Do you dread initiating the start of the bedtime routine in anticipation of non-compliance or other problem behavior?  If so, you're not alone!  Try starting the bedtime routine earlier than normal so putting PJ's on isn't correlated with going to bed right away.  Try engaging your child in a preferred activity (i.e., movie).  Interrupt the activity (i.e., pause movie) and indicate more access can be earned but first PJ's need to be put on (ex: "We can watch more Toy Story but first put on PJ's."). 

Once PJ's are on, the child can resume the activity that was in progress. This will change the sequence of events and the negative correlation with PJ's going on and going to bed.  Avoid activities that elevate your child's motor activity in the 30-60 mn prior to bedtime, such as running, jumping, spinning, tickling or other gross motor, rough house play. Target calming activities in soft or low light setting, such as reading books, conversing with your child, building with Legos/Duplos, puzzles, etc.   This is but one of many other strategies that could be employed to decrease bedtime resistance and bedtime refusal.  

If you're experiencing frequent, daily rates of non-compliance, temper tantrums, self-injurious behavior or severe aggression or disruptive behavior (i.e., property destruction, biting, hitting), you're encouraged to first seek professional assistance from a board certified behavior analyst or other professional competent in behavioral interventions to assist you in safely reducing problem behaviors in your home. 

 
 
Does your child seem bored despite having a plethora of toys available to play with? If so, try putting away some of the toys, such as in a storage bin or closet, for 2-3 weeks. Then, rotate the stored toys back into the play area and remove several different ones. This temporary absence will likely rekindle interest, motivation for and the reinforcing effectiveness of the toys. Therefore, your child may be more apt to then play with them upon them being returned to the play area versus having free access to them all the time.
 
 
BEHAVIOR MANAGEMENT TIP:  When stating demands to your child, avoid phrasing your demand in the form of a question (ex: "Can you pick up your toys?"). It's harder for your child to differentiate the semantics between when you're merely asking a question to ask for your child's response, input or preference and when you mean you want your child to complete the action specified in your question. Avoid this confusion by using clear language. Simply state the action you want your child to do (ex: "Pick up your toys").
 
 
Got guests coming to your home and want to visit without your child frequently interrupting to get your attention? Restrict access to a highly preferred item/activity (i.e., TV show, DVD, tablet, toy) the day of or several hours before guests arrive. The activity/item should be HIGHLY preferred so as to effectively compete with the value of adult attention. When your guests come, grant access to the activity/item and chances are your child will be more engaged in the toy/activity than wanting your attention...at least for a period of time.
 
 
BEHAVIOR MANAGEMENT TIP:  Catch your child being "good." Give specific praise and attention to your child for spontaneously saying and doing positive things, such as complying with directions, playing quietly alone while you visit with guests, please/thank you, cleaning up their toys, complimenting someone, sharing, accepting being told "no" appropriately, etc.
 
 
BEHAVIOR MANAGEMENT TIP:  Tell your children what you want them to do versus what you DON'T want them to do. For example: "Please eat with your fork" vs "Don't eat with your fingers" OR "Don't leave your dirty clothes on the floor" vs "Put your dirty clothes in the hamper". The word "No" seems to invite your child to do the opposite. Be sure to praise your child if he/she complies with what it is you're asking. 
 
 
Provide specific rather than general praise so you child is told exactly what it is he/she is saying or doing that you want him/her to continue doing. GOOD EXAMPLES: "Great job picking up your toys right away when I asked" or "Wow! I like how you offered to share your cars" or "You did an awesome job playing by yourself while I talked to Grandma on the phone. Now I can play with you." POOR EXAMPLES: "Good job" or "Way to go" or "You were good today" or "Good boy". Notice these are used above in the good examples but the child is also given more specific feedback about their behavior. Give it a try and see if you notice a change in your child doing more of what you're specifically praising, such as compliance!
 
