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Friday, October 17, 2014

Why Parents Give Up on Changing Kids’ Behavior

From Emory University
via Futurity

By Quinn Eastmann
October 15, 2014

People tend to focus on the short term, and care more about potential benefits that are available immediately. Psychologists and economists call this tendency for the perceived value of a delayed benefit to diminish “delay discounting.”

New research considers delay discounting as it applies to parents’ decision-making when it comes to engaging in treatment for their children’s problem behavior.

Original Study

The goal of the work is to design treatment programs that families can stick to, and to help them do so, according to lead author Nathan Call, director of Severe Behavior Programs at Marcus Autism Center, Children’s Healthcare of Atlanta and assistant professor of pediatrics at Emory University School of Medicine.

Effective behavioral treatments for children displaying problem behaviors exist, but immediate success is not guaranteed. On the part of parents, they require commitment, active adherence, and work.

"We're not surprised delay discounting appears in the
realm of parental decision-making," says Nathan Call.
"Clinicians know this is a problem. But I think if we can
measure it, we can possibly predict it or change it."
(Credit: Jonny Hughes/Flickr)

“It is not unusual for treatments for such severe problem behavior to require implementation by caregivers for six months or more to achieve positive outcomes,” the authors write.

“Here’s the frustrating moment for me as a clinician,” Call says. “It’s my job to meet with parents, and develop strategies and programs that we think will work. At the start, parents are committed. If you ask them to say how important is it to you to address these problems, on a scale from 1 to 10, they will say ’11,’ but within a couple months, some parents decide, ‘We’re not going to do this.'”

Call says that in response to signs of delay discounting, clinicians may be able to modify treatment programs to emphasize smaller, but more immediate treatment successes, or assign additional support resources if necessary.

How Parents Decide

In the new study, Call and his team gave 17 parents a series of choices, one set based on monetary rewards and another set based on treatment for their child’s behavior. The children’s most common diagnosis was autism spectrum disorder, and the most common problem behaviors were aggression, disruptive behavior, and self-injury.

In the test for monetary rewards, the choice was between $1,000 after a delay, or a lesser amount immediately.

Similarly, parents were offered a hypothetical treatment program that would stop their child’s problem behavior. They could choose between a program that would be effective for 10 years and would start after a delay, and a program whose benefits would start right away but would last for less time.

“The value these participants placed upon the outcome of a treatment for their child’s problem behavior consistently decreased the longer that outcome took to be achieved,” the authors write.

To be sure, when treatment to reduce problem behavior works, the effects are gradual, frequently incomplete, and it is difficult to predict the degree of success with certainty.

Call says his team’s follow-up studies are taking these uncertainties into account. Additional research could examine whether delay discounting tends to vary according to the age of the child or other family factors.

“We’re not surprised delay discounting appears in the realm of parental decision-making,” he says.

“Clinicians know this is a problem. But I think if we can measure it, we can possibly predict it or change it. Because so much is known about delay discounting in other areas, we can capitalize on that knowledge and use it to help us translate our findings into best practices.”

The study appears in the Journal of Autism and Developmental Disorders.

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