Henry Laviguer - The Use of Siblings as an Adjunct to the Behavioral Treatment of Children

BEHAVIOR THERAPY 7, 602--613 (1976)

The Use of Siblings as an Adjunct to the Behavioral Treatment of Children

in the Home with Parents as Therapists

HENRY LAVIGUEUR

Concordia University

The use of a sibling as a therapeutic aid to home parental management of a disruptive child was investigated in two families, using a multiple baseline technique. Having both siblings and parents act as therapists is advantageous in modifying a child's disruptive behaviors when inappropriate behaviors have a history of sibling reinforcement. However, in one of the families the undesirable behaviors of the target child were inappropriately attended to more frequently by his parents than by his sibling. The appropriate behaviors of the treated child appeared to be manipulable by parental treatment alone in both families. The sibling behavior modifier exhibited improvement in the specific behaviors which he treated in the target child. A more generalized reduction in the sibling's inappropriate behavior occurred in the family in which the sibling was a more consistent behavior modifier. In the family wherein the sibling was inconsistent in his performance as a therapist, a correction in the preferential parental attention to the target child (which had resulted from treatment) recovered his performance. Sibling relations improved concomitantly with the sibling's treating the target child in a more positive manner.

The attention of a problem child's peer group may influence his be- havior more than similar stimulation provided by adults (Browning & Stover, 1971; Buehler, Patterson & Furniss, 1966; Patterson, Littman & Bricker, 1967; Patterson, Note 1). Furthermore, the effectiveness of using peers as behavior modifiers in institutional settings has been well dem- onstrated (Browning & Stover, 1971; Solomon & Wahler, 1973; Wahler, 1967; Weisen, Hartley, Richardson & Roske, 1967). To date, there has been no controlled home investigation employing children as change agents for their siblings.

This article is based on a part of a doctoral dissertation submitted to the Department of Psychology at the University of Illinois in 1973. Sincere appreciation is expressed to committee members Sidney Bijou, Frank Costin, Donald Shannon, and Ralph Swarr for their valuable contributions to this study. Special thanks are extended to Warren Steinman, who, as thesis supervisor, provided help and encouragement in bringing the research to completion. Requests for reprints should be addressed to Henry Lavigueur, Psychology Department, Concordia University, Sir George William Campus, Montreal H3G 1M8, Quebec, Canada.

602 Copyright 1976 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.

SIBLINGS AS HOME BEHAVIOR MODIFIERS 603

The "helper therapy principle" (Reisman, 1965) predicts advantageous consequences to anyone taking on a therapeutic role in the form of better adjustment and broadened perspective. Several studies specifically indi- cate the beneficial influence on the interpersonal and task-oriented be- havior of school children used as change agents for peers (Freeman, 1971; Hawkinshire, 1963). But why would the peer acting as a helper show increased adjustment? Pearl (Note 2) proposes that he develops "a stake in the system" and therefore feels it more necessary to follow the sys- tem's code. The stake in the system may be an increased return in attention to the peer who is placed in a therapeutic role of giving approval. Charlesworth and Hartup (1967) and Weiss (1966) indicate that the amount of social reinforcement given by an individual seems to be posi- tively related to the amount that individual receives from others. Thus, it might be predicted that using peers as change agents of disruptive be- haviors of another child should contribute to the reciprocity and mainte- nance of a treatment program.

The present study examines the use of siblings as therapeutic aids to home parental management (via positive reinforcement, extinction, and time-out procedures) of a child who is considered disruptive. We ask two questions: Is a treatment program which includes siblings as behavior modifiers more effective than parental treatment alone in modifying the behavior of a child designated as a conduct problem? What are the benefits to the sibling acting as a modifier?

METHOD Subjects. In each of two families, a target child was designated as a particular problem by

his parents. Another child, who acted as a therapeutic aid, was less of a conduct problem, although exhibiting some undesirable behaviors of his or her own.

Family A was a working-class, black family with two daughters. The parents complained that the 12-year-old target child was withdrawn and hostile, sarcastic and evasive, participat- ing little in household duties and activities. They described her 10-year-old sibling as being more extraverted, verbal, and a great help around the house. Family B was a white, upper-middle-income family with three sons, ages 10, 9, and 3. The father was a profession- al, the mother a housewife. The 9-year-old target child was described by his parents as rude, tense, and a demanding child. The 10-year-old sibling who served as a therapeutic aid was described as an easy-going child whose behaviors did not constitute a particular problem.

