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Everyday Strategies for Child Behavior: Empowering Providers and Families and Facilitating Change with a Realistic Approach Matt Orr, PhD Department of.

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Presentation on theme: "Everyday Strategies for Child Behavior: Empowering Providers and Families and Facilitating Change with a Realistic Approach Matt Orr, PhD Department of."— Presentation transcript:

1 Everyday Strategies for Child Behavior: Empowering Providers and Families and Facilitating Change with a Realistic Approach Matt Orr, PhD Department of Family & Preventive Medicine University of South Carolina School of Medicine Collaborative Family Healthcare Association 14 th Annual Conference October 4-6, 2012 Austin, Texas U.S.A. Session # D2b October 5, 2012

2 Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3 Objectives At the conclusion of this presentation, the participant will be able to: Provide brief, yet rich, education on child development and behavior that engages and empowers parents in change process Integrate practical behavioral intervention strategies that are conducive to primary care-based office visits Identify and tailor brief interventions that fit the needs and abilities of the family and the child with disruptive behavior

4 Learning Assessment A learning assessment is required for CE credit. Attention Presenters: Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.

5 Moral of the Story, Punch Line, and Bottom Line 5 If we want to understand how to help children regulate their behavior, we must first understand what the behavior is regulating

6 Over Time 6 Goal is long-term growth… Skills that enable the child to adapt to the demands of everyday situations Survival Skills

7 Nature of Behavior 7 Help parents know what they are seeing Empower them with interventions that fit with familys needs & abilities Think Asthma or Allergies

8 Three Targets Over 1 st Two Visits 1. Success: Identify in what situations the child does well & put him in them as often as possible Promoting Task Completion & Productivity 2. Activities: Identify what extra-curriculars child is involved in Promoting Development of a Sense of Competence 3. Play: Use Mother Nature (i.e. movement) to set the stage for success Promoting Situational Self-Regulation 8

9 Anxious Tornadic Highly Active & Impulsive Irritable & Cranky Excessively Talkative Defiant & Annoying 9

10 Whats Out There Already 10 Behavioral Treatment usually means Behavior Modification /downloads/SCORxE%20Behavioral%20handout% 203-1-12%20printing.pdf /downloads/SCORxE%20Behavioral%20handout% 203-1-12%20printing.pdf

11 Pertinent Brain & Behavior (in 2 slides) 11

12 12

13 Temperament 13 Regulatory processes = developmental abilities Tasks that must be mastered Preferences & Quirks Goodness of Fit Match between child & environment

14 Dimensions – Chess & Thomas 14 Activity Level: Low________Hyperactive Regulation: Predictable__________Erratic Initial Response: Approach_________Withdrawal Adaptability: Flexible_____________Rigid

15 15 Intensity: Mild-Mannered______Forceful Mood: Cheery____Serious____Irritable Self-Control: Reflective______Impulsive Concentration: Persistent______Distractible Sensitivity: Unbothered________Reactive

16 Temperament in the Clinic 16

17 17 Dennis Mitchell This superactive young upstart…is active, agile, tireless and hard to catch. He's also inquisitive, imaginative and of an experimental turn of mind, which frequently lands him in situations he can't always control. With his impish grin, he delivers sometimes blunt observations of the truth. While never malicious or mean, the irrepressible Dennis remains a threat to property, the pomposity of adults and quiet afternoons. Adapted from (2009)

18 How was Dennis punished? 18

19 Behavioral Strategies: Establishing Boundaries 19

20 Behavioral Strategy #1 20 Grandmas Rule aka Premacks Principle First broccoli, then cake After shoes put away, then you can go outside

21 Adaptation 21 …and I will sit with you while you finish Come on, Ill walk with you to your room.

22 #2 Modify Time Outs 22

23 #3 Pro-Social Consequences 23 For more serious offenses Lying Stealing Harming others Make them doCommunity Service

24 Cognitive strategies: Teaching problem-solving 24

25 Cognitive Strategy # 1 25 Turn Shoulds into Coulds Creates Options Identifies alternatives & facilitates decision-making Leaves option to explode

26 Cognitive Strategy # 2 26 Replacements Must replace undesirable behavior with a more desirable one

27 Cognitive Strategy # 3 27 Rewind Try that again… Modifies caregiver response Gives child an opportunity to pause & choose more favorable response

28 Everyday Survival Skills for Kids and Parents Six Skills to Survive & Thrive 28

29 1. Modify Expectations 29

30 Common Complaints 30 Children do well when they can They do well in some situations but not others Cannot go into a store without asking for something Cannot sit still for more than a minute Cannot play outside without getting into an argument

31 2. Identify Success 31

32 We Can Only Do What We Can Do 32

33 Put Kids in their Element 33

34 The Message in the Behavior 34 Whats the message here?

35 The Message in the Behavior 35 Take a SNAPSHOT!

36 Whats the Usual Outcome? 36

37 Adaptive Regulation View 37 Behaviors are attempts to adapt to internal signals of discomfort or distress…to self- regulate o Stay awake o Focus o Move o Protect o Defend

