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Caregivers' Skills Program


David Stein has pinpointed what is necessary in behaviourally treating children to alter specific behavioural patterns, restructure their thinking and motivational patterns and eliminate completely the need for drugs for what is diagnosed as ADD or ADHD.

The Caregivers' Skills Program differs from other approaches and produces dramatic, positive changes in children by completely eliminating the ADD and ADHD patterns without the use of medication. There are five important differences:

Difference 1: Stop the Drugs to Allow the Training of New Behaviours

The drugs do control the behaviours, but then they serve to mask the problem behaviours and thus block the way for effective change. The behaviours must be occurring if we are to change them.

To begin the Caregivers' Skills Program, children must be taken off the drugs before their behavioural and thinking patterns can be changed. Please only do this under your doctor's directions.

In order to train a child to attend to her behaviours and learn self-control, we must have her in the state or situation where the problem behaviours occur. If Nancy is a behavioural problem in class and the teacher puts her desk in the back of the room, away from the other children, then the problem behaviours will not occur and we cannot teach her to learn to be aware of her behaviours and control them. The same is true for Ritalin. It controls the behaviours and, as a result, Nancy loses opportunities to learn to control herself.

Difference 2: Treat Them as Normal and Capable Children

Attention disorders are not diseases but patterns of inappropriate behaviours, faulty thinking, and lack of motivation. So-called ADD and ADHD children can be viewed as normal, but ones in whom the motivation to learn and perform well in school has failed to take hold and who have learned to behave in obnoxious ways. They are often lacking in strong, positive values.

Because neither ADD nor ADHD exists as a medical condition, the terminology for this program is changed. Children will be referred to as inattentive (IA) and highly misbehaving (HM). The solution to eliminating IA and HM patterns is to teach parents and professionals the requisite skills to produce the desired changes. This program teaches easy-to-understand, step-by-step parenting skills.

Difference 3: Change the Way They Think as Well as the Way They Behave

The focal point of the Caregivers' Skills Program is to understand that IA and HM children have the classic mental state or cognitive thought pattern of "not thinking." Once you understand this, everything in the program's method makes sense; you'll understand why it works so well and why other programs collapse.

Other traditional and typical approaches recommend a standard package of special tutoring, individual attention, medication, a few behaviour modification ideas, and perhaps a token economy program at home and at school. These methods actually highly reinforce and perpetuate the not-thinking pattern. Parents, teachers, and tutors constantly stay close to the child- prompting, guiding, cueing, coaxing, pointing things out, reminding, and warning. The adults do all the thinking for the child, who becomes highly dependent on assistance from other people. Adults become the child's reminder machines. The youngster does not learn the most basic, fundamental components necessary for obliterating the IA and HM (ADD and ADHD) patterns-namely, to focus, remember, pay attention, and monitor his own behaviour. We don't want mere compliance to what the adult is requesting. We want the child to think and remember on his own.

By the way, pharmaceutical companies have yet to find a medication that teaches children how to think. Drugs help to focus and to reduce undesirable behaviours but not to learn how to think. Once the medications are taken away, not thinking still plagues the child and all the problems re-emerge. A new trend is to continue the drugs into adolescence and adulthood, which heightens every risk we discussed earlier.

Difference 4: Change Your Parenting

Every topic in this program reverses much of what other approaches advocate. The Caregivers' Skills Program teaches children to think and monitor their behaviours at all times-on their own, with as little reminding and cueing as possible. Other programs focus on school-performance problems of the IA or HM child, but problematic behaviours and thinking patterns manifest themselves in both school and the home. School performance will never be fully controlled until the child learns to think and behave correctly at home. Once the child is under control at home, improving school performance is relatively easy. In approximately 80 percent of my cases, once behaviour is under control at home, schoolwork automatically improves without further intervention. (If school performance problems persist, there is a dedicated section of this program that will show you some further steps for getting this problem under control.)

