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.

brave story exposure ladder

Brave stories and exposure ladders for anxiety: a fear of the bike trailer

After great success conquering my daughter’s elevator fear, I was eager to try this method again. Conveniently, when you are around two 2-year-olds, there is always a fear that can be addressed. This is the story of how I put my 2-year-old niece in a bike trailer and thought everything was going great until an extremely fearful tantrum showed me it was not going great at all and I needed to slow waaaaaay down.

The weather was getting better and better and I wanted to start biking my daughter to the beach and forest. My husband and I decided to take my niece with us on our forest adventure. My husband rode his bike and I rode our e-bike pulling a double bike trailer to my sister’s house. I picked up my niece and started talking enthusiastically about going to “Turtle Pond” (a forested park with a pond that is a 5-minute bike ride from our house). My daughter has always loved the bike trailer and bike seat and she was sitting patiently in the trailer when I popped my niece in and away we rode. We had a great time playing in the forest. After dealing with my daughter’s meltdown right before we needed to leave Turtle Pond, I was trying to get the kids buckled in as quickly as possible so as not to be late for nap time. My niece was having none of it. She physically resisted (which is hard because she is tiny and slight with minimal muscle strength). I could have physically forced her into the trailer, but that is a parenting method I try to use very rarely. I stopped, pulled back, and talked to her about going to see her mommy. She said she wanted to drive back. I explained there was no car; this was the only way home. She continued to resist. Eventually, I think she misunderstood what I said and was somehow convinced to get into the trailer, but as soon as I secured the buckles she started screaming. The look of desperation and fear on her face was unmistakable. She screamed to be let out. And of course, just our luck, it was also raining so I zipped up the rain cover on the trailer making it even more of a constrained box. Thankfully, my daughter did not break down through all of this and sat their quietly (her meltdown came later!). Anyway, I looked at my husband with pleading eyes, thoughts whirling around: I do not want to bike this scared child; she is terrified; it is almost nap time, she’s probably tired and I have no other way of getting her home in a timely fashion. My husband convinced me to start biking and immediately she calmed down. Ok, I thought, maybe she did not know what the bike trailer was all about. This is fine. My husband played “peek-a-boo” with her during the ride home and got some smiles. I dropped her off and explained what happened to my sister in case my niece needed to “release her emotional backpack” in the form of a good cry again.

You can guess what happened the next time my husband and I tried to take my niece on an adventure. No dice. I had already told my husband there is no way I was going to strap a screaming Niece into the bike trailer. When there is so much fear going on, that fear needs to be addressed on her timeline, not mine. I do not agree with “sink or swim” methods as I think this can lead to phobias and I think it is disrespectful of the child as a human being [more info]. Instead, I took a step back and realized I needed to make a Brave Bike Trailer Story and exposure ladder. I also needed to figure out what exactly was fearful about the bike trailer from a limited-vocabulary, minimalist speaking 2 year old. Luckily, these things became evident one day during a walk. My niece said to my sister “tight” and “bump”. In a bit of context, we discovered that my niece was afraid of bumps in the bike trailer and the tightness/constraint of the straps. I included these two specific issues in the brave story (at the time, I knew the straps were an issue but I didn’t realize the word “tight” was related which is why it is not included in the story).

We read the story and started the exposure ladder:

  1. Read personalized story (reward: none)
  2. Bring bike trailer to front door for investigative play (reward: verbal encouragement)
  3. Bring bike trailer on walk to park for investigative play (reward: verbal encouragement)
  4. Offer ride in bike trailer used as a stroller (no buckles) (reward: book in trailer)
  5. Go over bumps in stroller-mode (no buckles) (reward: verbal encouragement)
  6. Ride in bike trailer for adventure with Mommy (reward: book in trailer)
  7. Goal: Ride in bike trailer for adventure with Auntie A (reward: book in trailer)

We stalled on step 2! Unlike my daughter, my niece had absolutely no interest in investigating the bike trailer and playing with the zippers and buckles. My daughter still spends many minutes sitting in the trailer buckling in her stuffed animal and zipping the zippers and asks to play in the trailer every time we use it. My niece could not have cared less about the trailer. I tried step 3 and there was minimal interest from my niece. She did not care about this trailer coming with us to the local park; she cared more about looking for bugs than zipping zippers. The next idea I had was to encourage her to sit in the bike trailer for a snack and I rewarded her with a chocolate chip. This worked, but I did not want to make this a habit since I do not allow my daughter to eat in the bike trailer. From this non-step, I discovered that my niece would get in the trailer under the right circumstances and she feels proud of herself for accomplishing brave tasks. Her smile was huge, and she clapped when I stated how brave she was for sitting in the bike trailer even when she felt scared.

My next idea was to use books as an enticement into the trailer. Unlike my daughter, my niece LOVES books. All she wants to do is have someone read books to her and she is also thrilled to flip through books alone. So, I collected a few small board books and put them into the trailer on our next walk. My niece walked along without so much as a glance towards the trailer. My daughter saw the new books and jumped into the trailer. This was finally the scenario that convinced my niece to get into the trailer. I decided not to secure the straps and just slowly pushed the trailer with the kids looking at the books. At the end of the walk, I specifically pushed it over some small “off-road” grassy bumps. I ended up combining steps 4 and 5 and we had success. I found new books for step 6, and with a beach destination my niece was excited. We set up the bike trailer, showed her the books, explained where we were going, and she jumped right in! We finished off the exposure ladder by leaving Mommy at home and now my daughter and niece happily ride in the bike trailer together reading books and singing songs.

I am relieved I did not force a screaming Niece into the bike trailer. Taking a step back and seeing the situation through her eyes and addressing her fears allowed us to move forward in a positive way that ended up right where I wanted her (able to ride in the bike trailer) and, more importantly, gave her a sense of bravery and accomplishment that we can now reference for future fears. The whole process took about 2 weeks with no tears and was not intensive (i.e. I did not read the story or implement the exposure ladder steps daily). This is an example of why you do not have to write the perfect story or make the perfect exposure ladder to get positive results. Give it your best first shot and then adapt as you learn new information from your child. However, developing a plan with thoughtful steps is important to prevent you from jumping too far ahead and going faster than the child’s pace.

In my next post, I will describe the behaviorally inhibited temperament, anxiety and the numerous behaviours I noticed in my daughter that were “different”.

Sink or Swim

I do not agree with using sink-or-swim methods on children for fears. I think the messages to children from sink or swim methods are negative and include:

  • The adult’s needs are most important.
  • The adult doesn’t care about my needs.
  • The adult does not know my concerns.
  • The adult is not going to take time to find out about my concerns.
  • The adult is bigger than me and can physically control me.
  • There is nothing I can do to stop the adult.

So even with a successful sink or swim method (i.e. the child eventually gets into the bike trailer without screaming/crying), the messages that the adult is sending are negative, aggressive, and controlling. Whereas, in a thoughtful, planned gradual exposure method based on the child’s fears and concerns, the messages are much more positive

  • The adult hears me.
  • The adult wants to help me.
  • I am scared and it’s okay to be scared.
  • I am brave.
  • I can do things all by myself.

We are all such capable adults that it can be hard to slow our life down and move at a child’s pace. But whenever we can take time, the results are so rewarding and go far beyond just conquering one fear. The child will develop greater confidence as their bravery increases as they face more fears when they feel in control of the progress.

The researcher in me is also curious if a person implementing a sink or swim method would find “success” any sooner than using a gradual exposure “planned” method. When you look at the grand scheme of life, two weeks is quite fast to go from fear of a bike trailer to happily riding for adventures!