38 Adaptive vs. Maladaptive 38 For children, environments (i.e. parents & teachers) determine whether a behavior is adaptive, not whether it helps the child pay attention, sit still, or be compliant Maladaptive behaviors = symptoms

39 3. Get Moving 39 314 - Piano stairs - - The fun theory.wmv

40 Play – Pellegrini et al. 40 Physical activity positively affects classroom attention More calm & relaxed Best in short bursts (20 min. optimum)

41 Proprioception 41 Sensory system involving stimulation to muscles, joints, & tendons Calms & Organizes Considered queen of sensory systems Helps integrate the entire system Includes Vestibular & Tactile senses

42 Proprioception 42 Central role in governance of motor control and planning! (i.e. ADHD) Regulates over- & understimulation Stimulation lasts for only 2-3 hours Recess anyone?!

43 Levels of Play 43 Vigorous Physical Activity – All out free play; sports; game provides the parameters Moderate Physical Activity (think Indoor) Boundaries/rules allow for control Play wrestling; indoor trampoline Fidgeting; Soothing Activities Playing with water Fidget toys

44 Vigorous – Move & Soothe 44 Team sports (especially soccer) Individual sports (swimming, karate, dance) Predictable after-school activity (play, music)

45 Move & Soothe 45 Traction Compression Play Wrestling Rough & Tumble Play

46 Move & Soothe 46 Bounce & Balance

47 4. Fidget to Focus 47

48 Fidgeting 48 Evidence that physical activity is related to central executive functioning – Working Memory ADHD & Non-ADHD We all fidget to focus (Rapport et al., 2009)

49 Move & Soothe 49

50 Playfulness to Recalibrate 50 Try not to smile when a child is laughing…good luck!

51 5. Apply the Breaks 51 Chunk tasks into manageable doses with breaks in between

52 6. Background Sound 52

53 Taming the Wizard Anxiety-Oriented Strategies 53

54 Oppositional & Explosive Behavior 54 Playful (i.e. physical activity) interventions are essential for kids who are: o Intense o Irritable o Insatiable

55 Decisiveness Coach parents to be DECISIVE Refrain from Well see Plan ahead If plans change, parents must prep the team Critical role in establishing emotionally secure atmosphere 55

56 Deflect-Reflect Situation: Child/Teen is in a fit, riddled with anxious-speak; unhappy with some aspect of self or situation Whining Negative self-talk Complaining Blaming 56

57 Deflect-Reflect 57 Maladaptive attempt to seek comfort from parent Conflict ensues because parent cannot meet irrational demands Youre just saying that! You dont understand!

58 Deflect-Reflect 58 Deflection: What do you think you are going to do about that? Reflection: Encourages child to think through/ name a solution At least, sends message I believe its possible for you to be competent You can sort this out

59 Sleep Routine Rhythm Relax (Flexibility) Ex: Sleep-Walk Technique 59

60 Parent Sleep-Walk Strategy Many parents report significant trouble with bedtime routine Consider sleep time vs. bedtime Anxiety does not turn off at bedtime! Not a problem for parents to be part of the bedtime routine; issue is with falling asleep 60

61 Parent Sleep-Walk Strategy Parents need a strategy that allows them to disengage at sleep time while still tending to childs needs for comfort & security Strategy allows parent to progressively disengage from the child when it is time to go to sleep Step-wise 61

62 Parent Sleep-Walk Strategy Child is given a roadmap: After I read to you I am going to Sit on the bed Lay on the floor Sit in the doorway Begin with what child can handle and progress farther away each night or every few days/weeks 62

63 Basic Behavior Management SOS Help for Parents by Lynn Clark, PhD If you seek easy-to-read & do behavior mgmt training for parents 63

64 For Further Reading Effective Parenting for the Hard-to-Manage Child: A Skills- Based Book by DeGangi and Kendall (2008) More detailed exploration of some of these ideas and intervention 64

65 Play – Pellegrini et al. Holmes, R., Pellegrini, A., & Schmidt, S. (2006, October). The effects of different recess timing regimens on preschoolers' classroom attention. Early Child Development and Care, 176(7), 735-743. Retrieved September 15, 2009, doi:10.1080/03004430500207179 Pellegrini, A., Dupuis, D., & Smith, P. (2007, June). Play in evolution and development. Developmental Review, 27(2), 261-276. Retrieved September 15, 2009, doi:10.1016/j.dr.2006.09.001 Pellegrini, A., & Holmes, R. (2006). The Role of Recess in Primary School. Play = learning: How play motivates and enhances children's cognitive and social- emotional growth (pp. 36-53). New York, NY US: Oxford University Press. Retrieved September 15, 2009, from PsycINFO database. 65

66 Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!

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