Child Interventions Nonspecific talk or play therapy in a
therapist’s office is not a form of treatment with scientific
support for children with ADHD. Instead, child-based
treatments for ADHD with a scientific basis are those that
focus on peer relationships and that typically occur in
group settings outside of the therapist’s office. Very often,
children with ADHD have serious disturbances in peer
relationships, and those problems are very strong
predictors of long-term outcomes. Children whose
difficulties with peers are overcome will have
considerably better long-term outcomes than those
whose peer relationships remain problematic. Thus,
intervention for peer relationships is a critical component
of treatment for children with ADHD and it is the focus of
child-based treatments. There are five forms of
intervention for peer relationships, listed below.
1. Systematic teaching of social skills
• Cooperation
• Communication
• Being positive and friendly
• Participation
• Helping/sharing
• Giving compliments
• Coping with teasing
An example of an intervention for peer relationships using
the systematic teaching of social skills could be
structured as follows:
Intervention: Systematic Teaching of Social Skills
Objective:
To help students develop positive peer relationships by
improving social skills such as cooperation,
communication, friendliness, participation, and coping
with teasing.
Sure! Here's a scenario that demonstrates how
systematic teaching of social skills can be
implemented in an intervention for improving peer
relationships:
Scenario: Intervention for Peer Relationships –
Systematic Teaching of Social Skills
Context:
The intervention takes place in a classroom setting for a
group of elementary school students who are struggling
to make and maintain friendships. Some of the students
have difficulties with communication, cooperation, and
handling social conflicts. The goal is to teach them
specific social skills in a structured, step-by-step manner
over a series of lessons.
Session 1: Cooperation
Objective:
Teach students how to cooperate with peers in group
activities.
Activity:
The teacher introduces the concept of cooperation by
discussing what it means to work together as a team
and why it’s important for building friendships.
The class is split into small groups, and each group is
asked to complete a task that requires cooperation,
like building a tower out of blocks or solving a puzzle
together.
After the activity, the group discusses the importance
of taking turns, listening to each other, and sharing
responsibilities.
Discussion Prompt:
“How did you feel when your teammate helped you
with the puzzle?”
“What did you do to make sure everyone in your
group was involved?”
Goal:
Students practice working together, sharing tasks, and
communicating openly with peers.
Session 2: Communication
Objective:
Help students improve their communication skills by
teaching them how to start conversations and respond
appropriately.
Activity:
The teacher introduces basic conversation starters
(e.g., "Hi, my name is [name], what's yours?" or
"What did you do over the weekend?") and
demonstrates how to listen and respond to a peer’s
answers.
In pairs, students practice having a short
conversation with each other, using the conversation
starters and responding with relevant questions or
comments.
Discussion Prompt:
“What was it like to start a conversation with
someone new?”
“How can you make sure the other person knows
you’re listening to them?”
Goal:
Students learn to initiate and maintain conversations by
taking turns, listening, and asking follow-up questions to
show interest.
Session 3: Being Positive and Friendly
Objective:
Teach students how to show positivity and friendliness in
social interactions.
Activity:
The teacher discusses the power of a positive
attitude and how showing friendliness can help build
strong friendships. Positive behaviors such as
smiling, saying “please” and “thank you,” and giving
compliments are highlighted.
Students practice by pairing up and complimenting
each other in a way that feels genuine. For example,
“I like your shoes!” or “You did a great job on that
math problem!”
Discussion Prompt:
“How did it feel to receive a compliment?”
“What can you say to make others feel good about
themselves?”
Goal:
Students learn to express positivity and appreciation
towards others, fostering an inviting atmosphere for
making friends.
Session 4: Coping with Teasing
Objective:
Teach students how to handle teasing or unkind
comments in a calm and assertive manner.
Activity:
The teacher explains that teasing is often hurtful and
it’s important to respond in ways that don’t escalate
the situation. Students are taught how to respond to
teasing by staying calm and using assertive phrases
like, “Please stop,” or “That’s not okay.”
Students role-play different scenarios where teasing
might occur. For example, one student teases
another about their clothes, and the other student
practices responding calmly with an assertive
statement.
Discussion Prompt:
“How did it feel when you said ‘Please stop’ to the
teasing?”
