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Battle of the Wills: Tools For Dealing With Difficult Behaviors in Children

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Battle of the Wills: Tools For Dealing With Difficult Behaviors in Children Shanna Neff, MSN, PMHNP-BC Family Psychiatric and Mental Health Nurse Practitioner – PowerPoint PPT presentation

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Title: Battle of the Wills: Tools For Dealing With Difficult Behaviors in Children


1
Battle of the Wills Tools For Dealing With
Difficult Behaviors in Children
  • Shanna Neff, MSN, PMHNP-BC
  • Family Psychiatric and Mental Health Nurse
    Practitioner
  • Creekside Counseling

2
Thoughts, Pearls and Caveats
  • Dealing with difficult behaviors in a child is
  • DIFFICULT
  • Remember, your child is not their behavior.
  • Behavior is what your child does, not who she is.
  • You want your child to feel loved and accepted
    regardless of their behavior.
  • Your ability to help them is tied to your ability
    to separate your childs identity from their
    behavior.
  • Behavior can be changed.

3
Remember
  • There are many paths that lead to the same
    destination
  • There is no ONE Right Way.

4
Session Goal
  • Explore concepts of Dialectical Behavior Therapy
    as they relate to managing behavioral
    difficulties in children
  • Examine the role emotions play in interactions
  • Adopt new assumptions about self, child, and
    behavior
  • Learn strategies to de-escalate intense
    emotional reactions and teach your child to
    express and manage their emotions in productive
    ways

5
Dialectical Behavior Therapy (DBT)
  • Is a type of therapy that combines standard
    Cognitive-Behavioral Therapy techniques and
    mindfulness techniques to help a person modify
    their behaviors and regulate their mood and
    emotions more effectively.

6
Why Use A DBT Approach With Children?
  • Provides a framework to develop skills that will
  • Enable a person to become a more effective parent
  • Help parents to develop a more positive
    relationship with their child
  • Allows a person to become more aware, accepting,
    and appreciative of reality while still
    motivating one to improve
  • Improves self-acceptance and acceptance of others

7
Emotions, Thoughts, and Behavior
8
Understanding Emotions
  • Primary emotions
  • Biologically based, nearly automatic, instinctive
  • Secondary emotions
  • Occur when we react to our primary emotion
  • We have more control over the development and
    utilization over secondary emotions

9
Example
  • Scenario you have just been notified that your
    child was involved in an altercation with another
    student at their school
  • Possible primary emotions
  • Alarm, Fear, Anger
  • When you arrive you are informed that your child
    was the victim and not the instigator
  • Secondary emotions
  • Guilt, Indignation, Need for justice/retribution

10
Emotional Behavioral Continuum
Intensity of Reaction Event Initial Reaction Delayed Reaction
Less intense Child A Gets up Resumes Tells parents about event
Child B Gets up, whimpers, resumes Tell family and friends of event
Child C Gets up, throws skateboard, walks away defeated Wont discuss Becomes irritable
Child D Stays on ground, cries, wait for someone to help, does not get back on skateboard Responds to comfort, may discuss with others later
More intense Child E Gets up crying, runs and screams for help, does not get back on skateboard Does not respond to comfort Cries for long time Acts angrily toward others
11
Assumptions and Judgments
  • What assumptions do YOU make about the behaviors
    of each child?
  • How do YOU judge each child based on their
    behaviors?

12
Responding Emotionally, Reasonably, and Wisely
Emotion mind Reasonable mind Wise mind
Interpretations and responses are dictated in the moment by feelings Perceptions of reality may be distorted so that facts of situation appear to coincide with feelings Emotions are not involved in decision making Perception of reality is based on logic and rationale Decisions are based on evaluating a situation as a whole by incorporating logic and feelings
Frustration, anger, short-temper, yelling Calm and unaffected by surrounding emotional distress Thinking wisely creates a sense of calm ability to make clear decisions
Difficult to problem solve Uncomfortable with emotions and dont understand them in others Allows one to adjust and respond to changes more easily
What type of mind do you typically operate
from? What type of mind does your child typically
operate from?
13
Nature versus Nurture
  • Emotion Dysregulation
  • Interaction between your responses and your
    childs responses
  • Unintentional Invalidation

14
Thoughts - internal phrases, attitudes, beliefs,
or images you say to yourselfFeelings
physiologic reactions in your body that shape
your experienceBehaviors are the result of
thoughts and feelings
15
The Story of Emotion
  • Vulnerabilities or Risk Factors
  • Prompting Event or Trigger
  • Thoughts and Beliefs About the Event
  • Body Sensations or Responses
  • Emotion(s)
  • Behaviors and Actions Outcome
  • Your awareness at each of the above steps allows
    you to make changes and effect the outcome of an
    event or incident.

