Presented by

Katharine Leslie, Ph.D., CFLEwww.brandnewdayconsulting.com

336-376-8366

Why Won’t This Child Behave?

• Differentiate between children who were over-indulged (bad) traumatized children with mental health problems (ugly)

• Both have behavior and relationship difficulties but the latter are far more difficult to work with and change.

First Step

– had his needs met early in life but was never taught that he was not the center of the universe.

– rewards and consequences for behavior are likely to help the overindulged child shift to more pro-social behaviors.

Overindulged

Mal-Attached

● Missed out on some or all of the first and most important stages of the p-c relationship

● Two fundamental developmental processes are negatively impacted.

neurodevelopment (physical and biological growth of the brain, nervous and endocrine systems

psychosocial/emotional development (personality, affect regulation, morals, values, social relationships).

Compromised Cognitive (Brain) Abilities ● Organizing, planning,

● Shifting attention, concentration

● Working memory

● Perceiving and adjusting to social cues

● Learning from previous experience

● Motivation and intention

● Sensory integration

● Auditory, language comprehension

● Speech and reading skills

● Logical/abstract thinking

Compromised Social/Emotional Abilities

● Object Relations – (fragmented ego identity)

● Attachment (insecure or nonexistent)

● Self-esteem (pseudo or low)

● Autonomy (excessive levels of shame)

● Initiative (low levels of guilt)

● Moral reasoning (low)

Paradigm ShiftEmotional/Mental Disorders in Children and Adolescents

By Linda Swann (See Appendix)

• Old paradigm– Behavior is learned from parents.– Children are too young to be diagnosed with mental

illnesses.– Parents need to learn to be non-toxic and less permissive– Child is seeking attention and is manipulative – "Acting out" is response to inner conflict from early

childhood– The child is able to act appropriately but won’t– Parents not asked for input; provider to fix child

Continued

• New paradigm– Behavior results from:

• sensory overload• distorted perceptions and mood• inflexibility, anxiety, low tolerance for frustration• tics, "limbic storms," low impulse control, • low executive functioning, poor short-term memory, • difficulty w/handwriting, coordination.

– Child has good and bad days– Focus on managing the illness– Parents need extraordinary skills and support

One continuum

Negative Positive

Two continuums

PositiveLow High

NegativeLow High

Negative vs Positive Out of Whack

INVISABLE CHILD

LOW POS/LOW NEG

ATTACHMENT

K RELATIONSHIP

QUALITY

INCREDIBLE CHILD

HIGH POS/LOW NEG

ATTACHMENT

RELATIONSHIP

QUALITY

INSUFFERABLE CHILD

LOW POS/HIGH NEG

ATTACHMENT

RELATIONSHIP

QUALITY

ECLECTIC CHILD

HIGH POS/HIGH NEG

ATTACHMENT

RELATIONSHIP

QUALITY

LOW

NEGATIVEbehaviors

HIGH

POSITIVE behaviorsLOW HIGH

Behavior Typologies

What Do We Do With This Knowledge?

Therapists:

Because some research suggests that certain aspects of the limbic system retain plasticity (stay open to experience-dependent change) throughout life the goal is to identify, access and positively effect those aspects.

Use treatments that reduce fear, build alternative neural networks, and create access to implicit memory.

Caregivers:

Accept that many of our children’s negative behaviors and lack of positive behaviors are a result of brain dysfunction.

Rehearse, rehearse, rehearse the positive

Cognitive Behavioral Therapy (CBT)

• Challenge behavior patterns and beliefs, reframe, build skills, evaluate outcomes

• Limitations– elicit explicit as opposed to implicit memory.

• Explicit memory of trauma is limited• Implicit memory stores more sensory motor

memories of attachment and trauma

• Child will actively avoid the vulnerability that occurs in developing a therapeutic relationship and will resist being directed into areas of shame and trauma.

