September 16, 2025 • 20 mins
Join us as we talk about challenging child behaviors! We'll explore why these behaviors can be developmentally typical and introduce the selective attention strategy for handling them. Learn key techniques such as specific praise, time ins, and the stoplight approach to help parents manage green, yellow, and red behaviors. Additionally, discover important clinical questions to determine when children might need further evaluation and treatment. Join us for practical insights to support both parents and children through difficult behaviors.
00:00 Introduction to Challenging Child Behaviors
00:42 Understanding Challenging Behaviors
01:44 Reframing Behavioral Issues
03:26 Practical Strategies for Parents
04:00 Selective Attention Technique
05:15 Categorizing Behaviors: The Stoplight Approach
06:43 Reinforcing Positive Behaviors - GREEN
12:26 Managing Annoying but Safe Behaviors - YELLOW
15:35 Handling Unsafe Behaviors -RED
18:01 When to Seek Further Evaluation
19:03 Summary and Conclusion
Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Elise Fallucco (00:00):
Welcome back to Child Mental Health for
Pediatric clinicians, thepodcast formerly known as
Psyched for peds.
I'm your host, Dr.
Elise Lucco, child psychiatrist,and mom.
Today we're gonna be talkingabout challenging behaviors in
kids, and I say challengingbehaviors instead of behavioral
problems because we know a lotof these behaviors can be
(00:21):
developmentally typical.
and I'm gonna share with you apractical strategy that you can
use in the office with familiesto help them.
Learn a framework for managingthese behavioral problems at
home.
Finally, we're gonna talk aboutthe questions you need to ask
clinically to figure out if achild with challenging behaviors
might need further evaluationand treatment.
(00:41):
So let's get started.
So what do we mean when we saychallenging child behaviors?
So this is everything fromdefiance.
The saying, no, I don't wanna dothis, or more active emotional,
verbal outbursts.
Things that we would call tempertantrums, or when they're older,
we might call them meltdowns.
And a really important principleto make sure that parents know
(01:04):
when we're talking about thesebehavioral issues is that
behaviors are just a way of kidsexpressing an emotion We see
these behavioral outbursts whenkids are feeling frustrated or
angry or overwhelmed or scaredor hangry or tired or all of the
above.
And part of our job as parentsis to try to figure out what the
(01:26):
emotion is that they'reexperiencing.
And then of course, we all know,the other reason that we see
these behavioral outbursts isthat a lot of times
developmentally kids have notyet developed the.
Ability to control theiremotions, to self-regulate and
to self-soothe, and that'susually when they get into
trouble.
But a positive thing to rememberabout.
(01:46):
Behavioral outbursts is thatthey really come from a good
place from the moment the kidsfirst take their couple, few,
couple of steps.
They're seeking autonomy.
They're trying to be independentindividuals and parents of
course, and pediatric cliniciansas well.
We all want them to becomehealthy, autonomous.
(02:07):
Grown adults.
So if we reframe some of thesebehavior problems as really a
kid's way of seeking autonomyand trying to assert their
independence, that can be a, amore positive take.
It certainly doesn't take awaythe fact that they're incredibly
frustrating from the perspectiveof a parent, but just something
to keep in mind.
(02:27):
Now, I'm sure you've had a lotof parents in your office say
things like, you know, Timmy isa tyrant and I feel like, you
know, my 2-year-old or my4-year-old is running the show
in our house and we don't likethat very much.
And when I hear that, Idefinitely reframe that as.
It sounds like Timmy is reallytrying to assert his
independence, and Timmy may havea really strong will, which is
(02:48):
gonna serve him really well inlife, but it makes it really
hard as a parent.
So one thing that parents can doat this stage is to offer Timmy
choices, knowing that he wantsto be autonomous, he wants to be
able to have a say in his out ofcontrol world.
And so let's say we're gettingready.
For school in the morning,instead of just telling Timmy,
(03:09):
put your clothes on, it's timeto get ready for school.
You can give him options like,okay, do we wanna wear the blue
T-shirt, or do you wanna wearyour fun red t-shirt?
And then he gets a sense ofchoice and the parents can get
the child to comply and movealong with the morning routine.
So let's get right into thepractical strategies that we can
(03:30):
share with parents to help themdeal with common challenging
behaviors in children.
What I'm about to tell you isreally based on a lot of
evidence-based studying variousparenting programs and parenting
strategies, and is drawing fromtried and true.