16
Effective Parenting
  • Interacting and/or responding to your child in
    ways that enable you to achieve your parenting
    goal to help you child grow with self-esteem,
    values, and a belief in himself.

17
DBT Assumptions
  • Your child is doing the best he/she can
  • Your child needs to do better, try harder, and be
    more motivated to change
  • Your child wants to do things differently and
    make things better
  • Your child must learn new behaviors
  • Family members should take things in a
    well-meaning way (benefit of the doubt)
  • There is no absolute truth

18
Practice the Assumptions
  • Which assumption do you think will help you most?
  • Which assumption will challenge you the most?
  • Consider how an assumption would change how you
    would feel or respond to your child
  • Describe the situation (What happened? What did
    you feel)
  • Write down the assumption
  • Describe a possible new response
  • Describe what you think the outcome would be
    based on the new response

19
Mindfulness Responding With Focus In The Moment
  • Take a step back
  • Observe
  • Separate the facts of the situation from the
    emotions
  • Respond with purposeful awareness (turn off the
    auto-pilot)

20
Nonevaluative Thinking Judging vs. Describing
Phrases That Judge Phrases That Describe
That is unacceptable behavior. Your behavior is not going to help you get what you want.
You are such a good boy. Thank you for doing what I asked.
I wish my child didnt cause so many problems. My child often breaks house rules and does not seem to listen to what I say.
You are great! I enjoy the time we spend together. I like when you tell me about what happened during your day.
21
Validation
  • The importance of validation
  • Acceptance and change
  • How to make validating statements
  • Find a way to act with a wise mind
  • Look at your child in a new way
  • Explore what is getting in the way (judgment)
  • Make a validating statement
  • PRACTICE!

22
Parenting Roles, Goals, Expectations
  • Interact and Communicate in Ways that Work
  • Assess your goals
  • Develop priorities
  • Feel effective
  • Assess your goals
  • What do you want to accomplish now?
  • What is the most important goal I have?
  • How do I want both of us to feel when this is
    over?

23
Parenting Roles, Goals, Expectations
  • Develop priorities
  • Do you want to set limits or give consequences
    for behavior?
  • Do you want to find out what was upsetting your
    child in the first place?
  • Do you want to communicate more effective ways of
    expressing feelings?

24
Parenting Roles, Goals, Expectations
  • Feeling effective
  • Evaluate the outcome of an event
  • Do not judge the effectiveness of your behavior
    based on your childs response
  • Be fair with yourself
  • Did you respond with an emotional, reasonable, or
    wise mind?
  • Did you stay calm?
  • Did you stay focused?
  • Did you accomplish what you set out to do?

25
Incorporating Balance
Balanced Thinking Unbalanced Thinking
Acceptance and Hope Black and White Thinking
Independence and Assistance Extreme thinking, behavior, and consequences
Choices and Limits Restricting independence versus a free rein
Giving In and Choosing Priorities Ignoring problematic behaviors
Goal Be Flexible.
26
Shifting Gears
Begin to apply principles to your child.
27
Your Childs Story of Emotion
  • Identify your childs vulnerability or risk
    factors.
  • Lack of sleep problem at school change in
    routine.
  • Identify your childs triggers.
  • Limits separation change your feelings
    siblings.
  • Imagine how your child view the world?
  • Recognize your childs body sensations.
  • About to cry speaking louder or faster avoids
    eye contact.
  • Name the emotions.
  • Indirectly speak about how others might feel
    this way if
  • Change the outcome by teaching alternative
    behaviors.
  • Discussing an event alone time alternative
    behaviors are not punishment.

28
Understanding What Your Child Is Telling You
  • Accept your childs truth.
  • Focus on reality not specifics.
  • Acknowledge things that are important to your
    child.
  • Dont minimize, judge, or try to fix.
  • Create a validating home environment.
  • Welcome the expression of ALL feelings.
  • Acknowledge positive and negative emotions in
    others.
  • Observing behaviors in others is less threatening
    for a child.
  • Share positive activities.
  • Dont reinforce negative emotions with more
    attention.
  • Talk about your own feelings.
  • Model the expression of feelings without
    burdening your child.

29
Ways to decrease the possibility of emotional
outbursts
  • Create routines
  • Develop consistent rules and expectations
  • Limit activities
  • Make your home a safe haven

30
When Your Child is Overwhelmed by Emotions
  • Provide opportunities for pleasure and mastery
  • What does your child enjoy? What activities bring
    your child happiness? What does your child do
    well?
  • Find ways to steer your child into activities and
    situations that challenge them and offer an
    opportunity for rewarding growth?

