We already tried that ... Refining your behavior management plans
Consequences are mainly needed for younger children and as back up to reinforcement. Similar principles apply to consequences. Consequences are most effective when used infrequently but consistently for the same behavior, unwanted by the child, done immediately after the unwanted behavior, related to the nature of the misbehavior and dosed appropriately (smaller is better!), and acceptable to the parents. The child should have a "clean slate" after the consequence to help restore the relationship. Painful, harsh, scary, or injurious consequences are neither acceptable nor effective.
Two methods of behavior modification I find easy to teach and implement are marks and points.
Marks make reinforcing behavior easy and fun for children 2-7 years old. The adult marks with a pen on the child’s hand along with verbal praise for each behavior "just a little bit better than usual," such as tantrums lasting 1 minute instead of 2, aiming for 6-10 marks per hour. High frequency helps adults notice more and smaller "okay" behaviors, often a deficit. At the end of the marking period each day, give a small reward (such as extra play time, grab bag prize, pennies) for having a "bunch" to confer value to the marks. Give bonus marks for outstanding or spontaneous behaviors (Hey, they’re free!). Marks are faded out when behavior has improved and parents are noticing and praising good behavior. While removal of marks for inappropriate behavior can be used, I do not recommend it as parents are often in a punitive cycle in that case and need to refocus on the positive.
For older children, a "token economy" (star chart) using points, stars, or poker chips is an evidence-based method for behavior change when done correctly. Optimal implementation includes outlining the plan with parent and child together so that the desired behaviors, rewards, and costs are clear and relevant. Together they set the "price" for behaviors (such as 5 earned for 30 minutes of TV without fighting or 10 lost for a squabble). While token economies work for chore compliance, the focus here is for behavior. A key component motivating participation is charging for things taken for granted such as TV, computer, outside play time. Give "bonus points" for initiating, extra acts of kindness, etc. "Purchases" for basics or privileges are deducted from the total kept on a card or a subset of freedoms can be allowed based on a minimum total "in the bank."
Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University School of Medicine, Baltimore, and creator of CHADIS. She has no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline Medical Communications. E-mail her at pdnews@frontlinemedcom.com.
