Parenting Children with Difficult & Challenging Behaviors

Created by: Robert C. Rodriguez

Director of Behavioral Management

San Marcos Treatment Center

And Verna Glassing, National Account Manager

Presented by: Verna Glassing, MS LCPC

San Marcos Treatment Center

Outline Why does this person behave this way?

Common Developmental Traits that appear as non-compliance

More Reasons: Need to belong

Attention seeking, power, revenge or inadequacy through escape

ABCs of Behavior

Interventions and Strategies

Parenting Strategies according to different Diagnosis categories

Why does this child keep engaging in this behavior? Putting the pieces together to figure out the reason(s) behind inappropriate

behavior patterns

Choose to Understand Is this pathological, psychological, criminal,

disability, lack of knowledge or just naughty adolescent behavior?

What are the youths disabilities? (IQ, learning, comprehension, trauma and history)

What are the youths strengths? (interests, talents, learning style, and coping strategies)

Dont blame them for what they cannot do.

We all desire to be heard and understood.

Seeking Understanding Why is this Behavior occurring?

What is their Payoff / Reward?

What is my responsibility in the situation?

What can I do to influence the outcome on our next interaction?

I can only control myself!

Making a plan for future interactions to prevent negative outcomes.

Answer to Why is. Ages and Stages

Some youth may have had problems with normal development

Some characteristics that are common and

expected at certain ages can spawn behavior that is viewed by adults as being defiant or disruptive

An awareness of these expected age-based traits can help us develop greater toleranceand remind us to make use of positive and respectful interventions that TEACH more appropriate ways of handling situations

Common Developmental Traits that Look Like Non Compliance (Ages 6-

12) Wants to determine behavioral boundaries

(for psychological comfort). Tests behavioral boundaries and constraints placed

by authority figures Asks Why? often

Ego-centric: Sees self as center of the universe Wants desirable things NOW Wants to do non-desirable tasks on own schedule Difficulty seeing the view/rights of others Often doesnt want rules, turn-taking, sharing to

apply to him/her Thinks people often pick on him/her Reacts to perceived unfairness or lack of support

by withdrawing or complaining

Developmental Traits cont (6-12yrs)

Possessive & Impulsive Thinks his/her needs & desires should come

before those of others

Its mine., I had it first., I want it!

Wants success at meeting goals to come easily

Complains that tasks are too hard

Expects to win every competitive situation

So what behaviors do you often see that reflect these traits?

Common Developmental Traits that Look Like Non Compliance (Ages 13-

18) Wants to make decisions influencing

his/her life Peer group influence exceeds that of

adults Engages in actions to earn acceptance of

highly perceived peers Attempts to gain positive attention from

those to whom he/she is physically attracted

Highly concerned about personal

appearance

Developmental Traits cont(13-18yrs)

Unconcerned about neatness of surroundings Needs to project appearance of competence even

if lacking or absent I know it already attitude

Views education unrelated to interests as boring Frontal lobe in boys probably poorly developed, in

comparison to girls, and results in lowered sensitivity to feelings of others less awareness/concern for safety of self &

others

A Few More Reasons Physical and mental influences (ADHD, Mood

Disorders, medication reactions)

Group influence/peer pressure

Rebellion against authority/ striving for increased decision making/ influence over ones life

His/her fear of failure or must be perfect

Surging emotions interfere with behavior fight or flight response

Is My Behavior causing their poor behavior? For every action there is equal and opposing reaction.

Goal of Parenting The Goal of Parenting: To raise our

children to be successful adults. Visualization: Close your eyes and see your child as an

adult. Identify character qualities you would

have for your child. Write 3-5 of them down.

Goal of Parenting Now Ask Yourself: What is my parenting style? How do I parent this child? Will that help them toward the adult they

are becoming? Will that hinder the adult they are

becoming? What can I do Today to get them to the

Adult I see them as?

