Behavioral Therapy Not Working

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    • #70826
      ajsd
      Participant

      We have been in behavioral therapy for a couple of months now and I hate to say it but what they are asking me to do is not working …They want my son on a “ticket” system if he does something I ask him to do without him getting mad or me having to prompt him more than 3 times he get a ticket …he has a menu of what he can choose from with his tickets at the end of the day or every two days …My son has flat out said he is not doing it and the tickets are stupid ..He is 9 yo 4th grade with ADHD at this point because of his behavior at home and at school (which is horrible) he doesn’t have access to iPad,DS,phones,or any video games he has…(these are things he loves) …he basically plays with stuffed animals or army men..because he refuses to be listen to me at home or listen to teachers at school. I am suppose to keep track of the things he does for the tickets but literally everything is an argument and nothing is getting on that list …Has anyone else had this issue with therapy ?

    • #70830
      TaurusMoon
      Participant

      Yes, we have this issue on and off when it comes to therapy. My son expected his sessions to be like what he has seen on tv and read in books- you lie on the couch and tell your doctor what is troubling you. Lol. He said “she talks to me like I’m a kid.” Keep in mind, he is 10 years old and in 4th grade. I told him that a session like that could get very boring for a kid and he may find himself not having anything to say. When I asked him if he was willing to give up the games and toys that his therapist has waiting for him, he had to think on that one. Lol.

      One therapy tool that we have been mostly successful with is the “Proud Bank.” My son made a bank with his therapist and some “proud coins” to deposit into the bank. This is to be used for “hard but proud” moments in my kiddo’s day, both at school and at home. In short, something he would normally push back on or not do (hard) but he powers through, finishes the task and is proud that he did so. Coin! He writes down that “proud moment” on the coin and deposits it into the bank.

      At the end of the week, we go through all of his deposits and he gets a small treat, not over $5. We set monthly and semi annual goals to keep him motivated and this positive feedback method focuses on his accomplishments that he can be in control of.

      Your son may find himself earning his tech back sooner than he thought, if he is up for earning coins!

      Good luck!

      • This reply was modified 2 years, 11 months ago by TaurusMoon.
      • #71901
        andrewk1901
        Participant

        More power to your son. I have always thought that the model of behavioural therapy in ADHD, and in fact the whole “executive functions model” is fragile, to say the least.

        In fact, to put it more baldly than that it is effectively an extension of the teaching methods that are already failing the ADHD person- but, what the hell– “if at first something soesn’t work do it again- but louder”
        .
        Im almost 56 and despite ADHD I work as a health professional. One thing I can say very clearly is that there are many times (in fact most times) when my executive functions work extremely well.
        Non ADHD individuals do not see this and do not see the times when we are functioning well and the nature of the way most people (including most professionals) see the problem is that it is relatively constant.

        The behavioural reward strategy seems predicated on a model which assumes we (us ADHD individuals0.don’t know these behaviours or why they are worthwhile. Personally, I find that insulting- and I suspect your son feels the same way.

        We do actually know thesebehaviours, and how and whyto use them, but sometimes we can’t access them. It makes it infuriating to then be treated as though we dont know stuff that we do- it usually gets our back up and brings out our oppositional side– which is best seen as a healthy and highly necessary ego defence.

        ADHD can be conceived as a disorder of self regulation- and the most important item to be regulated is autonomic function.
        Additionally the challenge of sitting in a chair and keeping enough blood flow to maintain circulation to the brain is a substantial one and if this mechanism fails we get either hyperactive, fidgety and impulsive, or worse we lapse into a state of low cerebral blood flow.
        I was pleased recently to encounter this analysis from an expert in autonomic nervous system dysfunction in Arizona– it explains my troubles perfectly:

        Note that “bad behaviours” like being fidgetty and tapping with ones feet are actually unconscious strategies to improve blood return from the legs into the central circulation—- but you can bet ADHD kids will be told off for that.

