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Care Givers' Skills Program: (5)
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A CHECKLIST FOR YOUR CHILD'S TARGET BEHAVIOURS

Check the box before each target behaviour that applies to your child.

Your Child's Name:

Group I: Active Manipulations

In these three target behaviours you will notice the child escalating his defiance toward his parents in order to get his way.

    1. Not Doing as Told - Disobedience

IA: very common; HM: very common

When your child is told to do something, he may fail to respond for different reasons. The child may choose to ignore your request, may not have learned to pay attention when being addressed, or may be an expert at tuning out. You may end up repeating the request more loudly, eventually yelling and threatening. Finally, when he is "ready"-and you are thoroughly exasperated-the child may finally comply. Does this sound familiar?

Our goal will be to get your child to respond immediately following your calm and firm request. Does this seem strict? Good. Children do not develop psychological scars by complying with a reasonable request. Parents are encouraged to be strict - although not punitive. Being strict involves setting guidelines and boundaries; being punitive hurts. Once guidelines on "fair" expectations are drawn, children seem much more content.

If your child responds appropriately in some other way, such as by asking, "Mummy, may I first finish what I'm doing?" then you should react reasonably. For example, if you say no, you should have a good reason. Children need to learn good assertive communication skills, which can develop only if parents treat their assertive requests fairly. But if the answer is still no with a good reason, then the child should comply immediately with the request.

Doing as they are told (compliance) is a very important target behaviour in the CSP for IA or HM children. We focus on behaviours that occur early, and long before the child loses control. If we rigorously and successfully focus on this behaviour, notice that very few of the more out-of-control behaviours will ever occur.

Goal: Immediate response to requests or commands, with very few lapses.

    2. Defying Commands - Defiance

IA: rare; HM: very common

HM (ADHD) children's response to commands often is overt defiance. A child may talk back, saying, "No, I won't" or may do the opposite of what you asked, for example, deliberately throwing down a toy when told to pick it up. The child may take on a sarcastic tone of voice or fold her arms across her chest as if to say, "No, I'm not going to, and you can't make me!" Defiance needs to be dealt with immediately. You'll learn how to do so in later sections.

Defying commands also is a behaviour that occurs early in the sequence of misbehaviours. If we focus on this behaviour, more severe behaviours, such as the next one-temper tantrums-will be prevented from occurring.

Goal: No defiant behaviour. None!

    3. Temper Tantrums

IA: rare; HM: very common

Temper tantrums are the target behaviour most frequently reported by parents of problem children. Many parents say that their child is a darling until they say no to the child's request. Then the battle ensues, often with parents finally giving in. Unfortunately, the parents' surrender actually reinforces the tantrums. The child learns to scream, slam doors, and fall on the floor in a rage in order to get his or her way.

Tantrums do not usually decrease as a child gets older; in fact, they typically get worse and may even carry over into adulthood. Practiced over many years, they become a deeply ingrained habit that can destroy many relationships. For married couples undergoing counselling, temper tantrums are reported frequently as a problematic behaviour. In almost every case, such tantrums begin in childhood.

Some critics say that children should be taught to express their feelings. The issue is how the feelings are expressed. We can teach offspring to express feelings assertively, such as "Mother, I'm angry at you because you aren't listening!" Expressing feelings through temper tantrums, however, should not be allowed.

Other critics view tantrums as necessary for ventilating anger that builds up in the child. Research shows that every violent outburst leads to an even more violent outburst and allowing frequent expressions of violent temper actually makes the behaviour worse over time. An occasional tantrum is normal, even for adults. But if tantrums occur more than a few times a year, then the behaviour should be targeted.

Goal: No more than four or five temper tantrums a year.

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Group II: Verbal Manipulations

The target behaviours in this group involve common verbal patterns that the child uses to get his way. Ask yourself if they work when used on you.

    4. Poor-Me Statements

IA: very common; HM: very common

Poor mes are self-deprecating statements or personal put-downs.

Examples are:

Sometimes these statements are more humorous exaggerations:

More serious statements include:

Although such drastic statements as "I want to die" and "I'm going to kill myself" are most often manipulative, to be on the safe side, parents must always seek immediate professional help for children who use them often. A professional cam best assess whether such threats should be taken seriously.

Also included in the poor-mes are such behaviours as pouting (hanging-lip syndrome), whining (puppy-dog syndrome) and crying (manipulatively, to get attention or to get his or her way).

Crying due to physical pain, exhaustion, or serious stress, which should only happen occasionally, is not a targeted behaviour. Sometimes crying serves as a release for tension, but even this should only occur occasionally. Often when parents say a child is sensitive we find a child who is an expert at making poor-me statements and who cries to manipulate.

