Georgia Psychological Association, Atlanta, April, PARENTING: Applying a Behavior-Analytic System to Assess and Treat

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1 PRESENTER: Teodoro Ayllon, Ph.D. Georgia Psychological Association, Atlanta, April, 2015 PARENTING: Applying a Behavior-Analytic System to Assess and Treat Children s Emotional and Behavioral Problems* Today s children confront parents with daily problematic behaviors involving repetitive inattention, forgetting, whining, manipulative clinging/ tantrums, back-talking, in-your-face confrontational defiance, and emotional meltdowns. These problems share certain behavioral features with Attention Deficit Disorder, Oppositional Defiant Disorder, Separation Anxiety, and other Anxiety-related Disorders. Treatment for these children is challenging and often made more difficult as therapeutic gains made in the therapist s office do not easily transfer to a child s home environment. This workshop presents a behavior-analytic system based on the emotional/behavioral influence that a child and his parents have over one another through their frequent twoway interaction. Harnessing the power of their interaction, parents can also generate and amplify gains made in the therapeutic setting thereby speeding up a child s emotional self-regulation and positive ways of relating to others. Similarly, school teachers report that children seem to be experiencing an increase in interpersonal problems at school, and with their own peers. These children have low frustration, are oppositional, moody, and pay little attention to rules and social expectations. The question is, how do psychological, behavioral, principles translate into parental action to help a child change at home and in schools? The focus of this workshop provides the clinical practitioner with a behavioral systems framework that, 1) looks at problematic behaviors as developing in the context of the family as the child s primary social environment. Problematic behaviors serve a child to connect and maintain a two-way communication with parents. 2) views problematic behavior as a child s efforts to deal with and control his social environment. 3) enables parents to change their style of interaction and lower dramatically the frequency of problematic behaviors. * This workshop is based on the book, Head Strong: A Parenting Survival Kit for Reducing Tension and Building Self-Esteem, 2011, by Ted Ayllon,PhD

2 Applying a Behavior-Analytic System to Assessment 1. Identifying the emotional/behavioral purpose behind a child s problematic behavior. (There are no blood tests, imaging studies or other tests to diagnose mental health problems). i. personal cost/benefits. what does he gain? What does he lose? What does he avoid? (gets excused from ). ii. What events precede, initiate, trigger the problematic behavior iii. In what situation(s) does it seem to occur most often? iv. In what situation does it never, or rarely, happen? V. Who is sympathetic to his/her behavior the way it is now? Who is most affected (+) (- ) Vi. Is there someone else in the family or very close friend who acts the same way? 2. Focusing on what the child does, not just on what s/he says. (He promises to do his homework, be on time to catch the bus, etc., but fails to live up to his promises). 3. Focusing on what parents do, not just on what they say. ( I told you yesterday you are responsible for catching the bus on time. I m not driving you to school anymore But as the child seems remorseful, cries and begs to be helped for the last time, mom relents and tell him to remember that this is the last time I m going to do it. 4. Tracking a child s active efforts to control parental attention and related personal benefits. 6. Identifying the personal cost/benefit consequences that foster and maintain dysfunctional and problematic child-parent interactions. 7. Distinguishing parental from child-based emotional and behavioral cost/benefits. 8. Recognizing the limits of verbal persuasion, reassurance, and unconditional love as a means to change repetitive problematic behavior. 2

3 Therapeutic Strategies and Tactics for Emotional and Behavioral Change 1. Recognizing the relative influence of the past and the present on the child s problematic behavior. 2. Understanding that a child s learning style is concrete, action-oriented, and favors hands-on training in the here-and-now. 3. Parents interactional style favors abstractions, is largely verbal, and future oriented. Most efforts to persuade a child to listen and follow instructions favor reasoning and logic which involve more talking to which he has shown to be impervious! 4. Fostering feelings of belonging and personal safety through house rules, limits and boundaries on behavior. 5. Focusing on changing problematic behaviors through natural consequences The Basic Therapeutic Strategy Involves Reinforcement of Positive Behavior to Compete and weaken Problematic Behavior. Consequences typically freely available at home. 1. A child seeks stimulation ( sound, motion, touch) by making physical contact with the world, In so doing a child also generates social parental stimulation, Loving efforts include sound, motion, touch, which are highly stimulating to a child. 2, Computer games, TV, cell phones, texting, an so on. Access to such items may be made available contingent on meeting initially a relatively easy requirement. The actual duration of access to any item may be for 15 minutes. Each block of 15 minutes is earned by doing homework, helping with household chores, etc. 3. Opportunities for social growth may include having friends at home, or visiting in friends homes. 4. Idiosyncratic choices may include staying up past bedtime, requesting certain food items( waffles) or meals at home (hot dogs), etc. 5. Consumer items. 3