“What can you do if someone teases you but you
don’t want to react negatively?”
Goal:
Students practice maintaining control over their emotions
and using assertive communication when faced with
teasing, rather than reacting angrily or withdrawing.
Session 5: Giving Compliments
Objective:
Teach students how to give genuine compliments that
make their peers feel valued.
Activity:
The teacher explains the importance of
complimenting others, focusing on how compliments
can help build positive relationships.
Students take turns giving compliments to each
other, focusing on specific actions or qualities (e.g.,
“I like how you helped me during the group project,”
or “You have a really nice smile!”).
Discussion Prompt:
“How did it feel to give a compliment?”
“What did you notice about how your friend reacted
when you gave them a compliment?”
Goal:
Students learn how to give thoughtful, sincere
compliments that strengthen their connections with
peers.
Outcome Evaluation:
After a few weeks of these systematic lessons, the
teacher checks in with students to evaluate progress by
observing how they interact with their peers. Are they
using the social skills they’ve been taught? Are they
participating more in group activities and feeling more
confident in their social interactions?
Reflection and Review:
At the end of the intervention, students reflect on what
they’ve learned:
What social skills do they now feel more confident
using?
How have these skills helped them form or
strengthen friendships?
Closing Discussion:
“What’s one thing you will do differently when you
meet someone new?”
“How can we keep using these skills in our daily
lives?”
Goal of the Intervention:
By systematically teaching these social skills, students
gain the tools they need to interact positively with their
peers. They are more likely to feel confident in their social
abilities, resolve conflicts appropriately, and build
stronger, healthier friendships.
1. Cooperation
Activity:
Group work tasks where students must collaborate to
complete a project (e.g., building a model or solving
a problem).
Goal:
Students learn to share responsibilities, listen to each
other, and work together toward a common goal.
2. Communication
Activity:
Role-playing exercises in which students practice
introducing themselves, starting a conversation, and
responding to others.
Goal:
Students learn how to initiate and maintain
conversations with peers, using both verbal and non-
verbal communication.
3. Being Positive and Friendly
Activity:
Practicing greetings and compliments in pairs. One
student says something positive about the other
(e.g., “I like your shirt” or “You’re really good at
drawing”).
Goal:
Students learn how to be positive and friendly in
their interactions, making others feel appreciated
and valued.
4. Participation
Activity:
Group activities like team sports, board games, or
classroom discussions where every student has a role
to play and is encouraged to participate.
Goal:
Students practice engaging actively in group settings
and learning to respect the contributions of others.
5. Helping/Sharing
Activity:
Encourage students to work together and share
materials or assist others who need help with a task.
Goal:
Students develop a sense of responsibility and
cooperation by helping their peers and sharing
resources willingly.
6. Giving Compliments
Activity:
Pair students up and encourage them to give
compliments to each other (e.g., complimenting a
peer’s work, appearance, or kindness).
Goal:
Students practice giving compliments to foster
positive connections and build self-esteem among
peers.
7. Coping with Teasing
Activity:
Role-playing scenarios where one student practices
how to respond to teasing, using assertive but non-
aggressive language.
Goal:
Students learn to handle teasing confidently without
reacting negatively, and to seek support if necessary.
By systematically teaching these skills in structured
settings, students are more likely to develop positive peer
relationships and navigate social situations effectively.
The intervention can be tailored to individual needs and
monitored for progress over time.
2. Social problem solving • Identifying problem •
Brainstorming solutions • Choosing best solution •
Planning implementation • Evaluating outcome
Here’s an example of how an intervention for peer
relationships using social problem-solving might look,
with each step in the process broken down into activities:
Intervention: Social Problem Solving for Peer
Relationships
Objective:
To help students develop the ability to identify and solve
social problems with their peers through structured
problem-solving steps.
1. Identifying the Problem
Activity:
Present a scenario in which two students are having
a disagreement (e.g., one wants to play a game, but
the other wants to do something different). Ask
students to discuss what the problem is and identify
the conflict clearly.
Goal:
Students practice identifying the core issue in a
social situation (e.g., lack of cooperation,
miscommunication, or conflicting desires) without
jumping to conclusions or blaming others.
