behaviorally inhibited temperament behaviour modification brave story exposure ladder fears

My daughter spoke during a birthday party, so why don’t I feel good about it?

My daughter turned 3 years old this past summer. We had virtual “parties” with her paternal relatives and in-person celebrations with her maternal bubble during the pandemic. We sang Happy Birthday and blew out candles many times. She loved it and continues to play “birthday” many months later. Two weeks after her birthday, we were invited to a socially distant outdoor gathering for my friend’s child’s birthday. I thought this would be a good opportunity for my daughter to experience a social gathering with no pressure to play with other kids or do anything at all other than stay by my side to maintain distance from other people. And that is how I should have left it. But…

…I decided to take the opportunity to practice giving something to another child (present) and saying a socially expected phrase “happy birthday, [Friend]”. I did not think she would do these things at the party, but we used the lead up to the party to practice these acts during play in our home. I wrote a story and even conducted a small exposure ladder which included visiting the front yard of the friend’s house the day before the party and stopping to have ice-cream on the sidewalk to increase familiarity with the house (without seeing any people) and provide a positive association with the location (ice cream!). I suspected that the lure of a special treat on the day of the party would be a strong motivator for her to try to speak.

At that time, my daughter only spoke freely to her special bubble of people: parents, maternal grandparents, and little cousin. She spoke with restrictions to a handful of other relatives. She did not choose to speak to anyone else. She would, on occasion, say short statements with my prompting like “hello” and “how are you?” to neighbours that we pass on the sidewalk with the promise of a chocolate chip treat.

If this friend had not had a birthday party, I would not have sought out this opportunity. Even at the time, I felt this was too soon to push social speaking or interacting with another child that we saw infrequently. However, I tried to channel our psychologist, and I think she would have encouraged me to take advantage of the opportunity (especially since I had time to write a story and do a small exposure ladder). When we arrived at the party, my daughter held the present and I encouraged her to pass it to the birthday child. She did so but was clearly nervous. I prompted her to say, “happy birthday” which she was able to blurt out and then we immediately picked a treat from the table. For the rest of the event, my daughter stood beside my chair and watched the proceedings unfold (a bunch of adults sitting at a distance chatting about work and life). At some point I realized she was a bit more frozen than I expected and when I touched her arm, I realized she was slightly shaking. I knew this was too much and reminded her that we were going to see her cousin afterwards and we would leave soon. After a couple of minutes, I told her we were leaving and suddenly she blurted, “I want another cookie!”. The fact that she was able to speak when she was clearly distraught was surprising. Cookies are a powerful motivator, apparently.

At the time, I felt like this event had been a huge success. My daughter completed the socially appropriate act of speaking and giving a birthday gift and was thrilled to have a treat as her reward. I praised her after the event, and she had a big smile on her face. But, deep in my gut, I did not feel good about the experience; something did not sit right. I felt that I had coerced my daughter into playing the role of a puppet. She knew that by performing, she would get treats and praise from Mommy. She may have even felt that my love for her hinged on performing this incredibly difficult and fearful task. How horrible. My love for her is unconditional, but what I know does not matter; what matters is how she interprets my actions.

After much reflection, I realize that this birthday party was me pushing my daughter to do something that she did not want to do and did not need to do. Why did I think this was a good opportunity? Why did I think this was the right thing to do? I have a child who is clearly behaving atypically (not talking to others), and sometimes I feel like I am on the edge of the normal circle looking in and I feel pressure to be making active strides to get into the circle all the time. It was my own feelings of doubt about what I was doing with my daughter, my own feelings of wanting to fit in with the group, my own motivation of making my family appear normal to others, my own interpretation of what my psychologist might have recommended that pushed me to push my daughter. And I regret it.

What makes this situation different from all the other brave stories, exposure ladders, and fear-based activities that we have worked on over the past year? The other stories and ladders and actions were generally motivated by a (fearful) reality that we had to face: COVID-19, I had a doctor’s appointment for a mole removal on my face, our friend’s struggle with a special needs “explosive child” and a toddler, we were trapped in our condo’s elevator which created a phobia, etc. When I reflect on how I have encouraged bravery, it is to face things that we must face even when we are scared. It is about explaining the unknown and making it known. It always felt like we were facing things together and coming away stronger than before. It was never about exposing my daughter to fearful experiences to alleviate my own concerns of being atypical, until this birthday.

