures where the rater was usually a parent who knew which group their child was in, improvements appeared across the board. On measures where the rater probably did not know, improvements in parenting and in children’s conduct problems held up, while effects on the core ADHD symptoms did not reach significance. [daley-behavioural]
A schematic of the pattern described in the meta-analysis discussed in this article, drawn to show direction rather than reproduce its effect sizes.
Two readings of that are wrong and one is right. It is not evidence that the training does nothing, because the things that survived blinding are the things that determine whether a household is liveable. It is also not evidence that it treats ADHD, and a programme sold on that basis is overselling. The right reading is that it reliably improves the behaviour that gets a child into trouble and the parenting that surrounds it, and leaves the underlying difficulty with attention roughly where it was.
That is worth having. Conduct problems, not inattention, are what get a seven-year-old excluded from a birthday party and a fourteen-year-old excluded from school.
The praise ratio, and why it is a technique
A child with ADHD accumulates far more correction than praise by the time they are eight, and nobody involved intended that. It happens because the behaviour genuinely does require more intervention, and each intervention is individually reasonable.
The consequence is that the child builds an account of themselves out of the sample they are given. This is the mechanism behind something you will meet later, which is a child who has decided they are bad and behaves accordingly, because the prediction is already made.
Reversing the ratio is a specific practice rather than an attitude:
- Praise the thing while it is happening rather than afterwards, because afterwards is too late to be attached to anything.
- Name the behaviour, not the child. “You put your shoes by the door” rather than “good boy”, which cannot be repeated on purpose.
- Praise the ordinary. The compliance you expected is exactly the behaviour that needs reinforcing, and it is the one that gets no comment.
- Count for a day if you doubt the ratio. Most parents are shocked, and the count is more persuasive than any advice.
Consequences: immediate, small, certain
The three properties that make a consequence work are not the three most households use.
| What tends to happen | What works better |
|---|---|
| A large penalty announced hours later | A small one that lands within a minute or two |
| Removing something for a week | Removing something for ten minutes, reliably, every time |
| Warnings repeated five times, then an explosion | One warning, then the stated consequence, with no negotiation phase |
| A reward chart with a payout on Friday | A payout today, even a trivial one |
| Discussing the behaviour at length afterwards | Naming it in one sentence and moving on |
Delay is the specific enemy. A consequence separated from the behaviour by three hours is, for this child, not connected to it at all, and the argument that follows is about fairness rather than about what happened. Small and immediate beats large and delayed by a wide margin, which is fortunate, because small and immediate is also less exhausting to enforce.
The other half is predictability. A consequence that arrives sometimes teaches gambling rather than compliance.
Ten minutes that change the ratio faster than anything else
The single most transferable element of the parent training programmes is a short daily block of child-led play in which the adult does not instruct, correct, question or teach. It sounds trivial and it is the part people skip.
Its purpose is not fun. It is to insert a reliable stretch of contact into the day that contains no correction at all, which for a child who spends most of their day being redirected is a different experience of the relationship. Parents usually find the not-instructing part genuinely difficult for about a week.
Ten minutes of child-led play
They choose the activity. For the whole ten minutes you do not instruct, correct, question or teach. You describe what they are doing and you join in.
10:00
Phones out of the room. No questions, since a question is an instruction wearing a disguise, and no teaching, even when they are doing it the hard way. Narrate what you see: 'you are putting the red one on top'. If they break a rule that matters for safety, deal with it and restart the timer another time. Aim for most days rather than every day, and keep it short enough that you will actually do it.
That is the whole exercise
Two things worth protecting
School has to hear the same account you do. Difficulties that appear in one setting and not another are informative, and a school that sees the child as simply naughty produces a very different set of years than one that does not. Ask for what the difficulty actually requires: seating, movement breaks, instructions in writing, extra time. Our piece on executive dysfunction is useful to hand over, because it explains the gap between knowing what to do and starting it, which is the part adults most often misread as laziness.
Your own state is part of the intervention. Parental depression and exhaustion are common in these households and they degrade every technique above, since all of them require you to be calm at the exact moment you are least able to be. Treating your own low mood is not a luxury layered on top of the parenting; it is a component of it, and the ADHD guide covers how often the condition runs in families, which is a conversation many parents end up having about themselves.
When to seek help
Speak to a doctor if the difficulties appear in more than one setting and are interfering with learning, friendships or family life rather than simply being tiring, or if your child is being excluded from school or activities. Ask specifically about behavioural parent training, since it is the thing with the best evidence for younger children and it is not always offered without being requested.
Go sooner if your child talks about themselves as stupid or bad, if their mood has dropped or they have stopped wanting to go to school, or if you have noticed your own drinking, temper or mood changing under the strain. Sleep problems and anxiety travel with ADHD often enough to be worth raising in the same appointment rather than a later one.
Contact your local emergency services or a crisis helpline if you feel unsafe or have thoughts of harming yourself.
How MyFreud can help
MyFreud is a mobile app that helps you find solutions to problems that have affected your mind and productivity. Live coaching sessions are for the parent rather than the child, which is the part usually left uncovered, and each one ends with an actionable plan for the week rather than reassurance that you are doing your best. Daily tracking is unusually useful in this household because it shows which days actually go wrong, and the answer is frequently a sleep pattern or a specific hour rather than the child’s mood. The notepad is where the praise count and the ten-minute block get recorded, since both of them work and both of them quietly stop happening.
Download MyFreud and start today: App Store or Google Play.