Therapeutic modalities likeparent-child interaction
therapy, and this technique andthis strategy has been shown to
(03:52):
improve child behavior, reducestress in the children, and most
importantly, reduce stress inthe parents.
So let's go.
So this strategy is called thestrategy of selective Attention,
and it's really based upon theidea that what we pay attention
to in our children is thebehavior that gets reinforced
(04:12):
because children desire parentattention.
They desire attention fromtrusted adults, and oftentimes
the behaviors that they're usingare their ways of trying to draw
us towards them.
And we know that as a parent,our instinct can be to pay
attention to the naughtybehaviors.
So think about it.
when the child has an outburstand decides that they don't
(04:36):
wanna get dressed for school, orthey don't wanna brush their
teeth and they flail on thefloor and they're kicking and
screaming, of course the parentis paying attention to that.
On the other hand, If a parent'strying to get dinner ready on
the stove and her child issitting on the floor and playing
nicely.
The parent's not gonna payattention to that.
(04:56):
They're gonna be relieved thatthey can get on with all the
things that they need to do.
All of that to say is that theparent instinct is often to give
attention to the behaviors thatwe don't wanna see repeated or
reinforced, and that we tend toignore and not pay enough
positive attention to the goodbehaviors that we wanna see
repeated.
Okay.
So what I would tell parents isthe first step in selective
(05:19):
attention.
Is to categorize child behaviorin one of three categories, and
I like to think of a stoplight.
So the red behaviors on thestoplight are those behaviors
that are unsafe, that are offlimits that we want to stop.
typically behaviors in thiscategory would be things like
aggression, you know, harmingothers, putting your hands on
(05:40):
others.
The next category is yellow.
Proceed with caution.
These are the behaviors that maybe annoying to the parents, but
they're not unsafe, and theseare the behaviors that we're
gonna teach the parents toignore.
And an example of a yellowbehavior would be something like
whining or interrupting or doingsomething similar that is
(06:03):
disruptive or annoying, but notfully a red type of behavior.
And then the third category ofchild behavior would be the
green category on the stoplight.
And these are the behaviors thatyou want to see.
Again, you want them to bepositively reinforced.
So this would be the childrenplaying nicely with their magnet
tiles on the floor, or the childputting his sock on as part of
(06:26):
getting ready for school in themorning.
Okay, so now that you'vecategorized the behaviors into
the stoplight, the red unsafebehaviors, the yellow safe
behaviors that are just annoyingthat we're gonna ignore, and the
green behaviors that arepositive, let's talk about what
we're doing with each of thesethree bins.
In concert with the principle ofselective attention, we wanna
(06:46):
spend most of our time, energy,and effort on the green
behaviors, the positivebehaviors that we want to
positively reinforce, and wewant to give them positive
attention.
And there are a couple ways ofdoing this.
One is to use specific praise tocatch them doing something good.
And to then.
Describe exactly what you likeabout what they're doing.
(07:07):
So this requires not onlynoticing when they're doing good
behavior, but also calling itout in a specific way.
So to give an example ofspecific praise, let's say it's
mealtime and your childtypically bops in and out of
their seat or their chairmultiple times.
What you would do as a parent isto catch them actually sitting
down quietly in between thejumping, um, in and out, and pay
(07:29):
attention to that and say, Ilove how you're sitting, so
still in your seat duringdinner.
And ideally then the child hearsthat, enjoys the positive
praise, and then wants tocontinue that behavior to get
some more.
So in addition to specificpraise, the other strategy for
reinforcing positive behaviorsor green behaviors is to try to
(07:51):
connect with a time in.
Time in or child-centered timeor child directed play is
something that parents can useto build a positive relationship
with their child.
And while that goal is good inand of itself, in addition to
that, the positive relationship.
We will pay dividends in thefuture as that will make the
(08:13):
child more likely to want tofollow directions and exhibit
good behavior.
So what is this time in?
This time in, I like toprescribe five minutes a day
where the parent lets the childdirect the activity.
So.
As a parent, you would need toput down your cell phone.
Any devices, sometimes sit onthe floor with the child and
(08:34):
say, you're the boss.
What should we play now?
And let the child choose thetoys, the game, the activity,
and you set your timer for fiveminutes and the child gets to be
the boss, assuming they're notdoing anything unsafe.
And there are specific skillsthat we talk about in
parent-child interactiontherapy.
That parents can use to make themost of these five minutes.
(08:55):
So the general idea of what theparent should do in time in is
to serve as a bit of a mirror tojust reflect what the child is
doing, repeat what the child issaying, and help the child feel
seen and valued.
