Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, November 1, 2012

Canned Punishments: Apps, Advice, and Erroneous Assumptions


People are really committed to the idea that punishment is the best form of child guidance, aren’t they? Yesterday two interesting messages about this came across my virtual desk. One was the suggestion of a nanny website that phone apps will make punishment easy and effective. The other was the blog of an adoptive mother who recounted how her “attachment therapist” had advised methods like locking a teenage daughter in the bathroom for several days as ways to a) make her attached to the adoptive mother, and b) behave the way the mother wanted her to.

In both cases, the adult action was clearly a punishment, whether or not anyone wanted to use the term “consequence”. The child did something that the adult disliked; the adult responded with an action that was expected to be unpleasant for the child; the expectation was that the child would not do the disliked act again. If the child did do the disliked thing again, the plan was to escalate the punishment. I refer to this strategy as “canned punishment”, because it is not shaped particularly to the situation, the individual, or the all-important time factor that determines whether punishment effectively reduces an undesirable behavior. Its “canned” nature is evident in the idea that when the punishment is ineffective, the adult simply does more of the same thing, rather than examining the situation to see whether a different approach might be more effective.

The nanny outfit has been in touch with me before, as have several others. I think this is the one that suggested Tabasco sauce on the tongue as an appropriate method for nannies to use. They seem eager to have their website mentioned, even though when I’ve mentioned it in the past I’ve criticized it unmercifully. (Parents, if you employ a nanny, you may want to make sure that she is not reading their advice!)

This time, the nanny site suggests “10 iPhone apps that help with discipline” and describe them as “most popular and useful for keeping up with kids’ behavior”. Here are a couple of the goodies :
“Timeout—Ultimate discipline tool—Tracking the length of a timeout to provide kids with a visual representation of how long they are sentenced to this punishment is a snap with this application….”

“Tymoot--  Designed by a parent for parents…  The Wheel of Discipline feature that allows your children to spin the virtual wheel in order to be ‘sentenced’ to one of eight customizable punishments”.

Think about the “timeout” method first. Timeout is not intended to be used as a punishment and would not necessarily be effective if it were used that way. The points of timeout are first to remove the child from any social situation that is rewarding bad behavior (like other kids laughing), and second, to interfere with a behavior sequence and help the child move to different behavior. Because these are the goals, “time-in”, in which the child stays close to an adult for a period of time, may be as effective as timeout, or even better. The length of the timeout or its discomfort is not the point. Neither is it the goal of timeout to  exert adult authority or to encourage wrangling with an adult about how much longer it is to go on--- the adult needs to display warmth, sympathy, and an interest in helping the child gain control over behavior. For the adult to use a “canned” approach is to remove the personal and emotional support that is key to working with young children.  

Second—about this Wheel of Discipline. Such a method delays the punishment,which needs to be immediate if it is to be effective. In addition, it makes the situation into a game, inserting a reward period before the punishment and thus effectively reinforcing the undesired behavior. It is worrisome to think of naïve nannies or parents trying to use this method to quell genuinely concerning behavior like running into the street or leaning over a banister, where ineffective guidance can put the child into serious danger.

All right, enough about the nannies. Let’s go on to my second “canned punishment example”. This is to be found at http://www.adoptionblogs.com/weblogs/author/donnav.  Donna V. has three adopted children, siblings 16, 14, and 9. And she has an “attachment therapist” who is instructing her about how to handle the children’s sometimes undesirable behavior, which she naturally attributes to Reactive Attachment Disorder.  You will understand where we are on this when I point out that the children ride horses every week to treat their RAD (see http://childmyths.blogspot.com/2011/02/clever-hans-rides-again-equestrian.html.) Donna and her attachment therapist believe that  the children must give up their wish to be in control in order to “bond”, and that only “bonding” (undefined) will correct such behavior problems as lying and stealing. Donna had been confining the 14-year-old girl to her bedroom when she did not meet the standard of being “respectful, responsible, and fun to be around”, but the therapist felt this wasn’t working because the girl was too comfortable. The isolation was then moved to the bathroom, where the girl spent 6 days and 2 nights. Then she said she was happy, was cooperative, etc.

