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Everyday Strategies for Child Behavior: Empowering Providers and Families and Facilitating Change with
a Realistic ApproachMatt Orr, PhD
Department of Family & Preventive MedicineUniversity of South Carolina School of Medicine
[email protected] Family Healthcare Association 14th Annual Conference
October 4-6, 2012 Austin, Texas U.S.A.
Session # D2bOctober 5, 2012
Faculty Disclosure
I/We have not had any relevant financial relationships during the past 12 months.
Objectives• At the conclusion of this presentation, the participant will be
able to:
• Provide brief, yet rich, education on child development and behavior that engages and empowers parents in change process
• Integrate practical behavioral intervention strategies that are conducive to primary care-based office visits
• Identify and tailor brief interventions that fit the needs and abilities of the family and the child with disruptive behavior
Learning Assessment
A learning assessment is required for CE credit.
Attention Presenters:Please incorporate audience interaction through a
brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy
accreditation requirements.
5
Moral of the Story, Punch Line, and Bottom Line
If we want to understand how to help children regulate their
behavior, we must first understand what the behavior is
regulating
6
Over Time
Goal is long-term growth…
Skills that enable the child to adapt to the demands of everyday situations
Survival Skills
7
Nature of Behavior
Help parents know what they are seeing
Empower them with interventions that fit with family’s needs & abilities
Think Asthma or Allergies
8
Three Targets Over 1st Two Visits
1. Success: Identify in what situations the child does well & put him in them as often as possible
Promoting Task Completion & Productivity
2. Activities: Identify what extra-curriculars child is involved in
Promoting Development of a Sense of Competence
3. Play: Use Mother Nature (i.e. movement) to set the stage for success
Promoting Situational Self-Regulation
Anxious
TornadicHighly Active & Impulsive
Irritable & Cranky
Excessively Talkative Defiant &
Annoying
9
10
What’s Out There Already
“Behavioral Treatment” usually means “Behavior Modification”
http://www.sccp.sc.edu/centers/SCORxE/protected/downloads/SCORxE%20Behavioral%20handout%203-1-12%20printing.pdf
Pertinent Brain & Behavior (in 2 slides) A
ROUSAL
REGULATION
11
BEHAVIORAffectAttent
ion
Activity
Sensorium
Temperament
Internal Thermostat & Control System
12
13
Temperament
Regulatory processes = developmental abilities
Tasks that must be mastered
Preferences & Quirks Goodness of Fit
Match between child & environment
Dimensions – Chess & Thomas Activity Level:
Low________Hyperactive
Regulation: Predictable__________Erratic
Initial Response: Approach_________Withdrawal
Adaptability: Flexible_____________Rigid
Intensity: Mild-Mannered______Forceful
Mood: Cheery____Serious____Irritable
Self-Control: Reflective______Impulsive
Concentration: Persistent______Distractible
Sensitivity: Unbothered________Reactive
Temperament in the Clinic16
Perception
Process
Response
Dennis MitchellThis superactive young upstart…is active, agile, tireless and hard to catch. He's also inquisitive, imaginative and of an experimental turn of mind, which frequently lands him in situations he can't always control. With his impish grin, he delivers sometimes blunt observations of the truth. While never malicious or mean, the irrepressible Dennis remains a threat to property, the pomposity of adults and quiet afternoons.
Adapted from www.kingfeatures.com (2009)
How was Dennis punished?
19Behavioral Strategies: Establishing Boundaries
20
Behavioral Strategy #1
Grandma’s Rule aka Premack’s Principle
First broccoli, then cake
After shoes put away, then you can go outside
21
Adaptation
“…and I will sit with you while you finish”
“Come on, I’ll walk with you to your room.”
22
#2 Modify Time Outs
23
#3 Pro-Social Consequences
For more serious offenses
Lying Stealing Harming others
Make them do “Community Service”
24Cognitive strategies: Teaching problem-solving
25
Cognitive Strategy # 1
Turn Should’s into Could’s
Creates Options
Identifies alternatives & facilitates decision-making
Leaves option to “explode”
26
Cognitive Strategy # 2
Replacements
Must replace undesirable behavior with a more desirable one
27
Cognitive Strategy # 3
Rewind “Try that again…”
Modifies caregiver response
Gives child an opportunity to pause & choose more favorable response
28
Everyday Survival Skills for Kids and Parents
Six Skills to Survive & Thrive
1. Modify Expectations
30
Common Complaints
Children do well when they can
They do well in some situations but not others
“Cannot go into a store without asking for something”
“Cannot sit still for more than a minute” “Cannot play outside without getting
into an argument”
2. Identify Success
We Can Only Do What We Can Do
Put Kids in their Element
34
The Message in the Behavior
What’s the message here?
35
The Message in the Behavior
Take a
SNAPSHOT
!
What’s the Usual Outcome?
