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[By Dr. Larry Silver. Reprinted with Dr. Silver’s permission from: Dr. Larry Silver’s Advice to Parents on ADHD. Click here to order entire book from Amazon.com.]Home Behavioral Management Concepts
Any behavioral plan must be based on two important concepts of learning theory. First, you are more likely to succeed in changing behavior by rewarding what is desired than by punishing what is undesired. Second, for a plan to work, your responses to acceptable and to unacceptable behaviors must be consistent and must occur each time. Inconsistent responses or inconsistent response patterns may reinforce the negative behavior. As parents you must learn that there is no right or wrong way to raise children. You must collaborate in developing a plan that you are comfortable with and agree on. Once decided on, the plan must be practiced in a consistent and persistent way.
Initially, you must be omnipotent. No more reasoning, bargaining, bribing, threatening, or trying to provoke guilt. Parents make the rules. Parents enforce the rules. Parents' decisions are final. You must learn that if you "step into the arena" and agree to debate or argue with your child, you will lose. If a parent says it is time to go to sleep and a child says, "But can I stay up 15 minutes more," the answer must be, "I did not ask you what time you want to go to sleep. I said it is bedtime." Argue about the 15 minutes and it becomes 20 minutes, and then 30 minutes. Soon, the parents’ frustration and anger will result in fighting. Later in the plan there can be flexibility, but not initially.
Initially, parents are usually overwhelmed. They have exhausted their choices of actions. They may feel helpless and like failures as parents. If there are two parents, there may be stress between them caused by disagreement on how to handle the behaviors or by blaming the other for the problems. Try to follow this plan. If you are too worn out or overwhelmed, seek professional help.
The first step is to collect data on your observations of the behaviors. Each parent should collect data separately. The differences between the two will be very useful. Don't be embarrassed by what you do. Record what really happens without worrying what someone will think. We already know that things are not working well. Just record your experiences so you can begin to change things.
You will need a structure to collect these data. The easiest model to use is an "ABC" chart. You record three things: the behavior (B), the antecedent to the behavior (A), and the consequences of the behavior (C). The chart will look something like
Date/Time Antecedent Behavior Consequence
Monday
4:30 P.M. Don't know; John hit sister; Told both
not there she hit him back to go to room
6:00 P.M. Talking to John teased her; Yelled at John
Mary she cried
Each parent may have different lists. In part, this reflects when each is home and with the child or adolescent. One may be the firm disciplinarian and the other the easygoing, "give them another chance" type. Each parent will see and list different things. Each has different experiences and expectations. Father may come home at 6:00 or 6:30 P.M. looking forward to being with the children and playing with them. Mother may be frustrated and short of temper, having had it by then, and wanting the kids to be quiet and to get their homework and other chores done so that they can go to bed.
Neither parent is right or wrong. The important goal is that both parents agree on their expectations and be consistent in asking that they be met. Consistency is the key. Inconsistency reinforces the behavior; consistency stops the behavior.
Certain patterns should become clear for each column and for overall behaviors. Certain antecedents lead to certain behaviors. The consequences that follow the same behaviors are inconsistent: one parent gets mad and yells at everything, or other family members seem to get punished as much its the child who caused the problems. A common theme is that when children do not get what they want or are asked to do something they do not want to do, they misbehave.
Once the data are collected, they are analyzed and patterns are looked for. The first task is to define clearly the unacceptable behaviors that need to be changed. Often parents start with a long list of behaviors. Once the data are studied, the behaviors can be clustered into two or three major areas. By doing this, you will not be as overwhelmed. You are not dealing with an impossible list of problems, but can focus on a few major areas.
Frequently, the unacceptable behaviors fall into three basic groups:
· Physical abuse (hitting sibling, hitting parent, hurting a pet, damaging property, etc.)
· Verbal abuse (yelling it sibling, yelling at parent, teasing, cursing or other unacceptable words, threatening someone, etc.)
· Noncompliance (not listening to what is said, not doing a requested chore, defying a parent's request, etc.)
Once the behaviors are identified, it is useful to study the relationship between the antecedents and the behaviors. Look for themes: the behaviors are more likely to occur if the child is tired, hungry, or about to be sick; the behaviors are more likely to occur during the first hour after coming home from school; the behaviors are more likely to occur when he or she is off of medication; or the behaviors appear to relate to the child's learning disabilities or sensory integrative disorder. These themes will be useful in helping the child or adolescent understand why he or she has difficulty and in helping you know when to be most alert to the possibility of problems.
