Monday, October 24, 2016

Parental Needs Matter: Supporting Teens with ADHD



The New Data - Old Truth
Your teen can indeed learn to hand their homework in on time without you supervising their every move. A pilot study published this year by Margaret Silbey (Parent–Teen Behavior Therapy + Motivational Interviewing for Adolescents with ADHD - 2016), has shown strong evidence that affirming a parent’s needs and motivation, is as important as identifying the student’s goals for themselves. 

This study is exciting to me for many reasons. It provides a model for collaborative parenting which is much needed in the field of ADHD coaching. There has been excellent work done on collaborative problem solving by Ross Greene and ADHD parent education by Russell Barkley, but this is the first time that the two have been put together in a comprehensive program.

For now, it is the role of the parent that I would like to share with you. The data shows that the best outcomes occur when the teen and parent are on a parallel path of self-reflection and change. The work is not about fixing the teen so much as it is about co-creating the conditions for the teen to learn the strategies for effectively managing their ADHD symptoms.

Social science data has shown for some time that healthier parents have healthier children. We also know that parents of teens with ADHD are “on” too many hours of the day organizing, advocating, disciplining, or otherwise being watchful that another failing grade is not around the corner.  This stress can shift the interactions between the child and parent in unhelpful ways. Silbey’s research takes this well-known truth and applies it in her treatment model for teens with ADHD.

STAND
Silbey’s program is called STAND (Supporting Teen’s Autonomy Daily) and focuses on building student self-efficacy, skill rehearsal and practice.  Both the student’s and the parent’s motivation for seeking help in the first place becomes the starting point. Poignantly, after non-judgmental reflection with a skilled facilitator, the parent-teen partners usually discover that they want the very same things: increased control over their own lives, better grades, and peace at home.  This common ground then becomes the motivational engine that drives the work. For example, Mom (or Dad) may say that she needs more time to herself, and her teen wants more autonomy. The pair then agree when, where and how Mom will check in. Mom also agrees that she will not “hover” while the work is getting done – no matter the outcome. The teen also agrees to practice new ways of “getting started” so that the work does actually get done.  Each wins. Needs are met on both sides.

The Importance of Parent Beliefs
To get to this point of collaboration, Silbey confirms that identifying limiting beliefs is key. By the time the parent seeks help, they have typically experienced years of frustration and failure to “make” their child do what he/she is supposed to do. Pressure from the school for a parent to “do” something increases this stress. Over time, these frustrations can harden into fixed beliefs about their child’s abilities. “These beliefs”, Silbey writes, “are powerful determinants of the parent’s behavior and guide their parenting choices.”

What is the Most Effective Parenting Style?
Silbey found three statistically significant patterns to describe parenting styles. One she termed, “broad disengagement” for a lack of supervision or structure at home.  These parents tend to be busy and believe that nothing they do will change anything with their teen.

A second type of parenting style she affectionately terms “personal assistants”, tend to be highly involved in all aspects of the teen’s schoolwork, including actually doing it for them. These parents often believe that if they did not supervise every detail their child would fail and the cost of that failure would be too high to tolerate.

The third type of parenting style is a “warmly collaborative” one.  These parents co-create structures with their teens for placing limits on freedoms and accountability for completing schoolwork. Notably, this group of parents has the highest level of personal well-being. It is this group that has the least conflict with their teens, and the teens have the most success in integrating adaptive strategies into their study habits. The parents in this group have the underlying belief that change is possible.

Building Parent Self-efficacy
So how can parents become warmly collaborative when they are feeling tired, discouraged and confused? They can get help from a professional who can support these changes and show them where their “parent” power is. STAND does this by showing that choosing to spend energy on adapting their own behavior is worthwhile and likely to lead to the “desired rewards”. For example, a parent will be asked to introduce a new strategy and later reflect on the results. Over time, the parent sees that these changes are indeed leading to better outcomes. This reinforces the belief that parents CAN and DO make a difference to their teen’s success. The fact that the teen is engaged in exactly the same process of trying new behaviours followed by reflection, can also be deeply encouraging for a tired parent.

The Payoffs
Successfully re-establishing the partnership between a teen and parent lead to improved outcomes in several areas. Teens recorded their homework more consistently, earned higher grades, and reported a reduction in inattentive and hyperactive/impulsive symptoms. Parents reported lower levels of parenting stress and this gain was maintained six months after the close of the study. In my practice, when these shifts occur, I also see reduced family conflict, increased parent and student resilience, and more space for loving connection. Ultimately, I believe, this last is the payoff everyone is looking for.

Lynda Hoffman, Certified coach 




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