Using ‘Taboo: The Game of Unspeakable Fun’ to Teach Impulse Control

Taboo isn’t just for dinner parties! Here’s a fun intervention idea submitted by reader Charity Armbruster that uses the game to treat impulse control. Ms. Armbruster earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

Taboo is a word guessing game by published by Hasbro. In the Taboo game, you need to get the other participant(s) to guess the secret word, but the obvious clues are strictly off-limits. To get someone to say pinball, you might say arcade, game, flippers, tilt, or roll. In this game you can’t because all of those words are strictly forbidden. There is an additional challenge in racing against a clock.

The Taboo Game can be difficult for children with impulse control issues and anger issues. However, as the game is played children are able to develop cooperation skills, persistence, impulse control, and learn how to delay gratification. I play the game with students in our schools who have anger issues. Many of these children can be rather explosive. As an angry child becomes more emotional, they may refuse or be unable to say why they are upset or what happened to cause their distress. Before starting the Taboo game I explain how difficult it can be to communicate when angry, and I state that when someone becomes so angry they cannot express their feelings, it’s like a game of Taboo. The teachers and aides are trying to figure out what the problem is, but the child is not saying anything. I explain that even a simple “I don’t know” can be more beneficial than not saying anything.

Playing the Taboo game is usually combined with other lessons related to anger control, such as identifying what makes me angry, strategies to control my anger, and techniques to regulate and/or healthily redirect my anger.

Example 1: In this example the game was played one-on-one with a student. I began by explaining the rules of the game to a student, and then I went first. The child’s task was to guess what the word on the card was. Within minutes the student became very upset  because he could not guess the word. As we played the game, we would stop and take breaks, and process the frustration and ways to handle it.

Example 2: During another game a student became frustrated and threw the cards across the room, stating this game is “stupid”. Again, I processed and discussed the frustration with the student. He sat in the chair and stared at me. He then said “it’s really hard.” I asked him if instead of throwing the cards could he “ask me for help from me.” Often I would stop and use humor to defuse his frustration before it became to explosive.

For children with impulse and anger issues, Taboo: The Game can be difficult because they may have a hard time finding the right word. However, playing the game over time gives the child and counselor ample opportunity to develop anger management strategies, frustration tolerance, and better communication skills.

TabooGame

Alexis and the Thumball: A Story About A Girl Who Did Not Want To Be In Therapy

Eleven year old Alexis had been to therapy many times for her disruptive behavior. Her parents and teachers were unhappy with her and it was her experience that they were ALWAYS mad at her. She did not want to be in therapy, and had made it clear to her parents and to me during the initial visit, that she had no intention of talking or cooperating with therapy.

At the beginning of the second session I checked in with Alexis and she assured me that she still did not want to come to counseling. While I was talking to Alexis I held a Thumball in my hand. I asked her how hard she had tried to convince her parents not to bring her back, and what she had said to them. I asked if there was anything I could do to convince her parents not to bring her back. Apparently there was! Just tell them there was nothing wrong with her.

I reminded Alexis that one of her parent’s concerns was that she had difficulty listening the first time. “How have you done this week, listening the first time?” Alexis assured me that she had done very well, and I suggested she wouldn’t be in therapy very long if that was the case.

image_0Alexis appeared to notice that she was engaging with me, and withdrew. She became a little quieter and the look on her face was somewhat angry. So, I changed the subject and asked her if she knew what a Thumball was? After she replied that she did not, I threw it to her, and immediately asked her to throw it back. This happened fairly quickly so Alexis didn’t have time to think about whether or not she was going to cooperate, and she threw it back. I responded to the first panel. I tossed it to her and she responded. After a few minutes I suggested that since we were stuck here for 45 minutes perhaps we could do something else. I suggested we could continue to talk, play in the playroom, do a sand tray, or play a game. She chose to play a game.

Like all good stories, this story should have a lesson or a moral. Something we can learn from it. First, let’s consider what this story tells us about play. According to the United Kingdom’s Children’s Play Information Service:

  • Play includes a range of self-chosen activities, undertaken for their own interest, enjoyment and the satisfaction that results for children;
  • Very young children, even babies, show playful behavior when they explore sound and simple actions and experiment with objects of interest;
  • Play activities are not essential to meet basic physical survival needs. But play does seem to support children’s emotional well-being as well as a wide range of learning within their whole development;
  • Children can play alone, but often they play with other children and with familiar adults. Even very young children engage in simple give-and-take or copying games with their peers, older siblings or with adults;
  • A playful quality in activities is shown by the exercise of choice, enjoyable repetition and invitation to others to join the play.