CBT with Sensory and Relationship Components

• Trauma - Focused CBTExternalize/Reactivate/Expose the traumaProvide corrective information to form a new narrative

• Attachment - Focused Therapy Dyadic Developmental Psychotherapy (DDP; Dan Hughes)ARC (attachment, self-regulation, competence;

Margaret Blaustein, and Kristine Kinniburgh)

Relationship Coaching (Katharine Leslie)

Attachment-Focused

• Rapport and trust are built through immediate, honest, forthright validation of the child’s trauma history and current behavior issues.

• Therapist’s job is to identify and challenge the child’s defenses (e.g., charm, distraction, flirting, acting dumb).

• Doesn’t expect child to be happy working through the trauma, or to like the therapist -- until the child is emotionally healthy.

Continued

• The practitioner, with the parents, is in charge of the session and of the child, in a nurturing, safe, and empathic manner. The adults take the lead in attachment therapy and are always observing and responding to the feelings and needs of all family members.

Other Interventions

• Brain (passive) Neuro-feedback (eegspectrum)

• Body (passive) Body work (massage, cranial-sacral, myofacial) Biometrics

• Body – Brain (active) EMDR Neuro-Developmental Re-patterning (Ziegler, D) Sensory Integration Occupational Therapy Body movement (dance, yoga, martial arts)

What Can the Rest of Us Do?

● Five Strategies

Prevent

Coach

Build a Relationship

Maintain an accurate frame of mind

Teach Responsibility

• Child Development– Discipline at child’s social-emotional level

• “listen” to what children’s behavior is telling you • Do not expect children to perform without readiness (i.e., bodily,

skills, knowledge)

• Child Behaviors– Verbal correction of bad/wrong behaviors and

opportunities for “do-overs”– Start rather than stop behaviors– Rehearsal

Right Focus

• Discipline– environmental: structure, rules, consequences

• Behavior– the individual

• Punishment– taking away privileges (after the misbehavior)

• Consequences– adding responsibilities

Definitions

Strategy 1: Prevention

● Be consistent

● Organize environment for success

● Don’t set up for failure

● Supervise

● Limit access

● Limit mobility

● Stated rules and consequences

• Focus– Less about the presenting negative behaviors and

more about the missing positive behaviors.– What the child should be giving in the relationship

• Rationale– encourages practice of desired behaviors and skills.– makes a clear connection between behaviors, feelings

and effects on others.– facilitates shift from shame to guilt by activating a

higher level response system - the social engagement circuitry.

Strategy 2: Coaching

How?

• Shape (by successive approximation and rehearsal)• Apply good cognition to negative behaviors• Cue positive behaviors• Cue positive interactions

– Every coaching phrase should contain an action, a feeling, and or a reason.

• Identify the underlying relationship need– Not necessarily what you need to provide to the

child but rather what the child needs to provide to you.

Apply Good Cognition: Connect the Dots

“You hit that child. You are scared of him.”

“You are chattering. You are worried that I don’t see you.”

You are out of your chair. You forgot to look around.”

“You are bossing. You want to control what’s happening.”

Coach Positive Actions

“This is when you…

work hard because you want me to be proud of you.”

bring me a book because you love me to read to you.”

tell that child you are sorry because you hurt him and you feel bad.”

smile at me because you are happy to see me.”

come get a hug because you are hurt and need me to help you feel better.”

Coach Positive/Truthful Verbal Interactions

“This is where/when you say to me…

I feel embarrassed when I do something wrong.” “Go”

I am really worried about something.” “Can you help me?” “Go”

I feel really angry when you tell me what to do.” “Go”

I don’t want to do my school work. School makes me feel dumb.” “Go”

I like when we do arts and crafts. Thank you.” “Go”

“Thank you for helping me.” “I needed it.” “Go”

Response to Child"Okay." 

"Is that right?" 

"That makes sense." 

“You are very good at that”

“We'll try that idea again later." 

"Yes it looks like fun for you."

"I understand." 

"I'd be happy to, thanks so much for asking.”

“I'll take it from here."

“What would you like to do about that?”

Tricks of the Trade

● Do not ask the child questions

● Questioning is likely to be perceived by the child as

accusatory and will push the child into defense mode

and shame.

● Use empathy

● Use action and feeling words

● Respond with reciprocal action and/or exaggerated

affect after the child repeats your coaching

● this evokes feelings of love, joy, and comfort (in both of

you).