        I also quote from an article called “Somatic Perspectives in Psychotherapy” by a Prof Stephen Porges, who is one of the most influential people working in the field of neurology. The full article can be accessed at his website:

        Physical and mental illness may be a consequence of an adherence to Descartes’ dictum. Thus not responding to the body’s own responses and filtering visceral feelings, over time may contribute to illness by damping (appropriate) bi-directional feedback between brain and body.”

        My comment here relates to the first video- ADHD kids are suffeing a powerful stress response because sitting still and upright in a chair is impairing the blood flow to their brains. The key command in the classroom is to NOT RESPOND to the body’s own responses and damping appropriate feedback- thus setting the stage for the many illnesses that adults with ADHD are prone to.

        P2 answer 3
        “Understanding the prerequisites for feeling safe is a critical issue in the modern world. Our culture takes a paradoxical perspective in defining safety. We focus on words and cognitive representations and minimise bodily responses and feelings to define safety.”
        – And again- the feeling of lack of safety comes from a physiological response to a situation that none of us have been aware of. It doesnt matter what anyone says- it FEELS LIKE there is threat because of the way the body is reacting.


        “If we observe children in a classroom, we see a variety of behavioural features that illustrate that some children are safe and can sit comfortably in the same situations that trigger in other children the hypervigilant behaviours characterising a lack of safety.
        Moreover, the children who are chronically monitoring the room for danger cues are the same children who have difficulties in learning, while those with the features of feeling safe can attend to the teacher and learn efficiently.

        Unfortunately, the traditional classroom model for education assumes that if some children can perform well in a classroom, every child should. Our society treats the behaviour of children who are behaviourally or viscerally reactive as “bad”. Society assumes that children should be able to turn these behaviours off voluntarily.”

        This is so important to understand- with an active stress response stable attention focussed on one item of school work is extremely difficult. It is even difficult as an adult- but not impossible.

        I much prefer mindfulness based therapies, which effectively ask “how does it feel when you are fuctioning well/hyperactive/ vague and inattentive” and how can you bring yourself into the zone where you function best.

    • #70833
      kearnsj00
      Participant

      I would start the cost reward system with all privileges in tact. And for your son, you may need to really try hard to find the smallest of the smallest positives and provide a ticket. Going this route will ensure behavior modification any day over negative consequences which just result in power struggles. Even if you say good morning and he isn’t rude. TICKET. Sometimes you have to start very basic.
      Also keep in mind behavior therapy especially with children takes a very long time to change behaviors. 2 months is an extremely short amount of time to assess change. If you have concerns schedule a parent meeting with the therapist.
      I have an adhd son in 3rd grade it can be hell sometimes. Keep fighting.

    • #70941
      Pump2Duncan
      Participant

      I agree, 2 months is a short amount of time. When we started behavior therapy, our therapist told us at the beginning to expect the behaviors to get worse before they got better. As he tested his new boundaries to see if I would stick with it, or give in and give him the reward without the good behavior. My son placed value on any sort of attention (both negative and positive) so it was months, upon months of ignoring negative behaviors and rewarding even the slightest positive ones.

      One thing we found really helpful was if my son got to pick the rewards. He got to pick what reward he felt was appropriate for what good behavior. We incorporated some of these rewards into his school day. Since he spent some of his day in the Resource Room (Special Education Room), if he modeled appropriate behavior during the school day he got extra computer time or some lego time in the Resource Room.

      It took MONTHS, and in the beginning I thought it was pretty dang stupid. But gradually we saw improvements and we started increasing what was expected to obtain an reward. Hang in there.

    • #70978
      donsense
      Participant

      Perhaps it was easier 70 years ago with large families, I am youngest of 12 and certified ADHD. Older siblings do set role models and in a crowded one bathroom home and six older sisters patience and frustration tolerance was a necessity learned early in life. Also entertainment almost always involved interacting with older children unless you went outside and joined others your age who did not return to play.if your social skills were to edgy. TV (eventually)
      was a family affair and youngest seldom chose the program.
      I am not recommending larger families but perhaps pleasantinteresting activities involving many similar aged children and teambuilding might be helpful. I am as far from an expert as one can be so iam seeking opinions not suggesting advice.

      PS many(but not all) of the Residual behavioral issues were solved at a military school/ Basic training facility at age 16 Apparently that doesnt work for all.

