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Evidence-Based Psychosocial Evidence-Based Psychosocial Treatment of ADHDTreatment of ADHD
Developed by the Center for School Mental Health with support Developed by the Center for School Mental Health with support provided in part from grant 1R01MH71015-01A1 from the provided in part from grant 1R01MH71015-01A1 from the
National Institute of Mental Health and Project # U45 MC00174 National Institute of Mental Health and Project # U45 MC00174 from the Office of Adolescent Health, Maternal, and Child Health from the Office of Adolescent Health, Maternal, and Child Health
Bureau, Health Resources and Services Administration, Bureau, Health Resources and Services Administration, Department of Health and Human ServicesDepartment of Health and Human Services
What works for ADHD?What works for ADHD?
All of the evidence-based practice All of the evidence-based practice elements for use in ADHD have their elements for use in ADHD have their basis in Clinical Behavior Therapy. basis in Clinical Behavior Therapy. We will first cover the basic premises We will first cover the basic premises
behind behavior therapy, then cover the behind behavior therapy, then cover the specifics of effective interventions for specifics of effective interventions for ADHDADHD
What doesn’t work for What doesn’t work for ADHD?ADHD?
Treatments with little or no evidence of Treatments with little or no evidence of effectiveness includeeffectiveness include Special elimination dietsSpecial elimination diets Vitamins or other health food remediesVitamins or other health food remedies Psychotherapy or psychoanalysisPsychotherapy or psychoanalysis BiofeedbackBiofeedback Play therapyPlay therapy Chiropractic treatmentChiropractic treatment Sensory integration trainingSensory integration training Social skills trainingSocial skills training Self-control trainingSelf-control training
Clinical Behavior Therapy: Clinical Behavior Therapy: TheoryTheory
Proposed Mechanism:Proposed Mechanism: Individuals with Individuals with ADHD have difficulty understanding ADHD have difficulty understanding the consequences of their actions.the consequences of their actions.
Approach:Approach: Application of the principles Application of the principles of of social learning theorysocial learning theory to modify to modify children’s behavior by training parents children’s behavior by training parents and teachers to manipulate and teachers to manipulate environmental antecedents, environmental antecedents, consequences and contingencies. consequences and contingencies.
The ABC ModelThe ABC Model
Behavior
Consequences
Antecedents
Contingencies
An example: The ABC ModelAn example: The ABC Model
BehaviorStudent ignoresbell while rest of
class takes out mathbooks
ConsequencesTeacher yells at
student
Antecedent9:30 bell signals
beginningof math period
The ABC ModelThe ABC Model
BehaviorStudent takes out
math book
ConsequenceTeacher smiles
at student
Antecedent9:30 bell signals
beginningof math period
Contingencies
Teacher makes eye contact with student, says, “Take out your math books.”
Specific interventions to help Specific interventions to help the student with ADHDthe student with ADHD
Psycho-education with parentPsycho-education with parent Parent praiseParent praise Commands/limit settingCommands/limit setting Tangible rewardsTangible rewards Response costResponse cost Parent monitoringParent monitoring Time outTime out Ignoring or DROIgnoring or DRO
Parent PsychoeducationParent Psychoeducation
Engage and empower parents by Engage and empower parents by teaching them about ADHDteaching them about ADHD
Establish relationship with parents as Establish relationship with parents as partner in treatment processpartner in treatment process
Look at how ADHD influences parent-Look at how ADHD influences parent-child interaction (bi-directional)child interaction (bi-directional)
Parent PsychoeducationParent Psychoeducation
Review information about ADHDReview information about ADHD SymptomsSymptoms CausesCauses Diagnostic criteria (3 sub-types)Diagnostic criteria (3 sub-types) Treatment modalitiesTreatment modalities
Emphasize caretaker role in Emphasize caretaker role in development and treatment of ADHDdevelopment and treatment of ADHD Problems in parenting and parenting Problems in parenting and parenting
styles may make ADHD worsestyles may make ADHD worse Establishing behavioral interventions at Establishing behavioral interventions at
