Managing Difficult Children

With some kids, the tantrums are endless. Others may refuse to do well in school. Handling a difficult child may not be easy, but applying certain tactics can change his/her behavior.

Dr. Alan Kazdin, president of the American Psychological Association and John M. Musser Professor of Psychology and Child Psychiatry at Yale University, was online Tuesday, March 25, at 11 a.m. ET to discuss methods for bringing out good behavior in defiant children.

A transcript follows.

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Dr. Alan Kazdin: Good Morning, I am Dr. Alan E. Kazdin. I am eager to be of any help I can. Please also look at www.alankazdin.com when we are finished if you would like more information. We also have a parenting center available to interested parents at www.yale.edu/childconductclinic.

We are here to help. Call if I can be of help to you personally.

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Canonsburg, Pa: My 15-year-old daughter (first born) asks me for help in certain situations, like homework, friendship problems, and when I try to help she lashes out and says what do you know? Why does she ask for my help only to criticize me when I can help? This is constantly, not just one time. So I have now stopped helping her, and I know thats not right. Any suggestions?

Dr. Alan Kazdin: Thank you for your comment. No one knows why to answer your direct question to me. If you hear an answer to that, be very suspicious! More importantly, in this case, we do not need to know why to solve it. Identify quite specific what behaviors you would like you daughter to engage in. Speaking to you nicely? Not saying these 10 words from 10-12:00 noon on Saturday -- be very specific and select a small period. For a teenager, negotiate privileges that can be earned by performing the behaviors you wish. A point chart is helpful here just to track all of this. 5 points = (privilege 1) etc. The privileges are negotiated with you two.

Even have her practice not lashing out -- in a game like situation once or twice a week and let her earn points for that.

Adolescence-a sensitive period for many children, huge biological changes, brain changes, and more -- try to do all behavior changes efforts when things are calm and there is no problem. Think of these lashing out moments as the equivalent of drowning--one cannot teach a person to swim them. Wait until all is well and then practice the behavior or praise great civil conversation. The praise has to be very specific (www.alankazdin.com). This should help.

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Baltimore: Dr. Kazdin, I hope you can help me. We have a "difficult" child (extremely high intelligence + extremely low impulse control); with her, everything is just more. I've spent so much time figuring out how to manage her that it's ridiculous. I finally developed a number of techniques that work ok -- always calm, immediate consequences for misbehavior, lots of praise for doing things right, no critical/sarcastic tone, and above all, not letting her provoke me into losing my temper.

My problem is my husband. He learned "old-school" parenting from his dad -- lots of yelling and spankings, kids expected to do what they're told instantly, etc. He is very authoritarian, with unreasonably high expectations (i.e., 6-year-old should always remember to do X because he told her once). He can turn the smallest thing into a power struggle, which always end with him yelling and her in tears (no spanking -- I laid down the law there).

Here's the thing: my husband's a smart guy; he sees that his approach isn't working. But he won't go see a counselor or parenting expert, or pay attention to the books I've given him, because he thinks psychology is bunk and he can manage himself. His "solution" is to hold it in as long as he can, and then explode over some minor thing. So how can I get through to him that what he's doing is damaging our daughter, when he is so closed off to the concept that child development experts might actually know what they're doing and be able to help?

Dr. Alan Kazdin: Thank you for your comment. First, you are doing many things that are likely to help. But small changes in what you are doing could make a huge difference. Focus on practice in game like situations when everyone is calm. Also, check your praise -- research shows it ought to have several characteristics to be effective (effusive, specific -- say exactly what behaviors you are praising, give something nonverbal with it -- a pat, touch, hug -- as appropriate). Also, it is not just about consequences--that is a small part of effective change programs. Look at setting up the behavior in practice or game like situations so there are many practice opportunities where you can use the special praise.

