please help, FAS/adhd child spiting, hitting, weting, being nasty to others....

Hi, I have my Nephew living with me. He is 6 and has FAS/ADHD. He has for the past 2 years spat on people, hit and hurt people and animals, wets himself at school and like a flood at night. He gets just plain nasty to anyone yet can be so loving as well. I am at the end of my teather...I know that mentally he is behind kids his age but I am hoping someone may have ideas on how to stop the behaviour and if there is light at the end of the tunnel.
I have tried the "oh well you had an accident, clean you up and away you go" but that made him worse.
Time out and anything else doesn't work.
I am starting to get frustrated as I gave up University to take on 2 children of my brothers, he is out partying it up and I am getting the bad behaviour. The 6 year old is an angel for his dad but nightmare for me.....please anyone....ideas??

[Richard B. Graff, PhD, BCBA-D]

When trying to determine how to develop a treatment for problem behavior, the most important thing that we need to consider is why the behavior is occurring. Most problem behaviors in children are learned behaviors, and they occur because the behaviors have a history of being reinforced; in other woprds, the behaviors, at least occasionally, result in the child getting the something he or she wants.  Speaking very generally, There are a couple of general categories of. items that can maintain problem behavior:

1)  Problem behavior can be maintained because, at least occasionally, it produces attention from others (e.g., the problem behavior is inadvertently followed be a lot of parental attention);
2)  Problem behavior can be maintained because, at least occasionally, it produces a tangible item that  from others (e.g., the parent gives the tantrumming child a toy to make them stop tantrumming);
3) Problem behavior can be maintained because, at least occasionally, it gets the child out of doing something they don't want to do--or at least the child can temporarily avoid doing the thing they don't want to do
4)  Problem behavior can be maintained because, at least occasionally, engaging in the behavior produces a pleasurable sensation (we typically think of these as 'self-stimulatory" behaviors;
5)  In more rare cases,  problem behavior can occasionally be maintained because engaging in the behavior leads to a reduction of an aversive event, such as pain (e.g., a child who has an inner ear infection that has not yet been discovered may start poking his fingers in the infected ear, because doing that may temporarily relieve the inner ear pain, at least for a few seconds).

So, why is it important to identify which of the above is maintaining the problem behavior?  Because if you don't know, all you can do is guess at what may be an effective treatment, which could be ineffective, or in some cases, your treatment may make the behavior worse!

You mentioned that time out did not work in reducing problem behaviors. Why might time-out not work for some children?  Well,  consider the reasons why problem behaviors occur.  One reason that some children emit problem behaviors is because it gets them out of, or at least lets them temporarily avoid, something that they do not like.  So, suppose a school-age child did not like doing his homework, and he tries to get out of doing it.  Eventually, he begins to tantrum, and the parent sends the child to time out.  What happens when the child is in time out?  He may go to a quiet area and have to stay there until he is calm; but, while he is in time-out, he is avoiding the work, which is exactly what he was trying to do by tantrumming!  So, in this example, when homework was presented, and the child tantrummed, the tantrum was actually rewarded, because it got him exactly what he wanted--it got him out of doing the homework (at least temporarily).  So, in my example, not only would I expect time-out not to work, I would expect that, over time, the behavior would get worse, because the parent is inadvertently reinforcing the child's problem behavior!

So, the first step in developing an effective treatment is identifying what is maintaining the problem behavior.  This will require a functional assessment or functional analysis.  The most qualified persons to do this are board certified behavior analysts (BCBA) who specialize in the assessment and treatment of problem behavior.  If you go to the behavior analyst certification board website (www.bacb.com), you can look for BCBAs in your area,  I would also begin discussions with the child's school about the necessity of having a qualified person conduct a functional assessment/analysis as a first step in the process of treatment development.

Best of luck!