Thursday, June 19, 2008
Behavior modification is not all about punishment

By Dr. Anthony Policastro

I spend a lot of time teaching behavior modification. Many parents indicate that they have already tried it. It didn't work for their child. That may be true. However, in most cases, it didn't work because there were problems in the way it was done. There are a number of things that can interfere with the success of a behavior modification program. The most common one is the idle threat. Children learn by consistency. That means that they learn best when parents react the same way every time. I hear many patients tell their children to stop misbehaving. They follow that request with an "if" statement. It goes something like: "If you do not behave, thenÉ" It is clear that they will not follow up on such a threat. Children will quickly learn when parents are just saying things like that. If they know that the consequences will rarely follow, they will ignore the statement. Every time a parent says "if you do not behave, then," they must carry out the consequence if the child continues misbehaving. The threat always must be followed by the threatened action. If not, children will ignore such statements in the future. You need to ask yourself how often you do this with your children. If you do it a lot and do not follow up on it, you have two choices. The first is to follow up with the threat every time. That can get cumbersome. The second is to only say it when you mean it. Then the child will learn that if you make the threat, you will follow up on it. A second thing that I see is parents telling their child not to do this and not to do that. Children can only pay attention to a few things at a time. Once the number of "don'ts" gets to be more than three, they are overwhelmed. Therefore, only 2-3 behaviors should try to be corrected at one time. Pick the worst ones and address them. Then do it consistently as detailed above. A third problem is parents not being specific. A parent may tell a child: "Be good." The parent knows what that means but the child does not. Then the child does something that is not in line with what the parents feel is being good. The parents get upset. However, the child does not realize that is what the parents meant. Directions should be short and to the point. "Don't hit your sister." "Don't have a temper tantrum." "Don't bite." Don't throw things." A fourth problem is choosing the wrong rewards or punishments. Parents will decide what they want to use for rewards and punishments. The child may not care. Parents might offer a reward. The child may think: "Who cares." Parents might threaten a punishment. The child might think: "Go ahead." The best way to select a reward or punishment is to ask the child. It is amazing at how honest they will be. A fifth issue is the expectation that behavior will change overnight. In the best of circumstances that is not true. If you find the right reward and you choose a specific behavior and you reward or punish it consistently, the best you could hope for is to see that behavior start to change in 7 - 10 days. If you give up before that, you will never see a change. A sixth problem is having a reward or punishment that is too far into the future. Children have little sense of time. Think of "Are we there yet?" Any kind of reinforcement has to be relatively immediate. Promising a reward far into the future will not be effective. Using a punishment far into the future will result in the child not remembering what the punishment is for. Things need to happen within minutes or hours and not days. A seventh problem is the length of the punishment. The Punishment only needs to be long enough for the child to know that he or she has been punished. Taking away 15 minutes of a child's favorite activity is sometimes more effective than not allowing the activity at all. In addition, once you take away the entire activity, then you have nothing left to take away. Therefore, they can be as bad as they want. One other thing that I often see is that it is all about the problem behaviors. Spending time giving rewards for behaviors that are not problems can result in the desire to have the same reward if the problem behavior stops. Even if it is only coming to the dinner table on time or brushing teeth, praise is always helpful. There is a "rule of six" that I like to use. Every parent ought to pick one hour every day. It can be a different hour each day. During that hour, they should praise the child for being good six times. That gives the child wanted attention for things other than bad behavior. If the only time you pay attention to a child is when he/she is bad, then that encourages them to behave badly to get more attention. Each of these items is not a problem in every behavior modification program. However, there are usually several of them present in every failed behavior modification program. It takes a long time for a child to develop bad habits. For that reason, it is complicated to break those bad habits. It is easy to make mistakes when trying to do so.

Stroke support group Nanticoke Memorial Hospital will offer free monthly Stroke Support Group meetings designed for individuals who have survived a stroke and their families and caregivers. Meetings are held the third Thursday of each month at Nanticoke Cancer Care Center, from 1:30 - 3:30 p.m. The meetings will consist of guest speakers and breakaway sessions, in which caregivers and survivors will meet in two groups to discuss concerns, provide support and networking. Refreshments will be provided. Sheila Brant and Joan Burditt, occupational therapists at Nanticoke Memorial Hospital, will facilitate the support group meetings. Pre-registration not required. For more information, call 629-6611, ext. 5121.

Oncology symposium planned The Sixth Annual Seaside Oncology Symposium will take place Saturday, Oct. 11, at the Boardwalk Plaza Hotel in Rehoboth Beach. The Tunnell Cancer Center and the Medical Society of Delaware sponsor this annual, half-day symposium to update participants on the diagnosis and management of cancer. It is designed for physicians, nurses and other healthcare professionals. The conference, which begins at 7:30 a.m. and ends with lunch at 1 p.m., is planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint-sponsorship of the Medical Society of Delaware and Beebe Medical Center. The Seaside Oncology Symposium is supported by unrestricted educational grants from various pharmaceutical companies and programs. Details regarding this year's topics and speakers will be available soon. Hotel reservations may be made directly with the Boardwalk Plaza at 800-332-3224.