Regarding the husband issues, I can only tell you what you already know perhaps. Telling people things, getting people to understand, reasoning, giving feedback -- all are wonderful for many reasons, but the generally are very weak in changing human behavior. Yes, that is a surprise to all of us. As to the psychology is bunk, I am elated to report research has elaborated so many facets of human behavior that can be of practical help right now! The book elaborates some of these -- I can make them available but do not wish to persuade or sell. Take a look at ABCs and tantrums in the book (www.alankazdin.com)--we outline ways that could make an even better black belt in the wonderful things you are already doing.

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4 going on 14: Our son is almost 5 and seems to be developing increasingly selective hearing, and an attitude along with it. Simple requests (eg: 'Stop') either get ignored or he'll qualify it with a technical explanation ('but I was doing ____!!'). Minor frustrations can bring him to tears -- if he can't turn the water tap, it's suddenly a major crisis instead of simply asking for help. He is such a great kid, but we were unprepared for him to turn from a charming toddler into a surly teenager overnight. How can we help him to actually listen to us, and deal better with his frustrations?Thanks!

Dr. Alan Kazdin: Thank you for your query. Professional consultation would always be the place to start with selective hearing. Complying with requests is not that difficult to get--I can feel you rolling your eyes as I write that -- What will be very useful is the ABC approach -- antecedents, behaviors, and consequences. On the antecedent side, develop a game at calm times and the game is pretending that you will say "stop," or "no you can't" whatever precipitates tantrums. The game like structure, your emphasis on just pretending, and your very special praise will change this. I recommend practicing this once or twice a day or say 5 times per week. This procedure is described in detail in the book to help you (www.alankazdin.com). I am writing from the Parenting Center right now and before the day is over we will be using this procedure.

The key -- specify the behavior you want (not what you do not want), practice it in game like situations (more practice trials are key). If you see the behavior occurring natrually jump on it with effusive praise.

It is all in the practice -- repeated practice will change develope the behavior you want. All children are different as are all parents of course, but 2-3 weeks should take care of this.

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Washington, DC: I'm confused by the suggestion to reward a child with food or TV time (RE: how to handle tantrums where the kid trashes his room). I thought that food shouldn't be used as a reward since it can set a person up for a lifetime of food issues. Ditto with TV. In our house, we eat treats and watch TV in moderation, and we don't use either as rewards. So how should I handle my 4-year-old's tantrums (which are relatively short and never destructive) or defiant behavior? Any suggestions other than a sticker-based reward system? Thanks.

Dr. Alan Kazdin: Thank you for your query. In general I recommend not using food or TV. In fact, even points are not really necessary. The key comes from practice opportunities and praising in a very special way, based on research findings. Reward (points, food) are a minor part of the program and if used by themselves are more likely than not to fail. The research has provided great guidelines on how to set up the behaviors so it occurs.

Tantrums are not a difficult focus. At calm times, practice calm tantrums--only a few times a week for the practice. The book (www.alankazdin.com) describes exactly how to do this -- it is based on very careful use of antecedents (what comes before the behavior) and praise (enthusiastic, specific, followed by a touch, pat, hug -- something nonverbal).

This is do-able. We do a program almost every week with tantrums that are really explosive.

Although we do not recommend food and I do not advocate that, I want to clarify something. There is absolutely no evidence to my knowledge that using food as a reinforcer sets a person up for lifetime food issues. The causes of "food issues" are multiple and this is not one of the influences yet known to be involved. That said, there is no need at all to use food. Research shows very special praise (different from what we naturally do as parents) can usually carry the day.

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West Des Moines, IA: We have 13-year old triplets (two girls and one boy)in 7th grade. Our two daughters go to sleep after 10:30 pm and wake up at 5:00 am everyday for school to primp (the school bus comes at 6:50 am). They have numerous meltdowns and are like terrible toddlers who need a good nap. They have missed many days of school due to sheer exhaustion. How can we get them to set-up better sleep and morning routine patterns?

Dr. Alan Kazdin: Thank you for your query. Permit me to reassure -- we have had this situation (but not many triplets) on many occasions. The issue begins by starting with either the morning or evening routine, but not both. Most parents begin with morning, but it makes no difference. Set up the specific behaviors you want from them. Perhaps getting out of bed by a specific time, perhaps being dressed and ready for school. If they rarely do these, practice on a weekend one day. Each could earn a privilege or points for each behavior performed each day; also, if all three perforn a given behavior or all behaviors, there could be a special privilege that day. The absolute key is based on praise -- praise the behaviors you want or close approximations and specify what the behavior is that you are praising.