Once you have a clearer idea of the behaviors that need to be changed, a plan can be developed. Define the behaviors as clearly as possible and work out a consequence that can be imposed consistently. Work out the plan in great detail, then introduce it to the family. The plan should be for all siblings. Even if the other children or adolescents do not cause problems, it will not affect them negatively to be part of the program. It might benefit them by rewarding them for their good behavior. It might have been that the "bad" child took so much attention that the "good" child was ignored or not thanked for being good. This plan will help you remember to reward good behaviors. If a sibling is provoking or encouraging the negative behavior, it will become clear if he or she also is on the plan.
As parents, you need to understand that there are several basic principles to reversing the pattern of punishing bad behavior and usually ignoring or only occasionally rewarding good or positive behavior. This plan will reward positive behaviors and withhold rewards for negative behaviors. Further, you will have preplanned responses that can be used every time. Your child or adolescent cannot catch you off guard, making you feel helpless and therefore angry. Each time a behavior occurs, there will be the same response from either parent.
Let me illustrate this point about consistency. Suppose a boy hits his sister five times in a week. On one occasion his mother was in such a rush that she yelled at him but did nothing else about it. On another occasion, she was tired and did not want to deal with him so she pretended not to see what happened. The other three times she did punish him. Now, if this child gives up hitting his sister because mother tells him to, he has to give up hitting her 100% of the time. If he continues to hit her, he has a 40% chance of getting away with it. He would be a fool to give up the behavior. If a parent is consistent, the behavior will stop. If the parent is anything less than consistent, the behavior might persist or get worse.
The basic plan can be divided into 3 steps:
Step 1. Divide the day into parts. For example, on a typical school day there will be three parts: 1) from the time the child or adolescent gets up until he or she leaves for school, 2) from the time he or she returns from school until the end of the evening meal, and 3) from the end of this meal until bedtime. Weekend or summer days can be divided into four parts by using meals as the dividers: 1) from the time the child or adolescent wakes up until the end of breakfast, 2) from the end of breakfast to the end of lunch, 3) from the end of lunch to the end of dinner, and 4) from the end of dinner until bedtime.
Step 2. Make a list of the child's or adolescent's unacceptable behaviors. This list should be brief and limited to the major problems. If the basic three noted earlier are used, a list might read:
1. No physical abuse (define in detail: no hitting sister, pulling cat's tail, kicking mother, breaking toys, etc.).
2. No verbal abuse (define in detail: no cursing, calling someone "stupid," teasing, etc.).
3. No noncompliance (define in detail: no refusing to do what you are told to do). For younger children, the term not listening might be used. Make it clear that you will request they stop the behavior several times. Then you will say, "If I have to ask you again, I will call it noncompliance." Any behavior continuing after this warning is called noncompliance. In this way the child or adolescent can never say, "But, you never told me I had to do this."
Step 3. The purpose of the plan is to reinforce positive behaviors. Negative behaviors are not mentioned as such. The child or adolescent can earn one point for each behavior he or she does not do during a unit of time. Later we will talk about "time out." With time out, too, the focus is on the positive and not the negative; thus, the wording is important. The parent says, "What you did is so unacceptable in this family that you must go to your room and think about the need to change what you do." The parent does not say, "Go to you room," with the connotation that doing so is punishment.
The child can earn points by not doing the unacceptable behaviors. He or she can earn one point for each negative behavior not done. For example, suppose a boy gets up in the morning, does all of his chores, and gets to breakfast on time. He does not hit anyone, but does call his sister "stupid." As he leaves for school his parent would say, "I am pleased that you earned two points this morning. You followed all rules and you did not hit anyone. I wish I could have given you the third point but you did call your sister a name and that is verbal abuse." This parent might then say to the sister, "I am happy that you earned all three of your points. Thank you for not calling your brother a name when he called you one," Remember, behavior is changed by rewarding what you want, not by punishing what you do not want.
A book or chart should be available and the points recorded. If the child is too young to understand points, a calendar or chart can be used and stars pasted on, or a jar can be filled with marbles to represent each point earned.
