ABA - Applied Behavior Analysis
There are many well-written articles about ABA available on the internet. Despite this, the public seems to have become somewhat confused, and that confusion is only likely to deepen as ABA becomes more visible and government (state and federal) becomes more involved. ABA is, at its most basic level, the use of behavior science in modifying the behaviors of individuals. In other words, it is a tool for achieving certain outcomes, which include reducing problem behaviors, increasing appropriate behaviors, and teaching behaviors or skills. This is incredibly broad, and can apply to children or adults, with or without various disabilities, and individually or in classes.
What it is
In its simplest form, ABA is a method of achieving certain behavioral goals for a child by changing the responses of individuals that interact with the child. This means using careful planning to understand what may trigger certain behaviors in a child and what responses have been used when the child engages in certain behaviors. Once this is understood, then it is easier to help decrease problem behaviors and replace them with appropriate behaviors. Yes, this means that it is "programming the child", but it is helping them to become more successful, which is also called "teaching." Typically when people say, "ABA" they are actually referring to "intensive ABA services", which means working one-on-one with the child (or adult) to modify the behavior, record data, and monitor progress. In reality, "ABA" is such a broad term that it may include intensive services, classwide behavior management, or parent education/consultation. Ideally, a child is receiving support through all of these methods simultaneously.
ABA stands for "Applied Behavior Analysis." The methods of ABA are mostly attributed to the work of B. F. Skinner, though in truth behavior science began well before Skinner, and some of the most important concepts were made popular by Thorndike (the "Law of Effect"). There are two main approaches to modifying behavior: operant conditioning, and associative (or "classical") conditioning. The first method basically means, "If you do ____, then you will get ____." The second method is essentially saying, "When you see ____, then it means that ____ is about to happen." The first relies on the individual doing something, whereas the second helps the individual know what to expect next. These two ideas are very important, but also very vague and not easy to apply. During the 100 years between the early development of behavior science and the present, many specific techniques have been developed to help with applying behavior science in day-to-day use. The result is that we now have a large collection of techniques and strategies that can be used by parents and educators to help children, and we have professionals who are trained specifically in behavior science and can develop new techniques as needed.
What it's for (not just Autism)
ABA is increasingly popular in the treatment of Autism Spectrum Disorders, and for good reason. Behavior modification techniques are quite possibly the most effective treatment option to address problem behaviors, teach appropriate behaviors, and develop useful life skills in individuals with Autism Spectrum Disorders. Behavior modification is the single most consistently supported treatment option with a great deal of evidence behind it. It is also very flexible because it can be used to develop a wide range of skills (including communication) and reduce a wide variety of problem behaviors. However, this does not mean that ABA = "Autism Treatment."
ABA can (and has been) used for a wide range of disorders (and non-disordered behavior). It simply means "behavior modification", which is useful for children with other developmental disorders, other behavior problems (including ADHD), and non-disordered problem behaviors (such as tantrums, toilet training, or aggressive behaviors). It is a tool, which has many uses. Behavior is essentially anything that an individual does, and behavior modification can be used for any kind of behavior. That means it is highly versatile.
Who does it
This is a more complicated question. In the most hypothetical sense, everyone uses ABA every day when interacting with others (if you smile because someone gave you a compliment, you just used a social reward to increase that behavior in the future). Usually when parents ask this question, they're wanting to know which professionals provide ABA services. Let's look at some professionals that are likely to have some experience with behavior modification.
Behavior science is the most pure representation of psychology, which should mean that psychologists can provide ABA. However, many psychologists do not train in behavior science heavily and would not be qualified to provide ABA services. With that said, there are also many psychologists that do train heavily in behavior science and can provide ABA services. This is not necessarily obvious and parents should feel encouraged to ask about the psychologist's background if seeking behavioral services. As discussed in a moment, we're in a transition phase with respect to behavioral credentialing, which should eventually make it easier to identify a qualified provider.
Teachers must learn effective classroom management strategies, which rely heavily on behavior modification, which should mean that they are familiar with ABA techniques. However, many regular education teachers do not train heavily in behavior science and have other responsibilities, and special education teachers must learn such a wide variety of skills that they are unlikely to be able to provide methodical ABA services (though they can often implement behavior plans within classrooms).
Pediatricians learn about child development as part of their medical training and are almost certain to come across a great deal of literature about behavioral development and behavior modification. However, they are primarily focused on medical health and are likely to refer parents to another professional (such as a psychologist or BCBA) to provide behavioral health services.
Board Certified Behavior Analysts (BCBAs) are specially trained in behavior science and often provide "intensive ABA services." Intensive services essentially means they will spend a lot of time one-on-one with a child (or adult) doing behavior modification techniques to achieve specific goals. BCBAs should also record data demonstrating progress toward specific goals. One very important component of the work a BCBA does is that they are very specific in defining a goal, how the goal will be measured, and tracking progress. Because of the nature of intensive services (many hours per week in one-on-one services), BCBAs are typically not able to see a large number of clients at a time. However, the services they provide may produce rapid gains in specific skills and are extremely valuable in certain circumstances (such as with reducing self-injurious or aggressive behaviors). Education of BCBAs usually includes a Master's level degree, though some have a doctorate (BCBA-D). BCBAs may supervise individuals with less experience or training, such Board Certified Assistant Behavior Analysts (BCaBA) or Registered Behavioral Technicians (RBT).
The BCBA certification is relatively new within the umbrella of psychological services, but is increasingly prevalent and is becoming more likely to be covered by insurance providers. Some psychologists will hold a BCBA credential in addition to their educational degree, but certainly not all. Likewise, some BCBAs may have other educational backgrounds in addition to their training as a BCBA. Seeing a BCBA credential should provide a guarantee of qualifications to provide behavioral services; otherwise, parents should ask about background training.
How to make the most of it (parent training)
As mentioned earlier, ABA services may include parent education/consultation. In this the parents receive training and support from a professional (often a psychologist or BCBA) to help them understand the child's behavior, the role of the environment and themselves in the behavior, and how to support the child's successful behavior in the future. Many parents may have an expectation that they bring their child to a professional and the professional "fixes" the child's behavior problems. However, this is rarely how things work, and almost never the most effective approach. The child's behavior develops in and responds to the environment. Ignoring the role of the environment (which includes the parents) would be a terrible mistake and could undermine any behavior program the child receives. To make the most of ABA, the parents should be learning at the same time as the child's behavior is changing.
Wednesday, February 10, 2016
Friday, January 8, 2016
IEP and 504?