2. Brainstorming Solutions
Activity:
In a small group, students come up with as many
possible solutions to the problem as they can. No
idea is too silly, and everyone is encouraged to
contribute. For example, solutions to the
disagreement might include taking turns,
compromising, or finding an alternative game that
both enjoy.
Goal:
Students learn to think creatively and collaboratively
about solving social conflicts. They are encouraged
to explore multiple solutions before deciding on one.
3. Choosing the Best Solution
Activity:
After brainstorming, students discuss the pros and
cons of each solution. Then, they work together to
decide which one might work best for everyone
involved.
Goal:
Students practice critical thinking by evaluating the
feasibility and fairness of different solutions,
selecting the most appropriate one based on the
situation.
4. Planning Implementation
Activity:
Once a solution is chosen, students develop a step-
by-step plan for how they will carry it out. For
instance, if the solution is to take turns in a game,
they might create a schedule or set a timer for how
long each person will play before switching.
Goal:
Students learn how to plan and organize their actions
to put the chosen solution into practice effectively,
with clear steps and responsibilities.
5. Evaluating the Outcome
Activity:
After the solution is implemented, students come
together to reflect on what happened. Did the
solution work? Were both parties satisfied? What
could have been done differently?
Goal:
Students practice self-reflection and learn how to
assess the effectiveness of their problem-solving
strategies, and to adjust their approach in future
situations.
Example Scenario:
Conflict:
Two students, Alex and Jamie, want to play with the same
toy during recess, but there’s only one toy available.
1. Identifying the Problem:
The problem is that both Alex and Jamie want the
same toy at the same time, leading to a
disagreement.
2. Brainstorming Solutions:
Take turns playing with the toy.
Play together with the toy and share it.
Choose a different toy to play with that both can
enjoy.
Ask a teacher to help resolve the conflict.
3. Choosing the Best Solution:
After discussing the solutions, they decide to take
turns with the toy, agreeing on a time limit for each
turn.
4. Planning Implementation:
They agree to set a timer for 5 minutes for each turn.
After one person’s time is up, they will switch.
5. Evaluating the Outcome:
After playing, Alex and Jamie reflect on whether the
solution worked. Both feel happy with the outcome
because they got to play with the toy and share the
time.
Through this structured approach, students can improve
their social problem-solving skills, reducing conflicts and
fostering better peer relationships by teaching them how
to work through issues collaboratively and thoughtfully.
[Link] other behavioral competencies that other
children consider important • Sports skills • Rules of
sports • Board game rules • Good sportsmanship and
good team membership
Here's an example of how you might structure an
intervention for teaching behavioral competencies that
are considered important by peers, focusing on skills like
sportsmanship, understanding rules, and being a positive
team member.
Intervention: Teaching Behavioral Competencies
for Peer Relationships
Objective:
To help students develop important social and behavioral
skills that will improve their relationships with peers,
including sports skills, understanding game rules, and
demonstrating good sportsmanship and teamwork.
1. Sports Skills
Activity:
Introduce students to basic sports skills, such as
dribbling a ball, passing, or shooting in basketball, or
kicking and passing in soccer. This could be done
through fun drills and games.
Example Exercise: Set up a simple relay race
where students practice passing a ball to each other
and running to the next station. Encourage students
to cheer for each other’s efforts.
Goal:
Students learn basic sports skills that allow them to
participate in group games and physical activities,
improving their confidence and engagement in sports
with peers.
2. Rules of Sports
Activity:
Teach the basic rules of a specific sport or game. For
example, when teaching soccer, explain the rules of
dribbling, passing, and scoring goals. When teaching
board games like Monopoly or chess, go over the
rules and how to take turns.
Example Exercise: Set up a mini-game of soccer
and walk students through each rule as they play,
stopping the game to clarify rules as needed.
Goal:
Students learn the importance of rules in maintaining fair
play and mutual respect in group activities. They also
learn how to follow instructions and help others
understand the rules.
3. Board Game Rules
Activity:
Introduce students to various board games, such as
Connect Four, Monopoly, or Uno. Walk them through
the rules and how to play each game.
Example Exercise: Play a round of a board game
where students take turns. Encourage them to wait
for their turn, follow the rules, and respect others’
turns.