Each part of the day is handled in the same way. In the model with three units of time during school days and four units of time on the weekend, the maximum number of points that can be earned on a school day is nine and the maximum each weekend day is 12. The total for a week will be 69. These points can be used in three ways: a daily reward, a weekly reward, and a special reward. The points are counted daily, then continue to be counted weekly or accumulatively. The child or adolescent should participate in developing the rewards. Parents make the final decisions but keep in mind the request. If the child or adolescent says, "This is stupid. I won't do it," the parent replies, "The plan starts tomorrow. Either you suggest what you might like to work toward or I will make the decisions for you."
Each reward must be individualized for each member of the family, and each must be compatible with the family's style and philosophy. Rewards that involve interpersonal experiences are preferred to material rewards. The daily reward could be an additional half hour of TV watched with a parent, being able to stay up 30 minutes later, reading a book or playing a game with a parent, or 30 minutes of special time with one parent.
The weekly reward might be going to a movie, going out to eat with the family, or having a friend sleep over. Points are counted from Saturday morning to Friday night; thus you know if the child or adolescent has enough points before the weekend starts. In this way, a baby-sitter can be lined up before any family activity. In the past, your son or daughter might have been impossible all week, but he or she would still go out with the family on the weekend. Now, this child stays home and you and the other children go out.
A special reward might be something important that must be worked toward. A new toy or a special trip might be selected. It should take a month or more to accumulate enough points for this reward.
For the daily and weekly rewards, set an initial goal of 80% of the maximum number of points that can be earned. After a month of success (which might take several months to reach), the goal can be raised to 90%. It is best not to set the goal at 100%. No one can be perfect all of the time. Any negative behavior early in the day or week could destroy all hope of a reward and the child or adolescent might give up.
For the plan described above, the child or adolescent would need seven points by each weekday evening to get the daily reward (80% of nine points). He or she would need 55 points by Friday night for the weekend reward (80% of 69 points).
Time out. Before starting the plan, define which behaviors will be considered so unacceptable to the family that they will result in the child not earning a point plus being removed from the family for a limited time so that he or she can think about the need to change this behavior. I always use this consequence for physical abuse. Other behaviors might be included. For the young child, 15 minutes is appropriate; for the older child or adolescent, 30 minutes is best.
This time is to be spent quietly thinking about what happened and why he or she needs to change. The child’s or adolescent’s room can be used if it is not filled with TV, stereo, games, and other pleasurable distractions. If his or her room cannot be used, a guest room or laundry room might be best. The door is to be closed and the child is to be quiet. Each time he or she opens the door or yells or throws something, the timer is reset to zero and the 15 or 30 minutes starts again. The child or adolescent soon learns that unless he or she is quiet and cooperative, a 15-minute time out can last for hours.
Time out can be used away from home as well. If you are at a restaurant and it is safe to do so, take the child or adolescent to the car. If concerned, a parent might want to stand near the car and watch. If in a shopping center, try to find a safe place for the child to sit. Tell him or her that you will return in 15 (or 30 minutes). If concerned, the parent can stand away from the child or adolescent and watch during the time.
For the plan to work, it must be exact as to expectations, behaviors that are rewarded, and consequences. Once initiated, the child or adolescent will find loopholes. The parents must be smarter than their son or daughter and close each loophole quickly. A common example is time out. A boy might be home with his mother. He is told to go to his room and refuses. He might defy his mother, run around the room, and dare her to chase him or run out of the house. If this happens, it is not good for his mother to chase him or drag him to his room.
The plan must be developed and explained in advance. The child or adolescent knows that this plan will be implemented the minute he or she refuses to go to the assigned room for time out. This plan can have two parts:
1. The parent will announce a time that the child is expected to be in the room (such as three minutes from the time that the parent informs the child to go to the room). After that time, he or she will need to spend two additional minutes in the room for every minute it takes to get to the room. This means that if the child or adolescent does not go to the room until father comes home two hours later, he or she will need to spend four additional hours in the room. This time cannot be counted after bedtime; thus it is spent in the room the next day, perhaps after school. Sometimes, the child or adolescent spends all of a weekend day making up the time needed because he or she tested the parent earlier. Soon, he or she learns to listen.
