Battle of the Wills: Tools For Dealing With Difficult Behaviors in Children

1. Battle of the Wills: Tools For Dealing With Difficult Behaviors in Children Shanna Neff, MSN, PMHNP-BC Family Psychiatric and Mental Health Nurse Practitioner Creekside Counseling

2. Thoughts, Pearls and Caveats • Dealing with difficult behaviors in a child is… DIFFICULT • Remember, your child is not their behavior. • Behavior is what your child does, not who she is. • You want your child to feel loved and accepted regardless of their behavior. • Your ability to help them is tied to your ability to separate your child’s identity from their behavior. • Behavior can be changed.

3. Remember • There are many paths that lead to the same destination… • There is no ONE Right Way.

4. Session Goal • Explore concepts of Dialectical Behavior Therapy as they relate to managing behavioral difficulties in children • Examine the role emotions play in interactions • Adopt new assumptions about self, child, and behavior • Learn strategies to de-escalate intense emotional reactions and teach your child to express and manage their emotions in productive ways

5. Dialectical Behavior Therapy (DBT) Is a type of therapy that combines standard Cognitive-Behavioral Therapy techniques and mindfulness techniques to help a person modify their behaviors and regulate their mood and emotions more effectively:.

6. Why Use A DBT Approach With Children? • Provides a framework to develop skills that will • Enable a person to become a more effective parent • Help parents to develop a more positive relationship with their child • Allows a person to become more aware, accepting, and appreciative of reality while still motivating one to improve • Improves self-acceptance and acceptance of others

7. Emotions, Thoughts, and Behavior

8. Understanding Emotions • Primary emotions • Biologically based, nearly automatic, instinctive • Secondary emotions • Occur when we react to our primary emotion • We have more control over the development and utilization over secondary emotions

9. Example • Scenario: you have just been notified that your child was involved in an altercation with another student at their school • Possible primary emotions: • Alarm, Fear, Anger • When you arrive you are informed that your child was the victim and not the instigator: • Secondary emotions: • Guilt, Indignation, Need for justice/retribution

10. Emotional & Behavioral Continuum

11. Assumptions and Judgments • What assumptions do YOU make about the behaviors of each child? • How do YOU judge each child based on their behaviors?

12. Responding Emotionally, Reasonably, and Wisely What type of mind do you typically operate from? What type of mind does your child typically operate from?

13. Nature versus Nurture • Emotion Dysregulation • Interaction between your responses and your child’s responses • Unintentional Invalidation

14. Thoughts - internal phrases, attitudes, beliefs, or images you say to yourselfFeelings – physiologic reactions in your body that shape your experienceBehaviors – are the result of thoughts and feelings

15. The Story of Emotion • Vulnerabilities or Risk Factors • Prompting Event or Trigger • Thoughts and Beliefs About the Event • Body Sensations or Responses • Emotion(s) • Behaviors and Actions = Outcome Your awareness at each of the above steps allows you to make changes and effect the outcome of an event or incident.

16. Effective Parenting “Interacting and/or responding to your child in ways that enable you to achieve your parenting goal: to help you child grow with self-esteem, values, and a belief in himself.”

17. DBT Assumptions • Your child is doing the best he/she can • Your child needs to do better, try harder, and be more motivated to change • Your child wants to do things differently and make things better • Your child must learn new behaviors • Family members should take things in a well-meaning way (benefit of the doubt) • There is no absolute truth

18. Practice the Assumptions • Which assumption do you think will help you most? • Which assumption will challenge you the most? • Consider how an assumption would change how you would feel or respond to your child: • Describe the situation (What happened? What did you feel) • Write down the assumption • Describe a possible new response • Describe what you think the outcome would be based on the new response

19. Mindfulness: Responding With Focus In The Moment • Take a step back • Observe • Separate the facts of the situation from the emotions • Respond with purposeful awareness (turn off the auto-pilot)

20. Nonevaluative Thinking: Judging vs. Describing

21. Validation • The importance of validation • Acceptance and change • How to make validating statements: • Find a way to act with a wise mind • Look at your child in a new way • Explore what is getting in the way (judgment) • Make a validating statement PRACTICE!

22. Parenting Roles, Goals, & Expectations • Interact and Communicate in Ways that Work • Assess your goals • Develop priorities • Feel effective • Assess your goals • What do you want to accomplish now? • What is the most important goal I have? • How do I want both of us to feel when this is over?

23. Parenting Roles, Goals, & Expectations • Develop priorities • Do you want to set limits or give consequences for behavior? • Do you want to find out what was upsetting your child in the first place? • Do you want to communicate more effective ways of expressing feelings?

24. Parenting Roles, Goals, & Expectations • Feeling effective • Evaluate the outcome of an event • Do not judge the effectiveness of your behavior based on your child’s response • Be fair with yourself • Did you respond with an emotional, reasonable, or wise mind? • Did you stay calm? • Did you stay focused? • Did you accomplish what you set out to do?