The Need To Belong The need to belong is significant. When

youth have a history of not being valued by adults and peers they may engage in one or

more of the following:

Seeking Attention

Seeking Power or Control

Seeking Revenge

Displaying Inadequacy through Escape

Attention Seeking Behavior may occur due to lack of positive

attention

Attention may be gained through disruptive and provocative behaviors

People will create disruptive situations to win your attention

People may be stuck in a pattern of seeking negative attention

Why would youth seek negative attention?

What is the payoff for attention seeking?

Seeking Power

Control issues Not trusting adults

Defiance issues Rejecting authority

Competition amongst peers Feeling not good enough

Compensation for loss of power Feeling powerless

Seeking Power - Issues of Esteem

Experiences lead to Belief which reflects Self-Image

Become very invested in preserving their Self-Image

Even to the point of self-sabotaging success (ie: Failure, bad, unlovable, worthless)

Better to be seen as Bad than to be seen as Stupid

Better to be seen as Bad than to be seen as Crazy

Dan Dubovsky SAMHSA Center or Excellence

Seeking Revenge

Revenge may be directed at adults or peers

I can only feel important or adequate by hurting others

Im just doing what they did to me

I dont care if Im disliked

Its a victory to be disliked and punished as long as I have made you suffer

Displaying Inadequacy by Escape

Rejection by others leads to feelings of worthlessness

Discouraged people guard their self esteem by removing themselves from situations

Why even try anymore?

Nothing I do even matters

Im Hopeless

Sensory Stimulation

Brain has difficulty processing information

Sensory overload

People engages in behavior that helps them cope

Self stimulation

Is there a neurological or cognitive deficit?

Multiple Motives? Can behavior happen for more than 1 reason? How do we know? All behavior is learned Habit of Behavior Behavior is a response to some action or event Behaviors exist because they either:

1. bring desired benefits (payoff / Reward) 2. fend off undesired events (protection /

Avoidance / Fight or Flight) Behaviors can be adjusted, modified or

extinguished by managing the events/ circumstances which trigger them

A.B.C s of Behavior An Action sparks a Behavior Response to Action (Think > Feel > Do) Consequence or Reward: (positive or negative

payoff) 1. physical 2. emotional 3. behavioral

Prevent misbehavior by preventing the action Reinforce appropriate desired behavior that

meets the same emotional/physical need Extinguish or reduce the behavior by depriving it

of what keeps it going: (No Payoff/Reward) 1. disallow the benefit 2. apply natural consequences 3. ignore it

Think > Feel > Do Cycle Following an Event, behavior is

motivated by: Thinking

Core Values and Beliefs Cognitive Distortions Thinking Errors

Feeling Emotions or unresolved anger Fears or Anxieties

Behavior Appropriate Response Reward Motivated Impulsive behavior - Reaction Fight or Flight Response Avoidance

Motivated

When and where do children Misbehave?

Public Places

Have a plan in place

When there is an audience

Remove the audience or from the audience

At Transitions (meals, bed time, or going somewhere)

Create transition reminders or cues and extra time

When Im on the phone, or doing something else.

Set an activity for when I will be busy

When one of us are tired, ill or stressed Provide nurturing, understanding and time for rest

Types of behavior One time or impulse behavior

No time to plan have to go with the flow

Repeat behaviors (why? Because I can! What is the payoff?) Anticipate the behavior Make a plan to alter this behavior

Chronic behaviors (habitual) Make a plan to break cycle that causes the

behavior (team approach) Dangerous High Risk behaviors Crisis Plan in place (team approach)

Victor Frankl said:

"Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our

growth and our freedom."

Making an Intervention Plan

Anticipate and define the behavior

Put up the STOP sign

Try strategies or interventions to change the behavior

Review success of the plan

How did that work out for you?