PROCEDURE An observation rating scale was employed within the home by two experimentally naive

undergraduate students. One was present during all intervention sessions, the second during about half the sessions to ascertain reliabilities. Observations were made only when all family members were present. Precautions were taken to minimize the reactivity of family members to having observers in the home (cf. Johnson & Bolstad, 1973, 7-67; Lytton, 1973). Several prebaseline visits allowed the families to habituate to the observers' pres- ence. To decrease their anxiety and embarrassment, parents were given a thorough expla-

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nation of the use of observation and informed that the observers were student research participants as opposed to experts in child rearing.

The behavioral categories presented in Table 1 were used to record the appropriate and inappropriate behaviors of the target child and sibling and the attention paid to these behaviors by the home therapists (the attention of both parents as well as the attention given by the sibling to the target child). Observers sampled three types of child-home therapist(s) interaction: target child-parent (both mother and father, each recorded separately) interac- tion, sibling-parent interaction, and target child-sibling interaction.

During 45 rain of continuous recording, each type of interaction was observed consecu- tively for only 3 min before sampling 3 min of each of the other two types. Five such sequences during each session provided 15 min of each of the three interactions. Rates of behavior for the target child during each session are based on 30 rain of observation whereas rates for the sibling are based on 15 minutes. A single occurrence of any behavior merited recording during a 20-sec observation interval, no matter what the duration of that occur- rence.

Therapeutic treatment of the target child was carried out by the parents and sibling under the direction of the experimenter. The study was divided into five phases:

Baseline: Ten sessions of parents, target child, and sibling interacting in their usual fashion at home.

Parental treatment 1. During the next five observation sessions parents were instructed and cued by the experimenter to reinforce one of the target child's appropriate behaviors, positive verbalizations, and to ignore or time-out one of his inappropriate behaviors, nega- tive verbalizations. Only in Family B were negative verbalizations sufficiently intense and disruptive to necessitate time-out.

During observation sessions, a "go-ahead" hand motion indicated to parents that they were to give the target child attention and praise. A "stop" hand motion signaled parents to withdraw their attention by avoiding body, eye, and verbal contact. The experimenter's pointing to the child's bedroom cued parents to use time-out, that is, to take the target child to his room. As parents learned to respond appropriately to the target child's behavior on their own, the cueing system was used less frequently.

At the end of each session parents were given specific suggestions (e.g., "Do not look at Johnny when he is muttering under his breath as this will tend to increase this behavior") or constructive praise (e.g., " I like the way you told Johnny to go to his room--you weren't overly emotional nor did you give him long explanations concerning what he did wrong").

Parental and sibling treatment I. During the next five sessions, parents continued to differentially reinforce (or time-out) the target child's verbalizations. However, the sibling was also instructed by his parents to attend to positive verbalizations and ignore negative verbalizations of the target child. With the experimenter present, the sibling was told that his brother (or sister) was currently having conduct problems which might get him in trouble and that the sibling could help him overcome these problems. The parents role-played positive and negative verbalizations and how the sibling should respond to these behaviors. It was emphasized that, in the future, the sibling might have similar problems and that the target child might then help him. Parents were encouraged to praise the sibling for carrying out his work, letting him know specifically how he was being helpful.

Parental treatment H. During the five sessions of this phase, the previous parental and sibling handling of verbalizations continued. However, the parents were now instructed and cued to reinforce a second appropriate behavior (offering help in Family A, helping in Family B) and to ignore (or time-out) a second inappropriate behavior (aggression in Family A, noncompliance in Family B). Again, Family A parents did not use time-out as the aggressive behavior of the target child, shoving and back-slapping of the sibling, was not sufficiently intense to disrupt family interaction.

SIBLINGS AS HOME BEHAVIOR MODIFIERS

TABLE 1 THE OBSERVATION RATING SCALE

605

Child row (target child or sibling): Inappropriate behaviors

(a) Negative verbalizations--rude verbalizations (e.g., "Shut up," "None of your business," "Who asked you?"); evasiveness in answers to parents' questioning; screaming (vocalizations louder than conversational level excluding sounds appro- priate to toys such as planes, guns, etc.)

