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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 Paren