Presented by Katharine Leslie, Ph.D., CFLE brandnewdayconsulting 336-376-8366

1. Why Won’t This Child Behave? Presented by Katharine Leslie, Ph.D., CFLE www.brandnewdayconsulting.com 336-376-8366

2. First Step • Differentiate between children who were over-indulged (bad) traumatized children with mental health problems (ugly) • Both have behavior and relationship difficulties but the latter are far more difficult to work with and change.

3. Overindulged • had his needs met early in life but was never taught that he was not the center of the universe. • rewards and consequences for behavior are likely to help the overindulged child shift to more pro-social behaviors.

4. Mal-Attached • Missed out on some or all of the first and most important stages of the p-c relationship • Two fundamental developmental processes are negatively impacted. • neurodevelopment (physical and biological growth of the brain, nervous and endocrine systems • psychosocial/emotional development (personality, affect regulation, morals, values, social relationships).

5. Compromised Cognitive (Brain) Abilities • Organizing, planning, • Shifting attention, concentration • Working memory • Perceiving and adjusting to social cues • Learning from previous experience • Motivation and intention • Sensory integration • Auditory, language comprehension • Speech and reading skills • Logical/abstract thinking

6. Compromised Social/Emotional Abilities • Object Relations – (fragmented ego identity) • Attachment (insecure or nonexistent) • Self-esteem (pseudo or low) • Autonomy (excessive levels of shame) • Initiative (low levels of guilt) • Moral reasoning (low)

7. Paradigm Shift Emotional/Mental Disorders in Children and Adolescents By Linda Swann (See Appendix) • Old paradigm • Behavior is learned from parents. • Children are too young to be diagnosed with mental illnesses. • Parents need to learn to be non-toxic and less permissive • Child is seeking attention and is manipulative • "Acting out" is response to inner conflict from early childhood • The child is able to act appropriately but won’t • Parents not asked for input; provider to fix child

8. Continued • New paradigm • Behavior results from: • sensory overload • distorted perceptions and mood • inflexibility, anxiety, low tolerance for frustration • tics, "limbic storms," low impulse control, • low executive functioning, poor short-term memory, • difficulty w/handwriting, coordination. • Child has good and bad days • Focus on managing the illness • Parents need extraordinary skills and support

9. Negative vs Positive Out of Whack One continuum Negative Positive Two continuums Positive Low High Negative Low High

10. POSITIVE behaviors LOW HIGH Behavior Typologies LOW NEGATIVE behaviors HIGH

11. What Do We Do With This Knowledge? Therapists: • Because some research suggests that certain aspects of the limbic system retain plasticity (stay open to experience-dependent change) throughout life the goal is to identify, access and positively effect those aspects. • Use treatments that reduce fear, build alternative neural networks, and create access to implicit memory. Caregivers: • Accept that many of our children’s negative behaviors and lack of positive behaviors are a result of brain dysfunction. • Rehearse, rehearse, rehearse the positive

12. Cognitive Behavioral Therapy (CBT) • Challenge behavior patterns and beliefs, reframe, build skills, evaluate outcomes • Limitations • elicit explicit as opposed to implicit memory. • Explicit memory of trauma is limited • Implicit memory stores more sensory motor memories of attachment and trauma • Child will actively avoid the vulnerability that occurs in developing a therapeutic relationship and will resist being directed into areas of shame and trauma.

13. CBT with Sensory and Relationship Components • Trauma - Focused CBT • Externalize/Reactivate/Expose the trauma • Provide corrective information to form a new narrative • Attachment - Focused Therapy • Dyadic Developmental Psychotherapy (DDP; Dan Hughes) • ARC (attachment, self-regulation, competence; Margaret Blaustein, and Kristine Kinniburgh) • Relationship Coaching (Katharine Leslie)

14. Attachment-Focused • Rapport and trust are built through immediate, honest, forthright validation of the child’s trauma history and current behavior issues. • Therapist’s job is to identify and challenge the child’s defenses (e.g., charm, distraction, flirting, acting dumb). • Doesn’t expect child to be happy working through the trauma, or to like the therapist -- until the child is emotionally healthy.

15. Continued The practitioner, with the parents, is in charge of the session and of the child, in a nurturing, safe, and empathic manner. The adults take the lead in attachment therapy and are always observing and responding to the feelings and needs of all family members.

16. Other Interventions • Brain (passive) • Neuro-feedback (eegspectrum) • Body (passive) • Body work (massage, cranial-sacral, myofacial) • Biometrics • Body – Brain (active) • EMDR • Neuro-Developmental Re-patterning (Ziegler, D) • Sensory Integration Occupational Therapy • Body movement (dance, yoga, martial arts)

17. What Can the Rest of Us Do? • Five Strategies • Prevent • Coach • Build a Relationship • Maintain an accurate frame of mind • Teach Responsibility

18. Right Focus • Child Development • Discipline at child’s social-emotional level • “listen” to what children’s behavior is telling you • Do not expect children to perform without readiness (i.e., bodily, skills, knowledge) • Child Behaviors • Verbal correction of bad/wrong behaviors and opportunities for “do-overs” • Start rather than stop behaviors • Rehearsal

19. Definitions • Discipline • environmental: structure, rules, consequences • Behavior • the individual • Punishment • taking away privileges (after the misbehavior) • Consequences • adding responsibilities

20. Strategy 1: Prevention • Be consistent • Organize environment for success • Don’t set up for failure • Supervise • Limit access • Limit mobility • Stated rules and consequences

21. Strategy 2: Coaching • Focus • Less about the presenting negative behaviors and more about the missing positive behaviors. • What the child should be giving in the relationship • Rationale • encourages practice of desired behaviors and skills. • makes a clear connection between behaviors, feelings and effects on others. • facilitates shift from shame to guilt by activating a higher level response system - the social engagement circuitry.

