Common behavioural modification techniques in ADHD

Setting up an Home token system

Setting up a home token system is fairly simple. The basic idea is that a child or pupil will earn tokens when they achieve an identified goal. There are no negative consequences for failing to achieve a goal in this approach. The tokens are only awarded on reaching or completing an identified goal. The tokens once earned can never be taken away. This enables the child to form a strong link with positive choices and earned rewards.

For some people they like to build in the potential of the child being able to earn extra credit for making more (agreed positive) contributions. i.e. if you help set the table you earn a token. That was their original goal. If they offer to help to stack the dishes after the meal (and do this) this could be an extra credit if agreed.

It is important to limit the amount of goals a child is being monitored for. I would suggest no more than three. Younger children may well benefit from two or even one goal. The goals need to be clearly identified and written in language the child can understand. It will also help to use a visual reference for the targets. Many ADHD children are visual learners and we need to focus on their strengths. Think carefully about how you will display their reward chart and were you will place it.

Pin the visual chart up on the fridge or somewhere easily seen providing the child is OK with it being displayed. Some children are sensitive about their charts being visible.

Think of SMART targets

S = specific
M =measurable
A = achievable
R = repeatable
T = time limited

Say it in a positive and caring way.

How you choose to phrase the goals is important. Rather than saying 'No swearing' we simply use positive descriptive phrases to show what we are looking for. This could become 'We use polite language' or 'We speak to people respectfully'. 'No hitting' could become, 'We use gentle hands' or something like 'We keep hands, feet and bad comments to ourselves.'

It is important to remember that if we are using a punitive tone of voice or aggressive body language when setting up or when applying a token system it will change the possibility of this approach being a successful, safe and nurturing environment for the child to want to change behaviour to one of a direct challenge that is very scary and will be only followed out of fear. This kind of change does not help the child to grow. When the fear factor is removed the behaviour will tend to deteriorate.

Rewarding children for non-disruptive behaviour

By choosing to identify a specific time and place you can give a reward token for expected behaviour. An example of this, prior to a trip in the car to the local shopping area, could be 'If the two of you can sit calmly during the car journey you will earn a token.' Or 'When you sit and eat in a polite way during dinner time you will earn two tokens.' Again, we carefully phrase every thing in a positive way. Remember to describe the behaviour you want to see not the behaviour you do not want to see.


Time-out can be used in a couple of ways. One of them is as a classic consequence of poor behaviour. “Go to your room for a 5 minute time out.” Perhaps more familiar might be “Take a time-out. Sit on the naughty step for 5 minutes.” This was can often be experienced as a negative consequence or punishment by the child.

Perhaps the more effective approach is to think of a time-out as a behaviour break from the negative behaviour choices. Not as a punishment but as a short period of time that enables the child (and parent or teacher) to have a few minutes away from the negative behaviour choices and allow them all some processing time or a calming down period.

What happens after the time-out is very important! Some people believe that after a time-out the child should come back and apologise, before they can carry on with the next part of their day. Other people think the time-out is a time spent away from the poor behaviour choices and that they should be able to rejoin the class or family without the embarrassment of apologising in front of an audience. My preferred way is for the child to simply rejoin what ever is happening. This saves on the inevitable arguments (and possible more battles) about whether or not the word 'sorry' said in the correct way.

Response costs

This is sometimes thought of as fines. This can be the loss of a previously earned token or the possibility of earning a future token. 'If you do not pick up your coat I'm going to charge you a token for picking it up.'

"Think aloud – think ahead" strategies

This is very helpful as a way of preparing ADHD children for transition times. Talk about the future changes that are coming up and run through the rules and the behaviour we are expecting to see during the transition. Then check for learning by asking the child to repeat back to you their understanding of the expectations during the transition. (Avoid the tap of repeating your message and saying that's what we are doing aren't we? The child will simply say 'Yes' without any idea what the 'yes' is attached too.)

This is similar to a technique called 'future pacing', where the future positive behaviour choice is explored prior to the event happening. The belief being that if we can show them the behaviour and let them 'see' the possible outcomes the children will be in a better position to stay on track. “We are going to go into the coffee bar to get a hot drink. (then ask the child) Can you see yourself walking into the coffee bar and sitting quietly and drinking your tea quietly and calmly?” Asking the child to imagine the process can create the internal possibility within the child that it can happen.