by Bob Doman

Rewards and consequences are the tools we have as parents, or, for that matter, as a society, to provide feedback, guidance, encouragement, and instruction, and to maintain order. Lack of consistent quality feedback leads to ambiguity, confusion, poor outcomes, and potentially chaos.

We need to reward the behaviors or things our children do that we like and want to see increase. Behaviors we do not like or want also require appropriate feedback. Rewards and consequences are the tools we have, the power we must use to teach our children, encourage them to do more of what we want, and dissuade them from doing things that are harmful or that will negatively impact their lives and futures.

What is a behavior? 

Everything we do can be defined as a behavior. For our children, it’s everything from walking and talking to reading, following directions, complying with requests and rules, and interacting with us and others—essentially, everything they do. 

Sadly, to many, the word “behavior” implies “bad behavior.” “Johnny has a behavior problem.” As stated, virtually everything our children do, whether it is helpful or harmful, is a behavior and is influenced by our response to it.

Feedback

Without feedback, children are in a vacuum, not knowing “Should I?” “Shouldn’t I?” “Does it matter?” or “Who cares?” Lack of quality feedback deprives the child of guidance and produces insecurity, anxiety, doubt, and poor outcomes. Unfortunately, many children receive poor or inconsistent feedback from their parents, schools, and society as a whole. 

Credibility—positive environment

To a significant degree, our influence is determined by our credibility. To create credibility, it is important to establish your primary role as loving, supportive, encouraging, and being on their side. The core of your child’s perception essentially reflects how positive or negative your overall interaction is with them. To have a positive environment, you should create a ratio of positive to negative feedback of 3:1 or 4:1 or greater. Part of the positive-to-negative equation is intensity. The stronger the reaction/feedback intensity, the stronger the impact. Ten smiles or “good” or “nice,” will not, in balance, equal one major hissy fit. Sadly, many parents reserve the intensity for the negative reactions. 

When responding to a behavior, a very important note is that our primary focus is not to specifically encourage or stop that immediate behavior, but to build those behaviors or extinguish them over time. Our measure of success or failure is the long-term results. Are we seeing more of the positive behaviors and less of the negative behaviors? If not, we have not succeeded and need to modify our response and feedback.

Consistency

A phrase often heard by parents from their children is, “It’s not fair.” It’s a safe assumption that you are not being consistent if you hear this from your child. Children seem to have an innate understanding of injustice, and inconsistency is at the top of their list of injustices. “I did this yesterday, and it was okay; why am I being punished for the same thing today?” Consistency is vital to build credibility, not appear unjust, and have the child accept and learn from your response. 

Did you mean it?

Many responses children receive for their “bad” or inappropriate behaviors are what I refer to as the equivalent of a 5-cent speeding ticket. Many of the supposed positive responses are not much stronger. I have referred to intensity as one of the foundational pieces of neuroplasticity. If something happens without sufficient intensity, our brains do not respond or change, and no learning occurs. One of the best gauges of the effectiveness of your responses is whether they worked. I often hear from parents things like, “I keep punishing the behavior, but he still does it.” If this is true, then you have not actually punished the behavior. You may have said or done something but did not punish the behavior. The definition of punishment is a response or consequence to a behavior that decreases the frequency of the behavior. If you haven’t changed it, you haven’t punished it, and doing something negative that doesn’t improve the behavior is cruel, and counterproductive, creates a negative environment, destroys your credibility and effectiveness, and harms your relationship with your child. 

The best consequences are the ones you only need to use once or twice. Do not be afraid when a consequence is warranted to go big. As an example, an age-old consequence has been writing sentences. Johnny picks on his little sister, creating all kinds of issues for the family. His consequence might be to write the sentence 10 times: “I have to be nice to Mary, and I cannot and will not pick on her.” I suspect that for many boys, this task would result in a lot of grumbling, and ten minutes later, they would be finished, and fifteen minutes later, Johnny would be picking on Mary again. What if Johnny had to write that sentence 300 or more times? This would probably take many hours; Johnny will have missed some things he would have liked to do, like his baseball game, and had said to himself 300 times while writing it, “I have to be nice to Mary, and I cannot and will not pick on her.” We call this frequency, and frequency changes the brain, which means learning occurs. Hopefully, this consequence will only be used once or twice to change the behavior.

It should be noted that consequences may only be effective if the overall balance between positive and negative, as mentioned, is 3:1 or 4:1 or greater. In a negative environment, the child may learn that they only get real attention if they do something “bad.” In this scenario, bigger consequences can result in more “bad” or worse behavior.

“Bravo”

We work with many families in Europe, and as we do with all our families, we have them post videos to their NACD Portal showing us how they implement the various activities we give them. When reviewing these videos, the word we often hear as they implement their child’s activities is “Bravo.” “Bravo” is a nice positive word, which essentially means, “Well done.” However, what we often see is “Bravo’’ meaning “you tried but got it wrong,” or “Bravo” meaning “we’re done,” or “Bravo” meaning “let’s do what’s next,” and “Bravo” meaning “good,” or “you did well,” or “you got it right.” In a thirty-second video we could hear ten “bravos.” This is not terribly effective. Although the tone is positive, which we strongly encourage, there isn’t much delineation between positive, negative, and neutral feedback. In such situations, it’s not that we want or need strong negative feedback for getting something wrong; it’s a matter that the positive needs to be much stronger. The response to “wrong” should be simple acknowledgment, such as “Oops, let’s try again,” but the response for getting something correct or done well should be robust and powerful.

Attention

Any attention is potentially reinforcing. Attention must be given with the knowledge that it has the potential to be reinforcing regardless of the intention. Many of our children’s negative behaviors begin as simple attention-getting behaviors. A child’s smile can elicit a smile from Mom. The smile got Mom’s attention, and she smiled back or picked up the child and rewarded the behavior, building that behavior. Johnny burps, and Mom responds, “Johnny, don’t burp.” The burp elicited attention from Mom, which potentially reinforced their behavior. “Johnny, don’t burp” is not a consequence. It’s attention, and any attention from a parent is potentially reinforcing. Of greater consequence are the parent’s response to minor possible hurts—hurts being little physical bumps, to a hurt feeling. If Mom overreacts, picks up the child and loves all over them, the odds are good that the crying doesn’t stop, but increases because of Mom’s attention. This reinforces the child’s overreaction, which essentially is a lie, and can potentially help teach children to lie. These children often become the “drama queens” because it works. Parents mistakenly perceive all the attention they give their children as a display of love and a good thing. Attention must be given judicially, understanding that it can be very influential.