So what does this look like?
So let's say you're sitting downon the floor and the child is
playing with trains, so youwould want the parent to
(09:17):
imitate.
Imitation is one of the keyskills.
So if a child is sitting downand playing with trains, do you
want the parent to literallygrab a train and imitate what
the child's doing with theirtrains to join in on the play?
The next of the three time inskills is to describe, so you
wanna be the parent, you wantthe parent to be a little bit of
a sports commentator and saythings like, oh wow, it looks
(09:39):
like Red Train has gone up thehill very fast.
Oh, and now Red Train is seeingBlue Train.
Oh no, I think they're gonnacollide.
And so like a sportscaster, younarrate the play that the child
is doing and.
This typically delights thechild, even though it feels a
little counterintuitive andawkward for the parent.
(10:01):
So after imitating anddescribing a third skill that
you can use in time in is toliterally reflect.
So if your child is speaking orsaying things like, let's say
we're playing with dolls andthey say, uh, little Sarah is
hungry, time for lunch.
As a parent, you could literallyrepeat what the child is saying,
(10:22):
but I find it better to kind ofrephrase like, oh look, Sarah is
hungry.
Good thing it's lunchtime.
And this type of verbalreflection demonstrates active
listening and it helps the childfeel heard and understood.
And as a side note, thistechnique is also good with kids
and adults of all ages and isreally important for people
(10:45):
helping to feel understood andheard.
And while I've given examplesabout time in that are really
more appropriate for preschoolaged children or kind of younger
children, this type of time inis something that we should be
doing with kids and teens of allages.
And so a time in with an olderchild might be something like,
they get to pick the game andthey decide that they're playing
(11:06):
chess.
And one of the things that wewould do to try to be the mirror
for them.
Would be to do the sportscommentary and say, Ooh, look
how.
You moved your queen in thatposition to block my rook, or, I
actually don't know a lot aboutchess, but narrating something
that has to do with the actualgame and then a time in for a
(11:26):
teenager might also look likegoing for a walk with them or
throwing the football or doingsomething else that they choose
that makes them feelcomfortable.
And before we move on fromtalking about addressing the
green behaviors, I also wannasay for a lot of families it
makes sense to only work on thegreen part of the stoplight for
a week or a couple of weeks togive positive attention knowing
(11:50):
that part of the reason why kidsexhibit the yellow and red
behaviors is that they're tryingto get our attention.
And so sometimes just investingin child-centered time or this
type of time in for a while willnaturally reduce some of the
yellow and red behaviors.
Alright, so to summarize, we'vetalked about how to positively
reinforce.
Good behaviors by using specificpraise and then connecting
(12:13):
during time ins and using thethree skills of imitating,
describing, or sportscasting andreflecting.
So now very briefly, let's talkabout the yellow behaviors.
These are the annoying, butannoying, unwanted, but still
(12:33):
safe behaviors.
So what we do for these is weignore them.
So let's take an example.
Let's say the parent is tryingto be on a phone call or a Zoom
call, and the child isinterrupting and saying, mom,
mom or Dad?
Dad, pay attention.
Pay attention.
Now, what we would coach theparents to do would be to ignore
these behaviors as much aspossible, and the idea is that
(12:57):
the child is.
Doing this type of behavior inan effort to gain attention from
the parents.
But again, we don't wanna givethem that attention'cause that
will positively reinforce thosebehaviors.
So it's our job as parents totry to ignore them and then try
to catch them in the momentswhere they're not nagging or
interrupting and where they're alittle bit quieter.
(13:17):
And then at that point.
Because that's a positive greenbehavior.
You'd reorient your intention tothem and reengage with them and
say, thank you so much forwaiting patiently.
I'm on a Zoom call right now,but I'd love to talk with you in
a little bit.
The important thing to noteabout this is that kids are very
savvy and so while in theory,while in the long term, when you
(13:38):
ignore behaviors, they tend togo away.
The reality is.
Um, that when kids are initiallyignored, they will just continue
the behavior, but just moreloud, more loudly and more
frequently in an effort to gainattention.
And so behavior will get alittle bit worse before it gets
better.
And in our mental healthcircles, we refer to this as
extinction burst, which is justthe idea that when we try to
(14:01):
change behaviors, they get moreintense and worse and almost
sort of increase beforeeventually children learn.
Okay, I'm not getting the.
Positive reaction that I wantedfrom this, and they get better.