home or at school require caretaker home or at school require caretaker involvementinvolvement
Knowledge enables parents to more Knowledge enables parents to more effectively advocate for better serviceseffectively advocate for better services
Parent PsychoeducationParent Psychoeducation
Parent PsychoeducationParent Psychoeducation
More effective if therapist devotes More effective if therapist devotes more than one session to more than one session to psychoeducationpsychoeducation
More effective if therapist educates More effective if therapist educates parents about ADHD across multiple parents about ADHD across multiple settings (home, school, playground, settings (home, school, playground, etc)etc)
Resources for Parent Resources for Parent PsychoeducationPsychoeducation
Center for Children and FamiliesCenter for Children and Families ““What Parents and Teachers Should What Parents and Teachers Should
Know about ADHD”Know about ADHD”
Children and Adults with Attention-Children and Adults with Attention-Deficit/Hyperactivity Disorder Deficit/Hyperactivity Disorder (CHADD)(CHADD) Fact sheets for parentsFact sheets for parents
Resources for Parent Resources for Parent PsychoeducationPsychoeducation
National Initiative for Children’s National Initiative for Children’s Healthcare QualityHealthcare Quality ““How to Establish a School-Home Daily How to Establish a School-Home Daily
Report Card”Report Card” Vanderbilt Assessment Scales (parent and Vanderbilt Assessment Scales (parent and
teacher version)teacher version) ADHD Resources Available on the InternetADHD Resources Available on the Internet ““Working with Your Child’s School”Working with Your Child’s School”
Parent praiseParent praise
Training parents to praise Training parents to praise correctly increases compliance in correctly increases compliance in youth with ADHDyouth with ADHD Praise can include Praise can include
Verbal praise, EncouragementVerbal praise, Encouragement AttentionAttention AffectionAffection Physical proximityPhysical proximity
Giving effective praiseGiving effective praise
Be honest, not overly flatteringBe honest, not overly flattering Be specificBe specific No “back-handed compliments” (i.e., No “back-handed compliments” (i.e.,
“I like the way you are playing “I like the way you are playing quietly, why can’t you do this while quietly, why can’t you do this while I’m on the phone?”)I’m on the phone?”)
Give praise immediatelyGive praise immediately
Training parents to praise Training parents to praise childrenchildren
Barkley manual, Step 2 (Defiant Children)Barkley manual, Step 2 (Defiant Children) Teach parents to set up “special time” to pay Teach parents to set up “special time” to pay
attention to their child during playattention to their child during play Teach parents to narrate their child’s playTeach parents to narrate their child’s play Teach parents not to ask many questions nor Teach parents not to ask many questions nor
give any commandsgive any commands Teach parents to ignore misbehavior during Teach parents to ignore misbehavior during
this playtimethis playtime Teach parents how to praise and praise Teach parents how to praise and praise
lavishly during this timelavishly during this time
Training parents to praise Training parents to praise teensteens
Barkley manual, Step 3 (Defiant Teens)Barkley manual, Step 3 (Defiant Teens) Encourage parents to set aside 15 minutes a few Encourage parents to set aside 15 minutes a few
times a week to pay attention to their adolescenttimes a week to pay attention to their adolescent Teach parents to pay attention to what their teen Teach parents to pay attention to what their teen
is doing, and show interest in a relaxed wayis doing, and show interest in a relaxed way Teach parents not to ask questions nor give any Teach parents not to ask questions nor give any
instructionsinstructions Teach parents to ignore if the teenager reacts Teach parents to ignore if the teenager reacts
with sarcasm, coolness or suspicionwith sarcasm, coolness or suspicion Teach parents to praise well and oftenTeach parents to praise well and often
Improving commands/limit Improving commands/limit settingsetting
Training for parents and teachers to Training for parents and teachers to give commands in the most effective give commands in the most effective wayway
Effective command increase Effective command increase compliance in children and compliance in children and adolescents with ADHD (and in adolescents with ADHD (and in others, too!)others, too!)