There are many options for students to receive additional support and services in school. Parents are encouraged to discuss their child's needs with the school. Collaboration between parents and schools can help build a good relationship and tends to be far more helpful for the child. It may be possible for a child to receive unofficial accommodations (such as the child being seated closer to the teacher to improve on-task behavior) without the need of a formal plan. However, sometimes a child needs more support, which may include an Individualized Education Plan (IEP) or a Section 504 Plan. These terms and the processes involved in them can be confusing for parents. It can also be challenging for a school to explain these services to parents.
Individualized Education Plans (IEP) and a Section 504 Plans are both formal plans to help a child receive additional support and accommodation in school. They both offer protection for the child as well. Both require the child to have an identified disabling condition, and the disability must affect the child's ability to function in the school environment. This article provides a brief primer on these two options for students, but it is not exhaustive and cannot accurately capture the variations in each state's, district's, or school's implementation. It is important that parents consult with their schools to learn more about the processes involved in developing these plans.
Individualized Education Plan (IEP)
An IEP is part of the Individuals with Disabilities Education Act (IDEA), which is designed to ensure that all students receive an appropriate education regardless of a disability. I usually explain to parents that an IEP is basically a more substantial support system. It will involve more paperwork, more meetings, and can provide more protections for the child. IDEA is federally-mandated and partially federally funded. The funds supplied may not actually be sufficient to cover all of needs of students within a school (the notion that schools "profit" by identifying disabilities is not unsupported by evidence). A student may receive an IEP for any of 13 categories of disability. Some of these are fairly obvious and easy to understand (e.g., blindness, deafness, autism, learning disabilities...), while other disabilities tend to get lumped into the category of "Other Health Impairment" (or "OHI"). OHI includes medical disabilities that may have an educational impact, such as Attention-Deficit/Hyperactivity Disorder. Another category, Emotional Disturbance, can be harder to understand, but essentially includes any persistent, severe emotional disturbance that impacts the student's ability to function in the school (such as severe depression or anxiety). Students with severe behavioral problems may not be covered under an IEP.
An IEP includes identification of the primary (and secondary) disability, a set of goals for the student (e.g., significant improvement in academic skills) and a set of accommodations and services that will be put in place to help the student achieve the goals. All of this is established at a meeting with the parents and school representatives. Parents play an important role in setting and agreeing to goals and, if parents are not satisfied with the goals and accommodations, then they can refuse to sign the IEP and enter Due Process. However, whenever possible, the parents and the school should reach an agreement to help the child receive the support they need and to help maintain a collaborative relationship between school and home. It is important that parents ask questions when unsure about something, to prevent later disagreements or frustration. The meetings can be intimidating for parents, which is also why it is important that they take their time in reading through and understanding all of the materials and decisions involved. The school psychologist is an advocate for the child and an important resource for parents to make use of.
ADA - Section 504 Plan
A Section 504 Plan is part of the Americans with Disabilities Act, which is intended to ensure that all individuals with disabilities receive free and appropriate accommodations. Because of this, Section 504 Plans can serve a very broad range of situations, including temporary medical disability (for example, a broken leg). Any medical condition that may impact the child's ability to function in the school environment and school activities may receive accommodation under Section 504. As mentioned, this may include temporary medical conditions, but also long-term or persistent medical needs, such as Attention-Deficit/Hyperactivity Disorder. Section 504 Plans are typically "lighter" than an IEP in that they may not have as long of a duration, may require fewer meetings and less paperwork, and may not provide as extensive accommodations. Nevertheless, Section 504 Plans can be very valuable for students.
Section 504 is federally-mandated by law, but does not receive the financial support that may be available under an IEP. More intensive accommodations and needs are usually served under an IEP instead of a Section 504 Plan. However, it is possible to have both a Section 504 Plan and an IEP at the same time.
Labels
Parents are often concerned about their child being "labeled" by receiving services. This is a valid concern, though not always as likely as parents may fear. There are two broad types of services students may receive: pull-out and inclusion. Pull-out services involve the student being removed from the classroom or school activities for a period of time to receive services to meet their educational goals. Pull-out may range from very brief (e.g., 15 minutes) to very long (e.g., entire day in a self-contained classroom). Schools generally try to minimize the amount of pull-out time, partially because it has been found that students tend to develop better socially and are better adjusted if they are in the classroom with their peers. As a result, schools have increasingly relied on inclusion services, which keep the student in the regular classroom, but with additional supports or modifications to assignments or activities. Inclusion classrooms may feature two or more teachers to help tend to the individual needs of students receiving services. These teachers often help all of the students in the classroom, though, which helps reduce any stigma from receiving special education services.
Students and teachers are often unaware of the specific needs or category under which a student is receiving services. That information is considered "privileged", so only those who need to know about it are granted access. Nevertheless, it is likely that students will be able to identify differences between them and their peers, regardless of measures taken to prevent it. Students are very sensitive to differences, and even if a student received no accommodations for a disability, their peers will likely be aware of a difference anyway. Therefore, it is usually best to ensure that the student is receiving whatever services are most helpful, regardless of the potential for stigma. The benefits typically outweigh the costs.
Individualized Education Plans (IEP) and a Section 504 Plans are both formal plans to help a child receive additional support and accommodation in school. They both offer protection for the child as well. Both require the child to have an identified disabling condition, and the disability must affect the child's ability to function in the school environment. This article provides a brief primer on these two options for students, but it is not exhaustive and cannot accurately capture the variations in each state's, district's, or school's implementation. It is important that parents consult with their schools to learn more about the processes involved in developing these plans.
Individualized Education Plan (IEP)
An IEP is part of the Individuals with Disabilities Education Act (IDEA), which is designed to ensure that all students receive an appropriate education regardless of a disability. I usually explain to parents that an IEP is basically a more substantial support system. It will involve more paperwork, more meetings, and can provide more protections for the child. IDEA is federally-mandated and partially federally funded. The funds supplied may not actually be sufficient to cover all of needs of students within a school (the notion that schools "profit" by identifying disabilities is not unsupported by evidence). A student may receive an IEP for any of 13 categories of disability. Some of these are fairly obvious and easy to understand (e.g., blindness, deafness, autism, learning disabilities...), while other disabilities tend to get lumped into the category of "Other Health Impairment" (or "OHI"). OHI includes medical disabilities that may have an educational impact, such as Attention-Deficit/Hyperactivity Disorder. Another category, Emotional Disturbance, can be harder to understand, but essentially includes any persistent, severe emotional disturbance that impacts the student's ability to function in the school (such as severe depression or anxiety). Students with severe behavioral problems may not be covered under an IEP.
