Therapy Gem: Develop New Child Behavior Through Enactment of In-Session Change

I. Out-of-Session Behavioral Change

Working with ADHD or oppositional children, do you work out a behavior management regime and send clients home to work the protocol?

Or do you develop the regime collaboratively and then practice it in-session?  Let’s take a look at these two strategies.

Let’s assume the therapist helps the family work out a new, well-crafted behavior therapy contingency program to change a child’s behavior.  You also include cognitive-behavioral strategies in the program.

You recognize the internal and external problems in the child’s world.  Internally, the child is poor at self-monitoring of behavior.  The child is self-critical (negative self-statements) after disappointing parents or poor performance in school. The child seldom gives positive self-reinforcement.  Working memory is poor.  Other executive functions, such as attention and emotional self-control are impaired.

In the environment, the child is deficient in positive reinforcement.  Parents and teachers call the child out for poor performance, so the child receives and internalizes criticism.  The result is low self-efficacy.

You might include these elements in a well-crafted contingency program.