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Tot Control

Behavior modification solves problems. Does it create any?

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"Your truck is moving across the floor," says Jane. "And now the truck seems to be tipping over. Yes! It's on its side and it's turning upside down! But it's still moving. And now you're making the truck climb the wall. Just look at that!"

With the enthusiasm of Harry Caray giving a play-by-play report of some dramatic exploit by the Cubs, Jane, a young Chicago mother, is describing in exquisite detail the actions of her towheaded five-year-old, Mark, as he plays with a little toy truck, maneuvering it through a series of childishly random gyrations. Both are kneeling in a partitioned cubicle, one of four such cubicles in a large former classroom. On a table in a corner of each cubicle are other toys, and on each wall hangs a sign indicating the precise order in which they are to be used: "boat, cups, ball, truck, blocks, beads . . ."

Off to one side, like a scrupulous referee at this bizarre sporting event, another mother sits on a chair holding a stopwatch in one hand and carefully marking her scorecard every few seconds. "Time!" says the scorekeeper after two minutes.

"All right, Mark," says Jane, glancing at the list on the wall. "Now let's play with the blocks." Mark hands over the truck and begins putting the blocks on top of one another. "Ah," says Jane, "you're piling up the blocks. It looks like a little tower . . . "

But Mark has evidently not been able to cast the truck out of his mind. He goes to the table, retrieves the truck, and starts moving it along the floor in the general direction of the blocks. It is a moment of crisis.

A sudden silence falls over the cubicle. Jane ceases her cheerful patter, turns away from Mark, folds her arms, and looks grim. The scorekeeper sits forward in her chair, more intent on the interplay. For about 25 seconds the only sounds are imitation truck-motor noises emanating from Mark, and even these cease as he notices the chill that has descended on the proceedings. He returns to the blocks, and Jane, just as quickly, returns to life. "Oh," she says, "I see you're banging one block against the other . . ."

So it goes for 20 minutes; a different toy is introduced every two minutes, and the child's behavior--whether cooperative or oppositional--charted every ten seconds. At the end of the session the information from the chart is tallied. It has been a good day for Mark. He cooperated 90 percent of the time, opposing instructions only 10 percent of it. These figures are in turn entered on his graph, which shows exactly how he has been responding during the twice-a-week sessions he and his mother have been participating in for six weeks. Mark's graph shows a steady curve in the direction of cooperation.

The program is called Tuesday's Child, and it is attracting a growing number of Chicago-area parents who, for one reason or another, cannot control their young children. They come to be trained in practical parenting techniques, to participate in parent support groups, to put some order back into their homes, which, they contend, have been turned into battlefields by their tyrannical toddlers, maniacal moppets, and pigheaded preschoolers.

Recalling what brought them here, mothers at Tuesday's Child talk about dinners that go on for hours, weeks of nearly sleepless nights, all-day marathons of getting their kids into their clothes, and screaming and crying tantrums that end only with the unconditional surrender of the parents. Here, they are not kidding when they refer to their offspring as "the little monster," talk about "peaks of awfulness," or discuss the exact age when their little one "went bad." Some recall nostalgically the good old days of childlessness and try to figure what went wrong.

The children are not brain damaged, emotionally disturbed, or otherwise impaired on the usual measurable scales. And the parents are not child beaters or incompetents. The vast majority are well-educated, professionally successful achievers. Many of these couples are quintessential yuppies, with two careers, two cars, no more than two children, a big expensive home, and a wealth of friends.

Tuesday's Child, located on two floors of the former Saint Alphonsus High School at the intersection of Lincoln, Southport, and Wellington, takes children between the ages of 18 months and five years, and involves them and their parents in a comprehensive and ambitious retraining program that gets rave reviews from scores of those who have participated in it. Currently, some 100 children are enrolled--with boys outnumbering girls by about three to one. The families come from as far away as Lake Zurich and Gary, Indiana, and there is talk of launching sister programs elsewhere.

