Behaviourally-based Treatments 331how to make it clear to the child or adolescent what is desired, how to
introduce it into the individual’s repertoire and practise it, and how to
reward it once it starts occurring.
5 Explain in a way that can be understood by everyone in the family:
(a)why the child or adolescent is currently behaving the way they
are, framing the explanation in terms of learned habits and the
circumstances maintaining them, rather than in terms of fixed
character traits or inner conflicts.
(b)that this way of looking at things shows that there is a possibility for
change, but this will require some change from everyone.
Techniques
To increase desired behaviours:
Positive reinforcement: reward desired behaviour through praise and
rewards.
Negative reinforcement: remove aversive stimulus after desired behaviour
has occurred (for example, stop nagging when child goes to bed).
Explain underlying theory to parents, and child: this includes helping them
formulate the treatment in a way that makes sense to them and is
attractive.
Train skillswith rehearsal, and role-play.
Remove interfering conditions.To reduce undesired behaviours:
Stimulus change: remove or change controlling antecedent stimuli.
Extinction. This should follow removal of previous reward identified with
reinforcement of the behaviour, for example, no longer giving attention
to child who is naughty. Parents need to be warned that for a period,
the child will work even harder to get back to the previous status quo
and behaviour may worsen, the ‘extinction burst’. Ignoring may mean
involving more than just parents, for example, preventing an aggressive
youth getting admiration from his peers.
Differential reinforcementof incompatible behaviour. As noted above, this
principle is central to much behavioural work. The desired or prosocial
behaviour that should be occurring is identified and rewarded, such
as sitting nicely during mealtimes instead of running around, playing
cooperatively instead of fighting, spending the night in the bedroom
rather than wandering downstairs, etc.
Punishment. This can involve the application of mildly noxious stim-
uli following inappropriate behaviour. In everyday childrearing this
is frequently a telling off or verbal criticism. Mild occasional physical
punishment, such as a light smack once a week, has not been shown
to be deleterious to children, whereas prolonged heavy painful punish-
ment in an atmosphere of cold, hostile rejection is certainly deleterious.
Physical punishment is often popular with parents as it may temporarily
suppress behaviour, and so be very rewarding for the parent, but often