Goal:
Students learn to follow the rules of board games, which
helps them understand how to engage in structured play
with others. They also practice patience and focus as
they take turns and learn strategies.
4. Good Sportsmanship and Good Team
Membership
Activity:
Teach the importance of positive attitudes, both in
winning and losing. Emphasize phrases like “Great
job!” or “Nice try!” and encourage clapping for
others. In team activities, emphasize teamwork,
communication, and helping each other.
Example Exercise: After a game or activity, discuss
with students how they can support each other, like
cheering for a teammate or offering encouragement
after a mistake.
Goal:
Students learn to be gracious winners and losers, showing
respect for others regardless of the outcome. They also
learn to work together as a team, supporting and
encouraging each other to achieve common goals.
Example Scenario:
Context:
The class is playing a group soccer game during recess.
1. Sports Skills:
o Students practice dribbling and passing the ball
during warm-up exercises, ensuring they’re
prepared to participate actively in the game.
2. Rules of Sports:
o Before starting the game, the teacher explains
basic soccer rules: no hands (except for the
goalie), staying onside, and how to score a goal.
3. Board Game Rules:
o After the game, the teacher introduces a board
game (e.g., Monopoly) and explains the rules so
students understand how to take turns and
follow the flow of the game.
4. Good Sportsmanship and Good Team
Membership:
o During the soccer game, students are
encouraged to congratulate their teammates on
good plays, help out if someone falls, and remain
positive if the team is losing. Afterward, students
reflect on how they felt when they won and lost
and how to keep a good attitude next time.
Through these structured activities, students develop a
variety of skills that are essential in peer interactions.
They learn to engage in sports and games with
understanding, fair play, and teamwork, which helps
them build strong relationships and feel more connected
with their peers.
4. Decreasing undesirable and antisocial behaviors •
Target bossy, intrusive, aggressive, and other disruptive
behaviors that children with ADHD exhibit with peers •
Establish reward/consequence program to reduce these
behaviors and to replace with prosocial behaviors taught
in social skills training
Certainly! Here’s a scenario illustrating how to decrease
undesirable and antisocial behaviors in children with
ADHD through a reward/consequence program
alongside social skills training to help them develop
more prosocial behaviors in peer interactions:
Scenario: Decreasing Undesirable and Antisocial
Behaviors in Children with ADHD
Context:
A 3rd-grade class has several students with ADHD who
struggle with behaviors like being bossy, intrusive,
aggressive, and disruptive in peer interactions. The
teacher, along with a school counselor, designs a
comprehensive intervention plan that includes a
reward/consequence system paired with social skills
training to address these behaviors.
Step 1: Identifying Target Behaviors
Behavior Focus:
Bossiness: Taking control of group activities or
speaking over peers without allowing others to
contribute.
Intrusiveness: Invading others' personal space or
interrupting conversations.
Aggression: Physical outbursts, like pushing or
grabbing.
Disruptive behaviors: Talking out of turn, distracting
peers, or causing distractions during class activities.
Teacher’s Action:
The teacher and counselor observe and track the
specific instances of these behaviors, documenting
when and how often they occur during group
activities, recess, and classwork.
The teacher also discusses with the student and their
peers to understand the triggers of these behaviors
and why they might be occurring (e.g., impulsivity,
difficulty waiting for turns, or feeling frustrated).
Step 2: Setting Up the Reward/Consequence
System
Reward System:
Positive Reinforcement: Students earn points or
tokens for demonstrating prosocial behaviors, such
as:
o Taking turns during group activities.
o Listening to peers without interrupting.
o Using calm words instead of aggressive actions
when frustrated.
o Helping a peer or working cooperatively in a
group.
Reward Example:
For every 10 tokens earned, the student can exchange
them for a reward like extra recess time, a special
classroom privilege, or a small prize.
Consequence System:
Negative Consequences for Undesirable
Behaviors:
Students who display bossy, intrusive, or aggressive
behaviors lose tokens or points. They may be given a
brief time-out or asked to reflect on their behavior
with the teacher or counselor.
Consequence Example:
If a student interrupts or takes over a group activity
without allowing others to participate, they lose 2 tokens
and are given a brief opportunity to reflect on how their
behavior affected others (e.g., through a “time-out” or a
quick discussion).
