Parent Coaching Cards: A System for Guiding Children Toward Behavioral Success
by Steven A. Richfield, Psy.D.
Guilford Publications, Inc.
THE ADHD REPORT
April 1997

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Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) routinely contend with a high degree of challenge as they navigate their offspring through the hurdles of childhood. Whether it be advocating for appropriate accommodations in the classroom, preparing their child to visit an unfamiliar place, or instilling good organizational skills, ADHD requires that parents take an active and enlightened role in their children's lives. The stress produced by all of this "navigational support", in addition to the typical ADHD-intensified behavior problems, can leave even the most road-tested parents in a weakened state of mind. Since so much energy is usually devoted to helping make the outside world more manageable to the ADHD child, parents often find their energy sources depleted when behavior problems arise at home.

Intense and recurrent episodes of noncompliance, temper tantrums, sibling rivalry, or emotional oversensitivity on the part of the ADHD child represent some of the more formidable challenges faced by parents at home. When confronted by such scenarios, a parents’ own problem solving skills and frustration tolerance may be challenged. In an effort to quickly extinguish the problematic episodes, parents may respond in varying ways. For example, while some may react in harsh and punitive styles, others may unduly cater to the child’s wishes. These approaches may work in the short run, however they fail to guide a child toward specifically overcoming such problematic behaviors. Ultimately, the behavior problems often intensify and the bond between parents and child is further strained by the cycle of conflict.

As a clinical psychologist who specializes in the treatment of Disruptive Behavior Disorders, much of my professional time is devoted to the needs of parents who find themselves in this predicament. Upon approaching me for help, their home life feels more like a battleground of power struggles than a place where nurturing, learning, and happiness reside. As a father of two wonderful, yet rambunctious school-aged boys myself, I can easily appreciate what it must feel like since glimpses of such conflict-torn interactions are familiar to all parents. In fact such personal experiences have been a wellspring for many of the parenting paradigms and techniques that I have developed and implemented in my clinical practice. During the past few years, I have been weaving these ideas into a cohesive model for parenting behavior disordered children. I call this model Parent Coaching.

Parent Coaching is a system for skillful and proactive parental intervention. One of the underlying rationales is that parents are in the ideal position to be child behavior change agents because family life mirrors so many of the real world challenges that children face. Yet, when parents are narrowly concerned with the outcome of their disciplinary efforts, and not the process by which they got there, opportunities to "coach" their child toward proper self-governed behavior are overlooked. A parent coach anticipates these situations and comes prepared to step into the coaching role. The coaching role stresses that no matter what problem is presented by the child, the parent ensures that their approach makes clear that they are on the same side as the child. This is supported by a viewpoint of behavior problems as opportunities to join with the child to review the triggers of the problem, consider corrective solutions, and reinforce healthy adaptation. Children are much more likely to accept such help if parents can approach their children's problems from a nonadversarial "coaching" position rather than an anger inducing "policing" position. As with any systematic parent training program, this approach requires parents to have an repertoire of behavior management tools and a deliberate, composed attitude within which to use them.

In an effort to expand parents' repertoire, and facilitate a coaching attitude, I have developed Parent Coaching Cards. They offer parents an immediately available reference tool when circumstances in family life require an enlightened, nonpunitive, and playful response. Although the cards are designed to be initially used by parents, they are written to appeal to a child's mind. The cards portray some of the most typical experiences of school-aged children. The language captures their concerns for acceptance, sensitivity to failure, vulnerability to peer pressure, tendency to oppose authority, and other important developmental issues. Each card is devoted to a particular skill lesson and divided into two sections; the first explains when the skill is needed and the second offers a "talk-to-yourself" message that reinforces the assimilation of the skill. The lessons are printed on 4" x 5 post cards that are laminated for durability and bond with A key ring. set Of ten is currently available the following titles: Thinking Side Reacting Stop Think First To Talk Smart Cooperation Stepping Into Your Cantaloupe Skin Don Take Bait You Can Always Get What Want Trust Jealous Feelings Beat Fear Importance Quick Recovery Repair Tear. better acquaint readers format I will provide full text from card.

"Stepping Into Your Cantaloupe Skin:"
There are a lot of things in life that hurt our feelings - being teased, getting punished, receiving criticism , not being invited to a party, and stuff like that. When you have your banana skin on, you feel bruised by these "hard knocks," and spend a lot of time feeling angry and hurt. Sometimes your reacting side makes you want to hurt others so that you are not the only one feeling bad. When this happens, try reading this talk-to- yourself message: Having my feelings hurt is part of life. I can't stop it from happening from time to time. I must remember that although I feel bad right now, I am not a bad person. I do a lot of things just fine and people notice me for those strengths. I need to remember my successes right now and the pride that I feel and others feel about all that I am capable of. I can use that pride to grow a thicker skin to recover from my hurt right now. I need my thinking side to help me through these feelings.