The approach (www.alankazdin.com) is on what is done to get the behavior (antecedents) rather than rewards -- this is not another reward program. The book tells how to program these to help in more detail than I can provide here.

As for the evening, here a wind down ritual 1 hour before bed time is very important -- only calm activities, leading to time in bed, then later lights out.

If there are tantrums that are a problem more generally, practice good tantrums at calm times and connect these to the praise. The book explains how to do this. Eliminating disastrous tantrums is something we do routinely -- it has not been one of the greater challenges.

I probably need a little more detail to help with the morning program (e.g., what precisely do you want and when).

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Tampa, Fla.: My husband and I have a niece and a nephew (different parents) that are having a lot of behavioral problems. We are just starting a family -- do you have any suggestions for reading up on early child development? We'd like to start off in the right direction but there are so many books and articles out there that I'm not sure how to identify the quality sources of information.

Dr. Alan Kazdin: Thank you for your query. Be very careful on the advice you are getting (including mine). I found that many parent books are relying in information that is now known to be wrong -- sound reasonable, common sense, and so on. The issue for my, my career, and colleagues -- is what is said known to be true, is there really any evidence for this. In child care and development, a pediatrician can advise on many critical issues. In terms of child development, behavior change, discipline and so on, there is much that you can do. The parenting book I wrote was out of frustration -- there is evidence on how to change child behavior -- the method turns out to be gentler than the usual shouting, frustration, and mild to not so mild punishment that often occurs in most homes. Peek at www.alankazdin.com -- this talks about how to change child behavior, but also family routines and rituals, quality time (no substitute for quantity time) and contexts that make home life and behavior change a little easier than what we probably experienced as children ourselves.

You are starting a family: Congratulations! Wonderful news.

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Silver Spring, Md: Do you have any strategies for potty training a defiant, stubborn child? We think he is ready (27 months old) because he hides when he has to go, and has had a few successes on the potty. But when we try to get him to sit on the potty, he has the worst tantrums. I'm just not one of those parents who thinks it's okay to wait until the child is 4 before starting to potty training, so how can we get past this?

Dr. Alan Kazdin: Yes, this is something, as you can imagine, we do routinely. (I am writing from my center right now -- Yale Parenting and Child Conduct Clinic.) The first question is always -- he might be ready but might not. Either way, I recommend you make a game out of this where you reward going to the pitting and sitting on it -- you do this when every one is calm You practice--a key (very hard to do)keep the game like factor high and the chill parent desperation (that desperation is called "normal" low). Use ABCs and practice -- this is all outlined in www.alankazdin.com -- requires practice, special prompts that have no tension, repeated practice, and so on. You will get what you want, but it is practice the routine -- you could practice this around the time the child has "accidents" but only if you can make sure the situation is very calm. The calm is a setting up event that helps this occur.

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Greenbelt, Md: My 3 1/2-year-old has a hitting problem -- both adults and other kids. He knows he's not supposed to hit, but does so anyway (usually in anger). I've tried time outs, grabbing his hands firmly and saying, "NO hitting;" everything except hitting him back (which I don't believe in). He does feel bad afterwards and apologizes, but what can I do to stop the behavior altogether?

Dr. Alan Kazdin: You raise wonderful points. The first is the most frustrating to all of us as parents but now known to be true. Understanding is of no help here -- scores of parenting books say, if your child understands, he/she will not do that. Understanding is very important -- relates to language, problem solving, school work, etc. -- will not change the behavior. Saying "no hitting" should not work either. Also, the child feeling bad will not do anything more than make him and then you feel bad -- will not change the behavior.