2. The second part of the plan is for the child or adolescent to know that during the time he or she refuses to go to the assigned room a second thing will happen. The parent will say, "I will always love you dearly. However, when you abuse me as a parent, I do not choose to parent you." This means that the parent will not talk to the child or adolescent or interact in any way. When mealtime comes, a place is set for everyone in the family but this person. If the child wants to eat, he or she must make his or her own meal and sit somewhere else. If the parent was to carpool to a meeting or sports practice or game, it will not be done. The child will have to face the consequences of not attending. If the behavior persists until bedtime, the parent will not respond to the child or adolescent nor put him or her to bed. Once the son or daughter goes to the room to spend the quiet time, parenting starts again.
Some parents find that the, "I love you but if you abuse me as a parent I chose not to parent you" approach too painful to consider. I remind these parents that allowing the unacceptable behaviors is more painful and potentially harmful to the child than the model suggested.
There are other loopholes children will find. For physical abuse, the child or adolescent does not earn a point and goes to a quiet room to think; thus the events are stopped. What about verbal abuse? For the first event, he or she will not earn a point. What does the parent do for the remainder of the time in this time period if this child or adolescent is verbally abusive again. I suggest that for the second occurrence, he or she must go to the quiet room for 15 to 30 minutes to think about the fact that such behavior is not acceptable in the family and he or she must change. What to do for noncompliance once the child does not earn a point is harder to handle. What do parents do when the toys still need to be put away or a bath is still needed? Later in this chapter, several alternative plans are described.
This reward-point system plus time out system will work. The key is to be consistent. You must be encouraged to develop the plan and to implement it. Your child will test the system, but, if you stick to it, the behaviors will improve. To some parents' surprise, once the external controls work and the child or adolescent functions better, he or she is happier, not more frustrated. However, once the behaviors improve, the plan must be continued. If stopped too soon, the behaviors will return.
The goal of this second phase of intervention is to help the child or adolescent internalize the controls. The first phase provided external controls. Now, the effort shifts to helping the child or adolescent build these controls into his or her behavioral patterns. The first phase continues; however, now a more interactive rather than omnipotent approach is used by parents. Once the unacceptable behaviors are under better control, reflective talking can be introduced. Initially, these discussions are held after the fact. The best time might be at night while sitting on the child's bed, talking with him or her. For example, perhaps a boy has been in a fight or a yelling match. He has spent time in the quiet room. Later in the day one of his parents sits with him in private and discusses what happened: "Fred, I am sorry you had so much trouble this afternoon. I love you and I do not like being angry with your behavior or having to ask you to remove yourself from the family. What do you think we can do to stop such things from happening?"
Let him talk. At first he may only make angry accusations of unfairness or of others causing the trouble. The parent might respond, "I don't know if your brother was teasing you before you hit him or not. I wasn't there. But, let's suppose that he did. What else could you have done? By hitting him you got into trouble and he did not. There must be a better way. Maybe you could have told me what you thought he was doing." Such conversations may have to occur many times before the child or adolescent begins to think about his or her behavior and to consider alternative solutions to problems. It is important that the parents not only point out the behavior but offer alternative solutions.
Gradually, you will be able to point out themes: "You know, Mary, I notice that you're most likely to get into trouble right after you come home from school. Do you suppose that you hold in all of your problems all day so that you won't get in trouble and then let them out the first time you are upset at home? If so, maybe we can do something to
help. Maybe, as soon as you come home you and I can sit in the kitchen, have a snack, and talk. Maybe if you tell me about your problems you’ll feel better and won’t have to let out your feelings in a way that gets you in trouble."
Soon you will be able to do the reflective thinking before the fact: "John, you and I both have learned that if you keep playing with your brother once the teasing starts, there will be a fight. Do you remember what we talked about? What else could you do?" or "Alice, you are forcing me to be a policeperson and to yell at you or punish you. I don't like doing that. I'd rather enjoy being with you than yelling at you or punishing you. Why do you think you force me to be a policeperson? Remember what we talked about the other night? Do you want to try some of the ideas we talked about?" Gradually, the child or adolescent will begin to try the new behaviors.
Your child can learn from hearing you openly discuss feelings and thoughts. Let the child understand how you feel--angry, sad, afraid, worried. You can role model how to handle these feelings. "I am so angry with what you did that I cannot talk to you. I am going into the other room to calm down. Later, we can talk." Not only will you feel more in control, but you will have demonstrated a way to handle angry feelings.