And this part during theextinction burst is usually when
most parents give up because youthink, okay, I've applied this
stoplight approach that mypediatric clinician told me
(14:24):
about and it is not working.
And in fact it seems like it'smade things get worse.
So it's really important to tellparents that the fact that the
behaviors are getting worse isactually a sign that it is
working and that we've justgotta hang on for a while and
definitely let them knowbeforehand about this
possibility so that they don'tget dismayed and frustrated and
(14:45):
give up.
And in addition, while parentsare tolerating this sort of
yellow behavior, it's criticalto be able to catch your child
doing something good withinthat.
Um, time period.
And then of course afterwards,you know, if you have a specific
behavior, let's say interruptingphone calls or interrupting
conversations with other adults,that you wait until everyone is
(15:07):
calmed down and then afterwardshave a little conversation and
say, I know you, you need to getmy attention.
Let's come up with a littlesignal that we can have if you
need to get my attention, but ina way that doesn't interrupt
these calls.
So if you wanna put your hand onmy leg and then I'll put my hand
on top of your hand, that can beour secret signal that you need
(15:27):
to get my attention and my wayof telling you.
I can be there, but you've gottawait or you can come up with
something creative on your own.
And then finally, this is thepart that I think everyone feels
the most comfortable with.
These are the red behaviors thatare unsafe and absolutely off
limits for which you can trythings like time out or other
(15:47):
types of consequences.
So an example of a red unsafebehavior could be something like
running out into the middle ofthe street, which you would
obviously wanna give yourimmediate full attention or it
could be something like hitting,kicking, doing something harmful
to a sibling or to anotherperson.
obviously you wanna have clearexpectations upfront with your
(16:07):
kids about what are red offlimits behavior and what the
consequences are so that it'snot a surprise when they exhibit
that behavior and then have tomeet those consequences.
So you wanna make sure that theconsequences for unsafe off
limits behavior are safe andconsistent and boring.
And what do we mean by that?
(16:28):
So.
Consistent.
Really what we mean by that isthat almost every time they give
that behavior or exhibit thatbehavior, you're responding with
these consequences.
Now onto the safe and boringpart.
remember the key for selectiveattention is that you don't want
to give positive attention fornegative behaviors.
The hardest part for adults whenwe get to this point is that our
(16:50):
tempers have increased and ourfrustrations have increased
along with the kids.
And so when we get to redbehaviors, parents are often at
the end of their rope as well.
And so it's really important tocoach parents to try to manage
their own emotions.
And to make sure that they'renot inadvertently reinforcing
these behaviors by their ownanger.
(17:11):
So what do we mean by that?
Well, it may seemcounterintuitive if a parent is
screaming or getting red in theface and really dramatic and
heated in delivering theconsequences, even though that's
negative attention, it still isattention and can inadvertently
reinforce these behaviors.
So important to coach parents totry to take their own time out
(17:34):
if they need it, or time off,um, to take a break and compose
themselves, and then to just saywith a straight face in a really
boring way.
Because you did this off limitsbehavior, it's time for whatever
the consequence is.
I imagine many of you arealready familiar with the
concept of selective attention,but I hope this idea of the
stoplight and what to do withthe red, yellow, and green
(17:57):
behaviors might be helpful forworking with parents and
families.
Before we close, here's somequestions that might be helpful
in your clinical practice todetermine whether the child
needs further evaluation andtreatment.
So there are the obvious onesthat have to deal with
dysfunction.
You know, is the child gettingexpelled from childcare or from
preschool or from school?
(18:17):
That would be a sign that.
They would need furtherevaluation and potentially
therapy or treatment.
We also sometimes use a littlebit of a time rule.
Temper tantrums and behavioraloutbursts should really just
last a couple of minutes and thechild should be able to
self-soothe and calm down at theend of them.
And.
You're consistently finding thattemper tantrums are very intense
(18:39):
and lasting for say, 15 minutesor longer and seem to be
occurring frequently that wouldalso be a sign or a little bit
of a red flag, and then alwaysif you see major self harm or
major aggression towards others.
That is another sign of majoremotional dysregulation that we
would wanna take a further lookat and potentially refer to one
(19:01):
of our child mental healthcolleagues.
All right, well, in summary, um,we talked about three major
things.
One.
The importance of remindingparents that some of these
challenging behaviors may bedevelopmentally typical and that
their child's way of expressingemotions and their child's way
(19:22):
of desiring autonomy.
