Day 14: Top 9 Tips From Our Behavioral Therapist

Top 9 tips from Behavioral Therapist

This is Day 14 in the series: 31 days on Living with ADHD, Autism and Sensory Processing Disorder: What We Have Tried, What Has Worked, What Hasn’t Worked, and Never Giving Up. 

When Mr Rockstar’s occupational therapist first suggested we start seeing a behavioral counselor it felt like such a defeat.  As if we were so incompetent as parents that we needed to see a parenting coach.  At the time the only diagnosis we had for Mr Rockstar was sensory integration disorder so it seemed like we should be able to handle him without seeing a specialist.  After all I had read a ton of parenting books.

Begrudgingly we started seeing a local behavioral therapist….and it as amazing, dare I say even transformational.  It is so hard to apply what you read in books to your specific kid.  If the “system” isn’t working is it because I am doing it wrong? or maybe I need to try harder? or it just takes time? or maybe it just doesn’t work with my kid?  Having someone with years of experience show you and then guide you through giving an appropriate time out, doing selective attention, or giving your child positive practice makes the world of difference.  She could see the temperaments of all our kids (we go as an entire family to the sessions) and then tailor a plan to work for each kid.  Not only did we learn a lot of new parenting tools, since Hubby went too, we were able to be very consistent as parents, working as a team.  Before seeing the behavioral therapist, quite often, Hubby and I would have different ideas on how to respond to inappropriate behavior and it was so hard to get on the same page.

Now that we have had a behavioral counselor there is no going back!  I think we will have one until all the kids move out of the house LOL.  It is like having your own personal parenting coach.  If times are tough we see her every week or two.  If the family is doing great then we see her every 4-6 weeks.  Any problem that comes up she usually has some good advice for addressing.  She has helped us with poor compliance, picky eating, night wakings, teeth brushing, school drop-offs, anxiety, screaming, whining, aggression, etc.  We started working with her when the twins were 22 months old and Mr Rockstar was 4.  Now the twins are 3 and Mr Rockstar is 6.  I think these techniques can be modified for almost any age (our therapist works with ages 2-18) but we have used them in the 22 month – 6 yo range.

The top 9 techniques we learned from the behavioral therapist:

1. Descriptive Praise

The moment your child even looks like they might start complying you come in with praise.  “Good job listening first time the fast way!”  We used to withhold our praise until the child had fully completed the task.  For example, if we asked Mr Rockstar to get in the car we would wait until he was in the car to praise him.  Now the moment he looks towards the door and acts like he is going to stand up we turn on the praise.  This idea of praise early and often is key to maintaining positive momentum.  Think about your child as a piggy bank.  Every time you have to correct a child you are making a withdrawal and every time you praise a child you are making a deposit.  You have to make more deposits than withdrawals in order to continue to get compliance.  One other thing to note, the praise can’t be generic.  “Good job!” is really not that meaningful.  The praise needs to be descriptive.  “Good job picking up those toys so fast!”

2. Precision Commands

Children, especially ADHD/autistic kids or any really young children, struggle to recognize when they are being asked to do something.  Too often we ask them a different way each time.  “Honey, would you pick up that toy?” “Come on Mr Rockstar , help me clean up.”  “Mr Rockstar I mean business.  You need to finish that school work.”  One of the most powerful parenting tools is precision commands.  You respectfully give them a command….and the trick is you do it the same way every time.  The format we were given was:

“Mr Rockstar, please pick up that toy.  Thank you.”  

Say all of this with an even tone of voice.  After you are done saying it avoid the temptation to stare them down.  It is better to look away and monitor them out of the corner of your eye.  The moment they look at the toy and act like they might comply come in with praise.  “Good job following that direction!  High five.”

So what do you do when 20 seconds later they have completely ignored you?  If after 20 seconds they aren’t beginning to comply you have a choice as a parent.  You can let it go and you haven’t reinforced bad behavior….too much.  This option is nice when you ask them to put on their shoes, you are running late to get out the door, and they still aren’t moving.  You don’t really have time to see a correction through to the end so you can just let it go.  If you do have time then the next step is:

“Mr Rockstar, you need to pick up that toy.  Thank you.”

This is said in the same calm tone of voice as the first command.  Note it is not “Mr Rockstar, you NEED to pick up the toy. Thank you.”  It is really tempting to say “NEED” loudly.  As soon as they start complying come in with praise.  The praise might be a little less enthusiastic.  Instead of “Good job following that direction first time the fast way!” you might just say “Good job following that direction.”.  If after 20 seconds they are still not moving towards complying then a correction is in order.  Some options are to time out the child or an object or you could use positive practice.

