In the treatment of ADHD in children, behavior modification therapy is one of a specific type of intervention psychotherapy that has been widely used and has been shown by evidence-based medical research to be in the same first line of treatment as stimulants. This treatment process involves doctors, parents, and teachers making a series of changes to the child’s home and school environment to provide more structured activities that allow the child to focus on learning. Before treatment, it is necessary to understand the condition and the factors involved to observe the main problems of the child’s behavior, to determine the baseline of the condition, to select the target behavior, to choose the appropriate behavior modification method, to increase the desired behavior and to decrease the undesired behavior, which requires the cooperation of all aspects of the family and society.
Behavioral therapy focuses on observable external behaviors and applies “learning principles” to improve non-functional or non-adaptive behaviors based on specific treatment steps. The learning principle means that behaviors are easily learned and maintained if they are “positively responded to”, i.e., encouraged or appreciated by others, or if the individual achieves a satisfactory outcome; conversely, behaviors that are “negatively responded to”, i.e., punished or unpleasant. On the contrary, if the individual’s behavior is “negatively responded to,” i.e., punished or has an unpleasant outcome, the behavior will not be easily learned or maintained, and may even be abandoned.
The first step in behavioral treatment is to evaluate the child’s ADHD behavior to obtain information; the second step is to develop and implement a behavioral program. In the first step of behavioral evaluation, the therapist should first pay attention to the child’s family functioning problems. The child’s parents should be informed of the need for self-control in communication with the child so that the child and adolescent must realize that behavioral symptoms can be controlled on their own, which is the basic guarantee for changing the child’s ADHD maladaptive behavior. Only when the undesirable behavior is under control, the person with childhood ADHD can start new studies and learn new good behaviors.
In order for behavior therapy to be successful, two basic behavioral principles are observed: first, rewards are more likely to lead to behavior change than punishment, with rewards leading to desired behaviors and punishment leading to undesired behaviors; second, in behavior therapy, responses to acceptable and unacceptable behaviors must be consistent from start to finish, and inconsistent responses may reinforce negative behaviors.
Types of behavior modification treatment.
1, Positive reinforcement procedures (Positive reinforcement procedures) or positive reinforcement. This method is based on operant conditioning and emphasizes that behavior change is determined by the consequences of behavior, and is used to correct undesirable behavior and establish good behavior. Positive reinforcement method means that whenever a child shows the desired behavior, or a good behavior that meets the requirements, a rewarding method is used to reinforce it immediately in order to enhance the frequency of a certain behavior.
Methods.
(1) Identify the target behavior and understand the baseline level of the behavior. The target behavior set should be one that the child can objectively control, can be observed, and can be repeatedly reinforced. For example, to identify a child’s homework distraction as the target behavior, understand that the child can work for 20 minutes without being distracted as the baseline level.
(2) Select effective reinforcement, including: 1 social reinforcement, such as praise or encouragement; 2 activity-based reinforcement, such as games and activities that the child enjoys; and 3 material reinforcement, such as toys, objects, food, or money for the child.
(3) Develop a behavior modification program that provides immediate reinforcement whenever the target behavior occurs; for example, if a child is not distracted for 20 minutes doing homework, the child is immediately given the reinforcement the child prefers and is made aware of the specific behavior being reinforced and knows the outcome of that behavior.
(4) When the target behavior is repeated, the time should be gradually extended, increasing from the original 20 minutes to 25 minutes and then longer, eventually matching the child’s homework time with the 35 minutes of class.
(5) The reinforcement of the target behavior changes according to the frequency of the behavior; when the target behavior appears several times, the reinforcement should be mainly social reinforcement, such as appreciation, praise, and encouragement, so that the target behavior can be maintained.
2, temporary isolation method (Time out): This is whenever the child appears a certain bad behavior, to timely isolate that child temporarily in a separate place, the use of isolation of this period of time, so that the child quiet, so that he understands that isolated because of their own bad behavior caused by, and the need to change this bad behavior.
Methods.
(1) Setting a behavior that is unacceptable to the family or teacher as the target behavior, e.g., aggressive behavior in children with ADHD (e.g., hitting).
(2) Place the child in an isolated place, such as a corner of a room, when the target behavior (hitting) occurs.
(3) Clearly define the duration of isolation. Younger children can be isolated for 1 minute per year of age, such as 3 minutes for 3-year-olds, up to 30 minutes for children over 8 years of age, and up to 1 hour for adolescents. If the isolation time is up and the child is still shouting, the isolation time needs to be re-established until he is quiet.
(4) When the child does not comply with the isolation, he needs to be told that he must comply with this, or else double the extended isolation time, and to insist on the implementation of this provision.
(5) The implementation of this method must let the child know that only if he changes that bad behavior, he will get his parents or teachers to cancel the anti-isolation, through this to reinforce, otherwise, when the aggressive behavior reappears to be isolated again.
(6) For children with developmental delay or mental retardation, isolation time should be specified according to the developmental age.
3, Extinction method (Extinction) by stopping the reinforcement of a bad behavior, so that the behavior gradually disappear a behavior treatment method. This method includes two features: first, the behavior is followed by the cessation of the supply of reinforcers to maintain the behavior, and second, the frequency of the behavior should be reduced. The following points should be noted: 1. Active attention to and reinforcement of the child’s daily good behavior is a prerequisite for the long-term effectiveness of the regression method. 2. the reinforcers that perpetuate the undesirable behavior should be identified through a functional analysis of the behavior. 3. the child’s undesirable behavior is eliminated by removing the reinforcers after the undesirable behavior. 4. because the above water regression procedures are firmly and thoroughly implemented to ensure the effectiveness of the regression method, it is important that 5 Understand the potential for a temporary increase in behavior at the beginning of the regression process and avoid premature termination of the treatment due to possible early “treatment failure”. Neglect is not the same as neglect. Neglect is a function or reinforcer that maintains the problem behavior, and neglect is equivalent to neglect only when the function of the problem behavior is to attract their attention.
4, Modeling (Modeling) is a therapeutic technique that presents an individual with certain behavioral role models to elicit imitation of good behavior from that individual. Many of children’s behaviors are produced through observation and learning, and imitation, like reinforcement, is a basic form of learning. The demonstration method involves three situations: 1 live demonstration, such as having a child with ADHD observe how other children follow classroom discipline in a realistic setting; 2 participation in imitation, where the child with ADHD is allowed to try to participate in a communication activity with guidance after observing the demonstration child interacting kindly with peers; and 3 television or video demonstration, where the child is allowed to gradually imitate good behavior through media outreach and education. When using demonstration techniques, the target behavior should be determined according to the ability of the child with ADHD. During the demonstration, the child’s attentional capacity should also be assessed, and if there is a concentration of attentional capacity, the presentation time of the demonstrated behavior can be appropriately increased to allow more time for ADHD to watch the demonstrated behavior. After the imitated behavior is produced, it should be recorded and reinforced in a timely manner so that the imitated behavior is maintained.
Summary
Behavior modification therapy, is a method of using learning theory to eliminate or correct abnormal behavior in children. It has been widely used in the field of mental health. Four methods are currently used most often: positive reinforcement, temporary isolation, abatement, and modeling. Having the approval and support of parents and schools, and the cooperation and adherence of the child is the key to the implementation of established principles and the success of treatment.