Yet because the Tuesday's Child approach contains strong elements of behavior modification, raising images of Pavlov's dog and B.F. Skinner's trained rats, it provokes some negative reactions among child experts. Though for some it's on the cutting edge of community-based self-help efforts, demonstrating how a mix of behavior psychology, peer support, and common sense can effect profound change, for others it is only a quick fix, using charts, stopwatches, and behavior-altering devices to manipulate children instead of trying to learn what's going on inside them.

In any event, the call for Tuesday's Child's services raises the question of why intelligent, well-intentioned adults cannot cope with the tiny people they have brought into this world. "More than ever in the past," says Dr. Victoria Lavigne, cofounder and executive director of Tuesday's Child, "people today anticipate that parenting will be a good experience. They want a healthy relationship with their child. When it isn't, they're not going to swat him or dismiss him as just a rotten kid. They look for solutions, they go searching."

The point is made in stronger terms by Bonnie McGrath, a journalist who says she, her husband, and her daughter benefited enormously from their experience in the program. McGrath wonders, however, about the societal conditions that create the need for this kind of program. "We are a society that's very antikid today," she says. "There's tremendous pressure to have a perfect child or else you feel like a criminal or an outcast. Tuesday's Child is caught up in helping parents change their children--just like they want a smoothly running washer and dryer and dishwasher with years of service to make them a proud owner. . . . Sometimes parents complain about their kids like they're possessions which just aren't acting up to warranty!"

But regardless of their motivation in starting the program, many parents find in it relief from seemingly intolerable burdens. Marla Chernier first became concerned about her son Warren when he was only ten months old. "He was just so aggressive," she says, "pulling hair and making a fuss. I had him in some play groups with other children, and it got so I didn't want to continue. I'd always leave with him crying, the other kids all upset, and the mothers sort of looking at me. His behavior seemed like a reflection on me and our home."

Marla, a dietitian, and her husband Larry, a successful salesman, weren't prepared for this. They waited for the phase to pass and it didn't. Everything became a battle: getting dressed, going to bed, surviving a meal as he threw his food around the room. The Cherniers had Warren checked, physically and psychologically. He had allergies and a series of ear infections, but nothing explained his severe antisocial tendencies. "I went to the psychologist," recalls Marla, "and I said, there's something wrong with him, isn't there? He told me, 'No, he's just a brat!'

"Well, I knew we had to do something when I was talking to my mother one day and I said, Mom, I hate this kid. It got worse. When my husband would leave for work at 5:30 in the morning, I'd try to stay in control, then I'd call him maybe a half hour later and say, come home, I can't take this!"

In early January this year, Marla heard about Tuesday's Child. She began making the hour and a half trip from her home in Wheeling twice a week with Warren, who was nearing three.

Has it helped? Her eyes widen and she looks like she's going to cry. "Has it helped?" she repeats. "Tuesday's Child is the best place in the world. I'm so proud of what they do here and what they've done for us."

Barbara Baksh, a divorced mother who lives in the Lincoln Park area, prided herself on her management skills. As the assistant to the president of a major, Chicago-based railroad, she knew how to handle temperamental people and get results amid the complexities of office politics. She did not know, however, what to do with her little Zachary, who was giving the term "the terrible twos" new meaning. "He would not go to sleep at night unless I sat with him for one hour or more," says Baksh. "He wouldn't eat any vegetables or meat. He was so stubborn about everything, we'd constantly get into this clash of wills. Spanking didn't do any good either."

Baksh heard about Tuesday's Child at a street fair and decided to give it a try. That was three years ago. Within weeks there was clear improvement, she says. "I gained confidence in being a parent. The progress was just incredible. Zachary [now five] is a delightful small person with whom I enjoy a marvelous relationship."

Isn't it possible Zachary would have outgrown the terrible twos without Tuesday's Child? Baksh doesn't think so. "It's what we learned that made the difference," she says firmly.

The crucial ingredient, according to Victoria Lavigne, is something called "differential attention." Children tend to increase behavior that has desirable consequences for them, she explains, and decrease behavior that carries undesirable consequences. A parent's attention--even disapproving or angry attention--is always a desirable consequence for children, says Levigne, so they learn how to attract and hold onto it.

