• Managing Children’s Behavior Creatively
• Indoor Activities
• Making Sense of the Senses
• Resilient Children

by Dr. Shoshana Rybak, Director of Psychological Services, HASC

In the past two decades we have experienced the burgeoning of literature on successful parenting and effective management of children’s behavior.  Parents seem bewildered by their offspring’s behavior and are often at a loss as to what to do when confronted by unacceptable behavior.  While training for most professional roles is rigorous and taken seriously, by contrast, training for the role of parent is often woefully poor or completely lacking.  For the most important mission of our life, the rearing of the next generation, we are generally, not well prepared.  Parents are often mystified by their children’s negative acts and seek expert advice on effective handling of problem behaviors.  Effective behavior management is neither mysterious nor too complicated.  While there may be a variety of techniques and combinations of methods in the toolkit of psychologists and educators, the basic principles can be easily understood by most parents.
            Basic Principle: Behavior is determined by its consequences.  A specific behavior is maintained, strengthened, or weakened by the consequences which follow that behavior.  The consequences may either reward (reinforce) the behavior causing that behavior to be strengthened, or those consequences may punish that behavior – causing that behavior to become weakened or eliminated. 
            For example, Avi’s mother wants to strengthen her three-year-old’s new behavior of picking up toys.  When he completes the activity of placing all the toys back in the toy-box, she quickly gives him a hug and verbally praises his good behavior.
            Consider another example provided by David’s mother.  The three-year-old hates to go to sleep in his own bed.  Little David cries, screams and whines relentlessly until his mother allows him out of bed to join his parents in another room.  Exhausted, the mother lets little David go to sleep in her bed.  His negative behavior (crying, screaming) is rewarded by the mother who allows him to get out of bed!  The consequences of his negative actions are very rewarding to David and thus maintain his negative behavior.
            An example of mild punishing consequences is supplied by Shana and Ruth’s mother.  When four-year-old Shana and five-year-old Ruth fight over their Cabbage Patch Doll their mother punishes this behavior by taking away the doll.  She steps in quickly, before the fight “escalates”, and promptly removes the coveted doll out of reach for a period of time (5 to 10 minutes) initially).  Her prompt intervention weakens the fighting behavior.
            There are a few rules of creative and effective behavior management.  The following list of do’s and don’ts may help parents better handle their children’s behavior.

• Reward good behavior promptly (and often).
• Help your child practice and rehearse the behavior that you want him to learn.
• Ignore some misbehaviors (which do not pose a danger to the child or others).
• Give clear and effective commands.
• Be attentive to your child – help him communicate.
• Don’t inadvertently reward bad behavior.
• Choose only one or two difficult behaviors to be corrected at any one time.
• Use punishment with caution.  An effective mild punishment with young children is Time-Out.