Most interestingly, in her Aug. 20 blog post, Donna V. describes the treatment as if it is a form of behavior modification that is withholding reinforcement for behaviors that were previously reinforced. She remarks that “as my kids start to respond to the new techniques and to the horse therapy, some of their behavior is actually getting worse. Some days I think that the extinction bursts are going to kill us.” She then accurately defines an extinction burst as “the temporary increase in the frequency, intensity, and/or duration of the behavior targeted for extinction”. Apparently the assumption is that any undesired behavior is occurring because it was rewarded in the past in some way, and that now withholding the reward will eventually cause the behavior to disappear (“extinguish”, in behavior mod terms).  How this relates to needing an isolation area to be uncomfortable, or to bonding, or to horseback riding, is far from clear. It’s also unclear how an extinction (non-reinforcement) procedure can influence any behavior that is self-rewarding--  and maybe that’s why she has turned back to attempts at punishment by taking away comfort or gratifying experience like having a cellphone. In spite of the canned punishment suggested by the therapist, such punishments are very difficult to employ because of the essential timing factor. By the time the mother has discovered a lie or theft, the effective time to use punishment has passed.

Maybe a good start would be to abandon the goal of being “fun to be around”, which is an ill-defined set of behaviors. Certainly punishment for not being fun is difficult to work out, because there are so many ways not to be fun.

My suggestions? Stop worrying about how to make the child more uncomfortable. Don’t look for a punishment that will do the job in a simple way. Seek a knowledgeable therapist who practices evidence-based methods. Realize that effective child guidance does not come in canned, frozen, or evaporated varieties, but must be worked out in individual ways within a specific family context. Keep in mind that teenagers are naturally working on the establishment of autonomy, and asking them to relinquish all control is not developmentally appropriate. Don’t think that a teenager can “bond” to a mother in the sense that a toddler forms an attachment to an adult.  And, if you want to ride horses, have a good time, but don’t imagine that this is therapy--  any more than any other pleasurable activity that helps modulate moods.






16 comments:

  1. Truly what 14 year old is "fun to be around?"

    I find it an interesting concept that the rejection and isolation of a child would be thought of as a way of promoting "attachment," that strikes me as very counter intuitive, to say the least.

    (Ironically i take the exact opposite approach when my 14 year becomes too unpleasant I ban her from hiding out in her room and do things like insist she run errands with me and play board games with her family. It is amazing how quickly she "gets" that if she wants autonomy, she needs to treat those around her "respectfully")

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  2. She made her kid stay in the bathroom for six days? How is that not child abuse?

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    1. It's like the tree that falls in the forest and no one hears it. If the parent and the therapist both fail to report, there's no reported child abuse, and therefore (officially) nothing has happened.

      You're right about this in terms of the NIS-4 child abuse standards, of course. Keeping people in confinement is abusive.

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  3. Drat - Sunday Taylor beat me to the "what 14 year old is fun to be around question". Although, I like her solution.

    I get frustrated with all the opinions (often sold as evidence based) of parenting experts on consequences or punishment. Some such as Alfie Kohn act like any consequences are at least bordering on abuse and will ruin the parent/child relationship. Other's like the above example, totally overdo things and do end up being abusive.

    To be honest, I gave up reading most of the "experts" when it comes to discipline, because it seemed to me that they start with an idea and then looked for evidence to fit. Unless you are an expert in reading research it's very difficult to sort out what is any good.

    I just try to keep my eyes open. I watch teachers and other parents and observe what seems to work for kids who are similar to my kids. Then when I discipline, I try to observe what seems to get through to my kids while minimizing fuss as much as possible. My observations lead me to think that an effective warning/consequence system results in far less fuss than a no or low consequence system. Every low or no consequence system I've seen seems to lead to lots of parent (or teacher) lecturing and emotionalizing. Consequences don't have to be overdone, a 4 or 5 minute time out for my 9 yo daughter is more effective than the prescribed 9 minutes. All I want is just enough time to get her to shift gears.

    I have found experts to be far more helpful in understanding WHY kids misbehave. Lying, for instance. I struggled for a while with my daughter in cover-up lying. She would lie about mistakes that were no big deal. It wasn't until I read that sometimes children who are anxious or perfectionists sometimes lie to cover up mistakes because they feel overly bad about them, that I was able come up with a more effective approach for cutting back on the lying.

    Of course there is still the problem with misrepresentations of why a child is doing an undesired behavior. Attach has alot of that problem. They attribute negative motives to children and then recommend "therapies" based on that. I think the subtle negative way (words like manipulative, facile) that the children are represented perpetuates over discipline and abuse.

    One of the best guidelines I saw (sadly I can't remember where) for looking for a therapy for an adoptive child was to beware any approach that attributed negative motivations to the child. That's probably good for finding a discipline approach too.

    Sorry, that was a ramble. Guess that means your post was very thought provoking. :)

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  4. Very well said, MinM. Your point about anxiety, lying,and concealment is worth repeating many times. All adolescents have good reason to be anxious as they confront new aspects of life where the stakes are heavy and adults are obviously anxious about them. How much more is this bound to be true of children who have been maltreated or neglected, and who are well aware that a "forever family" is not necessarily so? How silly they would have to be to risk exposure for a mistake when they might be able to get away with concealing it!

