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CBT: Working Toward Compliance



Before I go any further, I have to mention that I really don’t like the term “compliance.” I don’t like the idea of constantly telling my child what to do and having her feel like she simply has to obey. I know that’s some people’s preferred mode of parenting, but it’s not mine. The stuff that comes next required me to really think about what I wanted for my child. The bottom line for us has always been about helping them develop intrinsic motivation to make good choices in life. We don’t want them to say “no” to a friend offering them a beer at a party (when they’re older, of course) because “My dad would kill me,” rather, we want them to say “no” because they know they couldn’t drive home safely if they had a beer.

That means that the idea of “compliance” rubbed me the wrong way. I had to do some soul searching in order to determine how I really felt about it. Again, my thoughts returned to the fact that we had agreed to see the doctors at the Rothman Center as the experts who have helped hundreds of children dealing with the same difficulties as Dot. The approach we’d been using wasn’t helping her to lead a happier more peaceful life so far, and nothing being asked of us went against our morals. In fact, I realized that these things are all just tools to help her get to the point of being able to make good choices in order to experience what that feels like—and that’s how intrinsic motivation is developed, after all. I came to accept what we were doing from multiple viewpoints, but I appreciate that the doctors validated my concerns and gave me breathing room to make the decisions regarding what I felt was best for Dot.

Reinforcement and the Lack Thereof

Like pretty much every other modern parent, we’ve used timeout as a means to successfully extinguish undesirable behaviors in our children. HAHAHAHAhahaha! Just kidding. A more accurate description is probably that we have used timeout to get our kids away from us when we’re super mad because they’ve done something obnoxious. I can’t think of a single behavior that’s ever really stopped as a result of the kid getting a timeout.

With that history to draw from, I was pretty surprised when Dr. Rahman told me that timeout is actually THE most effective strategy for getting kids to stop unwanted behaviors. According to him, it works for 90% of children. I know my kids are special and all, but something that works for 90% of kids should probably work for them. So, why hadn’t we seen this miraculous transformation into sweet angel babies who never had a nasty word to say to one another? (I mean, besides living in reality?) It turns out, we were doing them wrong.

Remember, all the stuff we were learning was science-based. It’s all about the most basic levels of human behavior. There were plenty of times when Dr. Rahman and I would get sidetracked talking about Skinner Boxes, Pavlov’s Dog, or slot machines. The answer to almost every question regarding behavior is: reinforcement. Reinforcement is what keeps us engaging in a behavior. Remove the reinforcement, and most of the time, you can significantly decrease the behavior. That was the theory, anyway. I had yet to see if it was actually going to work for us.

The goal here was still to help Dot improve how she reacted to being given instructions. Rather than inattention or explosive anger, we simply wanted to get her to recognize for herself that following the instruction actually made her life better. Again, our intention was to improve compliance to help decrease anxiety responses when she eventually gets into situations that trigger both her desire to not do something and her anxiety about it. Separating from us to go to school, sleeping in bed by herself, and wearing socks with seams in them are all pretty common examples of things we will be tackling later. For now, though, it’s about things like putting toys away or flushing the toilet.

The process starts with us giving her an instruction. This is done like I already explained. First, we make sure we have her attention. This requires us to be in reasonable proximity to her. Shouting “make your bed” from the kitchen while cooking breakfast isn’t going to cut it. We need to make eye contact, and eliminate distractions if necessary, such as turning off the tv, having her put down her book, etc. Once these things have been accomplished, we actually give the instruction. It is short, clear, direct, and in the form of a to-do. If there is some unusual reason that the instruction needs an explanation, that should come BEFORE the actual request.

Once the instruction as been given, we stop talking and give her ten seconds to process the information, go through whatever emotions she needs to go through, and make a decision about whether or not she is going to comply with the instruction. During this time, we do not turn our attention elsewhere. Attention = reinforcement, after all, and we want to reinforce her listening and responding to an instruction. Often times, the instruction will begin with “I need you to…”

Honestly, I was totally shocked when Dot just started complying right away. Somehow she almost totally did what Dr. Rahman had indicated: The sense of urgency that used to only come when I yelled at her and been transferred to the window of time where I was counting to ten, only without all the negative stuff. In fact, I usually only have to start counting, and she’s off following the request.

We had a long weekend coming, and my job was to continue providing what is known as “effective instructions” using this approach. It was actually harder than one might expect. Every time I wanted to ask Dot to do something, I had to think through the whole thing. Was I only giving her one instruction? Was it clear and short? Did I get her full attention before making the request? Did I add in an unnecessary explanation? I caught myself hollering a request into the other room or asking her to do a series of things more than once. It was definitely awkward to change the way I’d been communicating with her, but when I started to immediately see results, you can bet I got pretty good at it pretty fast.