    • #71257
      kelly
      Participant

      Have you hold your son’s behavioral therapist that he thinks the tickets are stupid? Chances are, a structure for rewarding positive behavior isn’t going to work if you don’t have his buy-in. My 8-year-old son has been in behavioral therapy for 19 months and it’s helping with some things but not yet with others. We praise him when we catch him doing the behaviors we want more of, and have a set of consequences for the behaviors we want to stop. Is the therapist guiding you on how to set up effective consequences?

      I suggest sticking with behavioral therapy for at least two years before giving up. It does help! That said, we’re at the point where we’re considering medication.

    • #71268
      leanz
      Participant

      Tracking for rewards and consequences never worked for us. Every time It came to taking something away it resulted in drama.
      Stars, coins, tickets anything.

      Thinking about it, may be anyone would not like to be tracked this way.

      What works for us is a concept called immediate star. If he does something nice, kind, organised, helpful, loving that in-line with values, I give him immediate star on his hand and shower him with praise.

      Second thing that works for us is one-liners like ‘we make things, we don’t break things’ or ‘we conserve water, we don’t waste water’. Once I come up with a satisfying one liner, I don’t need to manage my emotions plus
      Find the words. All I do is repeat same
      Words again and again till the habit is finally built.

      Hope this helps.Take care.

    • #71670
      ajsd
      Participant

      Love the feed back thank you guys so much …Here is the thing about the tickets he literally will not even take it from me and put it in the ticket box that’s how “dumb” he thinks it is and I told the therapist I was putting them in there for him cause he wouldn’t and she said no he has to ..and the hard part is even if he works up to the amount to get a treat ..iPad time or video game time or playing a board game he literally gets so mad and frustrated with what he is doing if he is not “winning” at it BOOM major meltdown yelling and stomping and slamming of the bedroom door …so then we are back at square one …At this point I have stopped it.. kept his things away from him and I notice he just does things by himself if I ask him ..it works maybe 50 percent of the time but I will take it…If I notice him doing well I give him a treat or reward but severely limit the time…We have another meeting next week and I don’t know how I am going to tell the therapist where we are at is basically in the same place we started with the tickets ..I feel like I am in trouble or not a good Mom because I didn’t follow the rules of the therapy after our meetings ..believe me I tried and I will keep trying but when you have to pick your battles with our darlings I am all for the quieter way …

      leanz… I like the immediate star idea I might try that
      Kelly ..I will stick with it for as long as possible …5-10 years LOL

      I am seriously thinking of just paying him in real money …I always call him Mr Crabs like SpongeBob because he literally hoards his money and change ..I think he might see the actually accountability that way …He loves qtrs./dimes/nickels…I will let everyone know

      Hugs to all …Thank you

    • #71676
      Pump2Duncan
      Participant

      I agree, if the “reward” is causing a meltdown, it’s not the right reward. If he likes change, I think that would be a terrific replacement for tickets and something to certainly bring up with the therapist.

      One little child in my son’s group L-O-V-E-D to collect legos. Instead of something like tickets or stars, he got legos. Like seriously, a lego at a time. The child absolutely LOVED it and completely responded to it. My son responded to just getting smiley faces and a certain number of smiley faces got him a reward that he got to pick out. Our therapist was very willing to tailor the program to meet the individual needs of each child.

      You’re not a terrible Mom. Every kid just seems to respond a little differently. I’d see about the coins. I’d start with small value coins first though so you don’t go bankrupt. LOL.