In negative environments, attention gains even greater significance.

Opposite incompatible behaviors

Understanding the concept of opposite incompatible behaviors is very helpful for parents in focusing, creating a positive home environment, and successfully managing and developing their children.

Opposite incompatible behaviors reference the reality that you can’t be good and bad or try and not try, be responsible or irresponsible, etc., simultaneously. In our efforts to create good attitudes, work habits, and other behaviors, we always want to be aware of the opposite incompatible behaviors and focus primarily on building and reinforcing the positive preferred behaviors. This applies across the board, from behavior problems that need to be turned around to increasing focus on academics or responsibility with chores. When possible, focus on building what we want with positive attention/rewards, and when we need to use consequences, do so effectively and judicially.

• Create a positive environment.
• Provide consistent, definitive feedback.
• Be cognizant of the power of attention.
• Focus on rewarding the behaviors you want to build.

Reprinted by permission of The NACD Foundation, Volume 37 No. 3, 2024 ©NACD

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Quite a few of you know my story and journey with NACD, but for those of you who do not here it is in brief: We started our journey with NACD in December 2008. At the time my son Grant, who was five years old, was completely non-verbal, developmentally delayed, a flight risk, very stimmy, and had behaviors out of control. My husband and I were desperate for change and NACD gave us hope that one day our son might be able to first and foremost communicate with us and secondly live a happy and fulfilling life. I am very pleased to say that through our journey with NACD these hopes have become reality. He is fully conversational, a delightful young man, and living his best life. We continue to push forward and raise the bar on the expectations of him reaching his full potential.

In December of 2021 my dream job came to fruition, working for NACD as a coach, supporting families just like mine. As coach and now well into evaluator training, I have gained a different perspective through working with both evaluators and families. This has caused me to reflect on my personal journey with NACD and through reflection there are some things I wish I had understood more fully earlier on.

I wish I understood then just how important processing activities are as the critical foundation to global development. The background information I brought with me had me convinced I needed to prioritize other activities I felt were more important, like reading and math. These things are of absolute great value and importance, but the reality is the higher the processing is in a child, the easier these subjects will be to learn, and not only to learn, but to retain. Push to build the processing and the academics will fall into place much more easily.

I wish I realized that each activity on my child’s program is put on program with a specific intent and purpose. There are no “fluff” activities on program. Each activity is an important piece in building your child’s brain. Your evaluator has reason and intent behind each activity as to why it plays an important role. If you are unsure what an activity is accomplishing or why it is on your child’s program, ask us! The more you understand your program, the more successful you will be at implementation.

I wish I embraced the concept of pushing chores, responsibility, and self-help skills earlier on. I had my children learn chores, but I did not quite fully understand the bigger picture of what is accomplished through having a mindset of increasing the list of things my children can do. When it comes to chores it isn’t so much about what kids can do but more about what is happening through the act of doing chores. Chores build confidence and independence in kids. The more confident and independent kids are, the more intrinsic motivation they have to not only take on learning new things but are not intimidated doing hard things. Confident children have a “can do” mindset and this mindset overflows into academics as well. When this happens, they aren’t intimidated by working a tough math problem or learning something new, but instead they readily take on the challenge and with joy! There is another big piece of development that occurs through building the list of things a child can do, and this is maturity. Maturity comes with doing things for oneself and through doing things for others. We are raising highly capable adults. Highly capable adults are confident, independent, and mature. Keep raising the bar on the things your child can do!

Lastly, what I would tell my younger self when first starting our journey with NACD: Know your child’s program thoroughly. Watch the video tutorials and read the handouts from time to time, not just when you get a new program. You will learn something new every time you do. Ask questions if you are unsure about any activities or if something just doesn’t make sense to you. Take time to educate yourself by reading Bob’s articles in the newsletters and watching his YouTube videos. There is so much to be learned and the more you know, the better you will be at implementing program. Your time and efforts working with your child will be more efficient and your greatest work will be right before you, your amazing and unique child well on his way to reaching his full potential!

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Most of us have no idea what creatures of habit and patterns we are, nor how stuck we can be in these behavior patterns. I have three dogs that keep reminding me of what a creature of habit I am. If I’m watching TV in the evening and pick up the TV remote, my dogs notice; and if I turn off the TV, they all jump up ready to go. Which way they go is determined by the direction of my first step when I stand up. In the morning if I pick up my cup from the coffee machine and if I turn left, my dogs run down to my office. If I turn right, they go about their business because there are too many options as to what I might do. You probably put the same foot into your pant leg first most every day. The point is that we humans create hundreds of behavior patterns, most of which we are oblivious to.

When dealing with children, particularly children with developmental issues, the connection between the child and the parents and caregivers is amazing. This connection leads to each learning each other’s patterns. Patterns can become ruts, ruts that both parent and child can get stuck in.

One very common pattern or rut that creates problems involves what children will eat. In a very significant percentage of children who come to us, ranging from severely involved children to those who are gifted, a common problem is picky eaters. Back in the early ‘70s when we created a program specifically for children with autism, I worked with a teenage girl who had eaten no food other than apples for virtually her entire life. To compound the mystery of this child, she also had pica—she would put most anything in her mouth and eat it. This included everything from dirt to bugs and her dog’s feces from the yard, but not food. The issue with her eating a greater variety of foods was obviously not an issue with taste or smell, although this can be an issue for many children, particularly those on the spectrum. It was simply a matter of an established pattern, a habit. It should be noted that food cravings that come from eating a lot of some specific foods can also be a contributing issue. Kids are not simple.

In a previous article (Independence and the Developmentally Challenged Child) I discussed how important and vital independence is for the overall development of the child or young adult. The child’s and the parent’s patterns and habits often have a very negative impact on the development of independence.