Improving commands/limit Improving commands/limit setting with childrensetting with children
Barkley Step 3 (Defiant Children)Barkley Step 3 (Defiant Children) Teach parents and teachers:Teach parents and teachers:
To only give commands that they intend To only give commands that they intend to back up with consequences (positive to back up with consequences (positive and negative)and negative)
Not to present commands as questions Not to present commands as questions or favorsor favors
Not give too many commands at onceNot give too many commands at once
Improving commands/limit Improving commands/limit setting with childrensetting with children
Teach parents and teachers:Teach parents and teachers: To make eye contact with the child before To make eye contact with the child before
giving commandgiving command To reduce other distractions while giving To reduce other distractions while giving
commandscommands To ask the child to repeat the commandTo ask the child to repeat the command To watch the child for one minute after giving To watch the child for one minute after giving
the command to ensure compliancethe command to ensure compliance To immediately praise child when s/he starts to To immediately praise child when s/he starts to
complycomply
Improving commands/limit Improving commands/limit setting with adolescentssetting with adolescents
Barkley, Defiant Teens, Step 4Barkley, Defiant Teens, Step 4 Teach parents and teachers:Teach parents and teachers:
To consider the intent of their commandTo consider the intent of their command Do they have the time/energy to follow through?Do they have the time/energy to follow through? Do they have consequences for noncompliance?Do they have consequences for noncompliance?
To avoid ambiguity when issuing commandsTo avoid ambiguity when issuing commands To not respond to compliance with gratitudeTo not respond to compliance with gratitude
Improving commands/limit Improving commands/limit setting with adolescentssetting with adolescents
Teach parents and teachers:Teach parents and teachers: To praise teens for appropriate behaviorTo praise teens for appropriate behavior To tell teen what To tell teen what toto do, rather than what do, rather than what
notnot to do to do To eliminate other distractions while To eliminate other distractions while
giving commandsgiving commands To break down multi-step commandsTo break down multi-step commands To use aids for commands that involve To use aids for commands that involve
timetime
Tangible rewardsTangible rewards
Children and adolescents with ADHD do Children and adolescents with ADHD do not respond to natural (intrinsic) not respond to natural (intrinsic) rewards as well as typical youthrewards as well as typical youth
The training of parents and teachers in The training of parents and teachers in the use of tangible rewards is effective the use of tangible rewards is effective in increasing desired behaviorsin increasing desired behaviors Can use token systems, behavior charts, or Can use token systems, behavior charts, or
immediate rewardsimmediate rewards
Setting up a reward system for Setting up a reward system for children at homechildren at home
Barkley, Defiant Children, Step 4Barkley, Defiant Children, Step 4 Determine family’s readiness to Determine family’s readiness to
implementimplement Tailor the program to family’s ability-Tailor the program to family’s ability-
simplify it for overwhelmed or stressed simplify it for overwhelmed or stressed familiesfamilies
Use poker chip system with younger Use poker chip system with younger children (4-7), point system with older children (4-7), point system with older children (8 and up)children (8 and up)
Setting up a reward system for Setting up a reward system for children at homechildren at home
Set a positive tone for the programSet a positive tone for the program ““We are going to make sure that you get rewarded We are going to make sure that you get rewarded
for all of the good stuff you do at home”for all of the good stuff you do at home” Parent(s) buys chips and makes a bank, or sets Parent(s) buys chips and makes a bank, or sets
up a chart or notebook for tracking pointsup a chart or notebook for tracking points The parent(s) and child together (with your The parent(s) and child together (with your
help) make up a list of 10-15 rewardshelp) make up a list of 10-15 rewards There should be everyday rewards, like TV or There should be everyday rewards, like TV or
computer time, and longer term rewards, like going computer time, and longer term rewards, like going to a movie or earning a new video game)to a movie or earning a new video game)
Setting up a reward system for Setting up a reward system for children at homechildren at home
Help the parent(s) and child make a list Help the parent(s) and child make a list of jobs or problem areasof jobs or problem areas
