Parent to Parent: Family Training on AD/HD Session 3 to Parent: Family Training on AD/HD ... effective parenting strategies/interventions. ... • Set and clarify behavioral limits/boundaries.

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  • 3-1CHADD Parent to Parent 2008Revised 9-2010

    Parent to Parent:Family Training on AD/HD

    Session 3

    Developing Parenting Strategies and Positive Behavior Interventions

    Behavior Management - Part I

    CHADD Parent to Parent 2008 3-2

    Revised 9-2010

    Questions We Will Answer

    What are two management strategies for behavior problems?

    What are six types of proactive strategies?

    What are the most important house rules in your home?

    What are tips for using reinforcement effectively?

    What are the 10 steps to designing a token program?

    How do you design a response cost program?

    How do you know when to use what intervention?

    CHADD Parent to Parent 2008 3-3

    Revised 9-2010

    Deficits in Executive Functioning

    Deficits in Executive Functioning (EF) undermine the childs ability to use internalcontrol to regulate behavior.

    Therefore, the behavior of children with AD/HD is more externally controlled than children without AD/HD.

    Children with AD/HD are strongly influenced by the: Conditions of the immediate environment

    Availability of immediate rewards

  • 3-2CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-4

    Revised 9-2010

    CHADD Parent to Parent 2008 3-5

    Revised 9-2010

    Common Behavior Problems

    Failure to think prior to acting

    Noncompliance to rules

    Repeats past mistakes

    Verbal and/or physical aggression

    Lack of concern or sensitivity for others

    Needs immediate gratification - doesnt work for long-term incentives

    Poor problem-solving skills and internalization of the rules

    Easily frustrated - poor anger control

    Disorganized - poor response to time

    CHADD Parent to Parent 2008 3-6

    Revised 9-2010

    Two Management Strategies for Behavior Problems

    Proactive Strategies

    These interventions are implemented prior to the onset of a behavior.

    Proactive interventions are designed to minimize the occurrence of an inappropriate behavior.

    Reactive Strategies

    These are interventions that are implemented afterthe onset of a behavior.

    Reactive interventions use rewards to encourage appropriate behavior or punishment to discourage inappropriate behavior.

  • 3-3CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-7

    Revised 9-2010

    Creating an AD/HD Friendly Environment within the Home

    The following Proactive Strategies can help create an AD/HD friendly environment at home:

    Establish a parental division of labor Both parents must work together and be consistent!

    Form daily routines/schedules

    Provide space to be AD/HD

    Organize the environment

    Maintain a disability perspective

    Establish house rules

    CHADD Parent to Parent 2008 3-8

    Revised 9-2010

    Creating an AD/HD Friendly Environment within the Home

    Kids with AD/HD NOT Welcome!

    Parenting Style Does Not Cause AD/HD, but It Can Influence the Characteristics!

    CHADD Parent to Parent 2008 3-9

    Revised 9-2010

    Disability Perspective

    Adopting a disability perspective provides the foundation for parenting a child with AD/HD.

    A disability perspective shapes

    a parents responses to the

    childs symptoms of AD/HD.

    A disability perspective encourages the parent to be supportive, positive and sensitive to their child with AD/HD.

    Look, Mommy! I let the sunlight in.

  • 3-4CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-10

    Revised 9-2010

    Principles of a Disability Perspective

    Children with AD/HD Have a legitimate medical condition that

    undermines the ability to regulate their behavior. Have the same need/desire as other children to

    gain acceptance from others. Can improve their conduct with the assistance of

    effective parenting strategies/interventions. Should be expected to make gradual rather than

    rapid behavior progress. Will respond more favorably to supportive/positive

    discipline strategies than to rejecting/punitive discipline strategies.

    CHADD Parent to Parent 2008 3-11

    11-2008CHADD Parent to Parent 2008 3-11

    Revised 9-2010

    CHADD Parent to Parent 2008 3-12

    Revised 9-2010

    Establishing House Rules

    House rules provide clear behavioral expectations for the child with AD/HD.

    The house rules help to:

    Set and clarify behavioral limits/boundaries.

    Emphasize the importance of specific parental expectations.

    Maintain the awareness of the specific parental expectations.

    Make sure that there is consensus in the family about the house rules.

  • 3-5CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-13

    Revised 9-2010

    How to Form House Rules

    Hold a family meeting to brainstorm a list of potential House Rules.

    Select three to five of the rules from the list to be the House Rules that are non-negotiable. Parents retain the right to determine the final list.

    State the House Rules in specific, objective language. (i.e., do not say be responsible say put your dishes in the dishwasher.)

    Establish rewards and punishments for compliance or violation of the House Rules.

    Post the House Rules on charts that can be easily read.Remember to explain the rules to the child do not just post the rules.

