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Pediatric Therapy Corner: The Challenge Of Training Parents

By: Daniel Adatto, MA, BCBA
Founder and Clinical Director of Total Behavior Solutions
Our thanks to Daniel Adatto, MA, BCBA and Total Behavior Solutions for providing this article for our website.
Any kind of therapist that works with children faces the challenge of motivating parents and caregivers to implement and follow through on the therapeutic advice we offer for their children. This article was originally written for behavior intervention specialists, therapists that implement behavior modification programs using the principles of Applied Behavior Analysis (ABA). ABA has gained much recognition as the only evidence-backed treatment for Autism. It is based on many years of research into behavior, its causes, and techniques for changing behavior. It is essentially a positive-reinforcement system that creates desired behaviors by breaking them down into small, logical steps. We know that success in any child’s therapy program, whether it be speech or behavioral, can not be achieved without a significant commitment on the part of parents. Parents need to devote a considerable amount of time and energy to learn and implement the therapeutic principles and techniques we offer. So in reading this you can feel free to interchange behavior modification with speech therapy or whatever therapy you offer.
Parents can be the strongest influence in modifying a child’s behavior when they understand the principles of behavior modification and implement them consistently. We see again and again that when parents are the primary implementers of a behavior modification program and take on the role of therapist and teacher, the best results are achieved. In addition, maintenance of the desired behaviors across time and generalization across settings are accomplished.
That being said, parents can also be the weakest link in this process when they are not able or willing to implement the behavior modification strategies. There are many reasons why parents may resist taking action:

  • Some parents are in denial and do not accept that their child has a problem. “He behaves like every other 5-year old” is an excuse we often hear.
  • Other parents find excuses for not following through claiming they are too busy or too tired. In fact, parents do face the challenge of being very busy, overly tired and overwhelmed. Parenting is a very demanding job, especially when there is a child with special needs. Add to this that they are usually spending extra time working with professionals, often several (pediatrician, case manager, speech, occupational or physical therapist, teacher etc.) with respect to their child’s challenges. Each one of these professionals offers his/her own guidance and instruction and parents can feel overwhelmed with the information.
  • Some parents feel judged and therefore do not like to be told what to do, as in “Who are you to come to my home and tell me how to parent my child?”
  • Other parents discipline in a certain way due to lack of knowledge and experience. Yelling, spanking, taking away privileges is the only way of discipline they know.
  • Some parents are seeking a quick fix and do not want to be inundated with too much information “I give up, you fix my child”.
  • There are also parents who feel sorry for themselves and like to play the role of a victim “My child is impossible, poor me”.
  • Some parents, as a result of anger and frustration, lash out claiming “No one knows what to do with my child. Nothing works. Everybody is wrong”.

Regardless of the challenge, we need to approach our clients professionally rather than personally. This can be a difficult balance to achieve as we try to counsel parents with compassion and understanding. Our challenge as parent-trainers is to educate and motivate parents in the understanding of ABA principles and the implementation of the behavior change procedures.
From this point of view, our clients are the parents. It is about their behavior, their parenting skills. Therefore, we need to apply the same ABA principles and techniques we use in our behavior plans for children when working with parents:
Use of Positive Reinforcement: Parents need to be motivated. Reinforcing them for their efforts and commitment is crucial. We need to acknowledge and validate their feelings regarding their child with special needs. We have to be careful about not coming across as judgmental or critical. We should not point out their mistakes in parenting, rather provide them with the knowledge and tools to become more effective parents. We should not emphasize past mistakes but focus on the present and future by encouraging them with praise like “Good job Mom” or “You are doing a great job taking care of your child and advocating on his behalf”. Keep in mind that we reinforce successive approximations towards the goal. We want to reward direction, not perfection.
Effective Instruction: Make it simple. Break the complex concepts and techniques into small, easily achievable units. Review each unit until the skill is mastered. Provide sufficient modeling, examples and opportunities for turning theory into practice. If necessary, go to the grocery store and show mom how to handle her child’s behaviors. Provide parents with audiovisual materials such as research, articles, books and videos. This helps them to apply theory to real life situations.
Consistency and Persistency: People do not learn overnight. Patience is required when working with parents. It is not unusual that several lessons will need to be repeated. Sometimes parents need time to assimilate new strategies so a therapist need not feel frustrated when parents reject their ideas and advice.
Environmental Manipulations: Parents are not able to implement a behavior plan if they have a full work schedule; if they are currently dealing with an emergency or crisis such as an illness or divorce; if their lives are cluttered; nor if they are extremely stressed. Helping them with time/stress management could be crucial in ensuring the success of the program. In some cases, it is best to suggest seeking professional help, taking time of from work, changing jobs or getting help and support from family or community sources.
As with any therapeutic program, you should review the plan frequently to identify those roadblocks that make the recommendations difficult to implement for parents and make the necessary adjustments.
Featured Author: Daniel Adatto and Total Behavior Solutions
Total Behavior Solutions provides direction, education and inspiration to those seeking to make behavioral changes in their lives or working environments. Using the methods of applied behavior analysis (aba), we provide behavioral consulting to parents, individuals, organizations and professionals who work in the field of behavior and education
Daniel Adatto, MA, BCBA, created Total Behavior Solutions after spending over fifteen years working with parents and therapists who work with children who have developmental delays. He specializes in educating people in how to promote positive behaviors and how to reduce and ultimately prevent undesired behaviors using the methods of applied behavior analysis. He currently serves as the Executive Clinical Director at Wellspring in the greater Los Angeles area.
In addition to being an educator, Daniel has worked as a behavior consultant designing and implementing behavior intervention programs for school districts and service providers in the US and abroad including the California Regional Centers, Mentor Network, Holding Hands, Verdugo Hills Autism Project, Institute for Applied Behavior Analysis, Enosh Israel Mental Health Association and the Argentina Hospital for the Mentally Ill. He also teaches Applied Behavior Analysis at National University in Los Angeles. As a teacher, Daniel is known for his practical advice combined with a very entertaining delivery.
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