An example of a common pattern that slows down the development of independence in many children is helping them dress themselves. Most parents who assist their child in dressing and undressing assist in virtually the exact same way every time, and the child participates, or does not participate, in exactly the same way. As an example: Mom approaches Johnny with a T-shirt. Johnny sees it and waits for Mom to put it over his head, at which point he lifts his arms and she helps put his arms in the sleeves. Then she pulls the shirt down. Every day they follow the same pattern. If Mom doesn’t do something to change her pattern, the odds are great that Johnny doesn’t either; and Johnny’s development of independence in dressing himself goes nowhere. Parents need to become acutely aware of the hundreds of such patterns, habits that have been created by them and their children, and consciously work to break them.

It’s helpful when trying to grasp the significance of patterns to see how differently children perform with different people and in different places. Children who work with their parents, caregivers, therapists, and teachers are often going to react and perform differently with each person, or in each place, because patterns and habits are created together and are often person and place specific. Each adult establishes a new pattern, and to some extent the physical space helps establish a new mental picture and a new pattern as well. Most children on the spectrum are strong visualizers, creating mental pictures and videos associated with many aspects of their lives. For these visualizers anything that changes their picture (or habit) can lead to them becoming upset, with the net result being that family members and caregivers avoid upsetting the apple cart and work hard to maintain and reinforce the habits.

One of the most devastating and pervasive problems associated with patterns negatively impacting many of our children with developmental issues is prompt dependency. Prompt dependence is actually taught through creating a patten by which the child is prompted, generally verbally through virtually every step of what they are being instructed to do. Some children, after years of such instruction, develop such a strong pattern that they will do almost nothing without a prompt, requiring someone to guide them through most everything they do, creating greater dependency and stifling independence.

Referring back to the picky eater problem, parents often discover that their child will eat foods at the grandparent’s house that they won’t eat at home, or in a restaurant, or even outside. This is because a new place helps change the pattern.

The teenage girl with autism I met had her eating problem largely resolved within the week she and her family spent with us. Guess what we did to fix it? Almost nothing. The child had spent her whole life at home, eating by herself in the same kitchen at the same table and given the same food—apples—because her family been convinced that she wouldn’t eat anything else, and had established a very strong behavior pattern. When the family flew across the county, stayed in a hotel and at our offices, and ate at restaurants together, they broke the pattern. My little suggestion was to not have any apples nor bring apples to the restaurant and to simply order her the same food the parents were eating and tell her they didn’t have apples. She ate the food and within the week established a new behavior pattern, which was to eat what the family ate.

Patterns and habits affect all of our lives to amazing degrees. Having healthy diets for most people means establishing a new behavior pattern or habit. Exercising regularly for most people requires establishing a new behavior pattern or habit. Many people realize how difficult it can be to break an old pattern and create a new one and realize it doesn’t just happen. You have to very consciously work to create that new behavior pattern; and the longer a pattern exists, the tougher it is to change it, whether it is a good or a bad habit.

Typically developing children are neurologically changing rapidly, and that neurological change pushes them to do new things; and in the process it tends to break many previously established patterns of behavior. Typical children and their parents can certainly fall victim to habits. But when you slow down the developmental process, life tends to become just a series of pattens that essentially rule the child and the family’s life and can significantly and often dramatically inhibit change, development, and expectations. These patterns can affect all areas of development and function. An example is children learning patterns of communication. If whining works to get attention, and Mom interprets that as the child wanting something and becomes trained to start offering the child options until the whining stops, then the odds are good that the child will maintain that pattern of communication even though they neurologically are ready to start verbally communicating. In a similar vein there are children who develop a functional vocabulary of only a few words, who may go years without expanding that vocabulary. It becomes their pattern, and if the expectation is that it’s all he or she can do, then it becomes the perception of what can be, and it is accepted. A child who has a vocabulary of three words is demonstrating that they have the cognitive ability and the oral motor ability to think in words and produce words, why not ten words or twenty words or a thousand words?

If a child lacks mobility, the ability to move either through crawling, creeping, or walking to get to something, and learns to simply lay on the floor and space out, cry for attention, or whine until someone brings something to them, then often these become patterns and the child has no perception that they could move to go somewhere or get something. These children may have the cognitive and physical pieces that would permit them to move, but they are stuck in a pattern.

Looking at pieces of the child in isolation makes it very difficult at best to determine what is a reflection of the child being stuck in a pattern vs. what can, could, and should be. The perception of what can be is then easily limited to what has been, and doors are closed not based on the innate potential of the child, but rather on what patterns have been and are in place.

If, however, we view the “whole child,” the gestalt of the child, we can then see what could be and what pieces need to be put together to break the habits or patterns and move forward.

For example, one vital piece of the “whole child” is cognitive function. If we have understanding, auditory sequential processing, that says the child mentally has the ability to use language functionally and put two or three words together, as well as adequate oral motor skills for speech, but they only use a few words, then we know we have a child who today could be speaking much more, if not for being stuck in a pattern. If, however, we have the cognition, but not the needed oral motor function, then we know we need to work on the oral motor function hard, as well as working behaviorally to create the internal need to communicate. Conversely, if the child has sufficient oral motor function, but not the cognitive function, then the primary focus becomes the cognition.

Looking at a child as their isolated pieces and not understanding their patterns and habits can produce misdirected efforts and priorities, and more often than not turn the focus toward alternatives that lead to poor, low, or limited expectations that can negatively impact the child’s ultimate potential.

Not understanding the “whole child” or the impact of patterns can lead to pursuit of poor alternatives. For the child with limited language, the alternative may be an augmentative communication device that for the vast majority of children fails. If full mobility is deemed to be improbable, then putting the necessary developmental pieces together gets scrapped, and the therapy gets directed toward a child who will spend the rest of their life in a wheelchair. Or a child with unresolved behavior issues ends up being medicated, rather than having his pieces put together and patterns broken.

Habits and patterns impact all of our lives. For our children with developmental problems, these habits and patterns, both theirs and ours, can have devastating consequences. Every child needs to be viewed through the lens of the “whole child” and seen as a creature of habit if we are going to begin to provide them with a real opportunity to realize their innate potential.

Lack of function needs not and should not be viewed as a prognosis or predictor of potential.

Reprinted by permission of The NACD Foundation, Volume 34 No.5, 2021 ©NACD

The post How Patterns of Behavior Affect Your Developmentally Challenged Child appeared first on NACD International | The National Association for Child Development.

by Bob Doman

My son won’t do what I tell him to do.