    (contd.)

    CHADD Parent to Parent 2008 3-14

    Revised 9-2010

    How to Form House Rules

    Each week, target a House Rule for emphasis. Highlight or circle this House Rule on the chart and pay added attention to compliance / violations of this rule.

    Each night, review examples of instances in which your child complied or violated a House Rule.

    CHADD Parent to Parent 2008 3-15

    Revised 9-2010

    Reactive Strategies

    Reactive strategies are evidence-based behavioral interventions.

    Reactive strategies use positive/negative incentives called reinforcement or punishment to encourage or discourage appropriate or inappropriate behaviors.

    The behavioral consequences are applied after the occurrence of a behavior and thus are reactive rather than proactive.

  • 3-6CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-16

    11-2008

    CHADD Parent to Parent 2008 3-16

    Revised 9-2010

    CHADD Parent to Parent 2008 3-17

    Revised 9-2010

    A Changing Behavior ToolToken Economies

    Token economies are one of the most effective behavioral interventions for children with AD/HD.

    These strategies use a symbolic token to provide immediate reinforcement.

    The child earns a token for each occurrence of the appropriate behavior.

    The child may exchange the tokens for a valued reward when a predetermined number of tokens is collected.

    CHADD Parent to Parent 2008 3-18

    Revised 9-2010

    Types of Tokens

    Effective token programs use high-interest and novel tokens that maintain the childs interest and motivation.

    Suggestions include:

    Stickers

    Dot-to-dot charts

    Magic Grid

    Commercial programs

    Tangible objects poker chips, peg boards

  • 3-7CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-19

    Revised 9-2010

    Reinforcement (Reward)

    Guidelines

    The value of reactive interventions depends on the effective use of reinforcement.

    Guidelines are:

    Immediacy - apply right after the good behavior

    Frequency use often to encourage repetition of good behavior

    Novelty maintain interest in the reinforcement

    Enthusiasm communicate the importance of the good behavior

    Description specify the connection between the action and the consequences

    CHADD Parent to Parent 2008 3-20

    Revised 9-2010

    Limitations of Rewards

    The change is generally gradual rather than dramatic.

    The change may not persist after the reinforcement is discontinued.

    The reinforcement does not directly weaken the inappropriate behavior.

    CHADD Parent to Parent 2008 3-21

    Revised 9-2010

    Benefits of Rewards

    Sustains motivation and effort during low interest tasks.

    Highlights the connection the cause/effect link between the appropriate behavior and the positive outcome a reward.

    Directs attention to the outcome of a behavior.

    Enhances the childs sense of competency.

    Fosters a positive parent-child relationship.

    Builds the strength of good habits.

  • 3-8CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-22

    Revised 9-2010

    Three Types of Reinforcement (Rewards)

    Edible treats, favorite dinner

    Material toys, CDs, video games, clothing

    Activities or Privileges playing a board game, wrestling time with dad, bike ride with parents, later curfew, money for gas

    CHADD Parent to Parent 2008 3-23

    Revised 9-2010

    Ten Steps to Designing a Token Program

    Step 1: Select one specific behavior to target.

    Non example: Clean your room

    Example: Put your dirty clothes in the clothes basket.

    Step 2: Model the appropriate behavior for your child.

    Step 3: Select the tokens (or chart) to be used.

    Step 4: Select the reinforcement to be used.

    Step 5: Determine how many tokens must be acquired to earn a reinforcement.

    (contd.)

    CHADD Parent to Parent 2008 3-24

    Revised 9-2010

    Designing a Token Program

    Step 6: Determine the time period in which the target behavior will be monitored.

    Step 7: Put the terms of the program in writing.

    Step 8: Display the contract in a visible location.

    Step 9: Start the token program and monitor progress.

    Step 10: Identify obstacles to progress and make adjustments in the program as necessary.

  • 3-9CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-25

    Revised 9-2010

    Example: Justins Token ProgramKeep Hands to Self Chart

    Time of Day Kept Hands To Self

    6:00 to 6:30 Yes No

    6:30 to 7:00 Yes No

    7:00 to 7:30 Yes No

    7:30 to 8:00 Yes No

    8:00 to 8:30 Yes No

    Rules: For each yes, a sticker is earned. When Justin has earned four stickers, he may select an item from his reward menu.

    CHADD Parent to Parent 2008 3-26

    Revised 9-2010

    Justins Daily Reward Menu

    30 minutes extra TV time with Mom/Dad before bedtime

    Wrestling with Dad before bedtime

    Favorite dessert for dinner the next night

    $1.00

    Board game with Mom or Dad before bedtime or on the weekend with a set time with mom or dad

    CHADD Parent to Parent 2008 3-27

    Revised 9-2010

    Developing Token Programs:Cautions

    Begin with modest goals. Dont overreach. Target a behavior that you believe will be

    easy for your child to alter. Start slowly. Implement the program for a brief

    period of time each day and slowly extend its length as you feel more competent.

