Group Therapy for Parents of

Children With Difficult Behavior

2: Understanding Difficult Behavior (Part Two)

Quick Review – The High Points

Our Assumptions

Everybody pretty much does the best they can with what

they’ve got.

Behavioral Problems start when the demands of the

environment or situation overwhelm kids’ ability to cope.

Our ideas about the cause(s) of a problem behavior

always guide what we decide to do about the behavior.

Quick Review – The High Points

Inflexible/Explosive Children Typically:

Are easily overwhelmed

Have trouble thinking through conflicts

Have low frustration tolerance and very intense sense of

frustration

Tend to think in concrete, black-and-white terms

Have trouble with Executive Functions

Putting Aside Feelings

Short-term/working Memory

Planning/Organizing

Shifting Gears

Quick Review – The High Points

Inflexible/Explosive Children Typically:

Have trouble with Sensory Processing

May be over or under-sensitive to stimuli

May have trouble “decoding” or understanding stimuli

We Care About All This Because:

Most kids with behavioral difficulties tend to be diagnosed

with ADHD—which research suggests is primarily a

problem with Executive Functioning!

Sensory Processing Problems are often mistaken for

ADHD.

Sensory Processing Problems often co-occur with ADHD.

Meet the DSM!

The DSM-IV-TR is the American Psychiatric

Association’s big book of diagnostic criteria and

codes. The abbreviation stands for:

Diagnostic and

Statistical

Manual

IV (4th) Edition

Text

Revision

Some Cautions:

Psychiatric Diagnosis is not a perfect science.

The DSM is designed to classify disorders in terms

of reported symptoms and observed behaviors,

without reference to their cause (“etiology”).

However, similar behaviors and symptoms may have very

different causes indeed!

Some criteria can be open to interpretation:

For example: “often deliberately annoys people ” is one

of the criteria for Oppositional Defiant Disorder.

How often is “often”?

How can we be sure a given behavior is deliberate?

Etc.

Diagnosing Psychiatric/Behavioral

Disorders: 5 Axes!

A complete DSM diagnosis includes an assessment on each of 5 “axes” or dimensions:

Axis I: Most Clinical Disorders

Axis II: Mental Retardation or Personality Disorders

Axis III: Medical/Physical Disorders

Axis IV: Psychosocial Stressors

Axis V: “Global Assessment of Functioning” –a number from 1 to 100.

A GAF of 30 or below usually indicates need for inpatient treatment

A GAF of around 70 or above will rarely have need of outpatient treatment

Most outpatient mental health clients fall in around 55.

A Quick Glance at Some Disorders (Axis I)

A Quick Glance at Some Disorders (Axis I)

A Quick Glance at Some Disorders (Axis I)

A Model For Understanding Kids’

Misbehavior

As we try to get a handle on why our kids

misbehave, it can be useful to explore four factors:

The Child’s Characteristics

Physiological/Neurological Conditions – How s/he’s “wired.”

The Parents’ or Caretaker’s Characteristics

Physiological/Neurological Conditions – How s/he’s “wired.”

Family Stress

Can cause parents/caretakers to be less patient/more punitive—

or less attentive! Can also cause kids to be less patient/more

irritable, less attentive!

Parenting Style

What the parents/caretakers do in response to kids behavior.

Doesn’t completely erase the effects of the other three factors,

but can help!

So What Can We Change?

Can’t Do Much About:

The Child’s Characteristics

The Parents’/Caretaker’s Characteristics

Family Stress

We CAN Make Changes in Parenting Style!

Medication can help,

but we can’t

completely restructure

brains and physiology!

We can teach coping

skills, but we can’t

prevent the world from

making demands on

people!

Parenting style doesn’t cause ADHD or other conditions, but certain

styles can increase or decrease the likelihood of disruptive and

noncompliant behavior.

Remember: “Parenting Style” is simply how we respond to our kids’

behavior. It’s not about being a “good” or “bad” parent, but rather about

efficiently and effectively impacting our kids’ behaviors in the ways that

we want!

Behavior Management: The ABCs

Antecedent

(Or Anticipating Action/Event)

Behavior

Consequence

Antecedents: Anticipating Behavior

Prevent misbehavior by making changes in the

setting or environment.

