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Disciplining Your Special Needs Child: Patience and a Plan (11/23/2010)

By Dr. Sabine Falls, Ph.D.

You’re in the store, and your child sees a toy he wants. You refuse to buy it for him, and he has a meltdown – crying, screaming and kicking. What do you do? Grab him under one arm, push the cart with the other and proceed to the checkout with a wailing, wiggling child who gets louder every second? Forego shopping? Cajole him into stopping with the promise of a treat?

Before you can determine a successful approach for this situation, it helps to think about behavior. What is behavior, and what is behavior modification? How do you discipline your child with the goal of actually changing his or her behavior? Does behavior modification always work?

BEHAVIOR

Parents manage their children’s behaviors every day, whether they realize it or not. “Behaviors” are not inherently good or bad. They can be completely innocuous: Your alarm sounds at 6 a.m. You hit “snooze.” You sleep an extra 10 minutes. That was just one example of the behavior structure: antecedent (the alarm sounds), behavior (you hit snooze) and consequence (you sleep an extra 10 minutes).

All people exhibit behaviors, and children with special needs are no different in that respect. At ACCESS, we offer behavior management therapy for children 2 and older. This therapy is ideal for children presenting difficult behaviors such as tantrums, noncompliance and resistance (for younger children, this could be related to toilet training, bedtimes and feeding). Children diagnosed with autism spectrum disorders, oppositional defiant disorder, ADHD, developmental delays and children who have experienced some sort of trauma (foster children, abuse victims, and children dealing with parent divorce, severe illness or loss) may also benefit from these services. The following concepts, however, may apply to any child who is presenting negative behaviors.

Behavior is influenced by a child’s traits and temperament, his or her parents’ traits and temperaments, family stress and parenting skills. Out of these four areas, parents have the most control over their parenting skills, so let’s focus on those.

DISCIPLINING AND OTHER PARENTING SKILLS

For you to determine that your child is misbehaving, he or she must have broken what is either a known or unknown rule. Does your child have clear and specific rules for behavior at home, at school and in other public places? Your child should know the basic rules you have established (i.e. Keep your hands to yourself. Don’t interrupt.). Be consistent when enforcing these rules, and only give a direction or command when you are able to enforce it.

Reinforcement and Punishment

Reinforcement is the most effective method of behavior modification; it’s much more effective than punishment in changing behavior long-term. Punishment, however, works much faster than reinforcement; both can be used in tandem for a successful behavior management plan.

Reinforcement does not necessarily equate with a tangible reward. It can be words of praise, a pat on the back and other positive attention. It could also be in the form of a reward or a reward system: small tokens or stickers, getting to watch a favorite show or engaging in another favorite activity.

Punishment must be immediate and consistent. It could be a stern “No” and a mean look for a younger child, time out for children ages 2 and older, or the taking away of privileges. (A quick word on corporal punishment: It is not an effective behavior management tactic that grows with your child; there are much more effective means of disciplining your child that don’t involve what is essentially hitting your child.) Parents also must follow through with punishments, rather than threatening them, for them to be effective. One important thing to keep in mind when punishing, though: Use the opportunity to teach your child acceptable behaviors; don’t just focus on stopping negative ones. A rule of thumb: For every “negative,” (criticism, punishment, etc…), there should be at least five “positives” (praise, a hug, a supporting nod, etc…).

Making Requests

Parents may unintentionally encourage misbehavior by being unspecific or lax when giving their children direction. Develop more effective requests by using these tips:

•    Make eye contact with your child when making requests.
•    Pose requests as commands, not questions: “I want you to make your bed,” not, “Wouldn’t it be nice if you made your bed?”
•    Be specific and give requests one at a time. Instead of, “I want you to clean your room,” dole out tasks one at a time: “Let’s clean your room. First, put all the blocks in the big basket.”
•    Have your child repeat instructions back to you.
•    Follow up to make sure your child is complying.
•    Consider the developmental age of your child. Younger children or children who are a younger developmental age have not fully developed time concepts: “You have 10 minutes,” will not mean anything to them. Aid them by giving them clear instructions they can understand, one at a time.
•    Positively state requests. Ex: “Sit next to me,” rather than, “Quit jumping!”