 
Does your child spit out food, turn his head, swat at the spoon, throw food and cry or scream during mealtime?  Do you ever wonder if other parents encounter the same difficulties during mealtime?  If you answered "yes" to both, you're not alone. For children with developmental or intellectual disabilities, they face a variety of challenges in their life.  Pediatric food refusal happens to be one of the most common types of problems these children face (Kerwin, 1999). 

To qualify for a formal feeding disorder diagnosis, a child must refuse or be unable to eat a sufficient amount or variety of food that results in the child losing weight or failing to gain weight or meet their nutritional needs (Shore & Piazza, 1997).  A child with a feeding disorder may refuse to consume solid foods entirely or may be food selective in which only certain types or textures of foods will be accepted (i.e., smooth textures like pudding, yogurt, applesauce or mashed potatoes are rejected or only crunchy, brown peanut butter flavored cookies, granola bars and pretzels are consumed).  In other cases, children may display food selectivity based upon the presentation of the food, such as consuming plain white rice only but rejecting white rice if combined with vegetables, sauces, herbs or wild rice.  A peanut butter sandwich might be consumed but only if the peanut butter and jelly are each distributed on their own piece of bread without the pieces touching on the plate.  Over time, the variety of foods a child will consume shrinks and/or the list of rules about how certain foods must be presented in order to accept them grows, resulting in further weight loss and nutritional deterioration for the child. 

While approximately 25% of typically developing children experience a feeding disorder, the rates are as high as 80% for children with developmental disabilities.  Thus, this is a common problem challenging caregiver.  Pediatric food refusal is classified into one of three categories:  organic (medical), non-organic (behavioral) or mixed .  The research indicates that children who engage in food refusal of the non-organic or mixed type engage in refusal because often the demand to consume the foods is withdrawn.  This results in an increase in refusal or other problem behaviors in the future during mealtimes (Woods, Borrero, Laud and Borrero, 2010)

If you are concerned with your child's nutrition or if your child is displaying some of the symptoms described above, your child should be evaluated by a medical professional (i.e., pediatrician) to determine if your child's nutrition is deficient and the cause.  Your child's doctor will determine if a referral to other professionals, such as a speech pathologist, registered dietitian or OT, is necessary.  If medical variables have been ruled out and it is determined the problem is behavioral in nature, a Board Certified Behavior Analyst with specialized training in using Applied Behavior Analysis (ABA) can work with your child to increase acceptance of a wider array of foods and liquids.  At Alliant Behavioral Pediatrics, we treat mild to moderate cases of pediatric food selectivity that are not organic (medical) in nature.  Contact us at info@alliantbehavioral.com so we can determine if we can assist you in your child's needs.  Listed below are other recognized, qualified professionals specializing in the treatment of pediatric feeding disorders.   


RESOURCES
University of Nebraska Medical Center:  Munroe-Meyer Institute
Dr. Cathleen Piazza

http://www.unmc.edu/mmi/pfdclinic.htm
http://www.unmc.edu/mmi/cathleenpiazzaphd.htm

The Marcus Autism Center-Pediatric Feeding Disorders Program
Dr. David Jaquess

http://www.marcus.org/default.aspx?id=37

University of MN:  Pediatric Feeding Clinic
http://www.uofmchildrenshospital.org/Specialties/Rehabilitation/Programs/index.htm


REFERENCES
Woods, J., Borrero, J., Laud, R., & Borrero, C.  (2010).  Descriptive analyses of pediatric food refusal:  The structure of parental attention.  Behavior Modification, 34(1), p. 35-56.

Kerwin, M. (1999).  Empirically supported treatment in pediatric psychology:  Severe feeding problems.  Journal of Pediatric Psychology, 24, 193-214.

Shore, B, & Piazza, C.  (1997).  Pediatric feeding disorders.  In E.A. Konarski, J.E. Favell, & J.E. Favell (Eds.), Manual for the assessment and treatment of the behavior disorder of people with mental retardation (pp. 65-89).  New York:  Guilford.

 

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