An IEP includes identification of the primary (and secondary) disability, a set of goals for the student (e.g., significant improvement in academic skills) and a set of accommodations and services that will be put in place to help the student achieve the goals. All of this is established at a meeting with the parents and school representatives. Parents play an important role in setting and agreeing to goals and, if parents are not satisfied with the goals and accommodations, then they can refuse to sign the IEP and enter Due Process. However, whenever possible, the parents and the school should reach an agreement to help the child receive the support they need and to help maintain a collaborative relationship between school and home. It is important that parents ask questions when unsure about something, to prevent later disagreements or frustration. The meetings can be intimidating for parents, which is also why it is important that they take their time in reading through and understanding all of the materials and decisions involved. The school psychologist is an advocate for the child and an important resource for parents to make use of.
ADA - Section 504 Plan
A Section 504 Plan is part of the Americans with Disabilities Act, which is intended to ensure that all individuals with disabilities receive free and appropriate accommodations. Because of this, Section 504 Plans can serve a very broad range of situations, including temporary medical disability (for example, a broken leg). Any medical condition that may impact the child's ability to function in the school environment and school activities may receive accommodation under Section 504. As mentioned, this may include temporary medical conditions, but also long-term or persistent medical needs, such as Attention-Deficit/Hyperactivity Disorder. Section 504 Plans are typically "lighter" than an IEP in that they may not have as long of a duration, may require fewer meetings and less paperwork, and may not provide as extensive accommodations. Nevertheless, Section 504 Plans can be very valuable for students.
Section 504 is federally-mandated by law, but does not receive the financial support that may be available under an IEP. More intensive accommodations and needs are usually served under an IEP instead of a Section 504 Plan. However, it is possible to have both a Section 504 Plan and an IEP at the same time.
Labels
Parents are often concerned about their child being "labeled" by receiving services. This is a valid concern, though not always as likely as parents may fear. There are two broad types of services students may receive: pull-out and inclusion. Pull-out services involve the student being removed from the classroom or school activities for a period of time to receive services to meet their educational goals. Pull-out may range from very brief (e.g., 15 minutes) to very long (e.g., entire day in a self-contained classroom). Schools generally try to minimize the amount of pull-out time, partially because it has been found that students tend to develop better socially and are better adjusted if they are in the classroom with their peers. As a result, schools have increasingly relied on inclusion services, which keep the student in the regular classroom, but with additional supports or modifications to assignments or activities. Inclusion classrooms may feature two or more teachers to help tend to the individual needs of students receiving services. These teachers often help all of the students in the classroom, though, which helps reduce any stigma from receiving special education services.
Students and teachers are often unaware of the specific needs or category under which a student is receiving services. That information is considered "privileged", so only those who need to know about it are granted access. Nevertheless, it is likely that students will be able to identify differences between them and their peers, regardless of measures taken to prevent it. Students are very sensitive to differences, and even if a student received no accommodations for a disability, their peers will likely be aware of a difference anyway. Therefore, it is usually best to ensure that the student is receiving whatever services are most helpful, regardless of the potential for stigma. The benefits typically outweigh the costs.
Monday, January 4, 2016
Brain Exercise
It can be helpful to think of the brain like a muscle: exercise makes it grow and improves its capabilities. There are plenty of commercial products that claim to improve brain power (memory, processing speed, attention...), but the actual evidence for these products indicates either no real benefit or a very specific benefit (that is, improvement in that specific task, but not other tasks). There are simply no shortcuts for a "supercharged brain." That does not mean that various brain challenges are without value though. For example, crossword puzzles appear to help maintain the strength of long-term memory later in life. This article discusses a little bit about early brain development and why diverse experiences are important for children's brains, and a few specific ideas to keep in mind when trying to help your child develop their abilities.
Immature and Slow to Develop
Humans have an unusually long period of development. Our children are largely helpless for a very long time and their brains will not "fully develop" until possibly early to mid-20's. However, you can clearly see a lot of differences in the abilities of very young children and adolescents, with adolescents capable of understanding more abstract concepts and engaging in more complex discussions (Piaget and his colleagues generally explored these ideas long ago). Because the period of development is so long, that leaves a lot of time to help build a child's abilities and improve on areas that they may be struggling in. Children's brains are also very adaptable (a concept called "plasticity"). One example of that is how young children are more able than adults to recover from brain trauma. On the other hand, some neurological differences do not appear likely to ever be fully addressed. It would be difficult to discuss all of the types of abilities and differences that are "plastic" and those that are not, but we can cover some important areas that parents can work on with their children.
Critical Periods/Sensitive Periods of Development
Sometimes you may hear the term "critical periods" of brain development. This concept means that certain abilities (such as the ability of the brain to process visual information) must develop within a certain time window or else it will never develop. It may be an overstatement for us to say with certainty that some abilities will never be able to develop, but there are certainly times during which it is easiest for a child to acquire a certain skill (such as language). These times during which it is easiest for the child to develop an ability or skill are often called, "sensitive periods" instead of critical periods to help emphasize that the window of opportunity is not necessarily completely shut. Usually these periods are for very specific abilities, such as the ability to process certain types of sensory information, or to develop motor skills or language skills. We are still learning more about human development, however, and there are many areas that are less clear (such as social skills).
Impulse Control and Emotional Regulation
The ability to inhibit a behavioral impulse or an emotional response is important for success in many areas of life (jobs, social interactions, relationships...). Our capacity to do this seems to reside heavily within the front part of the brain (the prefrontal cortex). Fortunately, this appears to be the last part of the brain to reach full maturity, which means there is a lot of time to exercise it. On the other hand, this also partly explains why children, adolescents, and even young adults can be extremely impulsive or make some very questionable decisions at times. The development of the prefrontal cortex also seems to coincide nicely with our "cognitive peak." You could say that we are, essentially, at our smartest in early adulthood (though the decline afterward is actually rather slow). This means that for children we should continually encourage them to practice impulse control and emotional regulation. We can do this most effectively by giving them mild "patience challenges" that push slightly at their limits and providing them with appropriate feedback, encouragement, and (if necessary) rewards for achieving their goals. I would not recommend doing this with an overly high frequency (such as multiple times per hour, every hour, every day) as it's likely to produce so much frustration that you'll get resistance from them in the future. However, if it can be made slightly playful, then the child is building an invaluable ability and also building confidence in their abilities.