Parents, she believes, fall into a trap by giving the greatest amount of attention to misbehavior--by arguing, spanking, or surrendering. On the other hand, parents are likely to ignore the child when he's quiet or cooperative, possibly because they're afraid of breaking the spell. "They don't give the child much attention for eating dinner or getting dressed," says Lavigne, "since, after all, that's what he's supposed to do." But the upshot, in her view, is that behavior that gets only minimal attention is not likely to be repeated.

At Tuesday's Child, this unhappy syndrome is reversed. Parents are taught to pay great amounts of attention to behavior they want to increase and to withdraw all attention from activities they want to eliminate. The basic lab for teaching differential attention is the 20-minute play session described above. Every family involved in the program takes part in such sessions twice a week for two to three months. As long as the child follows orders and plays with the toy designated by his mother (some fathers are involved in the program but mostly on Saturdays), he gets gobs of attention. This is called "verbal following"--simply describing the child's actions in a positive tone, not telling or even suggesting what he should be doing with the toy. When the youngster violates orders, by playing with a toy out of sequence or just refusing to cooperate in the game, the parent is supposed to stop talking and turn away from the child.

Says Lavigne, "You don't just ignore the child and go on about other business. There's literally no activity until the child starts doing what she's supposed to." Then the supportive verbal following begins anew.

This wasn't an easy lesson to learn, admits one mother. "At first when I turned away, my little girl got scared and said, 'What's the matter, Mommy?' She had never seen me responding to her like that before." Indeed, many parents at Tuesday's Child admit initial reluctance to praise their child about anything. This little one who seems intent on driving them to distraction has made them feel hostile, angry, and negative.

Transferring the lessons from the play sessions to ordinary home life becomes easier, according to Tuesday's Child, if orders are broken down into small, manageable units. Instead of demanding that a child "come to the table, sit up, and act like a human being," parents are urged to take one step at a time. Just getting Junior to sit at the table may be an achievement worthy of considerable verbal approbation. Then gradually other elements are introduced, like using utensils, chewing and swallowing food, and eventually interacting socially with other family members at the meal.

Lavigne heartily recommends the use of "naturally occurring reinforcers" to facilitate civilized behavior: "First we have dinner, then we have dessert!" or "After you pick up your clothes off the floor we'll watch television."

Critical in all this, she insists, is the follow-through--that is, making sure that the desired activity gets done and showing lots of approval when it is. Of course, she adds, many disasters can be avoided by planning ahead, by anticipating the ingredients of conflict. Bringing a supply of games, toys, and other distractions on a long drive, for example, can decrease the likelihood of frayed nerves at the trip's end.

If, however, disaster seems imminent, Tuesday's Child advocates an emergency technique called "time out." Behavior that is dangerous or hurtful, such as biting people, hurling blocks at playmates, or running into the street, is curbed by instantly removing the child from the situation, sitting him down (preferably in a designated time-out area), and saying, for example, "No throwing blocks! Time out." The time out can last a few seconds or several minutes, and when it's over the parent is supposed to resume her supportive attitude, resisting the temptation of continued discussion and recrimination.

Learning differential attention, verbal following, and the other techniques takes time and effort. Those accepted at Tuesday's Child pass through two phases, and some go on for three. Enrollees had better be prepared for a commitment of at least four months. In the first phase, child and parent come in twice a week for two months or more. In addition to the parent-child play sessions, parents participate in discussions with other parents and in group meetings led by Lavigne, while the youngsters spend time in the program's large child center. Here the fundamental concepts are reinforced socially in the midst of other children.

In the second phase, the parent, by now familiar with the techniques, becomes a trainer. She is assigned to a newly enrolled parent and child, for whom she referees and charts play sessions, discusses problems, makes suggestions, and functions as a guide--usually for another two- or three-month period.

Some then go on to a third phase, of indefinite length, acting as a senior trainer or assisting in the child center. One drawing card of the program is that the child who was enrolled and his siblings can participate in the child center indefinitely. A few parents have remained active volunteers in the program for four years or more.

Bonnie McGrath calls Tuesday's Child "a reform school for toddlers," but it might more properly be called a reform school for parents. They seem to learn more about themselves than about their children.