Redefine the plan with other interventions

Seek professional and Support advice on alternatives

Be the change you want to see in the

world. M Ganhdi

Attention Seeking Interventions

Provide person with acceptable ways of gaining appropriate attention

Remind them in advance of major activities and transitions

Catch them being good Give signals/ hints to prompt the replacement

behavior Provide some examples Set up time to meet with the them for

communication or support (Positive Feedback Loop)

Increase positive reinforcement for any progress baby steps

Positive Attention Strategies

Verbally or nonverbally acknowledge any positive behavior

Dedicate brief periods of time for positive feedback

Engage the youth in brief conversation about topics that interest him/her (boundary appropriate)

Get involved in their activities

Use a behavior contract when appropriate

Utilize behavior enhancement incentives: 1. Bongo bucks

2. Play of the Day

Power Seeking Interventions

Avoid power struggles at all costs What is a power struggle? I win, you lose

v.s win - win Stay outwardly calm and maintain a professional

perspective Deliver requests that minimize a struggle Practice active listening skills

More Power Seeking Interventions

Pair criticism with praise What is right_____ what needs work________

I-centered statements vs. You centered statements When ____ I feel / need _______

Avoid a mismatch between your words and non-verbal signals Be clear and keep it simple

Say it, do it / consistent

More Power Seeking Interventions

Take time to think and slow yourself down before responding

Offer face saving exit strategies to the person

Discuss consequences in advance

Avoid lectures ( 5 second infomercial)

Avoid making demands when they are upset

Do not insist on processing when they are not ready / he or she is not on your time table

Revenge Seeking Interventions

Facilitate and lead activities in which the person and others (perhaps you) interact positively and cooperatively

Increase efforts to build positive rapport

1. Engage the them in social conversation 2. Treat him/ her respectfully and supportively

Expect resistance at first and do not take it personally

The Power of Therapeutic Rapport

Do not force the person to process

Attempt to process the acting out behavior before the end of the day

Let the them know you do not take his/ her comments personal

Processing behavior or the incident should include helping the person identify :

1. the inappropriate behavior

2. why the behavior was inappropriate

3. Alternative behavior options

4. ways he or she can handle a similar situation in the future

Inadequacy and Escape Interventions

Offer ongoing encouragement and support

Do not criticize

Focus on persons efforts not accuracy

Set up the them for success and recognize his/her effort

Positively acknowledge any effort

Avoid showing frustration (this may reinforce a sense of worthlessness)

Setting the Tone

Are you a Thermostat?

Or

Are you a Thermometer?

We can choose to set the tone of

our interactions and this choice will influence the behaviors and outcomes.

Diagnosis and Parent Response

Mood Disorders

Depression

Bipolar Disorder

Characteristics:

Irritability

Loss of Interest Moody Sad / Despair Apathy Withdrawal

(Too little / or too much of following)

Motivation Issues Sleep Issues Diet Issues Concentration Issues

Energy Issues

Behavior:

Not Listening:

I dont Care. Oh Bother!

Not Doing: Id rather Sleep.

Dont have energy.

Lashing Out: Leave Me Alone!

Parental Response: Depression:

Set Goals / Rules Encourage

Positive engaging

Monitor

Bipolar:

Boundaries with Support Appropriate Limits

Slow it down

Mentor / Monitor

Diagnosis and Parent Response

Attention Deficit /

Hyper-activity Disorder

Characteristics:

Distracted

Inattention

Off task

Forgetful

Disorganized

Loses Things

Impulsivity

Restless

Fidgets

Talks Excessively

On the Go

Interrupts or

Intrudes

Behavior:

Not Listening:

What are you saying?

Not Doing:

I forgot/ too many steps

Lashing Out:

Acts without thinking

Parental Response:

1 direction at time.

Slow down and get attention.

Keep it Simple:

Rules, Goals

Consequences

Redirect

Use Visual Cues

External Brain

Practice / Rehearse

Monitor / Mentor / Model

Diagnosis and Parent Response

Oppositional

Defiant Disorder

Characteristics:

Loses Temper

Argumentative

Breaks Rules

Blames Others

Irritable Angry

Resentful

Authority Issues

Vengeful

Antagonistic

Hostile

Negative

Tantrums

Uncooperative

Behavior:

Not Listening:

Argue or defensive

Not Doing:

I dont want to!

Lashing Out:

You cant make me!

