What would you do if your plan to "treat" your child doesn't work

Xiaohong is a first-year student with severe attention deficit/hyperactivity disorder (ADHD). The first time I met her was in kindergarten, we ran around in my office and backyard so I could evaluate her. She never stopped moving. Her creativity and curiosity burst forth from her— she easily mastered grade-level school tasks. The common goal of her family and the school is for her to continue her general education curriculum. Medications help – to some extent. The varsity team and her parents worked hard to get her on track.

At a school meeting, teachers and administrators expressed concern about her activities in the hallway. She never walked in a straight line—she kept twisting and turning. Sometimes she would turn back or sideways, move in that direction for a moment, and then return to her original path. She bumped into the other children, but didn't seem to notice. This also happens on the way in and out of the school. In the classroom, she struggled to sit still, often standing up and walking around the classroom while the teacher was presenting materials or guidance.

The school has implemented a behavior plan — counting the number of times she walks in a straight line, rather than her usual pattern. They counted the number of times she got out of her seat in the classroom and how long she had been in her seat. Stickers, marbles, and various rewards were in place, but she didn't have many points, and she couldn't walk in a straight line or sit still.

Xiaohong later began to go to bed in tears at night, asking her mother how she could become a "good girl". She thinks not winning marbles means she's "bad." She became increasingly irritable and opposed to going to school.

Stories of failed behavior plans pop up in many of my first visits with my family or school team. Often, many motivators are already in place – sometimes punishment is part of it (e.g., loss of privilege, points, or computer time). But the children didn't show improvement. Not only that, but they may also react angrily to restrictions or expectations. Their behavior may get worse than better.

Many behavior change systems are behind a flawed assumption

Traditional responses in parenting and classroom training programs make a single assumption when trying to solve behavioral problems. We assume that a child is controlling their behavior and deliberately failing to comply with behavioral expectations. We may conduct extensive behavioral assessments and ask children why they are not doing what they are told – often described as "seeking attention," "avoiding work," "manipulating others," or "seeking stimulation." However, regardless of the alleged motivation, the problem is still seen as something that the child can change through "right" rewards and motivations.

For many neurodevelopmentally normal children, a gentle behavioral program allows children and adults to focus on specific, clear goals for new developmental behaviors or tasks. However, for other children, especially those who develop outside the "typical" pathway, behavioral planning doesn't work and tends to make things worse. For children with ADHD, anxiety, depression, obsessive-compulsive disorder (OCD), language challenges, trauma, autism spectrum disorder, and other broad "invisible" challenges, we need to focus on giving them what they need to get what they want — rather than trying to fix them.

So, what can we do? We first let go of the assumption that children want to fail – they don't want what we want. We consider the likelihood that the child wants to succeed — want to be recognized by us — but can't. They can't do what we ask for – not that they won't. If we start in fundamentally different places, it expands our toolbox beyond behavioral planning.

Self-regulation is a path of development

Once we change our assumptions, our next task is to try to understand what is preventing children from successfully changing their behavior. Indeed, this is a question worth publishing in many blog posts. However, there is a core issue that plays an important role for many children. It's a developmental path that we don't often mark or identify — but it's just as important as motor, language, or play skills. It's self-discipline.

Throughout childhood and adolescence, the function of the child's brain and body is developed. We monitor our child's development over time. And we have typical age ranges for developing skills – walking, talking, building blocks, social games. We measure these because we can see them. We provide support and therapy for children who have delays in these skills, but we don't think they can change their minds to learn how to skip or say complete sentences at the same time as their peers.

But when kids have trouble self-regulation, such as managing big emotions, filtering out distractions, or controlling the urge to move or talk — it can seem like "bad behavior." Developmental challenges are not easily seen outside of behavior and external emotional expression. Kids who can't stop moving, or stop shouting so often, or stop drawing on the blackboard and sitting down to class aren't trying to be difficult. They're not trying to provoke us. They're trying to do things differently because these regulatory skills aren't as developed as other children of the same age.

Meet your child's self-regulation

So, if a child like Xiaohong can't control their movement levels like most 6-year-olds, we need to give her what she needs instead of trying to "fix" all her other children. She was different from the other children. We can't just expect her to do something her brain and body aren't ready for or can't do. After talking to her therapist and her parents and Xiaohong, it turns out that she is imagining herself in a video game in all the tortuous walks at school.

Once we realized this, we made a plan to give her some room for twists and turns. We set her a goal of not bumping into people and objects, which became part of her game. Parents and schools worked with therapists and me to figure out how to get Xiaohong to move around when she needed to get in and out of the classroom — to get her to stand and stretch — so as not to disturb others. She could sit on the floor on the carpet or stand and listen. If she's very active, she might be scheduled to "run errands" — bring something to the library or counselor's office. Her parents found an opportunity to help Xiaohong follow instructions instead of focusing on staying still.

The path is not easy – it has evolved a lot over time. Some things worked, some things didn't. The shift we assume is a game changer for everyone. Encountering any developing child – making sure to include self-regulation skills – opens up new worlds. Children and adults are not on the opposite side, and adults try to fix children. Instead, everyone is on the same team, working together to provide the child with what they need to thrive.