    Not only do ATTACh members and their friends attribute negative motives to children-- they also assume that whatever the child does,right down to vomiting, is voluntary and intentional. I see that people are still circulating that ghastly 1996 paper by Keith Reber in which he attributes all of a child's distress reactions to the intent to manipulate and exploit others and revel in control-- which he or she must be forced to give up.

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  5. 1. Technical point: The linked post should read "Clever Hans" - yes, horses do "nah". And equestrianism is a pleasurable activity which modulates moods.

    2. Canned punishment - I like it hardly more than canned laughter.

    3. Would be good to get a specific model of what "fun to be around" would look like. Joy Berry was good at this, at least for the little ones. (about 3 to 7 developmentally).

    4. Child guidance should be fresh, yes! And organic, too.

    5. In regard to the apps (and paper versions) I enjoy the Wheel of Power and Control which shows all the abusive things which caregivers do or might be tempted to do.

    6. Yes, the time in which someone becomes autonomous within her family environment is often under-rated and misunderstood.

    MinM: good points about low or no consequence systems and their consequences! And the effective warning system: this is another time to be fresh.

    And DonnaW would talk about empathy: not a thing you can easily popularise or make ersatz.

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  6. Thanks, Adelaide-- "Clever Nahs" certainly didn't work.

    And your point is good about warnings or cues. These require attentiveness and empathy on the parent's part-- much easier, though ineffective,to go with the canned approach.

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  7. Here we go, another case of ascribing bad motivations to a child ("controlling behaviors") and then punishing them for behaviors that are perfectly normal (eating).

    I just had a lengthy debate on a FB group for adoptive parents about why they should *not* call it "stealing" when their child wakes up in the middle of the night to eat. But I was drowned out by the chorus who said that behavior is controlling, and locks on all the food and/or an alarm on the child's bedroom door is the appropriate way to handle such "manipulative," "controlling," "selfish," "defiant" behaviors.

    I've posted this article on the FB group today. Maybe some will rethink their approach. (Probably not.) But I have to try.

    It's unthinkable to me to deny food to children, some of whom have come from real hunger in their pasts. My daughters each have mini-fridges in their rooms, along with a stash of food that's just theirs. They both experienced true hunger, and they exhibit an enormous amount of anxiety when they see the food in the kitchen dwindle, as is normal between food shoppings.

    We used to carry a "food bag" with us wherever we went in the car because they would have tantrums if they were hungry and we were a mile away from home. Seriously.

    I'm of the opinion that there may be no permanent cure for their anxieties, just as there has been no permanent "cure" for many folks who lived through the Great Depression and die with stocks of food in their cupboards, just in case.

    It's such a small behavior---why not let our children feel some relief from their worries and have some real way to ward off hunger?

    I am often appalled by the lack of compassion of other foster/adoptive parents, but it comes from ignorance, I believe, and following, too dogmatically, the experts who pretend to have all the answers to problems that, in general, have no easy solution (if any solution).

    Sigh ...

    http://www.dailymail.co.uk/news/article-2228614/Couple-starved-year-old-adopted-son-weighed-just-35lbs-alarm-door-wouldnt-steal-food.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490

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  8. I've also read about people who were shipwrecked and floated for weeks in life rafts-- then could not be comfortable for years after their rescue unless they had a mountain of canned goods nearby. This would not be interpreted as controlling or exploitative, so why do "we" call children these names when they are anxious about food? Goodness, is it stealing if I eat food that was bought for me, but not at the time when it's conventionally available?

    I also just came across the Minnesota case you note and will write about it soon.

    Thanks for your comments, insightful as usual, and let's hope you can have some impact on the group who have bought into that belief system.

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  9. Can't say that I'm having much of an effect, Jean, though a few folks click "Like" when I post information. On one group, the leader of the group (who is also a social worker/therapist and an author) had this to say to me today after I posted the Minnesota case and your article in Psychology Today, "To Bed Without Supper":

    Carol Lozier, LCSW: Marianne, I read the two articles you have posted. While they are very disturbing and clearly abusive, no one in this group has described utilizing any of these tactics. Please remember, the aim of this group is offer support, kindness, and compassion to one another.

    However, just a few days ago, there was an extensive conversation about limiting food for children who were "stealing" it at night. I didn't name any names or mention that conversation, but my posting the warning today clearly touched a nerve.