Parental Response:

Address Thinking Errors

Offer Choices

Redirect

Say it, mean it, do it!

United Front

Define Consequences

Set Goals / Rules

Create positive interactions.

Monitor / Mentor

Diagnosis and Parent Response

Autistic Spectrum / Aspersers Disorders

Characteristics:

Impaired Social

Poor eye contact

Poor Relationships

Disconnected

No Reciprocity

Misses Cues

Impaired

Communication

Language delays

Repetitive or Echo

Conversation diff.

Motor Mannerism

Preoccupied

Ridged Routines

Behavior:

Not Listening:

I dont hear you.

Not Doing:

Dont know how, or confused.

Lashing Out: Youre in my space!

Parental Response:

Make Eye Contact

Slow down and get attention.

Use Visual Cues

Redirect and Close Supervision.

Practice /Rehearse

Approach with care

Respect space / routine.

Applied Behavior Analysis plan

Good Questions to ask: Help me understand ..

What happened?

How you were feeling?

What you wanted?

What you were afraid of?

Can we both take 5 to calm down and then we can visit about this?

How can we do this better next time?

What are my available resources for help, new ideas, or some relief?

Taking care of yourself

Connecting with Support Team

Getting a Break

Date Nights

Faith Based supports

Social Worker or Community Therapist

Think> Feel> Do Cycle Processing after a problem (Teachable moment) What I think effects > How I feel > Which leads to how I behave

What is the precipitating event? How did they feel about what happened? Therefore what behavior did they choose? Where can we disrupt or intervene in the cycle

to adjust the outcome to desired behavior?

S.T.O.P. Plan S Stop the interaction or behavior T- Think what are the options

With younger youth this may need defined or discussed with consequences

O- Options What other choices are available?

P- Plan Can there be a choice for alternative

behavior? (Teachable Moment is the KEY!)

3 M Model Model show how its done and work

along side them Mentor Give verbal and visual cues

and stay close to help them stay on course

Monitor Observe and have them check in on how it is going

Slow it Down Walk Slowly

Say, give me (or us) 5 min. to think about that

Convince me on your side, or what your thinking

Breath for count to 5 or 10 Invite them to join in this if appropriate

If pressed remind them that: my initial response, you may not like can you give me time to think about this?

Contracts Lets Make a Deal

What is it they want?

What do I want accomplished?

If.. Then..

When Then..

remember with attention issues KISS

Reward the desired behavior

Positive Feedback Loop Keep them close Point out what it right, true and

good. Help them see alternatives to choices Catch them being good

Self Image Reframing

K. I. S. S Method Keep it Simple

Simplify the Rules (3-5 max)

One instruction at a time

Use visual and other cues to redirect

Increase Monitoring

Encouragement Authentic Appreciation and

Acknowledgement

Catch them being Good (no matter how small)

Focus on Effort Not Outcome

Focus on their Strengths and Interests

Unconditional Acceptance not based or them being good enough

Your are - valuable / lovable / worth while

Choices How can I say Yes!

Saying No is: Easy Habit

Can we have win/win? Never offer as a choice what you are Not willing to

follow through on. (perceived as lying or manipulation)

Choices within limits Give them 2 options I am comfortable with When.. Then / If Then / A, B or C

Vs. unlimited choice (they will choose what I am Not willing to offer and then we are back to power struggle)

Choices cont. 3 Rules for saying NO

Is it Life threatening?

Is it Immoral, Illegal?

Can I live with it? My personal ethics, values

My emotional boundaries / family wellbeing

Is No on this issue important?

Consequences Age and cognitive appropriate

Rule of thumb: 1-2 min / year or age to 6yrs 5-10 min to 12 years and low functioning

Reward the Desired behavior What are the + consequences to

encourage? Rather that threatening consequences.

