Parents as Friendship Coaches for Children with ADHD

A Clinical Guide

Amori Yee Mikami, Sébastien Normand

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000552010
• Edition: 1
• Topic: Psychology
• Subtopic: Attention-Deficit Disorder (ADD-ADHD)
• Index: Psychology

This book introduces Parental Friendship Coaching (PFC), an intervention that parents can use to support peer relationships in their elementary school-aged children with ADHD.

In the PFC program, clinicians work with parents to coach their children with ADHD in friendship behaviors that help develop and maintain high-quality relationships. Featuring 10 research-based clinical sessions, the book provides detailed, step-by-step instructions for clinicians about intervention provision. Each session includes skills teaching devoted to supporting children's peer relationships, activities to practice the skills in session, problem-solving about difficulties carrying out the skills, and homework to try the skills at home. This book also includes handouts for parents and clinicians, tips for clinicians about addressing common parent difficulties, and suggestions for progress monitoring.

Intended for mental health professionals working with families of children with ADHD and peer problems, this book will aid clinicians in educating parents on how to support their children's friendship development.

Session 1Understanding Your Child’s Social Behaviors

DOI: 10.4324/9781003221715-3

1 Clinician and Parent Introductions

Section goal: Orient parents to purpose of Parental Friendship Coaching (PFC). Build relationships between the clinician and parents. Watch out for: Poor credibility or expectancies about treatment, barriers to alliance.

As way of introduction, the clinician can share a bit about their own background and experience with attention-deficit/hyperactivity disorder (ADHD), as appropriate. If not already done, the clinician can review the parent’s social concerns about their child and explain why the PFC program may be useful for these concerns.

The clinician can then provide a bit of background of PFC. “Parental Friendship Coaching, or PFC, has been running since 2006 in several research trials. Parents have been excited about the program and have reported that it has helped their family. I hope it will be the same this time and that it will meet you and your child’s needs. The goal of PFC is to help parents of children with ADHD to learn how they can improve their child’s friendship-making and social skills with peers.”

“Why work with parents? Historically, therapists have tried to help children with ADHD by teaching the children social skills in a therapy session. However, there’s more and more evidence lately that while this helps children learn skills they do not know, this type of intervention is less successful in supporting children to actually use these skills outside of the session in real time. Researchers think this is because children with ADHD forget the skills they have learned when they are in the heat of the moment or when they are distracted by peers. But, parents can increase the likelihood that children with ADHD will show the skills they have learned in real-life peer situations, because parents can be there to remind the child with ADHD about the skills. Parents can do this until eventually, these skills become more natural and automatic for children.”

Handout 1.1: The PFC Pyramid

“In this program, the first thing we work on is helping you to give your child feedback in such a way that your child will be receptive to it. We do this first because everything else relies on your child being able to take in your guidance and not be defensive about it. The second thing we target is how you can teach your child social skills that your child can use in real-life peer situations to make and keep friends. Finally, we will help you arrange good peer situations where your child can practice these social skills and where you can remind your child about the social skills in real time.”

“Why work on friendship? Common sense tells us that friendship is important! Research shows that having high-quality, stable friendships improves the likelihood that children will stay in school, get better grades, and be happier and healthier. Good friendships in childhood also serve as practice for more complex relationships with romantic partners and co-workers as adults. Friendship is a skill just like any other skill such as learning to play a sport or a musical instrument. It takes practice, and practice will make your child better at it over time.”

Handout 1.2: Outline of Topics

Review schedule of PFC topics. “This gives us a sense of what we will be covering in the PFC program, and when we will be doing it.”

“For parents to get the most out of PFC, I invite you to actively participate in the program. This means thinking about each of the skills we go over, letting me know when you are skeptical about them (and it’s ok if you are), and being willing to try new things even if you aren’t sure if they will work.”

“The PFC program is based on a lot of research about ADHD and friendship-making, but you are the expert in parenting your child and in your child’s unique needs. I will present the skills that are thought to be effective based on the research, but I hope that you will also share ideas about how to best tailor these skills to fit your child. Sometimes we will have to put our heads together to troubleshoot how the skills can be adapted to fit your family situation. Any questions so far?”

Notes for Group Format

If conducting PFC in a group format, it can be useful for the clinician to prepare signs with each parent’s first name, child’s first name, and child’s age and give them to parents as they enter. The clinician can collect the signs at the end of each session, store them, and bring them out at the beginning of each subsequent group session. The clinician can also spend time having the parents go around the room and introducing themselves and their children.

The clinician may want to mention to the group that “all parents here have children who have ADHD and who have some friendship problems,” to aid group cohesion.

Consider adding meeting dates on the outline of topics (Handout 1.2).

The clinician may also want to state something like “I want parents to feel safe and share what matters to them and their child in this group. I will keep everything said within the group confidential, and I’d like to ask you to do the same. Like they say, ‘what happens in Vegas stays in Vegas’; what happens in group also needs to stay in group. If you talk about this group to someone else, please focus on what you or doing for your child, instead of what other parents have said. If two group members run into each other at a social event, consider that the other parent may not want others to know that they are attending this group. By the way, if I see any of you in the community, I will not go up to you in case it would be awkward for you to have to explain how you know me; but if you want to come up to me and say hello, I am happy for you to do that.”

2 Thinking about Your Child’s Social Problems

Section goal: Helping the clinician get to know the child, and helping parents recognize their child’s social issues. Watch out for: Parents who haven’t had an opportunity to feel heard about their concerns, or who have many concerns.