Psychiatrist Thomas Harris, author of the best-seller I'm OK- You're OK (1969), notes that people who view themselves negatively and believe they're not OK behave in ways that perpetuate the feeling. Developing such an attitude can lead to a lifelong battle with depression. Children who get in the habit of repeating not OK statements about themselves (the poor-mes) can start to believe them, resulting in a negative self-image. Verbal rehearsal can lead to internalizing - a psychological term that means they begin to believe what they have been saying. Such statements are probably firmly internalized by age ten. Curbing such statements before they become internalized beliefs is of utmost importance.

In the following sections you'll learn exactly how to curb these verbal patterns.

If a child makes poor-me statements only rarely, you can comfort or console the child appropriately. But if poor-mes are frequent, nurturing will reinforce them and increase their frequency.

Note: If a child who has not previously expressed poor-me statements suddenly begins to show this behaviour, attempt to learn if something specific may be troubling the child-perhaps a problem at school-and then try to remove it. The behaviour will probably stop.

Goal: Very few expressions of poor-me statements. More than once or twice a month is excessive and requires work.

    5. Negative Statements

IA: common; HM: very common

Negative statements are the flip side of poor-me statements. Rather than personal put-downs, they criticize other people or situations, suggesting the attitude that "You're not OK."

Examples are:

The sooner you can identify and correct these statements - preferably in early childhood - the better the personality development of the child. Youngsters who internalize these beliefs by age ten learn to see the outer world as negative. They can become cynical, critical, angry, and hostile. Trying to alter this attitude by adolescence becomes particularly difficult.

Goal: Only very few expressions of negative statements.

    6. Nagging

IA: rare; HM: very common

A child's nagging or repeatedly asking for something after he or she has been told no proves particularly annoying to many parents. When you tell your child no, explain why you are saying no. If your reasonable answer is still no and the child continues to nag, discipline should follow immediately but only the method of discipline covered later in the program. Be patient.

Goal: No nagging.

    7. Interrupting

IA: rare; HM: very common

The child who constantly interrupts when you are talking to others can be as annoying as the child who nags. In extreme cases a child may even interrupt when you are on the telephone, possibly by picking up an extension to demand something from you immediately. Interruptions should be allowed only to report a dangerous or aggressive situation.

Goal: No interruptions.

    8. Physical Complaints

IA: fairly common; HM: fairly common

When a child frequently complains of vague pains or of generally not feeling well but you have no indication of an actual medical disorder, the result can be that you won't believe your child when something is really wrong. As with poor mes and negative statements, a child can come to believe (internalize) his physical complaint and turn into a lifelong hypochondriac.

Physical complaints most often occur when a child wishes to avoid a normal but stressful situation, such as a spelling test at school. Sometimes a truly stressful situation may underlie the complaint - an overly critical teacher, for example, or a bully. In such cases if you can eliminate the problems, the complaints will disappear.

In the absence of excessive stress or any real physical malady, treat frequent physical complaints as manipulative and an inappropriate target behaviour.

Unless your child exhibits symptoms of a real illness, send him or her to school. You can always ask a teacher or school nurse to contact you if the symptoms get worse. If you are uncertain, consult your family physician.

Goal: No physical complaints unless the child is truly ill or feeling pain.

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Group III: Inattention Behaviours

All these target behaviours connect in a pattern of the child's "not thinking." Remember, this is the cognitive pattern of IA or HM (ADD or ADHD) children. You'll notice how each behaviour is connected to the others, which means that each of these behaviours contributes to the overall pattern of inattention.

    9. Not Paying Attention - Inattentive

IA: very common; HM: very common

For many parents, the central problem of the IA or HM child is his inability to pay attention and remember things. As you probably realize, talking to such a child can be an exercise in futility. Children with attention problems are experts at tuning out. But just as being able to pay attention is a learned behaviour, so is inattentiveness.

Attention has three parts: looking, listening, and remembering. Our first concern is visual attention, which you can observe easily. The child's eyes should focus directly on a task or directly on the adult speaking. Teachers call this "staying on task."

Goal: Set a strict goal for visual-task attention; eyes should divert only very briefly.

Focus next on auditory attention, which you cannot observe directly. To check whether the child is listening, you must ask, "What did I just say?"

Goal: If the child consistently cannot answer correctly, then listening should be treated as a target behaviour; the goal should be to answer correctly every time.

Last, consider remembering or, conversely, not forgetting, which is a crucial behaviour to develop in youngsters with attention problems. Most such children have been trained not to remember what they are told to do because parents repeat commands, nag, prompt, coach, or issue warnings. These are the techniques promulgated by other behavioural approaches; they defeat the goals of the CSP. The child has little incentive to use his own mind. If your child constantly tells you, "I forgot," when you ask, "Why haven't you done this?"- or when you ask your child who is not on task, "What are you supposed to be doing?" and his response is a completely bewildered look - then treat forgetting as a target behaviour that will have negative consequences. Your child can learn to remember. It is a learned skill just like any other target behaviour.