Difference 5: Change All Misbehaviours, Not Just the Behaviours of Impulsivity or Not Paying Attention

The Caregivers' Skills Program focuses on every behavioural and motivational problem, including aggression that may occur both in the home and at school. It teaches parents exactly what behaviours and thinking patterns are producing IA or HM problems and how to correct them. A comprehensive approach is the only way to eliminate troublesome patterns. We work on behaviours that precede IA and HM (ADD or ADHD) behaviours. We don't wait until they are out of control; we move in when there is even a hint of not thinking or not paying attention or not minding their behaviour. Yes, this is a rigorous approach, but it is a lot safer and far more effective than drugs or patchwork behavioural approaches. The piecemeal approaches mentioned before are doomed to repeated collapses of any initial gains.

The Caregivers' Skills Program uses a form of discipline that is neither punitive nor reinforcing to undesirable behaviours. It teaches the use of time out in a way that requires IA or HM children to think and remain alert at all times to what they are doing and what is going on around them. It is applied in a very rigorous fashion and in a very different way than you may have learned elsewhere.

Remember this: Once you begin working with your child, you should see dramatic results within one to two weeks.


Effective parenting is crucial for the IA or HM (ADD or ADHD) child and can be achieved with this program. There are two parts to the secret of the high success rate of this program: The first is to use behavioural techniques correctly, which is what this it is all about. The second is, after getting their behaviours under control, to give children the time and attention they need in order to structure and train their values so that school and achievement become important.

The Caregivers' Skills Program (CSP) is a comprehensive parenting approach designed for IA and HM children that teaches you how to bring your child's behaviours under control. Knowing how to parent your child effectively eliminates his or her annoying and disruptive behaviours, which in turn reduces a lot of your stress. Your resulting calmness and the security of knowing healthy parenting skills serve to ease tension in the home. This tense and strained environment underlies much of children's agitated behavioural patterns. Knowing how to parent your children will give them structure, that is, knowledge of the boundaries and limits for their behaviour. A much calmer household environment will result. We can disrupt the negative stress cycle and reverse it to a more positive cycle.

The model or outline for the CSP is shown below. At the top are the caregivers who are trained in positive and negative control methods (reinforcement and discipline) to change the IA and HM child's behaviour patterns (target behaviours). This model serves as the outline for this program. Everything covered is specifically designed for changing the IA and HM child and keeping him away from Ritalin.


The Caregivers' Skills Program is based on scientifically grounded principles of behavioural treatment methods and distilled into a clear and easily followed program for parents with IA or HM children. Everything in the CSP has been tried and tested over many years.

The Caregivers' Skills Program.

Primary Caregivers

(Parents, teachers, etc.)

Control Methods

The CSP puts a stop to negative interactions. The home environment becomes calmer, quieter, and more positive. Parents learn tools that are healthy and effective alternatives to yelling and hitting. Also stopped are the reminding, prompting, and cueing that contribute to children's cognitive dependency. Children learn to think and be attentive at all times.

The CSP helps to eliminate the disruptive behaviours that consume so much of your child's time and energy and interfere with creativity. You will learn to reinforce your child's creative efforts- drawing, painting, writing-in ways that increase creative expressiveness. Most important, as your child settles down the two of you can be closer. You can begin the process of nurturing truly meaningful values that will guide him for the rest of his life.

As youngsters internalize proper values, they become more motivated and their ability to focus improves. Concentrating is a learned skill, which requires children to be enthusiastic and motivated.

Instinct Versus Knowledge

You may know people who seem to be naturals at raising well-behaved children, that is, they seem to have good parenting instincts. However, not all parents do. And some may never have learned the basic rules of good parenting. The purpose of this program is to teach the parenting skills needed to raise a well-behaved child, and especially to parent the IA or HM (ADD or ADHD) child. Using these principles, you should discover that parenting can be pretty easy - even a joy. Hundreds of parents have found that they were not as angry as they used to be, and they could stop feeling so guilty about their child's uncontrollable behaviour and poor school performance because these things have disappeared.

Training the Adult, Not the Child

Focusing the training on primary caregivers fosters change more quickly and dramatically than when the therapist works with the child on a weekly basis using play- or talk-therapy. Of course a therapist must work directly with children if they are grieving a major loss or recovering from physical or emotional abuse. These youngsters have primary emotional problems and need to learn to cope with what they have suffered. But most of children are not emotionally disturbed; they exhibit behavioural problems.