“Most children with ADHD have some sort of problems getting along with peers. They may receive other treatments for their ADHD, but they still have trouble with peer relationships. Difficulties with peers can mean different things for different kids. Here is a handout that lists some common social behaviors in children with ADHD.”

Handout 1.3: Common Social Behaviors Displayed by Children with ADHD

Go over the handout with parents, and invite them to reflect on their child’s social profile. A good question to ask parents is, “which of these behaviors concerns you the most right now, and why?” This information can help the clinician know which behaviors to target. To the extent that parents raise issues that will be covered in the PFC program, say so. The clinician can also ask parents to talk more about their child’s social strengths and what situations elicit those strengths. This information can help the clinician generate strategies for increasing positive social behaviors in the child. The clinician might thank parents for this information and let them know how they plan to use the information in treatment planning.

Notes for Group Format

When discussing the handout, the clinician could poll parents to indicate, with a show of hands, how many think their child shows inattentive social problems, hyperactive/impulsive social problems, and other problems. Parents could go around the room and briefly state: (a) What their primary concern is about their child’s social behaviors; and (b) one thing about their child’s social style that they would NOT want to change. As parents speak, the clinician can note the range of problems as well as similarities and differences between them. This can help parents to feel connected with one another. Issues to potentially consider are the child’s age, gender, ADHD presentation, other comorbidities, and cultural background. Try to encourage a socially supportive environment among parents where they see each other as resources and as on the same team.

3 Antecedents, Behavior, Consequences (ABC) Model

Section goal: Introducing the concept that the child’s friendship behavior can be affected by antecedents and consequences provided by the parent; antecedents are typically underused. Watch out for: Some parents may immediately say “I do all that already” or have a hard time with the idea that their behaviors can affect the child (this may feel stigmatizing).

“Most parents don’t spend much effort thinking about how to help their children make friends, and this works if they have a kid without behavior problems. They tell their kid to ‘go play outside,’ or they sign their child up for an activity and their child makes friends, doesn’t get into trouble, comes home on time, and still has time to do their homework after that.” (Some parents may laugh as this is not their experience).

“But parents of kids with ADHD have to be super parents. You have to be proactive, organized, structured, consistent, and explicit with your kids if you want your kids to behave well and to make friends. We know from research that ADHD is caused by biological factors and not caused by parenting. But super-parenting is needed to help support kids with ADHD, like giving glasses to a nearsighted child is needed to help the child see even if the glasses have nothing to do with causing the child to be nearsighted to begin with.”

If not already known, find out if the parent has attended behavioral parent training classes in the past. As mentioned in the Introduction to this clinical guide, we recommend the PFC program for families who have had previous experience with psychosocial treatment and are not new to the ADHD diagnosis. In particular, having been exposed to behavioral parent training will help the parent contextualize the PFC skills.

If the parent has experience with behavioral parent training, ask if they have heard of the Antecedents, Behavior, Consequences (ABC) model and if so, what (if anything) they remember about it. This is a model that is presented in behavioral parent training.

“The ABC model is a basic model of shaping child behavior that we will go back to over and over to discuss how you can encourage your child’s friendships. An antecedent is something that happens before a behavior—such as moods, environmental cues, or instruction from parents that lead to a child behaving a certain way. The behavior that your child does comes in the middle. A consequence is something that happens after a behavior. The consequence can either encourage or discourage your child from behaving the same way again.”

• Example 1: You are at the supermarket with your child.
  Antecedent: Your child is hungry and tired already.
  Behavior: Your child throws a tantrum at the market.
  Consequence: You leave the market before your shopping is done.

Discuss: “How could you change the antecedent to reduce the likelihood that your child will show that behavior? How could you change the consequence to reduce the likelihood that your child will show this behavior again next time?” Some ideas:

• (Antecedents) Don’t take your child; make sure they’re not hungry and tired before going; talk to your child before you go in.
• (Consequences) Punish your child after for the tantrum; talk to your child about why that was unacceptable behavior.

“There is not one right answer or one strategy that will work every time. If there was, then all parents would know that strategy and would be doing it already, and there would be no more behavior problems in children. The point of PFC is to give parents a larger box of tools to draw upon in handling their child’s behavior, specifically their social behavior with peers.”

For the next example, the clinician is encouraged to select a behavior that is relevant to the parent, based on what the parent has said about the types of social problems their child has. However, two possibilities are below. Brainstorm with the parent about how to introduce antecedents that will prevent the behavior from happening, or consequences that will reduce the likelihood that the behavior will happen again, for the chosen scenario.

• Example 2: Your child has a peer over to play.
  Antecedent: ?
  Behavior: Your child ignores the peer and goes off to do something alone.
  Consequence: ?
• Example 3: Your child has a peer over to play.
  Antecedent:?
  Behavior: Your child gets angry because the peer is touching your child’s model figurines.
  Consequence: ?

“Most parents have an easier time identifying consequences than antecedents. Consequences are necessary sometimes, but most parents don’t use antecedents enough to prevent behavior problems from happening in the first place. Changing antecedents is something we will be trying to do more of. Why do you think it can be harder to focus on antecedents as opposed to consequences?” Some ideas:

• It’s easier to react than to plan.
• Antecedents take effort when parents want to relax.

“However, even though they are sometimes more difficult, addressing antecedents usually pays off in the long term because this stops big problems before they happen.”

Handout 1.4: The Antecedents, Behavior, Consequences Model Worksheet

Homework 1.1: Complete Handout 1.4. “Observe ...