It is important for parents to begin to explain or role model acceptable ways for their son or daughter to handle feelings. Many families are quick to tell their children how they may not show anger or sadness or disappointment, but they do not teach them acceptable ways of showing these feelings. Anger is a normal feeling and children and adolescents must learn how to handle these feelings in an acceptable way in the family. Can they yell as long as they do not curse? Can they stamp their feet or slam the door as long as they do not break anything? Watch out for confusing messages. One parent in the family yells or throws things when angry. The other parent pouts or goes to a room alone when angry. But, when the child gets angry and starts to yell, he or she is told, "You may not do that." If he or she walks off pouting, the parent says, "You come back here. I am talking to you." It is acceptable for families to have different rules for he adults and the children. However, parents must then teach their children or adolescents what are acceptable ways for them to express feelings in the family.
In addition to the basic plan, other concepts can be added to address specific problems. These plans may work best with issues of noncompliance. What do you do after the child or adolescent has not earned a point, the requested behavior is still required? The basic concepts are the same: the parents are in control, and the rules and consequences are consistent and persistent.
To avoid any confusion about chores or other duties expected by the family, you must make a detailed list of expectations. Individual chores might include putting dirty clothes in the hamper, making one’s bed, and picking things up off of the floor. Family chores might include setting the table, loading or emptying the dishwasher, and vacuuming. Place the list in an obvious place. Clarify if these chores are to be rewarded by money or they are expected as part of family responsibility. If the family chores are to be shared on different days, make a clear list of what each child is to do each day: "Alice clears the table on even number days, and Charlie clears the table on odd number days."
If the chores are expected and are not done, what will be the consistent consequence? What can you do if the child "forgets" or does not do an expected chore? Should you continue to nag and then shout? Several models are suggested below. Each gives the parents the controls. If a task is not done, there is a clear consequence. The choice is for the child or adolescent. If he or she does the chore there is the expected reward. If he or she does not do the chore there is the expected consequence.
Tell your child that all "parent services" are not supplied free of charge. If chores are not done by a set time, you will do them, but not for free. Make a list of the chores. Set a reasonable fee for each chore. Be realistic for the age and financial resources of the child or adolescent. For example, 25 cents for making the bed, 50 cents for picking up things from the bedroom floor, and 50 cents for putting the bike in the garage. Then, stop arguing, reminding, or nagging the child. If the chore is done by the preset time, fine. If it is not done, do the chore without comment. At the end of etch day or week, submit a bill for the service. If the child gets an allowance, you might present the bill at the end of the week; for example:
Allowance $5.00
Maid service 3.75
Balance due 1.25
Your child might get upset and ask how lunch drinks or snacks are to be bought. You reply, "Think about that next week when you decide not to do a chore." If your child does not get an allowance, use birthday or savings money. If there is no such money or if your child owes you more than the allowance, give him or her specific work details to earn the money owed: "I will pay you $2.00 per hour to clean the garage. You owe me $3.00, so I expect you to work one-and-a-half hours this weekend."
No more getting angry. No more reminding. No more fights. The child has only two options now: do the chores and get the rewards or not do the chores and pay someone else to do them.
Set up a "box" in a secure place. A closet or room that can be locked or the trunk of a car will do. Make it clear that, after a predetermined time each day, any items left where they should not be (such as toys, bike, books, coat, shoes, etc.) will be placed in the box and that the box will not be emptied until Sunday morning. This means that if a favorite game or bike or piece of sports equipment is left out or not put away, it is lost until Sunday. If the objects are clothes or shoes and cannot be done without, the child or adolescent must pay a fee to retrieve them early.
The Sunday box worked so well in one family that a wife placed her husband on the plan. His clothes, work papers, or other things that had been left lying around disappeared into the Sunday box.
The initial response to property damage by a child will be based on the plan in place. If this behavior is called physical abuse, he or she will not earn a point and must spend time in a quiet room thinking. If a larger consequence is needed, make the child pay to repair or to replace the item. The money could come out of his or her allowance; if the amount is large, the money might come out in installments until the debt is paid off, or the money could come from the child's savings account, if one exists. If this model for payment is not possible because your child does not have a savings account, give him or her a way to earn the money. Assign tasks that are not regular chores (such as cutting the grass, washing clothes, washing the kitchen floor, and cleaning the garage) and pay by the hour. The first time a child gets angry and kicks over and breaks a $50.00 lamp and then learns that he or she must work for 25 hours at $2.00 an hour to pay for the damage may be the first time that he or she starts to think before acting. And, this is the goal, getting the child or adolescent to stop before acting and to think about the consequences of the behavior.
