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Attention Deficit Hyperactivity Disorder

Behavior Modification Techniques

02/15/1998

Question:

My son is 4 years old and acts very "hyper" to the point of being dangerous to himself. I am afraid to take him shopping because he can be out of my site within seconds! What can I do?

Answer:

Your situation sounds very challenging for both you and your son. Your child may benefit from behavior modification techniques, such as the following: Focus on his behaviors, not him as a person. For example, offer short sentences and directives, "I need you to always hold my hand when we go shopping" instead of "You were bad." Compliment and praise him on any of his good behaviors, especially right before you go shopping, during and after. Say "Great job for putting your coat on!" Singing together, story-telling and other activities that engage his attention can be effective methods to help him avoid impulsive behaviors. Assigning small tasks that he can do easily can also keep him focused and help him feel a sense of control and accomplishment. Laugh with him and love him! Four year olds have short attention spans despite "hyper" behavior. Limit your shopping to twenty minute periods. Establish a routine with such events, such as taking him first thing in the morning when he is well rested but eager to do some activity. Try to keep your voice calm when you give directions. Speak to him at eye level and ask him to repeat, in his own words, what he understood you to say. This helps him to avoid misunderstandings and allows you to gauge what he heard and if he understood your directions. When he does put himself in a dangerous situation, such as starting to run across the street, use a louder, but firm voice. Otherwise, avoid this tone except for these types of situations. There is controversy about the effect of diet on "hyper" behaviors. Dr. Benjamin Feingold promoted his diet modification in the early 1960's. Although some parents say this diet helps, there is not clear agreement about its effectiveness among professionals. If interested, you might try avoiding meals with processed foods, such as bologna, hot dogs and cheese, or packaged cereal, ice creams and candy, prior to such activities. This diet also recommends avoiding foods high in sodium salicylates such as almonds, apples, berries, cucumbers and tomatoes. Consistency with rules and established daily routines, including weekends, are a must to help children feel a sense of control over their behavior. If the behaviors continue and if he is having difficulty in preschool, talk with his physician about an evaluation of his behavior. There can also be medical causes of behaviors that appear "hyper." His physician can also provide additional suggestions or referral for behavior modification techniques. Good Luck! Your efforts now will help prevent escalation of negative behaviors in the future and will provide for your child's safety and well being. Marcia Hern, R.N., Ed.D.

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Response by:

Margaret C Sweeney, MD
Formerly, Associate Professor of Clinical Family Medicine
College of Medicine
University of Cincinnati