I has shocked at how quickly using precision commands improved the compliance of all the children.  Their ears perk up now when I say “Miss Tomboy, please….”.  They know they are being asked to do something because we ask them the same way every time.  They also know when they hear the “need” command there is no getting out of complying and they are about to get a correction if they fail to comply.  It takes about a week to retrain yourself as parents to use the precision commands but it is well worth it.  Even on his bad days Mr Rockstar has decent compliance now because half the time he goes on autopilot when he hears the precision command.

3. Positive Practice

Positive Practice is calmly asking your child to repeat over and over and over again whatever task they are struggling with doing appropriately.  It works best when you do it right before some activity your child really wants to do.  For instance before they would watch their cartoons, or go biking, or eat supper, etc.  An example of this technique is when Miss Tomboy will throw a toy, I will ask her to pick it up and set it down again gently.  I have her repeat this a couple times so she practices doing it correctly.  Another example is Mr Rockstar used to take FOREVER to get his shoes on and get out of the car (he takes his shoes off the moment he gets in the car so he has to put them back on before getting out).  One night when we got home from the behavioral specialist he was really hungry.  While Hubby was inside whipping up some dinner, I stayed outside with Mr Rockstar and had him practice over and over again getting out of his carseat, putting on his shoes, getting out of the car, getting back in the car, taking his shoes off, getting back into his carseat etc.  A couple tips for this techique:

  1. Don’t make eye contact or even really look at the child.
  2. Keep a monotone voice.  Say “Please get out of your car seat.  Thank you.”  “Please put on your shoes.  Thank you.” etc.  Use the precision command format for your requests.  You can drop their name after a while because you will be giving the same commands over and over.
  3. Have them continue to practice just past the point it starts to irritate them.  When you see their eyes rolling, or they say “This is stupid”, or they start huffing and puffing about it, then you know you only need them to do it one or two more times.
  4. Don’t push it too far past irritation or the whole thing will backfire on you.
  5. If they are resistant you can cue with “Keep the problem small and follow the direction so you can (blank).”

4. Time Out the Child

After speaking with a couple different behavioral coaches, they all agree almost every body does time-outs incorrectly.  I know I was!  We never had time-outs as a kid so it is hard to know if you are doing it right or not.  How does a time out work anyway?

One story a behavioral counselor used to describe an what an effective time-out should feel like was:

What if you were sitting in a football game and everybody is cheering their and then unbeknownst to you …you did something completely inappropriate.  Maybe you picked your nose.  Suddenly out of no where some CIA men (think of the movie Men in Black) show up and said “Please come with us” and then wordlessly led you to a sound proof cell.  Suddenly you go from having all this stimulus of the game to complete silence in a white room.  After 5 minutes the men open the door and wordlessly return you to your seat.  Of course after this bizarre incident you are wondering “What triggered that?”  “Was it me picking my nose?”.  Of course naturally you would try picking your nose again only for the men in black to suddenly arrive again and wordlessly escort you to the silent cell.  Pretty quickly you would figure out what the poor behavior was and since you are missing the fun of the game you would probably also decide to stop picking your nose.

Is this how time-outs work in most houses?  Or are we continuously reacting to our kids poor behavior even when they are in time-out?  When our child leaves the time-out area do we wordless and gently return them or do we start yelling at them?  Does the child get put into time-out in a non-confrontational way or do we get so worked up as parents that we become the best show on the block for them?  At its most basic form time-out is time away from all attention both positive and negative.

The steps for an appropriate time out are:

  1. Say “Mr Rockstar, please take a time-out on the stairs.  Thank you.”  Notice the precision command language?  If they don’t comply and go to the designated time-out location then you can ask again using the “need” command
  2. Once they are on the stairs they must say “Ready” and slap their knees.  Basically you want them to acquiesce their little wills (not break their wills but acknowledge they aren’t the ones in control of the situation) to your authority.  We have them say “ready” and slap their knees but you could come up with something else.  Just be consistent.
  3. If they refuse to go into time out or to say “Ready” then you must COMPLETELY IGNORE THEM.  Don’t make eye contact.  Even if they are trashing the house ignore them.  It is just stuff.  You can occasionally cue them with “Keep the problem small and start your time-out.”  I use this cue especially when they are trying to get my attention.  Early on it could be an hour or more before Mr Rockstar would start his time-out.  Eventually he would want something from me and he would give in.  Once the girls saw their big brother doing time outs consistently they followed suit with no trouble.  If the child is becoming a danger to themselves or others consider a time-out room.  I have had to put Mr Rockstar in the laundry room (don’t worry it is rather large and I did this with the blessing of the behavioral coach) a time or two.  He would get so aggressive he would either try to hurt me or his sisters.  It gets bad sometimes.  Once he is in the time out room, he quickly calms down because he knows nothing he does will get my attention.  The show is over.  It also tells me that even the slightest bit of attention from me is motivating to him to continue bad behavior.
  4. Once the child has said “Ready” and slapped his/her knees the time-out timer begins.  We have a loud egg timer.  The rule of thumb is 1 minute per year old the child is….but NOT when you are first starting out!!!  If it is taking your child forever to start their time-out you have already won the battle once they say “Ready”.  If you push them too hard and make them stay in time-out a long time you could be triggering another war.  You want this to end on a positive note so they think “If I just quickly take my time out life is good”.  Once they are starting their time-outs quickly then you can slowly lengthen the time-out to a maximum of the number of minutes the child is old.  Never completely reset the timer because of inappropriate behavior while in time-out.  Simply ignore the behavior and wait until the has been a minute or two of good behavior before ending the time-out.  If the child tries to leave the time-out area after starting his time-out gently redirect them back without making eye contact.
  5. Once the time out is over give them a hug and say “Thanks for taking your time-out”.  If they went into time-out for non-compliance then they need to finish whatever task you initially asked them to do.

A couple notes:

  1. Have a positive practice session with your child when he/she is in a good mood and wants something from you …so you can get compliance.  First show them how to take a time-out.  Let them role-play as the adult and you as the child.  While you are play acting as a child you can act out an appropriate time-out as well as an inappropriate one.  Ask your child after each “Did I do it correctly?”.  Usually they LOVE correcting mommy so they will answer honestly.  Next switch roles and see if the child can do even better than you at taking a time out.  Challenge them to start their time-out even faster than you did.
  2. Reserve Time-Outs for overt non-compliance and aggression.  This should be one of your big gun disciplines.  Don’t overuse it.

5. Time Out an Object

If a child is acting inappropriately time out an object.  The object can either be a toy they have in their hand (especially if they are playing inappropriately with that toy), or a beloved object (Miss Tomboy’s pacifier or Miss Princess’ bunny were the objects of choice for a while!), or any toy you want to grab.  Then you completely ignore the child and avoid eye contact the same as with a regular time-out.  Once the child has calmed down the object is returned.  You can say “Thank you for calming down.”  This also works great for whining.  If the girls were whining/screaming at us when they were little we could say “No screaming.  Bunny is going in time out.”  The moment they stopped screaming the bunny was returned.  Compared to putting the child in time-out, this is easier for the child to get out of because all they have to do it calm down.  So for some kids this might be easier than putting them in time-out.  For our girls putting an object in time-out seemed to work much better (they understood the correction more) when they were really young.

Miss Princess' bunny still makes the perfect object to time-out when she is in trouble.
Miss Princess’s bunny still makes the perfect object to time-out when she is in trouble.

6. Selective Attention

When a child is being inappropriate (usually screaming or whining) you can selectively ignore the inappropriate behavior.  The key to this is you HAVE to come in the MOMENT the child is appropriate.  It could be 4 minutes ignore, 30 secs attention, 2 minutes ignore, 40 secs attention, etc.  Miss Princess used to come up to us and just started screaming to get what she wanted.  We would ignore the screaming.  She would stop crying suddenly and sneak a look at us to see if we were listening.  When these brief interludes of silence would occur, we would immediately say “Hi Miss Princess.  Thanks for calming down.  How can I help?”  Initially this triggered more screaming because she felt like she had our attention so she was going to cry to get what she wanted.  After a couple rounds of screaming, stop, attention from mommy, screaming, stop, attention from mommy, etc she would catch on that she could just get what she wanted if she calmed down and used her words.  This technique works great but invest in some good ear plugs for you and the rest of the family.  It can drive you crazy in the short term.  To be successful with this technique you have to come in the MOMENT they are calm.  

7. Easy, Easy, Easy, Hard

Research shows if you have positive behavioral momentum with your child, it is much more likely the child will continue to comply.  If you know you have a hard direction to give to your child, consider asking your child to do 2-4 easy, fun directions first before giving them the difficult direction.  Say “Miss Tomboy, please jump on one foot.  Thank you.” then “Miss Tomboy, please touch your nose.  Thank you.” then “Miss Tomboy, please rub your belly.  Thank you.” and finally “Miss Tomboy, please pick up your toys.  Thank you.”  You can give descriptive praise after they follow each one of these commands.