Many parents reinforce dawdling by reminding, nagging, yelling, screaming, and then, in anger, doing the task with or for their child. All this does is teach the child that he or she can get away with dawdling, can force the parents to help, or can make the parents upset. Instead, you must define the limits for a behavior and establish clear consequences for overstepping those limits.
For example, a girl may not get dressed on time. She is not openly oppositional, but she is so busy playing or looking out the window that tasks just never get done. As the time for the school bus gets closer she has not yet dressed or eaten because she is dawdling and playing. As a parent, you’ll probably go into the bedroom, yell at her, and quickly dress her so she'll have time to eat and catch the bus. She has succeeded in getting you upset and angry and in getting you to help her. It is important in this situation to consider whether the difficulty in getting dressed is related to a learning disability (such as a sequence, organization, or motor disability), a sensory integrative disorder, or ADHD behaviors present because the child is not on medication during these hours.
For this type of behavior, you might first establish the rules. If, for example, your child is expected to be ready to leave for the bus by 7:40, tell him or her that "the kitchen is open until 7:30. You must be dressed to enter. If you come in before 7:15, I will make you a hot breakfast. If you come in after 7:15, you may have cold cereal. After 7:30, no food will be served; you will have to go to school hungry."
But what do you do if it is 7:40 and your child is still not dressed? For older children and adolescents, you can tell them that if they miss the bus or car pool, you will not take them to school. Thus, unless they can walk or take public transportation, they will not be able to go to school. Perhaps they will take a taxi, but they will have to pay for it. Further, tell them that you will not write a note if they are late or absent, thus the school might issue a detention: "Sorry, the problem is yours. Maybe tomorrow you will get dressed." If they remain home, they must stay in their room during normal school hours. No TV. No interactions with parents. Obviously, if both parents work an alternative plan is needed.
If the child is young and the school is cooperative, another plan can be developed with the help of the bus driver, the classroom teacher, and the principal. Tell the child the plan in advance. When it is time to leave for the bus, quietly take all of the clothes that have not yet been put on and place them in a bag. Wrap the child in a robe or coat and walk him or her to the bus, pajamas and all. The bus driver, having been briefed, smiles and says hello. The child gets on the bus with the bag of clothes. The parent then calls the principal to have the teacher alerted. If the child dresses on the bus, fine. If he or she arrives at school in pajamas, the teacher quietly says, "Would you like to go to the bathroom and get dressed?" The child will not starve without breakfast on this day, but he or she will have learned that dawdling no longer works. Only he or she is impacted on by the behavior.
This approach might work in other situations. At bedtime, whether in pajamas or still in street clothes, put the child in bed and turn out the lights. When the family is ready to leave for a movie, a visit, or a shopping trip and the child is not ready by the requested time, you should leave with the rest of the family. If the child cannot be left alone, have a sitter on call for the early phase of this approach so that you can follow through with the plan. Once the sitter is called, it is too late to change plans. Even if the child then quickly dresses, he or she still stays home. After a time or two, when he or she loses rather than the parents or the rest of the family, this child will get the message: "Finish your tasks on time or accept the consequences. You lose, not the rest of us.
When a consistent behavioral plan is used in a family, unacceptable behaviors begin to change to more acceptable behaviors. Both parents regain control and confidence in their ability to parent. Children and adolescents learn that they can be controlled and that they will not be overwhelmed by not being in control. They are usually happier. Now, all of the positive experiences with the family reinforce the behaviors as well.
If the plan does not work or does not work as well as desired because of learning disabilities, a sensory integrative disorder, or other associated disorders or because the ADHD behaviors are not being managed by medication during all critical hours, these clinical issues must be addressed. The behavioral program should clarify these problems and help focus the needs.
If the plan does not work either because one or both parents do not follow the plan or defeat the plan or because the child or adolescent has such emotional problems that he or she cannot give up being in control or the need to be punished, more intensive individual, couples, or family therapy might be needed.
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