The cards are typically introduced to parents at the completion of an evaluation where behavior problems are a source of concern. (Sometimes I have already shown certain cards to the child during individual appointments in order to "test the waters.") I share with parents my belief that one of our most important jobs as parents is to guide our children towards developing the behavior skills to succeed in life.

Skills, such as cooperation, recovery from disappointment, and age-appropriate self-control enrich children's life experience and aid their use of social and intellectual skills. Certain emotions, such as anger, jealousy, and the problem behaviors they give rise to, often interfere with children’s' attempts at social and academic success. These same emotions and behaviors disturb the family peace and leave parents wondering how they can help their child better manage the situations in life that trigger these interferences. I explain that Parent Coaching Cards were developed as tools for coaching the skills that children need for victory over interfering feelings and behaviors.

Parents are often intrigued by the notion of coaching self-help behavior skills and strategies to their child but typically express caution that their child will not freely accept such assistance. Some of the time their worry is justified: the climate at home has deteriorated to such a degree that the child demeans parental authority. In these cases, the child may require a "therapeutic warming up" to the cards through individual and/or family appointments. When parent-child conflict is particularly acute, I will invite parents into a child's appointment to model how to employ the cards in a nonthreatening, collaborative manner. With other cases, a child's willingness to respond to the cards can be cultivated through discussion of how rewards increase and punishments decrease when children are willing to be coached. If necessary, a behavior contract is drawn up that pairs the proper use of the cards with specific reinforcers.

Not all cases require such preparatory therapeutic work for Parent Coaching Cards to provide benefit. Since they are offered on a mail order basis, many parents have used them without any clinical intervention. In those situations, parents are advised to slowly introduce the language depicted, i.e., "step into your cantaloupe skin" to signify the need for the child to emotionally prepare themselves to deal with a potential triggering event. Since many of the skills are applicable to adult life, parents are encouraged to refer to the cards' self-help strategies when discussing their own daily life experiences. This modeling can pave the way for children to be more receptive to the language. Some family situations are amenable to a parent sitting down with their child and reading the content of the cards out loud, suggesting places where both of them might use the skills, and then leaving them somewhere where they can be turned to when needed. As the child becomes familiar with the message on the card, parents can paraphrase the language in order to prompt the use of the self-instructional message. For instance, "Remember Jeremy, this is a place where you probably need your cantaloupe skin."

Children spanning a wide age range have benefited from Parent Coaching Cards. Younger children, between ages five to ten, require more direct parental involvement to learn how the cards apply to real life. When appropriate parents can suggest how certain skills are depicted on television shows or encourage role play to get children accustomed to using adaptive self-talk. Children over ten-years-old may be willing and able to use the cards on a relatively autonomous basis, with perhaps a little help from parents to get them started. Ideally, the older child requires less and less coaching as they become more adept at using the skills on each of the cards. Several of my ADHD patients have been amenable to using the cards in school to aid compliance with a broader behavior management program. In these cases, the cards are often kept within a zippered pencil pouch to protect the child’s privacy. When behavior problems occur teachers are encouraged to offer children the option of quietly reviewing their cards rather than face disciplinary consequences. This option often greatly curtails the need for teachers to remove children from the classroom due to chronic disruptive behavior.

One clinical example of how Parent Coaching Cards reduced parent-child conflict and promoted pro-social school behavior involves fourteen-year-old Adam. Adam had been diagnosed with ADHD at age 11 and responded well to psychostimulant treatment. As Adam entered adolescence, his parents noticed him lagging further and further behind his peers in the areas of maturity, social judgment, and "silly attention-seeking."

Although his academic performance continued satisfactorily, Adam was brought for treatment to "learn to grow up." Adam also recognized that he was falling behind his peer group and antagonizing his family members with his immature escapades. But like a lot of ADHD teenagers, he lacked the skills to do anything about it. When shown the Coaching Cards, (I often drop the word "Parent" when suggesting the cards to older kids) he was immediately relieved that I could offer him something tangible to take home and use. He wasted no time in doing so. During sessions, he reported how the cards were relied upon during the intervening week, especially "Don't Take The Bait" and "Stop And Think First To Talk Smart." The cards made it much easier for him to inhibit much of the impulsive speech and behavior that proved so troublesome in his peer group and family relations. In turn, Adam could benefit more from therapy sessions since instead of "putting out fires" at home and school we could focus upon expanding and refining his social and problem solving skills in the context of his specific life circumstances.

