Yesterday 5-year-old Angela attended her weekly physiotherapy session. Angela is a slightly built child, with a small pretty pixie face and a wonderful imagination world filled with fairies. She is is also hypermobile, is generally quite weak, does not like running or climbing on the monkey bars and her drawing is very immature.
Angela does not like putting effort into new and challenging tasks: she is very good at suggesting alternative things we can do instead of the more challenging ones that I suggest, particularly after the first 15 minutes of the session when she is starting to get tired and keeping going requires physical and mental effort.
Angela’s avoidance of challenging mental and physical tasks is typical behavior for the many young children whom I see for strength, flexibility and endurance training. Different children employ different avoidance strategies when faced with challenging tasks and parents will recognize one or more of the following tactics:
- Escape into imagination land: here the child is always in control and can choose what happens next
- Change the subject and start talking about something else
- Make suggestions for doing something else
- Simply refuse to participate: sit down and fold the arms, lie down on the floor, get into an argument
- Act silly, mess up doing the task;
- Start clowning to distract your attention
- Run away
- Whinge, whine or start crying
- Do what one asks, but not try very hard and give up quickly.
Motivation, self efficacy and effortful control
Engaging in challenging tasks requires a sense of self efficacy: the feeling that one has the resources and ability to do what is needed to achieve the goal. Self-efficacy is specific to the task: a child may feel competent and be very motivated doing some things and lack confidence and shy away from doing other things.
Self-efficacy is situation and task specific. Angela is a very good swimmer: In the water she is active and brave, diving under the water and swimming lengths of the pool. In the water her self motivation is strong. But when it comes to running and jumping, ball games and drawing she has no confidence in her own abilities at all. She gives up even before she has tried. She has very poor self motivation to work at these tasks.
Some things I do in a physiotherapy session to motivate a child
The first and most important thing is to set goals for an activity.
Children need to know what they are expected to do and what the goal of the task is. Decide how many times an activity needs to be repeated and how well is should be done to count towards a reward. Start with a few repetitions of an activity and work up to more repetitions.
The child also needs to know what the reward will be for achieving the goal. Children will often respond to a very simple incentive, that is immediate and can be seen.
I have two favorite ways of providing immediate rewards.
Me acting silly:
Most children think it is funny when I pretend to fall over or make silly gestures. So I will act silly after a successful each successful attempt and do nothing when the goal is not achieved.
The marble reward motivation
I have two small bowls, a blue one with ten marbles and a red one that is empty. Each time the child achieves a goal, we transfer one marble from the blue into the red bowl.
Once the child has the hang of the “game” I let the him/her to decide on how many marbles an activity is worth, and she gets to move the marbles herself.
I may also add a negative element to the game – whining, whinging or refusal may result in a removal of a marble from the reward bowl. This does not work so well with the younger children, but by the age of 6 children will usually respond by checking their avoidance behavior because they do not like the negative consequence.
It is important to be neutral about failed attempts. Cautious children with performance anxiety often respond to failure with a negative emotional response that may only register as an unpleasant body sensation. The unpleasant sensation may not be obvious even to the child but will have a negative impact on their behavior.
At the end of the session the child may receive a small reward if all the marbles have moved into the red reward bowl. But more often than not the child is quite satisfied with the positive feedback and sense of satisfaction that the goal has been achieved.
Angela working at doing big jumps
Today we are going to practice doing 5 big jumps between two big cushions. The exercise is to jump from one big cushion to the other, taking of from two feet and landing on two feet. Angela does not like doing big jumps. She complains that her legs will break if she jumps too much.
Because Angela is very reluctant to do this exercise, I need to make the reward for each jump instant: so each time she jumps landing on the cushion on two feet, I act silly. She finds this very funny - so keeps jumping to keep me going. She forgets herself and manages 10 jumps.
Angela's mom and I make a big fuss after the 10th jump: she has been very brave and worked hard and her muscles are feeling the burn from all the hard work.
Next week I will only act silly after 5 jumps as Angela starts to learn to be self motivated to achieve a goal that she finds challenging.
Beware of too much praise
Parents are sometimes so anxious about their child's failures and inability to perform a task, that they praise the child even when an attempt has failed and there has been very little effort.
Children know when they have succeeded and deserve praise. If a failed attempt leads to praise, praise becomes meaningless. It is not linked to outcome; it becomes noise.
Children also need to learn to evaluate their own actions: did I do a good job in this case? Sometimes a child will constantly look towards the parent to check for approval or affirmation that they have done a good job.