A note about punishment is in order.  Punishment, to be effective, must be consistent and mild, not severe and erratic.  Parents often forget this and overreact.  A useful method of punishment is time-out.  In time-out procedure the child is placed in an area that is low on stimulation and is, in fact, quite boring.  The child is expected to stay there (and the parent must firmly insist on it) for the duration of time-out.  Time-out need not be long. Five minutes will often suffice.  Ten minutes, however, may be needed for the older child.  A good rule to follow is one minute for each year of age.  To facilitate the child’s understanding of time, a portable timer should be used and set to ring following the specified minutes of time-out.  When the child is sent to “time-out” the command must be clear and brief, no more than ten words and within ten seconds.
An alternate method, to be used when appropriate, is to “time-out” a toy or playing material which is abused.  For example, Daniel uses his crayons to scribble on the kitchen table against his mother’s wishes.  His mother places the crayons in “time-out”.  Time-out for toys used in an abusive manner or for objects over which the siblings fight and refuse to share may take a little longer. The timer again could be used effectively.
To successfully manage the young child’s challenging behavior, we advise parents to remember the basic ABC’s of effective management: Antecedents, Behavior, and Consequences.  Antecedents refer to events or situations that occur before the child reacted with a specific behavior.  Behavior is any action or a series of actions that creates (or is followed by) a response.  Consequences are anything which immediately follows a behavior. Consequences can be negative, positive, or neutral. For example, being yelled at, praised, or ignored.
In the example above, the immediate consequence for Shana and Ruth’s fighting over the doll, was to remove the doll and deny the girls continued playing with the doll. The mother, looking at any antecedent event that might have set the stage for this negative behavior, may consider several variables including any remarks made by any of the girls, time of the day, were the girls tired? Bored? Were they left alone in the room?
In the other example, little David’s screaming and crying behavior when placed in his bed for the night is followed by the consequence of being removed from bed and allowed to join the parents (with all the additional attention and possible free play provided). When thinking abut the antecedents, the parents may contemplate not only the obvious fact that placing David in bed sets in motion the behavior (e.g. screaming), but also the tone and body language of the parent putting him to sleep, the words used, the dimming or turning off lights, etc. Are these things done in a way that conveys a hurried, anxious parent?
The ABC’s of sound behavior management are also to be interpreted as Anticipation, Behavior, and Consistency. By anticipation we mean the active anticipation of a particular scenario in a specific situation based on the child’s previous behavior.  The parents who are familiar with their child’s pattern of reaction may anticipate a behavior and mentally prepare for it with a contingency response.  For good behavior they should provide prompt positive reinforcement (rewards, praises, hugs, etc.).  Similarly, for  negative behavior, parents should prepare and mentally rehearse responses aimed at reducing or  eliminating the behavior.
      Behavior, in this paradigm, stands for the parent “being there” for the child; catching the child “behaving” nicely; and for providing positive reinforcement for good behavior.  Reinforcement of good behavior should be prompt and frequent.  It also means “being there” for the child when he or she is misbehaving and providing a rational, appropriate, and non-aggressive means of punishment.  By considering in advance the appropriate course of action for a negative behavior, the parent avoids the emotional, aggressive and uncontemplated reaction of spanking and physically hurting the child.  The parent’s rational and appropriate behavior presents a good model of behavior for the child and also conveys to the child that the parent loves him or her and is not just interested in disciplining the child.
Consistency is a key application in effective management.  By maintaining an attitude of consistent behavior instead of vacillating back and forth depending on “pressure” applied by the child, the parent will effectively communicate his or her resolve to correct a negative behavior.  Good results are obtained through consistent application of the principles discussed.  For example, five-year-old Shani is a picky eater.  The doctor suggested that dessert be given to her only after she eats the main course.  At mealtime Shani whines and demands the dessert first and her chicken afterwards.  Initially firm, the mother gives in to Shani’s request the following day or when she feels tired and can’t tolerate the whining.  Consequently, Shani’s eating habit remains erratic; she frequently takes only one bit and refuses to eat the main course.  Her mother’s inconsistent approach actually rewards her whining and poor eating habits!
In short, creative and effective behavior management requires attentive listening to your child’s communication, prompt reinforcement for positive behaviors, active anticipation of his or her behavior, consistent and rational mode of response and, above all, commitment and love which manifest themselves in caring for and guiding your continually developing son or daughter.

 

Here are some suggestions for indoor activities to help keep kids engaged, and at the same time practicing some great skills!

All you need for this fun activity is a small plate or bowl, a plastic drinking straw, dish washing liquid and tap water. Place two drops of dish washing liquid in the center of a plate or bowl. Run water over the dish soap to create foam or bubbles. Have children point their straws into the water, and blow softly and gently into the water. Slow and steady will create huge bubbles!

Use any box that closes or has a lid, a shoebox is ideal. Cut a hole in the side of the box large enough for a child's hand to fit inside. Place an object inside the box and see if they can guess what it is. If they can't guess right away, let them ask questions or provide them with clues until they figure it out.

If you have kids, you need one of these! You can find shoe box sized plastic containers with lids from your local dollar store. Stock the box with crayons, markers, colored pencils, small plain paper pads, envelopes, stickers, stencils, a pencil sharpener and an eraser. This box should be kept stocked so that when needed, everything will be at your fingertips. Explain to children that this is a "special" writing box and that everything that comes out, must go back in for the next time they want to get creative.

The easiest form of this requires only a paper lunch bag and crayons or markers. Simply draw on a face and you have a puppet! To make the characters more elaborate, decorate with yarn for hair, buttons for eyes, and glitter for cheeks. Ribbon can be added to the hair or made into a bow tie for the "neck". Draw on eyelashes and lips with colorful markers.