Of course, I want my daughter to be able to have good mental health and strategies to cope with feelings of anxiety. I hope that one day social situations and speaking will cause lower levels of anxiety, altogether, but pushing too much too soon will not get us there. My goals for my daughter speaking and engaging in social behaviours are long-term. They do not fit with the traditional age-requirements of our society where all preschools and classes are drop-off by 3 years old. I need to get creative. I need to find or make my own solutions that fit our life. It will be my advocacy and ingenuity that will create the environment my daughter needs to thrive such that we reach those long-term goals without sacrificing our relationship.

In my next post, I will discuss scripts I wrote for my sister to help her toddler make transitions.

behaviorally inhibited temperament behaviour modification

Behaviour Modification: the good, the bad and the balance

Behaviour modification is an oft recommended strategy for extinguishing undesired behaviour and increasing desired behaviour in children. You have probably encountered methods based in behaviour modification psychology like rewards, praise, ignore, time-outs, and consequences. In fact, many health organizations (like the Center for Disease Control in the US and The Child Mind Institute) recommend a basic form of behaviour modification as a general parenting strategy; it sure as hell beats spanking! However, you also may have heard that time-outs are bad, or why too much praise is bad. This is confusing. And research is not necessarily going to help you! There are many randomized control studies to show that behaviour modification works to change behaviours and there are a number of formal methods based on behaviour modification, all with evidence-based research to support them: the Yale ABC Parenting course based on the Kazdin Method (which, paradoxically, does not appear to be based on traditional behaviour modification!), the Triple P Parenting philosophy, and the Parent Management Training program. But there are other psychologists and clinical counsellors that do not recommend traditional behaviour modification strategies (Laura Markham, Gordon Neufeld, Ross Greene, Daniel Siegel (sort of), Vanessa Lapointe, and others). These experts theorize that there are underlying “hidden” consequences of behaviour modification:

  • Loss of connection between parent and child
  • Using parental attention (i.e. love) as a bargaining chip to change behaviour
  • Ignoring the child’s perspective (i.e. being disrespectful).
  • Creating an external locus of motivation (i.e. child will only perform for rewards)

Does the loss of connection between adult and child do long-term damage to the child? For example, administering a time-out for bad behaviour could result in the child experiencing love-withdrawal or humiliation, even while extinguishing the bad behaviour. Drs. Siegel and Kazdin say the problem with time-outs is that most people use them as punishment instead of in a “positive” way; the result is that time-outs, as implemented in the real-world, may be interpreted by the child as punishment, love-withdrawal, and humiliation.

Asking and answering research questions is difficult. Some questions are easier to ask and answer than others. It is easy to answer the question, “Do time-outs reduce the frequency of behaviour X”? We randomly assign a group of families to the “treatment” group of receiving instruction on administering time-outs and then we record the before and after frequency of behaviour X (this would be a within subject study design where the subject’s post-treatment behaviour is compared to the same subject’s pre-treatment behaviour) and we can also compare the frequency of behaviour X in the treatment group to a matched control group that didn’t receive treatment. Counting the times behaviour X happens is relatively easy. You can see if it happens. You can record it. However, it’s hard to answer the question, “are time-outs interpreted as love-withdrawal and humiliation by a child and do those experiences affect their self-worth (or other outcome) over the long-term?” or “Do time-outs negatively impact the parent-child relationship over the long-term?” These questions are more interesting, but they are hard to answer. How do you define “long-term”? Is 1 year good enough? 5 years, 20 years? How exactly do you measure humiliation? Is the child asked after a time-out, “did you feel humiliated”? How old is the child? Do they understand this word? Do all cultures define humiliation in the same way? In what language are you asking the question? Do you ask adults to reflect back on time-outs they received as young children? Do you find a surrogate blood marker like cortisol (the stress hormone) and say that a particular increase in cortisol indicates stress and is associated with humiliation? How do you define the parent-child relationship? Is it just based on the theory of attachment as defined by the Strange Situation experiment? Is there a measure of warmth or love and can this be measured in the same way between a 3-year-old and parent and an 18-year-old and parent? These topics are hard to define and a researcher’s definition might not be the same as your definition, making it even more difficult to generalize results. As far as I know, long-term relationship and connection questions have not been adequately answered in the behaviour modification literature, which is exactly why there is debate about behaviour modification strategies!