"We wanted to do the right thing for our son," said Joan Zurakov, who lives in the Edgewater neighborhood, "but we didn't know how. All we had to draw on was our own experience growing up." Joan and her husband, Mike, a computer programmer, grew up in the 1950s and early '60s when marriage and family were more commonly regarded as rocklike institutions and parental authority still carried an aura of infallibility. "My parents expected us to comply with orders without an argument and always to be well mannered," says Joan. "And that's pretty much what we did."

When their son Daniel refused to obey and started throwing tantrums, Joan attempted to compel more civilized behavior, using the same techniques her parents had. Not only did those tactics not work with Daniel, they led to serious disagreements between Joan and her more lenient husband.

"I'd say my basic approach to discipline was 'nonassertive aggressive,'" says Joan. "I'd tell Dan, come on, it's time to eat. Well, he'd just keep watching TV. I'd get mad and yell. And that would set him off. . . . The crying would go on and on. It got so he'd go to bed crying and wake up crying. We were always tense and I got desperate."

Last January, Joan and Dan, then four, came to Tuesday's Child. "The first thing I had to learn was getting over my anger," says Joan, "to articulate the things he did and try to understand them. Then I had to begin looking for positive things in him . . . to see that the glass was half full not half empty."

At first the timed play sessions went badly. Joan found the verbal following technique both difficult and revealing. "I realized I had not been relating to Dan in an approving way at all. I was always trying to control. It's a skill to acknowledge another human being without controlling him or to praise someone without demanding something back." But soon Dan's graph showed a definite upward swing.

Joan put a chart up on the refrigerator at home and marked each time she uttered a word of praise to her son. The first week there were only 5 instances, the second week 25, the third 40. She also learned how to reshape her aggressive posture into a less confrontational approach. Now, she notes, "when it's dinnertime I'll say something like 'Dan, the bell will ring in five minutes for dinner. I want the TV off by then and you ready to come.' At first when he didn't respond to this, I just calmly shut off the TV and took him by the hand to the table. I didn't get mad and he didn't have a fit. . . . We don't have that trouble anymore."

Now, she says, she thinks in terms of consistent patterns and logical consequences. Order has been restored; it's not the familial and social order of Joan's youth, but an internal order that affects what she does and how she handles family decisions. "Dan goes to bed with a smile on his face," she says. "He's cooperative and fun to be with."

She, meanwhile, serves as a phase-two trainer in Tuesday's Child, passing on the lessons and her own enthusiasm to other bewildered parents. "What attracts people to this place," she says, "is the structure it gives your life."

Sometimes the imposition of structure gets immediate results. Sydney Sidwell and her husband Randy Honold entered the program last June in a state of near panic. Both were in graduate school and both needed a good night's sleep. But their blond two-year-old daughter, Greta, kept them up most of the night, crying and crawling into their bed.

The answer was differential attention. Instead of chatting with the little girl and trying to calm her down over and over, says Sidwell, "our trainer told us to take her back to her room and say nothing every time she got up. I counted, and the first night we took her back 110 times! The next night it was about 50. After that it dropped off. And now she sleeps right through the night. It was so simple!"

Like most parents at Tuesday's Child, Sidwell and Honold do not agonize over what triggered Greta's sleeplessness in the first place. The aim is to control domestic anarchy. Says another mother who used to spend up to eight hours getting her son into his clothes, "Why was he like this? I still don't know and I'm probably never going to find out. All I know is life is a joy again, and this place is responsible!"

It all started in 1980 as a pilot project funded by the U.S. Department of Education at Children's Memorial Hospital, where Lavigne was employed as a child psychologist. She and Katherine Augustyn, who is now Tuesday's Child's program director, patterned it after a unique project they had observed in Nashville, Tennessee. The idea was to catch behavior problems in the very earliest years, before the child could wreak havoc in nursery school or the classroom and be forever afterward labeled a "problem case." Lavigne and her husband, Dr. John Lavigne, chief psychologist at Children's Memorial, had two young children of their own, so the program, titled the Early Intervention Project, held practical as well as theoretical interest for them.

In 1983, when the grant ended, Lavigne, who is also assistant professor of clinical psychiatry at Northwestern University Medical School, and Augustyn, an education instructor at Northeastern Illinois University, took their not-for-profit project into the community, moving into the cavernous, empty Saint Alphonsus school building and renaming the program Tuesday's Child (who, according to the old rhyme, is "full of grace").

