A Developmental Approach to Behavioral Challenges: Nuts and Bolts Presented by: Jonine Biesman, Psy.D., ABPdN Guest Speaker: Cherisse Sherin, M.A. DIR FLOORTIME COALITION OF CALIFORNIA ANNUAL CONFERENCE, 2014 Some Typcial Problematic Behaviors (Can be Externalizing or Internalizing) • Aggression • Yelling and Screaming • Swearing/Name Calling/Being Cruel to Others • Crying Meltdowns • Difficulty Tolerating Losing • Refusal/Opposition • Conduct Problems (e.g., stealing, lying) • Impulsivity • Disrespect • Withdrawal • Drop in grades • Executive Functioning Weaknesses (e.g., poor disorganization, time management) • Sibling/Family Conflict • Getting Cognitively Stuck • Unable to Move Away from Obsessions and Compulsions • Anxiety • Non-responsiveness DIR/Floortime Coalition of California: October 2014 Conference, Lafayette Page 1 • Seeming to Lack Motivation or Effort • Difficulty Separating; Cannot Seem to be Alone • Cannot Focus Is There a Role for Behavioral Plans? Sure, why not. Never turn away from anything that might possibly be helpful. BUT, in my humble opinion this is just one small piece of a much larger puzzle. Behavioral plans have their limitations. It is akin to putting a band-aide on a wound that requires more care and attention. Behavioral plans can be challenging to implement and are usually based solely on a contingency (if-then) line of thinking. They should be frequently evaluated and re-vamped because children quickly become desensitized to the same rewards and quickly discouraged if they do not earn what is set up. If relying solely on this method of interacting with children, there is no room for the development of internal resources. 101 Nuts and Bolts Strategies: Try the following and please feel free to speak up with “I’ve done this, but…” LET US KNOW YOUR OBSTACLES 1) Regulate, regulate, regulate. You are nowhere without regulation. 2) Offer empathy, reflection, and reassurance. 3) SLOW EVERYTHING DOWN! 4) Focus on the relationship, not the object or conflict itself. 5) Modify the environment as needed. 6) Examine your own responses and tools. The greatest success and progress will actually come with your changes. Stay calm and in control DIR/Floortime Coalition of California: October 2014 Conference, Lafayette Page 2 no matter how out of control your child is. Manage yourself. Don’t take your child’s behavior personally. 7) Be patient. 8) Intimately know your child’s individual profile. 9) Seek parent education and novel ideas. Get really creative. Rely on crowd wisdom. We have to outsmart our kids. 10) Predict and prevent to the degree possible. 11) Stay calm, light, and matter-of-fact. 12) Do not be afraid to set limits. Limits are needed. Certain family rules and values are simply non-negotiable. 13) Do not let your kids see your stress. Sound confident and directive. Know when not to ask a question but instead when to provide structure and let your child know the plan. 14) Give the aura of being “all-powerful.” 15) Reduce language to the degree possible with an out of control child. 16) Don’t try and rationalize with someone who is irrational. 17) Understand the role of underlying emotion and how overwhelming strong emotion is for some children. We must understand these underlying emotions ourselves and help our children to better understand them as well. 18) Think holistically when considering the contributing factors to your child’s behavior. Consider your child’s educational model and the totality of your child’s day. Is there reasonable balance and support? 19) Implement ACTS OF KINDNESS. 20) Make sure your therapeutic intervention is frequent and intensive enough with a focus on generalization. 21) Artfully distract. 22) Offer choices but not too many (two is good and probably no more than three). 23) Be confident that you can help your child figure out the problem. 24) Break their code. Try and figure out what is really being communicated through challenging behaviors or words. For example, if your child is screaming, “I hate you!!!”… You might respond, “I think what you are trying to say right now is that you were really, really disappointed that we did not go to…” DIR/Floortime Coalition of California: October 2014 Conference, Lafayette Page 3 25) Listen to what he/she wants to communicate (e.g., “Tell me your idea. I am listening.”) 26) Don’t butt heads. Learn the art of “Rolling with the Resistance.” Power struggles never get anyone anywhere. Know when to disengage and go about your business. 27) Be okay with compromising, negotiating; and yes, even bribing. 28) Choose your battles; Know when to back off and give time and space. 29) Understand sensory contributions. 30) Get an Occupational therapist to conduct a home visit to help create and rig sensory-regulatory solutions in the home. 31) Know when you need outside professionals. 