Ok, so what will? This is not that difficult but could surprise a bit. When things are calm develop a game (all in detail in www.alankazdin.com) in which he practices being angry -- you tell him its pretend, you say something that usually makes him mad, you wink and remind this is pretend, tell him how you would like him to behavior right there and then, praise wildly when he does, may be give a point on a point chart. Then say, "I'll bet you can't do that twice in a row" (very playfully). He will want to do this again -- you praise again. Do this 4 or 5 times a WEEK!

Again, this is all specified in the book.

The key is practice with the very special praise. Research shows us exactly how to do this. After a week or two sometimes three--the issue is over.

Again, saying no, fostering understanding, feeling bad, and apologies will not do the trick here. But there really is an alternative. Good luck!

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Washington, DC: Do you have any advice for relatives of challenging children? (ie. grandparents, aunts/uncles)? It is very hard when this child visits our homes because he/she is allowed to behave in a manner at their own home that is not tolerated in our homes. It makes visits very trying. We love this child and don't want to ruin any relationship with her/him but we see a bleak future as he/she ages and the parents are not stepping in to help her/him. Do we just have to "let it go" when that child visits and have chaos, should we impose our own house rules...what do we do? (by the way - recommending anything to the parents is out of the question)

Dr. Alan Kazdin: What wonderful relatives your are! Yet, there is much you can do and children can learn quickly different standards and rules of behavior in very different situations. The old concern -- if their parents are doing x all the time, me doing y is not likely to be effective. Not quite true. When the children come over, put your arm around and convey gently what behaviors you would like -- be clear, sweet, and calm -- this is not psychobabble -- these antecedents will really help get the behavior. Then as soon as you can--go back over to the children and praise exactly what they have done that you like. The praise has to be done in a special way -- Great, good boy, nice job--not the way to do this. (Please see www.alankazdin.com--with a DVD to show how in the book too.) In short, there is much you can do that does not undermine the parents.

If you think more is needed, we have a parenting center -- parents fly in for our program to handle situations that are from everyday challenges to very serious childhood dysfunction (severe aggression and antisocial behavior). I hope this helps.

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College Park, Md: The article advocates walking away from your child's tantrum. What about when the child involves the parent in the tantrum? When my son was 3 (adopted at 21 months from Eastern Europe, some adjustment/mild attachment issues diagnosed), he spent entire days tantruming, and all of the tantrums involved him grabbing me (his mother), particularly around the legs to try to knock me off balance, pulling my hair, throwing my glasses, scratching, biting, etc. Through work with a wonderful therapist, he stopped these behaviors at 4, but now (at 10), when he's too tired and out of balance, he still grabs me around the legs to try to pull me over -- and absolutely refuses to let go to get into time out. He's too big to drag there now. What do you do with a child who behaves as he did at 3? What about when a 10-year-old acts as he does now? Thanks.

Dr. Alan Kazdin: Thank you for the very clear description. We have this all of the time at my training center. That does not make it any less frustrating. But there is much to do. The key is practicing the exact behaviors you want -- set up a game (exactly specified in www.alankazdin.com)in which he pr actices dealing with you when he is mad. You pretend, he engages in more appropriate behaviors -- you must describe and even model what these are for the game -- and praise it. The key is practice the positive opposite, i.e., the behaviors you want. Time out alone will not do the trick at all (any more severe punishment would be even worse because of side effects and exacerbating the very behaviors you wish to change. You would use antecedents, behaviors, and praise (very specially delivered). The absolute key is repeated practice -- in game like situations. These will transfer to the situations you want. Also, if you see the behaviors you want occurring outside of the game, huge praise, specific comments of what you liked and a high five would go miles along the path I have outlined.

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Atlanta: Dr. Kazdin, I submitted a question before the show but I'll try to do a shorter version. My son (7 years old) sometimes engages in dangerous behaviors and seems to be testing us. Examples are running down the street or running out of the house at night (saying he's running away) or throwing things at the parent who's driving the car when he gets into a fit of rage over something. How can these dangerous behaviors be handled without reinforcing them?

Dr. Alan Kazdin: Genuinely dangerous behaviors are usually a good reason to seek professional help. There is danger involved and more intensive efforts are usually needed than what we can accomplish here (www.yale.edu/childconductclinic).

