Flashpoint*

A joke can end silliness and irritation in laughter rather than tears. It’s also easier to ignore silliness if you’ve got something else to do - try the radio or phoning a friend. If things get out of hand, vent your feelings by clapping instead of smacking, or saying, ‘if you don’t stop, I’ll scream’ - and then doing so!

HOW TO TARGET AND ELIMINATE NEGATIVE BEHAVIOURS

By Dr. Laura Lustig

Few of us who become parents are able to foresee how profoundly our lives change when we raise children, and more particularly, when those children present problems that make it harder to communicate with them. The issues faced are also complicated by the dilemmas that today's families must deal with in general. Even though the 20th century saw an explosion of knowledge about child development, greater freedom from rigid gender constraints about mom and dad roles, and more technical support for sustaining quality of life in children with serious disability, yet a larger-than-ever number of two-parent families work just to keep afloat, and family and community supports are shrinking. The overall cost to the family is that we are finding many more parents having to remain involved longer into their children's adult lives than ever before. Children most vulnerable to this situation are the ones who need extended supports most, those with developmental disabilities.

The conclusion that must be drawn is that parenting can no longer be a process that just comes naturally, taking it one day at a time. The end goal must be kept in mind; that the child's growth keeps pace, to the extent possible, with the parents healthy passage through their own life stages. When children lag in their developmental stages, parents still need to be conscious of their future needs and find the resources to help a child negotiate steps toward as independent a life as possible. Resources are out there, but not readily available on into the child's future, unless parents are focused in that direction early on. The more skills your child builds for living in a social setting, the more likely you will have choices involving your own future, and his/hers.

Behaviour problems in developmentally disabled children make it particularly difficult for parents to hold onto overall goals and values they believe in. The tendency is frequently to put aside thoughts about future needs, or future plans, and try to muster the energy just to get by day by day. At the same time, the vulnerable child with behaviour problems may become the central focus in the family, which can have negative effects on other family members as well.

It follows then, that in working with behaviour problems, it is important to prioritize behaviours targeted for elimination. Your priorities need to take into account personal and family needs. For example, if everyone has to be out of the house in the early morning, then problems involving getting up on time and getting dressed might be the first area to concentrate on, ahead of, say, behaviour problems at other times of the day. You might also think about the consequences of the problem for your child's growth toward his or her future life among other people. For example, the child who eats his food with his fingers or throws it on the floor may present a greater problem than one who won't go to bed on time. Both problems may affect family functioning, but they need to be prioritized based on what you hope to be doing a year or two from now.

What follows below is just one of the many techniques that works with all kinds of children, and in modified form can work with developmentally disabled children who have even minimum cognitive abilities.

When you are ready to select one of your list of target behaviours (and I recommend you only select one at a time), it would be advisable to pick one that is most likely to meet with success because he or she has some capabilities already demonstrated to overcome the undesirable behaviour. To take the food example, if your child's motor capabilities are so limited that he cannot hold a spoon or fork in his hand, you would need to modify your goal; perhaps limiting it to harnessing his frustration so that he doesn't throw food on the floor (or anywhere else).

Now comes the part requiring exceptional discipline. With a developmentally disabled child, it is particularly important that the whole household is well structured around tasks to be accomplished. I suggest you write a list of daily routines and activities in which you are involved with the rest of the family, enlist their cooperation in the routines you will be setting up, and make space and time for the work you will need to do. You will need to set aside special time each day for re-training your special child's behaviour. You will also need to practice tolerance for the time it takes to work on it steadily and consistently. Most importantly, believe in yourself - it takes determination to overcome patterns that have been longstanding.

Let's say that tantrum behaviour from your child is being targeted. Make a chart for week 1 in which you change nothing you're presently doing, just observe a base line of the number of tantrums over the course of a week, and record these. I recommend that you also record time of day, what event preceded the tantrum, mood of the child, and most importantly, what, if anything, you have noticed that has helped to moderate tantrum behaviour. Taking the time to observe is helpful in many ways. It can give you a basis for changing behaviour, but it also gives you the space to think more about what underlies the difficult behaviour; or what can be used to divert it. This kind of analysis is often much more difficult to do when we are involved in a vicious cycle of stressful reactions.

Week 2 is the beginning of your new strategy. You will have figured out when your child is most vulnerable to tantrums, what capabilities he already has that you can use, what cues he demonstrates (such as mood) that precipitate the negative behaviour, and immediate consequences for behaviour. It is most important that you make a chart he can look at with you. The behaviour is framed on the chart as a positive one that substitutes for the undesirable behaviour. So don't label it "tantrums" but "helping" or "teamwork," for example. (You will need to find a word he understands, that is related to a substitute for tantrum behaviour - not just "good" behaviour because that is too general.) He gets a star every time he exhibits the behaviour, and he earns a reward, at first each time he exhibits it, then every other time, etc. Try to stretch out the number of stars he must earn, but always show him you've noticed the good behaviour.

The reward can be something tangible like an extra treat, an extra playtime with you, a program he wants to watch, etc. It's a good idea to identify a positive reward related to the substitute behaviour. For example, if he has a tantrum when you're trying to get him dressed in a hurry, but cooperates at other times when he's going on an outing he likes, use the word you chose, give him a star for this behaviour at those times it is exhibited and anticipate the next time he will be reacting differently by telling him in advance you want to see the "helper" do his job in the morning rush. What you are doing is using a positive coping response and helping him to generalize it to other times of the day. To use the present example, you might also notice if the hurrying behaviour on your part is cuing in the negative behaviour on his part. To make it work, in other words, you need to minimize other factors that interfere. When tantrums are about to erupt, try to turn them off before they've gotten too far. Your analysis of the cues he gives when he is about to erupt, and other cues in his environment that you've noticed during the base week, should help you.

There is much more that can be said about behavioural controls; tactics like diversion, special play techniques to help minimize frustration, and use of humorous words and puppets to represent good guy/bad guy behaviours are just some of the tools parents can develop in their armory. In future articles, I will discuss some of these.

You may find that you also have developed some ways of responding to your child that need to be targeted for elimination. Remember, angry responses beget more anger from your child. As much as possible, and I know it's easier said than done, keep it ‘cool.’ Remember too, as the saying goes, "Rome wasn't built in a day." Give yourself, and your child, the gift of patience and, once established, follow the routine consistently. Incidentally, while you're about the task of organizing the rest of your family, don't forget that your other children (and spouse, if this applies) need to feel special in their own way too. You need cooperation all around to make this work.

One more thing. Even developmentally disabled children receive messages transmitted from the family. If the message is, we all work together to help each other, and we are all participants in a system which values what each can contribute, your child will be more likely to come through for you.

If you are having a difficult time following this routine, or would like additional assistance, I am always available through email for consultation.

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Dr. Laura Lustig, Ph.D., L.M.F.T., a licensed psychologist and marriage and family therapist in practice for 20 years, is the President and Founder of The New Learning Center in Westport, CT. This not-for-profit center is well known for their work with individual and family therapy. Dr. Lustig focuses on cases with chronic disabilities in the family, ranging from children with mental and/or physical disabilities, developmental disabilities and emotional difficulties, to parents and couples, one of whom may have acquired any of the above disabilities. She also teaches a course for Sacred Heart University on the dynamics of families with a disabled member and is approved by the American Association for Marriage and Family Therapy to supervise other marriage and family therapists. For more information about The New Learning Center, please visit their website at http://www.newlearningcenter.com.