Behavior Management Techniques for Infants and

Toddlers

By: Vicki Williams, OTR/LInfant and Toddler Connection of Hanover

What is behavior modification?

• Behaviorists say: The consequences and probable consequences of behavior, more than any other factor, determine the behavior a person exhibits

• Consequences are called reinforcers – which increase, decrease or maintain a behavior

• Reinforcers can be:– tangible-food, drink, tokens, sensory input– Intangible –social: praise, smiles, approval/disapproval

• Behavior modification is the SYSTEMATIC manipulation of reinforcers in order to change behavior

Types of reinforcers• Positive-pleasure, presented after a behavior

occurred-tends to increase or sustain the frequency of a behavior (Think rewards)

• Extinction-removal of consequences that sustain or increase a behavior-tends to decrease behavior (Think ignoring undesirable behavior)

• Negative-removal of an already operating aversive stimulus-tends to strengthen a desired behavior (Think making something uncomfortable stop)

• Punishment- an aversive consequence that follows a behavior – tends to suppress undesirable behavior – least effective type of reinforcement – behavior frequently returns in the absence of the

punisher

Where to start• Define the problem• Be prepared to change YOUR behavior• Focus on one problem at a time• Think small• Be consistent• Be positive• Let children know what to expect

ABC recording• A (antecedent)

– what happened immediately before the behavior• B (behavior)

– specifically defined behavior that occurred after A• C (consequence)

– what happened to the child following the behavior?

Difficult behaviors generally serve 1 of 4 purposes:– Attention: + or – from adults or peers– Escape: from a task, situation or individual– Tangible: something desired that is not available– Sensory: a sensory need is met

Form a hypothesis

• Only after defining the behavior and examining A&C over time can we begin to decide what the problem behavior is

• Questions to ask: who, when and where• Test the hypothesis by changing either the

antecedents or the consequences• A behavior cannot be eliminated without

teaching an appropriate replacement that is similar to, or serves the same purpose as the original behavior

Basic discipline techniques

• Praise– Behavior not personality– Be specific– Praise progress– Fit the child– Use it immediately and feed the

meter– mix praise with positive regard

Rewards

• Survey preferences• Vary rewards• Always deliver

Punishment• Choose a punishment that

decreases the undesirable behavior• Use it sparingly & in combination

with positives • Don’t delay punishment• Explain consequences• Be Consistent

Gradual Exposure Technique

Gradual Exposure Technique

Modeling by therapist, peer or parent

Reward with tokens or social attention

Need multiple trials in a session & multiple sessions

for success

Self Management• A way to recognize and change behavior • Controlled by the child with adult supervision• Promotes independence and personal control• Select target behavior (child gives input)• Select reward and %required for reward

(child gives input)• Create chart , get timer and any other needed

equipment • Teach child and parent how to score or reward• Practice with parent initially then when the

child is accurate start the program

Strategies for tantrums and other difficult

behaviors• Tantrums• Connect with respect• Kind ignoring• Patience stretching• Feed the meter

Tantrums• A normal but mostly avoidable

behavior• Peak in children between 18 and

24 months• Often resurface again at 3 ½ years• Can push our buttons and make us

over react

Tantrums

Tantrums occur because:• Toddlers have intense primitive impulses and

feelings– greed, stubbornness, aggression, impatience…– mixed with: poor impulse control and poor ability to

communicate• Lack strategies to deal with feelings• Over-stimulated or bored• Children feel emotionally cornered• Children have observed bad examples• Young kids learn much more from what we do

than from what we say

How to minimize or eliminate tantrums

• Work on improving – impulse control– communication– self regulation

• This has to be done proactively• Tap in to established plans such as

Dr. Harvey Karp’s techniques– The Happiest Toddler on the Block– The Happiest Baby on the Block

Connect with respect• Get on the child’s level• Acknowledge their feelings using few words • Big emotions trip our brains from the logical

left brain (words) to the impulsive right brain (gestures and tone)

• Remember sympathetic override• What is said registers less than how it is said• Use gestures and tone to imply sympathetic

understanding• They say why they cannot have what they want

Kind ignoring• 1st decide what can and cannot be

ignored• Pay NO attention to the behavior &

deprive the child of your attention without being mean

• Behavior may initially get worse• Reinforce desirable behavior

Kind Ignoring• Removes the spotlight of attention• Connect with respect first• Lovingly turn away, do not look at the child and

act busy if you have to for a short time, talk to yourself to help you through the moment etc.

