In this week's blog post, guest author and RDI Program Certified Consultant, Chris Mulligan L.C.S.W, will discuss how families can use RDI principles and strategies to help manage when their children present with Attention Deficit Hyperactivity Disorder (ADHD) as a co-occuring condition to autism.  

This post is the third post of three in a series focused on ADHD: Part one described ADHD as a neurodevelopmental disorder and then discussed deficits related to regulating behavior and controlling impulses. Part two discussed deficits related to following directions, sustaining attention, and doing work consistently. Part three discusses parenting strategies for effective management from an RDI Program perspective. This series also draws from the work of Dr. Russell Barkley – a highly respected researcher and clinician who has written two of the very best books on ADHD; ADHD and the Nature of Self-Control and Taking Charge of ADHD. 

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The focus of the RDI Family Guided Participation Program is to restore the Guided Participation Relationship. Guided Participation refers to the process in which children’s cognitive and emotional development takes place through an apprenticeship with adults. Various neurodevelopmental disorders derail this process. Through the RDI Program parents are provided with a second chance to promote brain development and create mental growth. Parents work to actually remediate neurological deficits rather than rely on compensatory strategies.

Although RDI was originally designed to address the specific needs of families raising a child with ASD, the RDI approach to parent training can be applied to a variety of neuro-developmental disorders, ADHD included.

 This blog post will be devoted to a summary of how I use the RDI Program to help parents successfully raise children and teens challenged by the neurological deficits of ADHD. As discussed in my previous post that identified the core characteristics of ADHD, parents must learn to address behavioral inhibition that takes the form of impulsivity and hyper-responsiveness.

 Guiding the Child with ADHD

 Be proactive:  RDI recognizes it is very difficult not to react in an impulsive or ad hoc manner when a child reacts in an impulsive and hyper-responsive manner. One of the keys to success is to have a solid plan in place. In other words, it is important not to wait for something "bad" to happen and then scramble for a solution. With the help of an RDI Consultant, parents learn how to structure and modify the environment (referred to as scaffolding) whenever possible to prevent impulsivity and hyper-responsive behavior. Within the guide-apprentice relationship, when a child is developmentally ready, parents guide the child as s/he learns self-regulation and problem solving skills. 

 Utilize behavioral rehearsal: Before engaging in activity that is challenging for your child, it is important to carefully review the behavioral and/or social expectations related to that activity. Within the RDI framework children are supported so that they learn to think about problems rather than memorize static solutions. Ask your child to think about what might happen, what options are available, and how he will handle challenges. Model your thinking through the use of self-talk. Allow your child to follow your thinking so that he begins to develop a template for problem solving.

Communicate efficiently and forcefully:  RDI recognizes that in order to set a clear and consistent limit, communication with the impulsive and hyper-responsive child must be direct and clear. “Say what you mean and mean what you say.” It is better not to give a direction than to give a direction and not back it up with action. Act, don’t yak!

Begin sentences with "You need to.” Avoid directions that begin with "Would you please?" or "Could you please?" This sounds like a question and permits your child the opportunity to decline. Above all, do not negotiate or bargain when it comes to responding to impulsive and hyper-responsive behavior. You are your child’s guide and you are in charge. Try to remain calm, consistent, logical, and respectful. Convey a sense of empathy and authority.

 Provide immediate feedback and consequences: Impulsive and hyper-responsive children live in and for the moment. As such, they need feedback and consequences in the moment. If your child is being successful (regulating his behavior according to the demands of the situation) he needs a specific feedback during the activity as well as positive consequences immediately after the activity.

 Provide frequent feedback: ADHD children also need continuous and detailed feedback from their parents to help sustain their inhibition and parents need feedback from the child to give meaningful feedback. Within RDI framework this is referred to as an emotional feedback loop that is critical to guiding. If your child is staying on task while doing homework he not only needs to have his behavior acknowledged during homework time, but he needs to get this feedback frequently throughout homework time.

 Use the vocabulary of problem solving: It is important to improve the problem solving skills of children who are impulsive by actively teaching them strategies that help them decrease their impulsivity. As stated earlier impulsive/hyper-responsive children do not plan their behavior in advance of action. In order to slow down the child you can reference problem-solving methods such as the six-step system.

 1)         Define the problem (What is my role?)

2)         Think of three possible solutions (What can I do to solve the problem?)

3)         Consider the outcomes of possible solutions

4)         What is the best course of action?

5)         Implement the solution.

6)         Evaluate the solution (Did it work? If not, why not?)

 Avoid power struggles: Impulsive and hyper-responsive children can be exceptionally stubborn and rigid and are often willing to engage in lengthy power struggles. Whenever possible try to short-circuit power struggles and conflicts by use of humor, distraction, affection, or by modifying the activity or expectations related to the activity.

 Focus on your own behavior: In keeping with the RDI framework that places parents at the center of change, try to focus on ways that you can improve your responses to the challenges of raising a child that struggles with behavioral inhibition (rather than focus on the child’s behavior). Ultimately the person who you can influence the most is yourself.  RDI asks parents to write a parenting mission statement that describes your goals and your values. Read your statement and revise as you and your child grow and develop.

 Take a breather: RDI recognizes that the process of remediating neurodevelopment disorders is a marathon and not a sprint. As such, it is crucial to find ways to separate yourself from the rigors of parenting. Rest is necessary for good parenting. Find a wedge of time every day and do something you find enjoyable.

 Do not personalize and practice forgiveness: Try to remember that your child does not intend to be challenging, annoying or disruptive. Try not to take these behavioral characteristics personally. Above all, try to let go of all negative behavioral incidents on the day that they occur.

 Keep a neurological perspective: Always try to remember that your child is struggling with a neurological problem, not a problem of character or personality. Maintaining this perspective will help maintain your empathy and give you greater resilience.

 Take the long view:  Try to take a long view about your child's deficits. That is, try not to make too much of any given incident or event. Remember your child is struggling with a developmental disorder. It takes time and a lot of hard work for your child to reach his full potential.

 *Note to reader: In RDI we begin by modeling solutions first and carefully transferring that process over to the child. Some of the above strategies span several RDI Stages and cannot be implemented until the child is ready, or entering a higher stage.

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Christopher Mulligan, LCSW, is Founder and Clinical Director of Groupworks West in Los Angeles, California.  He has held clinical and administrative positions at therapeutic day schools, day treatment centers and residential settings in the Los Angeles area and has been a mental health consultant to two local school districts: Santa Monica Malibu Unified School District and Redondo Unified School District. Christopher began his career teaching kindergarten and first grade for four years.

In addition to being an certified RDI consultant, Christopher specializes in group intervention, family therapy and parent management training.  For over 17 years, Christopher has designed comprehensive treatment plans for children and families challenged by complex psychiatric diagnoses and behavioral problems such as:  Pervasive Developmental Disorders, ADHD, Bipolar Disorder, Impulse Control Disorders, Anxiety and Depression, OCD, Tourette’s Syndrome, Eating Disorders, and Addiction.  He has worked with adolescents transitioning to and from residential treatment and also is experienced in divorce and custody mediation for families of special needs children.

Christopher received a BA from Sarah Lawrence College and an MSW from the University of Southern California (USC).  

GroupWorks West Inc.

1453 14th Street, Unit F
Santa Monica, CA 90404
Phone: 310.428.4781

Email: groupworkswest@aol.com