    Give reinforcement a chance to work. Do not rush into the use of punishment.

    Be consistent and stick to the agreed terms of the contract.

    Be fair. Do not withhold reinforcement that your child has earned because he/she has done something else that is inappropriate.

  • 3-10CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-28

    Revised 9-2010

    Benefits of a Token Program

    The token program clearly specifies the behavioral expectation(s).

    Tokens provide the child with the incentive needed to sustain the effort to make a change in behavior.

    Tokens help a child make the link between what they did right and a favorable outcome.

    The tokens cue the onset of the appropriate behavior.

    CHADD Parent to Parent 2008 3-29

    Revised 9-2010

    Example: Jakes Cell Phone Chart

    TIME OF DAY STAYED OFF THE CELL PHONE

    6:00 to 6:30 p.m. Yes No

    6:30 to 7:00 p.m. Yes No

    7:00 to 7:30 p.m. Yes No

    7:30 to 8:00 p.m. Yes No

    Rules: If Jake earns at least three yes marks between 6:00 and 8:00 p.m., he may select a privilege from his reward menu.

    CHADD Parent to Parent 2008 3-30

    Revised 9-2010

    Jakes Reward Menu

    May use the cell phone from 8:00 p.m. to 10:00 p.m.

    Have screen time from 8:00 p.m. to 10:00 p.m.

    $5.00 worth of gas

    Permitted to go to a friends home until 10:00 p.m.

    Money for a car wash

  • 3-11CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-31

    Revised 9-2010

    Activity 1: A Token of My Affection

    Behavior of Concern:

    Meg is an eight-year old child that often tattles on her older brother. The tattling creates frequent conflicts between Meg and her brother. Use the blank chart found on the next slide to design a token program to reward no tattling.

    CHADD Parent to Parent 2008 3-32

    Revised 9-2010

    Megs No Tattle Tale Chart

    MONITORING SESSIONS MEG REMEMBERED NOT TO TATTLE

    Rules:

    CHADD Parent to Parent 2008 3-33

    Revised 9-2010

    Advanced Token Programs

    Advanced token programs target more than one behavior at a time or break a complex behavior into smaller, sequential steps.

    For example, performing homework might be divided into four separate behaviors:

    Recording the homework

    Bringing appropriate materials home

    Completing the homework

    Turning the homework in to the teacher

  • 3-12CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-34

    Revised 9-2010

    Behavior Reward ChartMorning Routine

    Week of 9-12 thru 9-16PAYOUT

    Get out of bed within 2 requests 4 Tickets

    Put on your clothes that are laid out 4 Tickets

    Brush Teeth 4 Tickets

    Come to breakfast within 2 requests 2 Tickets

    Take your backpack to school with you 2 Tickets

    Go out and wait for the school bus by 8:15 a.m. 6 Tickets

    TOTAL that can be earned daily 24 Tickets

    Monday Tuesday Wednesday Thursday Friday

    CHADD Parent to Parent 2008 3-35

    Revised 9-2010

    Behavior Chart

    What can I purchase with my tickets?

    1. One hour TV time in evening on school days 6 Tickets

    2. Ice cream cone after dinner 6 Tickets

    3. Half hour of dads time to help me with homework

    6 Tickets

    4. One hour of computer games before bedtime 10 Tickets

    5. A toy valued at $10 to be purchased with mom or dad at a time specified by mom or dad

    150 Tickets

    CHADD Parent to Parent 2008 3-36

    Revised 9-2010

    Evaluating the Success of the Program

    Parents sometimes incorrectly decide that the token program is ineffective when it is providing benefits.

    Keep these considerations in mind when determining the effectiveness of your program:

    Expect gradual rather than rapid progress.

    Ask yourself the following questions:

    Is the behavior occurring less often?

    Is the behavior lasting for a shorter duration?

    Is the behavior less intense or severe than

    before?

  • 3-13CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-37

    Revised 9-2010

    Free Response Cost:Do It or Lose It!!!

    In a free response cost program, the tokens are freely provided at the onset of the program.

    These programs have several advantages: It is very useful to reduce the rate of high

    frequency inappropriate behaviors. The loss of a token is less frustrating because the

    child is not losing something that was previously earned.

    The programs are easy to design and implement. The tokens provide a firm and visible behavioral

    boundary. The programs are adaptable to public settings.

    CHADD Parent to Parent 2008 3-38

    Revised 9-2010

    Designing a Free Response Cost Program

    Select the target inappropriate behavior (e.g. swearing)

    Collect data. How often does it occur within a certain period of time?