Ross Greene also has an evidence-based parenting strategy, Collaborative and Pro-Active Solutions that is not based on behaviour modification techniques because he feels those are coercive and disrespectful to the child. A lot of psychology and parenting techniques are based on decades-old philosophies and ideas about children being lesser beings than adults. Children did not deserve respect as true and complete human beings. They needed to be controlled and manipulated into the human we wanted. They were a blank slate and needed to be filled with the “correct” ways of being a human.

For me, the idea of disrespect comes back around to temperament and accepting the child you have. Of course, we cannot accept violent behaviours or behaviours that prevent a child from living a healthy life (with the definition of healthy being subjective to the society in which you live). So, you may find yourself questioning, as I often do, about what strategy is best – behaviour modification because we know it changes behaviour and has a LOT of supporting experts and evidence or a connection-informed approach that appears a little more vague and little more open to interpretation like Dr. Markham’s Peaceful Parent approach (which is anti-consequences, anti-time-out and anti-praise/rewards and uses loving connection and empathic limits to guide children’s behaviour) or Dr. Greene’s approach (generally for older children) to involve them as equals in proposing solutions for daily conflicts (randomized control trial shows the effectiveness of this approach)?

When I met with the child psychologist, she walked me through her course on anxiety and treatment for young children using examples from my experience (the general guidance was very similar to the free course on Anxiety Canada). Over time, the psychologist offered nuanced guidance that alleviated my fears about over-exposing my child to fearful things and “forcing” her to do uncomfortable things. The strategies are based in behaviour modification techniques, specifically differential reinforcement. Briefly, this is a combination of praise/ignore techniques to reinforce desired behaviour and extinguish undesired behaviours. For example, you could use labelled praise to reinforce independent play while you make dinner, “I like how you are using so many colors for your picture” and then ignore the child whining, “Mommy, come play with me.” If you are consistent, and offer more praise than ignoring, your child should eventually play/color without whining while you make dinner. Ignoring should be done less than praise (I think I read somewhere a ratio of 1:10 ignore:praise statements). Ignoring should only be done for minor behaviour issues that do not involve self-harm, harm to others or harm to property. This is an important caveat because if you misinterpret this technique, you may ignore a child hitting another child (or assume two preschoolers should be able to “work it out” on their own).

However, I do not like ignoring because I feel like it breaks my connection with my child. In addition, I am a naturally quiet person and continuously praising my daughter is uncomfortable. I like my daughter to just carry on in her day without me constantly commenting on her behaviour. However, I do see merit to the idea of using praise for specific issues for young children. For example, I am trying to “catch” my daughter and her little cousin sharing/taking turns and praising their behaviour to reinforce my expectation that they take turns and their great accomplishment of successfully taking turns! I use praise as the “rewards” for various steps on exposure ladders as I can see the joy on my daughter’s face that I have acknowledged her effort in a difficult task.

As I am reading Discipline without Damage, by Dr. Jennifer Lapointe, I find myself aligning more and more against traditional behaviour modification. As she argues, the greatest need a child has is connection to their big person. If that big person disconnects (for example, by ignoring the child during a tantrum), the child will eventually do whatever it takes (including changing behaviour) to get that connection back. But, should your love and connection with the child be used as a bargaining chip for desired behaviour? Shouldn’t your love and connection be unconditional? Dr. Lapointe, argues for unconditional connection and, therefore, argues against ignoring “bad behaviour”. In addition, she also views “bad behaviour” as developmentally appropriate behaviour and not necessarily something to change! Just like the phase of diaper wearing will eventually end, so too will the phase of tantrum-throwing, for example.