    • #71693
      lisatransue
      Participant

      Ok I have been to therapists for DD and they didn’t work if anything I was in there with her and I ended up helping the therapist through something that she was going through and we ended up talking about her instead of why we were there. very frustrating. I think alot of these Doctors need someone to listen to them instead. So just wanted to mention my DD has been diagnosed for 13 yrs with ADHD and she is on medication and also my 9 yr old boy. My DD is on Focalin it has been great but I am trying to lower the dosage since she is getting older and want to see where she is but anyway about Behavior therapy at home we just bought a hug a pod it hangs off the ceiling and it is really neat. it cradles the body and it is a special space for her, she can swing with it or just get that sensory that she needs sometimes, she also has a very soft fluffy blanklet that she likes that relieves her. hope it helps

    • #71694
      swamijie
      Participant

      So, here’s the thing: behavioral therapy is not about simply rewarding behavior. That is a complete misunderstanding of the science behind behavior modification works. In order to successfully modify behavior, the best way to do it is reinforcement; reinforcement does not simply mean reward. Think of behavior in terms of sABC (setting surrounding behavior, Antecedent to behavior, Behavior and Consequence of behavior). So, as parents we are in better positions to understand the settings surrounding behavior (time of day, mood, hunger, etc) and antecedents to behavior (what happens right before) and we often observe the behavior but don’t mind consequences. Every behavior has a consequence that will increase the likelihood of the behavior happening again because the outcome was positive, decreasing the behavior because the consequence was negative or no change because the consequence had no salience or didn’t mean anything. In terms of reinforcement, it’s up to us to find proper reinforces. Praise, positive attention, foods or any other item that makes the child feel good about what he or she has just done is a reinforcer. The tickets agent working because they either have no salience or lost their salience. They don’t mean anything or don’t mean anything positive to your child. Sometimes children simply grow out of certain reinforcers (e.g. a balloon isn’t going to work on a teenaged child). However, it’s up to you to figure out what works as a reinforcer and perhaps associate that with the ticket or whatever other system you choose to use.

      • This reply was modified 2 years, 11 months ago by swamijie.
      • This reply was modified 2 years, 11 months ago by swamijie.
      • This reply was modified 2 years, 11 months ago by swamijie.
    • #71710
      marwoo99
      Participant

      Tickets/Points always has felt like bribery to me – Maybe as a result of my not being comfortable with the process it never worked for my son either.

      What helped A LOT (note – nothing is 100%) was “time in”. This helped not only my son but it helped my husband and I establish a more positive approach after just being plain worn out to the point of feeling resentful.

      “Time In” is setting aside 10 minutes a couple of times a day (more time if you have time) to play with your child. His choice of activity (LIKE IT OR NOT!!!), no phone/ipad/computer for parent or child, no parental instruction, no conditions (i.e. we’ll do this IF you do that); set a timer. If a fit is thrown or rudeness occurs during that time then you can give a warning that you will postpone your time-in for another time when he/she can speak nicely/play fairly (or whatever).

      Options my son chose were: playing catch, playing a game (we even willingly played the ones we hate!), puzzle, walk, trampoline, legos etc.
      There is no “Earning”the time in. He just gets it.
      We couldn’t say no to the activity
      No TV/Movie watching. It must be actively engaging.

      My son started knowing when to ASK for positive attention rather than doing things that caused negative attention. We started having FUN again with our son and appreciating him more.

    • #71717
      kimenking
      Participant

      It sounds to me like your son may have ODD in addition to ADHD. My son has both, secondary to reactive attachment disorder, acquired from trauma in his birth family. He was long impervious to either rewards or consequences. The only thing that really helped him (not medications, not talk therapy) was neurofeedback, which has slowly rewired his brain, giving him much greater emotional control and ability to tolerate frustration. He still has a ways to go, but things are so much better now that we were able to get him off of the 5 psychiatric medications he came to us with at age 12. I highly recommend it and I also recommend investigating the Institute for Attachment and Child Development for articles that might help you figure out what’s going on with your kid. You don’t mention whether he is adopted or not, but if so, there’s a good chance that his behaviors are related to attachment disorder, and if that’s the case, you need a different approach and a lot more support than you’re likely getting from your existing therapist. My experience has been that most therapists don’t have a clue about RAD. Best of luck and know that you are a good parent!