Mom said, “Stop it!” for the ten-thousandth time.

Why should I?

The kids are out of control.

You’re not the boss of me.

Susie won’t sit at the table and finish her meal.

I can’t get him to do anything.

Many parents feel powerless to get their children to obey. They try rewards and every “punishment*” under the sky, but the kids still ignore them and do what they want, when they want.

Even though I’ve heard it perhaps thousands of times, every time I hear an adult, a parent, tell me their little thirty-pound child won’t listen to them and that they can’t get their child to obey, follow directions, stop doing something harmful or dangerous, or do something important for their development and education, I am a bit taken aback. Whether your child is two, ten, or a teen you have power—if you wish to exercise it—to gain control.

Your child can’t eat something unless you buy it; they can’t watch TV, listen to music, play a video game, use an iPad or any screen for that matter unless you let them. They can’t go to the park or do many things unless you facilitate or permit it.

The things your child really likes are the things that provide you with parent power; if you are willing to use your power. Access to favorite foods or treats, access to screens, music, special toys, extra or special events, etc. are not in the category of necessities. They are things you as a parent can choose or not choose to provide. These things need to be perceived by you as special things you are providing for your child; not having them is not deprivation.

If I suggest to some parents that they need to withhold favorite items or activities and use them as rewards for compliance, cooperation, or trying, I will hear comments such as, “Johnny will throw a fit if I limit his screen time!” A parent who is afraid to control their child is the parent of a child who is doing a better job of using rewards and consequences with their parents than the parents are with them.

A rule of thumb with children’s behavior is that they do what works, regardless of how self-defeating it may appear to be. If you tell Johnny he can’t play with the iPad and he throws a fit, he is doing it because throwing a fit works; it gets you to do what he wants. He is punishing your behavior. When you need Johnny to keep himself occupied and stay out of trouble and he quietly spends hours on the iPad, he is rewarding your behavior of letting him do what he wants. If Johnny’s fits didn’t work, he would stop having them. The typical parental response to this is, “I don’t let it work, I don’t give him what he wants.” My response to the parents is, “How consistently do you not give in and let it work?” Even if the parent’s response is, “most of the time,” that isn’t enough. If Johnny believed you, he wouldn’t do it because he knows it’s not going to work. Kids are terrible with odds. You wouldn’t gamble on something with lousy odds, would you? It depends, doesn’t it? You might buy a Powerball ticket with odds of 1 in 292,201,338 with the chance of winning millions. Guess what? To your five-year-old, getting the iPad right this minute is more significant than 100 million dollars to them (at least in part because they may have spent so much time on it that they are now addicts).

Historically I haven’t found that taking everything away from children to be productive. It is and feels to them to be punitive and it doesn’t work. But controlling their one favorite thing, or a few of their favorite things, and having them earn them does work. There is a difference, a significant difference.

There are a few important principles for parents to learn in dealing with their child’s behavior.

Behavior Principle #1

First is the concept of opposite incompatible behaviors. If you take advantage of this concept, in many, if not most cases, you can reward a behavior rather than punishing an opposite behavior. Rewards almost always work better than punishments and they make us as parents feel much better. They also move us toward creating a positive environment.

Examples of Opposite Incompatible Behaviors:

• not staying in bed/staying in bed
• not doing a chore/doing the chore
• siblings fighting/siblings not fighting
• not cooperating/cooperating
• having a lousy attitude/having a good attitude

Behavior Principle #2

Second, if we are trying to start a new behavior, we start with a small demand and a big reward. In the category of behavior, we have everything from a child saying “please”, to a child playing nicely with a sibling, to taking off their socks, to working hard on a processing activity. As we get the new behavior started and are establishing a new behavior pattern, we decrease the intensity/size and the type of the reward.

Behavior Principle #3

Third, always couple a tangible reward such as a treat, a special privilege, or even money, with a “social” reward. A social reward means praise, a hug, a high five, etc. As we build the habit of the new behavior, we decrease or phase out the tangible reward and maintain the “social” reward, albeit perhaps at a less intense level.

Behavior Principle #4

Fourth, if we are using something they like and that is important for them as a reward, if that thing can only be accessed as a reward, it has much greater power than if it is just a way to get more of whatever.

How to Implement These Principles

Let me give you two examples of how to implement these principles:

Example 1:

You have taught little Susie how to make her bed and the expectation is that she will now make her bed before leaving her room in the morning. If Susie does not make her bed, do we come up with a punishment? Do we punish this “bad” behavior or find a way to reward the opposite incompatible behavior? After we have taught her how to make her bed independently, we tell her that we want her to make her bed by herself before she leaves her room and comes to breakfast. To help this brand-new behavior along, we kick-start it with a BIG reward. So, for example, you tell Susie what you want and that you are going to be very proud of her if she does this grown-up thing. If she does it, you will make her pancakes for breakfast with syrup, strawberries, and whipped cream. Then after breakfast, you will go to the park. When she comes out for breakfast, you go into her room with her to see if she has completed her job. If she has, you cheer, pick her up, twirl around and give her a big hug, then proceed to make her pancakes, and then head to the park, all the while taking opportunities to tell her how proud you are of her for making her bed. If it turns out she did not make her bed, say something like, “I’m sad you forgot to make your bed. I was going to be so happy to make you pancakes and go to the park, I bet you can remember to do it tomorrow. Without mentioning it, plain eggs for breakfast and no trip to the park; also do not make a big deal of it all. Any attention has the potential to be rewarding, so drop it and move on.

As we continue with Susie making her bed, we slowly decrease the size and frequency of the tangible reward and to some degree the intensity of the “social” reward. Day two of success may earn the pancakes with all the fixings and the trip to the park. Day three, the pancakes, without the strawberries and whipped cream, but no park. After day six or so, start making the pancakes randomly every two to three days, always praising her for the good job she is doing, and then slowly phase out the pancakes, leaving a new behavior pattern and small social rewards, shifting emphasis to new behaviors. We can now avoid the unhealthy pancakes again or save them to help start another new behavior, but only make pancakes when they are being used to build a new behavior—they’re special and have special power.