This year's $275,000 budget comes from fees, donors, and fund-raising events. The fees, based on a sliding scale depending on family income, range down from $250 a month to nothing. But practically no one currently enrolled is at or near the poverty line. Despite its size and complexity, Tuesday's Child has a small full-time staff of only five core employees, including Lavigne and Augustyn, and a contingent of seven part-timers, some of whom are involved exclusively in clerical work. The vast majority of one-on-one counseling and hand-holding is done by first-phase graduates who have moved into trainer positions in phase two.

"The people who come here bring so many strengths with them," says Lavigne. "They don't need a lot of expert instruction. They're supportive of one another, they teach one another, and they become a kind of community." The program's success can be seen, she adds, in the fact that 69 percent of those who are accepted at Tuesday's Child complete at least the first two phases; in parent-training programs run exclusively by professionals, the completion rate of 72 percent is only slightly better.

According to Dr. Leonard Jason, a psychology professor at DePaul University and president of the Behavior Analysis Society of Illinois, Tuesday's Child represents "a new paradigm in community psychology," because "it gives itself away" to the people who come. "It is proving," he says, "you don't need experts in rigid control at every step. There's a tight methodology and technology here that ordinary people can appropriate and teach themselves."

Today many mental health professionals, he adds, remain "overly concerned with their own preciousness. They insist on always assuming the expert mode with clients." Often all that's really needed, says Jason, is to provide parents who feel vulnerable and helpless with a sense of control. "That's what this program does."

The program also gets high marks from Evelyn Ginsburg, a social worker with the Chicago Board of Education and president of the Chicago Association for Behavioral Analysis. "Tuesday's Child is effective parent training in action," she says. Since unacceptable behavior, in Ginsburg's view, is basically the result of maladjustment, of unhappy interaction with one's environment, probing into minds for deep causes is unnecessary. "There aren't deep causes," she contends.

Such assessments drive other psychologists, especially those with a strong psychoanalytic bent, up the wall. "There are deep causes," says Dr. Ann Kaplan, a child psychotherapist associated with the University of Chicago. In some cases, she admits, behavior-modifying approaches may be useful, as when there is a simple failure to communicate or use good judgment. But in other situations, she claims, they can be dangerous. When you treat symptoms but gain no insight as to their causes, it's like putting a cap on a live volcano--pressure continues to build up beneath the surface.

"We have to accept their child's emotionality and take an interest in the content of his mind," declares Kaplan. "We need to be in touch with his anxieties, not treat him like a pawn on a chessboard."

The point is made in even stronger terms by Laya Frischer, a child psychotherapist associated with Evanston Hospital. Behavior modification of children tends to be destructive, she says, because it is "so manipulative, so controlling. The message I get from Tuesday's Child is that compliance is always terrific. It shows up right on their brochure, which is entitled 'My Three-Year-Old Was Pushing Me Around.' Well I don't think compliance is always so terrific, do you? When we manipulate children, the kid learns to manipulate back."

Frischer also stresses the importance of investigating the causes of undesirable behavior. In one instance, she notes, she was called in by the parents of a two-year-old boy who kept trying to run away from his home. The family had tried a behavioral management program to no avail. Through visits to the home, Frischer learned that the boy's five-year-old brother was profoundly retarded and unable to walk. Somehow the two-year-old had decided that, due to his own misconduct, he would end up like his brother and sought to flee this awful fate. This hidden terror emerged, says Frischer, after she spent time with the youngster in an unstructured setting at the home and got him to playact his deepest fears. Finally, the real problem could be addressed by his parents and a psychotherapist. On the other hand, attempts to control his urge to run away through behavior modification would not have resolved the tension, Frischer believes, only pushed it deeper.

She does not totally condemn Tuesday's Child, however, noting that "a warm, empathetic therapist," even a behaviorist like Lavigne, can counteract many of behavior modification's inherent shortcomings.