32) Schedule many times for recovery, bonding, and special dates. We call this re-attachment. 33) Offer positive feedback frequently. Catch the great moments and offer praise. 34) Tap into motivation. 35) Create mastery experiences across settings (home, school, community). Set your child up for success. 36) Identify and build upon INTERESTS AND STRENGTHS (e.g., www.thrively.com). 37) Really appreciate how much bang for your buck you can get from play with a purpose if developmentally relevant. Let your child process their strong feelings through play, to represent their feelings and impulses symbolically where it is safe. Eventually, you will bring their play themes around full circle to reflect on their personal experiences. 38) Know how to direct conversations in a manner that will promote thinking, problem-solving and internal capacities. Don’t underestimate the power of playing dumb. 39) Know when a neurobiological problem will benefit from neurobiological support. 40) Rule out any medical complications. 41) Carefully evaluate sleep and nutrition. 42) Work on developing Big Picture Thinking and Perspective Taking. 43) Use “Thinking Bubbles and Talking Bubbles.” 44) Flush angry feelings down the toilet or bury them in the sand. DIR/Floortime Coalition of California: October 2014 Conference, Lafayette Page 4 45) Ask your children their wishes. What does an ideal day look like to them? 46) Teach your kids about “GRIT.” 47) Agree to use the re-set button; there are ALWAYS opportunities to make good choices and try again. 48) Ensure that your treatment team communicates and brainstorms regularly. 49) Move your child into calm choices when they seem to be over-excited (writing a letter, drawing a picture, listening to music, taking a walk, swinging). Help empower them. 50) Stay on top of Evidence Based Practices and emerging fields such as Neurological Music Therapy. 51) Remain aware and attuned. Read signals carefully. Some children need to be watched much more closely than others (some even moment by moment) 52) Use books and social stories to represent children’s challenges symbolically. 53) Be on the same page with the other primary caregivers in the house. Be predictable, reliable, and consistent. 54) Make sure your child gets enough movement and exercise during the day. It does not have to be organized sports. Exercise can come in many different forms. Mastering sensory motor challenges is excellent for the developing brain. 55) Advocate for your child. If accommodations or educational support services are required, ensure that they are procured and implemented. Don’t be afraid to ask for daily communication from your child’s teacher so you know what frame of mind and body to expect when he/she returns home. 56) If behavior is out of control and unsafe; ensure safety first. Remove dangerous items. Keep a more sterile environment if necessary. Explain repeatedly, as many times as necessary, that violence is not acceptable and yours is not a violent family. 57) Let your child know what he/she CAN do instead. 58) If you are in the car and your child is causing problems, pull over until the situation is stabilized. Do what is necessary to get home safely. DIR/Floortime Coalition of California: October 2014 Conference, Lafayette Page 5 59) Be prepared to change your course and plan for the day if you need to. Your ability to be flexible is vital. Two rigid people never make a situation work. 60) Be aware of placing your child in an unfair situation. Have realistic expectations. 61) Remove yourself and your child’s siblings if you have to, as long as your child can not get hurt. 62) Bring in an outside person such as a neighbor. Sometimes a child will act differently in front of other adult figures for fear of embarrassment or judgment. 63) Create save havens at home and calming spaces. 64) Use humor to diffuse tough situations and defiance. 65) Let your child play head of the household for thirty minutes. 66) Have your teacher talk to your child about their expectations for them at home, if behaviors are difficult at home but not at school. 67) Offer daily structure and visual reminders. 68) Learn from trial and error. If what you are doing is not resulting in change, don’t waste time trying to repeat what has not worked in the past. 69) Be intriguing. Effectively capture attention (e.g., “Wait, wait, wait, wait, wait! I have an AMAZING idea!!!” Or, “Guess what?!! I bet you’ll never guess what I am thinking…”) 70) If your child is having difficulty shifting attention, it may be necessary to offer some help. For example, move in closer. Be explicit (e.g., “It’s time.” “I can see this is really hard for you. I am going to help.”) 71) For very extreme behaviors, don’t be reticent to be direct in communicating to your child when an action is against the law and to contact authorities if necessary.