Step 3: Implementing Social Skills Training
Social Skills Lessons:
Students attend weekly social skills training sessions
where they learn specific behaviors that will replace
disruptive behaviors. These skills include:
o How to Take Turns: Learning to wait their turn
during activities and conversations by using a
“talking stick” or setting up a “waiting time”
structure during group discussions.
o Active Listening Skills: Practicing listening to
peers by looking at them, nodding, and asking
follow-up questions.
o Managing Impulsivity: Using tools like a “self-
regulation card” (a visual reminder to stop and
think before acting) to help students control
their impulses, especially when feeling frustrated
or excited.
Role-Playing:
During social skills lessons, students role-play
situations where they practice these new behaviors.
For example, one student might act out a scenario
where they have to share a toy or participate in a
group discussion, and the teacher provides feedback
on how well they followed the rules of taking turns
and listening to others.
Peer Support:
Students with ADHD are paired with peers who
demonstrate strong social skills. They are
encouraged to model appropriate behaviors and give
positive reinforcement to their classmates when they
see them using the new skills.
Step 4: Monitoring and Reinforcing Progress
Weekly Check-ins:
At the end of each week, the teacher meets with
each student to review their progress. They discuss
what went well, what needs improvement, and how
many tokens they earned or lost. The teacher also
checks in with peers to get feedback on how the
student interacted with them.
Example:
Student A: This week, they earned 8 tokens
because they worked hard on taking turns during
group projects and practiced listening when their
classmates spoke. However, they lost 3 tokens for a
small aggressive outburst during recess, where they
pushed another student when frustrated.
Student B: This week, they earned 12 tokens,
mostly by being kind and offering to help peers with
tasks. They did lose a couple of tokens for
interrupting the teacher during class instructions but
were reminded to use active listening strategies.
Positive Reinforcement Example:
After a good week, Student A earns their 10th token
and chooses extra recess time as a reward. They
reflect on how they used the new skills learned in
class to manage frustration and communicate better.
Step 5: Involving Parents and Caregivers
Home Reinforcement:
The teacher sends home a weekly progress report to
the parents detailing the student’s behavior, token
count, and any strategies they can use at home to
reinforce prosocial behaviors.
Parents are encouraged to provide rewards at home
for displaying positive behaviors, such as extra
screen time or choosing a family activity.
Parent-Teacher Collaboration:
Monthly meetings between the teacher, counselor,
and parents help ensure the intervention is
consistent between school and home. The team
discusses whether additional strategies are needed,
and the parents share any concerns or progress from
home.
Step 6: Evaluating Success
Reviewing Behavioral Changes:
After several weeks, the teacher reviews whether the
behaviors have improved. Are students with ADHD
showing a reduction in bossy, intrusive, or aggressive
behaviors? Are they using their social skills (e.g.,
taking turns, listening) more frequently in group
settings?
Example Reflection:
Student A: Over the past month, they have
noticeably reduced aggressive outbursts. Instead of
pushing peers, they are using “I need a break” as a
way to ask for help managing frustration. Their
participation in group activities has also improved,
and they are more cooperative with peers.
Student B: This student has successfully
implemented active listening skills, leading to fewer
interruptions. However, they still need more practice
with managing impulsive behaviors, especially when
frustrated.
Conclusion:
Through this comprehensive approach of targeting
undesirable behaviors with a reward/consequence
system and reinforcing prosocial behaviors through
social skills training, students with ADHD are able to
decrease disruptive behaviors and build more positive
relationships with peers. By consistently reinforcing these
skills, both at school and at home, the intervention helps
them navigate social situations more successfully,
boosting their confidence and social acceptance.
Certainly! A "talking stick" is a tool often used in group
settings (like classrooms or meetings) to help manage
turn-taking during discussions or conversations. The basic
idea is simple: the person holding the talking stick has
the right to speak, and others must listen without
interrupting. Once they finish speaking, they pass the
talking stick to the next person who wants to talk.
How it Works:
1. The Object: A physical object is chosen to serve as
the "talking stick." It could be anything from a small
toy, a wooden stick, a ball, or any item that is easily
passed around.