The second thing we talked aboutis the principle of selective
attention and using thestoplight approach to guide
parents in understanding andmanaging behaviors in kids.
The third part that maybe themost important part is
encouraging parents to practicepositive parenting.
(19:43):
That's hard to say out loud.
And build the relationship withtheir child through time, in and
through using strategies likeimitating and.
Describing or doing sportscommentary, and reflecting back
during scheduled regular time inpractices.
Alright, that is it for a briefreview of management of
(20:05):
challenging child behaviors.
Thank you for tuning in and lookforward to seeing you next week.
Welcome back to Child Mental Health for
Pediatric clinicians, thepodcast formerly known as
Psyched for peds.
I'm your host, Dr.
Elise Lucco, child psychiatrist,and mom.
Today we're gonna be talkingabout challenging behaviors in
kids, and I say challengingbehaviors instead of behavioral
problems because we know a lotof these behaviors can be
(00:21):
developmentally typical.
and I'm gonna share with you apractical strategy that you can
use in the office with familiesto help them.
Learn a framework for managingthese behavioral problems at
home.
Finally, we're gonna talk aboutthe questions you need to ask
clinically to figure out if achild with challenging behaviors
might need further evaluationand treatment.
(00:41):
So let's get started.
So what do we mean when we saychallenging child behaviors?
So this is everything fromdefiance.
The saying, no, I don't wanna dothis, or more active emotional,
verbal outbursts.
Things that we would call tempertantrums, or when they're older,
we might call them meltdowns.
And a really important principleto make sure that parents know
(01:04):
when we're talking about thesebehavioral issues is that
behaviors are just a way of kidsexpressing an emotion We see
these behavioral outbursts whenkids are feeling frustrated or
angry or overwhelmed or scaredor hangry or tired or all of the
above.
And part of our job as parentsis to try to figure out what the
(01:26):
emotion is that they'reexperiencing.
And then of course, we all know,the other reason that we see
these behavioral outbursts isthat a lot of times
developmentally kids have notyet developed the.
Ability to control theiremotions, to self-regulate and
to self-soothe, and that'susually when they get into
trouble.
But a positive thing to rememberabout.
(01:46):
Behavioral outbursts is thatthey really come from a good
place from the moment the kidsfirst take their couple, few,
couple of steps.
They're seeking autonomy.
They're trying to be independentindividuals and parents of
course, and pediatric cliniciansas well.
We all want them to becomehealthy, autonomous.
(02:07):
Grown adults.
So if we reframe some of thesebehavior problems as really a
kid's way of seeking autonomyand trying to assert their
independence, that can be a, amore positive take.
It certainly doesn't take awaythe fact that they're incredibly
frustrating from the perspectiveof a parent, but just something
to keep in mind.
(02:27):
Now, I'm sure you've had a lotof parents in your office say
things like, you know, Timmy isa tyrant and I feel like, you
know, my 2-year-old or my4-year-old is running the show
in our house and we don't likethat very much.
And when I hear that, Idefinitely reframe that as.
It sounds like Timmy is reallytrying to assert his
independence, and Timmy may havea really strong will, which is
(02:48):
gonna serve him really well inlife, but it makes it really
hard as a parent.
So one thing that parents can doat this stage is to offer Timmy
choices, knowing that he wantsto be autonomous, he wants to be
able to have a say in his out ofcontrol world.
And so let's say we're gettingready.
For school in the morning,instead of just telling Timmy,
(03:09):
put your clothes on, it's timeto get ready for school.
You can give him options like,okay, do we wanna wear the blue
T-shirt, or do you wanna wearyour fun red t-shirt?
And then he gets a sense ofchoice and the parents can get
the child to comply and movealong with the morning routine.
So let's get right into thepractical strategies that we can
(03:30):
share with parents to help themdeal with common challenging
behaviors in children.
What I'm about to tell you isreally based on a lot of
evidence-based studying variousparenting programs and parenting
strategies, and is drawing fromtried and true.
Therapeutic modalities likeparent-child interaction
therapy, and this technique andthis strategy has been shown to
(03:52):
improve child behavior, reducestress in the children, and most
importantly, reduce stress inthe parents.
So let's go.
So this strategy is called thestrategy of selective Attention,
and it's really based upon theidea that what we pay attention
to in our children is thebehavior that gets reinforced
(04:12):
because children desire parentattention.
They desire attention fromtrusted adults, and oftentimes
the behaviors that they're usingare their ways of trying to draw
us towards them.
And we know that as a parent,our instinct can be to pay
attention to the naughtybehaviors.