Save old magazines and catalogs and store them in a cabinet just for this purpose. Have the kids cut out pictures and paste them onto a piece of cardboard or construction paper. You can let them cut out whatever they want, or assign each child a letter of the alphabet or a theme to go by for a more challenging project. Keep a trash can close by for the scraps and be sure to keep a stock of glue sticks on hand!

Place a handful of dry, uncooked pasta, such as ziti, rotini or farfelle, into a plastic zipper baggie. Add a tablespoon of white vinegar and 2-3 drops of food coloring. Close the baggie and have the kids shake the bag until the pasta is completely colored. Spread out onto a paper plate or paper towel and allow to dry. Use several baggies to create different colors. Once the pasta is dry, kids can use yarn to string together pieces to make necklaces and bracelets, or glue them to paper plates or construction paper to create a work of art.

Play a family memory game with your kids by asking questions like "Who has a brother named Ari?" and "Who is married to Aunt Tammy?" Look through old photo albums and see if kids can guess who is who in each picture.

You can do this out loud or have kids write their entries on paper. Someone starts the story with "Once upon a time there lived a...", that person chooses the character and setting (princess in a far away land). The next child tells the next part of the story, and so on around the room, the story changing with each new addition.

 

Trying to solve a tedious trigonometric problem on paper is difficult enough when one thinks about it. Now imagine that the pen you’re holding is covered in sandpaper. Or the buzz of the fluorescent light above you is so loud, it’s deafening. Or even worse, trying to find the solution while feeling seasick. Would you be able to finish the task at hand through these distractions?

While this might seem to be nothing but an exercise of the imagination for most of us, it is a daily occurrence for some children who have a condition called sensory integration dysfunction (SID). For these children, the world is a confusing, threatening place they’re not comfortable to be in, much less to explore. They are unable to correctly find meaning in the sensations entering their systems, or organize their behavior to successfully interact with the world. These children feel lost and overwhelmed in their surroundings, and view the normal tasks of childhood as insurmountable challenges. Parents frequently perceive that these children are out-of-sync with others and feel helpless when the child has meltdowns in the most inappropriate situations.

To properly understand the problem, one needs to know how a person’s sensory system works. Ask a man on the street what his senses are, and he will be quick to answer the basic five – vision, hearing, smell, taste and touch. These senses provide us with "external" input – information about our surroundings, such as what the table in front of us looks and feels like, or what kind of bread is baking in the oven.

What is not readily apparent is that there are other sensory systems that serve as the base from which the other five senses work. These systems – the vestibular sense (subserving balance and movement) and proprioception (for muscle and joint sense) – provide a person with the “internal” information of our body’s position with respect to gravity, and where our limbs are in relation to our other body parts. They determine how comfortable we are in participating with the outside world and if not optimally functioning, would also cause the other senses to misfire.

How the sensory systems take in all the information, then combine them with past experiences and memories is what is termed as sensory integration. Considering how complex this process is, it is amazing how time and time again the brain can organize all input from the sensory systems simultaneously, present it to a person’s nervous system in a way it will find useful, then formulate a response to the demands of the environment – with these occurrences all occurring at the same time. This process goes on all the time in our brains, so our nervous system is always in a state of activity. In children with SID, this process is imbalanced and inconsistent, causing problems in learning and relating with their friends and loved ones. The roles they need to fulfill during their childhood – to play, be a student, and form friendships with others – are severely curtailed, setting up the stage for further difficulties in their teenage years and into adulthood.

Difficulties in sensory integration take a myriad of forms. Some children may be overly sensitive to some sensations, as in a child who gets easily upset with movement on a swing; while others need greater than normal amounts of sensory input for it to even register in their nervous systems. Still some cannot correctly distinguish salient sensory information from all other input from the environment, making the child easily distracted by ambient sounds and sights. A child may present as hyperactive, have poor balance and awkward coordination. Disorganized behavior is also common – a child may present as impulsive, lacking safety awareness, or have difficulties in adjusting to new situations or following directions.