They are agreed on before hand We Do Not give consequences when we are

upset (that is punishment or punitive) We remind of consequences earned when we are

able to hear it without a new battle

Personal Space Normal Space is 3 feet / Arms length Particularly with ASD or ADHD Impulsive or Explosive behaviors In escalating situation

Take 2 or 3 steps back rather than forward Give time to slow it down Count to 5 or 10 Take lower position (unless there is risk of

aggression or harm)

Drawing them Out Making the time to Listen/Hear

Without distraction / busy-ness

Cooking or eating Meals Driving, cleaning or walking

Sideways communication is less threatening to adolescents

Hip Patrol Giving them the opportunity to teach or

lead activity

External Brain Things outside of us to help us stay on

course Sticky notes

Timers, alarms

Visual cues or pictures

smart phone

Friend or mentor to cue Jiminy Cricket let your conscience be your guide

Behavioral Analysis What is the motivation behind the

behavior? Goals? Rewards? What are the limitations?

Emotional, behavioral and intellectual ability?

What are their strengths? What supports will help them be

successful? What do they need? What Strategy will motivate new

behavior

Escalating behavior Do I take 1 step in? or 3 steps back?

Give them space Respect their feelings (even if you dont agree

with their behavior) Remove the audience Time outs are not just for kids!

Breath, relax and choose not to contribute to the behavior

Who can I seek support from? Who will tag team with me Can I call in reinforcements from family or friend

Crisis Planning When there is a possibility of escalating

into a crisis, What is Plan A? Who are may support people?

Who will watch the other children when Im dealing with the crisis.

Who can I tag team with?

What is Plan B?

What are the Phone Number of emergency (ie: 911 or On Call)

Moral Development / Thinking Errors

Emotional immaturity or Very sensitive

Use of Faith Based or Virtues/Values Based activities

Goal is to take responsibility for Actions and Choices without causing HARM

All or nothing thinking: You don't see middle ground.

Overgeneralization: You extrapolate your future based on a single event.

Minimizing and maximizing: You inflate your errors and discount your accomplishments.

Fortune-telling: You predict that things will turn out badly, no matter what you say or do.

Emotional reasoning: You get lost in your emotions.

Shoulds and oughts: You focus on other people's expectations of you, instead of on your own needs.

Moral Development / Thinking Errors

MENTAL FILTER Focusing exclusively on certain, usually negative or upsetting, aspects

DISQUALIFYING THE POSITIVE Continually shooting down positive experiences for irrational reasons

JUMPING TO CONCLUSIONS Assuming something negative where there is actually no evidence to support it.

LABELLING and MISLABELING Related to overgeneralization, explaining by naming. Rather than describing the specific behavior, you assign a label to someone or yourself that puts them in absolute and unalterable negative terms.

PERSONALIZATION & BLAME Personalization occurs when you hold yourself personally responsible for an event that isnt entirely under your control.

Additional Resources The Other 23 Hours: Child-Care Work with

Emotionally Disturbed Children in a Therapeutic Milieu by Larry Brendtro (Author), James Whittaker (Author), Albert Trieschman (Author), David Wineman (Foreword)

The Gus Chronicles: Reflections from An Abused Kid by Charles D. Appelstein

Creative Interventions for Troubled Children & Youth by Liana Lowenstein

Parenting with Love and Logic, Cline and Jim Fey National Institute of Mental Health

http://www.nimh.nih.gov National Alliance for the Mentally Ill

http://www.nami.org

http://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_1?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Larry%20Brendtrohttp://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_2?%5Fencoding=UTF8&search-type=ss&index=books&field-author=James%20Whittakerhttp://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_2?%5Fencoding=UTF8&search-type=ss&index=books&field-author=James%20Whittakerhttp://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_3?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Albert%20Trieschmanhttp://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_4?%5Fencoding=UTF8&search-type=ss&index=books&field-author=David%20Winemanhttp://www.amazon.com/Charles-D.-Appelstein/e/B001KCEX64/ref=ntt_athr_dp_pel_1http://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_1?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Liana%20Lowensteinhttp://www.nimh.nih.gov/http://www.nimh.nih.gov/http://www.nami.org/http://www.nami.org/http://www.nami.org/

THANK YOU

Questions or Comments ??