Dealing with Youth with Challenging Behaviors

Challenging Behaviors

Dealing with Youth with Challenging Behaviors:

Why Kids Act the Way They DO

Presented By Mark Purcell, Psy.D., M.Ed.

Presented by Mark Purcell, PsyD. 1 Challenging Behaviors

A,B,C’s of Behavior

All behavior serves a purpose. Understanding the events prior to the behavior, the purpose of the behavior, and the consequences can help us understand what may reinforce it. Think of a youth you work with whose behavior is problematic for you or others. Describe the A, B, C’s of the behavior  A (antecedent): What was going on prior to the behavior? When does the behavior typically occur?,  B (behavior): Specifically what is the behavior? What context?  C (consequences): What are the consequences following the behavior? What does the youth get from the behavior? What reinforces the behavior?

A, B, C’s of Behavior

A (Antecedent)

B (Behavior)

C (Consequence)

Bio Psycho Social Assessment Think of a youth you work with whose behavior is problematic for you or others. Then, try to identify factors which may be contributing to the behavior based on three domains: Biological, Psychological, and Social. When possible, identify the specific behavior that is impacted by the factor.

Factors Affecting Youth’s Behavior & Interpersonal Interactions

BIOLOGICAL

PSYCHOLOGICAL

SOCIAL

Biosocial Theory

Conflict Cycle

• Stressful event ACTIVATES youth’s irrational beliefs (“Everyone hates me”)

• Beliefs TRIGGER intense feelings

• Feelings DRIVE inappropriate behaviors

• Inappropriate behaviors INCITE others

• Others MIRROR negative behaviors

• Negative REACTION escalates conflict into self-defeating power struggle

• Reinforcement of SELF-FULFILLING PROPHECY

Aggression Replacement Training

Anger Control Group Outline

1. A,B,C’s of Aggressive Behavior

2. Triggers

3. Cues & Anger Reducers

4. Reminders

5. Self-Evaluation

6. Thinking Ahead

7. Angry Behavior Cycle

8. Rehearsal of Full Sequence

Skills Practice

Dialectical Behavior Therapy: Mindfulness

States of Mind

Emotional Mind Wise Mind Rational Mind  Feeling - Centered  Thoughts + Feelings  Thought – centered  Logical thinking is  Integrate best of  Emotions are ignored difficult emotional & rational  Focus on Facts & Logic  Facts are distorted to minds  Feelings of self & others match mood  Viewing situation with not considered  You may be impulsive or loving detachment  Cool and detached “Hot Headed”  Observing & responding  Operate in “Robot” Mode  Emotions are in control  Not Intense Reacting  Emotions influence and  Not Cool Distancing control your thinking &  Operate in “Wise” behavior Mode  Operate in “Emo” Mode

DBT: Distress Tolerance Skills

DBT: Interpersonal Effectiveness Skills

Three Goals of Interpersonal Interactions • Get what you want • Maintain effective relationship • Maintain Self-Respect

DEAR MAN • Describe, Express, Reinforce, Mindfully listen, Act confidently, Negotiate

DBT: Validation Validation strategies require professional to search for, recognize and reflect to the client the validity inherent in his/her response to events. With difficult youth, parents and professionals have to catch them while they're good in order to reinforce their behavior. Similarly, the therapist has to uncover the validity within the client's response, sometimes amplify it, and then reinforce it. When a person confides in you, they are not usually looking for advice or problem-solving unless they specifically ask for it. Rather, they are looking for validation. Level One: Listening Non-judgementally Overall show interest in the other person (through verbal, nonverbal cues), show that you are paying attention (nodding, eye contact, etc.) Ask questions - "What then?" Give prompts - "Tell me more," "Uh-huh."

Level Two: Accurate Reflection Use accurate reflection - "So you're frustrated because you son hasn't picked up his room." Summarize what the person is sharing, then ask - "Is that right?" Take a nonjudgmental stance toward the person, be matter-of-fact, have an "of course" attitude. Example: "My therapist doesn't like me." Validation: "You are feeling really certain she hates you." Note that you don't have to actually agree with the person about their perceptions.

Level Three: Articulating Unspoken Thoughts and Feelings Try to "read" a person's behavior, imagine what they could be feeling, thinking or wishing for. It feels good when someone takes the time to think about our life experiences. Remember to check for accuracy. It is best to not make assumptions.

Level Four: Understanding the Historical Background of a Behavior Validate the person's behavior in terms of causes like past events present events even when it may be triggered based on dysfunctional association. *Validate feelings like, "Since your new boss reminds you of your last one, I can see why you'd be scared to meet with her," or "Since you have had panic attacks on the bus, you're scared to ride one now."

Level Five: Confirming Thoughts, Behaviors and Feelings Based on Current Circumstances Communicate that the person's behavior is reasonable, meaningful, effective. *Validate feelings like, "It seems very normal to be nervous before a job interview - that sure makes sense to me," or "It sounds like you were very clear and direct with your doctor."

Level Six: radical genuineness, which requires the therapist to speak authentically Treat the person as valid - not patronizing or condescending. Recognize the person as they are with strengths and limitations. Give the person equal status, equal respect. Be genuine with the person about your reactions to them and about yourself. Believe in the other person while seeing their struggles and pain. DBT: Behavior Chain Analysis

Example

Creating an Environment for Positive Change Control versus Change

Think of the environment in which you work with the youth you serve. Which components are in place that are aimed at controlling their behavior. Which components are aimed at changing behavior. See if you can propose interventions aimed at change for interventions that are currently aimed at controlling behavior.

Control Change

Positive Discipline

IDENTIFYING PROBLEM BEHAVIOR  Identify underlying need behind behavior  Identify problematic behaviors (not youth)  Clarify desired behavior  Reinforce positive behaviors  Discover youth strengths  Provide opportunities for belonging  Seek mutual responsibility among youth  Encourage use of “I” Statements

RESPONDING TO PROBLEM BEHAVIOR  Set clear consistent consequences  Validate youth feelings first  Identify problematic behaviors  Offer cooling off place not punishment  Make first request for adaptive behavior  Reinforce (+) or Make second request  Remind youth of consequences  Reinforce (+) or Implement Consequences

EFFECTIVE INTERACTIONS  Ignore (-) behaviors / Attend (+) behaviors  Even, calm, yet firm tone of voice  Remain matter-of-fact  Model 3 R’s:  Recognize mistake  Reconcile  Resolve

IDENTIFYING PROBLEM BEHAVIOR  Identify underlying need behind behavior  Identify problematic behaviors (not youth)  Clarify desired behavior  Reinforce positive behaviors  Discover youth strengths  Provide opportunities for belonging  Seek mutual responsibility among youth  Encourage use of “I” Statements

Presented by Mark Purcell, PsyD. 13