Optimistic Parenting:Optimistic Parenting:Hope and Help for the Hope and Help for the

Challenging ChildChallenging Child

V. Mark Durand, Ph.D.V. Mark Durand, Ph.D.

University of South Florida St. PetersburgUniversity of South Florida St. Petersburg

Positive Behavioral SupportPositive Behavioral Support

One-half to two-thirds of the One-half to two-thirds of the outcomes are successful outcomes are successful when when carried out completely, under carried out completely, under controlled conditions.controlled conditions.

Carr, E.G., Horner, R.H., Turnbull, A.P., Marquis, J.G., Carr, E.G., Horner, R.H., Turnbull, A.P., Marquis, J.G., McLaughlin, D.M., McAtee, M.L., Smith, C.E., Ryan, K.A., Ruef, McLaughlin, D.M., McAtee, M.L., Smith, C.E., Ryan, K.A., Ruef, M.B., & Doolabh, A. (1999). M.B., & Doolabh, A. (1999). Positive behavior support for Positive behavior support for people with developmental disabilities: A research synthesispeople with developmental disabilities: A research synthesis. . Washington, D.C.: American Association on Mental Washington, D.C.: American Association on Mental Retardation.Retardation.

Evidence for Clinical UtilityEvidence for Clinical Utility

Does Positive Behavioral Support Does Positive Behavioral Support “work” for everyone?“work” for everyone?

Example – sleep problemsExample – sleep problems

Research DilemmaResearch Dilemma

Are we helping all families or just Are we helping all families or just the ones who fully participate in the ones who fully participate in our interventions?our interventions?

Prevention ProjectPrevention Project

Prospective longitudinal studyProspective longitudinal study N=128N=128 Age 3 to age 6Age 3 to age 6

Durand, V.M. (2001). Future directions for children and Durand, V.M. (2001). Future directions for children and adolescents with mental retardation. adolescents with mental retardation. Behavior Therapy, 32Behavior Therapy, 32, , 633-650.633-650.

Developmental ProgressionDevelopmental Progression

Predicting Later ProblemsPredicting Later Problems

Not severity of disabilityNot severity of disability Not severity of behavior problem Not severity of behavior problem

Predicting Later ProblemsPredicting Later Problems

Best Predictor?Best Predictor? Parental pessimismParental pessimism

Pessimistic or Optimistic?Pessimistic or Optimistic?OptimisticOptimistic

My child needs help My child needs help learning new skillslearning new skills

My child is not ready My child is not ready yet for long yet for long shopping tripsshopping trips

I am working toward I am working toward more time to myselfmore time to myself

PessimisticPessimistic My child is disabledMy child is disabled

Shopping with my Shopping with my child is a disasterchild is a disaster

I will never have my I will never have my own lifeown life

Pessimistic or Optimistic?Pessimistic or Optimistic?

OptimisticOptimistic I’ll try it.I’ll try it.

I’m willing to try I’m willing to try it again.it again.

OK, I’m ready for OK, I’m ready for this.this.

PessimisticPessimistic That won’t work That won’t work

with my child!with my child! I tried that I tried that

already and it already and it didn’t work!didn’t work!

Oh, no. Here we Oh, no. Here we go again.go again.

Pessimistic or Optimistic?Pessimistic or Optimistic?

OptimisticOptimistic He can learn to He can learn to

behave better.behave better.

She will need to She will need to learn how to learn how to control herself.control herself.

PessimisticPessimistic He can’t do this He can’t do this

because of his because of his autism.autism.

She has enough She has enough to deal with. I’m to deal with. I’m not going to not going to push her.push her.

Current ApproachesCurrent Approaches

Providing Intervention StrategiesProviding Intervention Strategies General Family SupportGeneral Family Support

Positive Family InterventionPositive Family Intervention

Can we make pessimistic Can we make pessimistic families more optimistic?families more optimistic?

Integrating Integrating cognitive-cognitive-behavioral interventionbehavioral intervention with with positive behavioral supportpositive behavioral support

Positive Family InterventionPositive Family Intervention

Standard protocolStandard protocol 8 weeks8 weeks 1 ½ hours per individual session1 ½ hours per individual session Standardized measuresStandardized measures

Example from ProtocolExample from Protocol

HomeworkHomework (i.e., information (i.e., information gathered through watching and gathered through watching and recording; MAS) recording; MAS)

Ask them to Ask them to share a difficultyshare a difficulty and and thoughts/feelings associated with thoughts/feelings associated with the eventthe event

Ask them to Ask them to share a successshare a success and and thoughts/feelings associated with thoughts/feelings associated with the eventthe event

Share a DifficultyShare a Difficulty

Example - “She wouldn’t leave the Example - “She wouldn’t leave the TV to go to school.”TV to go to school.”

What were you thinking?What were you thinking? Pessimistic Scenario – “Here we go Pessimistic Scenario – “Here we go

again.”again.” Optimistic Scenario – “I knew this Optimistic Scenario – “I knew this

might happen and I have a plan to might happen and I have a plan to handle her if she tantrums.”handle her if she tantrums.”

Share a SuccessShare a Success

Example - “My son sat through a Example - “My son sat through a whole meal without yelling.”whole meal without yelling.”