(b) Noncompliance--not following orders; not responding (neither verbally nor by gestures) when spoken to. (This category was only employed in Family B.)

(c) Aggression--pushing someone else's property over or destroying it; hitting; kick- ing; shoving; pinching; slapping; attempting to strike; biting; pulling hair; but not: (1) striking oneself; (2) throwing ball, airplanes, or pillows (even at people) as these are play objects.

(d) Negative affect--crying; dragging feet and lowered head when these are not cus- tomary postures; making faces whether or not at others (typical of this would be frowning, sticking out tongue, pushing out lips in combination with squinting).

Appropriate behaviors (a) Positive verbalizations--all speech directed to another person which is not nega-

tive. (b) Spontaneous verbalizations--that non-negative speech which is not made in re-

sponse to another person's previous question, order, or statement and therefore initiates a new conversation.

(c) Helping--following orders or carrying out household duties, whether by request or spontaneously. (This category was only employed in Family B.)

(d) Offering help---a verbal proposal of help (e.g., "May I get it for you?", "I'11 do the dishes this time."); spontaneous initiation of a helping response. (This category was only employed in Family A.)

(e) Positive affect--smiling, laughing, singing, humming, dancing. (f) Playing--engaging in a pleasurable activity which involves cooperative interaction

with another child (e.g., playing ball, cards, building toy airplanes together but excluding television-watching and other such autonomous activities).

Therapist row(s) (mother, father, or sibling): (a) Negative attention--physical restraint or negative physical contact (hitting, strik-

ing, pinching) initiated by the therapist towards the child; critical verbal comments or high intensity verbalizations (yelling, screaming, scolding, or raising voice) directed towards the child; keeping child from doing activity, sending to room, use of time-out.

(b) Positive attention--praising the child; smiling at the child; initiating a play activity with the child; non-negative physical contact with the child.

(c) Neutral attention--all verbal attention (including orders and commands) to the child which is neither negative nor positive.

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Parental and sibling treatment H. All previous parental and sibling contingencies were still employed during this final five session phase. The sibling was now instructed and reinforced for attending to the second appropriate behavior and ignoring the second inap- propriate behavior of the target child.

RESULTS AND DISCUSSION

Reliability was calculated by dividing intervals of agreement between the two observers by intervals of agreement plus intervals of disagree- ment and multiplying by 100 (Bijou, Peterson, Harris, Allen, & Johnson, 1969). The interobserver agreement on each of the 13 categories ranged from 83 to 95%. Calculations were performed on data pooled from the 25 sessions in the two families during which a second observer was present.

Family A

The desirable behaviors of the target child, positive verbalizations and offering help, increased when attended to by her parents during Parental Treatments I and II, respectively (Fig. 1). One undesirable behavior of the target child, negative verbalizations, decreased only under the therapeu- tic manipulation of her sibling during Parental and Sibling I.

The sibling behavior modifier exhibited increases in positive verbaliza- tions and offering help and a decrease in negative verbalizations when she began to treat these behaviors (Fig. 2). No parallel change was noted in parents' attention to the sibling's behaviors during these periods. 1 Im- provements in the sibling's behavior appear to be the outcome of her acting as a behavior modifier, rather than an outcome of parental handling of her behavior.

When the sibling modified negative verbalizations in the target child during Parental and Sibling I, not only her own negative verbalizations but also her own aggression and negative affect 2 decreased. Again, it should be noted that there was no change in parental attention to these behaviors. The target child's negative verbalizations decreased con- comitantly with the sibling's treatment of this behavior but her aggression and negative affect only decreased concomitantly with parental treatment of the former behavior. This suggests that acting as a behavior modifier may be a more powerful treatment strategy for reducing generalized negative behavior than being the recipient of behavior modification efforts of significant others.

Tables indicating the percentage of the target child's and sibling's behaviors attended to (positively, neutrally and negatively) by other family members may be obtained in full from the author upon request.

2 Negative affect is not included in Figs. 1 and 2 since this behavior correlated with aggression in both the target child (r = .621, p < .005) and the sibling (r = .546, p < .005) over the 30 sessions of the study (Pearson Product Moment).

SIBLINGS AS HOME BEHAVIOR MODIF IERS 607

FIG. 1.