4 Consequences are not everything. Antecedents must also be considered. 1. Conditions, settings, people, sounds, formal, informal settings are some of the antecedents that affect the occurrence of behavior: they represent the Context of behavior. i. setting: school. 2. the behavior of interest.: Disruptive behavior. Child fails to follow teacher s instructions. 3. the contingencies: teacher gives parents feedback re: appropriate behavior, e.g. when child follows teacher s instructions teacher gives Good Behavior note, or . (No news is bad news). i. mom receives positive feedback: she gives child a big hug, gives child a choice of his preferred activities. Also writes it on the calendar next to the fridge. Focus on the positive and de-emphasize the drama associated with problematic behavior. Defusing Anger and Generally Offensive Behavior at Home 1. What has been going on with the parents? Parental issues, job related issues. 2. How is he doing in school, both academically and socially. Does s/he have friends 3. Conceptualize problematic behaviors not as symptomatic but as adaptive behaviors to prevailing social-environmental conditions. 4. Minimize, and lower emotional reaction to problematic behavior. 5. Interpret a child s inappropriate behavior (persistent disobedience, frequent temper tantrums and the like) as resulting from his not feeling well. i. Suggest he take a few minutes to rest and relax. He does not have to go to his room. He just needs to go to a spot in the house where he will not be bothered by the noise or by anyone at home. Tell him to come back when he gets to feeling better. ii. Avoid making a whole scene because that energizes him and makes the situation worse. What we are doing is minimizing the attention he is provoking. iii. When he returns, busy yourself so as to avoid re-enacting the previous awful scene. As far as he s concerned you are too busy to notice much of anything. Again, you want to avoid discussing the issue. iv. Recognize the unintended consequences of soothing a child s anger. 4

5 v. Recognize that the struggle for control is exciting, energizing, reinforcing to a child. 6. Developing positive behaviors to replace inappropriate ones. i. Following instructions is a learned skill. ii. Child needs practice to develop fluency in any skill, e.g. playing basketball, playing a musical instrument, doing his homework, etc. iii. Parents are coaches. iv. Expect a child not to be a good camper. v. This is where parents shine. 7. Over-protection and the rise of frustration i. Frustration tolerance is a learned skill. ii. Self-control is a learned skill. iii. Tutorial training for skill-challenged children iv Self-esteem is a by-product of competent performance or skill Misuses of Positive Reinforcement and Time-Out i. Motivational deficit. ii. A Disconnect between Behavior and its Outcome. iii. Skill Deficit. iv. What to do when problematic behavior persists. 5

6 GPA2015 REFERENCES Power, T.J., Moutone,J.A., Soffer, S.L., Clarke, A.T., Marshall, S. A., Sharman, J., Blum,N.J., Glanzman, M., Elia, J., and Jawad, A.F. A family-school intervention for children with ADHD: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 2012, 80, A behavioral intervention that involves a daily report card, the delivery of contingencies at home based upon teacher reports of school performance is effective in reducing ADHD symptoms, and increasing parental involvement in their children s education. Ayllon, T., Garber, S., and Pisor, K. The elimination of discipline problems through a combined school-home motivational system. Behavior Therapy, 1975, 6, A Good Behavior letter was sent home linking the child s daily classroom behavior to differential consequences provided by the parents at home. This procedure quickly eliminated classroom disruptive behavior. When the Good Behavior letter was given irrespective of conduct in school, disruption increased by 50%. Hawes, D.J., Dadda, M.R., Frost, A.D.J., and Russell, A. Parenting practices, and prospective levels of hyperactivity/inattention across early and middle-childhood. Journal of Psychopathology and Behavioral Assessment, 2013, 35, The differential effects of parenting practices on ADHD symptoms suggest that environmental factors must be considered within a developmental context. Wyatt, W. J., and Midkiff, D.M. Biological Psychiatry: A practice in search of a science. Behavior and Social issues, 2006, 15, As recently as 2003 there was no compelling evidence for biological causation for most mental and behavioral disorders. The authors call for a shift from biological causation and toward environmental causation. Ayllon, T., and Roberts, M. Eliminating discipline problems by strengthening academic performance. Journal of Applied Behavior Analysis, 1974, 7, Disruptive behavior competes with academic performance in the classroom. By reinforcing academic performance a substantial decrease in disruptive behavior is achieved. 6

7 Steinberg-Epstein, R., Book, T., and Wigal, S. Controversies Surrounding Pediatric Psychopharmacology. 2011, 01,-01Z, 58, Issue 1, Behavioral issues now represent a growing portion of pediatric visits. The top 3 pediatric mental health disorders are anxiety, depression, and ADHD. Autism is considered to be the fastest growing developmental disability. Children s mental health has become a priority issue for the American Academy of Pediatrics. Novak, G., and Pelaez, M. Child and Adolescent Development: A Behavioral Systems Approach. Sage Publications, Inc., The book presents an approach that explains development as influenced by the process of the learning environment and the constant reciprocal interactions between nature and nurture. 7