Tuesday, June 12, 2012

How to handle spitting by 5 year old

Thank you for your post, Dr. Gottlieb. It has been difficult as of late when he keeps spitting over and over, but does not appear fully angry. It is hard to know what to do to pull him out of this. (This is a follow-up question by the parent of the previous post.)

Hi,  First try to keep a record for a week of what is going on before the spitting starts.  Is there a pattern:  type of situation (such as meal time), theme (such as not getting to do what he wants), time of day, the person who is on the receiving end.  Then think about whether it is possible to re-arrange the sequence to avoid spitting, or whether it is possible to use distraction before it gets to the point where spitting occurs. 

You can also consider behavior modification strategies, which work better if your child is not in complete anger overload.  If in complete overload, the child would not be thinking rationally at the moment and would be less likely to respond to incentives or consequences. However, if you catch the sequence before this point and you target spitting (but not the anger per se), you may be able to reduce the frequency of spitting.  What you would do is this:  when everyone is calm give the example of spitting compared to some other examples such as yelling "I don't want to."  Then mention a short term incentive, for example, playing with a certain toy (whatever toy you pick becomes off limits unless he earns it) for an hour, if there is no spitting for a whole day (or you could make the goal no spitting for some part of a day if he currently spits more than once a day).  He would earn the reward time if he yells "I don't want to" (or any words other than spitting).  You are not expecting him to stop getting angry, just stop spitting.  You do not mention the reward while he is angry but wait until everyone is calm before announcing that he earned the reward.  (Say nothing if he did not earn it.) If you use a short term consequence, do not mention it until everyone is calm.  Now a word of warning:  behavior modification strategies do not always work with anger overload because the child sometimes wants to get back at you in whatever way he knows is most noxious to you.  But some children will try to cut back on a behavior if they care a lot about the incentive or consequence.  All the best, Dr. Dave Gottlieb

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