Kaak's Commandments

(dealing with behaviour problems in children)

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1.Equality of Bonding: a. weakening the strongest

An excessively strong bond between mother and child is very often at the heart of the problem; this can be weakened by encouraging the child's relations with his peers, mother developing other friendships/activities and strengthening the other two bonds as below.

2. Equality of Bonding: b.Strengthening the weaker bonds.

Encouraging mother and father to have more quality time alone (as a prescription or permission); encouraging father to have more one-to-one time with his child.

3.Restoration of Rights

As in sleep problems. Infants do have erratic sleep patterns and have a 'right' to know that they have not been abandoned by their parents; the child does not have a right to spend each night in the parents bed and disrupt the whole household. Therefore the disturbed child should be comforted by the parent sitting in the room until the child goes to sleep, resisting all entreaties to pick him up. Generally put an awake child to bed rather than let her fall asleep in your arms and then put her to bed; she should learn to fall asleep herself!

4. Empowerment: returning responsibility.

As in bedwetting where the whole ethos is to reassure the child that 'you can do it' with an associated age-related 'reward' for each successful accomplishment. Except for emergencies, the medicalisation of bedwetting with the use of drugs (except in emergencies) is to be eschewed.

5. Proportionate Response.

As in temper tantrums. The child screams and shouts and hurls his body around - ignore him - he isn't hurting anything or anybody. (NB: ignoring bad behaviour is the greatest stimulus for its extinction). He starts breaking things: he is sent to his room. He damages the room: you sit with him in the room. He attacks you/furniture etc.: immobilise him and promise that you will continue to sit on him until he has "regained control" NB: parents are bigger and heavier than children.

6. Defining what is expected

As in school refusal: the child must go to school and the parents must remain calm and willing to do whatever it takes. Remember the child will exploit any weakness in the chain. e.g. a teacher who 'spooks' at a child vomiting and sends her home!

7. Understanding the source of the problem.

Listening to the child talk about her problems, and discovering what the problem means to her in the context of her stage of development will gain insight, rapport and often suggest solutions. "Pretend" and visualisation work well with children.

8. The therapeutic Trial: a. ADHD

Trying to concentrate for instance in class for such a child has been compared to trying to do Algebra at a fun-fare! Such children are dysfunctional, disruptive, disobedient and a disappointment to themselves and everyone concerned. A trial of medication (e.g. Ritalin) with the parents 'on board' is entirely appropriate; Ritalin is safe, short-acting and in the right dosage will deliver the answer in a very short time!

9.The Therapeutic Trial: Depressive Illness.

Don't be scared of SSRIs in children - certainly after age 9; a therapeutic trial will often turn things around completely, and if it doesn't work - stop it!

10.Understanding the Social Dynamic.

Sometimes if all else fails, the answer may lie in bullying at school, drugs, child abuse etc.

Professor H. Otto Kaak, Kentucky