Example 2:

Sean spends every possible minute he can watching YouTube on the iPad and when you try to take it away so he can do some reading, chores or other productive activity, he throws a huge fit. Sometimes he wins immediately, and you give up and let him watch his favorite videos. Other times you take it away and fight with him for an hour until he sort-of does what you want and then is immediately back to his screen. Do we punish the negative behavior of throwing a fit and not giving up the iPad, or do be find a way to turn the iPad into power?

In Sean’s case we actually have a few issues. He is addicted to watching/perseverating with YouTube videos, he is being defiant, and he is wasting his day doing an unproductive and harmful activity rather than being present, engaged and learning. To compound the problem, the constant negative attention he was getting from fighting and often winning was making his world extremely negative. The negativity was teaching Sean to work for the negatives, not the infrequent positives. It was defining him to himself and others as a negative, unhappy, and uncooperative child. Used correctly, the iPad could not only provide us with power, but it can be used to develop new positive behaviors.

The first thing I would do with Sean, is to take away the iPad completely for a week or two to start breaking the addiction and to teach him that you, and not he, are in control. Take it away, lock it away, and tell him that he has been watching it too much and that it has become bad for him. Period. No further discussion, no arguments. Of course, he will throw a massive fit, but don’t argue, discuss, or give in. As soon as you convince him that he isn’t getting it (if you have an option like going with him and leaving the iPad at Granddad’s house, use it), he will stop fighting. Kids do what work, and when he decides that you aren’t giving in and that his fit isn’t going to work, he will stop. After a few days of peace, it’s time to use the power.

Our goal is to turn the negative behavior of Sean watching endless YouTube videos into the opposite incompatible behavior of working, cooperating, and doing things that are positive for his growth and development. For Sean there is probably a long list of things you would like to see him do, from specific chores, to reading, working on processing, to math. In the past, every one of these things had become negative and he would either have a tantrum and win or throw a fit and eventually sort of do what was asked, but neither well nor as an active participant.

To start on the road to the new Sean, we would define a task that is definitive, that is clearly accomplished correctly. Examples include things like doing five math problems correctly (make it easy), taking the trash out, or emptying the dishwasher. Sean is told that when he accomplishes his task well he will be permitted to play on the iPad for 10 minutes. If Sean enjoys playing good games or doing things other than watching YouTube, I encourage removing all of the offensive material, including YouTube, from the iPad before giving him access. Upon proper completion of the task, give Sean a lot of positive praise and then set a timer for 10 minutes and immediately let him play for the ten minutes. As you proceed with Sean, you would add more and more projects for him, and while maintaining all of the positive social rewards, you would also increase the demands and decrease the iPad time and start looking for other perhaps healthier rewards. As Sean’s world becomes more and more positive, he will hopefully start perceiving himself differently and being happy, while you are moving the tangible rewards in better directions and slowly phase them out completely. You should also be able to decrease the intensity of the social rewards. It’s important to note that another term for “social rewards” is “adult rewards.” As we teach Sean to be a positive active participant and how it feels to receive positive acknowledgement for his efforts, we are also teaching him to appreciate adult reinforcement and to become more mature and responsible.

Parents, learn not to jump when your child says, “jump.” If you are tired of your child pulling the strings and if you would like to gain control, help your child develop, and make his or her world and your world more positive, use the “power” and remember to use the four principles.

*Punishment—a consequence to a behavior that decreases the frequency of the behavior. If you continue to “punish” a behavior and it is not decreasing or being eliminated, you are in fact not punishing, but may be reinforcing a behavior with attention, possibly being abusive or punitive and definitely creating a negative environment.

Reprinted by permission of The NACD Foundation, Volume 33 No. 7, 2020 ©NACD

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In my last article I mentioned that working memory is another factor to consider when looking at anxiety in our children. Bob Doman, founder and director of NACD, has been at the forefront of understanding working memory and its impact on global function since the early ‘80s. It is a big deal. It is not just big, but huge, gargantuan, as it is the foundation that permits us to think. It not only permits us to think, but it also plays a role in our ability to regulate our emotions. Let’s spend some time on working memory, defining its role in our ability to handle stress.

Let’s first review how the brain works in a simple way. Information comes into the brain through our senses. If our sensory channels are functioning normally, the information gets perceived correctly, then it gets processed through our short-term memory. Our working memory is what allows us to think about this information along with taking information that we already know out of long-term memory. For example, if I am sitting in a class and I am listening to a lecture, I am taking in what that teacher says, hearing the information, processing what they are saying, and using my working memory to think about what I already know about that topic, how what they say impacts what I already know, what client comes to mind when I think of what the teacher is saying, etc. I am visualizing, conceptualizing, and developing an opinion or my own thoughts about that particular topic and how it may or may not benefit my work.

According to Bob Doman, “Working memory is the foundation for global neurological maturity and function. It essentially encompasses most of what we think of as ‘thinking.’”

“The NACD model of cognitive function recognizes various components of thinking and learning. Of all of these functions, working memory, including executive function, encompasses the areas that impact simple and complex behavior regulation and problem solving the most. The development of various parts of executive function appears to be a good indicator of future academic success, as well as future life success. Mathematics, reading, and critical thinking are all affected by how well various components of executive function develop and work. Not only do these neurological functions impact academics, but NACD and researchers also find that they impact social skills, job skills, and the skills needed for a child or adult to navigate daily life independently. Time management, time awareness, goal setting and planning, organizational skills, social awareness, financial planning, running a household, writing a research paper, writing a paragraph, and forming thoughts into conversation are all functions that depend on this higher cognitive level referred to as working memory and executive function.” (Doman, 2016)

So what does all this have to do with anxiety? When we think of our kids, anxiety can creep up when they have too much information coming in through their senses, but not enough short-term and working memory to manipulate the information. Have you ever seen a World History textbook? If you have a smart kid who wants to do well in school, but doesn’t have well developed short-term and working memory abilities, they are very likely to get anxious just looking at the book. The pieces that allow them to manage their time with material, organize their studying, and plan how to work through the material are not where they need to be in order for that child to be successful. Now if we have that same kid with five or six classes, with similar amounts of material, imagine how much more anxiety can develop.