Determine how much each is worthDetermine how much each is worth Add up how much the child might earn in a Add up how much the child might earn in a
dayday Harder jobs should earn moreHarder jobs should earn more Bigger rewards should cost moreBigger rewards should cost more Make sure the child has some success in the Make sure the child has some success in the
beginningbeginning
Setting up a reward system for Setting up a reward system for children at homechildren at home
Discuss the concept of bonus chips to Discuss the concept of bonus chips to reward helpful or other positive behaviors, reward helpful or other positive behaviors, even if they aren’t on the listeven if they aren’t on the list
Chips and points are only given if the child Chips and points are only given if the child complies after the complies after the firstfirst command command
Don’t take away chips or points (response Don’t take away chips or points (response cost)cost)
All caregivers should use the same systemAll caregivers should use the same system Remind parents to praise while giving the Remind parents to praise while giving the
pointspoints
Setting up a reward system for Setting up a reward system for children at schoolchildren at school
Barkley, Defiant Children, Step 8, Daily Barkley, Defiant Children, Step 8, Daily School Report CardSchool Report Card
The teacher tracks the child’s behavior The teacher tracks the child’s behavior and reports it to the parent daily, who and reports it to the parent daily, who rewards the childrewards the child
This is particularly effective because both This is particularly effective because both the parent and teacher are involvedthe parent and teacher are involved
If the parent can’t be involved, the If the parent can’t be involved, the rewards may be given at schoolrewards may be given at school
Setting up a reward system for Setting up a reward system for children at schoolchildren at school
Choose a few target behaviors at Choose a few target behaviors at schoolschool Choose one that the child will be Choose one that the child will be
successful with most of the timesuccessful with most of the time Set up a system for school report card or Set up a system for school report card or
school/home note systemschool/home note system See samples on page 244-246See samples on page 244-246
Pick from the targets given, or create your Pick from the targets given, or create your own with the blank samplesown with the blank samples
Setting up a reward system for Setting up a reward system for adolescents at homeadolescents at home
Barkley, Defiant Teens, Step 5Barkley, Defiant Teens, Step 5 Use a point system (see previous slides) Use a point system (see previous slides)
for 13/14 and underfor 13/14 and under Set up basically the same way as with Set up basically the same way as with
childrenchildren Warn parents to expect resistance, their teen Warn parents to expect resistance, their teen
is used to getting all of their privileges for is used to getting all of their privileges for free! Make sure parents don’t give in.free! Make sure parents don’t give in.
Make sure parents only choose privileges they Make sure parents only choose privileges they can controlcan control
Setting up a reward system for Setting up a reward system for adolescents at homeadolescents at home
Barkley, Defiant Teens, Step 5Barkley, Defiant Teens, Step 5 Use a behavior contract for teens 14/15 Use a behavior contract for teens 14/15
and olderand older See sample contract on page 208See sample contract on page 208 Begin with only “do” behaviors (clean up Begin with only “do” behaviors (clean up
room, set table, get ready for school on room, set table, get ready for school on time)time)
““Don’t” behaviors are dealt with under Don’t” behaviors are dealt with under response cost in next sectionresponse cost in next section
Setting up a reward system for Setting up a reward system for adolescents at schooladolescents at school
Barkley, Defiant Teens, Step 9Barkley, Defiant Teens, Step 9 Establish a homework contract (see sample Establish a homework contract (see sample
on page 121)on page 121) This can be adapted for other behavioral This can be adapted for other behavioral
goalsgoals Can also set up guidance counselor, tutor or Can also set up guidance counselor, tutor or
peer as “coach” for organizational skills or peer as “coach” for organizational skills or other targetsother targets Rewards for teen’s participation can be made part Rewards for teen’s participation can be made part
of the home contract, or part of a school reward of the home contract, or part of a school reward systemsystem
Response CostResponse Cost
Using a point or token system in Using a point or token system in which negative behaviors result in which negative behaviors result in the loss of points or tokens.the loss of points or tokens.
