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Appendix - Client Reproducible Worksheets


Test | Table of Contents

Track 1 Shaping Attentional Styles
#1 Sharing Attention
Engage in joint activities with your child.  Foster his or her attention within a sharing relationship.

#2 Recognizing the Fear of Failure
If your child, upon experiencing frustration or failure, decides he or she is finished with that activity, he or she may be afraid of failure.  Try to point out to your child the elements of the situation that are not his or her fault or were inevitable, and provide lots of encouragement.  Often, children who move on because of frustration or a sense of failure also feel like no one wants to spend time with them.  This can set up a vicious cycle in which the child takes control of the anticipated rejection by distancing him- or herself or by trying to be rejectable through his or her behavior.

Track 3 Equivocal Statements
#1 Common Indirect Statements
One communication barrier between parent and younger child is that the parent says one thing, but the child hears another.  For example, if the parent says, "What did I just say?!" the question may need to be followed by a direct command.  Otherwise, the child could be confused, possibly leading to further acts of violence and acting-out.

#2 Using Emotion as a Communicator
When you use anger to try and manipulate your child, you may be fueling his or her own feelings.  His or her acting out might be a manifestation of his or her own anger or confusion.  The child may begin to interpret anger as a way to manipulate others and get his or her way.

Technique: The Anger Inventory
With a list of common anger triggers, rate them with the numbers one through five:  one meaning the situation does not make you angry at all and five meaning the situation makes you extremely angry.  Some of the situations include the following:
                You ask your child to do something and he or she won’t do it.
                Your child complains.
                Your child does something that bothers you over and over again.
                Your child gets into something he or she is not allowed to.
                Your child screams and yells at his or her sisters and/or brothers.
                Your child makes too much noise when you are busy working or talking.
                Your child won’t answer you when you ask him, or her, a question.
If a 3 or higher is marked often on the list, you may want to consider looking into anger management therapy.

If your child disobeys or defies your instructions, commands, or rules in any of the following situations, circles Yes, then circle the number that reflects how severe your anger is in that situation.  If not, circle No.  Then add up your Yes answers you circled, and calculate the average severity rating of your anger. 

Situations

Yes/No

Mild

 

 

 

 

Severe

While playing alone

Yes

No

1

2

3

4

5

6

7

8

9

While playing with other children

Yes

No

1

2

3

4

5

6

7

8

9

At mealtimes

Yes

No

1

2

3

4

5

6

7

8

9

Getting dressed

Yes

No

1

2

3

4

5

6

7

8

9

Washing and bathing

Yes

No

1

2

3

4

5

6

7

8

9

While you are on the phone

Yes

No

1

2

3

4

5

6

7

8

9

When visitors are in your home

Yes

No

1

2

3

4

5

6

7

8

9

While visiting someone else

Yes

No

1

2

3

4

5

6

7

8

9

In public (restaurants, stores, church, etc)

Yes

No

1

2

3

4

5

6

7

8

9

When the other parent is home

Yes

No

1

2

3

4

5

6

7

8

9

When asked to do chores

Yes

No

1

2

3

4

5

6

7

8

9

When asked to do homework

Yes

No

1

2

3

4

5

6

7

8

9

At bedtime

Yes

No

1

2

3

4

5

6

7

8

9

While in the car

Yes

No

1

2

3

4

5

6

7

8

9

When with a babysitter

Yes

No

1

2

3

4

5

6

7

8

9

 

 

 

 

 

 

 

 

 

 

 

 

Total number of problem situations:

 

 

 

 

 

 

 

 

 

 

 

Mean severity score of your anger:

 

 

 

 

 

 

 

 

 

 

 

Tracks 6 and 7 The Five Minutes Technique
The 5 Minutes is a simple yet highly structured communication technique designed to provide children and adolescents with a reliable ongoing experience of genuine parental interest in their feelings, experiences, opinions, and desires.  The 5 Minutes should be private and uninterrupted, a daily occurrence, it should not compete with any other activity, and there should be no touching, so the child’s space is respected.

Track 9 Communication Problem-Solving
There are six steps to this problem-solving method.  First, talk to your child about his or her feelings and needs.  Second, talk about your own feelings and needs.  Third, brainstorm all possible solutions without judgment.  Fourth, eliminate solutions that aren’t mutually agreeable.  Fifth, try to pick the best solution of combination of alternatives.  Sixth, develop a plan for implementation and evaluation.

Track 10 Blowing Up at Children
Technique: The Parental Anger Survey
In this technique, there is a list of eighteen possible trigger thoughts associated with high levels of anger.  These are grouped into three main categories, including assumed intent, magnification and labeling.  Examples of trigger thoughts include "You’re defying me," "I can’t stand it" and "You’re so selfish."

Look back on recent events, and try to recall which of the trigger thoughts in the list he might have used during any of those episodes.  Try to pay particular attention to any trigger thoughts you have had on more than one occasion.  You may use many different trigger thoughts depending on the situation or a very few may see to come up over and over again.  Put a check mark next to the triggers that you remember having at least once.  If any of the trigger thoughts stand out as ones that you’ve used often, mark them with a star.  You might want to give these thoughts specific attention as you learn more about identifying and changing your thinking patterns in stressful situations.