Many of the anxious children on our caseload, who may be pre-adolescent age and are struggling with school to the point of shutting down, have poor working memory and conceptual thought. They simply don’t have the ability, YET, to be able to perhaps even process the information coming into their brain, let alone manipulate it and problem solve, think and reason through all that is being presented to them. Let’s also take into consideration what is happening with their bodies during this time frame. They become so overloaded they shut down. With our kids that have good short-term memory but poor working memory, rather than solve a problem that they are facing, sometimes these children may ruminate on the problem itself. Rumination is simply rehashing a problem in their head over and over without having the working memory that permits them to organize their thoughts and reach a conclusion, therefore creating increased anxiety. The more developed a person’s working memory is, the more likely they are able to solve and reason through their problems.

The more a child can reason, the less likely they are to get stressed and shut down. If we look at a neurotypical 3-4-year-old, they are just learning how to reason and problem solve. If they encounter something that is stressful to them, they don’t have the working memory to process the situation and are likely to dart or hide behind their mom versus using conceptual thought to reason as to how best to approach something. The same can be true for a child who is 12 years old but has the working memory of a 3-4-year-old. The same behavior happens, only it looks more problematic because it is an immature behavioral response for a child at that age.

We also have very bright individuals on our caseload who are also anxious because of their incessant need to be the best, to be perfect, to be the straight A student. When does academic pressure, measuring kids, too much testing, and narrow competition get recognized as potentially one of the greatest causes to mental health issues in our kids? Stay tuned to next month’s article.

Reprinted by permission of The NACD Foundation, Volume 32 No. 9, 2019 ©NACD

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I know a boy. He is a very smart, fun, engaging boy. From the outside you would think this kid has lots of friends, is very social, the class clown, etc. But at home just calling a friend to go do something is a very big feat. The act of calling a friend, or even texting them, to go do something creates stress. He is so afraid of being turned down that he would just rather avoid the task, even if that means not going to a movie or going to do something fun with a friend. I noticed this about three years ago when I knew in my heart he wanted to go sledding with someone, not just his baby sister. However, he literally cried hysterically about having to call his friend. I persisted (debating in my head whether or not this was right—knowing that “Mother of the Year” was not an award I was going to win). He finally called his friend, who said yes, and they went sledding together and had a blast. He had a smile from ear to ear. Did the act of calling the friend create a lot of anxiety? Yes! But as his mother, pushing him out of his comfort zone was needed in order for him to understand that he had friends who actually wanted to be with him. Can you relate? Is it easier to just let our kids avoid things that in their eyes are hard to do, whether it be doing a chore, doing a reading assignment, or even learning how to brush their own teeth? Yes. Is it easier to let our kids avoid doing school work or avoid going to dance class or avoid going to Scouts because it is out of their comfort zone, or even worse– having to deal with an absolute tantrum or fight so we let them win? Absolutely. But when does letting avoidance patterns work become too harmful for them? Are we teaching them anything here? If avoidance behavior is a hallmark for anxiety, how can we as parents assist our children in addressing stressful situations so that they can persevere through life’s challenges?

What Is Avoidance Behavior?

Avoidance behavior is when a child sidesteps a person, place, task, or situation that makes them feel anxious or uncomfortable. In the moment it brings relief, so the brain learns to repeat it. Over time that relief becomes a habit, and the list of things a child avoids tends to grow rather than shrink. Recognizing avoidance early gives parents the best chance to help a child face challenges in a calm, successful way.

Common Signs of Avoidance Behavior in Children

Avoidance can look different from one child to the next. Some common signs include:

• Refusing or stalling on tasks that feel hard, such as homework, chores, or getting dressed
• Big emotional reactions (tears, tantrums, or shutting down) when asked to try something new
• Making excuses to skip social situations like calling a friend, going to class, or joining an activity
• Complaints of stomachaches or headaches before a feared event
• Sticking only to activities that feel safe and familiar

Spotting these patterns is the first step toward helping your child move through them.

According to Dr. Alice Boyes, Ph.D. (2013), avoidance coping (behavior) is the most important factor in anxiety and causes it to snowball. She believes that people avoid situations that may cause some of the feelings you get when you are stressed; however, if you keep avoiding those situations, this can lead to more debilitating anxiety levels. It is important to understand that all people experience stress. It is not uncommon for the human brain to engage in the process of fight or flight when it is introduced to something stressful. “While avoidance behaviors might give kids some immediate symptom relief, they don’t help them learn to cope with their triggers. In fact, the fears actually have a tendency to snowball when kids engage in avoidance behaviors” (Hurley, 2016).

It is also very important to understand that each child and brain is unique and what stresses one kid out may not the next. NACD has experienced that how we react to our children and how we provide them with the right instruction in the correct manner, along with building the neurodevelopmental pieces, allows our children to handle stress much more easily. In an upcoming article, I will discuss the significance working memory plays in handling stress and anxiety. But for now, I would suggest to parents that you try to sit back and look at your children and evaluate their behavior patterns. Do they avoid? Do they freak out when they need to do something that is within their ability to do? How do you react? If it is something that may be difficult in their eyes, we encourage parents to break down the task into smaller parts or have them do a particular task for a set amount of time that allows them to be successful, then gradually increase the duration. When you are wanting to teach something to your child, it is important that you have a calm, confident, and positive demeanor. When teaching your anxious child to ride their bike, for example, letting them know that they can do it and that you are with them and that you know that this is something that they can do is significant. How you talk to them, your demeanor, matters. Setting a timer then stopping and doing it again with frequency (not once a week but several times a day) can help decrease their anxiety and build up their confidence to do the skill. With some children, video modeling of a certain scenario can be effective. For example, if going to the dentist causes your child a lot of anxiety, making a video of going to the dentist so that the child can get a positive image in their minds of that experience can help decrease that fear. This is a common example of exposure therapy that has been used to address anxiety for many years. Avoidance behavior patterns can start at a very early age. If they aren’t addressed early, the behavior patterns can become stronger and generalize into all areas of a child’s life—to a point where they shut down completely. That is why it is important to be mindful of them and help your child face their fears in a successful way.

