by Martin L. Kutscher, MD

Consider the two following scenarios:

What's going on here? John gives the same response whether asked about something good or bad. His negative response clearly has nothing to do with the actual request. It has to do with his being interrupted. It has to do with his being overwhelmed. It has to do with his ADHD. Obviously, rewards and punishments won't work in this setting. The problem is an inability to control a sensation of being overwhelmed, not a problem with motivation. (After all, you are already offering fresh pancakes.)

When typical rewards and punishments don't work, you may need an approach that Ross Greene refers to as "Plan B." Here, our focus is on preventing over-heated meltdowns. We anticipate problems and try to head them off: we stop, we stay calm, and we negotiate if possible.

"Just Stop!" is the key - for the ADHD person and you.

STOP! Those four letters are the key to behavioral treatment for most people with ADHD. The exclamation point is a reminder of how important the step is; and how hard it can be, as well.

As described so well by Russell Barkley, the primary difficulty in ADHD is a lack of inhibition of the present (so that you can use your other executive functions to plan the future). In other words, people with ADHD have trouble putting on the brakes. They have trouble stopping. Nothing good comes from speeding out of control. So, their first step is to just STOP! Once everyone stops, then time can cool our minds. The brakes come on. Executive function can regain control. We can chart a productive course.

There are several amazing things that come from just stopping (if you can do it):

1. It works! Time heals. Even 5 or 10 minutes is usually enough for even the most ADHD brain to regain composure. If it routinely takes more than 30 minutes to regain it, consider other diagnoses such as depression or bipolar depression.

2. With the benefit of time to regain composure, most people will reach the right conclusion. They will begin to come around and comply. If you just state calmly what is expected as you leave the scene of the impending argument, you will be typically surprised that - at some point fairly soon - the child is addressing the situation. Not always. But surprisingly often. After all, ADHDers are usually far from stupid. They know how to think. They know the rules of morality. They know the right thing to do. They just need a little longer than the rest of us to regain control and sort it all out. A formal procedure for thinking through choices is described in the chapter on Problem Solving Skills.

3. Once you and the child have cooled down, the other behavioral methods will usually be quite clear. In other words, most of the advise in sections on behavioral management will seem almost blatantly obvious - if you are calm. For example, we discuss keeping it positive. We discuss seeking to understand and making the child part of the problem solving process. We discuss choosing only productive punishments. When you are calm, these approaches are not exactly rocket science, and are almost self-evident. When you are screaming, these approaches are not available.

Just Stop. This means you, too.

Yes, you. There is no one else reading this right now. I mean you, the parent. You have to put on the brakes as well. You are a human being who is struggling with self-control also. Although your brain theoretically has normal control, ADHD in the family can be so exacerbating and even demoralizing that our ability to stop and see things clearly is debilitated as well. [Note that there is a forty percent chance that one of the parents also has ADHD - so indeed there may be other reasons why stopping is so hard in these families.]

Why would we expect the child to be the only one trying - and succeeding - at exerting self-control? Why would we expect the only one with a recognized physiological disability in self-control be the only one working on the project? How about ourselves? You may answer, "Well, I'm so overwhelmed and stressed by my environment that it's hard to stay in control." Welcome to the club. That's what your child is experiencing also. You won't let him get away with that excuse...

Not only doesn't it work, screaming at the child is actually counter-productive.

She is already over-whelmed. She is already overloaded and over stimulated. Being screamed at just inflames the situation, and ultimately makes it harder for your child to achieve her goal: regaining composure so that her own brain can reach the right decision.

Warning symptoms of getting overheated.

The earliest signs of overload include voices getting raised, muscles tightened, faces reddened, or grunting. This is the time to defuse. At this point, you may be able to salvage the situation with humor, negotiation, redirecting the conversation in a different direction, or maybe even taking a few deep breaths. s.