Track 11 Three Misdirected Goals
Technique: Reinforcement
Draw a line down the center of piece of paper and write your child’s most aggravating and common misbehaviors on the left side.  On the right side, write your responses to each behavior.  Think carefully about what parts of your responses might be rewarding to your child.  Next, reflect on what other rewards might exist for the misbehavior.  Perhaps your child reduced his or her anxiety, got attention from friends or was able to avoid something unpleasant.  Maybe the behavior was fun or allowed him or her to be closer to you.  Finally, are there any consequences to each behavior?  If not, then there would be no reason for your child to stop it.  If consequences are only intermittent, he or she still might take the chance, thinking that he or she could escape a strong response this time.

Track 12 Building Assertive Parent-Child Communication
There are 3 parts to an assertive message.  First, identify feelings other than anger elicited by your child’s behavior.  Write down brief descriptions of 3 situations where your child has misbehaved, and next to each write a feeling other than anger that you felt at the time.  Second, try to identify why your child’s behavior affects you the way it does.  Review the 3 situations you wrote down and the feelings you felt in each instance.  Then write a brief explanation of why your child’s behavior affected you in those ways.  Third, describe what you want from your child in each particular situation.  Try to be as clear and specific as possible.

Track 13 Assessing the Effects of Anger on Your Child
#1 Looking for Danger Signs
There are a few behaviors that are commonly seen in children who are being negatively affected by parental anger.  If your child is afraid to try new things, abusive with other children or siblings, seems depressed or lethargic, resists spending time with you, has problems in school, displays low self-esteem or appears to have little empathy when relating to people who are hurt or sad, these behaviors may be red flags indicating a problem.  While these behaviors are commonly associated with children who experience high levels of parental anger, your child might have other problems not related to anger at all.

#2 Talking to Your Child
Perhaps the best way to assess the effects of anger in your parent-child relationship is to ask direct questions of your child.  This method is limited to children who are older and both able and willing to express their feelings.  Try asking questions such as, "Is it scary for you when I get angry?" "Do you feel bad about yourself when I’m angry with you?" "Does your bad feeling last a long time?" "Do you wonder when I’ll get angry?" "Do you know things that get me angry, or is it usually a surprise, where you never know what will upset me?" "When I get angry at you, do you feel scared that I’m going to hurt you?"

 

Track 12 Building Assertive Parent-Child Communication
Technique: Child Dissociative Checklist

Child Dissociative Checklist (CDC), Version 3
Frank W. Putnam, MD

Date: _________________        Age: ______        Sex:   M      F                          Identification: _______________

Below is a list of behaviors that describe children. For each item that describes your child
NOW or WITHIN THE PAST 12 MONTHS, please circle 2 if the item is VERY TRUE of your
child. Circle 1 if the item is SOMEWHAT or SOMETIMES TRUE of your child. If the item is
NOT TRUE of your child, circle 0.

0     1     2      1. Child does not remember of denies traumatic or painful experiences that are know to have occurred.
0     1     2      2. Child goes into a daze or trance-like state at times or often appears "spaced-out." Teachers may report that he or
                                she  "daydreams" frequently in school
0     1     2      3. Child shows rapid changes in personality. He or she may go from being shy to being outgoing, from feminine to
                                masculine, from timid to aggressive.
0     1     2      4. Child is unusually forgetful or confused about things that he or she should know, e.g. may forget the names of
                                friends, teachers or other important people, loses possessions or gets easily lost.
0     1     2      5. Child has a very poor sense of time. He or she loses track of time, may think that it is morning when it is
                                afternoon, gets confused about what day it is, or becomes confused about when something has happened.
0     1     2      6. Child shows marked day-to-day or even hour-to-hour variations in his or her skills, knowledge, food
                                preferences, athletic abilities, e.g. changes in handwriting, memory for previously learned information such as
                                multiplication tables, spelling, use of tools or artistic ability.
0     1     2      7. Child shows rapid regressions in age-level behavior, e.g. a twelve-year­ old starts to use baby-talk sucks thumb
                                or thaws like a four-year old.
0     1     2      8. Child has a difficult time learning from experience, e.g. explanations, normal discipline or punishment do not
                                change his or her behavior.
0     1     2      9. Child continues to lie or deny misbehavior even when the evidence is obvious.
0     1     2     10. Child refers to himself or herself in the third person ( .g. as she or her) when talking about self, or at times
                                insists on being called by a different name. He or she may also claim that things that he or she did actually
                                happened to another person.
0     1     2      11. Child has rapidly changing physical complaints such as headache or upset stomach. For example, he or she
                                may complain of a headache one minute and seem to forget about it the next.
0     1     2      12. Child is unusually sexually precocious and may attempt age-inappropriate sexual behavior with other children
                                or adults.
0     1     2      13. Child suffers from unexplained injuries or may even deliberately injure self at times.
0     1     2      14. Child reports hearing voices that talk to him or her. The voices may be friendly or angry and may come form
                                "imaginary companions" or sound like the voices of parents, friends or teachers.
0     1     2      15. Child has a vivid imaginary companion or companions. Child may insist that the imaginary companion(s) is
                                responsible for things that he or she has done.
0     1     2      16. Child has intense outbursts of anger, often without apparent cause and may display unusual physical strength
                                during  these episodes.
0     1     2      17. Child sleepwalks frequently.
0     1     2      18. Child has unusual nighttime experiences, e.g. may report seeing "ghosts" or that things happen at night that he
                                or she can’t account for (e.g. broken toys, unexplained injuries).
0     1     2      19. Child frequently talks to him or herself, may use a different voice or argue with self at times.
0     1     2      20. Child has two or more distinct and separate personalities that take control over the child’s behavior.


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