What were you thinking?What were you thinking? Pessimistic Scenario – “He must Pessimistic Scenario – “He must

be in a good phase.”be in a good phase.” Optimistic Scenario – “My efforts Optimistic Scenario – “My efforts

and patience are beginning to and patience are beginning to pay off.”pay off.”

Positive Behavior SupportPositive Behavior Support

Session 1: Establishing GoalsSession 1: Establishing Goals Session 2: Gathering InformationSession 2: Gathering Information Session 3: Analysis and Plan Design Session 3: Analysis and Plan Design Session 4: Preventing ProblemsSession 4: Preventing Problems Session 5: Managing ConsequencesSession 5: Managing Consequences Session 6: Replacing BehaviorSession 6: Replacing Behavior Session 7: Putting Plan in PlaceSession 7: Putting Plan in Place Session 8: Monitoring ResultsSession 8: Monitoring Results

Situations & BeliefsSituations & Beliefs Identify situations that provide triggers Identify situations that provide triggers

to negative thinking (e.g., What was to negative thinking (e.g., What was exactly happening? Where were you? exactly happening? Where were you? What did your child and others do?)What did your child and others do?)

Identify beliefs associated with the Identify beliefs associated with the event (e.g., What were you feeling and event (e.g., What were you feeling and thinking while this was going on? What thinking while this was going on? What did you say to yourself?)did you say to yourself?)

Identifying Situations & BeliefsIdentifying Situations & Beliefs

ConsequencesConsequences

Identify the consequences or results Identify the consequences or results of the negative (and positive) of the negative (and positive) thinking (e.g., When you were thinking (e.g., When you were thinking _____, how did that affect thinking _____, how did that affect what you did? What were the results what you did? What were the results of your actions – both immediate and of your actions – both immediate and long-term?)long-term?)

Recognizing ConsequencesRecognizing Consequences

DisputationDisputation

A Strategy for arguing or A Strategy for arguing or

challenging beliefs.challenging beliefs. Step 1: Identify the negative beliefStep 1: Identify the negative belief

(e.g., What exactly do you say to (e.g., What exactly do you say to yourself that is pessimistic?).yourself that is pessimistic?).

Step 2: List evidence that supports Step 2: List evidence that supports the beliefthe belief. (e.g., What makes you . (e.g., What makes you believe that to be true?)believe that to be true?)

DisputationDisputation

Step 3: Find alternative explanations Step 3: Find alternative explanations for the problemfor the problem (e.g., Are there other (e.g., Are there other possible reasons/motives?).possible reasons/motives?).

Step 4: Evaluate the usefulness of Step 4: Evaluate the usefulness of maintaining the beliefmaintaining the belief. (e.g., In what . (e.g., In what ways does that belief benefit you/ ways does that belief benefit you/ others or improve the situation?)others or improve the situation?)

Disputing Negative BeliefsDisputing Negative Beliefs

Disputing Negative BeliefsDisputing Negative Beliefs

SubstitutionSubstitution

Replace the pessimistic ideas with Replace the pessimistic ideas with positive thoughts or affirmations positive thoughts or affirmations (e.g.., “This is a difficult situation and (e.g.., “This is a difficult situation and I am handling it well. I am a I am handling it well. I am a committed, loving parent. If I can committed, loving parent. If I can follow through with my plan, things follow through with my plan, things will get better.”)will get better.”)

Substituting Positive ThoughtsSubstituting Positive Thoughts

Positive Family InterventionPositive Family Intervention

Pilot data suggest differences in attrition.Pilot data suggest differences in attrition. Without cognitive behavioral Without cognitive behavioral

intervention – only 55% complete intervention – only 55% complete training.training.

With cognitive behavioral intervention – With cognitive behavioral intervention – 72.2% complete training.72.2% complete training.

All children improve if families complete All children improve if families complete training.training.

% Families Completing Intervention

72.2%

55.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PFI PBS

Standardized Behavior Change DataN=16

PBS PFI

SIB

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ex -40

-30

-20

-10

0

Serious

ModeratelySerious

MarginallySerious

Normal

Pre

Post

Pre

Post

Preliminary Results (Problem Preliminary Results (Problem Behavior)Behavior)

Average % of Problem Behavior

0%

10%

20%

30%

40%50%

60%

70%

80%

90%

100%

PBS PFI

BEH Pre

BEH Post

How Effective Are We?How Effective Are We?

Are our interventions only successful Are our interventions only successful with highly motivated with highly motivated families/professionals?families/professionals?

We need to begin to design our We need to begin to design our strategies to reach those families strategies to reach those families who need our help the most.who need our help the most.

Optimistic ParentingOptimistic Parenting

Durand, V.M. & Hieneman, M. Durand, V.M. & Hieneman, M. (2008). (2008). Helping parents with Helping parents with challenging children: Positive challenging children: Positive family intervention, Facilitator’s family intervention, Facilitator’s guideguide. New York: Oxford University . New York: Oxford University Press. Press.

Durand, V.M. & Hieneman, M. Durand, V.M. & Hieneman, M. (2008). (2008). Helping parents with Helping parents with challenging children: Positive challenging children: Positive family intervention, Workbookfamily intervention, Workbook. . New York: Oxford University Press.New York: Oxford University Press.