Prevention Tactics

One way to avoid misbehavior is to change the antecedent causing the negative behavior. If your child can’t play a certain game with his or her sibling without starting a fight, change their shared activity. Use discretion with this tactic. Children live in the real world, where they will not always have the luxury of having their environment engineered to avoid certain situations. They must still develop coping skills to handle situations that will continue to arise throughout their lives.

Practice “trial runs” with situations that always end in misbehavior: For example, if your child always has a meltdown at the grocery store, create a plan by giving your child simple rules, scheduling a trip when it’s not necessary for you to finish it and giving your child the opportunity to practice the rules. If your child misbehaves, you can immediately leave the store and return home for the punishment (perhaps time out or removing a privilege). If the child behaves, you can implement a pre-arranged reward for good behavior. It may take several trial runs to establish a pattern of good behavior, especially for misbehavior that has gone unregulated for some time. Your child’s behavior may actually worsen as he or she tries to prove your new rules won’t work. Be patient, and be consistent.

One underused prevention tactic is to regularly praise children for good behavior. We tend to give attention to children most when they misbehaving; when your child is playing quietly or demonstrating other positive behaviors, recognize him or her with your praise or a small reward.

Finally, give your child choices but set boundaries. For example: Which spoon do you want to take your medicine? The red one or blue one? Note that not taking the medicine is not an option in this example.

MEDICATION

Behavior modification takes a long time. If a child is misbehaving in a way that is dangerous to himself or others, medication may be recommended. When that happens, medication can be combined with behavior modification so coping skills can be acquired. It’s possible that, with a behavior modification plan in place, a child may be weaned off medication as he or she learns coping skills and self-control.

THE PLAN

Disciplining your child to encourage good behavior is a constant exercise. Creating a successful plan depends heavily on parental involvement: determining what motivates your child, creating appropriate reinforcement and punishments that will shape his or her behavior, getting buy-in from your spouse and other caregivers, and consistently following the plan.

This can be quite challenging for parents. Perhaps you were a fairly obedient child, and you’re unsure what to do with the willful child you have. You may be unintentionally using an ineffective punishment or reward and encouraging misbehavior or quelling good behavior. Maybe your spouse or your child’s caregiver undermines you by not following the plan.

As your child develops and learns social boundaries, misbehavior is inevitable. If you accept this and arm yourself with a plan and plenty of patience, you will be more successful in creating the positive behaviors you want your child to display. Don’t be afraid to seek help: There is an art to effective behavior management and an entire professional field concerning behavior theory. You may need guidance and support if your child’s behavior is negatively affecting home life, academics and social life.

A Word on Time Out
Time out works well for children ages 2-8. It is highly effective for managing negative attention-seeking behaviors, but it may not be ideal for every child. For example, it may not be the best approach for autistic children, who may be happier to be removed from a social situation. At any rate, there are some ground rules for implementing time out:

TIME: Time out should be at least one minute per year of age. Only the parent should determine when a child is released from time out, not the child. Don’t use a timer for this reason. Time out shouldn’t begin while a child is having a tantrum; simply state that time out is starting when a child calms, and only release the child after a short period of quiet. If the rules aren’t followed, you may add extra time, or you might have to restrain the child by confining him or her to a certain room or place in the room, like a bed or chair.

PLACE: Time out shouldn’t be a sanctuary for the child. Don’t send a child to his or her room if the room has a TV, games to play or other positive reinforcement.

HOW: Don’t explain, berate, reason or be emotional when placing your child in time out; rather, be matter-of-fact: “You’re going to time out because you hit your brother.” If the time out was given because the child refused to comply with your request, make him or her complete the request after time out: “Please pick up your toys.”

Dr. Sabine Falls, Ph.D., clinical psychologist for ACCESS Group Inc., has more than 16 years of pediatric psychology experience. At the ACCESS Evaluation and Resource Center, Dr. Falls applies her broad experience in pediatric psychology, performing comprehensive assessments and diagnosing disabilities such as Attention Deficit Disorder, specific learning disorders (dyslexia, mathematic disorder, disorder of written expression) and autism spectrum disorders. She is also experienced in diagnosing and treating children who are suspected of having or have been diagnosed with anxiety and depression and who have problems related to difficult life events. In addition to evaluations, Dr. Falls provides cognitive-behavioral therapy, client-centered therapy, parent trainings and family therapy.

Click here for more information on the ACCESS Evaluation and Resource Center.

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