    • #71808
      Amberdanijo
      Participant

      I feel your pain. And the ticket system you are doing sounds like it isn’t rewarding enough fast enough. My son is the same age. I had tried various rewards and charts without success. I recently read The Kazdin Method For Parenting The Defiant Child because things at his school were going down hill quickly this year. When I really paid attention to what was different from other rewards systems and why they failed it made sense. Most systems offer some sort of withholding or punishment along with the rewards. Would you want to go to a job where you get paid only if you do everything perfectly? And on a timeline that doesn’t meet your needs?
      Yes, it requires that adults do more than other systems but it also removes the daily battles. I involved my son in picking his rewards. If it isn’t something he wants then he won’t be motivated to work for it. I also gave him a chance to earn two to three more points than the book suggests since he does have adhd and we are working to change his natural tendencies. I’m finding that as long as I am actively and consistently doing my part then the program works.
      I wish both of you the best.

    • #71721
      sandman2
      Participant

      The thing about behavioral therapy is that one size does not fit all. And yes, while it can be effective, it does not happen over night. The type of reward system you were suggested to use can work great for younger kids, but as the kids age – its not as effective. Your therapist needs to know it is not working and should then make adjustments. If the therapist can not make adjustments to this kind of “canned” approach, then I would look into other therapists. The other thing is that You need to be an active part in this therapy. Its what you do at home, how you react to him that is most important! For example there is a lot of material on the additudemag.com site that gives very practical ways to work with ADHD kids. A good example is this: https://www.additudemag.com/slideshows/anger-management-for-kids/?utm_source=eletter&utm_medium=email&utm_campaign=December
      this is the kind of information you should be getting.

    • #71924
      andrewk1901
      Participant

      I believe the whole system of behavioural therapy and rewards is perverse and is not supported by an understanding of human behaviour.
      I have ADHD myself, I am a health practitioner and I always did at least moderately well at school, sometimes very well. Even in subjects that were dull I failed to fail. I always did much better if I liked the teacher, and I knew he/she liked me.

      That is called attachment based learning. It is well covered in the book “Hold on to your Kids” by Dr Gabor Mate and Dr Gordon Neufeld. The latter is a clinical psychologist who specialises in troubled adolescents.
      He emphasises the need for children to be able to attach to adults who like them, and also that standard approaches like rewards and time out are insulting and damaging.
      He is right.
      The effect was demonstrated decades ago in “The Magic Marker Experiment”.
      In this experiments kids were given some nice textas and paper and asked to draw what interested them.
      One group was given an incentive reward for each picture they produced. The other was not.
      The group that was not given rewards produced more art.

      I can’t for the life of me figure out why this has not filtered through into behavioural psychology.

      This attachment effect influences us all to some extent- but it is much stronger in ADHD. Our emotions are as unstable as our attention.
      That’s not surprising- they are both orienting responses.

      Many kids perceive this sort of behavioural therapy as insulting.
      I would too.
      Their resistance shows strength of character.

    • #71925
      andrewk1901
      Participant
    • #80559
      peaceout
      Participant

      Token economies always backfire with DD (unless the odd occasion when SHE comes up with the plan and has a specific goal to work toward). They drive her anxiety higher. For her it is easier to know for sure she won’t be getting whatever it is than it is to sit and worry about it all day, so she self-sabotages.

      We have tried counseling for DD on three separate occasions with little to no success. The first time she was 6 and just too young to really let the CBT stuff sink in. The next time was a “structured discipline” approach that just wreaked havoc. The last time was supposed to be CBT and self awareness/self soothing techniques, and halfway through they wanted to change to a structured discipline technique (PCIT, which is for kids 6 and under and she was 8.5), and I just said no and discontinued therapy. If they can’t support me and what I have learned about DD then I am done at this point.

    • #80780
      caringmom
      Participant

      in my sons case too,this reward and consequences things are not of great help till now.He is not intrested in smilies and stickers at all,he says and actually behaves nicelly whenever he wants his tech things,but he doesnt want anything to come between good behaviour and reward…says its tooo boaring ,lets not play it.He is quite practical at 6 and half…
      And about consequences ,if I Say you didnt give me the laptop back at the time we mutually decided,now no laptop tomorrow then he will say, ok then he also will not study that day.So on every consequence,he has his counter condition also.I WILL sure ask the the theropist about this next time?So ASJD you are not alone ..BUT I am sure you can find out your own tricks in between theropists advise and your childs behaviour…
      Anyone here who hasthe similar experience like mine…

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