    It's always a delicate balancing act: maintaining enough of a connection to have my voice part of the group's conversation, but not letting too much atrocious stuff go by without commenting. I've been "shunned" in more than one group. LOL. But even then, who knows?---perhaps some of my opinions made an impact and protected a child.

    In any case, there are bazillion people on FB talking about these issues, and new groups always being formed. I join a few at a time and say my piece.

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  10. That's the name of the game at all professional and parental levels: don't criticize anyone or anything-- don't have enough kindness and compassion to "say something when you see something", even though there may be a personal price to pay.


    One person who's active in this area actually has to write under an assumed name because of probable professional consequences. Another lost his job and only got a new one in his profession by deciding not to speak up again.

    What keeps us going is the thought that we may have helped someone who is helpless-- that, I guess, is about the only carrot to keep us little donkeys trotting along.


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  11. By the way, there are nearly 1,000 people in the group where I got the "Stop being so un-supportive" comment, and the recent conversation about food "stealing," which seems to indicate some parents are already on that slippery slope that can lead to depriving children of food that they need, went like this [names changed to protect the nonprofessionals who posted; professionals ought to be accountable for their words, I believe]:

    Jessica Peterson
    JP: How do you all deal with kids getting up in the middle of the night stealing food. And he steals other things too but mainly food. I am seriously so frustrated. I hate the feeling of someone stealing from me in my own home. Or at all really. Apparently this has been going on a long time without our knowledge. I know this is a common issue. How do you handle this??? This is a fairly new behavior as far as we know. But like I said he's been getting away with it a while. And its all candy and chips that we would have given him if he would have asked. He also has been stealing toys out if the treasure box. I found where he has been stashing the stolen goods. My thought is that he was trying to get "revenge" for when he had to go to bed early or for other things he felt like he owed us revenge for. Thats pretty much how he operates.

    RR: We have a $6 buzzer on our daughter's door. Works like a charm! Wish we had known about it a long time ago! You can find them at Walmart. I could have written your post word for word with absolutely no changes. You are right it is common.

    JP: Awesome. Thanks for the tip. We are gonna go get one. We had decided we were going to set our motion sensor of our security system for the kitchen to be on at night. I just hate living like that :( sometimes this feels like running an in home residential facility.

    DS: Some suggest you give the child a plastic container filled with nonperishable food items that he can keep in his room. We never tried that...With five, and the crumbs, I just couldn't imagine fighting the bugs....plus we don't eat many processed foods. An alarm on the door is the best way to know exactly whenever he is out of his room. Even if you solve the food issue, it seems they find some other retaliatory behavior.

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  12. [cont'd]
    JP: He seems to feel like he has some right to get back at us if we give him a consequence or even tell him "no." I was explaining to him that we are the parents and that is why it is our job to give consequences and say "no" sometimes, and that that doens't give him a right to "get back" at us. He was not conviced. I think he totally thinks that he has a right to do this. DS, yeah I'm sure the behavior will just evolve. They don't go away they just change because the trauma hasn't been addressed in an appropriate way. So really no consequence ever works anyway. I hate having to live and feel like I can't trust him to not be sneaking around at night. We will definitely have to get a little buzzer for his door or something so that at least maybe that can stop. We have a motion detector in our kitchen that was set up with our security system but I hate to use it on our own son. We got the security system to keep thiefs out. Didn' know it would be our own son :( I'm sure there's a reason he's doing it I just run out of ideas on what to do. We have been through all sorts of therapy with him. He has pretty much been in therapy since he was conceived. Obviously the issues have never been resolved. I know he will be able to heal it's just difficult sometimes. We have thought about putting food in his room but I don't know if that would matter to him because he is more doing it to get back at us. Could be worth a try though. He has actually gained a bit of weight lately and that must be why. He's been eating total junk. THe food issues are at school now too actually. He will sneak his snack early and eat his lunch at inappropriate times and then he doesn't have much lunch at lunch time. So this all seems to be happening at once.We would pack him large lunches and a snack and he would eat it mostly before lunch. But he never wanted breakfast at home. NOw we make him eatbreakfast no matter what but he still has been sneaking snack at school early. So it's not a hunger issue.

    DS: No, I think it's a control issue. My thinking has always been that is not a food issue, because mine never stole an apple or a banana...only cake, cookies, gum, and candy....treats....things that mom and dad put limits on.

    JP: Yes. Definitely. We have a fruit basket that we have told him he can have anytime he gets hungry.

    RR: Yep. Same here... you can have fruit pretty much any time you ask.

    CS: I would HIGHLY recommend reading The Great Behavior Breakdown by Bryan Post. He covers this topic pretty thoroughly (though I don't remember most since it isn't what we've needed to apply here).