Goal: Allow no forgetting.

Overall Goal for Attention: The ability to keep eyes on work, to listen attentively, and to remember what has been said, with very few lapses.

    10. Helplessness and Dependency

IA: very common; HM: very common

Three forms of dependency overlap considerably:

1.    Task dependency involves a child needing excessive support and prompting in order to begin or complete a task. With the IA or HM child, the task that readily comes to mind is homework.

2.    Cognitive dependency involves not thinking throughout the day. The child does not pay attention to how to behave correctly in different environments, such as a restaurant, a grocery store, or the classroom. He doesn't monitor his own behaviour throughout the day.

3.    Emotional dependency is an irrational belief that one cannot be alone. The emotionally dependent individual experiences strong feelings of anxiety (fear) when alone. Emotional dependency also involves a second belief that an individual must always have someone taking care of him.

The IA or HM child's hallmark is the first two forms of dependency: task dependency and cognitive dependency. Currently popular behavioural treatments highly reinforce both patterns. Sitting with the child during homework and constantly prompting and guiding her work helps to get the task done but reinforces the child's task dependency. When you sit with your child, she doesn't learn to concentrate on her own and actively figure out how to complete the task. Focusing and concentrating on a difficult task requires considerable energy and resolute motivation.

Research also shows that IA or HM children have difficulty organizing their work without help; when they do the work, it's done in a hasty and sloppy fashion. Here, too, popular methods involve helping children organize and coaching them to work neatly.

IA or HM children can do the work, can organize their materials and can work neatly without constant coaching. You can show them one or two times how to organize but do not continue to prompt and coach thereafter. Let the consequences, which we'll soon learn, do the work. They'll then learn quickly.

In the CSP program once all target behaviours are well controlled, about 80 percent of the children automatically begin performing school-related tasks, such as homework and class assignments, quite well. Often these children do know how to organize their work and do not really have skill deficits. Often their grades and the quality of their work improve to a passing grade level without teaching them organizational skills or constantly coaching them to work neatly. For the remaining 20 percent, a school program can be designed to enforce meaningful consequences as an external way to help motivate these children. In most cases it succeeds.

Coaching and reminding throughout the day before entering new environments is also suggested in other approaches. This reinforces cognitive dependency. Some research indicates that IA and HM children lack the requisite social skills. Again this coaching reinforces the "not thinking" and the "not remembering" of these children. In the CSP when the coaching is eliminated and instead consequences are enforced, these children dramatically change in less than two weeks, demonstrating that they knew exactly how to behave, that they could control themselves, and that they do know the proper social skills.

Research on whether the constant coaching espoused by other approaches ultimately contributes to developing emotional dependency is lacking. However, because the CSP minimizes coaching and mobilizes independent functioning, it's safe to say that the program doesn't encourage the development of emotional dependency. In addition, in the CSP it is recommended that parents not do everything for the IA or HM child but instead should teach him skill building: teach and require him to perform self-help skills, including making his own bed, cooking, doing laundry, and so on. How to accomplish this is discussed in the next section. Sharing in household responsibilities helps children feel good about themselves, gain confidence and feel like an integral and important family member.

(Notice that verbal manipulations such as poor mes, negative statements, and physical complaints occur very frequently with each form of dependence. Work on all these target behaviours simultaneously.)

Goal: The ability to work independently and assume responsibility. Very rarely coach, remind, prompt, help, or warn the IA or HM child. Enforce the consequences, using discipline methods described later, without warning.

    11. Dawdling

IA: common; HM: common

The child who begins tasks slowly and takes more time than necessary to complete them is a deliberate dawdler. Frequently, for example, the dawdler isn't ready on time for the school bus. Parents then wind up rewarding the child by driving her to school. Dawdling when doing homework is very common with both IA and HM children. By sitting and helping them, you are actually reinforcing the dawdling.

Goal: Only very rare instances of dawdling-and never on school mornings.

    12. Poor Reading Skills

IA: very common; HM: very common

Attention disorders and poor reading often go hand in hand. Many children diagnosed with IA or HM have been diagnosed with dyslexia, which means they have impaired reading ability. The reasons underlying reading problems are enormous and complex. Treatment usually involves relearning the fundamental reading skills taught earlier in school and approaching them slowly.

    13. Poor School Performance

IA: very common; HM: very common

IA and HM children are of normal intelligence but consistently receive D's and F's in most academic subjects. Often these children are held back at least once in school and their academic problems are the primary reason they are referred to psychologists. As noted, not paying attention has a lot to do with the poor academic performance of IA and HM youngsters.