A little later, the signs of being overwhelmed get pretty obvious, if we would just listen. They are usually something subtle like: "STOP! Get out! Leave me alone! I can't take it, anymore!" Your child is not making this stuff up. That is how he feels. Pretty awful. Take his advice. Stop. He is actually telling you in clear words just what you need to know: "I need to stop now." Ideally, he would have said it calmly. Ideally.

This is not the time to give in to our impulse to just get it over with. You might have the self-control to do that. Your ADHD child was not born that way. Don't assume that just because you can handle it, that he can as well. All brains have equal rights, but all brains are not constructed the same.

"But what if he doesn't just stop?"

Encourage compliance with the system be ensuring that the child recognizes that this cooling off period is not punishment. It is not like the old punitive "time out" system, which works best with elementary students. Rather, the child gets to go do some pleasant - yet soothing - activity. Consider reading (their choice - magazines and comics are okay), Legos, or listening to music. Adrenaline producing activities such as Nintendo are probably not a good idea. Truly cool activities, like playing on the computer or watching TV may be hard to stop after the intended 5 minutes. Do not forget a similar system for yourself.

If that doesn't work - and there are some oppositional children for whom it won't - then ignore the child. It takes two to fight. No one can enlist you in an argument unless you enter the arena.

After stopping, then state the rule once and leave.

The decision to declare a cooling off period has nothing to do with a decision as to who "won." You are not giving in. Calmly state the rule or action that is required, and end the discussion. Come back later when cool heads prevail.

"But all he ever does is ask to stop. How do we ever get anything done?"

Good point. But, here are your choices: s:

1. Keep fighting for 30 minutes, get nothing accomplished after that, chip away at our relationship with our child, and increase household frustration levels making the next blowup more likely; or

2. Take a 5-10 minute break, get something accomplished, maintain our relationship with our child, and lower household frustration levels making the next blowup less likely.

When you STOP and think about it, the choice is pretty obvious, isn't it? Yet when faced with that choice in the heat of the moment, most of us have been taking the wrong course.

Indeed, this is not always a terribly efficient system. However, neither you nor your child has been dealt great choices. But STOPPING is the least bad option. It certainly beats the alternative of counter-productive screaming. You already know that does not work.

Good luck, and do not expect results overnight. This is a multi-year task to learn. Model it well. Once you've stopped, you are ready for the next steps:

After Stopping: Defuse, don't inflame.

• Your child is already overwhelmed and confused. Parental anger does not work, and only makes the situation worse - but then, you already have discovered that.

• STAY CALM. That deserves repeating. STAY CALM. (Much easier said than done.)

• LOWER YOUR VOICE.

• WALK AWAY. Announce that discussion will begin again once everyone has achieved composure. Once calm, negotiate, negotiate, negotiate. Parents need to model negotiation, not inflexibility. Don't worry about losing control: the parent always gets to decide which compromise is accepted.

• PICK YOUR FIGHTS. Is this fight worth chipping away at your relationship with your child? Remember, this is not war. The family that stays together wins.

• ADHD is the inability to inhibit behaviors. Why do we expect ADHDers to be the only ones who actually control themselves? As adults with better self-control, shouldn't we be the first to actually use it?

• Don't say things that you will regret, such as gratuitously hurtful comments or punishments that you cannot enforce.

• For homework, stick calmly by a simple rule: First we work, then we play.

Remember: negative behaviors usually occur because the ADHDer is spinning out of control, not because he is evil. While evil behavior would need to be aggressively squelched, the much more common overwhelmed behavior needs to calmly defused. Good luck!

Dr. Kutscher is board certified in Pediatrics and Neurology, with Special Competency in Child Neurology. Dr. Kutscher is currently an Assistant Clinical Professor of Pediatrics and Neurology at the New York Medical College. His ADHD e-BOOK: Living 'Right Now! focuses on organization, foresight, over-reaction, and impulse control problems as key difficulties in ADHD. Many people with ADHD also have anxieties, socialization problems, and depression. The text summarizes the best home, school and medical treatments for these issues.

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Written 2001. Reviewed: 02/2006