So, once Alexis and I threw the ball back and forth, we were engaged in play, a game of catch. However, play as it is engaged in by play therapists is not just a behavior or an activity. It is not just something done with toys in the playroom. The therapist’s attitude of playfulness is important in bringing play into the session and engaging the child. I was playful in my approach to discussing Alexis’ lack of desire to be in the session, but still respected what she had to say and her desire to not participate in therapy. I held a ball in my hand, which implies that play may occur.

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If I held a book, or an axe, something different would have been implied.

The game of catch has likely been with us since humans discovered they could pick something up and throw it, and most children know that you throw the ball back after you throw it to them. So play is both an attitude of playfulness, and an activity.

Winnicott argued that playing is a necessary part of working with children. “Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play. (Winnicott, D.W., 1968)

Play is the most developmentally appropriate way for children to build relationships with adults. Through play children develop critical thinking skills, impulse control, process stressful experiences, and learn social skills.

How does play become Play Therapy? I would argue that the moment Alexis catches the ball, our engagement is deepened and is becoming therapeutic, and we are engaging in Play Therapy. How is that play therapy? Alexis is now having fun with an adult who is enjoying her, liking her, and listening to her. And she’s not being required to talk about what a bad kid she is, so now she can relax a little. As an adult who is also a therapist I bring an expectation and desire to promote change, or resolve difficulties, in a particular way. And this is communicated through my attitude and communication style, and supported by my training, understanding of the problem, and intervention techniques.

Unlike her experience in any of her previous sessions, Alexis’ mood is now elevated and improved as she engages in a playful activity. At her next session, her parents quietly whispered to the therapist as he brought Alexis back to her session, “she didn’t complain once about coming back to therapy.”

Teaching Personal Boundaries with Hula Hoops

This fantastic intervention idea comes from Kathryn Lanier, MS, CI, NCC. It’s a simple, wonderful way to teach children how to respect personal boundaries. Mr. Lanier earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

While working with an autistic child in an elementary school I found the use of hula-hoops borrowed from the PE teacher to be very useful. The child I was working with was having issues with personal boundaries and was touching or climbing on other children as well as the teachers. The child and I picked up the hula-hoops from the gym and walked back to my office with each of us holding one around our waist to represent our personal space and illustrate the distance we should have from another person while walking with them. Back in the room we each sat in the center of a hoop while we played and simply moved the hoops with us as we scooted around the floor during play. If the child wanted to reach out to me and cross my hula-hoop boundary–say to hold my hand or tap my shoulder–the child was required to ask my permission to enter my sphere. I, of course, did the same for him, which gave him a sense of control over his environment and personal safety. It was a huge success! This is a valuable visual and physical tool for children who have attachment disorders and seek affection from strangers.

‘Play Doh Sculpts’ Listening Exercise

Here’s a great play therapy listening exercise submitted by reader Emily Clifton, LISW. Ms. Clifton earned a gift certificate to childtherapytoys.com for her submission. Learn how you can do the same!

Purpose: To work on communication and listening skills between two family members.

Materials Needed: Two tubs of Play-Doh.

Appropriate for: A group of two. If you have a whole group, break family members up into groups of two and rotate.

Directions: Have each person break their Play-Doh into two halves. With the first half, ask each person to make a simple sculpture without letting the other person see. Then have each person take a turn giving their partner instructions on how to recreate the sculpt. When they are finished, have them compare to see how close they were. Then ask each person how they feel they communicated and how they could have communicated better.

Variations: Could use Legos, building blocks, painting, etc. Just make sure that each person has the same materials to work with: i.e.-3 blue Legos, 5 red Legos and 1 yellow.

Family Environment and Children’s Behavioral Disorders

This contribution is from Martha Nodar, who earned a $100 gift certificate to childtherapytoys.com. Learn how you can do the same!

Family Environment and Children’s Behavioral Disorders

Confounding influences such as family environment may have a significant role in children’s disruptive behaviors at home and at school, which may continue and worsen by the time they reach adolescence (Green & Gibbs, 2010). Green and Gibbs (2010) are referring to parental discord, divorce, neglect, verbal abuse, corporal punishment, parental substance abuse, and poor or inconsistent parenting skills as examples of family environments conducive to children’s disruptive behaviors. Poor or inconsistent parenting skills may include subscribing to an unreliable disciplinary paradigm, such as disciplining the child according to the parents’ mood at the time. Green and Gibbs (2010) also include “harsh punitive discipline,” such as “scolding, spanking, restraining, grabbing” (p. 227) as triggers of disruptive behaviors in children. However, they cite “humiliation or contempt” (pp. 227-228) as the types of abuse responsible for inflicting the most psychological damage in children and the antecedent of most disruptive behaviors. This paper advances the current literature by offering a perspective on different forms of intervention and the implications for school counselors and therapists.