• Return and try again, if the behavior doesn’t stop wait a little longer, repeating as needed until the behavior stops

• Behavior that does not stop or escalates will require stronger consequences (think removal you or the child)

Kind Ignoring

Patience stretching • Patience is a teachable skill• Teach waiting- do this with something a child really

wants• When the child asks for it, almost give it• Then hold up a finger and say “wait”• Look away for a moment• Turn back to the child, give them the object and

compliment the waiting• Practice several times daily• Gradually stretch out the time the child must wait• Teach turn taking• Eenie, meanie, miney, moe• Notice and compliment waiting at other times

throughout the day

Patience Stretching

Feed the meter• Provide short periods of focused attention to

boost good behavior• Time-Ins:

– Attention – watch with interest, smile thumbs up, hugs, high fives, wow, describe what the child is doing well , touch, rewards

– Praise-in a balanced way,, praise action you want to encourage, praise good tries, don’t give praise mixed with criticism

– Gossip- makes praise five times more effective, tell someone else when child is listening

Other helpful skills• Teach kids about their emotions

– talk or read books about feelings– label feelings when they occur (child's and others)– Play games about being mad, happy sad– Make pictures books of kids emotional faces to develop

awareness• Give kids strategies- things they can do when they are

mad– count to ten (or 3)– take a breath (magic breathing)

• Strategies will have to be practiced first, and at times when the child is not upset, and receptive to learning so they are skills the child owns when they need to use them

Other helpful skills• Teach children (ahead of time) what is

expected– Use stories (made up or books)

• Social Stories: with actual pictures of the child and their situation

• Video modeling: preferably of the child , being successful

• Play the fool and let the child tell you what is expected

• Give children opportunities to be active and burn off energy

Sleep problems• Relaxation for better sleep habits • Schedules- control input

– Bath before bed, low lights, quiet and dark, make sure children get enough exercise

• Therapeutic listening (metamusic for toddlers)• Melatonin-be sure to check with physician

– No blue light before bed (TV, new computers, energy efficient light bulbs)

• Blue lights slows melatonin production and can keep us awake for up to 90 minutes after the TV is turned off. Blue light filters and glasses are available.

Eating problems• Be sure to rule out medical issues• Set the stage with arousal and sensory strategies:

– strategies to lower arousal prior to meals• Be systematic in presenting new foods:

– just on the tray, on the plate, touch it, lick it nibble (safe container to spit in) and bite it

– Sequential Oral Sensory (SOS) approach Kay Toomey

• Food chaining- Fraker, Fishbein, Cox and Walbert: – look at food in regard to taste, texture,

temperature. Start where the childe is and expand by chaining to similar foods.

Eating problems• Structured meal times, behavior

modification techniques• Social stories and video modeling

Eating Problems

Transitions• Visual cues

– calendar – PECs cards

• Reminder list – things to do/bring

• Sound cues – timer– musical interlude

• Countdown• Social story• Photos/videos• Schedules• Warnings

Transitions• If the child resists the transition to a new

activity , insisting on obtaining/maintaining a preferred activity

• Physically transition the child to the new activity

• Engage the child in the new activity; assist or prompt the child as needed

• Decrease the amount of assistance or prompts as the child begins to engage

Social stories• A tool to help kids learn new skills and see themselves

differently• Can be used o help kids understand social interactions

or expectations, as well as unfamiliar activities• Brief descriptive stories that provide information to

expand experience or skill• Best for developmentally younger children and

children with communication problems• Read several times daily and include all family

members • Work with the parents to be sure the language is

appropriate and exactly what they want (bye bye boo)• Make copies for family, day care, grandmas etc.

Is it Sensory or it behavior?

• Is it sensory?

• Is it behavior?

• Why is it important to know the difference?