An important thing to keep in mind is that emotional regulation and impulse control (or "behavioral regulation") appear to rely on basically the same neurology. To build greater emotional regulation, it is often helpful to teach the child to voluntarily withdraw from a situation when needed (by rewarding them for doing so if necessary). This can give their brain (prefrontal cortex actually) time to catch up and reassert its control over the situation. I've seen parents use many approaches to explaining this to their child, but I think my favorite has been the idea of an "overheating engine" that needs to cool off. Teaching the child how to recognize the signs of getting emotionally overwhelmed is a helpful (possibly critical) step in teaching them to self-regulate their emotions more effectively. A variety of physical cues can help, including their heart rate and breathing, as well as how impatient they're feeling.
Frustration Tolerance and Patience
Similar to building greater impulse control and emotional regulation, the capacity for frustration tolerance and greater patience are likely to be great contributors to a child's long-term success. Tolerance for frustration or setbacks increases the likelihood a child will persist at a challenging task and, as a result, learn more skills and ultimately enjoy more success. Explaining this to a child is not likely to convince them to keep working on a particularly frustrating homework assignment though. As the parent, you effectively coach your child by encouraging them to persist, giving them just enough help when they need it (called "scaffolding"), and showing them how their continued effort has paid off. Then celebrate their success with them! The more they do this (and enjoy the success that follows), the more likely they are to persist at challenging tasks again in the future.
Building patience may be more challenging because "having it now" is always more appealing than "having it later." Individuals who are unable to wait (called "delayed gratification") are less likely to enjoy bigger successes later in life. Those who are able to wait can develop more complex plans and enjoy bigger rewards as a result of their patience. One way to help is to require the child to do "just one more time" or wait "just one more minute" on a fairly frequent basis (ideally at least a few times per day if circumstances permit it). I would not recommend prompting them to do a second round (at least not at first), because they may just get too frustrated, doubt your sincerity in the future, and decide they'll just make it happen on their own (whether you agree or not). You can also offer them bigger rewards for their patience (though starting with praise and allowing them what they originally wanted is a good idea). For example, "Sure, I'll let you have a cookie, but if you can wait until we're done with this, I'll let you have two cookies instead."
Training with ADHD
All of this comes to one final point. While reading this far (good patience and persistence!), you may have thought several times that the skills discussed sounded kind of like what is lacking in a child with ADHD, and you would be right. The neurology of ADHD appears to primarily be underactivity of the area of the brain involved in impulse control, emotional regulation, frustration tolerance, and patience. These skills are important for helping a child to persist at challenging tasks, maintain focus on one thing for an extended time, develop a complex plan, and carry out that plan. They're also important for preventing the types of impulsive or hyperactive behaviors that often get kids in trouble when they have ADHD. Because of that, the exercises discussed here are especially important for children with ADHD (though helpful for all children). This doesn't mean that children with ADHD just needed to do these exercises more, or that their parents committed "bad parenting", which lead to the problems with ADHD (there is clearly a strong genetic component to neurological development and a difference in brain chemistry for individuals with ADHD). Many children with ADHD may have more difficulty with completing these exercises successfully as well, and therefore may need a combination of medication and behavior therapy (rather than just behavior therapy). Progress in developing these skills may also be very slow for a child with ADHD (which can frustrate the parent), but slow progress eventually produces significant progress, and the time is well-spent. Remember, the prefrontal cortex seems to be the last area of the brain to mature, which means that "exercising that muscle" may help to reduce the neurological difference by the time your child is much older.
Immature and Slow to Develop
Humans have an unusually long period of development. Our children are largely helpless for a very long time and their brains will not "fully develop" until possibly early to mid-20's. However, you can clearly see a lot of differences in the abilities of very young children and adolescents, with adolescents capable of understanding more abstract concepts and engaging in more complex discussions (Piaget and his colleagues generally explored these ideas long ago). Because the period of development is so long, that leaves a lot of time to help build a child's abilities and improve on areas that they may be struggling in. Children's brains are also very adaptable (a concept called "plasticity"). One example of that is how young children are more able than adults to recover from brain trauma. On the other hand, some neurological differences do not appear likely to ever be fully addressed. It would be difficult to discuss all of the types of abilities and differences that are "plastic" and those that are not, but we can cover some important areas that parents can work on with their children.
Critical Periods/Sensitive Periods of Development
Sometimes you may hear the term "critical periods" of brain development. This concept means that certain abilities (such as the ability of the brain to process visual information) must develop within a certain time window or else it will never develop. It may be an overstatement for us to say with certainty that some abilities will never be able to develop, but there are certainly times during which it is easiest for a child to acquire a certain skill (such as language). These times during which it is easiest for the child to develop an ability or skill are often called, "sensitive periods" instead of critical periods to help emphasize that the window of opportunity is not necessarily completely shut. Usually these periods are for very specific abilities, such as the ability to process certain types of sensory information, or to develop motor skills or language skills. We are still learning more about human development, however, and there are many areas that are less clear (such as social skills).
Impulse Control and Emotional Regulation
The ability to inhibit a behavioral impulse or an emotional response is important for success in many areas of life (jobs, social interactions, relationships...). Our capacity to do this seems to reside heavily within the front part of the brain (the prefrontal cortex). Fortunately, this appears to be the last part of the brain to reach full maturity, which means there is a lot of time to exercise it. On the other hand, this also partly explains why children, adolescents, and even young adults can be extremely impulsive or make some very questionable decisions at times. The development of the prefrontal cortex also seems to coincide nicely with our "cognitive peak." You could say that we are, essentially, at our smartest in early adulthood (though the decline afterward is actually rather slow). This means that for children we should continually encourage them to practice impulse control and emotional regulation. We can do this most effectively by giving them mild "patience challenges" that push slightly at their limits and providing them with appropriate feedback, encouragement, and (if necessary) rewards for achieving their goals. I would not recommend doing this with an overly high frequency (such as multiple times per hour, every hour, every day) as it's likely to produce so much frustration that you'll get resistance from them in the future. However, if it can be made slightly playful, then the child is building an invaluable ability and also building confidence in their abilities.
An important thing to keep in mind is that emotional regulation and impulse control (or "behavioral regulation") appear to rely on basically the same neurology. To build greater emotional regulation, it is often helpful to teach the child to voluntarily withdraw from a situation when needed (by rewarding them for doing so if necessary). This can give their brain (prefrontal cortex actually) time to catch up and reassert its control over the situation. I've seen parents use many approaches to explaining this to their child, but I think my favorite has been the idea of an "overheating engine" that needs to cool off. Teaching the child how to recognize the signs of getting emotionally overwhelmed is a helpful (possibly critical) step in teaching them to self-regulate their emotions more effectively. A variety of physical cues can help, including their heart rate and breathing, as well as how impatient they're feeling.