So think about it.
when the child has an outburstand decides that they don't
(04:36):
wanna get dressed for school, orthey don't wanna brush their
teeth and they flail on thefloor and they're kicking and
screaming, of course the parentis paying attention to that.
On the other hand, If a parent'strying to get dinner ready on
the stove and her child issitting on the floor and playing
nicely.
The parent's not gonna payattention to that.
(04:56):
They're gonna be relieved thatthey can get on with all the
things that they need to do.
All of that to say is that theparent instinct is often to give
attention to the behaviors thatwe don't wanna see repeated or
reinforced, and that we tend toignore and not pay enough
positive attention to the goodbehaviors that we wanna see
repeated.
Okay.
So what I would tell parents isthe first step in selective
(05:19):
attention.
Is to categorize child behaviorin one of three categories, and
I like to think of a stoplight.
So the red behaviors on thestoplight are those behaviors
that are unsafe, that are offlimits that we want to stop.
typically behaviors in thiscategory would be things like
aggression, you know, harmingothers, putting your hands on
(05:40):
others.
The next category is yellow.
Proceed with caution.
These are the behaviors that maybe annoying to the parents, but
they're not unsafe, and theseare the behaviors that we're
gonna teach the parents toignore.
And an example of a yellowbehavior would be something like
whining or interrupting or doingsomething similar that is
(06:03):
disruptive or annoying, but notfully a red type of behavior.
And then the third category ofchild behavior would be the
green category on the stoplight.
And these are the behaviors thatyou want to see.
Again, you want them to bepositively reinforced.
So this would be the childrenplaying nicely with their magnet
tiles on the floor, or the childputting his sock on as part of
(06:26):
getting ready for school in themorning.
Okay, so now that you'vecategorized the behaviors into
the stoplight, the red unsafebehaviors, the yellow safe
behaviors that are just annoyingthat we're gonna ignore, and the
green behaviors that arepositive, let's talk about what
we're doing with each of thesethree bins.
In concert with the principle ofselective attention, we wanna
(06:46):
spend most of our time, energy,and effort on the green
behaviors, the positivebehaviors that we want to
positively reinforce, and wewant to give them positive
attention.
And there are a couple ways ofdoing this.
One is to use specific praise tocatch them doing something good.
And to then.
Describe exactly what you likeabout what they're doing.
(07:07):
So this requires not onlynoticing when they're doing good
behavior, but also calling itout in a specific way.
So to give an example ofspecific praise, let's say it's
mealtime and your childtypically bops in and out of
their seat or their chairmultiple times.
What you would do as a parent isto catch them actually sitting
down quietly in between thejumping, um, in and out, and pay
(07:29):
attention to that and say, Ilove how you're sitting, so
still in your seat duringdinner.
And ideally then the child hearsthat, enjoys the positive
praise, and then wants tocontinue that behavior to get
some more.
So in addition to specificpraise, the other strategy for
reinforcing positive behaviorsor green behaviors is to try to
(07:51):
connect with a time in.
Time in or child-centered timeor child directed play is
something that parents can useto build a positive relationship
with their child.
And while that goal is good inand of itself, in addition to
that, the positive relationship.
We will pay dividends in thefuture as that will make the
(08:13):
child more likely to want tofollow directions and exhibit
good behavior.
So what is this time in?
This time in, I like toprescribe five minutes a day
where the parent lets the childdirect the activity.
So.
As a parent, you would need toput down your cell phone.
Any devices, sometimes sit onthe floor with the child and
(08:34):
say, you're the boss.
What should we play now?
And let the child choose thetoys, the game, the activity,
and you set your timer for fiveminutes and the child gets to be
the boss, assuming they're notdoing anything unsafe.
And there are specific skillsthat we talk about in
parent-child interactiontherapy.
That parents can use to make themost of these five minutes.
(08:55):
So the general idea of what theparent should do in time in is
to serve as a bit of a mirror tojust reflect what the child is
doing, repeat what the child issaying, and help the child feel
seen and valued.
So what does this look like?
So let's say you're sitting downon the floor and the child is
playing with trains, so youwould want the parent to
(09:17):
imitate.
Imitation is one of the keyskills.
So if a child is sitting downand playing with trains, do you
want the parent to literallygrab a train and imitate what
the child's doing with theirtrains to join in on the play?
The next of the three time inskills is to describe, so you
wanna be the parent, you wantthe parent to be a little bit of
a sports commentator and saythings like, oh wow, it looks
(09:39):
like Red Train has gone up thehill very fast.