Is your child confident? In our experience, one reason kids can struggle with avoidance behavior, which can lead to anxiety, is that they are too afraid to fail—and parents don’t let them. Failure is a part of growing up. It is a part of learning. When I was younger, I remember ruining a bunch of whites in a load of laundry because I had a red sock in the mix. I didn’t pay attention when sorting and that was the consequence. I failed with that particular load of laundry. Did the sky cave in? No. Did my mom ground me for a month? No. Did I learn a valuable lesson in how do to the laundry? Yes. My mom didn’t take over that job. She just said to pay better attention, and I had to go without those white shirts that I ruined. In order to help our children become confident, developing independence with daily living skills, including self-help and chores, is very important. A very common scenario—a kid attempts to pour their juice, it spills, and the parent cleans it up and doesn’t let them do it again because it makes a mess. Another kid isn’t allowed to load the dishwasher for fear that he may break something. Parents, caregivers, teachers of young ones, do not be a roadblock for your child’s independence. Independence brings so much to their global mental health and function. Develop it, build it, help them realize that failure happens and that it is ok. These things, no matter what age or developmental issues your child may have, are huge for addressing or preventing avoidance behavior and anxiety later on.

Bob Doman (2013), founder and director of NACD, wrote a blog post several years ago about Herculean tasks:

“One of the great opportunities our children can have and lessons they can learn is to be presented with and accomplish Herculean tasks. Herculean tasks help your children learn what they can do if they really try. They teach them to look at a task that they think is impossible and to learn that they can really do it. As parents you should be on the alert for tasks that appear to be Herculean. The ideal Herculean tasks are those that look huge and to the child seem impossible, but which are doable, although they may take a whole lot of time and effort. The child who is used to 5-minute chores might perceive shoveling a driveway covered in a foot of snow, a yard covered in leaves to rake, an entire vegetable garden to weed, a stack of logs to move, or washing all the windows in the house all as Herculean/impossible tasks. But they are not impossible; they are possible if they try. Completion of Herculean tasks provides children with an opportunity to redefine themselves, to change their perception of what is possible, and to learn that if they try, they can in fact do it. The child who learns they can do Herculean tasks will continue raising the bar on their perception of what they can do and will learn to attack new tasks with the intention of succeeding–not just trying, not just making an effort, not just going through the motions, but having the intention of accomplishing the task. The child who learns they can do Herculean tasks won’t shut down when presented with the task of writing a twenty-page report, reading a 500-page book, learning all of the bones in the body, or pushing to take another tenth of a second off their 100-yard dash.”

A Neurodevelopmental Look at Anxiety and Avoidance

At NACD we look at the whole child. Avoidance behavior rarely stands alone. It often connects to how a child processes information, holds instructions in working memory, or manages sensory input. When we strengthen those underlying pieces, facing a hard task becomes less overwhelming, and avoidance has less room to take hold. This is why two children with the same fear may need very different support. Families navigating ADD/ADHD, the autism spectrum, or everyday anxiety all benefit from a plan built around their own child.

If you would like individualized help, join our free Get Started program and NACD will help you build a plan tailored to your child.

In conclusion, NACD understands that being a parent takes hard work. Being a parent of a child who is anxious requires patience and positive persistence and understanding! It is important to understand what avoidance behavior is and how to address it with your own unique child. We also understand that there are many contributors to a child’s avoidance behavior and to varying degrees. NACD believes in looking at “whole” kids. The more individualized we can be with understanding a child’s behavior patterns, the more confident parents can feel in how to help their child. Helping our children become more independent can also increase their self-esteem, helping them to become more confident individuals. In my next article, I will discuss another significant piece to understanding anxiety—working memory. Stay tuned!

References

• Boyes, A., Ph.D. (2013, March 5). Why Avoidance Coping is the Most Important Factor in Anxiety. Retrieved April 5, 2019, from https://www.psychologytoday.com/intl/blog/in-practice/201303/why-avoidance-coping-is-the-most-important-factor-in-anxiety
• Doman, R. J. (2013, February 01). Waiting for Hercules. Retrieved April 8, 2019, from http://blog.nacd.org/2013/01/waiting-for-hercules/
• Hurley, K., LCSW. (2016, February 3). How to Help Your Anxious Kid Avoid Avoidance Behaviors. Retrieved April 5, 2019, from http://practicalkatie.com/2016/02/03/how-to-help-your-anxious-kid-avoid-avoidance-behaviors/

Frequently Asked Questions

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We have all heard it a thousand times: eating better, sleeping better, getting physical exercise helps our overall health. While this is something that our NACD families in general are very conscious about with their children with developmental issues, it is not uncommon to hear that those rules don’t really apply to everyone in the family. Let’s face it, it is easier to be more lenient on our neurotypical kids or ourselves, but does that help everyone in the long run? It is important to really get serious across the board about our overall physical health in the family, as that impacts our mental health significantly.

Sleep is such an important part of one’s life. According to the National Sleep Foundation, children ages 6-13 years old need 9-11 hours of sleep each night to be at their best. Teenagers ages 14-17 need 8-10 hours of sleep to be at their best, and adults should have between 7-9 hours of sleep per night. This is good, quality sleep! Not being in bed on your smartphone scrolling, but actually ASLEEP! Unfortunately for most teens, their biological clocks shift during that stage, where they tend to have more energy at night, increasing the desire to stay up later and sleep in longer. If your children are like mine, they start school at 7:20. They are up and out of the house before 7am. This can leave them already sleep deprived as they aren’t always ready to fall asleep by 10pm the night before. A study from the British Medical Journal in 2015 researched the effects of screen time and lack of sleep in a substantial sample of adolescents, over 9000. They found that the more screen time the subjects engaged in each day, the longer it took for them to fall asleep. If they had four or more hours of screen time per day, they were 360% more likely to have less than five hours of sleep a night and 49% more likely to take over an hour to fall asleep (Hysing, M. et al, 2015). When our brains are tired, mental health issues such as depression and anxiety increase. We are not able to think as clearly and have more difficulty handling stress than when in a rested state. NACD recommends consistent nighttime bed routines starting when children are little, such as no screens in the bedrooms, and devices are to stay with parents. We suggest having at least an hour to an hour and a half of no screens prior going to bed. We also encourage very dark rooms (blackout shades or curtains) and white noise to help facilitate a good night’s rest.