To repeat: In 80 percent of my cases, when the home behaviours are completely under control, school performance automatically improves.

If school performance does not improve, teachers will need to deal with the following target behaviours:

Academic Performance (IA and HM students)

    1. Not staying on task (or not paying attention)

    2. Not finishing work on time

    3. Not doing work neatly

    4. Not doing work correctly and accurately and thus consistently getting grades lower than C (or a similar standard depending on the school's grading system).

Conduct (HM students only)

    1. Failing to be quiet - noisy

    2. Not staying in seat - fidgeting and running around

    3. Blurting out questions without politely raising a hand

    4. Pushing in line rather than waiting and walking in line

There is a section devoted exclusively to analyzing and treating problems with school performance should it remain a problem after completely improving at home.

Goal: No grades below a C and no poor conduct grades. Many IA and HM children can begin to earn A's and B's.

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Group IV: Other Common Misbehaviours

These target behaviours also apply frequently to youngsters with attention problems, especially those in the highly misbehaving category.

    14. Tattling

IA: fairly rare; HM: fairly common

All children tattle occasionally. When tattling occurs frequently, treat it as a target behaviour. In most cases it is recommended that you tell the tattler to work things out with the other child. Working things out means being assertive and using good communication skills. Earlier we discussed inappropriate verbal behaviours - the poor mes, negative statements and temper tantrums. When we discussed these verbal patterns, the importance of teaching your child appropriate communication and assertion skills was mentioned. Recall our discussion about how to substitute angry outbursts with assertive expressions of feelings. Don't try to teach the skills at the moment a target behaviour occurs, because that inadvertently reinforces or conditions the behaviour. If you talk with your child at the moment she is tattling, she becomes conditioned to getting attention and nurturing by tattling. You'll later learn how to discipline the tattler to avoid inadvertently reinforcing this verbal pattern.

It is best to try not to interfere, whether the problem involves playmates or siblings. Children develop social skills by trial and error and developing appropriate social skills requires particular effort from IA and HM children.

Tattling is allowed, of course, if the child being tattled on is doing something dangerous or has become physically aggressive. In such cases tell the tattler she used good judgement in coming to you.

Goal: A minimum of tattling.

    15. Fighting with Siblings

IA: fairly common; HM: very common

Sibling fights create problems for many families. All siblings sometimes get on one another's nerves and bicker or argue among themselves. The behaviours of HM children can seriously annoy siblings; getting these behaviours under control often automatically improves sibling relationships. (One note: parents should never tolerate physical aggression of any kind and should always deal with it strongly, as advised in the discussion of aggression as a target behaviour.)

In dealing with sibling fights, avoid asking, "What's going on here?" Once each child has related his side of the story, you will have little idea who actually did what to whom. Instead, discipline both parties immediately without asking questions. Of course if you have observed directly who initiated the conflict or if you recognize a pattern of disruptive behaviour from one child rather than the other, you may discipline that child only. Keep in mind, though, that a child who looks like an angel may still be guilty of secret taunting and teasing.

Allow children to work out their differences themselves. One useful technique for cutting down on sibling fights is to allow children to enter one another's bedrooms only with permission (assuming children have their own rooms). Then a child who wishes to avoid a fight can quickly retreat to his or her room.

Goal: No more than three or four loud, disturbing fights a year. However, allow mild squabbles and let siblings iron out their differences.

    16. Aggression

IA: rare; HM: occasionally

Aggression - violent contact with others, whether directly or using objects as weapons - is a low-frequency, high-priority behaviour. Not many children exhibit aggressive behaviour, but immediate action must be taken with those who do. A specific diagnosis of this disorder is defined for HM (ADHD) with aggression, and there is a separate section of this program devoted to the control of aggressive behaviour.

Goal: No aggressive behaviour except when absolutely necessary for self-defence.

    17. Lying

IA: fairly common; HM: fairly common

A child may lie to avoid punishment or to gain something she probably would not get by telling the truth. Like aggression, lying is a low-frequency, high-priority behaviour and should be dealt with at the earliest age possible. Children who lie early on become extremely skilful liars as they get older, and their lies become increasingly difficult to detect.

Many parents ask about imaginary play or fantasy, which is perfectly normal and should be permitted. Of course, imaginary play should decrease considerably as the child approaches the age of ten.

Goal: No lying.

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Care Givers' Skills Program: (5)
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Acknowledgement: The content of this program is based on Ritalin Is Not The Answer: A Drug-Free, Practical Program for Children Diagnosed with ADD or ADHD by David B. Stein, PhD (Jossey-Bass, 1999 paperback) 
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