Oh, and now Red Train is seeingBlue Train.
Oh no, I think they're gonnacollide.
And so like a sportscaster, younarrate the play that the child
is doing and.
This typically delights thechild, even though it feels a
little counterintuitive andawkward for the parent.
(10:01):
So after imitating anddescribing a third skill that
you can use in time in is toliterally reflect.
So if your child is speaking orsaying things like, let's say
we're playing with dolls andthey say, uh, little Sarah is
hungry, time for lunch.
As a parent, you could literallyrepeat what the child is saying,
(10:22):
but I find it better to kind ofrephrase like, oh look, Sarah is
hungry.
Good thing it's lunchtime.
And this type of verbalreflection demonstrates active
listening and it helps the childfeel heard and understood.
And as a side note, thistechnique is also good with kids
and adults of all ages and isreally important for people
(10:45):
helping to feel understood andheard.
And while I've given examplesabout time in that are really
more appropriate for preschoolaged children or kind of younger
children, this type of time inis something that we should be
doing with kids and teens of allages.
And so a time in with an olderchild might be something like,
they get to pick the game andthey decide that they're playing
(11:06):
chess.
And one of the things that wewould do to try to be the mirror
for them.
Would be to do the sportscommentary and say, Ooh, look
how.
You moved your queen in thatposition to block my rook, or, I
actually don't know a lot aboutchess, but narrating something
that has to do with the actualgame and then a time in for a
(11:26):
teenager might also look likegoing for a walk with them or
throwing the football or doingsomething else that they choose
that makes them feelcomfortable.
And before we move on fromtalking about addressing the
green behaviors, I also wannasay for a lot of families it
makes sense to only work on thegreen part of the stoplight for
a week or a couple of weeks togive positive attention knowing
(11:50):
that part of the reason why kidsexhibit the yellow and red
behaviors is that they're tryingto get our attention.
And so sometimes just investingin child-centered time or this
type of time in for a while willnaturally reduce some of the
yellow and red behaviors.
Alright, so to summarize, we'vetalked about how to positively
reinforce.
Good behaviors by using specificpraise and then connecting
(12:13):
during time ins and using thethree skills of imitating,
describing, or sportscasting andreflecting.
So now very briefly, let's talkabout the yellow behaviors.
These are the annoying, butannoying, unwanted, but still
(12:33):
safe behaviors.
So what we do for these is weignore them.
So let's take an example.
Let's say the parent is tryingto be on a phone call or a Zoom
call, and the child isinterrupting and saying, mom,
mom or Dad?
Dad, pay attention.
Pay attention.
Now, what we would coach theparents to do would be to ignore
these behaviors as much aspossible, and the idea is that
(12:57):
the child is.
Doing this type of behavior inan effort to gain attention from
the parents.
But again, we don't wanna givethem that attention'cause that
will positively reinforce thosebehaviors.
So it's our job as parents totry to ignore them and then try
to catch them in the momentswhere they're not nagging or
interrupting and where they're alittle bit quieter.
(13:17):
And then at that point.
Because that's a positive greenbehavior.
You'd reorient your intention tothem and reengage with them and
say, thank you so much forwaiting patiently.
I'm on a Zoom call right now,but I'd love to talk with you in
a little bit.
The important thing to noteabout this is that kids are very
savvy and so while in theory,while in the long term, when you
(13:38):
ignore behaviors, they tend togo away.
The reality is.
Um, that when kids are initiallyignored, they will just continue
the behavior, but just moreloud, more loudly and more
frequently in an effort to gainattention.
And so behavior will get alittle bit worse before it gets
better.
And in our mental healthcircles, we refer to this as
extinction burst, which is justthe idea that when we try to
(14:01):
change behaviors, they get moreintense and worse and almost
sort of increase beforeeventually children learn.
Okay, I'm not getting the.
Positive reaction that I wantedfrom this, and they get better.
And this part during theextinction burst is usually when
most parents give up because youthink, okay, I've applied this
stoplight approach that mypediatric clinician told me
(14:24):
about and it is not working.
And in fact it seems like it'smade things get worse.
So it's really important to tellparents that the fact that the
behaviors are getting worse isactually a sign that it is
working and that we've justgotta hang on for a while and
definitely let them knowbeforehand about this
possibility so that they don'tget dismayed and frustrated and
(14:45):
give up.