One must be cautious with a labeling a child with SID however, because not every child who has trouble learning has difficulties in sensory integration. One needs to consult an experienced occupational therapist (OT) to determine its presence, and to differentiate what might be a neurological response from misbehaviors. Extensive knowledge and training in sensory integration make OTs the most reliable professionals to evaluate a child’s sensory needs and formulate the appropriate intervention strategies. The expansive nature of sensory integration, however, requires that many professionals in the healthcare and educational fields collaborate in the treatment of a child with SID. Schools and treatment centers now have specially-trained physical therapists, speech-language pathologists and special education teachers working alongside an OT for this purpose. Pediatric dentists, psychologists, play therapists are also some of the many people who have played important roles in the home and school settings.

To encourage the development of sensory integration skills, a child needs an environment with the "just right" challenge – one that is specially designed to meet his needs, while not overwhelming him and causing his fragile nervous system to shut down. A child is provided with therapeutic activities under the guise of play, encouraging him to play interactively in a manner that is organized and functional. In a way, a child is given the structure in which he can practice his skills, while providing him the necessary freedom to explore and have fun. In Answers to Questions Teachers Ask about Sensory Integration, Jane Koomar, PhD, OTR/L, FAOTA states: "By balancing structure and freedom, the therapist helps the child to develop both his neural organization and his inner direction. The child is given much control over therapy as he can handle, as long as his activity is therapeutic. The therapist controls the environment, while the child controls his actions."

This balancing act of having the child direct the therapeutic process, while the therapist makes constant but appropriate adjustments to the environment, forms the core of sensory integration intervention. Developmental skills of self-care, writing and gross motor play are best taught this way, with therapists and teachers helping the children along in overcoming obstacles by themselves and maximizing their potential for development. And with these professionals working closely with the children, they also form warm, dynamic relationships that are vital for development of social skills.

Most of the improvements noted may be subtle at first – it may be as simple as increased eye contact between the child and his parents, or a greater eagerness to climb over playground equipment. The implications of these changes are far-reaching, though. An improved attitude about one’s self often translates into better command of his life, because a child will have more control of his own reactions, and greater self-confidence to relate to his environment and peers. He will feel less anxious about exploring the world around him and, in his own time, grow into the responsible young adult that all parents strive for their children to be.

“Hinai ma tov uma naim shevet achim gam yachad”

Special families are exceptional in many ways, from the moment of awareness of their child’s special needs, to the rallying of loved ones and the marshalling of resources to meet the challenges, they display their unique approaches. However, most show a strong commitment to grow, learn, adjust, and overcome challenges alongside their special children. We often focus on the role of the parents, their personality, strengths, devotion and commitment, and less often on the other significant members of the family: the siblings. Nonetheless, much of what can be said about being a parent of a child with special needs can also be said about a brother or sister of a special child.

Often siblings will be involved in the lives of their exceptional brothers or sisters long after the parents have departed from this world or can no longer advocate on their behalf. Siblings have an enormous influence on their brothers and sisters, usually second only to that of the mother. Their role in the life of a brother or sister with a disability often extends sixty to eighty years – much longer than that of the parents. Yet the contributions of siblings to the lives of children with disabilities have not been explored as much in the literature. Note, for example, how many CSE (Committee on Special Education) meetings involve siblings or compare the services and considerations offered by most agencies to parents with special needs children to those given to the siblings. In many cases, the role and contribution of siblings is neglected, and more importantly, their experiences, personal concerns and issues are overlooked.

All siblings provide a continuing relationship that allows them to exert considerable influence on each other: from early childhood as playmates to adult relationships as confidants, counselors, and helpers in difficult times. Siblings are socializing agents who provide their brothers and sisters with opportunities to develop social understanding, sensitivity to others, care-giving and conflict management. Siblings often teach their brothers and sisters skills and add to their language and cognitive development.

The literature on the effect of a child with special needs on his or her siblings has been, until recently, confusing and contradictory, with reports of both negative and positive impact. Many early studies that reported negative effects were methodologically flawed. Many positive effects might not be seen initially, but become more evident in adolescence and adulthood. What then determines whether a brother or a sister of a child with a disability will be affected negatively or positively? The answer lies in parental attitudes and expectations, culture, family resources, and patterns of interactions between siblings.

The rise in recent years in our community of the many services offered to families, including siblings, reflects our commitment to improving the lives of the families, their disabled children and siblings. More importantly, with greater understanding of special needs and educational options, our attitudes have become ever more positive and vice versa – our positive attitudes have greatly impacted the availability of services and educational options.