Frustration Tolerance and Patience
Similar to building greater impulse control and emotional regulation, the capacity for frustration tolerance and greater patience are likely to be great contributors to a child's long-term success. Tolerance for frustration or setbacks increases the likelihood a child will persist at a challenging task and, as a result, learn more skills and ultimately enjoy more success. Explaining this to a child is not likely to convince them to keep working on a particularly frustrating homework assignment though. As the parent, you effectively coach your child by encouraging them to persist, giving them just enough help when they need it (called "scaffolding"), and showing them how their continued effort has paid off. Then celebrate their success with them! The more they do this (and enjoy the success that follows), the more likely they are to persist at challenging tasks again in the future.
Building patience may be more challenging because "having it now" is always more appealing than "having it later." Individuals who are unable to wait (called "delayed gratification") are less likely to enjoy bigger successes later in life. Those who are able to wait can develop more complex plans and enjoy bigger rewards as a result of their patience. One way to help is to require the child to do "just one more time" or wait "just one more minute" on a fairly frequent basis (ideally at least a few times per day if circumstances permit it). I would not recommend prompting them to do a second round (at least not at first), because they may just get too frustrated, doubt your sincerity in the future, and decide they'll just make it happen on their own (whether you agree or not). You can also offer them bigger rewards for their patience (though starting with praise and allowing them what they originally wanted is a good idea). For example, "Sure, I'll let you have a cookie, but if you can wait until we're done with this, I'll let you have two cookies instead."
Training with ADHD
All of this comes to one final point. While reading this far (good patience and persistence!), you may have thought several times that the skills discussed sounded kind of like what is lacking in a child with ADHD, and you would be right. The neurology of ADHD appears to primarily be underactivity of the area of the brain involved in impulse control, emotional regulation, frustration tolerance, and patience. These skills are important for helping a child to persist at challenging tasks, maintain focus on one thing for an extended time, develop a complex plan, and carry out that plan. They're also important for preventing the types of impulsive or hyperactive behaviors that often get kids in trouble when they have ADHD. Because of that, the exercises discussed here are especially important for children with ADHD (though helpful for all children). This doesn't mean that children with ADHD just needed to do these exercises more, or that their parents committed "bad parenting", which lead to the problems with ADHD (there is clearly a strong genetic component to neurological development and a difference in brain chemistry for individuals with ADHD). Many children with ADHD may have more difficulty with completing these exercises successfully as well, and therefore may need a combination of medication and behavior therapy (rather than just behavior therapy). Progress in developing these skills may also be very slow for a child with ADHD (which can frustrate the parent), but slow progress eventually produces significant progress, and the time is well-spent. Remember, the prefrontal cortex seems to be the last area of the brain to mature, which means that "exercising that muscle" may help to reduce the neurological difference by the time your child is much older.
Friday, January 1, 2016
Getting Compliance
Parents typically expect that if they ask their child to do something (for example, "Put on your coat"), that the child should get up and comply with the request. Though this may be the expectation, in reality compliance happens far less often (perhaps anywhere from 10% of the time to 70% of the time). There are many factors that affect the likelihood of compliance. Understanding some of these can help parents to increase the likelihood of compliance and reduce their frustration. Additionally, it actually reduces the child's frustration as well, which has the added benefit of reducing a variety of undesirable behaviors. This article presents some of the factors that affect compliance in children.
1. Phrasing - Simply put: If a request is open-ended, then the the likelihood of compliance is much less. Some examples of open-ended requests:
We can greatly reduce the resistance that comes from this sense of finality by mentioning that they will be able to do the activity again and some idea of when that will be. For example, "I want you to stop doing that for a moment and put up that other toy. You can continue playing afterward." In my practice with children, simply providing them with some idea of when they can do the activity again, and making clear that we're not actually stopping the activity, merely pausing it, greatly reduces their resistance. There are many situations where an activity must be truly stopped for an extended time, in which case providing them with an alternative of what they will be able to do can help. For example, "Go ahead and put up those toys please. We're going home and you can play with your toys there."
3. Credit - The relationship between a parent and a child can significantly affect the likelihood that the child will perform the parent's request. If there has been a history of opposition, frustration, or conflict, then the child is less likely to comply with the request (and more likely to actually oppose the parent directly). Spending time with the child in a non-directive, and non-corrective way can help "build credit" with the child. This credit is consumed when making requests. Building more credit can help to make interactions much easier overall. Credit-building requires planned periods of time doing activities together (without the parent correcting the child, if possible), which should usually be daily at first and for about 20-30 minutes at a time. This can be very challenging, but the pay-off is worth it. (More info on having Planned Together Time)
4. Choices - Choices can greatly reduce resistance, especially with children who act as if they want control over their lives (Note: it's hard to know what the true motivation is, but many children act in a way that suggests they want control). There are two kinds of choices you can offer: a) choice between your request and getting something they want, or not doing your request and not getting what they want, b) choice between two or three activities that you want.
The first one is basically where you tell the child what you want them to do and then offer them an incentive for doing so. For example, "Please clean up the den. Then you can go outside." For this to work, you absolutely must follow through. If they do not clean the den, then they do not get to go outside. At the same time, you offered them a choice and they can choose to not do it with no further consequence. If "I'm not cleaning the den." is not an option, then do not offer the choice.
The second is where you are offering a few options, but they are expected to choose one. For example, "You can clean your room, vacuum the den, or load the dishwasher." The child is expected to perform one activity, but only one. Using additional rewards with this approach is often much more effective (see Token systems).
5. Placating/Reasoning - Don't do this. If at all possible, do not try to reason with the child about why your request is a great idea and that they should comply because they want to. It is extremely unlikely that reasons (no matter how compelling) will make a significant difference over the long-run. In the process, you risk undermining your authority (what if the child thinks your reasons aren't very good?) and give the impression that everything is negotiable. There are certainly times for those kinds of discussions, but when you're making the request is not the best time for it.
Even more importantly, try to avoid the (natural) temptation to begin offering up more incentives for the child to comply with your request (aka "placating"). Decide before what approach you want to use with the request (if you're going to offer a reward for completing the request) and then decide what you will offer. If the child finds your offer undesirable, then that should be the end of it. If you start to add more, then you're teaching your child to hold out for better offers in future requests as well. Certainly teaching children to be effective negotiators has some value, but there are better ways to develop that skill without undermining your authority as the parent.
