Clinical Partner Dr Sabina Dosani, Child and Adolescent Psychiatrist, discusses the role the humble sticker chart has for children who have ADHD.
We would all love our children to be ‘little stars’ – perfectly behaved in every setting. For any child, this is an unrealistic expectation, but children with ADHD tend to be told off more than other children, both in school and at home. It can be much harder for children with ADHD to get their behaviour right, but I see every day how even very simple behavioural interventions can make a big difference to children with ADHD.
A packet of little sticky stars can be a really accessible and fun way to start.
Star charts can be incredibly useful for correcting behaviour or encouraging behaviour you’d love to see more of. There are lots of companies who sell behaviour charts, but to get children on board, I always advise getting your child involved in making and decorating one. At their simplest, you can use a star chart to reinforce behaviour you’d like to see more of, or to extinguish behaviour you’d like to see the back of. For instance, waiting her turn at dinner, reading quietly in bed or completed homework equals one star on the chart.
Sticker charts can also be used to increase attention span. Little children usually get what they want straight away because, as parents, we rightly respond quickly to a crying baby or fretful toddler. Older children can be taught to wait and you can use star charts to increase their ability to wait their turn or their concentration span. How?
Start by timing how long your son or daughter can typically play quietly or concentrate on homework. This may only be a few minutes but make a note of the time.
After school, set the kitchen timer or your phone for the amount of time you know she can definitely stay still. If she manages the set time, she gets a sticker.
For example, over the next few days, your child might collect a sticker for each of the following:
After a few days, she’ll have the idea of collecting stickers and will be motivated to do things that mean she can have one.
By day four of using the sticker chart, add a minute or two to the length of time you expect her to be quiet or cooperative. Many parents find it helps to do this at the same sort of time every day, like immediately after school, or before dinner. The key to success is not to lengthen the time until she has been successful at a shorter time on at least three or four occasions.
You can get more value out of star charts by encouraging children to swap a certain number of stars for a tangible reward. Using rewards adds to your child’s excitement and helps build towards a sense of achievement when the chart is finished. Rewards shouldn’t be huge, but should be treats that mean a lot.
Some parents worry that all the treats that are swapped for stars are spoiling their children. Often one parent feels rewards should be less material and that a few words of praise ought to be enough.
Children with ADHD often need more powerful rewards than other children.
Stars, stickers, tokens, points and treats like little toys motivate them. Many parents of children with ADHD worry that their child may miss out on more subtle rewards that come from within, like feeling satisfied with a job well done, the warm glow associated with finishing a drawing or pride at completing a school project. However, children with ADHD are less motivated by these internal feelings than they are by the prospect of earning stars to exchange for a Pokemon sticker pack or little plastic pony.
Q. We started using a sticker chart to help my daughter be good at mealtimes. It worked for a few days, but now she’s all over the place again, getting up, picking at her food, interrupting conversations and behaving in unacceptable ways. What can we do?
A. It sounds as if you are trying to correct too many behaviours at once. Don’t worry, lots of parents make this mistake. I’m not sure exactly what you want your daughter to do, so chances are, she’s not sure either. Spend a few minutes writing down exactly what you mean by “being good at mealtimes”. What do you want her to do? Maybe you want her to stop playing with her food and eat what is on her plate using cutlery? Perhaps you want her to sit at the table until everyone has finished. Alternatively, you might allow her to leave if she asks permission first. How do you feel about her leaving after the main course and returning for dessert? Think these things through, and once you are clear in your own mind what is important, stick to it. Explain to her what she needs to do to earn a sticker, remind her before meals and perhaps get her to do a drawing of being good at mealtimes to keep with the sticker chart.
Q. Until last year, my son found sticker charts really motivating. There were great improvements in his behaviour. However, recently my wife and I have noticed we are on a diminishing return. How can we get extra mileage out of one of the few things that really worked?
A. As children get older, stickers and stars start to lose their appeal. You might like to try small sums of money, like 10p or 20p instead of stickers.
Dr Sabina Dosani is a Consultant Child and Adolescent Psychiatrist at Clinical Partners.
Clinical Partners is the UK’s largest private partnership of Psychiatrists, Psychologists and Psychotherapists helping thousands of people every year access the health care they need.