Problems in Using Behavior Modification With PTSD Children

The use of traditional behavior modification techniques with stress disordered children needs to be done with caution and extra care. The issue of the primary source of the child’s behaviors needs to take precedence over simply “pressing on” with behavior modification techniques. The key indicator to the clinical team treating the child is that they will find the child’s behaviors getting much worse despite using behavioral methods that should be working.This initially can be mistaken as an “extinction burst”, and the team may be motivated to apply more behavior modification pressure.Of course, such efforts are doomed, because the central issue is not “non-compliance”, but reactivity to stress loads. Essentially, such adherence to strict behavior modification protocols in working with PTSD children is working out of a mistaken idea of what the source of the behavior is (read: “the child is trying to manipulate or control’.)

It is often difficult for people who have a strong background (and success) with behavior modification to adapt to the Gentling Approach because it feels counterintuitive. Not only clinicians, but teachers, Therapeutic Support Staff, parents, and foster parents also struggle with the change from a classic behavioral approach. But again, the “proof is in the pudding”, so to speak: when repeated attempts to use a behavioral technique that should work is not working, behavior modification theory states that the plan needs to be reworked. In this case, the behavior modification techniques, though still very valuable, must make room for the Gentling Approach to work side by side. Indeed, there are times when the behavior modification techniques must take a back seat to the Gentling Approach if progress is to be made.

Behavior modification techniques are excellent in helping a stress disordered child to feel safer in their environment, especially if the child comes from a family of origin environment that has been chaotic and inconsistent in setting boundaries and limits. Tightening boundaries and limits adds to the security and lessens stress loads for the child. The trick is for the caregiver to know when, and more importantly, when not to use behavior modification techniques. Essentially, classic behavior modification techniques are inherently stress inducing. Applying them during a stress episode is simply counterproductive. Secondary to this is for caregivers to be able to accurately ascertain when the child’s stress levels are at the edge of the child’s tolerance. Another way of expressing this is that once the child is at the “tipping point” of being near the entry into a stress episode, behavior modification techniques will only serve to push the child into the highly painful and destructive stress episode.

Overall, the application of behavior modification techniques should not be the first choice of approaches in the beginning of treatment, but rather, grow in use, scope, and intensity as the child’s stress levels decrease. Care must be taken along the way of the increase to ascertain if the selected behavioral techniques and the scope of their use is overloading the child’s stress tolerance. This is not to ignore the difficult behavior issues that the child may have, and that may, in fact, be quite pressing. It’s just a matter of “triage”: you can’t work the underlying difficult behaviors of manipulation, opposition, nastiness, and social awkwardness until the stress levels stabilize to a level that allows such work.