Training parents and teachers to use Training parents and teachers to use response cost is effective in reducing response cost is effective in reducing undesired behavior and undesired behavior and noncompliancenoncompliance
Response Cost with ChildrenResponse Cost with Children
Barkley, Defiant Children Step 4 & 8Barkley, Defiant Children Step 4 & 8 Train parents and teachers:Train parents and teachers:
To develop list of undesirable behavior to To develop list of undesirable behavior to be fined by reward systembe fined by reward system
To deduct points/chips for undesirable To deduct points/chips for undesirable behaviorbehavior
Parent and child have chosen to reduce whiningParent and child have chosen to reduce whining If child whines, parent deducts three pointsIf child whines, parent deducts three points Penalties increase based on severity of behaviorPenalties increase based on severity of behavior
Response Cost with ChildrenResponse Cost with Children
Train parents and teachers:Train parents and teachers: To avoid “punishment spiral”To avoid “punishment spiral”
When parent fines child for misbehavior, the When parent fines child for misbehavior, the child may respond with more misbehaviorchild may respond with more misbehavior
Child continues to lose points, then loses Child continues to lose points, then loses motivation for the point systemmotivation for the point system
Rule: Parent fines child Rule: Parent fines child once once through point through point system, then sends child to time out if system, then sends child to time out if undesirable behavior continuesundesirable behavior continues
Response Cost with Response Cost with AdolescentsAdolescents
Barkley, Defiant Teens Step 6Barkley, Defiant Teens Step 6 To train parents and teachers:To train parents and teachers:
To now use behavioral contract with the To now use behavioral contract with the teen for “fines”teen for “fines”
Teen agrees to not swearTeen agrees to not swear If teen swears, teen loses Internet privilegeIf teen swears, teen loses Internet privilege
Response Cost with Response Cost with AdolescentsAdolescents
Train parents and teachers:Train parents and teachers: To begin with 1 week “training period,” during To begin with 1 week “training period,” during
which parent labels misbehavior every time it which parent labels misbehavior every time it happens and warns of new fineshappens and warns of new fines
To avoid “punishment spiral”To avoid “punishment spiral” When parent fines teen for misbehavior, the teen When parent fines teen for misbehavior, the teen
responds with more misbehaviorresponds with more misbehavior Teen continues to lose privileges, then loses Teen continues to lose privileges, then loses
motivation motivation Rule: Parent fines teen Rule: Parent fines teen no more than twiceno more than twice, then , then
directs teen to “cool off” away from the situationdirects teen to “cool off” away from the situation
Response Cost with Response Cost with AdolescentsAdolescents
Encourage parents to act as “judge and Encourage parents to act as “judge and jury” when teen liesjury” when teen lies The teen should remain above suspicionThe teen should remain above suspicion
Response cost allows parents to Response cost allows parents to discipline/educate instead of discipline/educate instead of justjust punish punish
Emphasis of response cost is onEmphasis of response cost is on ““Warm” – positive, lovingWarm” – positive, loving ““Firm” – specific, immediate, and consistentFirm” – specific, immediate, and consistent
Parent MonitoringParent Monitoring
Give parents a structured way to Give parents a structured way to monitor their child’s behaviormonitor their child’s behavior
Measurement of the target behavior Measurement of the target behavior should be repeatedshould be repeated
Can use either informal or formal Can use either informal or formal measuresmeasures
Parent MonitoringParent Monitoring
Informal measuresInformal measures Daily homework logDaily homework log Behavior chart as part of a reward Behavior chart as part of a reward
systemsystem Home Situations Checklist (Barkley, Home Situations Checklist (Barkley,
Defiant Children)Defiant Children)
Parent MonitoringParent Monitoring
Formal measuresFormal measures Vanderbilt Scales (from your Resource Vanderbilt Scales (from your Resource
Toolkit or on the web)Toolkit or on the web) Disruptive Behavior Disorders Scale (in Disruptive Behavior Disorders Scale (in
Barkley or on the web)Barkley or on the web)
Time OutTime Out
Time out is the removal of a child or Time out is the removal of a child or adolescent from all reinforcement for adolescent from all reinforcement for a specified period of time after a a specified period of time after a targeted misbehaviortargeted misbehavior It is an effective intervention, but only if It is an effective intervention, but only if
