Behavioral Treatment

Behavior treatment does not have a super power that crosses the disorder off the affected person. It is however a program that helps a person decreases or eliminates the inappropriate behavior and increases the potential of the appropriate behavior appearance frequency. The medication modifies the patient’s physical, mental, and emotional state for some time that may continue from 3 to 12 hours depending on the quality of the medication taken by the patient. As it supports the positive reaction with the different social situations and school assignments, what guarantees the patient an increase in the successful experiences rate and a decrease in the rate of the unsuccessful ones, which improves self-image and increase the self-confidence.

Behavior modification

Behavior modification: is a program that encompasses 3 interrelated main elements:

1. Behavior preceding events

2. Behavior

3. Behavior results

1. Behavior preceding events:

Behavior preceding events play a key role in forming and identifying the behavior whether it is positive or negative. This is according to the rule ” negative introductions lead to positive results.” If we are to change a certain behavior, we have to change or rearrange the events that preceded it, i.e. introductions and instructions.

The way through which a child responds to the instructions or to the introductions depends on three main aspects:

Rules:

By rules we mean all laws and regulations that control the child’s behavior and performance in school or in home. Teachers and guardians may think that they already have enough rules for this purpose. Except that most of those rules are either unwritten or unclear especially in AFTA children’s’ case, who need repeated reminding of these rules in addition to writing them and explaining their meanings. Where Playing has rules, school performance also has rules, and if these rules are not abided, reacting or dealing with the situation positively will be difficult. Therefore, the method or the way by which the rules are presented greatly affects how the child responds to them. The child may not respond appropriately to these rules if they are not clear and comprehensible. For instance, when the teacher sees the child talking out of his/her turn in the classroom, and tells him/her ” Do not do that, you know the rules” here are some examples of some situations to which there should be written rules and meaning explanation to AFTA children.

”Wait for your turn in speaking”, ” Do not rely on other people when you are angry”, ” Be quiet when the teacher is explaining the lesson”

As for little children who find it difficult to read or understand the written rules, pictures and drawings must be provided.

Expectations:

It is obligatory to explain and specify what behavior is expected from them in certain situations. These expectations differ according to the child’s age and ability to understand what is said to him/her and then keeping it. Here are some examples of clear expectations:

For example, the teacher tells the student ” I will start explaining the lesson now and I expect you to not to talk to your college while I am doing that and to raise your hand and ask for permission if you want to ask.”

Communication:

Delivering the information to the child is one of the most important elements of behavior modification, because AFTA children cannot pay full attention while receiving instructions. Therefore, we must make sure that the child received the directed message. In order to ensure that, the following should be taken into consideration:

• When giving instructions to the child make sure of making eye-contact with him/her, you are facing him/her, and you may sometimes need to hold his/her shoulder to ensure their full attention and concentration.
• When speaking to AFTA children, speak clearly and naturally, you must not shout or use high tone of voice as they are hypersensitive.
• Instructions must be direct and about what you would have the child do
• Make sure the child has understood what he has been told by asking himher to repeat it, if he/she could not do so; you have to repeat the instructions to them, until the child is able to repeat the instructions as well as he/she heard them. Then you emphasize that by telling them ” now you should apply those instructions”

2. Behavior

It is everything the child says or does, as its observable, countable, and changeable. It is either desired or undesired hence we can add to it, modify it, or remove it.

3. Behavior results

Are the behavior subsequent events. They are either positive consequences or results that are represented in rewards that support the desired behavior and keeping it, or negative consequences represented in punishment that either ways, with it or without rewarding, will cause the behavior to become weak. Given that the absence of rewards will decrease the potential of the behavior reappearance, while the absence of punishment on the other hand, will cause the undesired behavior to become stronger and to reappear.