Social impairment is the hallmark of behavioral disorders, which may encompass shouting at teachers or parents, kicking siblings or classmates, and the inability to play with peers. Green and Gibbs (2010) argue that “repressed hostilities and rage” (p. 226) as the result of perceived deficits in nurturing may be the underpinning driving the children’s disruptive behaviors. These scholars suggest that most of the time disruptive behaviors emerge during the preschool years when the children come in contact with their peers. Drawing from their experience, Green and Gibbs believe there is a relationship between how children may behave with others and the type of attachment they may have formed with their primary caregiver, who in many instances may be the mother (Bowlby, 1988). Insecure attachment (avoidant or withdrawn), elicited by perceived inconsistent care, tends to trigger children’s reliance on “primitive structures” such as kicking and screaming, rather than using social skills (Green & Gibbs, 2010, p. 228).

Based on a 2012 study that Duncombe, Havighurst, Holland and Frankling conducted with 373 children between the ages of 5 and 9 years-old, they found that parents’ mental health; a habit of dismissing their children’ s emotions such as sadness, “inconsistent parental discipline and corporal punishment are associated with the development of serious problem behavior” (p. 728). In particular, inconsistent parental discipline is the one especially correlated to disruptive behavior disorders. When these disruptive behaviors continue to escalate as preschoolers start grade school, some children may be diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). Attention Deficit Disorder (ADD) is usually the diagnosis given to children with mild ADHD. Leisman et al. (2010) cite ADHD as “the most common neurobehavioral disorder in childhood” (p. 283). Inattentiveness, being easily distracted, unable to sit down for any period of time, social impairment, and physical impulsivity are some of the characteristics found in both ADHD and ADD. These characteristics range from mild to severe in both ADD and ADHD depending on where they may fall in the spectrum.

Pfiffner,McBurnett, Rathouz, and Judice (2005) argue that disruptive behaviors in children with ADD/ADHD are likely to be not only triggered but also exacerbated by family dynamics. In order to find support for their theory, Pfiffner et al. (2005) assessed 149 children between the ages of 5 and 11 years-old who had been diagnosed with ADHD, and their parents. Grounded on their findings and in agreement with some of Green and Gibbs’ (2010) arguments, Pfiffner et al. cite paternal antisocial behavior; punitive or inconsistent parenting style, and lack of parental warmth in their interactions with their children, as examples of a family environment that may precipitate behavior disorders in their offspring with or without ADD/ADHD.

Although disruptive behaviors are a symptom of ADD/ADHD, not all children with disruptive behaviors have ADD/ADHD. Recent research points to the notion of a behavioral continuum range where normative behaviors of young children are found at one end of the behavioral landscape, and those behaviors that fall outside the normative range are clustered toward the opposite end of the spectrum. In a pioneer study, Wakschlag et al. (2007) examined the quality of behavior of preschoolers (the pervasiveness, intensity and frequency of the behavior) to determine what they refer to as “clinical discrimination” (p. 976). This means, for clinicians to have the ability to discern what falls inside or outside the normative range of behaviors observed in young children.

Download the entire article here.

Fun idea for working with oppositional or dysregulated kids

Here’s a fun idea from Kristy Snedden for working with children who are oppositional, dysregulate easily, etc.

Use colorful index cards. On each index card, write one goal the child is working on. Allow the child to “choose” two cards.  Various choice methods can be used;  kids I see put the cards in a Bilibo spinner seat and spin … usually one or two cards pop out.

Kids seem to get to work faster and be much more amenable to treatment goals when they are allowed this choice.

If a child cannot complete this exercise, having him or her “spin” for a bit in the chair usually regulates them enough so they can then work with this exercise.

Lying

All children lie: Children as young as age two can lie. In fact, researchers have found that the ability to tell a lie at this age may suggest advanced thinking, and may be predictive of greater success on cognitive tasks in the future. In one study, 20 percent of two year old children were reported to have lied. This number increases to virtually 100% by age 12, and then begins to drop off throughout adolescence. During adolescence teens begin to tell “white lies” that are designed to avoid offending or hurting someone’s feelings. Despite what many parents think, most young liars are expert at not giving away the lie with a non-verbal signal.

