School teachers and nursery teachers should get help and counselling to deal with their child's behaviour at school or in the classroom. This can be in the form of a written opinion with recommendations on how to deal with the child, or systematic training provided within the health system, the psychological-educational counselling centre, or by a school psychologist or educator (provided they are suitably trained). The main interventions that seem to be necessary at school are changing the structure of the class and the demands made on the pupil (e.g. seating the child close to the teacher, shortening tasks, interspersing classroom activities with physical exercise) and identifying problem situations and the pupil's associated behaviour.

In children, it is important to be informed about the diagnosis, the associated symptoms, teaching to observe their behaviour and how to cope, this is particularly important in adolescents.

2. Elements of behavioural psychotherapy

Working with parents in the form of parent coaching or behavioural interventions within the family are methods with proven effectiveness in the treatment of ADHD and hyperkinetic disorder and oppositional defiant behaviour disorder.

Behavioural interventions in the family can be carried out by the treating clinician in therapy visits or individual psychotherapy sessions, by a psychologist in psychological counselling or individual therapy sessions as well as in group therapy as parent coaching. Behavioural interventions can also be conducted in other medical or non-medical facilities (e.g. psychological-educational counselling centres, district family support centres, NGOs), provided they have qualified staff. The provision of behavioural interventions does not require full psychotherapeutic training and can be carried out by a psychologist, a specialist child and adolescent psychiatrist or a psychiatrist (also people in the course of both specialisations) and others provided they have completed other training (educationalists, occupational therapists). Information on the conduct of behavioural therapies or parenting training or family therapy, if conducted in another institution, should be recorded in the medical records.

The basic techniques recommended during behavioural therapy include:

• giving positive attention to desired behaviour and compliance,
• giving commands more effectively
• drawing negative consequences when problem behaviour occurs.

photo: pantherstock

The therapist is also tasked with helping parents identify specific problem situations and select appropriate techniques. Often in families of children with ADHD there is inconsistency in the use of punishments for undesirable behaviour and rewards for desirable behaviour. When negative behaviours predominate in the parent-child relationship, parenting skills should be expanded during therapy sessions. Parents should be taught appropriate ways of giving commands and setting rules (e.g. maintaining eye contact with the child, giving a small number of commands at a time, formulating commands without using negation) and giving positive attention when the child follows the rules. Token systems can be used to reinforce appropriate behaviour. As part of behavioural interventions, a system of negative consequences proportionate to the misconduct should be implemented together with the parents. In cases of overt dysfunction in the family system, the implementation of behavioural interventions should be preceded by family therapy, and it is possible to carry out behavioural interventions as part of family therapy.