    Give tokens to the child on a scale that reflects the behavior. (Swearing 10 times per hour, give seven tokens.)

    Determine when and how long the behavior will be monitored.

    Remove a token for each occurrence of an inappropriate behavior.

    If the child has at least one token remaining at the end of the monitoring session, provide the incentive.

    CHADD Parent to Parent 2008 3-39

    Revised 9-2010

    Example: Connies Swearing Free Response Cost Program

    Target Behavior Number of Tokens

    Swearing 1 2 3 4

    Rules: Connie will be monitored for swearing between 7:00 p.m. and 9:00 p.m. each week night. Connie will lose one token each time she says a swear word as defined by her parents. If Connie has at least one token remaining at 9:00 p.m., she may stay up until 9:30 to watch TV.

  • 3-14CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-40

    Revised 9-2010

    Allens Free Response Cost Program

    Time # of Tokens Tokens Remain?

    5:00-5:30 1 2 3 Yes No

    5:30-6:00 1 2 3 Yes No

    6:00-6:30 1 2 3 Yes No

    6:30-7:00 1 2 3 Yes No

    Target Behavior: Breaking House RulesRules: 1. Allen will lose 1 token each time he violates 1 of the posted House

    Rules.2. If Allen has at least 1 token left at the end of each half hour, he will

    earn a yes.3. If Allen earns at least 3 yes marks in an evening, he may select an

    item from his reward menu.

    CHADD Parent to Parent 2008 3-41

    Revised 9-2010

    Allens Reward Menu

    30 additional minutes of screen time at night.

    Board game with Mom/Dad.

    $2.00

    Special Dessert.

    Pillow fight with Mom/Dad.

    CHADD Parent to Parent 2008 3-42

    Revised 9-2010

    Free Response Cost in Public Places

    Free response cost is particularly useful in public locations such as:

    Restaurants

    Malls

    Car trips

    Grocery stores

    Classroom settings

  • 3-15CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-43

    Revised 9-2010

    Using Free Response Cost in Public Places

    Example #1: John is a seven year old child who misbehaves at the grocery store.

    His mother explains the rules of conduct while at the store.

    His mother provides him with 4 tokens.

    John loses one token for each rule violation.

    If John has at least one token remaining when his mother is finished shopping, he earns a milkshake.

    CHADD Parent to Parent 2008 3-44

    Revised 9-2010

    Using Free Response Cost in Public Places

    Example #2: Carol acts out whenever her parents take her for a long ride in the car.

    Carols parents explain the rules of the road.

    Carol is provided with 3 tokens for a 15 minute ride.

    One token is removed for each rule violation in the 15 minute period.

    If Carol has at least one token remaining at the end of the ride, she earns 30 minutes extra screen time.

    CHADD Parent to Parent 2008 3-45

    Revised 9-2010

    Review: When to Use What

    Token Economies Advantages:

    Clearly specifies behavioral expectations

    Provides frequent reinforcement to sustain effort

    Tokens cue appropriate behavior

    Tokens link the appropriate behavior with the outcome

    Token Economies Limitations:

    Requires more time and effort to design and implement

    Must be cautious not to make the program too complex

  • 3-16CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-46

    Revised 9-2010

    Review: When to Use What

    Advanced Token Economies Advantages:

    Use with complex behaviors that need to be broken down into smaller tasks

    Replaces frustration while learning a new skill with feelings of progress and success

    Advanced Token Economies Limitations:

    Require more planning, modeling and monitoring

    CHADD Parent to Parent 2008 3-47

    Revised 9-2010

    Review: When to Use What

    Free Response Cost Advantages:

    Easy to design and implement

    May easily be used in public places

    Quick way to reduce high frequency, inappropriate behaviors

    Provide a specific and visible behavioral boundary

    Free Response Cost Limitations:

    Does not teach or reinforce appropriate behavior

    Loss of token may frustrate some children

    CHADD Parent to Parent 2008 3-48

    Revised 9-2010

    What My Child Should Know

    Mom and Dad are going to teach him/her how to organize his/her room and clothes.

    The family will be following a list of House Rules.

    There will be a designated space in the home for play and toys.

    Mom and Dad will be setting up a chart with incentives to earn prizes or privileges.

    Mom or Dad will discuss the rules of behavior before a long trip or outing to a store.

  • 3-17CHADD Parent to Parent 2008Revised 9-2010

    CHADD Parent to Parent 2008 3-49

    Revised 9-2010

    Questions We Have Answered

    What are two management strategies for behavior problems?

    What are six types of proactive strategies?

    What are the most important house rules in your home?

    What are tips for using reinforcement effectively?

    What are the 10 steps to designing a token program?

    How do you design a response cost program?

    How do you know when to use what intervention?

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