Parents often seek out psychotherapy services to help remediate their children’s behavior problems. There is little evidence to support that play therapy alone is an effective treatment for childhood behavioral problems.
For childhood behavior problems to be effectively remediated, it is necessary for parents to be included in the treatment, if not be the sole participators in the psychotherapeutic process. Depending on the age of the child and symptoms, children may be included in very few sessions.
Parental Psychotherapy Intake
Parents first have an intaking session for psychotherapy. It is common during the intake for behavior therapists to see a parent explain her child’s behavior problems, and place the blame on the child for the behavior, and frequently fail to see how their own actions or passivity have contributed to these problems.
At the outset, parents should be made aware that they will be primary participants in the psychotherapy process. If behavior is the primary issue, behavior modification and parenting skills should be the primary treatment.
The first step in parenting skills and behavior modification for the treatment of childhood behavioral disorders is psychoeducation to the parents regarding the process and theory. It is important for parents to understand that every behavior has a specific function. Functions for behaviors are reviewed with parents. People behave for several reasons and for every behavior there is some type of reinforcement that a person is gaining, even if only for a second. People (and children) do not engage in a behavior unless it is in some way self-serving.
Functional Behavioral Assessment
Each function of behavior should be explained to parents at the outset of therapy. There are five main behavioral functions that should be explained to parents. The first function of behavior is attention seeking. It is often the case in childhood behavioral disorders, in which the child’s behavior serves the purpose of gaining the parents’ attention. Parental attention may not always be positive. It may be reinforcing for a child to receive negative attention from his parent as well, such as a parent yelling at a child.
The second function of behavior that is reviewed with parents is an escape/avoidance, especially when faced with depressions. This means, that a person may engage in a particular behavior to avoid undergoing a task that he finds aversive. It is important for parents to understand that if a child is engaging in a behavior to avoid a certain task, they must not give in and allow the child to avoid that take, but persist until the child completes the task that he was trying to avoid. Otherwise, the child will learn that by engaging in this behavior he is permitted to escape from doing what he is required to do.
A third function of behavior involves getting something tangible. People go to work because they receive monetary gain. Children cry in a store because they receive candy. If a child receives something tangible for behavior, it is likely that is the function of the behavior. Fourthly, people engage in behaviors due to medical reasons.
For childhood behavioral disorders, it is always important for a skilled therapist to rule out medical conditions as a function for specific behaviors. Finally, sensory issues may be the function behind behavior. If a child is flapping his hands for sensory stimulation, the function of the behavior is sensory. It is important for a behavior therapist to rule out sensory issues before beginning a behavioral management program.
Once parents understand the functions of their children’s behavior, they are ready to begin devising a plan to extinguish these behaviors. If it is determined that a behavior is attention-seeking, then parents are trained to ignore those behaviors. Parents should be warned that a behavior is likely to escalate before it extinguishes. This is known as an “extinction burst.” The behavior will get worse before it gets better. It is important to review with parents that their resiliency and remaining calm are crucial to successfully extinguishing and attention seeking behavior.
Behavior therapists may teach parents deep breathing skills or other relaxation techniques to manage their own emotions when trying to extinguish their child maladaptive behaviors. If the function of behavior is determined to be escape/avoidance, the behavior therapist will work with parents on maintaining consistency and enforcing rules, as not to give into a child’s attempts at avoiding a certain task.
It is important for two parents to both be consistent, as well as any other caretakers or babysitters that are involved in child care. Starting a behavioral management program involves setting up tangible reinforcers for the child. This means the child earned something tangible for engaging in specific behaviors. A reward chart is helpful in achieving this. Children may earn a certain number of stars or points, which add up to a specific prize. Similarly, a punishment system may also be put in place if the child disobeys or engages in negative behaviors.