"It worked for a little while..."

This story is really about two behavioral concepts that often surprise and frustrate parents: the "Extinction Burst" and "Spontaneous Recovery." First off, when a child is continually engaging in misbehavior, we know that we must change our response if we want the behavior to change. After all, why would behavior change if it seems to be working for the child? So we develop a plan (a "behavior modification plan" or a "behavior improvement plan"), start applying it, see a change in the child's behavior, pat ourselves on the back, and then become shocked and discouraged when the behavior comes back worse than ever before. These events are frustrating, but they are also typical and expected.

An extinction burst is what happens when a behavior the child used to do reduces in severity for a while, but then comes back worse than it was before. There are a lot of ways to think about how and why this happens, but one of my favorites is to consider what people do at elevators or crosswalks. If there is a button that can be pushed to activate the elevator or the "walk" sign, then we often see someone push it once. If the machine doesn't respond in the time we expect, we might push it again. If we're frustrated, we are likely to push it again many times and maybe even harder. This is similar to what is happening with the child. A good example of when this happens is with tantrums.

Initially the tantrums will often reduce as the child has noticed that the way you're responding has changed. We think, "Oh wow, it's gotten better already, that's great!" However, the child is responding to the change because it is new. Once the child has figured out that the change is long-term and gets used to it, the "new" has worn off. Now the child wants things to work the way they did before. She wants something, you say "no", she gets mad and is going to punish you for your behavior. The tantrum starts up and you don't respond. Knowing that tantrums worked before, she's going to go past what she has done before and make a more severe tantrum. The idea, essentially, is that if this worked before, then she just needs to push the button even harder to make it work again. What is critical is that you maintain the same response and plan as you have been doing. That is incredibly hard to do at times because a really severe tantrum is hard to ignore.

Spontaneous recovery is kind of like an extinction burst, except it occurs much later. In spontaneous recovery, we've managed to get a behavior to reduce and it has stayed that way for a long time. We feel pretty good, like we're out of the woods and the behavior is simply "better" now. Suddenly the behavior comes back without warning and we're surprised. It isn't necessarily as severe as an extinction burst, but it surprises us because it has been so long. What we have to remember is that a behavior is never truly completely gone. There is always a chance that it may occur, even if we've managed to reduce it to a very small chance. Just like with the extinction burst, we need to maintain our same response plan, exactly as we did before, and things will continue. It's hard to remember these things, especially if a child is going into a full tantrum and we're stressed out, embarrassed, or frustrated. If we can remember our plan and stick to it, though, we'll help the child learn the appropriate behavior and get things going in the direction we want.

(This is an excellent picture showing the typical pattern of Extinction Burst. It is from another blog, which also has good information about behavior! http://www.iloveaba.com/2011/12/extinction-procedures.html)

Planned "Together Time"

One of my favorite stories from my work is about a child who frequently had severe tantrums and disruptive behaviors at home. The problems weren't quite as bad at daycare, but when he was home after daycare, he would often seemed to suddenly engage in disruptive behavior (like screaming, slamming the door, hitting/kicking the wall or couch...) with little apparent reason. The mother and I brainstormed for a while trying to figure out what was setting him off. It's not rare for triggers to be things we don't notice, so we have to take time to really sit and think of all possibilities and rule them out.

In this case, the child was being raised by a single, working mother. She dropped him off at daycare in the morning and picked him up at about 5pm. Then she made dinner and let him play. After talking for a while, we noticed that whenever he would engage in these tantrums and disruptive behaviors, his mother would go over and talk to him to try to calm him down and find out what was bothering him. He would usually calm down after a bit, but then might start up again later. We thought that maybe it was in fact the mother's response (direct attention) that was maintaining the behavior. Essentially, he was acting up to get her attention.

We came up with a plan for this child that involved a planned period of "together time with mom" every day after daycare. They would simply sit down and enjoy an activity together. The activity isn't terribly important, and if it is TV, then that's fine (we'd rather it be something interactive, but TV is better than nothing!). The mother also taught the child a different way to ask for attention: he could come sit by her, tap her, or hug her. Any of those would start some "together time with mom." (Using words to ask for attention is fine too, but if the child doesn't have good language yet, then these alternatives are easy for them to do.)