One issue that siblings often complain about is that parents treat them differently. Differential treatment is sometimes more extreme in families having a child with a disability. Regardless of how the siblings feel as a consequence of the differential treatment, as a general rule, they do not vent their frustration on the special brother or sister. Mostly, they are kinder and gentler with the special sibling than with other siblings. Often they assume the role of a helper or teacher and even conflict mediator. At times their enthusiasm and desire to protect and to help is so great that parents have to intervene and guide the sibling in allowing the brother or sister “to learn for themselves.” Differential treatment remains an issue in many families with very young siblings. However, as the siblings grow and mature, they begin to see and understand how having a disability mitigates the perception of differential treatment.

Conflict between siblings is almost universal in families with two or more children. Although it might be expressed more subtly in families with a special child, it exists as a challenge and often adds to the burden of the overstressed parents. Below are some suggestions on how to reduce sibling conflict:

• Listen to feelings. Conflict breeds intense emotions and bruised feelings. Simple listening, reflecting and exploring of feelings go a long way in tension reduction. Don’t challenge the feelings, rather acknowledge and validate them. Don’t tell your child “you can’t be angry with your brother.” Instead say, “ I hear how angry and hurt you must feel.”
• Make time for each child. It is important for parents to regularly spend time alone with each child. This allows each child to feel valued and appreciated. The “ten-minute exclusive” is a technique suggested by a colleague. After giving birth to her seventh child, she felt that her older children were clamoring for attention, with sibling fighting escalating sharply. She devised “exclusive time with Mommy” for each child each day. During that ten minute interval, there were no phone calls, no outside interruptions, no other chores – only Mommy and son or daughter engaged in whatever activity or conversation the child chooses. This was an investment of one hour each day that went a long way in fostering harmony and family solidarity. As the children grew, the “ten-minute exclusive” became a time of intimate conversation about friends, school, hopes and aspirations. What an opportunity to bond with a child!
• Provide parental modeling of good social problem solving behavior. Encourage your children to use words to express feelings and model discussion as a way to solve family disputes. Children learn how to negotiate differences by observing others. If parents yell, rave and vent by way of conflict resolution, their children are likely to resort to the same “methods.”
• Schedule family meetings. The “family council,” as my colleagues refer to it, is another effective technique. Children who experience it describe it as a great time when everyone sits around and talks about family activities, the chores that have to be done, who is responsible for what, who wants to change and why, who needs a hand or a cheer. This is a great time to pool together resources and come up with creative solutions or even just emotional support and validation of each other’s feelings and contributions.
• Create a balancing act of emotional support. Do not shower on the sibling of a special child uneven “guilt-driven” attention or over-indulgence of gifts and privileges, nor treat the sibling as a “ surrogate parent”, demanding of him or her maturity beyond their years. It is important to treat the children fairly, and that often translates into unequal time allocation. Instead of worrying about giving equal amounts, focus on each child’s individual needs. Instead of worrying about giving each child equal love, show each child that he or she is loved uniquely.
• Let the brother or sister help. Assign to your children manageable, age-appropriate household chores. Use specific feedback and reward close approximations. By the same token, encourage the special child to do things for the common good, chores or assignments that he or she is able to do. Moreover, encourage the special child to do chessed too, in accordance with his or her capacity and temperament. We have seen many children with Down syndrome regularly help elderly residents in nursing homes. The residents have cherished their assistance and friendship.
• Encourage the children to develop hobbies and a wide range of skills at which they can feel successful. This supports their self-esteem and positive outlook.
• Enroll the siblings in sibling support groups. We have come a long way in establishing in some communities frum support groups for siblings at which they learn how others cope, learn new skills and thrive. This social and psychological support provides many siblings with the kind of added encouragement they need.

The brothers and sisters of children with special needs are, by and large, a resilient bunch. As they grow up they develop into sensitive and caring individuals. They are more involved in giving of themselves to others than ordinary siblings. They take less for granted and appreciate life’s gifts more. They feel privileged to help others. They are much more likely to use patience, love and acceptance in dealing with others – and their vocational choices often reflect this spirit. Many choose the helping professions or specialties in special education in order to continue to serve the community and make a difference in the lives of others.

Dr. Shoshana Rybak is the Director of Psychological Services at HASC and an adjunct professor at Touro College.