And in addition, while parentsare tolerating this sort of
yellow behavior, it's criticalto be able to catch your child
doing something good withinthat.
Um, time period.
And then of course afterwards,you know, if you have a specific
behavior, let's say interruptingphone calls or interrupting
conversations with other adults,that you wait until everyone is
(15:07):
calmed down and then afterwardshave a little conversation and
say, I know you, you need to getmy attention.
Let's come up with a littlesignal that we can have if you
need to get my attention, but ina way that doesn't interrupt
these calls.
So if you wanna put your hand onmy leg and then I'll put my hand
on top of your hand, that can beour secret signal that you need
(15:27):
to get my attention and my wayof telling you.
I can be there, but you've gottawait or you can come up with
something creative on your own.
And then finally, this is thepart that I think everyone feels
the most comfortable with.
These are the red behaviors thatare unsafe and absolutely off
limits for which you can trythings like time out or other
(15:47):
types of consequences.
So an example of a red unsafebehavior could be something like
running out into the middle ofthe street, which you would
obviously wanna give yourimmediate full attention or it
could be something like hitting,kicking, doing something harmful
to a sibling or to anotherperson.
obviously you wanna have clearexpectations upfront with your
(16:07):
kids about what are red offlimits behavior and what the
consequences are so that it'snot a surprise when they exhibit
that behavior and then have tomeet those consequences.
So you wanna make sure that theconsequences for unsafe off
limits behavior are safe andconsistent and boring.
And what do we mean by that?
(16:28):
So.
Consistent.
Really what we mean by that isthat almost every time they give
that behavior or exhibit thatbehavior, you're responding with
these consequences.
Now onto the safe and boringpart.
remember the key for selectiveattention is that you don't want
to give positive attention fornegative behaviors.
The hardest part for adults whenwe get to this point is that our
(16:50):
tempers have increased and ourfrustrations have increased
along with the kids.
And so when we get to redbehaviors, parents are often at
the end of their rope as well.
And so it's really important tocoach parents to try to manage
their own emotions.
And to make sure that they'renot inadvertently reinforcing
these behaviors by their ownanger.
(17:11):
So what do we mean by that?
Well, it may seemcounterintuitive if a parent is
screaming or getting red in theface and really dramatic and
heated in delivering theconsequences, even though that's
negative attention, it still isattention and can inadvertently
reinforce these behaviors.
So important to coach parents totry to take their own time out
(17:34):
if they need it, or time off,um, to take a break and compose
themselves, and then to just saywith a straight face in a really
boring way.
Because you did this off limitsbehavior, it's time for whatever
the consequence is.
I imagine many of you arealready familiar with the
concept of selective attention,but I hope this idea of the
stoplight and what to do withthe red, yellow, and green
(17:57):
behaviors might be helpful forworking with parents and
families.
Before we close, here's somequestions that might be helpful
in your clinical practice todetermine whether the child
needs further evaluation andtreatment.
So there are the obvious onesthat have to deal with
dysfunction.
You know, is the child gettingexpelled from childcare or from
preschool or from school?
(18:17):
That would be a sign that.
They would need furtherevaluation and potentially
therapy or treatment.
We also sometimes use a littlebit of a time rule.
Temper tantrums and behavioraloutbursts should really just
last a couple of minutes and thechild should be able to
self-soothe and calm down at theend of them.
And.
You're consistently finding thattemper tantrums are very intense
(18:39):
and lasting for say, 15 minutesor longer and seem to be
occurring frequently that wouldalso be a sign or a little bit
of a red flag, and then alwaysif you see major self harm or
major aggression towards others.
That is another sign of majoremotional dysregulation that we
would wanna take a further lookat and potentially refer to one
(19:01):
of our child mental healthcolleagues.
All right, well, in summary, um,we talked about three major
things.
One.
The importance of remindingparents that some of these
challenging behaviors may bedevelopmentally typical and that
their child's way of expressingemotions and their child's way
(19:22):
of desiring autonomy.
The second thing we talked aboutis the principle of selective
attention and using thestoplight approach to guide
parents in understanding andmanaging behaviors in kids.
The third part that maybe themost important part is
encouraging parents to practicepositive parenting.
(19:43):
That's hard to say out loud.
And build the relationship withtheir child through time, in and
through using strategies likeimitating and.
Describing or doing sportscommentary, and reflecting back
during scheduled regular time inpractices.
Alright, that is it for a briefreview of management of
(20:05):
challenging child behaviors.
Thank you for tuning in and lookforward to seeing you next week.
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