Professional Documents
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Behavior
Behavior
Behavior
BEHAVIORS
JORDAN KONCINSKY, MD
• b) Give the family parent and teacher Vanderbilt’s and have them return in
one month
• c) Recommend sending the boy for a weekend visit with his grandmother
• b) Give the family parent and teacher Vanderbilt’s and have them return in
one month
• c) Recommend sending the boy for a weekend visit with his grandmother
• Carlos presents with his mother, • Your ABC history reveals that
Ms. Sanchez for his 6-year-old Carlos begins to act out right after
check-up. Ms. Sanchez states he is told to go to bed. He refuses
Carlos is doing well at school, but to turn off the TV or leave the
is difficult to control at home. He couch, he yells, screams, and “goes
refuses to go to bed at night, limp” if his mother tries to
falling asleep on the couch in physically move him or turn off
front of the TV. He is not overly the TV. He will not stop until he is
aggressive with his younger allowed to remain on the couch
siblings, but refuses to complete with the TV on. Ms Sanchez tries
his chores and “talks back” to his to punish him by telling him he
mother. cannot watch TV before bed the
next day, but his grandmother
watches him in the afternoon and
evening. When Ms Sanchez arrives
home from work the TV is always
on.
DISCIPLINE AND POSITIVE PARENTING
WITH LIFE ADJUSTMENTS
• New stressors or changes can incite behavioral changes in
children. These behavior changes are generally transient, especially if a
previously established routine and secure attachment with the
caregiver was in place prior to a change (eg. new sibling).
• Children who experience divorce, separation, extreme poverty,
substance abuse, and parental mental illness may be at greater risk for
persistent behavior disorders
• Pediatrician counseling should focus on maintaining consistent
routines in the during specific periods of adjustment to ensure a safe,
warm environment for the child.
Rachel is a 28-month-old female who has tantrums when told “no”, pushes
other children when she wants a toy, and hits when physically restrained.
Which of the following is the best approach?
a. Give a hug during the tantrum, model sharing with other children, and
spanking for hitting other children
b. Restrain during tantrum, model sharing with other children, and 5-
minute time out for hitting
c. Ignore the tantrum, model sharing with other children, 2 minute time
out
d. Ignore the tantrum, model sharing with other children, explaining that
hitting is inappropriate
e. Talk to Rachel during the tantrum, remove Rachel from other children
when not sharing, 2 minute time out.
Rachel is a 28-month-old female who has tantrums when told “no”, pushes
other children when she wants a toy, and hits when physically restrained.
Which of the following is the best approach?
a. Give a hug during the tantrum, model sharing with other children, and
spanking for hitting other children
b. Restrain during tantrum, model sharing with other children, and 5-
minute time out for hitting
c. Ignore the tantrum, model sharing with other children, 2 minute time
out
d. Ignore the tantrum, model sharing with other children, explaining that
hitting is inappropriate
e. Talk to Rachel during the tantrum, remove Rachel from other children
when not sharing, 2 minute time out.
DISCIPLINE-”TO TEACH”
Give Good Directions Toddler “We will get ready for bed in 5
minutes. First we do X, then we
do Y. I will warn you in 3
minutes”
Time Out Toddler-school age 3 year old hits his brother. Walk
child to wall for 3 minutes.
BEHAVIOR STRATEGIES CONT.
Enforce limits and Toddlers- 6 yo turns on TV after being told to do HW. Parent
rules Adolescence reminds child of rule. Consequence of canceled play date.
Insist on an apology School Age 8 yo took siblings toy and broke it. Parent requires an
apology and way to fix or replace toy.
Act like a coach School age 9 yo has a new toy that her brother grabs away, she
begins to yell. Parent says “I know you’re frustrated but
stop and take a breath. How can we communicate
without yelling?”
Offer rewards School age Use star chart or token system with reward after earning
a specified amount.
Reggie missed his 30 month WCC but is coming in at 3 years old. You have taught
Mr. and Mrs. Smith several discipline techniques including effective use of time
outs, ignoring bad behavior and using consequences as negative
reinforcement. They are happy to have learned to avoid corporal punishment but
feel as though their relationship with their son is too negative. What can you add
to their discipline portfolio to help?
• a) At this age, positive reinforcements are too confusing to be effective. They should
plan to initiate a star/sticker chart when the child is in pre-school.
• b) A simple star/sticker chart would allow them to encourage and celebrate good
behavior with their son
• d) Their anxiety about the negativity implies that the discipline techniques are
overused. They should be directed to employ only positive reinforcement for a few
months.
STAR CHARTS-DOS AND DON’TS
• 1-2-3 Magic: Effective Discipline for Children 2-12 by Thomas W. Phelan Ph.D.
• Positive Discipline A-Z: 1001 Solutions to Everyday Parenting Problems (Positive
Discipline Library) by Jane Neslon, Ed.D.
• Authoritative Parenting: Synthesizing Nurturance and Discipline for Optimal Child
Development by Robert E. Larzelere
• The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your
Child’s Developing Mind, Survive Everyday Parenting Struggles, and Help
Your Family Thrive by Daniel J. Siegel, MD and Tina Payne Bryson, Ph.D.
• No-Drama Discipline: The Whole-Brain Way to Calm the Chaos and
Nurture Your Child’s Developing Mind by Daniel J Siegel, MD and Tina
Payne Bryson, Ph.D.
• https://www.cdc.gov/parents/essentials/videos/index.html
• http://www.smarterparenting.com/specific-lesson/
The next patient on your schedule is John, a 4-year-old with chief
complaint of “behavior problems”. The medical student you are
working with will see the family first. You discuss the “ABC”
approach to a behavioral history. What are the components of the
“ABCs” of behavior?
• a) Assess parental capacity; Be objective; Clarify confusion
• https://www.empoweringparents.com/free-downloadable-
charts/behavior-chart-preschool-kids/
• https://www.psychologytoday.com/us/blog/dont-worry-
mom/201408/the-dos-and-donts-the-sticker-chart
• https://ped.peaconline.org/
• https://www.cdc.gov/parents/essentials/videos/index.html
• http://www.smarterparenting.com/specific-lesson/
• https://depts.washington.edu/hcsats/PDF/TF-
%20CBT/pages/combined/CBT+-Home-Token-Economy-
Guide.pdf
THANKS!