During this time, I also got lots of practice deciding what things were actually important. It turns out there’s a difference between giving an instruction and making a request. If I wasn’t willing to participate from the time I got her attention, through giving the instruction, until she had started to comply, then it wasn’t worthwhile to give the instruction in the first place. Sometimes I would be annoyed that she wasn’t complying but when I reviewed the situation, I would see that I’d made a request rather than giving an instruction. Ideally, of course, my kid would jump to help when I simply asked her to, but that’s not the point we’re at. We’re building up to that, but at this point, it’s important to stick with the process for important things and let the other not-so-important stuff go.

Speaking of not-so-important stuff, we were strongly encouraged not to let ourselves get distracted by mildly disrespectful behavior when Dot was in the middle of complying with an instruction. Sure, she might roll her eyes, or sigh, or even say something a little whiny, but the fact of the matter is that she is still complying, which is a pretty wonderful step forward. Scolding her for that kind of stuff while she’s actually following through is going to be counter-productive and is basically just taking our eyes off the prize. Now, I don’t plan to have a teenager who is full-on rude to me someday, but I can concede a little of the power in the situation knowing that she is making the right underlying choices.

Timeout

At this point I’ve gone pretty thoroughly into what it looks like when the kiddo is on board with the program and catches on to compliance. What about when it doesn’t happen? What about when you get to ten, and the kid is still lying on the floor refusing to make eye contact or sticking out her tongue? What happens then?

What happens is timeout. If 90% of kids respond to a properly done timeout with a decrease in undesirable behaviors, you can bet your booty I wanted to know how to do them right. At first it seems like giving a kid a timeout is about introducing a consequence for unacceptable behavior. However, if attention = reinforcement, then a timeout could actually encourage a behavior. This is something that I have struggled with for as long as I’ve been a parent. Everyone tells you that kids will engage in behaviors that get them attention, even if it’s negative attention. I’m actually really good about giving my kids positive attention, so I’ve never understood why they also sought out the negative. Are they just jerks?

Nope. Well, not all the time, anyway. They’re just attention junkies. They’ll take it all and beg for more—positive, negative, whatever—as long as they’re being acknowledged. And that is why timeout can be so effective. A properly-done timeout removes pretty much every single bit of reinforcement for a specified period of time. It turns out that humans dislike this so intensely that we will alter our future behavior to avoid it.

The first step is to find the perfect timeout area. It should be away from all kinds of distractions. The child should not be able to see the TV from there, should not have access to toys, and should definitely not have siblings going by making faces at them. The space should also be well-defined with the child understanding exactly where she needs to be. A chair or a square of masking tape on the floor can be used. We found the perfect place at my mom’s house. The bedrooms were down a hallway that was set a bit off of the living room. I put a rug at the end of the hallway, and when someone had to go to timeout, they would sit on the rug with absolutely nothing to do. The doors to the bedrooms could even be closed to make it super boring with nothing to look at.

As a little aside, I want to mention that I was happy to discover that a “proper” timeout is a really low-intensity intervention. That’s a fancy way of saying that it’s actually a whole lot easier for the parent than pretty much anything else we’ve ever tried. It’s totally clear when someone has earned a timeout, they don’t really need to be monitored during the timeout, and it is over quite quickly. For me, that beats the heck out of getting all mad and yelling about stuff for the next 20 minutes while my kid cries and tells me how mean I am…and still doesn’t do what I asked. There’s also a really short list of things that earn a timeout, so I’m not constantly sorting through my options trying to determine how to address certain behaviors. If it’s X or Y, they earn a timeout. If it’s anything else, then perhaps I need to offer some instruction. I was nervous going into the weekend knowing we were going to be trying this, but within two days, I was a believer.

With the perfect, zero-reinforcement timeout spot ready to go, I explained what the girls could expect. This is really important, as they knew the deal from the get-go. Maybe more importantly, I knew that they knew the deal.

  • You only earn timeout for two things: 1. Non-Compliance (not following an instruction*) or 2. Aggression (we started with only physical aggression against others, self, and objects).

  • I will tell you when you are about to earn a timeout.

  • When someone is in timeout, they get absolutely no attention from anyone.

  • When the timer goes off, timeout is over, and you need to go ahead and follow the previous instruction or apologize for the aggression.


*This refers to the child intentionally not following an instruction. It’s not about them forgetting to do something or not doing it perfectly.

