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Session # D2b October 5, 2012. Everyday Strategies for Child Behavior: Empowering Providers and Families and Facilitating Change with a Realistic Approach. Matt Orr, PhD Department of Family & Preventive Medicine University of South Carolina School of Medicine [email protected]

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Session # D2b

October 5, 2012

Everyday Strategies for Child Behavior: Empowering Providers and Families and Facilitating Change with a Realistic Approach

Matt Orr, PhD

Department of Family & Preventive Medicine

University of South Carolina School of Medicine

[email protected]

Collaborative Family Healthcare Association 14th Annual Conference

October 4-6, 2012 Austin, Texas U.S.A.


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.


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


Over Time

  • Goal is long-term growth…

  • Skills that enable the child to adapt to the demands of everyday situations

  • Survival Skills


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


Three Targets Over 1st Two Visits

  • Success: Identify in what situations the child does well & put him in them as often as possible

    • Promoting Task Completion & Productivity

  • Activities: Identify what extra-curriculars child is involved in

    • Promoting Development of a Sense of Competence

  • Play: Use Mother Nature (i.e. movement) to set the stage for success

    • Promoting Situational Self-Regulation


Excessively Talkative

Defiant & Annoying

Anxious

Highly Active & Impulsive

Tornadic

Irritable & Cranky


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


REGULATION

Pertinent Brain & Behavior (in 2 slides)

AROUSAL


Temperament

Attention

Sensorium

BEHAVIOR

Affect

Activity

Internal Thermostat & Control System


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 Clinic


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?


Behavioral Strategies: Establishing Boundaries


Behavioral Strategy #1

  • Grandma’s Rule

    • aka Premack’s Principle

  • First broccoli, then cake

  • After shoes put away, then you can go outside


Adaptation

  • “…and I will sit with you while you finish”

  • “Come on, I’ll walk with you to your room.”


#2 Modify Time Outs


#3 Pro-Social Consequences

For more serious offenses

  • Lying

  • Stealing

  • Harming others

  • Make them do “Community Service”


Cognitive strategies: Teaching problem-solving


Cognitive Strategy # 1

  • Turn Should’s into Could’s

  • Creates Options

  • Identifies alternatives & facilitates decision-making

  • Leaves option to “explode”


Cognitive Strategy # 2

  • Replacements

  • Must replace undesirable behavior with a more desirable one


Cognitive Strategy # 3

  • Rewind

  • “Try that again…”

  • Modifies caregiver response

  • Gives child an opportunity to pause & choose more favorable response


Six Skills to Survive & Thrive

Everyday Survival Skills for Kids and Parents


1. Modify Expectations


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


The Message in the Behavior

  • What’s the message here?


The Message in the Behavior

Take a SNAPSHOT!


What’s the Usual Outcome?


Adaptive Regulation View

  • Behaviors are attempts to adapt to internal signals of discomfort or distress…to self-regulate

    • Stay awake

    • Focus

    • Move

    • Protect

    • Defend


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


Play – Pellegrini et al.

  • Physical activity positively affects classroom attention

  • More calm & relaxed

  • Best in short bursts (20 min. optimum)


Proprioception

  • Sensory system involving stimulation to muscles, joints, & tendons

  • Calms & Organizes

    • Considered queen of sensory systems

    • Helps integrate the entire system

  • Includes Vestibular & Tactile senses


Proprioception

  • Central role in governance of motor control and planning! (i.e. ADHD)

  • Regulates over- & understimulation

  • Stimulation lasts for only 2-3 hours

  • Recess anyone?!


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


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)


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


Anxiety-Oriented Strategies

Taming the Wizard


Oppositional & Explosive Behavior

Playful (i.e. physical activity) interventions are essential for kids who are:

  • Intense

  • Irritable

  • 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


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


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!”


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


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


Parent Sleep-Walk Strategy

  • Parents need a strategy that allows them to disengageat “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


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


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


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


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.


Session Evaluation

Please complete and return theevaluation form to the classroom monitor before leaving this session.

Thank you!

[email protected]


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