31
De-escalate When Your Child is Experiencing
Overwhelming Emotions
  • Remain calm yourself
  • Speak with a soft tone of voice
  • Slow down your breathing
  • Use wise mind
  • Take a step back to observe the situation in
    order to find a more effective response
  • Describe the situation dont judge

32
Help Your Child Calm Down
  • Assist your child to engage in calming activities
  • Provide a safe and soothing environment
  • Dont make demands in the middle of an outburst
  • Validate even when the anger is directed at you
  • Be accepting and nonjudgmental
  • Get feedback and input from your child

33
Behavioral Principles
  • Do not assume the worst.
  • Do not be judgmental.
  • Validate your child.
  • Be responsive, not reactive.
  • You can lose the battle and still win the war.
  • It takes TWO to engage in power struggles.
  • Remember to balance your responses (be flexible).
  • Choose the most effective response.

34
Behavioral Principles
  • Reinforcers or Reinforcement increase the
    probability that a behavior will occur again
    and/or increase how often the behavior occurs.
  • Punishment Decreases the probability that a
    behavior will occur again.

35
Reinforcement
  • Increase the effectiveness of a reinforcer by
  • Choosing them with your child
  • Evaluate, modify or discard based on their
    effectiveness (even if chosen by child)
  • Using the reinforcer when your child has not
    already had access to it
  • Providing several reinforcement choices (so your
    child doesnt get bored).

36
Reinforcers
  • Are not bribes.
  • Need to be provided as immediately as possible
    that your child begins to associate the
    reinforcement with the immediately preceding
    behavior.
  • Intermittent Reinforcement reinforcement is
    provided occasionally so that the child may
    increase frequency of behaviors in order to get
    desired reward
  • Remember that this principle applies to both
    positive and negative behaviors

37
Reinforce Incompatible Behaviors
Behavior To Decrease Behavior To Increase/Reinforce
Yelling Using a softer voice
Demanding Using the word please
Cursing Acknowledge days with no abusive language
Destruction Acknowledge days or periods of time without aggression
Hitting others Expressing anger in words
To reduce your childs negative behaviors,
provide reinforcement when he is demonstrating
the appropriate (desired) behavior.
38
Shaping
  • Teaching your child how to complete a series of
    tasks by reinforcing small, gradual steps that
    move toward a larger goal
  • Break the overall behavior into small, manageable
    behaviors that your child can accomplish.
  • Reinforce completion of the first behavior until
    he is able to follow through consistently on that
    behavior.
  • Once first behavior is consistent, add another
    expectation and reinforce when both behaviors
    occur.
  • Add another behavior to all previous behaviors
    and only reinforce when that new behaviors joins
    all the others.
  • Repeat until all expectations can be met by your
    child reinforcement now only occurs when the
    child has met the overall goal.

39
Contracts
  • Increase your childs use of effective behaviors
  • Enable your child to feel good about their
    success
  • Aim for improvement not perfection
  • Explicitly state the conditions under which a
    reinforcer will be given and what the reinforcer
    will be
  • If you (behavior child must do) then (you will
    respond in a certain way).

40
Punishment
  • Involve taking something away or doing something
    the child does not like.
  • Effective punishments are given immediately, are
    specific and time limited, and are in proportion
    to the severity of the crime.
  • Natural consequences are effective and complete
    (no additional punishment necessary). Saving or
    protecting your child from natural consequences
    does not help him to learn OR become responsible
    for their actions.

41
Punishment
  • Reinforcement is more effective than punishment.
  • Reinforcement teaches your child how to behave.
  • Punishment teaches your child how not to behave
    and does not often provide an opportunity to
    teach alternate behavioral strategies.
  • Punishment yields negative outcomes while
    reinforcement yields positive outcomes.

42
Guidelines for Punishment
  • There are times when punishment is needed
  • Time-out is an effective punishment as it removes
    the child from the social situation (where he
    might be inadvertently reinforced), and gives the
    child time to calm down.
  • The child may come out of time-out when he is
    calm, but not before.
  • Avoid taking things away instead give access to
    it when the child is behaving effectively.

43
Conclusion Back to You
  • Self-care
  • Learning new ways to behave (think and feel) is
    difficult not only for your child, but for you
  • Acceptance
  • Denying reality only leads to more suffering
  • Recognize what can and cant be changed
  • Dont judge yourself
  • You become less effective.
  • Ask for help
  • Friends, family, baby-sitter, support group,
    health care provider, counselor, etc.

44
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