How Emotional Problems Can Develop in the IA or HM Child

If the behavioural problems of IA and HM children are not brought under control, true emotional problems may develop. Tension and inconsistency in a household help create a breeding ground for the child to develop anxiety symptoms. In addition, the highly misbehaving child engenders negative reactions from just about everyone. Let's face it, these children are obnoxious. Teachers don't like them and frequently show it with looks of disdain or even disgust. Teachers get mad at them and punish them frequently. These children fail tests frequently, and each failed test only reinforces their ever-lowering self-image. Other kids don't like them. They frequently get teased, taunted, and picked on. They are excluded from playing with the other children. Sometimes out of frustration they explode and get into physical altercations. Add all this to the negative treatment they receive from their parents and, year by year, their self-image goes lower and lower, underlying their increasing emotional problems.

When caregivers learn how to parent more effectively and the environment becomes less stressful, children's emotional stability will improve. As their behaviours improve the responses from teachers and other children will also improve, which will in turn enhance self-esteem. Having the child learn correct behaviour is the best thing we can do for that child. A pill does not teach correct behaviour.


Usually, parents and teachers have the most contact with the child, but others such as grandparents, older siblings, friends of the family, and day-care workers may play a major role in the child's development. Everyone who spends significant time with the child must be included in the training to reduce family strife and to lessen the child's confusion. Training everyone who cares for a child provides consistency and continuity of care. Common technique reduces children's confusion. They quickly learn what is expected and proper behaviour in any and all circumstances. In addition, the frequent arguing among caregivers subsides, further reducing household tension.

The techniques in this program are powerful. To be effective they require the adult to be firm, loving, and in charge. All children - particularly IA and HM children - need structure, guidance, and consistency. Failure to provide these essentials in a resolute manner can create a thoroughly confused child whose behaviour is abominable.

Most people welcome the opportunity to learn good parenting skills.


We'll learn to identify the specific behaviours, called target behaviours, that we must focus on in order to help children behave. We will compare our CSP list with the symptoms typically listed as problematic.

The shifting of focus to the CSP list of behaviours is a major innovation of this program. We will review the basic reasons this shift is essential for working successfully with IA or HM children. We'll also carefully review the CSP target behaviours so that by the end of this chapter you'll have a firm grasp on which behaviours you can help your child change. Once target behaviours are eliminated, the IA or HM diagnosis can be resolved and all pressures to put your child on Ritalin will disappear.


The first task of changing the IA or HM child is to know clearly what behaviours need to be brought under control. These are behaviours that are readily observable, i.e. they can be seen or heard. For example, calling the child immature or disruptive or referring to emotional problems - or even diagnosing a child as having an attention disorder - does not go far enough. We have to identify a child's observable behaviours that we wish to change - specific behaviours we can see or hear.

For example, if we refer to Johnny as immature, do we mean that he cries easily? Or speaks in a babyish voice? Or cannot pay attention and stay on task when doing his homework? Or loses his temper easily and hits other children? What if we say that Sally has emotional problems? Do we mean that she has temper tantrums? Or that she does not play well with other children? Or that she whines and pouts? To define Johnny's immaturity or Sally's emotional problems, we must look for specific, observable behaviours.

A basic rule in behavioural psychology is to reinterpret vague terms such as immature and emotional problems as observable behaviours. When we have simple, precise, clear behaviours that we can observe, we know exactly what to modify. The terms immature and emotional problems are commonly used by teachers and psychologists, so be careful when you hear them.

They are mentioned here for two reasons:

(1) parents hear them frequently; and

(2) they often elicit a feeling of fear and panic in parents that something is terribly wrong with their child.

Redefining these terms as observable behaviours is usually reassuring to parents because they can then see clearly what they are going to work on, that is, what their goals and objectives are.


A target behaviour is habitual, frequently occurring, inappropriate, and distinctly observable. We can see or hear it. All children occasionally act out many of the behaviours described. They are not problem or target behaviours unless they occur regularly and frequently. You need to use good judgement and fairness to determine what is normal and what is excessive.