No reason for alarm: While many parents become alarmed when their young children begin to lie, there is no reason for immediate alarm. Lying is a normal part of development. Successful lying involves integrating many sources of information and manipulating that information to one’s advantage. “Better” lying suggests more advanced cognitive development. When a child is caught in a lie the parents have an opportunity to teach important life lessons.

What to do when a child lies: The first step is to determine the purpose of the lie. A child may be fearful and lying to avoid a negative consequence. Children may lie to protect a peer or a sibling. Some children are bored and have a good imagination. This may lead to creative lying or “storytelling.” Children will lie to avoid an unpleasant task, such as cleaning their room or brushing their teeth. Children can be an impulsive. A lie may slip out because they haven’t paused to reflect on an appropriate response. Children who want more attention and approval may try to achieve this by lying to peers and family members. Adolescents may lie to generate more distance between themselves and their parents.

The best way to deal with lying is to foster truthfulness. Parents need to demonstrate the value of being truthful, by being truthful. Young children will need to be taught the difference between lying and telling the truth, both through role modeling and having conversations about lying and truthfulness, and fantasy and reality. When a young child lies they may benefit from a simple explanation or statement such as: “That was a lie. Now let’s talk about taking things without asking.” Move on quickly to dealing with the actual misbehavior. When the opportunity arises children need to be reinforced for being “honest even when it is hard.” Responses to misbehavior need to be carefully calibrated so the child understands that a negative consequence is solely for the behavior and they are not being consequenced for having admitted a wrong doing.

When a child does something wrong it is important to focus on the behavior and not the child’s character. Children that are shamed or humiliated will be motivated to lie in the future in an effort to avoid these difficult emotions. Parents should avoid playing “20 questions” or acting like the Grand Inquisitor. Parents should act on what they know, that is, observable behavior and deal directly with the behavior.

When lying becomes a problem: Of course lying may reflect a more serious emotional or behavioral problem. Chronic lying, or lying that appears to be habitual, is maladaptive and will cause the child or adolescent to have relationship issues with peers, family and teachers. Children and adolescents who clearly know the difference, but still tell elaborate stories that appear to be truthful, likely have some underlying emotional problem. These children and adolescents often tell their “stories” with a great deal of enthusiasm and appear to be quite believable. Some children and adolescents may lie to take advantage of others, or lie to cover up their own maladaptive behavior, such as drinking, taking drugs, or engaging in other delinquent behavior.

Seeking help: If a child or adolescent develops a pattern of lying which is serious and repetitive, then professional help is indicated. The child and parents should consult with a child therapist and determine if there are more serious underlying emotional issues or if the lying is primarily related to behavioral issues.

Eleven Warning Signs of Mental Illness in Children & Adolescents

The “Action Signs” Project is a new tool kit to help identify children with mental health disorders. Approximately fifty percent of serious mental health conditions manifest themselves by the age of fourteen and as many as one in ten youngsters has a serious mental health condition that impairs their functioning in either home or school or in the community.  Family practice doctors and pediatricians are in an ideal position to identify these children, and the eleven signs identified in The “Action Signs” Project can be extremely useful.

The “Action Signs” Project  tool kit that was recently released by the REACH institute and was funded by The Substance Abuse and Mental Health Services Administration. The authors of the tool kit spent the last ten years sifting through studies and interviewed more than 6,000 families and children in an effort to identify the most efficient and simplest method for identifying the most serious mental health disorders.

The researchers identified eleven signs that require immediate action. They include severe mood swings that cause problems in relationships, intense worries or fears that get in the way of daily activities, sadness that lasts more than two weeks, or sudden and overwhelming fear brought on for no apparent reason.

Dr. Peter Jensen, a Mayo professor of psychiatry, was the principal investigator on this study. He noted that there is frequently a disconnect that occurs between what a child says and how a parent interprets that message.  For example, four to five percent of parents respond “yes” when asked if their child has “ever talked about wanting to kill himself or made a plan to do so?”  But then, when a follow up question is asked, “Has he seen anyone for that,’ they’ll say ‘no’ two out of three times,” Jensen said in an interview with Minnesota Public Radio.  Jensen said part of the problem is that parents don’t always recognize when the threats or behaviors their children display aren’t normal.

The 11 action steps listed in The “Action Signs” Project are designed to make these situations very clear. For example a child who has severe Attention Deficit/Hyperactivity Disorder is described in these 17 words: “extreme difficulty in concentrating or staying still that puts you in physical danger or causes school failure”.