it is used correctly and is not used too it is used correctly and is not used too oftenoften
Using Time Out with Children Using Time Out with Children at Homeat Home
Barkley, Defiant Children, Step 5Barkley, Defiant Children, Step 5 Teach parents to give an effective Teach parents to give an effective
command (Step 3)command (Step 3) Teach parents to count out loud Teach parents to count out loud
(initially) from 5 to 1(initially) from 5 to 1 Teach parents to give a time out Teach parents to give a time out
warning if the child has not compliedwarning if the child has not complied After warning, count from 5 to 1 againAfter warning, count from 5 to 1 again
Using Time Out with Children Using Time Out with Children at Homeat Home
Teach parents to guide child to time out chair Teach parents to guide child to time out chair IMMEDIATELYIMMEDIATELY
Teach parents to place the child in the chair Teach parents to place the child in the chair “Stay there until I tell you to get up”“Stay there until I tell you to get up”
Teach parents not to argue or interact with Teach parents not to argue or interact with the child in any waythe child in any way
Teach parents to not come back until the Teach parents to not come back until the child is calm. Once the child is calm and the child is calm. Once the child is calm and the time is served, the child must correct the time is served, the child must correct the misbehaviormisbehavior
Using Time Out with Children Using Time Out with Children at Homeat Home
Teach the parents that the child should Teach the parents that the child should now go and comply with the previous now go and comply with the previous command, or correct the misbehaviorcommand, or correct the misbehavior
Teach the parent to now praise Teach the parent to now praise compliance, and to praise the next compliance, and to praise the next behavior that the child does wellbehavior that the child does well
Time Out Tips with ChildrenTime Out Tips with Children
The first time out may be difficultThe first time out may be difficult Prepare parents for a worst case scenario of a Prepare parents for a worst case scenario of a
complete struggle.complete struggle. Reassure parents that this is how the child Reassure parents that this is how the child
learns time out and correcting misbehavior.learns time out and correcting misbehavior. Make sure the time out area is away from Make sure the time out area is away from
anything interesting or funanything interesting or fun Remind parents not to “make up for” the Remind parents not to “make up for” the
time out (i.e., saving dessert for them)time out (i.e., saving dessert for them)
Using Time Out with Using Time Out with AdolescentsAdolescents
Barkley, Defiant Teens, Step 8Barkley, Defiant Teens, Step 8 ““Grounding” = “house arrest”Grounding” = “house arrest”
NO access to privileges (phone, TV, etc)NO access to privileges (phone, TV, etc) Parent must be home to enforceParent must be home to enforce Most effective with younger teensMost effective with younger teens May include “work detail” (cleaning out May include “work detail” (cleaning out
basement, scrubbing bathroom floor)basement, scrubbing bathroom floor)
Ignoring and Differential Ignoring and Differential ReinforcementReinforcement
Train parents and teachers to Train parents and teachers to selectivelyselectively Ignore mild unwanted behaviorsIgnore mild unwanted behaviors
ANDAND
Attend to alternative positive Attend to alternative positive behaviorsbehaviors
Teaching parents and teachers Teaching parents and teachers to ignoreto ignore
Teaching parents and teachers Teaching parents and teachers how and when to ignore how and when to ignore undesirable behaviorundesirable behavior Ignoring can includeIgnoring can include
Visual cuesVisual cues Postural cuesPostural cues Vocal cues Vocal cues Social cuesSocial cues
How to ignoreHow to ignore
Visual cuesVisual cues Look away once child engages in undesirable Look away once child engages in undesirable
behaviorbehavior Do not look at the child until behavior stopsDo not look at the child until behavior stops
Postural cuesPostural cues Turn the front of your body away from the Turn the front of your body away from the
location of child’s undesirable behaviorlocation of child’s undesirable behavior Do not appear frustrated (e.g., hands on hip)Do not appear frustrated (e.g., hands on hip) Do not vary the frequency or intensity of your Do not vary the frequency or intensity of your
current activity (e.g., chopping faster, current activity (e.g., chopping faster, hammering harder)hammering harder)
How to ignoreHow to ignore
Vocal cuesVocal cues Maintain a calm voice even after your child begins Maintain a calm voice even after your child begins