Important considerations for behavior modification

• Immediacy: immediately holding the child responsible for the undesired behavior now and not later.
• Repetition: having the child pay attention each time he/she does inappropriate behavior.
• Excitement: to have the desire to guide the child.
• Eye-contact: the teacher must make sure he/she is making an eye-contact with the child and facing him/her when giving instructions or guidelines.
• Expectations clarification: the teacher should explain and specify what kind of behavior is expected from him/her in certain situations. These expectations differ according to the child’s age and ability to understand what is said to him and then keeping it. For example, the teacher may say ”I will start explaining the lesson now, while I’m doing so I do not expect any of you to speak without a permission, speak out of his/her turn, or to interrupt me”
• Compatibility: the teacher and the student are agreed on the resulting consequences if the unacceptable behavior has appeared. The student is now aware of the undesired results, thus he/she will commit to the acceptable behavior. In contrast, he/she will act appropriately; being well-aware of the desired results.
• Causality: in case the child did not commit to what he/she has agreed on with his/her teacher, punishment will certainly be the result. Nevertheless, the child must be made aware of what causes this punishment before starting to punish him/her which is violating the terms of the agreement.

Behavior modification is based on two important things:

1. Training the parents on behavior modification

2. Providing the child with skills he/she lost owing to the disorder, by training his/her to control and ease the symptoms of the disorder

Here are some advantages of the behaviour modification:

• It trains the child (or any person with the disorder) on the skills required to deal successfully with different situations in home, school, or the surrounding environment.
• It increases one’s ability to have social interaction and acceptance.
• It develops the person’s self-image and increases his/her self-confidence.
• It helps the person overcome the manifestations and the problems associated with the disorder by establishing self-control, controlling his/her responses, boosting his/her motivation and determination to achieve his/her goal, as well as increasing his/her concentration on performing the task . This will eventually guarantee success on the academic, social, and professional levels.

Important tips that should be followed when modifying a child’s behavior:

• The appropriate behavior must be enhanced, because it lasts as long as it results in benefits
• Focusing on prevention form the undesired behavior (or that need to be modified) instead of responding to it after it has occurred.
• The undesired behavior must be reduced to a lower level.
• The alternative appropriate behavior must be encouraged.
• Make sure to use multiple behavioural programs.
• Constancy and persistence are necessary for implementing the behavior modification program, as the undesired behavior can get worse before it improves.
• Verify the behavior efficiency programs
• The behavior modification program must be changed after 3-4 weeks if it appears to be inefficient
• Do not get bored or give up so early, as behavior modification needs patience and constancy especially during the first days of implementing the behavioral treatment.
• The child’s behavior may get worse at the beginning of the treatment (this is normal and may last for a short period of time), but the behavior will soon begin to improve. Therefore, patience and constancy are very important at this stage.
• The child must understand the behavior modification method being followed before it’s been implemented.
• The child reward must not be postponed in case he/she has achieved a certain goal or behaved appropriately. Because delaying the reward causes the appropriate behavior to disappears.
• The reward can be chosen according to what you think is suitable for the child. It can be very simple such as: approval or patting his/her shoulders, and it can be money, gifts, or letting him/her sit beside his/her best friend.

 

Behavioral treatment

First: establishing a positive relationship

The activation of feeling between the child and the parents is the first step in the Behavioral treatment. One way to reaching that is allocating daily time for the child (30 minutes) during which the child chooses an activity and the parents make sure to spend it well with their child.

It’s important at that time not to ask questions or give orders, instead have the child believe that he/she is doing great. For example, when the parents say while building cubes ”this tower has become very high”

The purpose behind that time is establishing the positive relationship and having the child interested in pleasing his/her parents, only then the parents will be surprise when the child starts doing his/her homework

If this time has become a daily routine, there will be very satisfying results in the child-parent relationship.

Second: using the positive reaction

The second focal point of this treatment is having the child feel the positive results of his/her appropriate behavior by motivating him/her and giving him/her gifts when he/she behaves well in an attempt to increase the frequency of this good behavior. (Such as posting stickers on the agenda)

The least you can do is to observe your child’s doings as well as encouraging him/her to act appropriately by giving nice comments on his/her actions such as ” you are doing great, I’m proud of you”

Always remember to reward your child for his/her good behavior, and make a list of all things you want your child to embrace.