It should be noted that that the eleven action signs won’t be able to identify every child with a mental health problem. The developers of the tool kit suggest the tool kit will identify at least half of the children who are currently undiagnosed.

These are the eleven signs:

  • Feeling very sad or withdrawn for more than two weeks.
  • Seriously trying to harm or kill yourself, or making plans to do so.
  • Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing.
  • Involvement in many fights, using a weapon, or wanting to badly hurt others.
  • Severe out-of-control behavior that can hurt yourself or others.
  • Not eating, throwing up, or using laxatives to make yourself lose weight.
  • Intense worries or fears that get in the way of your daily activities.
  • Extreme difficulty in concentrating or staying still that puts you in physical danger or causes school failure.
  • Repeated use of drugs or alcohol.
  • Severe mood swings that cause problems in relationships.

The Shaping Game

Source: Strayhorn, Joseph (1988). The Competent Child. New York, The Guilford Press.

The Shaping Game is a cooperative game that teaches children how to listen for positives and follow directions, models positive talk which the child can use to guide their internal dialogue, and teaches parents the concept of “catching their child being good.”

In the shaping game there are two players, a Shaper and a Shapee. The Shaper (the therapist is the first Shaper) writes a target behavior on a piece of paper and shows it to the parent, or anyone else in the room. The Shapee (client) doesn’t get to see what is written on the paper. The object of the game is for the Shapee to guess what is on the paper.

The Shapee is guided by feedback they receive from the Shaper. Success is dependent on the Shaper giving good clues and the Shapee doing a good job of listening and trying out lots of different movements and behaviors in the room. Therefore, this is a partnership, both win or both lose. It is important when starting this game to start with a really simple behavior that will ensure success. When outlining the rules and the object of the game, it is important to stress that the Shapee has to keep moving. The therapist should get up and model moving around the room, touching things, picking things up, opening and closing the door, and flicking the light switch off and on.

The Shaper is limited to positive comments, and can’t use words like “hot”, “cold”, or “you’re close”. Positive comments include: “I like the way you’re ______,” “Thank you for _____,” “I really like the way you’re getting close to _____,” “You’re doing a good job of _____,” “I appreciate you touching _____,” and so on. The Shaper can be very specific about the behavior that they like.

The Shapee must keep moving and trying different things. If the Shappee doesn’t do anything the Shaper won’t be able to provide any positive feedback. The Shaper may only comment on a behavior that has actually been carried out. For example, the Shaper can’t say, “It would be really nice if you’d touch that box.” No corrective or negative comments are allowed.

This is a fun game to play with parents. However, it is important for the therapist and client to have had clear success with the game before parents become the Shaper. Many parents, even after viewing the game several times, have difficulty resisting the urge to give corrective responses or make negative comments. Others have difficulty generating positive statements. The Shapee is allowed to be a Shaper when they have demonstrated success at being a Shapee. For example, performing a very complex activity, or performing the target behavior 6 or 7 times. Make sure the child understands they need to choose a behavior that is both doable and simple the first time they are the Shaper.

EXAMPLE OF THE SHAPING GAME
The therapist writes “pick up the tissues” on a piece of paper and hands the paper to the parent. The tissues are located on an end table about six feet from the child.

Therapist: Are you ready.
Client: Yes.
Therapist: OK, so you’re going to keep moving around and trying different things, and listen carefully to my clues.
Client: Yes
Therapist: OK, let’s begin (T. looks expectantly at the child and waits, child stands up). Thanks for standing up. I’m really pleased you did that (child looks around the room and hesitantly begins to walk). You’re doing a good job of walking. I really like it when you walk around (child walks away from the end table where the tissues are located. The therapist is silent until the child turns around). I’m very pleased you turned around (child walks in the direction of the end table). Thank you so much for walking toward the table. You’re doing a nice job of getting close to the table (child arrives at the table, and looks at it). You’re the best. I am happy you’re next to the table, and you’re doing a good job of looking at things on the table (child touches clock, and then the tissues. Therapist and parent begin cheering and clapping their hands). What do you think was written on the paper?
Client: Pick up the Kleenex?
Therapist: Check it out. Look and see what it says.
Client: “Pick up the tissues.”
Therapist: Great job. That was really easy for you. Do you want to do it again?
Client: Give me a hard one!
Therapist: Ok, I’ll give you one that’s harder (The next item should be only marginally more difficult, as the therapist still needs to ensure the child is successful. Ideally, the level of difficulty will keep pace with the child’s growing skill at the game, and they will always be able to perform the behavior requested.)