8. Layering in Preparation

Another technique to use BEFORE giving a difficult direction is the layering technique.

  1. First approach you child and talk to them briefly about what they are doing.  “Mr Rockstar that is a cool rocket ship.  Did you build that all by yourself from your legos?”
  2. After talking for a couple minutes say “I am going to come back in a minute and give you a hard direction.”
  3. 2-3 minutes later come back and say “Are you ready for that hard direction?  Mr Rockstar, please unload the dishwasher.  Thank you.”

This seems to work really well especially if the child perceives it as a challenge.  They start worrying about what the “hard” direction is.  Then when you give them the direction they want to prove to you it isn’t really THAT hard and so they quickly comply.  Plus this technique helps them prepare to transition to a new task.

9. I’ll Be Back in Just a Minute

I don’t know about you but we go through phases when it doesn’t seem like I can even find 5 minutes without a child needing me.  One technique to help with children that excessively demand attention or have severe clinginess is to first load them up with attention.  Play with them for 5-10 minutes.  Then say “I will be back in just a minute.”  Walk away and then turn around and come right back.  Repeat this cycle of play, then “I will be back in a few minutes”, leave for a few minutes, and then come back and play again.  Every time you do the cycle you slowly extend the amount of time you stay away.  It goes from 1 minute, to 3 minutes, to 5 minutes, etc.  Eventually you will have 20 minutes all to yourself!  Maybe you can even go to the bathroom without having the kids trying to knock the door down LOL.

"Please pick me up mommy!"
“Please pick me up mommy!”

Summary

  1. Lots of descriptive praise early and often.
  2. Use precision commands so your child knows he is being asked to do something and he doesn’t have to stop and think about it.
  3. Positive practice.  If you have a recurring problem using positive practice is a great correction.
  4. Have your child take a time-out (correctly) for any overt non-compliane or aggression.
  5. Time-out an object.  This is especially useful for younger kids.
  6. Give selective attention – ignore inappropriate behavior such as screaming and whining and reward calm positive behavior with attention.
  7. To create positive momentum give your child a few easy, fun directions followed by the hard direction.
  8. Prepare the child for a hard direction by first showing interest in something they are doing, followed by a warning that a hard direction is coming in a few minutes, and lastly give the difficult direction to the child.
  9. Prevent excessive demands for attention and clinginess by giving the child plenty of attention up-front and then gradually extending the amount of time you are away from the child.

Prevention is Best

Just having a good correction won’t make you have a magically perfect child.  90% of getting good behavior is prevention.  You have to teach you child what is expected of them before hand and prepare them for upcoming transitions or any potential behavioral triggers you are aware of.  Use Positive Practice to teach your child how to take a time out, what is expected of them, how to gently close the door, how to quickly get into the car, etc.  Practice is what kids need.  Not yelling or hitting.  Use Easy, Easy, Easy, Hard and Layering techniques to help prepare your child for a hard direction to prevent a blow-up.  Prevent clinginess by playing with your child and then demonstrating to them that when you say “I’ll be right back.” you will come back when you promise.

One tip a behavioral specialist shared with us is you can only use as many words in a correction as the child is old.  So for a one year old there is a lot of  “No”, “Hot”, a two year old it might be “No Street”, “Stove Hot”, etc.  I think this is a good rule to prevent us from monologuing or trying to talk our kids into behaving form across the room.  Children respond to actions not words from parents.

A brief note on spanking….growing up Hubby and I were spanked.  I think if spanking is done rarely and done correctly it can be ok if you want to use it.  The problem with spanking is almost all adults are angry when they are spanking a child.  Anger associated with any punishment, but especially with spanking, is a huge problem.  You are trying to teach your child to stay in control of themselves and yet you are losing control of yourself while dealing with them.  If spanking can be done without anger, I think it can be effectively used especially in life or death circumstances.  If one of my girls runs into the street I have no problem giving them a spanking and saying “NO”.  But spanking should be a rare event not an everyday correction.  Also, we learned that if you have a sensory child who craves deep pressure they can actually come to crave spankings.  Weird huh?  I am ashamed to say when I was first parenting spanking was the only tool I really had for correction.  I am so glad now that we have much better tools!  Remember stay calm, stay consistent, and mix it up.  Don’t get too tied to one correction.

What are your go to corrections?

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