Check out Shirley S. Wang’s article, Tantrum Tamer: New Ways Parents Can Stop Bad Behavior in 11/08/11 Wall Street Journal
Ms. Wang reports about findings at Yale University and King’s College, London indicating that the ways in which a parent responds to a child’s disruptive behavior can significantly reduce these behaviors. If you’ve been following my blog posts, this will come as no surprise to you and in fact you may already understand why these findings make sense. The studies at these parenting research clinics essentially use principles of behavioral therapy to help parents shape their child’s behaviors by both eliminating reinforcement of the bad behaviors, skill building (teaching these children alternative behaviors to do when their distress is triggered), and rewarding their child’s successes at managing distressing situations in appropriate, rather than disruptive ways. They call their parent-training model, the ABC’s. The A stands for antecedents; in other words, what was the situation that triggered the tantrum. The B stands for behaviors; what are the target behaviors that the parent wants to eliminate or reduce. The C represents the consequences of the behavior (the goal is to reward a child for not doing the bad behavior at all or for doing a behavior that is less disruptive). They guide parents through a structured training module, that they admit is difficult and requires a great deal of discipline and focus by parents.
I use behavioral shaping principles and techniques every day in my practice with children. When working with children a good portion of treatment involves teaching parents how to respond and more often, how not to respond to behavioral issues. Though I have not yet reviewed the specific studies referenced in the WSJ article, I can see by reading it that some of the children in their studies had anxiety disorders and/or were highly sensitive. They sited an example of a little girl with extreme separation anxiety; something I see in my office weekly. A significant part of what successfully treats separation anxiety is gradual exposure to being separated from Mom(or other significant other). This is what they were doing in the example case that the article used; coaching the mother to move her daughter from her lap, instructing mother not to reassure her daughter, but rather to be neutral and descriptive. Another part of what the psychologists did with the mother-daughter duo, and in fact the focus of the entire article is how the mother responds to her child’s signs of distress. Again, the scientists instructed mother to remain neutral, to not jump in and try to quell her daughter’s distress or rescue her from a situation that triggered fear.
Often kids with anxiety disorders or kids who just have low tolerances for distress react in extreme ways. Sometimes the purpose of the tantrum is to avoid a given situation (A in the studies sited for the WSJ article). Other times, sensitive and anxious children become irritable because managing their internal distress is so very energy and attention consuming. Some children engage in disruptive behaviors to get attention. Doing these behaviors, however, offers nothing positive to the child or parent, unless you consider avoidance of a situation that triggers fear or discomfort a positive, which in the short run it is for the child, but in the long run avoidance only reinforces a child’s fears and low tolerance for distress.
What I do in my practice with parents of children exhibiting behavioral problems is multi faceted. First, one must have an accurate conceptualization of the purpose of the behaviors. Is the child suffering from anxiety? Does he have a very low tolerance for distress? There are many kids who don’t present with clear anxiety symptoms, but who fall into this latter category. They are the ones who can’t stand itchy labels, seams on socks, feeling too hot or too cold, feeling hungry, etc. These are children who are often prescribed sensory integration training (which is a behavioral intervention involving skin brushing of essentially exposing them to the stimuli that distresses them until they habituate). Once I have accurately identified the problem, I must find an appropriate solution, which involves treating the source and managing the behavior problems that reinforce the source problem. If, for example, it is determined that the source of tantruming behavior is to seek attention, then we make sure the parent practices “safe ignoring” during a tantrum. We also might set up a behavioral plan that involves rewarding a kid for resisting the urge to tantrum for specific doable amounts of time. For example, through careful evaluation of the antecedents of a tantrum situation we might see that leaving for school is a vulnerable time for the child. We might set up a behavior management plan that rewards the child for not yelling, throwing things, making threats (the target “Stop Behaviors” must be clearly defined and readily observable to parent and child alike) for 5 minutes of that vulnerable time and reward her to successfully achieving that goal. If, on the other hand, the purpose of the tantrum is to avoid going somewhere that triggers specific anxieties, we treat the fears through gradual exposure to the feared stimuli, and work to eliminate avoidance and other safety behaviors. Since the tantrum in this example is a form of avoidance, we reward the child for controlling herself for chunks of time she can manage in situations that are no too distressing and gradually increase the time spans and broaden the situations.
These are basic, cognitive behavioral principles that most CBT clinicians who work with children utilize as a matter of course. I am so very pleased when I see that proven CBT techniques are brought to the attention of the lay public, as with this article. The article underscores how very important a parent’s role is in determining the course of the behavioral problems that children exhibit. When parents get educated about how they can positively impact their child, this is a powerful tool. This helps parents make educated decisions regarding how to manage behavioral issues and how to know what to ask for when they seek the help of a mental health professional.