– “Why did you break that toy?” becomes…

“I broke my toy because sharing makes me mad.” “Go.”

– “Why didn’t you do your home work?” becomes…

“I did it, then I threw it away because I don’t want anyone to know I’m smart.“ “Go.”

– “Why did you lie?” becomes…

“I lied because I didn’t want to get into trouble.” “Go.”

Instead of Questioning

Strategy #3-Build a Relationship

● Create safety – provide for basic needs (food, shelter, warmth) routinely and predictably.

● Create positive interactions in play and conversation (promotes falling in love).

● Expect Reciprocity (use coaching method)

Parent

Child

Give

Receive

Relationship

NOT a Relationship

Parent

Child

Relationship

Give

Receive

Receive

Give

BINGO!

What Do Children Typically Give?

● Share Values of Parent

● Elicit Positive Attention from Parent

● Ask For Help and Comfort from Parent

● Show Caring and Thoughtfulness of Parent

● Demonstrate Trust in Parent

● Contribute Joyfulness and Fun

● Express Love and Affection to Parent

Furthermore

● Children’s development is not satisfactorily completed

until they are ready willing and able to be reciprocal

(i.e., meet parental relationships needs).

● A child not taught how to meet parental needs will

likely lack the desire and skills to meet the needs of

all others.

● As a result- they will miss out on the benefits and gifts

of relationship throughout their lives.

Strategy 4: Reframe Your Thinking

● Acknowledge that our children have real brain dysfunction.

● At times their brain dysfunctions manifest as mindless intentionality.

● Feel bad for them, but do not take their actions personally.

● Hold them accountable not to punish but to teach

Rethink “Shoulds” and “Musts”

● “He should love me.”

● “She must be normal.”

● “She shouldn’t still be doing this after all this time.”

● “He must not embarrass me in front of others.”

● “She must stop doing these behaviors.”

New Thinking

● “My child is incapable of loving me - yet, and it’s not personal.”

● “My child is not normal, no matter how well he acts sometimes.”

● “My child may continue to act this way for the rest of her life.”

● “I have no reason to be embarrassed by my child’s behavior. I didn’t do anything wrong.”

● “Even if my child doesn’t stop this behavior I can find something else to focus on.”

Strategy 5: Teach Responsibility

●Balance privileges with responsibilities

●Provide payback opportunities

Admit

Apologize

Repair/Restitution

Out of BalanceToo Much Too Soon

Responsibility

Privilege

Give

TakeTake

Balanced

ResponsibilityPrivileg

e

Give Take

Accommodations

• Basic Package

• Room and board• Clothes• Medical care• Food• Education

• Luxury Package

• children don’t need but are given out of the goodness of a parent’s heart:– Extra-curricular activities– Chauffer services– Vacations– Parties– Dinners out– $$$

Qualify for Luxury Package?

• mutually satisfy parental needs in some ways, most of the time. – Respectful– Responsible– Fun to be around

Pay Back

●Restitution

Allows the child to make up for the damage he has caused (physical or emotional)

Assists in shifting the child out of shame and into appropriate guilt

Helps to develop self-control, self-esteem, moral character, responsible behavior, emotional IQ, and orderly conduct in an individual or a society.

Restitution/Consequences

●Do the victim’s chore

●Do a household chore

●Create napkin holders for everyone

●Assist parent

●Do something nurturing (e.g., comb hair, massage, foot rub)

●Draw a picture/create artwork

Thank You,

Katharine Leslie336-376-8366

www.kpleslie@att.net

To purchase Dr. Leslie’s books go to

www.brandnewdayconsulting.com

To purchase a CD recording of this seminar call Meds-PDN and ask for

Shannon Bergquist

(715) 836-9900

Important Websites

www.brandnewdayconsulting.comwww.eegspectrum.orgwww.tlcinst.orgwww.childtraumaacademy.comwww.traumacenter.orgwww.musc.edu/cvc/guide1.htmwww.modelprograms.samsha.govwww.attach.orgwww.radzebra.org