6. Short Interactions - This is an interesting one. Research has repeatedly shown that long interactions between a parent and child (during conflicts, arguments, requests, etc.) are likely to escalate and that the result is seldom desirable. Simply put, you should keep the request interaction short. Make your request, lay out your terms, and if the child refuses, carry through a brief plan for how you're going to deal with it. Just imagine there is a timer counting down and if it hits 0, then the time limit for the interaction is up. Conversely, do not try to rush a child either. If a child is rushed, they are put under stress. If they are put under stress, then frustration and resistance are likely to increase, and the interaction may escalate. It is somewhat difficult to explain without showing, but essentially you are working under an imaginary time limit, but trying to keep your "game face" on and not let the child see that you're trying to hurry through. So allow the child a moment to wrap up what they were doing, then repeat the request (while indicating that they will be able to resume the activity or engage in another afterward), and if necessary try to help them begin doing what you requested.
More info on Child Defiance
1. Phrasing - Simply put: If a request is open-ended, then the the likelihood of compliance is much less. Some examples of open-ended requests:
- "Can you put your shoes on?"
- "Is it time to go?" or "Can we go now?"
- "Would you like to give ____ a turn now?"
- "Please put your shoes on."
- "It's time to go, let's get ready."
- "Give ____ a turn now" or "Let's share and give ____ a turn now."
We can greatly reduce the resistance that comes from this sense of finality by mentioning that they will be able to do the activity again and some idea of when that will be. For example, "I want you to stop doing that for a moment and put up that other toy. You can continue playing afterward." In my practice with children, simply providing them with some idea of when they can do the activity again, and making clear that we're not actually stopping the activity, merely pausing it, greatly reduces their resistance. There are many situations where an activity must be truly stopped for an extended time, in which case providing them with an alternative of what they will be able to do can help. For example, "Go ahead and put up those toys please. We're going home and you can play with your toys there."
3. Credit - The relationship between a parent and a child can significantly affect the likelihood that the child will perform the parent's request. If there has been a history of opposition, frustration, or conflict, then the child is less likely to comply with the request (and more likely to actually oppose the parent directly). Spending time with the child in a non-directive, and non-corrective way can help "build credit" with the child. This credit is consumed when making requests. Building more credit can help to make interactions much easier overall. Credit-building requires planned periods of time doing activities together (without the parent correcting the child, if possible), which should usually be daily at first and for about 20-30 minutes at a time. This can be very challenging, but the pay-off is worth it. (More info on having Planned Together Time)
4. Choices - Choices can greatly reduce resistance, especially with children who act as if they want control over their lives (Note: it's hard to know what the true motivation is, but many children act in a way that suggests they want control). There are two kinds of choices you can offer: a) choice between your request and getting something they want, or not doing your request and not getting what they want, b) choice between two or three activities that you want.
The first one is basically where you tell the child what you want them to do and then offer them an incentive for doing so. For example, "Please clean up the den. Then you can go outside." For this to work, you absolutely must follow through. If they do not clean the den, then they do not get to go outside. At the same time, you offered them a choice and they can choose to not do it with no further consequence. If "I'm not cleaning the den." is not an option, then do not offer the choice.
The second is where you are offering a few options, but they are expected to choose one. For example, "You can clean your room, vacuum the den, or load the dishwasher." The child is expected to perform one activity, but only one. Using additional rewards with this approach is often much more effective (see Token systems).
5. Placating/Reasoning - Don't do this. If at all possible, do not try to reason with the child about why your request is a great idea and that they should comply because they want to. It is extremely unlikely that reasons (no matter how compelling) will make a significant difference over the long-run. In the process, you risk undermining your authority (what if the child thinks your reasons aren't very good?) and give the impression that everything is negotiable. There are certainly times for those kinds of discussions, but when you're making the request is not the best time for it.
Even more importantly, try to avoid the (natural) temptation to begin offering up more incentives for the child to comply with your request (aka "placating"). Decide before what approach you want to use with the request (if you're going to offer a reward for completing the request) and then decide what you will offer. If the child finds your offer undesirable, then that should be the end of it. If you start to add more, then you're teaching your child to hold out for better offers in future requests as well. Certainly teaching children to be effective negotiators has some value, but there are better ways to develop that skill without undermining your authority as the parent.
6. Short Interactions - This is an interesting one. Research has repeatedly shown that long interactions between a parent and child (during conflicts, arguments, requests, etc.) are likely to escalate and that the result is seldom desirable. Simply put, you should keep the request interaction short. Make your request, lay out your terms, and if the child refuses, carry through a brief plan for how you're going to deal with it. Just imagine there is a timer counting down and if it hits 0, then the time limit for the interaction is up. Conversely, do not try to rush a child either. If a child is rushed, they are put under stress. If they are put under stress, then frustration and resistance are likely to increase, and the interaction may escalate. It is somewhat difficult to explain without showing, but essentially you are working under an imaginary time limit, but trying to keep your "game face" on and not let the child see that you're trying to hurry through. So allow the child a moment to wrap up what they were doing, then repeat the request (while indicating that they will be able to resume the activity or engage in another afterward), and if necessary try to help them begin doing what you requested.
More info on Child Defiance
Tuesday, June 16, 2015
Subclinical Diagnosis
When a parent brings their child in for evaluation, I naturally assume first that there is something out of the ordinary. At the very least, there is something out of the ordinary from the parent's perspective. The parent is worried about their child and wants to either make sure there is nothing wrong, or if there is, then it is identified so they can take whatever steps would likely be helpful. For this reason, it can be very frustrating for a parent when the child is evaluated and does not qualify for a diagnosis. It would seem strange that a parent would want their child to be diagnosed with a disability or disorder. Indeed, I do not think the parent wants their child to be diagnosed, but the parent wants some kind of answer or explanation for their child's behavior (and what to do about it). It may be that the parent merely wants reassurance that the behavior is actually "normal", or wants a strategy to use with the behavior of concern. In this post, I want to discuss "subclinical diagnosis", which is what happens when a child's behavior is unusual, but not unusual enough for a diagnosis.