Nursing assistant program begins Become a member of the rapidly expanding health care field by taking the evening nurses' assistant course, offered through Delaware Technical & Community College, Owens Campus. Instruction will be given at Lifecare at Lofland Park in Seaford from June 9 to Aug. 27. Classes will meet on Monday, Tuesday, and Wednesday from 5 to 10 p.m. This 150-hour course teaches students to safely perform basic nursing skills under the supervision of a licensed nurse. Graduates will be prepared to take the Nurse Aid Competency Exam for certification. All nurses' assistants must take this exam to be certified to work in Delaware. For complete information, contact Delaware Tech's Corporate and Community Programs at 302-854-6966.

Weight Loss Surgery Support The Western New Life WLS Support Group will be having its monthly meeting on June 19. We meet at Trinity United Methodist Church, 17249 Phillips Hill Road, Laurel. We meet each third Thursday of the month. This month meeting is June 19 from 7-8:30 p.m. Everyone who has had, or is thinking about, having weight loss surgery is welcome. Activities:
June 19 - bring a new friend night; emotional eating issues.
July 17 - craft night - we'll be making new bracelets for our medical IDs.
Group Leaders: Jennifer Rosen ( and Heather O'Connor (

Depression support group The Mental health Association in Delaware will be sponsoring a Depression Support Group in Laurel on the second and fourth Thursdays of each month. The meetings begin at 7 p.m. The MHA encourages anyone dealing with a depressive disorder to attend. Register in advance by calling 1-800-287-6423. Peer support groups sponsored by Mental Health Association of Delaware are not intended to replace professional mental health treatment. MHA does not publish support group locations; locations are provided with registration.

Caregiver support group Join our monthly support group at the Cheer community center, the second Monday of each month at 11 a.m., 302-854-9500.This support group is for you, whether you are a new caregiver or have been taking care of a loved one for years. We are turning the "Fearless caregiver" book into a guide for our support group. Each month a chapter will be discussed, concerns shared and support given.

Safe sitter classes offered Safe Sitter classes for girls and boys ages 11 to 13 will be offered at Nanticoke Memorial Hospital. The 2-day course will be held from 9 a.m. to 4 p.m., Tuesday, June 24 and Thursday, June 26. The Safe Sitter program is a medically-accurate instructional series that teaches kids how to handle emergencies when caring for younger children. The cost is $50. Participants are to bring a bag lunch. To register your son or daughter or your child's babysitter, call 629-6611 ext. 2540. The goal of Safe Sitter is to reduce the number of accidental and preventable deaths among children being cared for by babysitters. Thousands of young adolescents across the country have been trained by Safe Sitter to handle life-threatening emergencies. For more information, contact Nanticoke Memorial Hospital at 629-6611 ext. 2540.

Uniform Sale The Look-In Glass Gift Shoppe at Nanticoke Memorial Hospital is holding a "Scrubs and Beyond" sale. All of the latest in uniforms and scrubs for the medical professional will be available. The sale will be held in the lobby of Nanticoke Memorial Hospital on Thursday, June 26th, 7 am to 7 p.m. and Friday, June 27th, 7 am to 3 p.m. Payroll deductions are available for NHS employees. All proceeds from The Look-In Glass Gift Shoppe benefit Nanticoke Health Services.

New marketing specialist The Marketing Department of Nanticoke Health Services has added a new staff member to the team. Ginger Calloway has joined the organization as a Communication Specialist for Nanticoke. In her role she will focus on the day to day communications for the organization. In the near future Ginger will be sending you media information, press releases and story ideas related to Nanticoke. This new role will enable Nanticoke Health Services to communicate more timely information to the media and the healthcare community that we serve. Ginger will work closely with myself to communicate new stories for Nanticoke Health Services. Ginger may be reached by calling 629-6611, ext. 4536, via email at or via pager at 853-4038.

New physician Liaison Nanticoke Health Services is proud to welcome Ms. Michele Bell as its new Physician Liaison. Bell started her role in May and is looking forward to coordinating and implementing strategies and programs for improved relations at Nanticoke Health Services. As Physician Liaison, she will play a critical role in Nanticoke's strategic plan of increasing market share and improved service and quality. The liaison is responsible for working with physicians to facilitate utilization of Nanticoke services and increased admissions to Nanticoke Memorial Hospital. She will be a critical link between the organization and referral sources among the Medical Staff and within the geographic service area. Bell, a Delaware native, received her Bachelors in Human Resource Management and Associates in Marketing and Management and is an active member of the community. She brings with her over fifteen years of experience in the healthcare field and is a familiar face to the Nanticoke Health Services organization.

Delaware tomatoes on safe list On Tuesday, June 10, the U. S. Food and Drug Administration added Delaware to the list of states that have tomatoes that are "safe to eat." Delaware tomatoes are not associated with the recent salmonellosis outbreak in several states that is due to certain types of raw red tomatoes and products containing raw red tomatoes. Delaware Secretary of Agriculture, Michael Scuse says, "Delaware tomato season is just beginning. The Delaware tomatoes that are now hitting the shelves of markets and found at local farmers' markets were grown well after the salmonella outbreak in other states; they are not part of the problem. Enjoy Delaware's fresh local tomatoes anytime."ÊA complete list of states, territories, or countries not associated with this outbreak is available at