Adaptive Regulation View37
Behaviors are attempts to adapt to internal signals of discomfort or distress…to self-regulate o Stay awakeo Focuso Moveo Protecto Defend
38
Adaptive vs. Maladaptive
For children, environments (i.e. parents & teachers) determine whether a behavior is adaptive, not whether it helps the child pay attention, sit still, or be compliant
Maladaptive behaviors = “symptoms”
3. Get Moving
314 - Piano stairs - Rolighetsteorin.se - The fun theory.wmv
40
Play – Pellegrini et al.
Physical activity positively affects classroom attention
More calm & relaxed
Best in short bursts (20 min. optimum)
Proprioception41
Sensory system involving stimulation to muscles, joints, & tendons
Calms & Organizes Considered queen of sensory systems Helps integrate the entire system
Includes Vestibular & Tactile senses
Proprioception42
Central role in governance of motor control and planning! (i.e. ADHD)
Regulates over- & understimulation Stimulation lasts for only 2-3 hours Recess anyone?!
43
Levels of Play
Vigorous Physical Activity – All out free play; sports; game provides the parameters
Moderate Physical Activity (think “Indoor”) Boundaries/rules allow for control Play wrestling; indoor trampoline
Fidgeting; Soothing Activities Playing with water Fidget toys
44
Vigorous – Move & Soothe
Team sports (especially soccer) Individual sports (swimming, karate,
dance) Predictable after-school activity (play,
music)
Move & Soothe
Traction
Compression
Play Wrestling
Rough & Tumble Play
Move & Soothe
Bounce & Balance
4. Fidget to Focus
Fidgeting
Evidence that physical activity is related to central executive functioning – Working Memory
ADHD & Non-ADHD
We all fidget to focus
(Rapport et al., 2009)
49
Move & Soothe
Playfulness to Recalibrate
Try not to smile when a child is laughing…good luck!
5. Apply the Breaks
Chunk tasks into manageable doses with breaks in between
6. Background Sound
Taming the Wizard
Anxiety-Oriented Strategies
53
54
Oppositional & Explosive Behavior
Playful (i.e. physical activity) interventions are essential for kids who are:
o Intenseo Irritableo Insatiable
Decisiveness
Coach parents to be DECISIVE Refrain from “We’ll see” Plan ahead If plans change, parents must prep the
team
Critical role in establishing emotionally secure atmosphere
55
Deflect-Reflect
Situation: Child/Teen is in a fit, riddled with anxious-speak; unhappy with some aspect of self or situation Whining Negative self-talk Complaining Blaming
56
57
Deflect-Reflect
Maladaptive attempt to seek comfort from parent
Conflict ensues because parent cannot meet irrational demands
“You’re just saying that!” “You don’t understand!”
58
Deflect-Reflect
Deflection: “What do you think you are going to do about that?”
Reflection: Encourages child to think through/ name a solution
At least, sends message “I believe it’s possible for you to be competent”
“You can sort this out”
Sleep
Routine
Rhythm
Relax (Flexibility)
Ex: Sleep-Walk Technique
59
Parent Sleep-Walk Strategy
Many parents report significant trouble with bedtime routine
Consider “sleep” time vs. bedtime Anxiety does not turn off at bedtime! Not a problem for parents to be part
of the bedtime routine; issue is with falling asleep
60
Parent Sleep-Walk Strategy
Parents need a strategy that allows them to disengage at “sleep” time while still tending to child’s needs for comfort & security
Strategy allows parent to progressively disengage from the child when it is time to go to sleep Step-wise
61
Parent Sleep-Walk Strategy
Child is given a roadmap: After I read to you I am going to
Sit on the bed Lay on the floor Sit in the doorway
Begin with what child can handle and progress farther away each night or every few days/weeks
62
Basic Behavior Management
SOS Help for Parents by Lynn Clark, PhD
If you seek easy-to-read & do behavior mgmt training for parents
www.sosprograms.com
63
For Further Reading
Effective Parenting for the Hard-to-Manage Child: A Skills-Based Book by DeGangi and Kendall (2008)
More detailed exploration of some of these ideas and intervention 64
Play – Pellegrini et al.
Holmes, R., Pellegrini, A., & Schmidt, S. (2006, October). The effects of different recess timing regimens on preschoolers' classroom attention. Early Child Development and Care, 176(7), 735-743. Retrieved September 15, 2009, doi:10.1080/03004430500207179
Pellegrini, A., Dupuis, D., & Smith, P. (2007, June). Play in evolution and development. Developmental Review, 27(2), 261-276. Retrieved September 15, 2009, doi:10.1016/j.dr.2006.09.001
Pellegrini, A., & Holmes, R. (2006). The Role of Recess in Primary School. Play = learning: How play motivates and enhances children's cognitive and social-emotional growth (pp. 36-53). New York, NY US: Oxford University Press. Retrieved September 15, 2009, from PsycINFO database. 65
Session Evaluation
Please complete and return theevaluation form to the classroom monitor
before leaving this session.
Thank you!