To receive a clinical diagnosis, a child must meet certain conditions. These conditions are laid out in the Diagnostic and Statistical Manual of Mental Disorders (currently Fifth Edition), also called the DSM-5. However, a clinician does not rely exclusively on the DSM-5 for determining if a child has a disability. A skilled clinician has many resources used for understanding development and disorders (such as professional journal articles, books, and workshops), and ultimately the clinician must use "clinical judgment" when determining if a child presents with enough symptoms and enough severity to qualify for a diagnosis. The DSM-5 allows for "clinical judgment", and the clinician should meet with the child's parent to discuss the evaluation results and how to understand the results.
Discussing the results of an evaluation can take a lot of time, but the clinician has a responsibility to help the parent understand what the results mean and how the parent can use that information. If a child meets the conditions for a clinical diagnosis, then the clinician will explain this and what it means (along with recommendations of what to do about it). Alternatively, a child may not meet the conditions for a clinical diagnosis, in which case no diagnosis is given because the number or severity of symptoms is too low. In some cases, a child may not meet enough of the conditions for a clinical diagnosis, but does exhibit a number of significant symptoms, which require an explanation and may need accommodations. This may lead to a "subclinical diagnosis." A subclinical diagnosis may eventually lead to a clinical diagnosis if the symptoms continue or worsen in the future. Symptoms of a subclinical diagnosis may also be distressing for the parent, child, or teachers. The clinician should take time to discuss symptoms of a subclinical disorder with the parents and provide recommendations for how to address these, even though the child does not currently meet all of the requirements for a clinical diagnosis.
If a child does not meet the conditions for a clinical diagnosis, then it may be more difficult for a parent to get services for the child. Typically, a clinical diagnosis is one required part of getting school-based services (special education services) under IDEA (the Individuals with Disabilities Education Act). A child with a subclinical diagnosis may, at the school's discretion, receive additional assistance such as a Behavior Improvement Plan. Therefore, it is recommended for parents to discuss their concerns with the school and maintain a cooperative relationship with the school.
Lastly, if a parent is concerned that the evaluation may not be adequate or valid, then they should always be willing to seek a second opinion from another qualified professional. Evaluations provide a limited period of insight into a child and their behavior. The child may simply not show their usual symptoms during that time, which can lead to no diagnosis.
For more information on diagnosis and evaluations, see the following:
To receive a clinical diagnosis, a child must meet certain conditions. These conditions are laid out in the Diagnostic and Statistical Manual of Mental Disorders (currently Fifth Edition), also called the DSM-5. However, a clinician does not rely exclusively on the DSM-5 for determining if a child has a disability. A skilled clinician has many resources used for understanding development and disorders (such as professional journal articles, books, and workshops), and ultimately the clinician must use "clinical judgment" when determining if a child presents with enough symptoms and enough severity to qualify for a diagnosis. The DSM-5 allows for "clinical judgment", and the clinician should meet with the child's parent to discuss the evaluation results and how to understand the results.
Discussing the results of an evaluation can take a lot of time, but the clinician has a responsibility to help the parent understand what the results mean and how the parent can use that information. If a child meets the conditions for a clinical diagnosis, then the clinician will explain this and what it means (along with recommendations of what to do about it). Alternatively, a child may not meet the conditions for a clinical diagnosis, in which case no diagnosis is given because the number or severity of symptoms is too low. In some cases, a child may not meet enough of the conditions for a clinical diagnosis, but does exhibit a number of significant symptoms, which require an explanation and may need accommodations. This may lead to a "subclinical diagnosis." A subclinical diagnosis may eventually lead to a clinical diagnosis if the symptoms continue or worsen in the future. Symptoms of a subclinical diagnosis may also be distressing for the parent, child, or teachers. The clinician should take time to discuss symptoms of a subclinical disorder with the parents and provide recommendations for how to address these, even though the child does not currently meet all of the requirements for a clinical diagnosis.
If a child does not meet the conditions for a clinical diagnosis, then it may be more difficult for a parent to get services for the child. Typically, a clinical diagnosis is one required part of getting school-based services (special education services) under IDEA (the Individuals with Disabilities Education Act). A child with a subclinical diagnosis may, at the school's discretion, receive additional assistance such as a Behavior Improvement Plan. Therefore, it is recommended for parents to discuss their concerns with the school and maintain a cooperative relationship with the school.
Lastly, if a parent is concerned that the evaluation may not be adequate or valid, then they should always be willing to seek a second opinion from another qualified professional. Evaluations provide a limited period of insight into a child and their behavior. The child may simply not show their usual symptoms during that time, which can lead to no diagnosis.
For more information on diagnosis and evaluations, see the following:
Thursday, December 4, 2014
"Why should I?" (Child Defiance)
Parents and teachers make many requests of children. These requests are assumed to be reasonable (by the adult), but children may refuse to comply. Children may have many reasons for refusing to comply with a request, and understanding the reasons is usually helpful in getting compliance.
Can't do or won't do?
The first question we should ask is if a child is refusing to do the task because they "can't do" or if they simply"won't do?" If a child is incapable or believes that she is incapable of doing the task, then it is a "can't do" problem. We usually address this by teaching and practicing with the child to make it easier. Teaching and practicing a task that the child is refusing to do, however, can be difficult. Having some kind of a reward as an incentive can encourage them to put forth the effort and "give it a try." Giving them feedback as they get better can help them become more motivated and more confident (which makes it easier to get compliance in the future).
A "won't do" problem means that the child is able to do the task, but it is unpleasant for them or they would rather do something else. It's very common for children to want to do something else (for example, playing or watching TV), and a task like "clean your room" is naturally not appealing. One approach for getting compliance in this case is to allow the child to do what they want to do after they finish what you've asked them to do. When needed, you can also offer bigger rewards (for bigger tasks). This is essentially like paying your child for doing the task, which is not necessarily a bad thing (they will learn about that in the future anyway). Many parents are afraid that their child will come to expect a reward for "every little thing", but this rarely appears to happen and we can always reduce how often they get the rewards in the future. It is important to not think of it as "bribing" the child, though, because bribes are given for unethical or inappropriate activities, whereas rewards are given for appropriate activities.
Avoiding direct conflict (aka "opposition")
There are many things we cannot make a child do, and children will eventually discover this during direct conflicts with a parent. It does not help to get into a "power struggle" with a child because we 1) give them something they can oppose, and 2) they will sometimes win. By setting up choices for a child, we reduce the opportunity for them to directly oppose a parent, and essentially leave it up to them. If they want to play a favorite game, then they need to first complete their chore. If they refuse to complete their chore, then they simply do not get to play their favorite game. This is less about fighting with the parent (though expect the child to whine and nag; see Tantrums) and allows the child to make the decision for herself.
