Getting children and teens to actively practice Exposure and Response Prevention (ERP) and to stop doing rituals can be challenging. If you face this challenge, there are basically two types of consequences to give.
Positive consequences can reinforce a desired behavior and are best to try first. Example: If a child does his homework every day, he can earn an extra hour of screen time. Negative consequences teach a child to make a good choice. Example: If homework isn’t done, then you lose your phone for a day. Consequences work well when children realize that they have more to gain by eliminating the negative behavior (such as a compulsion, avoidance, or seeking reassurance). Children also respond well to behavior charts, earning stickers or extra privileges for good behavior.
Consider these tips for how to give consequences that will work!
1. The consequence of losing a privilege has to be of great importance to the child to be effective. It has to be something they truly want and desire so that they learn to make a better choice. Take time to find out what your child or teen really treasures (phone time, video games, shopping, time with friends, a specific meal, “movie night,” etc.). Asking them what they think a good consequence would be can be helpful and often surprising!
2. Consequences should be immediate, and, the younger the child, the more immediate. Example: A young child will respond to smaller, more frequent rewards such as earning a sticker for each session of ERP. Stickers can accumulate to a larger reward. Consequences should also be natural. For example, if the child is playing with a toy and doesn’t follow directions, they lose the toy for a short amount of time. For a teen, it might be harder to pick the consequence immediately. It is okay to take time to think about what would be the best consequence. This gives you time to consult with significant others if needed.
3. Parents must be consistent in delivering consequences and reinforcement. When parents say consequences are not working, I often ask about consistency. Children are most likely to continue an unhealthy or unwanted behavior when they learn that parents might give in or forget to follow through with a specific consequence. This can be hard due to the fact that when they are delivering consequences, parents are impacted as well. Example: Parents who shut off the WiFi for a day after their child did not follow through with their ERP homework or clear instructions on response prevention will also miss out themselves. Parents might be impacted on an emotional level, too. Simply put, it can be distressing to parents to witness their child struggle with anxiety or an angry outburst as the child is trying to resist engaging in a ritual–and that can make it even more challenging for the parent to remain consistent with following through with consequences. This is why it is so important for families to remember that resisting urges to engage in compulsions is the key to overcoming OCD, even if numerous people within the family are experiencing heightened emotions as they go through the process of ERP.
4. The degree or size of the consequence is important to consider. If a child doesn’t comply, the consequence should be in proportion to the violation. Example: If a child doesn’t engage in homework, they don’t earn a sticker toward a reward or lose phone privileges for the day. If the consequence was to lose the phone for a month, the child may feel frustrated and lose hope. It is also key that all significant others work as a team in decision making around delivering consequences.
5. Finally, vary the consequences. If you are only always taking away the phone, the child/teen might not care after a while. Mix it up.
Remember the following: How can we help this child improve? What do they need to understand? Do they need to learn healthy skills? Be calm and consistent and explain why the consequence is happening. Explain your rules and what you expect. You can also have a system of earning back time for positive behavior, or if they can role play a more constructive way to manage an ERP exercise after one has not gone well. If the above factors are present, chances are you will have a good system of delivering consequences and changing your child’s compulsive behaviors!