Test yourself and your team with this scenario based on pharmacy practice

Regular customer Megan Standish calls in and you inwardly give thanks that she hasn't brought her six-year-old son Alfie with her.

Alfie is not very good at waiting quietly with his mum while prescriptions are being dispensed and the staff have been known to complain about having to tidy up the fixtures nearest the counter after he has visited the pharmacy.

"The doctor thinks that Alfie has ADHD," Megan says. "We've been referred to a specialist at the hospital, but the GP also said that I need to work on managing Alfie's behaviour.

"My GP is sending me on some kind of course, but is there anything you can suggest for me to get started with?"

What is the role of behaviour management in ADHD?

There is a lot of focus on the use of pharmacological treatments such as dexamfetamine and methylphenidate in the management of ADHD, but these should form only part of an overall package of care.

Behaviour management is an important aspect, as it encourages children to try to control their symptoms. Training programmes, usually run over a number of weeks, are designed to teach parents and carers techniques that they can use to encourage the desired behaviours, increase their confidence in their ability to care for their child and come to terms with the diagnosis.

What could Megan try before her course starts?

A lot of the behaviour management techniques are common sense, but it is all too easy to lose sight of the most appropriate way to handle a situation when you are at the centre of it.

Some simple things to try include: ● Make instructions clear and simple. Instead of giving orders then descending into pleading or bargaining when they are not followed, write a short checklist. Make sure the language is clear and the child understands it, then stick it on the wall near where that particular activity takes place. ● Be specific. General admonishments such as "be good while we're out" are meaningless, whereas getting the child's attention then explaining exactly what "good" means is much easier to understand. ● Find the balance between rewards and penalties. Swinging between bribes and punishments can be confusing for children. Be clear about consequences if they do not do as asked, but also make sure there is plenty of encouragement and positive feedback when things go well, no matter how small. Reward charts can be helpful. ● Have realistic expectations. A child with ADHD will struggle to sit at the dining table for 30 minutes so don't set them up to fail. ● Advice and support is available from a number of organisations, including the National Attention Deficit Disorder Information and Support Service (addiss.co.uk/information.htm) and the Royal College of Psychiatrists (rcpsych.ac.uk/expertadvice/youthinfo/parentscarers/disorders/adhdhyperkineticdisorder.aspx)

If you identify a gap in your knowledge, consider making a CPD entry.