Later, if his mother noticed the child getting upset, then instead of scolding him, she would happily call his name and ask him to come sit with her. This is preempting the behavior (catching it before it escalates) so that behavior doesn't get rewarded. To preempt a behavior we have to be especially observant to notice before it occurs. That can be hard to do, but if we can prevent the behavior from even occurring, then it is not rewarded, which is good!

The theory behind this solution:
When a child is engaging in a "bad behavior" to get something (tantrums in this case), it's often helpful to see if we can find an alternative behavior they can do to get the same thing. We want that behavior to be as easy or easier than the original target behavior. That's not always possible, and if it isn't, then we want to make the reward (the payoff) even better to compensate. Ideally, the child also won't have to do the new behavior for as long or with as much energy as the original (basically like just saying one word to get the reward as opposed to a whole conversation).

This story shows an example of addressing the "antecedent" (things that occur before the behavior and maybe cause the behavior to occur) and identifying the reinforcement (the reward that maintains the behavior). Additionally, there is a lot of value in promoting a close relationship with a child: the child listens better, pays more attention to the parent, values the parent's opinion, and the parent feels less stressed and more patient with the child.

Token Reward Systems

Also known as "Token Economies", a token reward system can be a very effective way of modifying a child's behavior, but setting one up and maintaining it is often more involved and more challenging than parents expect. The basic idea is fairly straightforward: Token systems are "money" for children.
However, they require many considerations, such as"

• How many tokens does a behavior earn?
• Should all behaviors earn tokens?
• Should tokens reset at the end of the week?
• How many tokens should the rewards cost?
• Do I need to provide a token every time?
• Can tokens be taken away? 

I've seen quite a few parents begin to implement a token system and run into unexpected difficulties, and I've seen quite a few parents come in and tell me, "we've tried token systems, they don't work!" I'll not say that token systems always work, but they can be used with many behaviors and produce excellent success, but parents need to plan and prepare.

I've written up a basic guide on implementing token reward systems. The guide is meant to provide some guidelines and help parents plan a token system. Token systems often look different depending on the family, the behavior, the child's age, and what the child likes. Parents should feel encouraged to modify these systems as suits them, and involving the child in planning the rewards is usually a good idea!

One last word of caution with a token system: Make it predictable and consistent. Stick to it. It can take a child a while to figure out how a new system works and that it is actually something that's going to be around for a while (and therefore is worth adjusting to). 

Basic Token Reward System Guide

Toilet-Training

The pattern in raising young children seems to be that we strive to help them learn new skills that inevitably make things more challenging for us as parents (crawling, walking, talking... eventually pushing the rules, questioning authority, and making their own decisions). It's all an effort to promote independence, which is good in the long-term, but a challenge in the short-term. Fortunately, toilet-training is one of those times when we're helping them develop a skill to make things easier on us.... eventually.

The process of toilet-training can be tiring and frustrating for the parent and the child. I've worked with a number of parents and children in developing toilet-training skills, including problems such as awareness training (so the child knows when he needs to go), following all of the steps, and overcoming the fear or reluctance to sit on the toilet. Fortunately these problems can usually be resolved with a combination of behavior planning and patience. I've written a general guide to help with toilet-training. The information is from a variety of excellent sources I've read as well as my own experiences in helping parents overcome the challenge of the porcelain throne.

Toilet Training

Why I made this blog...

I have created this blog to collect and present information to parents. I work with many parents and children with childhood disorders and behavior problems. In my experience I have found that parents often come to me with similar questions about their child's behavior, and I often end up saying the same thing. We aren't taught how to parent, as we are taught how to read or do math. It is something we learn through our experiences as children, observing other people, and trial and error. Naturally, we get confused, get overwhelmed, and make mistakes.

Parents also come to me with concerns about their child's development. They worry that their child may be falling far behind in development, failing to learn, or exhibiting abnormal behavior. In truth, there is a wide range of "normal" for children, but sometimes we are right to be concerned. I will also try to provide information to help parents figure out what may be "normal" and what may actually be a significant problem.

This blog is a place for me to collect and make available a variety of resources on how to identify and work with many of the problems that may come up during childhood and how parents might address those problems. I will be posting guides on certain problem behaviors, resources on how to identify potential problems, and tips on how to tell what is "normal" and what may need further evaluation. I will also occasionally post information about certain problems that have come up and how they were resolved; it can be comforting to see what we're not alone in our experiences, and seeing how someone else solved a problem can be very helpful.