Greater parenting stress has been associated with the families of children with ADHD. Some of the techniques that can be helpful for family members and primary care givers are briefly highlighted below.

Parents or caregivers could learn what ADHD is and how to communicate with kids who have ADHD. Few things a therapist can help with:

• Parent and child encouraged to talk and discuss about ADHD and its effects
• Information about ADHD provided to parents and teachers
• Myths about ADHD cleared, treatment goals and outcomes discussed
• Provided community support groups
• How to develop organizational skills
• Educate about sleep management and anger control

With younger children, the first task for parents is to decide concretely and specifically what behaviours require limitations or change. It is important to be concrete and specific so that the rules can be stated clearly and explicitly. Let us give some examples of vague, meaningless rules and how they can be clarified. Let’s understand it from an example “He should clean his room.” As we have indicated, this rule is highly ambiguous. If by “cleaning the room” the parent means put everything away and the child understands make your bed, he can feel wronged if he makes his bed, leaves, and is criticized. Furthermore, there is room for endless debate. The child cleaned the room by his standards but did not clean it by his mother’s. Not only does the child not know what his parents mean if they are not specific— and he can and will argue with them in the best legalistic fashion about what they might have meant— but also parents will have a much harder time determining whether progress has really taken place.

The second task of parents is to establish a hierarchy of importance for the rules. They must decide what is essential, what is important, what would be nice, and what is trivial. The parents must decide what are five- star rules and what are one- star ones. They must fit the punishment to the misbehaviour. The usefulness of establishing five- and one- star rules is that it helps parents concentrate on the more important areas first and gives the child some breathing room. After the most essential problems have been brought under control, the parents can move to the next category.

In addition to establishing sound rules to help the child, parents must pre-decide a plan of rewards and punishments. These rewards and punishments should be seen as such by the child and not only by the parents. All that is meant by reward is something the child likes, particularly attention, praise, or a small special privilege. Certain privileges, toys, and so forth can be useful under special conditions.

No one likes criticism, and children are no exception. When, for example, the ADHD child has just hit his baby sister for picking up his favourite toy, reducing her to a howling mass, the parent is likely to explode and say such things as: “Why must you be such a bad child?” Reacting this way is understandable. Nevertheless, such an explosion is not helpful. If parents have thought about the problem areas in which improvement is wanted, they are in a far better position to criticize specifically. For example: “I do not like it when you eat with your hands— that is for small babies, not big children”; “Mommy gets upset when she asks you to clean up your room and you do not. Nobody likes to look at messy rooms. Please go back and clean it.” In the examples given, the parent expresses anger— but for specific acts.

Hence, the therapist must not only focus on the needs of the child, but also on the needs of other family members and consider whether these are being met. It is important to note family dynamics and gain an understanding of how reciprocal relationships operate within the family, as the behaviour of one will influence the behaviour of another. Whilst negative cycles within the family have been reported, there is a potential positive here: change in the behaviour of one may influence change in the behaviour of another.