The key would be to identify positive opposite behavior, i.e., behavior you want to replace those you wish to eliminate. These must be praised effusively whenever they occur and practiced.

Perhaps you could identify three nondangerous behaviors you want him to engage in; set up a point program (put the chart in some place where it is conspicuous--research shows the conspicuousness makes a difference) and praise and give points whenever one of the nondangerous behaviors occurs. Alternatively provide points for each period (e.g., morning, afternoon) in which no dangerous behavior occurs. In short, work on developing nondangerous behaviors.

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Bethesda, Md: Question about your response re: potty training. What if making the potty sitting is impossible to do in game like way. My 4 year old son has a lot of anxiety about using the potty and cries when he feels like he has to go. Despite our best efforts, there is no way to make this fun for him. Any ideas on how to keep him interested and motivated?

Dr. Alan Kazdin: My experience, may not apply to you. Parents have made this very tense. In 1974, researchers who developed a procedure to train children even asked the parents to go shopping for a day and went to the homes to train the childen. The game like atmosphere is important. Think of the first challenge to make the situation as far removed from anxiety as possible. Maybe a quick trip before TV where you are at your calmest -- write back -- we have made this fun under the most tense situations. To take the pressure off you, this will occur -- few of us know adults who are not toilet trained -- I mention this to help you treat this like something that is going to happen anyway. If there is someone else in the home who could give you a break on this, that would help too. Game includes pretend, some light silliness, no demands for successful potty, even say, I do NOT expect you to use the potty but just to practice -- we will both practice in fact (modeling is an excellent setting up event -- see www.alankazdin.com)

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The 15-Year-Old: I'm not a parent, but I was a 15-year-old girl once. I remember wanting to talk to my mom about stuff, and her taking it as a request for advice. The "advice" involved jumping on the opportunity to correct/nag/patronize me. Eventually I stopped talking to her about friends or boyfriends because it felt like I couldn't do anything right. So try listening to her problems with an open mind, asking if she wants your advice, and, if she does, phrasing that advice as neutrally as possible. Teenagers, especially "uncool" ones, spend an inordinate amount of time listening to people list their faults. Why pile on?

Dr. Alan Kazdin: Excellent comment -- research shows that teenagers prefer to talk to their parents about difficult topics (sex, drugs) and prefer their parents to their peers. Many of the reasons they do not seek their parents are those you describe perfectly. Related, punishment (reprimands) foster avoidance and escape by those who are punished (e.g., teenagers) and this harms relationships.

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Alexandria, Va: Dr. Kazdin, thanks for taking my question. Is there any evidence that this condition, whatever it is, can be inherited? We're the classic situation where my husband's mother always wished that he would have a child exactly like him, and now that has come to pass! Whew. But even she admits our 6-year-old can make my husband look easy. I mean, he never trashed an entire house in under 15 minutes! Is there any hope for our future grandkids? Thanks for your time.

Dr. Alan Kazdin: The research is showing that yes, many conditions are inherited and run in families, but there is new excitement as well because many things that are inherited are not expressed (i.e., show up) and child rearing practices can suppress some genetic effects. In short environments (what we do) can actually affect some expression of genetic effects, and environments change the brain and biological and psychological influenes are in a wonderful dance throughout life. In short and more practical, what you do can still make a big difference.

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Odenton, Md: Kazdin, my husband and I have five children, two that could possibly be called "difficult" and three that are more easygoing. Do you have any suggestions as to how we can balance how we handle each one? I mean, even the "easy" ones act up on occasion, but the overall differences are very noticeable. You know kids, they resent what they consider dissimilar treatment and I have to admit, they have a point.

Dr. Alan Kazdin: Dissimilar treatment builds all sorts of problems and why should the more difficult child be getting praise, points, or privileges? There group based programs where the behavior of a few earns privileges for everyone (please see www.alankazdin.com where these are outlined). I have worked with many families where one or two of several children are as you indicate and in many classrooms where one or two children require special programs -- there are group options that allow focus on those who need a special program and yet build support (rather than resentment) from peers. Very do-able.