Example: Making sure dangerous items are out of small

children’s reach!

Example: Johnny is more likely to do his class work if

he’s not sitting right next to his best friend!

Example: For Mary, shouting stirs memories of past

abuse. She is more likely to “hear” a reprimand and

correct her behavior if addressed firmly but with a normal

volume of voice.

Consequences

Positive consequences reinforce behavior—they

make behavior more likely to be repeated.

Negative consequences discourage behavior.

But…

If it’s so simple, why is it so hard to manage some

kids’ behavior?

Check the “Wiring…”

Often, the defiant or uncooperative youth has trouble

making the connection between a behavior and its

consequence! Why? Some possibilities that

hopefully sound familiar:

Problems with Attention

Problems with Working Memory

Problems with Receiving or Processing Stimuli

Problems with Shifting Gears

Problems Planning/Organizing a Satisfactory Response

Problems Separating Feelings From the Situation

Getting Through

To Keep the Connection Between Behavior and

Consequence crystal clear, we have to:

Be Specific About Both Expectations and Consequences!

Provide Consequences Immediately!

Especially with kids diagnosed with ADHD!

Be Consistent!

Again—With Both Expectations and Consequences!

To Be Effective, Consequences Must Be:

Meaningful to the Youth

Many kids are motivated more by tangible, immediate

consequences than by intangible, long-term ones: A pat

on the back NOW is worth more than a sense of

accomplishment next week!

Frequent

Remember that verbal praise, smiles, and thumbs-up

gestures can all be Consequences! Folks with ADHD in

particular often do well with a near-constant “patter” of

feedback.

Well-Balanced

If Negative Consequences continually outweigh Positive

Consequences, most of us will lose our motivation.

When We Reward Negative Behavior:

The Coercive Behavior Cycle

Another reason the ‘ABCs’ ain’t so simple is that we

can often inadvertently reward undesirable behavior!

Let’s say we ask Bob to Take Out the Trash….

On a good day, Bob complies--he takes out the trash--and

we get on with our lives:

But a lot of the time Bob is engrossed in video gaming,

and we repeat our request several times:

Request Compliance

Request Noncompliance

When We Reward Negative Behavior:

The Coercive Behavior Cycle (Continued)

After a while we get irritated and escalate the request with

a few threats, raised voice, etc. In response, Bob

escalates his refusal by shouting back, slamming doors,

etc.:

At which point we usually do one of two things:

Try to force Bob to take out the trash

Give up and take it out ourselves

Request!!! Noncompliance!!!

When We Reward Negative Behavior:

The Coercive Behavior Cycle (Continued)

By and large, Forcing people to do things is

inefficient at best (wastes a lot of energy). At worst,

it escalates into physical violence.

And “Giving Up” and taking the trash out ourselves

Reinforces Bob’s noncompliant behavior! We are

rewarding Bob for not complying with our directive!

Think Before You Make a Directive!

If you:

don’t have a consequence planned …

don’t have the energy to follow through with a

consequence ...

You might do more harm than good!

Homework

Take a look at your parenting style—particularly

when things don’t seem to be working. Check your

requests/directives—are they specific and clear?

Are your consequences immediate, consistent, and

meaningful to your kid? Are the negative

consequences outweighing the positives and

sapping your kid’s motivation to comply?

Remember to think through your directives and

consequences.

Don’t give up!

Further Reading / Resources

Books

Barkley, Russell A. (1995). Taking Charge of ADHD,

Revised Edition: The Complete, Authoritative Guide for

Parents. New York: The Guildford Press.

Barkley, Russell A., and Benton, Christine M. (1998). Your

Defiant Child: Eight Steps to Better Behavior. New York:

The Guildford Press.

Barkley, Russell A., and Benton, Christine M. (1998). Your

Defiant Teen: Ten Steps to Resolve Conflict and Rebuild

Your Relationship. New York: The Guildford Press.

Further Reading / Resources

Websites

ADHD

http://www.russellbarkley.org/

http://www.drhallowell.com/

Childhood Psychiatric Disorders

http://www.aacap.org/cs/resource.centers

Miscellaneous Psychiatric Disorders, Interventions, Etc.

http://www.wellnessproposals.com/mental-health-library-

index.html