    Marianne Milton: JP, I'm afraid I don't understand your perspective on your son's eating. He's your child, he lives with you; why can't he eat whatever is in the house, whenever he wants? I don't see that as "stealing." Both of my daughters came from hunger. They're teens now, and they each have a mini-fridge and a stash of food in their bedrooms: whatever they want. And they're always allowed to eat whatever other food is in the house. Turns out, they've both become good cooks and like to share the food that they cook with others, including me. It delights them to have enough food to eat, share, and enjoy. I think they will always be anxious about food scarcity; most people are if they've endured true hunger at any point in their lives. To restrict food will simply increase anxiety.

    LE: i put a basket of food and water bottles in my child's room that we have chosen together that she is free to access anytime she wants, i hear people do the same with kitchen drawers. some people use little packs to keep with their children. it tamps down the stress and worry that comes from being hungry once.

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  13. KP: Food represents a basic need but as others have said it is more a control and in security about getting their needs met. I went to a seminar for the Great Behavior Breakdown and their suggestion when the parent said having a basket of food in their child's room did not work was for the parent to bring the child food in the middle of the night. This would show the child that the parent is serious that they will meet their needs and validates their feelings.

    RR: I can't speak for JP, but none of my kids.. bio or adopted have ever been able to eat what they want whenever they want. We have rules and set times for sweets and treats especially. It's how our family works and I am quite comfortable with it. If you are sneaking out to get food that is restricted from EVERY child at a time when nobody knows you are doing it, it may not be stealing in the criminal sense but it is deceptive, it is taking what isn't your to take. In our house that is wrong. Having said that, there are definitely ways to help your child... several have been mentioned here. Our daughter can have fruit or veggies WHENEVER she wants it... pretty much unlimited. Just like all our kids she can only have sweets and treats at the allotted time.

    JP: RR, these are my feelings exactly. And he does it so that he can eat it all and no one else can have any. So we don't let him eat up all the chips and sweets to himself and then have none left the whole week for anyone because he wanted all of them at 3am. He isn't allowed sweets and junk unlimited. He is allowed fruits from the fruit basket anytime he wants. He didn't touch the fruit. He ate all the candy and ate chips that he wanted, on more than one occassion. He also stole toys at the same time. So while I might say "stealing" maybe that isn't the correct word. But it's dishonest and he is sneaking in the middle of the night when he should be sleeping. So we do have a problem with that. And just a couple of weeks ago he literally ate until he was sick. He will gorge himself so we do have to control portions. We are pretty good judges of his motives and if he is truly wanting something out of hunger.This was not a hunger thing.

    DS: I agree with RR and JP. I have seen my kids gorge as well. We restrict portions for that reason. We also restrict sweets for health reasons. If my kid got up in the night and ate a banana, I would think he was hungry. But to sneak and get only snacks and treats that are limited, tells me there is more to it than hunger.

    LG: I put healthy snacks next to my daughters bed after she falls asleep. It's helped to build trust. I lock the cabinet door at night, though. She will eat non-stop if I don't. I'm talking whole boxes of cereal, entire jars of peanut butter, five or more bananas.... Honestly, she seemed to appreciate the lock. She knows its bad to eat that much, she knows I provide and won't let her starve, but I've taken away the temptation. She can't get into the cabinet so that isn't a temptation to fight.

    RR: My daughter will remind us to put her door buzzer on if we forget. Now she doesn't have to wake up in the middle of the night and fight with herself about whether she will do the right thing... I think she likes it too.

    [End]

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  14. Oh boy-- so Bryan Post is in this too! I thought he'd gone underground after Oklahoma told him to stop calling himself "Doctor". His former sidekick Heather Forbes now seems to be with Ronald Federici, who advises in his self-published book that food must be under parental control.

    The thing is, Marianne, these people have elected to follow some self-proclaimed experts who focus almost exclusively on controlling everything. These assumptions are the way we get adopted children weighing half of what's appropriate for their age.

    I am hoping that boy in MN will turn out to be Russian-born and Pavel Astakhov will come steaming along-- too bad the poor little Ethiopians don't have such a champion.

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  15. I'm not a prison warden, and I don't want either of my daughters to grow up feeling like an inmate, because, uhm, then that's what they'll be good at, right? Locks and alarms and dog training and "snappy" obedience. Oh my!

    It probably wouldn't help advance the effort if I quoted Foucault's "Discipline and Punish" to the Trauma Mamas, would it? LOL.

    Anyway, thanks for your support, Jean. It's pathetic that the exchange/debate of ideas is verboten in so many corners.

    I'd despair, but then the children wouldn't have the support of my miniscule contribution to their welfare.

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