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Bethesda, Md: How do I handle a child who is consistently late for school and therefore makes me late for work? She's too big to simply pick up and throw in the car. We have a reward system at home and at school, but she complies less than 50 percent of the time.

Dr. Alan Kazdin: The is a disaster for a working parent can start OUR days with more tension than needed. Most reward programs do not really work unless they include other components. Please take a look at www.alankazdin.com -- here antecedents are critical -- how you set up the behavior and how you foster practice. This will surprise you perhaps -- practice the behavior on the weekend -- your child plays a game with you--must be game like in all ways -- that is part of the antecedent part that will make this work -- even practice it twice on Sat and once on Sunday -- your rewards might still be used but the key will be in the practice and praise.

The book includes a section on Troubleshooting--what to do when a program is working in mediocre way--the key is practice followed by very very special praise--must be done in a special way--not difficult to do but nothing like what we usually do as parents.

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Fairfax, Va: I have a very serious problem with a stepson. He is 16, and in my opinion he exhibits traits of a sociopath. He has no remorse in stealing or lying. He takes money from his younger brother's piggy bank, lies about everything and cannot be trusted. For example, I have his school lunch money automatically added to his lunch card, and then noticed the sums increasing. I believe he was buying breakfast and lunch for his friend or perhaps trading for cash. He is lazy and his mother has to continuously yell at him to just clean his own area. His school grades are like a yo-yo, he get Ds and Fs, and then miraculously can bring them up to Bs. I personally wonder about the quality of education when someone can manage those swings.

Dr. Alan Kazdin: At my clinic, we see a range of families -- many with the regular challenges of child-rearing but also very severe oppositional, aggressive, and antisocial behavior. If you feel your step child is more toward that end, professional help is essential. The good news -- there are now several interventions that have been effective even with the more extreme cases. Perhaps look at our clinic web site for further information www.yale.edu/childconductclinic and seek additional assistance from the Virginia Psychological Association referral service.

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Age issue: Hi, What I'm reading about your book, is it for age 12 and under? Will it be useful for 2.5 year olds? Some of these techniques I can't see working just yet, because he doesn't quite get "pretend." Thanks

Dr. Alan Kazdin: Thank you--great question. We are now using the techniques in the book for children 1 1/2 to 16 years of age. (The procedues work with older adolescents but we are busy with this restricted age group.) Try to get the pretend going by just asking him to do the behaviors. He does not need to udnerstand or "get it" for this to work -- this is really critical. If he were older, you might be fooled (like the rest of us are as parents) that now that he understands he will do the behavior you want more/better. Understanding can help but is not needed here. Justs try to get the game going -- focus on your great praise as you will see in the book. Antecedents -- how you set this up -- and your praise -- precisely how you deliver that can make a night/day difference.

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Rockville, Md: We have a 10-year-old girl who is generally great but can immediately change when she doesn't get her way and become very surly, extremely rude and angry. When she gets worked up, she can scream for more than an hour. What would you recommend?

Dr. Alan Kazdin: This is an excellent situation to identify precisely what behaviors you want from her when she does NOT get her way. Now set up a program in which you practice pretending to not give here something she wants, getting her to behave differently, AND praising this. This is described in detail in the book and illustrates the method at its best. It brings together antecedents, behaviors, and consequences to build the behaviors you want. Also, if she ever does not scream for an hour (even if a 1/2 hr) mention how mature and big girl like that was--this latter point is not a substitute for the pretend program.

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Dr. Alan Kazdin: Dr. Alan Kazdin: Thank you all for your excellent questions. I am sorry I was not able to answer all of them.

Let me note once more that in the past 20 years, many of the challenges of parenting (e.g., tantrums, feeding issues, aggressive behavior, teen attitude, and so much more) have been studied. There really is research to guide on how to change behavior and with good side effects (e.g., building better relationships, reducing family stress). If you find yourself reprimanding a bit, shouting a bit, or relying on punishment, there really are alternatives now. Temporary programs with these alternatives can help a lot.

Good luck. Alan Kazdin (www.alankazdin.com)

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