25. Incorporating Balance Goal: Be Flexible.

26. Shifting Gears Begin to apply principles to your child.

27. Your Child’s Story of Emotion • Identify your child’s vulnerability or risk factors. • Lack of sleep; problem at school; change in routine. • Identify your child’s triggers. • Limits; separation; change; your feelings; siblings. • Imagine how your child view the world? • Recognize your child’s body sensations. • About to cry; speaking louder or faster; avoids eye contact. • Name the emotions. • Indirectly speak about how “others might feel this way if…” • Change the outcome by teaching alternative behaviors. • Discussing an event; alone time; alternative behaviors are not punishment.

28. Understanding What Your Child Is Telling You • Accept your child’s truth. • Focus on reality – not specifics. • Acknowledge things that are important to your child. • Don’t minimize, judge, or try to “fix”. • Create a validating home environment. • Welcome the expression of ALL feelings. • Acknowledge positive and negative emotions in others. • Observing behaviors in others is less threatening for a child. • Share positive activities. • Don’t reinforce negative emotions with more attention. • Talk about your own feelings. • Model the expression of feelings without burdening your child.

29. Ways to decrease the possibility of emotional outbursts • Create routines • Develop consistent rules and expectations • Limit activities • Make your home a safe haven

30. When Your Child is Overwhelmed by Emotions • Provide opportunities for pleasure and mastery • What does your child enjoy? What activities bring your child happiness? What does your child do well? • Find ways to steer your child into activities and situations that challenge them and offer an opportunity for rewarding growth?

31. De-escalate When Your Child is Experiencing Overwhelming Emotions • Remain calm yourself • Speak with a soft tone of voice • Slow down your breathing • Use wise mind • Take a step back to observe the situation in order to find a more effective response • Describe the situation – don’t judge

32. Help Your Child Calm Down • Assist your child to engage in calming activities • Provide a safe and soothing environment • Don’t make demands in the middle of an outburst • Validate – even when the anger is directed at you • Be accepting and nonjudgmental • Get feedback and input from your child

33. Behavioral Principles Do not assume the worst. Do not be judgmental. Validate your child. Be responsive, not reactive. You can lose the battle and still win the war. It takes TWO to engage in power struggles. Remember to balance your responses (be flexible). Choose the most effective response.

34. Behavioral Principles • Reinforcers or Reinforcement: increase the probability that a behavior will occur again and/or increase how often the behavior occurs. • Punishment: Decreases the probability that a behavior will occur again.

35. Reinforcement • Increase the effectiveness of a reinforcer by: • Choosing them with your child • Evaluate, modify or discard based on their effectiveness (even if chosen by child) • Using the reinforcer when your child has not already had access to it • Providing several reinforcement choices (so your child doesn’t get bored).

36. Reinforcers • Are not bribes. • Need to be provided as immediately as possible that your child begins to associate the reinforcement with the immediately preceding behavior. • Intermittent Reinforcement: reinforcement is provided occasionally so that the child may increase frequency of behaviors in order to get desired reward • Remember that this principle applies to both positive and negative behaviors

37. Reinforce Incompatible Behaviors To reduce your child’s negative behaviors, provide reinforcement when he is demonstrating the appropriate (desired) behavior.

38. Shaping • Teaching your child how to complete a series of tasks by reinforcing small, gradual steps that move toward a larger goal: • Break the overall behavior into small, manageable behaviors that your child can accomplish. • Reinforce completion of the first behavior until he is able to follow through consistently on that behavior. • Once first behavior is consistent, add another expectation and reinforce when both behaviors occur. • Add another behavior to all previous behaviors and only reinforce when that new behaviors joins all the others. • Repeat until all expectations can be met by your child; reinforcement now only occurs when the child has met the overall goal.

39. Contracts • Increase your child’s use of effective behaviors • Enable your child to feel good about their success • Aim for improvement – not perfection • Explicitly state the conditions under which a reinforcer will be given and what the reinforcer will be: • “If you (behavior child must do) then (you will respond in a certain way).”

40. Punishment • Involve taking something away or doing something the child does not like. • Effective punishments are given immediately, are specific and time limited, and are in proportion to the severity of the crime. • Natural consequences are effective and complete (no additional punishment necessary). Saving or protecting your child from natural consequences does not help him to learn OR become responsible for their actions.

41. Punishment • Reinforcement is more effective than punishment. • Reinforcement teaches your child how to behave. • Punishment teaches your child how not to behave and does not often provide an opportunity to teach alternate behavioral strategies. • Punishment yields negative outcomes while reinforcement yields positive outcomes.

42. Guidelines for Punishment • There are times when punishment is needed • Time-out is an effective punishment as it removes the child from the social situation (where he might be inadvertently reinforced), and gives the child time to calm down. • The child may come out of time-out when he is calm, but not before. • Avoid taking things away – instead give access to it when the child is behaving effectively.

43. Conclusion: Back to You • Self-care • Learning new ways to behave (think and feel) is difficult not only for your child, but for you • Acceptance • Denying reality only leads to more suffering • Recognize what can and can’t be changed • Don’t judge yourself • You become less effective. • Ask for help • Friends, family, baby-sitter, support group, health care provider, counselor, etc.

44. Discussion or Questions