2. Turn-Taking: Only the person holding the talking
stick is allowed to speak. This encourages
participants to wait their turn and be respectful when
others are speaking.
3. Active Listening: While someone has the talking
stick, the other group members practice active
listening. They focus on what the speaker is saying,
without interrupting.
4. Passing the Stick: Once the speaker is done, they
pass the talking stick to someone else who has
something to contribute.
Purpose and Benefits:
Encourages Fairness: It helps ensure that
everyone gets a chance to speak, especially in a
group where some may be more dominant in
conversation.
Teaches Patience: Participants learn to wait for
their turn and not interrupt others, which can be
especially helpful in teaching children how to listen
actively and practice patience.
Reduces Disruptions: By having a clear system for
who can speak, it minimizes interruptions and
promotes a more organized conversation.
Example in a Classroom:
Imagine a classroom where children are learning to take
turns during a group discussion or activity. The teacher
introduces a talking stick and explains the rule: "Whoever
holds the talking stick gets to talk, and everyone else
needs to listen until it's their turn."
A child raises their hand to speak and is handed the
talking stick.
They share their thoughts or ideas, and once they’re
finished, they pass the stick to the next person.
This keeps the conversation orderly and ensures
everyone has a chance to speak without
interruptions.
In the context of children with ADHD, the talking stick can
be a useful tool to help them learn to wait their turn and
practice focused listening, which is part of social skills
training to improve their peer interactions.
A "self-regulation card" is a visual tool designed to
help individuals, especially children, manage their
emotions and behaviors. It serves as a reminder or
prompt to guide them in regulating their actions,
particularly in moments when they feel overwhelmed,
impulsive, or upset.
How It Works:
1. The Card: The self-regulation card is typically a
small, portable card that can easily be carried or kept
on a desk, in a pocket, or even on a lanyard. It may
include visual cues, simple instructions, or reminders
for calming down, taking deep breaths, or using
coping strategies.
2. Instructions on the Card: It might contain steps or
strategies that the child can follow to help manage
their emotions. For example:
o “Take three deep breaths.”
o “Count to ten slowly.”
o “Pause and think before acting.”
o “Use your words to explain how you feel.”
o “Ask for a break if you need one.”
3. When to Use It: The card is typically used when a
child is feeling frustrated, anxious, or overwhelmed
and may need help calming down. When the child
notices they’re starting to lose control of their
emotions or behavior, they can use the card as a
prompt to stop and regulate their reactions.
4. Role in Self-Regulation: The self-regulation card
helps children practice self-awareness (noticing
when they’re getting upset or impulsive) and self-
control (using coping strategies to manage their
emotions before reacting). Over time, it can support
them in learning how to independently manage
challenging feelings and behavior.
Purpose and Benefits:
Immediate Reminder: The card acts as an
immediate, tangible reminder of strategies for
calming down, helping children recognize when they
need to take a pause.
Promotes Emotional Control: By having specific
steps to follow, children learn how to control
impulses and handle stress or frustration more
effectively.
Visual Support: For children, especially those with
ADHD or other attention-related challenges, having a
visual tool can be a helpful way to stay focused and
remember the steps they need to take in challenging
situations.
Increases Independence: The card encourages
children to take responsibility for their emotions and
behavior by providing them with the tools to self-
regulate.
Example Scenario:
In a classroom, a child named Alex has trouble staying
calm when things don’t go his way, such as losing a game
or being asked to wait for his turn. The teacher gives Alex
a self-regulation card with the following instructions:
1. Take a deep breath.
2. Count to ten slowly.
3. Ask for a break if you need one.
When Alex starts to feel frustrated, he pulls out his self-
regulation card, reads the instructions, and practices the
steps. He’s able to calm down and avoid an outburst.
Over time, Alex learns to use the card independently,
helping him manage his emotions better in peer
interactions.
A self-regulation card can be an excellent tool for
children, especially those who struggle with impulsivity or
emotional control, to foster emotional intelligence and
positive peer relationships.
5. Developing a close friendship • Develop program to
help child with ADHD develop a close friendship with
another child • Work with family and teacher to facilitate
the relationship • May serve an important role in
improving long-term outcomes