Medically reviewed in February 2021
Matthew, an active 7-year-old, and his mother, Judy, came to see me. From the moment Judy began talking, I noticed tears welling up in her eyes.
"Matthew's school evaluated him for attention problems and asked me to talk with you about their findings," she said, handing me the school's assessment report. "His teacher mentioned that he might need to take medication. That really worries me because of all I've heard about the overmedication of children these days. I don't want to put him on drugs if it's not absolutely necessary."
The report listed all the tests given to Matthew to assess his behavior and determine how it might affect his performance in school. His score on the Behavior Assessment System for Children (BASC) showed he was borderline ADHD. Also included in the packet was Matthew's report card.
"It looks like he's having some difficulty," I said.
Judy confirmed that he was struggling academically, which she suspected was due, at least in part, to the fact that he can't sit still. "If he's not up to sharpen his pencil, he's rummaging through his backpack. He'll return to his seat if asked, but in a few minutes, he's up again. And he's always talking -- to a classmate, to himself, to someone passing in the hallway. If he thinks he knows the answer to a question, he just blurts it out."
After ruling out other causes for his fidgety, impulsive behavior, Matthew fit the profile of a child with ADHD. But I wasn't convinced that medication alone would be the best step in treating him. Although it's often effective, I find medication works best when paired with behavior modification.
Because his lack of focus and inability to sit still were having a serious impact on his schoolwork, I suggested that Judy talk further with his teacher and the school psychologist. Together, we could develop a program that would be geared specifically to the problems Matthew faced. The plan needed to include plenty of positive reinforcement, but with consistent consequences, too -- and strong follow-through at home so Matthew was always sure what was expected of him.
With any kind of reward system, it's important to discuss the ultimate goal and explain that it's about success, not failure, and about rewards, not punishment. Using a chart provides a visible way of tracking progress. When a child sees that he has some control over his world, and receives positive reinforcement, his ability to succeed improves.
The basic plan for Matthew is one that can be helpful for many children. Just alter it to fit specific behavior problems and goals.