The list of target behaviours you will be learning about here is very different from those typically list listed.

Here are the differences:

1.    Most of the DSM-IV* behaviours occur in school. Examples are fidgeting, pushing in line, and not paying attention. The CSP behaviours occur in both the home and school but are not included in the DSM-IV list. Examples include not doing as told, being defiant, using poor-me statements, and making negative verbal statements. Teachers cannot devote the time and attention needed to train an individual child in a large class. Parents can work on this training at home.

2.    In the CSP we focus primarily on behaviours at home instead of at school. That re-establishes the parents as the child's authority figures. The emphasis of the CSP is on the parents because they carry out the consequences. This doesn't undermine the teacher's authority because the teacher can easily notify the parents of any misconduct and the consequences will be enforced at home.

3.    The behaviours listed in the DSM-IV occur late in the sequence of misbehaviours. Examples are when the child has lost control-leaving her seat, running, pushing, blurting out answers. In the CSP list, many of the target behaviours occur earlier in the sequence of behaviours, at the preliminary stage and during milder forms of misbehaviours. For example, in the CSP we work on children complying immediately with a command to sit still and do their work. At a hint of being off task, consequences are enforced. We don't wait until children fidget or get up and walk around the room-behaviours defined in the DSM-IV. A major difference between CSP and all other programs is the rigorous emphasis on controlling mere hints of misbehaviour, way before the child loses control. In this way, the child learns that forgetting to monitor and control his behaviours early in the sequence will engender consequences. Therefore, the child has to learn to be more alert and vigilant to even the subtlest misconduct. A whine or a pout is dealt with in the CSP before the tantrum erupts.

4.    Some of the DSM-IV behaviours are vague. For example, "failing to give close attention to details" or "failing to sustain attention" isn't clearly specific and observable.

 In the CSP we break this down to three easily observable components:

  • Looking: Are their eyes on their work or the speaker?
  • Listening: Can they answer the question, What did I just say?
  • Remembering: Can they answer the question, What should you be doing?

These three elements are the specific components of attention problems that can be observed and altered by imposing consequences.

5.    Getting IA or HM children under control at home results in 80 percent of the children automatically improving in school. Recall that the CSP predominantly emphasizes getting children under control at home. The DSM-IV list focuses predominantly on school. In the remaining 20 percent of the cases we will focus more on the DSM-IV list of behaviours occurring in school, but we'll learn how to coordinate efforts between the teacher and the parents. The parents, having firmly established their authority, will enforce the consequences at home, as indicated in systematic communication with the teacher, that is, in a daily report card.

Identifying Target Behaviours for the CSP

The list to follow is divided into four basic groups, including the seventeen target behaviours of the CSP that are common among IA and HM and other challenging children:

Group I: Active Manipulations

1.    Not doing as told - non-compliance

2.    Defying commands - oppositional

3.    Temper tantrums

Group II: Verbal Manipulations

4.    Poor-me statements

5.    Negative statements

6.    Nagging

7.    Interrupting

8.    Physical complaints (saying they are ill or hurt when in fact they are not)

Group III: Inattention Behaviours

9.    Not paying attention

10.    Helplessness and dependency

11.    Dawdling

12.    Poor reading skills

13.    Poor school performance

Group IV: Other Common Misbehaviours

14.    Tattling

15.    Fighting with siblings

16.    Aggression

17.    Lying

Disruptive behaviours may apply much more often to HM children than to purely IA children, who often behave well but simply do not pay attention.

In order to succeed with your child, you must identify each and every target behaviour, no matter what the child's official diagnosis. A key feature of the CSP is the comprehensive control of all target behaviours. Controlling only a few behaviours while allowing others to occur establishes a confusing learning environment and prevents the child from clearly comprehending what is expected.















Acknowledgement: The content of this program is based on Ritalin Is Not The Answer: A Drug-Free, Practical Program for Children Diagnosed with ADD or ADHD by David B. Stein, PhD (Jossey-Bass, 1999 paperback)