You may think that this way is simple and not useful but it is very effective. We usually recommend children who have ADHA to exert effort in order to notice any good attitude resulting from child daily. Even if it is for a short time not more than five minutes and by doing this way the child may know that each attitude has its different consequences whether it is acceptable or unacceptable one. Therefore he may repeat the good act and avoid the bad one. In addition the behavioral treatment provide the child with physical stimuli and tangible reactions when he acts perfectly. You can try certain ways for example, the children may get one point as a reward for his good attitude and get nothing for unsuitable manner and when he reaches a specific number the child get a present for example, take him to a place that he loves.

Handling a plan for behavioral treatment is not easy an expert may intervene in order to make it successful . in spite of any behavioral plan differs from one child and parent to another, but there are many rules taken into consideration:

1. when identifying the good behavior in which the child get a present for it, the required act must be clear and understandable
2. be logical in determining manners that your child must do it and they have to be suitable for his age also do not put an faraway expectation that might desperate you and him
3. do not change more than one manner at the same time
4. let your child select his own prizes and benefits
5. put a program for a child in which he can see its beneficial consequences
6. remember the continuity and the stability
7. be sure that you give more social prizes and positive enhancement in addition to the physical presents and benefits

Third: Using negative consequences eliminates bad attitude :

Using positive enhancement concept ( reward) to encourage good behavior , the behavioral treatment also needs punishment concept in order to eliminate an acceptable attitude . when there are serious consequences each time for a negative behavior this may reduce repeating this attitude in the future

Implementing the effective punishment concept:

1. the child must understand what is the acceptable attitude exactly
2. you must tell your child that you and him must not agree to each other but in an adequate way , they can also express their dissatisfaction
3. tell him what gifts he will get if he did not repeat this manner
4. tell him that if he commits to the positive attitude he will get free time like playing play station or watching tv , by collecting points each time he will not commit bad attitudeBy arranging the issues in this way the child will understand and be sure that the perfect attitude only leads to thing he loves

Important: Try hard not to exaggerate in response to the negative act because their enthusiasm fades toward this plan if the punishment is not used correctly

Fourth: you must have a plan for play

It is wonderful that the bad behavior fades through implementing punishment concept from the first time.

For example if you choose a punishment for your child like forbidding him from watching TV and he completely neglects you . he also tells you that he does not care about you and he continues doing his bad behavior . in this case your situation is so hard and there is no choice for you except punish him in different ways in order to show him that you are strict. for example do not allow him to go out for two weeks or cancel his birthday party. Thus to avoid all these punishments you have to plan in advance for gradual punishment plan and you have to implement it when your child does not behave good. For example you can punish him by not letting him watching TV for five minutes and then for ten minutes then cancel the TV watching time completely . then move to another punishment like go to bed early or him stay at home in special occasion. The punishment must be gradual and in different steps . you must be calm and remind him of good attitude . the punishment must be for one day and it is better that the next day is a new start. Accordingly the child will learn that the continuity of the stubbornness accompanied by increasing gradual punishment .

Fifth: teach your child that stubbornness is not accepted

It is the way in which you retreat and it is accompanied by a lack of response of a child and the continuity of bad behavior.

for example, if you ask your child to collect his toys and he neglects you then you ask him again in this case you will get angry and so your child, in return your child will be agitated and you cannot control him neither his behavior.

Or you will resort the choice and you will collect toys by yourself. In this case the child will learn that if he will become stubborn he will get what he wants. Therefore you must know that if you ask him to do anything you must be strict and follow the above-mentioned gradual punishment because your child should know that these are serious and undebatable issues and stubbornness is getting nowhere. This way is beneficial with children thus it is a mixture of building positive relation with reward and punishment way will support the good behavior but the question here does this work with ADHA children. Although the main rules are equal but there are special factors for ADHA needs modifications.

The most important modifications are:

1. children with ADHD needs more reaction than their peers when they do something right. The studies show that these children act perfectly when we give them positive reactions and enhancers by one a hour a day more than the end of the day
2. children with ADHA act perfectly if we set for them short-term goals more than setting long-term goals. for example encouraging them by giving them a gift at the end of the day , and this is better than taking them to a picnic at the end of the week
3. children with ADHD needs to be reminded frequently if what they asked to do and remind them about the positive result that they will get
4. children with ADHD needs continuous changes in the program in order to remain interested in it , for example changing the method of collection the points and the prizes

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