Hi again. Thank you so much for all of the detailed information you provided during our chat earlier. I’d like to commend you and your husband for being such wonderful, proactive and loving parents.
It’s very difficult to provide a detailed solution-focused answer to your presenting question, because with such a vibrant, intelligent, communicative and sensitive child like your Amara it is very important to have very detailed behavioral observation and to test ongoing strategies for helping her adapt her way out the current conundrum.
First, I’d like to reinforce the importance of talking with your family dr. about the throwing up and behaviors of concern. Although what we’ve been talking about may be primarily behavioral and psychological, there could also be a subtle medical issue contributing to her current pattern of responding at the child-minder’s. It’s in Amara’s best interest to really rule any and all potential medical contributors out.
From the behavioral angel, you can also systematically rule out medical factors or non-behavioral interventions by really learning and helping the child-minder to observe “behaviorally”. There are 2 important areas to pay attention to. The first thing to watch for are “contingent antecedents” to her behaviors of concern. The second are called “distal antecedents”. Proximal antecedents are the ones that happen within a second or 2 of the behavior change.
An antecedent is any person, place, thing or subtle stimulus change (social or environmental) that comes right before the behavior of concern. Often and especially with mood and emotion in children, the child’s own behaviors can be the antecedent to their own behavior of concern.
One example of a very subtle antecedent that a sensitive intelligent child can easily pick up on would be care-giver behavior’s associated with compassion fatigue. A subtle but normal change in eye contact or a sense of frustration on the child-minder’s part could be associatively reminiscent of the kind of role overload that is commonly seen in nursery staff, from the previous care-environment. I’m not saying this is the case here; I’m just giving one of many possible examples, that can only be gleaned through more refined behavioral observation and even simple data collection or charting in some cases.
Distal antecedents are environmental events and changes that precede the behavior of concern by more than a few seconds like in proximal antecedents. “Distals” can sometimes take place hours or days before the behavior. For example, from our chat, your brief change of work schedule can very likely be viewed as a distal antecedent to the current your daughter’s current behaviors.
Proximal and distal antecedents can often work together in a behavioral effect. For example, your change of schedule may have set the emotional tone for a 2 way response. If your daughter was missing you that day, her subtle emotional communications and increased need for proximity and soothing could have elicited the subtlest compassion fatigue response in the child-minder, (as I’m sure you know good research shows that meeting the emotional, social and developmental needs of single child Amara’s age is considered a full time job) that would not have influenced your daughter if there wasn’t a schedule change. This is an effect I have observed in children in real time, but again it serves only as a theoretical example here.
You also touched on the recuperative effect that the 3 day family vacation had on Amara. When a child’s attachment behavioral system is stimulated by a sense of separation anxiety, there can be subtle changes in their little nervous systems that can take some time to recover or recalibrate. Beyond rephrasing what you already knew an expressed, you may consider a similar vacation as an adjunct behavioral parenting strategy if the following recommendations fail independently.
Here are some suggestions to help Amara readjust:
Refine your already excellent parenting strategy to look for what works. I think really starting to learn more about ABC’s behavioral observation (this is a pun because ABC stands for Antecedent, Behavior, and Consequence) will really make a difference in helping Amara get back on track when the normal schedule changes or other potential attachment triggers come up.
The difference here would be to really start to experiment and observe. One of the most powerful tools for managing the social withdrawal and task avoidance behaviors and even to counter the mood changes that can go with attachment-responding is to find and work with high probability behaviors towards increased activity and on-task time. Questions to ask here are what are some novel and enjoyable new tasks apart from looking at and reading books that can be introduced?
Front end interventions or supports are one important strategy. That’s where you look for and reduce identifiable antecedents to the problem behaviors and intervene immediately or do your best to get rid of or to replace the problem antecedent.
It’s often best to combine front-end interventions with back-end interventions through the use of positive reinforcement. A positive reinforcer is any stimulus you deliver within 1 second of a behavior that reliably predicts and increase in that same behavior next time, under similar conditions. Reinforcers are very child specific so again, it’s good to experiment with different types and combinations. This is called a reinforcer assessment process, and you can actually get charts to help you optimize this process. Verbal praise is usually very powerful, stickers, sing-song praise, a short celebration dance/song healthy edibles, when appropriate or when other reinforcers are not as effective.
Targeting and shaping replacement behaviors can also be very helpful here, so you have something that is helpful to Amara to reinforce. So you could shape a specific behavior to get involved with an activity that she can easily access when things are difficult.
Of course she knows these social skills already implicitly and does them when naturally motivated because she’s brilliant, but the idea is to have a set behavior that she practices with you when things are fun and that is densely positively reinforced.
If you use specific parental instruction word’s like “let’s draw and earn some stickers!” The child-minder can use the same antecedent instruction and then reinforce the behavior similarly. This kind of behavioral parenting intervention would only be indicated as a “scaffolding” tool for when Amara is having difficulty, - to help distract her, manage her mood and get her moving again naturally. Then you don’t need the behavioral intervention any more. It’s much like “activation therapy” for adults across a wide spectrum of issues.
You don’t need to intervene once the natural and logical consequences of her natural behavior take over the reinforcement function again. It’s like providing a cast for a bone to heal. In another metaphor, the distraction and increased pro-social activity this would allow may provide similar conditions to taking a short vacation, allowing her emotional system to recover and recalibrate.
Here are some further learning resources to consider this perspective and evidence-based intervention and support approach:
Here is some more detailed info on positive behavior change:
Here’s a good site that explains Attachment fairly comprehensively:
The “incredible years is a great behavioral parenting program that has very positive effects on attachment. Here’s a free article on its application in a daycare center in an impoverished neighborhood. The sited research and positive behavioral effects are quite helpful:
I’m doing some online research for you to find resources on the kind of behavioral strategy I’m advocating. It’s difficult to find popularized articles on this topic because your daughter is so bright. So much of the available online resources are for kids with severe, traumatic attachment disorders and real problem behaviors.
A final suggestion I have is you may want to consider working with a Board Certified Behavior Analyst. They can provide very tailored and simple intervention tools and strategies to very precisely target positive replacement behaviors (like increased social and activity involvement at the child-minder’s. They would also be able to provide you with “simple data collection tools for the child minder to use. I know from my work as a behavior consultant for a major school board that data collection can often positively change care-giver interactions and help alert them to strategies and observations they often miss otherwise.
BCBA’s are the hidden gold mine for evidence-based behavior change interventions. They are most often associated with ABA for children with autism, where in most cases they can academically and socially normalize an otherwise highly under-functioning autistic child. However BCBA’s also work in every facet of psychology you can think of. They are even working in businesses to help increase performance and help people get along with through the same behavior change principals I’m talking about here.
You may even be able to work at no cost with a Master’s level BCBA student who is accumulating hours towards board certification. In that case you’d have the BCBA candidate and the highly experienced BCBA supervisor helping you to intervene here. You can work with BCBA by phone and online as well if there isn’t one in your area.
Here is the BCBA link to learn more:
Actually here are some Scottish BCBA’s you could talk to. They will generally provide you with free initial consult to see if you, Amara and them, are a good match. You can also ask about BCBA students who might want to work with you under supervision for free. BCBAs are specially trained to look for and rule out non-environmental sources of behavior as well, which would help any other professionals you would then work with:
Well I hope, my answer has been helpful, and our chat thought provoking. Sometimes just hearing another opinion helps you to refine your own. If you feel I’ve missed something in my answer I can opt-out and let another expert take a crack at providing you an answer. Don’t pay for an answer you don’t like. Just let me know.
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I wish Amara, you and your husband the very best!