The behaviour that triggers attention will be repeated.
This uses the need of everybody to be seen!
Why children choose to act disruptive?
The reason for this is, that the behaviour that results in the most attention gained by the child is the behaviour that will be most likely repeated.
Often enough the effort of the child it is not acknowledged if they just sit still. They do not gain brownie points for doing nothing. But alternatively, if the child act destructively, everybody will jump on it, to just prevent them from causing more havoc. So, with distractive behaviour, the child won the war for attention. At that moment, it doesn’t matter to the child that they gained a negative response, but they “got us” and that is what matters to the child at that moment.
How is disruption triggered?
There are two main situations when children in my office show distractive behaviour:
- The paediatric patient, who might become bored after the examination is done.
- The second child who was brought along to the consultation but is not the patient.
How do I deal with this disruption?
For the first case, it would be necessary to clearly structure the consultation for the child. After the examination, I tell them, that the next step of our encounter might be boring for them because I and their parent/ carer would need to talk.
At that moment, I hand out an age-appropriate toy for them to play with and direct them to the children’s table in my room as a place where to play. With this change of environment, it becomes obvious that the examination is done, and then the child can relax.
The behaviour that triggers attention will be repeated.
So I praise when it starts playing.
And for the second situation?
The solution for the second case is described in the next blog post!
But here we look at the situation where boredom or fear are at the base of disruptive behaviour.
How to guide the child to the wanted behaviour?
In any case, if we want specific behaviour, we will need to trigger it.
We trigger it, by offering an immediate reward when the behaviour is shown.
Examples for this wanted behaviour are:
- Coming towards the doctor when called
- Daring to shake the doctor’s hand
- Daring to sit at the place of examination
- Allowing the examination
- Playing by themselves, while the adults are talking
The behaviour that triggers attention will be repeated. For that reason, we need to grant attention, whenever we see the behaviour we want.
In general, there has to be a balance: in case that the child did something good, there should be a tangible effect of the positive behaviour for the child.
What could function as a reward?
It needs to be an obvious positive reaction:
- Positive verbalisation of the action of the child (“I see that you … ”)
- Praise of its braveness (“wow, you are my bravest patient today”)
- Praise of good cooperation (“thank you, for helping me to help you”)
This should be done immediately when the behaviour happens and should be frequently repeated.
When are the rewards needed?
Any reward needs to be concrete and timely. Children live in the now, not in the future, let alone in long-term-planning.
The child cannot understand or perceive the consequential benefits of their actions on their long-term health. Therefore, the verbal reward needs to be right here and right now. Furthermore, the child does need frequent repeated encouragements.
What does not work?
Sometimes parents try to win their child over by offering bribes: “If you behave now, we will do something nice later.”
There are several problems with that statement: what does “behave” really mean? This demand is far too vague for the child to live up to it. What should the child expect when the parent promises “something nice”?
The tension between “now” and “later” points again to the different perception that children have towards time compared to adults. They live far more “at the moment” and delayed rewards as well as any delayed results of actions are not perceived as real and have no weight to them. If a tangible reward is promised (a sweet, a present, or just “to leave this place”), the reaction needs to be granted as soon as possible after the promise because the child just can’t wait.
In their mind, it is “now or never”.
In a nutshell:
The behaviour that triggers attention will be repeated.
Boredom or fear are at the base of disruptive behaviour.
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