22. How? • Shape(by successive approximation and rehearsal) • Apply good cognition to negative behaviors • Cue positive behaviors • Cue positive interactions • Every coaching phrase should contain an action, a feeling, and or a reason. • Identify the underlying relationship need • Not necessarily what you need to provide to the child but rather what the child needs to provide to you.

23. Apply Good Cognition: Connect the Dots “You hit that child. You are scared of him.” “You are chattering. You are worried that I don’t see you.” You are out of your chair. You forgot to look around.” “You are bossing. You want to control what’s happening.”

24. Coach Positive Actions “This is when you… work hard because you want me to be proud of you.” bring me a book because you love me to read to you.” tell that child you are sorry because you hurt him and you feel bad.” smile at me because you are happy to see me.” come get a hug because you are hurt and need me to help you feel better.”

25. Coach Positive/Truthful Verbal Interactions “This is where/when you say to me… I feel embarrassed when I do something wrong.” “Go” I am really worried about something.” “Can you help me?” “Go” I feel really angry when you tell me what to do.” “Go” I don’t want to do my school work. School makes me feel dumb.” “Go” I like when we do arts and crafts. Thank you.” “Go” “Thank you for helping me.” “I needed it.” “Go”

26. Response to Child "Okay."  "Is that right?"  "That makes sense."  “You are very good at that” “We'll try that idea again later."  "Yes it looks like fun for you." "I understand."  "I'd be happy to, thanks so much for asking.” “I'll take it from here." “What would you like to do about that?”

27. Tricks of the Trade • Do not ask the child questions • Questioning is likely to be perceived by the child as accusatory and will push the child into defense mode and shame. • Use empathy • Use action and feeling words • Respond with reciprocal action and/or exaggerated affect after the child repeats your coaching • this evokes feelings of love, joy, and comfort (in both of you).

28. Instead of Questioning • “Why did you break that toy?” becomes… “I broke my toy because sharing makes me mad.” “Go.” • “Why didn’t you do your home work?” becomes… “I did it, then I threw it away because I don’t want anyone to know I’m smart.“ “Go.” • “Why did you lie?” becomes… “I lied because I didn’t want to get into trouble.” “Go.”

29. Strategy #3-Build a Relationship • Create safety – provide for basic needs (food, shelter, warmth) routinely and predictably. • Create positive interactions in play and conversation (promotes falling in love). • Expect Reciprocity (use coaching method)

30. Relationship Parent Give NOT a Relationship Receive Child

31. BINGO! Parent Give Receive Relationship Receive Give Child

32. What Do Children Typically Give? • Share Values of Parent • Elicit Positive Attention from Parent • Ask For Help and Comfort from Parent • Show Caring and Thoughtfulness of Parent • Demonstrate Trust in Parent • Contribute Joyfulness and Fun • Express Love and Affection to Parent

33. Furthermore • Children’s development is not satisfactorily completed until they are ready willing and able to be reciprocal (i.e., meet parental relationships needs). • A child not taught how to meet parental needs will likely lack the desire and skills to meet the needs of all others. • As a result- they will miss out on the benefits and gifts of relationship throughout their lives.

34. Strategy 4: Reframe Your Thinking • Acknowledge that our children have real brain dysfunction. • At times their brain dysfunctions manifest as mindless intentionality. • Feel bad for them, but do not take their actions personally. • Hold them accountable not to punish but to teach

35. Rethink “Shoulds” and “Musts” • “He should love me.” • “She must be normal.” • “She shouldn’t still be doing this after all this time.” • “He must not embarrass me in front of others.” • “She must stop doing these behaviors.”

36. New Thinking • “My child is incapable of loving me - yet, and it’s not personal.” • “My child is not normal, no matter how well he acts sometimes.” • “My child may continue to act this way for the rest of her life.” • “I have no reason to be embarrassed by my child’s behavior. I didn’t do anything wrong.” • “Even if my child doesn’t stop this behavior I can find something else to focus on.”

37. Strategy 5: Teach Responsibility • Balance privileges with responsibilities • Provide payback opportunities • Admit • Apologize • Repair/Restitution

38. Responsibility Out of BalanceToo Much Too Soon Give Take Take Privilege

39. Responsibility Balanced Give Take Privilege

40. Accommodations Basic Package Room and board Clothes Medical care Food Education Luxury Package children don’t need but are given out of the goodness of a parent’s heart: Extra-curricular activities Chauffer services Vacations Parties Dinners out $$$

41. Qualify for Luxury Package? • mutually satisfy parental needs in some ways, most of the time. • Respectful • Responsible • Fun to be around

42. Pay Back • Restitution • Allows the child to make up for the damage he has caused (physical or emotional) • Assists in shifting the child out of shame and into appropriate guilt • Helps to develop self-control, self-esteem, moral character, responsible behavior, emotional IQ, and orderly conduct in an individual or a society.

43. Restitution/Consequences • Do the victim’s chore • Do a household chore • Create napkin holders for everyone • Assist parent • Do something nurturing (e.g., comb hair, massage, foot rub) • Draw a picture/create artwork

44. Thank You, Katharine Leslie 336-376-8366 www.kpleslie@att.net To purchase Dr. Leslie’s books go to www.brandnewdayconsulting.com To purchase a CD recording of this seminar call Meds-PDN and ask for Shannon Bergquist (715) 836-9900

45. Important Websites www.brandnewdayconsulting.com www.eegspectrum.org www.tlcinst.org www.childtraumaacademy.com www.traumacenter.org www.musc.edu/cvc/guide1.htm www.modelprograms.samsha.gov www.attach.org www.radzebra.org