Adam's case demonstrates how Parent Coaching Cards can provide swift therapeutic impact in the hands of a bright and motivated ADHD teen. The value of using the cards soon became so apparent to him that his parents offered little direct coaching. In keeping with the normal autonomy of adolescence, he did it on his own. If faced with a conflict with his parents, he reviewed the cards in private and thereby summoned the behavioral skills needed for resolution. His parents were especially pleased by this outcome because they no longer got trapped in the old cycle of conflict. During collateral parent counseling sessions, I suggested that if Adam began acting out his problem behaviors they should refrain from scolding and merely explain that they would continue spending time with him after he reviewed the cards. This condition significantly reduced the intensity of conflict surrounding many emotionally charged issues.

The case of ten-year-old Allison more closely demonstrates the use of Parent Coaching Cards by parents. A consultation was initiated after unsuccessful individual psychotherapy treatment left the parents feeling helpless and frustrated due to their "bystander" status in the prior effort. Evaluation found Allison to fulfill criteria for ADHD and ODD (Opposi- tional Defiant Disorder). Problems with noncompliance, emotional overreactivity, and peer relations were the chief areas of concern in Allison's home and school functioning. Yet, despite her argumentative nature, Allison desperately wanted to be accepted by others and enjoy popularity at school. The cards were introduced as a means to help her overcome the hurdles to being seen as more popular and mature by her peers. This incentive served as a hook, much like in the prior case of Adam, because her peer group's receptiveness increased as her pro-social and "thinking side" behaviors were in greater evidence. She agreed to carry the cards to school and was offered a private place to review them if needed.

Allison's choice to keep the cards at school foreshadowed her reluctance to use them at home. This stance is common to oppositional ADHD children who readily perceive the cards as a threat to their "freedom," e.g. control, at home. Therapeutic efforts to soften up her resistance met with the same angry withdrawal and intimidation tactics familiar to her Allison's parents. Despite the progress she was exhibiting at school, her extreme defiance at home continued. Much to her dismay, a comprehensive behavior management plan was established through parent counseling sessions. When this was unveiled in an appointment attended by all three, her protests grew even more resounding. She issued many threats of greater noncompliance in an attempt to scare her parents into submission.

But by this point they had found the resolve to continue with the program of firm limits and enlightened coaching until their daughter learned to accommodate to their structure in the same way she was doing at school. Before too long, Allison began to gradually relinquish her attempts to control her parents through manipulation and overreactions since her parents refused "to take the bait."

The critical ingredient in enlarging the scope of intervention in Allison’s case was to bring her parents directly into the therapeutic arena. While this may be the goal of many behavior modification efforts with ADHD children, success tends to hinge upon the degree of empowerment felt by the parents. Parents who have been contending with years of chronic problem behaviors tend to feel less empowered and more overpowered by their child’s obstinacy. This was the case for Allison’s parents as well when parent counseling began. By gradually exposing the family factors that were continuing to perpetuate the problems, and substituting age-appropriate expectation, consequences, and tools for "parental intervention," Allison's parents felt the empowerment so vital to guide and sustain behavior change in ADHD and ODD children.

Parent Coaching Cards had a pivotal role in giving the parents an empowering tool to refer to when the going got tough with Allison. Although Allison would rarely participate in any voluntary collaborative discussion about the skills depicted on the cards her parents made frequent mention of them and they were never far from their own thoughts when behavior problems were threatened. Thus, the Parent Coaching system could be quickly accessed and the empowering attitudes that went along with it.

These two cases demonstrate how the employment of Parent Coaching Cards can be individualized to the needs of the child and parents. This versatility also allows different users to blend them to a particular style or location. As with other tools offered for ADHD, Parent Coaching Cards are designed to be but one component in a parents' multi-modal approach to this condition. But perhaps more than other tools, these cards hold the promise of diminishing parent-child conflict by establishing a path of collaboration and problem solving between parent and child. When the relationship between parent and child can be protected from the damage of protracted conflict, a child's efforts in the face of ADHD stand a much greater chance of success. Parents can intuitively appreciate that this protection of the parent-child bond is essential if other multi-modal treatment efforts are to provide the greatest benefit, no matter what condition a child is suffering.

Dr. Richfield is a licensed clinical psychologist who is in full-time private practice in the Philadelphia suburbs. His practice is primarily devoted to the needs of ADHD adults and children. He can be contacted directly for further information on Parent Coaching Cards and workshops at P.O. Box 1263 - Blue Bell, PA 19422. Phone/Fax inquiries to (610) 275-0178.