I hear many times “my kid has a balanced diet; they eat some of everything every day.” But how much of those foods happen to be processed? Have extra or hidden sugars? Artificial ingredients? More and more research on the foods we eat are targeting how they impact our mental health. “In recent years, a direct relation between the occurrence of anxiety disorders, sleep disturbances, and mood disorders has been observed as a consequence of poor or inadequate diet. Eating habits in Western societies have greatly changed in recent decades, with an increase in the consumption of foods low in vitamin and mineral content, high in caloric value, and rapidly prepared and easily consumed.” (Fernandez-Rodriguez, M., et al., 2017) There is a direct interrelationship between physiological health and neurological function. NACD has known this since its inception in the ‘70s. Time and time again our clients have shown that those who eat better function better. In general, diets rich in plant based foods, healthy fats (in the form of plants, nuts, seeds, and fatty fish like salmon), and lean meats are far superior in promoting mental function. In contrast, diets high in sugar, dairy, breads, and processed foods have been shown to be related to depression, chronic inflammation, and anxiety. This isn’t just for adults! According to Natalie Kling, a Certified Clinical Nutritionist from NACD’s Professional Advisory Committee, “the human body is always moving towards homeostasis, or perfect balance. When a body is out of balance, we see or experience symptoms (physical AND mental). We can soothe symptoms by giving the body the interior environment it needs to return to balance. Rest, hydration, oxygen, nutrients, detoxification, and a healthy and loving environment provide the ingredients the body needs to repair, regenerate, and reorganize. In contrast, when we introduce processed foods, sugar, not enough sleep, chemicals, environmental toxins, or stress, we push the body out of balance and create obstacles to the body’s ability to thrive.”

Personally, I have noticed a great difference in my son’s “teenager attitude” when he doesn’t eat these foods. When his diet is clean, whole food based, there is a positive difference. Often times I see parents eating healthy, but their kids are eating foods loaded with sugar and the “bad stuff” because “they’re kids.” NACD suggests to parents to develop a palate for healthy food with their children in infancy. NACD recommends to our families to work with one of our nutritionists if you need help in getting started. Natalie Kling, who also happens to be an NACD mom, has suggested that parents can start by just focusing on getting more vegetables into your kids. Smoothies (without added sugars and dairy), homemade sauces, etc., are ways to start that process. If you are a new parent with young children, keep their diets high in plant-based foods so that they develop a taste for it. If you are a parent with a picky eater, they don’t have to be. By giving the brain and body the correct fuel it needs, this can help to improve your child’s physical AND mental health as well.

Many children and adults struggle with anxiety due to lack of physical exercise. If we sit back and look at our lives today, we lead more sedentary lifestyles. We watch our TVs, screens, sit and scroll through our phones, many of us work all day at a desk, and many of our children are in school for 6+ hours (sitting for a huge chunk of that), many without daily physical exercise. According to the US Department of Health and Human Services (2018), children ages 3-5 years of age should engage in at least 3 hours of physical activity with varying degrees of intensity. Children ages 6-17 should engage in moderate to vigorous physical activity (aerobic, muscle, and bone strengthening) for 60 minutes DAILY. Adults should have a similar amount. Do you get that? Do your children? Exercise stimulates endorphins in your brain that allow for improved executive function, attention, and mood. Essentially, it allows you to handle stress better and not let it handle you. NACD recommends families make an effort to include physical exercise as part of your day. Schedule it in. In fact, on some of our programs we will write screen time = chore time = exercise time. For my children, the screens, homework, and chores don’t happen after school until physical exercise does. It might be going to the gym or doing an online video. Sometimes it is going for a run or even a fast walk. Snow or sun, we make it a priority.

In conclusion, it is important that as parents we really understand how significant lack of sleep, poor diets, and lack of physical exercise impacts our children’s physical and mental health. They work together, impacting one another. NACD looks at the whole child and sees this as a huge piece to impacting the global mental function of a child.

Reprinted by permission of The NACD Foundation, Volume 32 No. 1, 2019 ©NACD

References

Fernández-Rodríguez, M., Rodríguez-Legorburu, I., & López-Ibor Alcocer, M. I. (2017). Nutritional supplements in anxiety disorder. Actas Espanolas De Psiquiatria, 45(Supplement), 1.

Hysing, M., Pallesen, S., Stormark, K. M., Jakobsen, R., Lundervold, A. J., & Sivertsen, B. (2015). Sleep and use of electronic devices in adolescence: Results from a large population-based study. BMJ Open, 5(1), e006748-e006748. doi:10.1136/bmjopen-2014-006748

How Much Sleep Do We Really Need? (2019). Retrieved February 5, 2019, from https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-we-really-need

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

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Growing up in small town Idaho, anxiety was rarely expressed as an issue with children and adolescents. Anxiety was something that adults had. Even in college 20-24 years ago, stress was an issue when papers were due, or it was finals week. The talk of anxiety and panic attacks was never common, and medication was not needed to help my fellow college companions cope. Having said that, it is hard to know if childhood friends or college roommates had these issues all along but didn’t know what it was? How many of them turned to substance abuse to cope? How many of them are now dealing with debilitative mental health issues that could have been resolved when they were younger?

While anxiety may not have been a significant issue then, it is now. With suicide rates climbing at lightning speed in our youth, we cannot ignore the growth of children and adolescents being diagnosed with anxiety and other mental health disorders. NACD is all about helping children reach their full potential so that they can be happy, contributing, productive adults to our society. As such, we must evaluate the various factors that could be impacting our children’s stress levels both at home and at school. Research in the area of anxiety in children and adolescents has grown and includes possible contributors to this epidemic.

Over the next several articles, I will discuss the following as anxiety contributors and offer suggestions from a neurodevelopmental perspective:

1. overall physiological health of children today from sleep deprivation to diet and exercise
2. avoidance behaviors in children that lead to increased anxiety later
3. children who never learn how to do basic living skills and the significance of developing working memory
4. smartphones and too much screen time
5. children not being present or “mindful”
6. lack of social connection and community
7. high stakes testing, school pressure, and narrow competition.

With this series of articles, my hope is to educate parents and hopefully provide you with some general guidelines to think about as you raise your little humans in this generation.

Reprinted by permission of The NACD Foundation, Volume 32 No. 2, 2019 ©NACD

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