Providing multiple choices can be helpful at times as well. We may tell a child that she can choose which chore she wants to do and give her two or three options. It is usually not recommended to give too many options (which can be overwhelming). When a child selects one of the options, then she may be more willing because it was "her choice" (even though you set the options).
Why should I?
Always keep in mind that it is a fair question for the child to ask, "why should I?" when you ask them to do something. Just because it's a "fair question" doesn't necessarily mean that you have to engage them in some kind of debate or negotiation. However, acknowledging to yourself or anticipating this question can make it easier to understand the child's resistance and how to best overcome that resistance. There is further discussion about working with resistance and defiance in this post about "making concessions."
The last point I would like to make is: try to remain calm and patient. Defiance can be extremely frustrating, but becoming angry is not a good long-term solution even if it gets an immediate response. Your child watches and learns from how you handle these situations.
Can't do or won't do?
The first question we should ask is if a child is refusing to do the task because they "can't do" or if they simply"won't do?" If a child is incapable or believes that she is incapable of doing the task, then it is a "can't do" problem. We usually address this by teaching and practicing with the child to make it easier. Teaching and practicing a task that the child is refusing to do, however, can be difficult. Having some kind of a reward as an incentive can encourage them to put forth the effort and "give it a try." Giving them feedback as they get better can help them become more motivated and more confident (which makes it easier to get compliance in the future).
A "won't do" problem means that the child is able to do the task, but it is unpleasant for them or they would rather do something else. It's very common for children to want to do something else (for example, playing or watching TV), and a task like "clean your room" is naturally not appealing. One approach for getting compliance in this case is to allow the child to do what they want to do after they finish what you've asked them to do. When needed, you can also offer bigger rewards (for bigger tasks). This is essentially like paying your child for doing the task, which is not necessarily a bad thing (they will learn about that in the future anyway). Many parents are afraid that their child will come to expect a reward for "every little thing", but this rarely appears to happen and we can always reduce how often they get the rewards in the future. It is important to not think of it as "bribing" the child, though, because bribes are given for unethical or inappropriate activities, whereas rewards are given for appropriate activities.
Avoiding direct conflict (aka "opposition")
There are many things we cannot make a child do, and children will eventually discover this during direct conflicts with a parent. It does not help to get into a "power struggle" with a child because we 1) give them something they can oppose, and 2) they will sometimes win. By setting up choices for a child, we reduce the opportunity for them to directly oppose a parent, and essentially leave it up to them. If they want to play a favorite game, then they need to first complete their chore. If they refuse to complete their chore, then they simply do not get to play their favorite game. This is less about fighting with the parent (though expect the child to whine and nag; see Tantrums) and allows the child to make the decision for herself.
Providing multiple choices can be helpful at times as well. We may tell a child that she can choose which chore she wants to do and give her two or three options. It is usually not recommended to give too many options (which can be overwhelming). When a child selects one of the options, then she may be more willing because it was "her choice" (even though you set the options).
Why should I?
Always keep in mind that it is a fair question for the child to ask, "why should I?" when you ask them to do something. Just because it's a "fair question" doesn't necessarily mean that you have to engage them in some kind of debate or negotiation. However, acknowledging to yourself or anticipating this question can make it easier to understand the child's resistance and how to best overcome that resistance. There is further discussion about working with resistance and defiance in this post about "making concessions."
The last point I would like to make is: try to remain calm and patient. Defiance can be extremely frustrating, but becoming angry is not a good long-term solution even if it gets an immediate response. Your child watches and learns from how you handle these situations.
Monday, October 27, 2014
Importance of Silver Linings
"Bad behavior" is frustrating, common, and can quickly drive a parent to the end of their patience. Whatever we expect to see is what we are more likely to notice, regardless of how often it is really happening. We are quick to notice when a child is engaging in bad behavior and before long it can become all we notice. In the same way, a child who has a tendency to get in trouble a lot quickly begins to expect to get in trouble. The process can become an unpleasant cycle and can put a strain on a parent's relationship with their child.
In a similar way, there is an effect referred to as "behavioral momentum." It is called "momentum" because the tendency is for an individual to continue behaving in the same manner when they start behaving in a certain way. This is commonly used by effective sales-people to convince customers to agree to things they probably would not have if simply asked upfront. In the case of a child, we can begin to prime a child's behavior to get more good behavior simply by getting the child to change their direction and praising them for it.
These two concepts (the first paragraph and the second paragraph) can be important for parents. When a child begins misbehaving, parents are quick to point it out, which begins to frustrate the child after it has happened a few times. The child quickly gets into a pattern of misbehavior, and the parent quickly gets into a pattern of scolding the child. More scolding is not likely to improve things; indeed, if the parent is having to scold many times, it has already been shown to not work at that time. It can take a tremendous effort, but if the parent deliberately changes direction and begins praising the child for doing relatively simple things correctly, then the child may begin to get into a more positive direction with their behavior too.
This may mean trying to identify the things the child has done right, creating easy requests for the child to make an opportunity to do something right, and trying to focus on the many things the child does right while not focusing on the little things that are done wrong. This process is not simple, but it can make a world of difference for a frustrated parent and child.
Another strategy (the Penny in a Pocket technique) for changing a child's behavior and our own behavior as parents is provided here.
In a similar way, there is an effect referred to as "behavioral momentum." It is called "momentum" because the tendency is for an individual to continue behaving in the same manner when they start behaving in a certain way. This is commonly used by effective sales-people to convince customers to agree to things they probably would not have if simply asked upfront. In the case of a child, we can begin to prime a child's behavior to get more good behavior simply by getting the child to change their direction and praising them for it.
These two concepts (the first paragraph and the second paragraph) can be important for parents. When a child begins misbehaving, parents are quick to point it out, which begins to frustrate the child after it has happened a few times. The child quickly gets into a pattern of misbehavior, and the parent quickly gets into a pattern of scolding the child. More scolding is not likely to improve things; indeed, if the parent is having to scold many times, it has already been shown to not work at that time. It can take a tremendous effort, but if the parent deliberately changes direction and begins praising the child for doing relatively simple things correctly, then the child may begin to get into a more positive direction with their behavior too.
This may mean trying to identify the things the child has done right, creating easy requests for the child to make an opportunity to do something right, and trying to focus on the many things the child does right while not focusing on the little things that are done wrong. This process is not simple, but it can make a world of difference for a frustrated parent and child.
Another strategy (the Penny in a Pocket technique) for changing a child's behavior and our own behavior as parents is provided here.
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