undesirable behaviorundesirable behavior Do not vary the frequency or intensity of your Do not vary the frequency or intensity of your
voice (e.g., don’t talk faster or shout over the voice (e.g., don’t talk faster or shout over the child)child)
Social cuesSocial cues Continue your intended activity even after your Continue your intended activity even after your
child begins undesirable behaviorchild begins undesirable behavior Do not panic once child’s begins inappropriate Do not panic once child’s begins inappropriate
behavior (i.e., do not draw more attention to child)behavior (i.e., do not draw more attention to child)
When to ignoreWhen to ignore
When to ignore undesirable behavior When to ignore undesirable behavior Child interrupts conversation or classChild interrupts conversation or class Child blurts out answers before question Child blurts out answers before question
completedcompleted Child continuously talks during dinnerChild continuously talks during dinner Child tantrums while at the grocery storeChild tantrums while at the grocery store
Do Do notnot ignore undesirable behavior that ignore undesirable behavior that could potentially harm the child or could potentially harm the child or someone elsesomeone else
Differential reinforcementDifferential reinforcement
Teach parents and teachers how and Teach parents and teachers how and when to differentially reinforce when to differentially reinforce desirable behaviordesirable behavior Step One: Ignore (stop reinforcing) the Step One: Ignore (stop reinforcing) the
child’s undesirable behaviorchild’s undesirable behavior Step Two: Reinforce the child’s desirable Step Two: Reinforce the child’s desirable
behavior in a systematic mannerbehavior in a systematic manner The desirable behavior should be a behavior The desirable behavior should be a behavior
that is incompatible with the undesirable that is incompatible with the undesirable behaviorbehavior
Differential reinforcementDifferential reinforcement
Define the behavior of concern Define the behavior of concern (target)(target) Determine how often the target behavior Determine how often the target behavior
occursoccurs Determine how often to reward the child Determine how often to reward the child
for alternative behaviorfor alternative behavior Fixed interval – reward every X minutesFixed interval – reward every X minutes
Determine how to reward the child for Determine how to reward the child for alternative behavioralternative behavior
Praise, attention, points or chipsPraise, attention, points or chips
Reinforcement of target Reinforcement of target behaviorbehavior
Target behavior: InterruptingTarget behavior: Interrupting Alternative behavior: Playing by himselfAlternative behavior: Playing by himself Reward schedule: 5 minutesReward schedule: 5 minutes
If child goes 5 minutes without interrupting, If child goes 5 minutes without interrupting, the child receives reinforcementthe child receives reinforcement
If child interrupts before 5 minutes is up, the If child interrupts before 5 minutes is up, the child does not receive reinforcementchild does not receive reinforcement
Re-set schedule once child interruptsRe-set schedule once child interrupts
Differential reinforcementDifferential reinforcement
Parent or teacher systematically Parent or teacher systematically delays reinforcement once child delays reinforcement once child responds to initial scheduleresponds to initial schedule Target behavior: InterruptingTarget behavior: Interrupting 11stst reinforcement schedule: 5 minutes reinforcement schedule: 5 minutes 22ndnd reinforcement schedule: 6 minutes reinforcement schedule: 6 minutes 33rdrd reinforcement schedule: 7.5 minutes reinforcement schedule: 7.5 minutes
Problems with ignoring and Problems with ignoring and differential reinforcementdifferential reinforcement
Extinction burstExtinction burst Warn parents and teachers that the behavior Warn parents and teachers that the behavior
will get worse before it gets better (child will will get worse before it gets better (child will work harder to gain their attention)work harder to gain their attention)
If you put your money in a vending machine, and If you put your money in a vending machine, and the soda doesn’t come out, what do you do? You the soda doesn’t come out, what do you do? You probably press the button a few more times, probably press the button a few more times, maybe you even try pressing hardermaybe you even try pressing harder
Indiscriminant reinforcementIndiscriminant reinforcement Train parents to reward the alternative Train parents to reward the alternative
(desirable) behavior, so they don’t reward (desirable) behavior, so they don’t reward other unwanted behaviors by mistakeother unwanted behaviors by mistake