Q:I have an adolescent with FAE who has some serious behavior problems. Adderall and Prozac was a real help for the attention deficits and impulse control. When he started raging at age 10, the doctor put him on risperdal and depakote, and that has lessened the outbursts a great deal. But he doesn't seem to respond well to behavior management techniques, like reward systems, which are not effective at all. He likes getting prizes at school, but he seems to forget things he needs to do to earn the prizes, like getting papers signed. He just doesn't seem motivated. Please help! --a tired mother

A: I think that behavior modification systems can work if we change the way we view and use them. When something doesn't work, we need to stop saying that the individual is just not motivated enough or we haven't found the right motivator and begin to ask "what are we not doing to make sure that this individual succeeds." What does your son need to get the fabulous prizes and how can the school and others make sure he gets them? Expecting him to remember everything and get things from home to school regularly may be just setting him up to fail. How can we ensure that things get back and forth.

We can use a reward system as long as we are dedicated to making sure they receive the reward. That might entail seeing them do something "right" or trying to do something "right" and giving them a certain number of points. It might mean helping them get dressed in the morning and when they are finally dressed after much prompting and support, giving them their points or reward. It also means that the reward often has to be much better connected time-wise than it usually is. If you get your stars in school for the next 2 weeks, you can go on the class trip will usually not work. The sense of time (which is an abstract concept) is just not there. The only way something like that should be used is if the teacher will guarantee that s/he will make sure the child has the stars needed for the trip.

For my son, his motivation was always to fail so no matter what motivator was found, if it was something he really wanted, he would make sure he didn't get it. That had to do with his view of himself as a "bad kid" and his early experiences in life. It's not on a conscious level for him so talking with him about it doesn't do much. However, he really wants to be liked and helpful and if someone asks for his help and then after he helps tell him he earned points, he feels good. I call that catching kids at succeeding and I think we need to do that more - not make too big a deal about it, but make sure that we help them succeed. After all, if they could do it on their own, they wouldn't have many of the problems that they do have. --Dan