But, since I was knee-deep in behaviour modification psychology, as guided by my psychologist, I decided to try out the strategies and maybe unsurprisingly had mixed results.

Successful Ignoring Anecdote

I tried ignoring for a specific instance with success when my daughter was just over 2 years old. My daughter started crying every morning at breakfast about whether her blueberries were hot or cold. Whichever one they were, she seemed to want the opposite. She started jumping out of her bed when I opened her door in the morning, and she would race into the kitchen to monitor the blueberry preparation. She was becoming hypervigilant about blueberries. I relayed this story to the psychologist, and she suggested I try ignoring her and serving the blueberries however I wanted. I am averse to creating power struggles, especially around food and I was not convinced that this was the best solution. My mom suggested I serve both hot and cold blueberries at the same time to try to determine which one my daughter prefers. One afternoon, I did my mom’s suggestion and my daughter happily ate both bowls of blueberries! She did not seem to have a temperature preference. I decided to try out the ignoring. I got my husband on board and we tried the first morning. She cried. I did not speak or look at her and carried on with the rest of breakfast. Eventually, she ate her blueberries. Repeat for about 3 days and I have not had a cold/hot blueberry issue since (it has been over a year)!

Unsuccessful Ignoring Anecdote

Buoyed by my blueberry success, I tried ignoring when she refused to put her shoes on to leave her grandparents’ home, but it escalated into a full tantrum every time. Ignoring did not seem to help that situation and instead her upset continued to escalate. What did help was offering a piggy back ride so that she didn’t have to put on her shoes; I ended up using the piggy back strategy for about two months and then she started wearing her shoes again without being upset.

In hindsight, I think the blueberry issue was my daughter’s anxious brain trying to control the first thing that happened in the morning when she was starving and taking in a lot of visual stimuli and her brain went into hypervigilant overdrive. When the control was removed her brain was relieved and able to relax as her Big Person (me) took control! Whereas the shoes issue seemed more to do with her discomfort with wearing shoes at that time of day and was solved simply by not requiring the wearing of shoes. This brings me to one of the most difficult aspects of parenting anxious (and all) children: finding the root of the problem. I do not like behaviour modification strategies because they focus on solving downstream behaviours when I would much rather focus on addressing the root. But for many children, especially those that do not speak, a parent must be an astute detective to decipher the path back from the behaviour to the root. Hindsight helps and I hope that my hindsight will eventually strengthen my foresight.

As I previously mentioned, Ross Greene, author of The Explosive Child and Raising Human Beings does not use behaviour modification. I love his strategy, although it generally pertains to older, verbal children, and I look forward to using his Collaborative & Proactive Solutions approach as my daughter gains more speech and language ability.

As a scientist, I find it interesting when people emphatically claim that one method (behaviour modification) is the only “correct” parenting method because there is supporting scientific evidence. As far as I can tell, the evidence shows that behaviour modification strategies successfully alter the behaviour for most children (but not all!). However, the studies do not necessarily tell you if the overall long-term effect on the child is positive or negative. For example, time-outs may alter behaviour in most kids (always seemed to work on Nanny 911 and Supernanny!). However, for the minority of children with an inhibited anxious temperament, they may interpret a time-out (or even ignoring!) as punishment, embarrassment and love-withdrawal and come to fear the experience and authority figure (parent). This type of child may stop their negative behaviour but may also resent the parent, which could lead to long-term distrust within the parent-child relationship. I do not know any studies that specifically account for and address temperament with behaviour modification strategies. From everything I have read on inhibited, anxious, sensitive children, it is better to air on the side of caution by favouring loving, warm connections rather than do anything that could be perceived as a punishment by the child. My plan is to continue to use ignoring as minimally as possible and use empathic limits, collaborative solutions, and encouragement for desired behaviour while always looking for the root of a behaviour to meet my daughter’s needs.

I will visit some of the empowering stories from the Brave Tools in my next post and describe how they formed the foundation for taking brave actions.