Another psychotherapist, Dr. Chaya Roth, director of the Parent-Infant Development Service at the University of Chicago Medical Center, acknowledges that she even occasionally refers clients to Tuesday's Child. "Sometimes you have to curb certain behavior before you can even enter the mind of a child," she says. "But when the behavior disappears, I still have a strong inclination toward gaining insight into the causes of the problem. . . . You know, I think every good psychologist today has a dose of the behaviorist approach. You can't be entirely one-sided."

In agreement with Roth are Faye Kravitz, a social worker, and her husband, Dr. Fred Kravitz, a psychologist in private practice. They came to Tuesday's Child four years ago when their son Mitchell, then three, "did everything to excess."

"We both had education and experience with psychological problems," says Faye. "And I think we had insight into what was upsetting Mitchell, but we still didn't know what to do about it. It's hard to be objective about your own child."

At Tuesday's Child they found practical answers that, in combination with their professional training and insight, have apparently solved the dilemma. Faye was so impressed with the program that she continued on at Tuesday's Child as a phase-three associate for several years and became a full-time social worker with the program earlier this year.

Victoria Lavigne declines to be put in any pigeonhole with B.F. Skinner, the pioneer behaviorist guru who denies even the existence of a thing called "mind." He has stated that since all human interaction involves manipulation anyway, he would simply like to see people manipulated "more effectively." Lavigne leans toward the more moderate cognitive behavioral school, which upholds the existence of mind and will but stresses the cardinal importance of environment in shaping conduct.

On a typical morning at Tuesday's Child, 15 mothers are sitting around a big table for their weekly group session. All are white, most in their early 30s. The focus of attention is Dr. Lavigne, who dispenses advice with the easy, informal authority of an Ann Landers specializing in tot control.

"What can I do about lying?" asks one mother. It seems four-year-old Sean is into all kinds of mischief around the house, putting carrots in the VCR and rubbing soap on the furniture. "When I scold him, he just denies he did it," she explains.

Lavigne says it's much better to teach truth-telling behavior by consequences, not by scolding or lecturing. For making a mess, she suggests, Sean should be told he's getting a five-minute time out--with an extra five minutes for lying. "Don't argue," says Lavigne. "Let him see his actions carry definite consequences."

Another young woman is worried because her four-year-old won't share toys with his little sister. In this instance, Lavigne again stresses the importance of consequences but the recommendation is different. "Talk to him about what his refusal to share does to his sister," she says. "And get him to talk about how he thinks it makes her feel." The mother nods enthusiastically, as if to say, "Of course, why didn't I think of that?"

The next mother's story is more complicated. Her eight-year-old daughter was crushed when she didn't get a part dancing in the Nutcracker. She had passed the preliminary auditions and made the final 10 percent. What hurt most was that the part went to another girl who had lied about her age. "She thinks it's so unfair," says the mother.

Lavigne is wrapped in thought for a few seconds, then she says, "Your daughter is right. It's a rotten deal! But it's important for kids to learn that life isn't always fair. Be sympathetic with her and let her know she doesn't have to make the feelings go away."

Then comes the case of six-year-old Scott, who imitates the children he plays with to the point of recklessness. "He'll jump off the stairs or do anything at all!" says his mother. "I want him to be independent, not just go along with the gang."

"Get him to evaluate the behavior of the other children," suggests Lavigne. "Ask him to talk about the possible results of the kinds of things they're doing. Then verbally follow his responses. Don't give orders."

The discussion continues for 90 minutes, as the director, in Solomon-like fashion, produces nuggets of wisdom--all based on the foundation stones: logical consequences, differential attention, time outs, etc. The approach seems consistent, full of applied common sense, and anything but manipulative.

Still, the old suspicions about behaviorism linger: Are these techniques teaching children how to live happily in this world? Or are they, as Peter Schrag suggests in his book Mind Control, teaching them "that their freedom and will are limited, that they are prisoners of their own . . . conditioning and that the requirements of the culture are scientifically normative"?

"That's not even an issue I care to discuss," says one mother. "You never saw my two-year-old in action! For me it was strictly a choice between Tuesday's Child or a mental institution for me and my husband."

Art accompanying story in printed newspaper (not available in this archive): photos/Kathy Richland.

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