Timeouts typically start at two minutes for us. I’ve always heard you should give the kid a timeout for the number of minutes that correspond to their age. So, Dot’s timeouts would be 7 minutes, Lucy’s would be 4, Winnie’s would be 2. It turn out this oft-repeated piece of advice wasn’t the right approach for us. Instead, we just start at two for everyone.

Let’s say I need Dot to get her stuff off the table for dinner. I would make sure I had her attention, tell her, “I need you to put away your art supplies,” and then silently count to ten. Dot, however, doesn’t want to be done with her drawing and ignores me or tells me “no.” At this point, I go ahead and let her know, “If you don’t put your art supplies away now, you’re going to earn a two minute time out.” I keep my attention on her and count to ten again, usually while holding up my fingers and possibly counting aloud. At this point, Dot’s response is usually a haughty “FINE!” as she gives me dirty looks and gathers up her stuff. If I get to ten, though, she has earned a timeout.

Dot’s pretty good about taking herself to timeout relatively quickly. Lucy, on the other hand, isn’t. When she chooses not to comply, she generally goes pretty big with it, so that an exchange might look something like this:

Me: Lucy, I need you to let me brush your hair.
Lucy: No!
Me: One…
Lucy: No!
Me: Two…
Lucy: No!
Me: Three…
Lucy: No!
Me: Four…
Lucy: No! No! No!

Me: Ten…
Lucy: Nooooooooooooo!

At that point, I tell her that if she doesn’t let me brush her hair, she will earn a two minute time out. If she still refuses, I change my instruction to, “I need you to go to timeout for two minutes.” If I’m lucky, she’ll do it. If I’m not so lucky, just go ahead and re-read the exchange above. If that happens, then I let her know that the timeout is now four minutes. If necessary, it gets increased again to six. Dr. Rahman and I decided that six minutes was the cutoff for us.

So, now Lucy has messy hair and a six-minute timeout that she hasn’t done. This was seriously one of my biggest fears when it came to the whole timeout thing—and I knew it was going to be Lucy who put it to the test. Once the kid has refused to go to timeout, the game changes. Since attention = reinforcement and reinforcement, well, reinforces the behavior of not going to timeout, we withdraw all attention from her. Her sisters are not to play with or talk to her, Mama and Papa don’t respond to her questions, and if the TV or computer are on, they get shut off. The only way that Lucy gets attention reinstated is by taking herself to the designated spot and doing her time.

I cannot believe how well this works! My bull-headed little girl needs to have some control over the situation, but she also cannot hold up under the silent treatment for very long. Sometimes it takes her a couple of minutes to decide to go to timeout, sometimes it takes longer. But, she has followed through every single time and rarely refuses to go if she does get a timeout now. The biggest difficulty with this is that she doesn’t tell me when she’s going to timeout, so if I don’t keep a subtle eye on her, I won’t know she’s there waiting for me to tell her when the time is up.

When the timeout is over, the child needs to go and follow the original instruction, with a few exceptions. If the parent had to take care of it (say, I had to clear Dot’s art supplies in the earlier example so we could set the table while she was in timeout), she needs to perform a different but similar task. If there just isn’t time because you’re running out the door for school or something, then the task or a similar one will need to be done when the child gets home. The same is true if you run out of time for the timeout. If it gets to be school time and the kid still hasn’t gone to timeout, pick back up after school. If they fall asleep at night without having done the timeout, they get reminded in the morning and don’t get reinforcement until it’s done.

Because of Winnie’s age, there is no escalation in the amount of time for a timeout. She just gets two minutes no matter what. That said, I will actually pick her up and set her in timeout if needed because she hasn’t quite gotten to the point in her cognitive development where she can rationalize all of this out. There are also methods for taking time off of a timeout once it’s been earned, but we’re not there yet.

By the way, I keep using the word “earned” regarding timeouts. Dr. Rahman teaches parents to use that word because it gives the kids ownership of what is going on. There’s a very different feeling between “I’m giving you a timeout” and “You’ve earned a timeout.” The first one is me imposing my will, the second is the kid facing an outcome of their own making.

As a final note for this piece, it’s good to let the kids know we’re not infallible. There may be times when I tell Dot to go to timeout for aggression but then later find out that it was actually Lucy who did it. We make sure they know that we’re not perfect and that there may be times when they disagree with our take on the situation. That’s okay, but discussion of it needs to take place after they’ve complied with the instruction. We will listen to them after that and will apologize if appropriate and will work to make that kind of thing less common in the future.
 
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