U

Z

0

Z

U

POSITIVE VERBALIZATIONS

. . . . . . . . . . ' . . . . ; . . . . . r . . . . . . . . . . NEGATIVE VERBALIZATIONS

I

~ I , ~t r . . . . . . . . , , 1 t . . . . . , ~ . -~" . . - - ~ J " ~ J , ~ ,

OFFERING HELP

AGGRESSION

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E S l~ TREATMENT TREATMENT.

S I O N S

Percentage of occurrence over time of the target child's behaviors in Family A.

During the final two treatment periods, during which no specific man- ipulation took place for the purpose of increasing their playing together, the two girls began playing more. Specific behavior improvements in both children generalized to play behavior which was not treated.

Family B

Unlike the Family A sibling, who consistently modified her interactions with the target child according to the treatment plan, the Family B sibling exhibited some reversal to baseline interaction during Parental Treatment II (Fig. 4). For example, during this period, he responded with negative attention to 5% of the target child's positive verbalizations (as compared to baseline and Parental and Sibling Treatment I rates of 5 and 0%, respectively). Nevertheless, most of the improvement in the sibling's behavior can be traced to his acting as a behavior modifier. The sibling exhibited increases in positive speech and helping and decreases in nega- tive verbalizations and noncompliance when he began to treat these behaviors.

The target child's positive verbalizations and positive affect increased during Parental Treatment I and his helping behavior increased during

608 HENRY LAVIGUEUR

Parental Treatment II, demonstrating that parental attention influenced the frequency of these desirable behaviors. However the target child showed most positive affect during Parental and Sibling Treatments I and II, those periods when the sibling reinforced him differentially for appro- priate behavior (Fig. 3).

In Family A, the sibling's acting as a behavior modifier led to an immediate decrease in all of the sibling's negative behaviors whereas the application of behavior modification techniques to the target child only decreased that negative behavior of the target child which was specifically treated. However in Family B the target child decreased all his aversive behaviors 3 (including noncompliance which continued receiving inap- propriate parental attention) simultaneously with parental treatment of negative verbalizations, whereas the sibling did not show less non- compliance, until the period when he acted as a behavior modifier for this behavior. One hypothesis is that the Family B sibling did not enact the role of behavior modifier as the Family A sibling had. In fact, as noted above, there was greater inconsistency in the sibling performance as a behavior modifier over time.

One contributing factor to this inconsistency may have been the marked preferential treatment of the target child which was noted in Family B once parental treatment began. For example, while during baseline the mother in Family B attended equally to the positive verbali- zations of both children, during the first three treatment periods she attended positively to 9% and neutrally to 56% of the target child's positive verbalizations while attending positively to only 1% and neutrally to only 18% of the sibling's positive verbalizations. When, upon the experimenter's request, parents equalized attention to the two children during Parental and Sibling II, the sibling regained his performance as an effective behavior modifier. Furthermore his positive affect, which had decreased to zero during the last two sessions of Parental Treatment I|, concomitantly with his reverting from therapeutic interaction with the target child, exhibited its highest frequency. Both children's play also increased.

It is also noteworthy that during baseline the Family A sibling rein- forced a much greater percentage of the target child's inappropriate behaviors than did the Family B sibling. The Family A sibling had at- tended neutrally to 60% and negatively to 50% of the negative verbaliza- tions of the target child whereas the Family B sibling had attended neutrally to only 17% and negatively to only 28% of the negative verbali-

3 Negative affect and aggression in both the target child (r = .594, p < .01; r = .672, p < .005, respectively) and in the sibling (r = .644, p < .005; r = .781, p < .005, respectively) were correlated with their respective rates of negative verbalizations over the 30 sessions of the study (Pearson Product Moment).

SIBLINGS AS HOME BEHAVIOR MODIF IERS 609

FIG. 2.

' I8 t ROSTVE VERBALIZATIONS= 40 i

U 20 0

. . . . . . . v i . . . . . . . . . . ' ' Z 20 ~ NEGATIVE VERBAUZATI NS I

16

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60

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BASELINE I ] I. H.

PARENTAL PARENTAL PARENTAL PARENTAL TREATMENT ~ SfBLING TREAT~'ENT = SIBLING

I. TREATMENT II. TREATMENT

S E S S I 0 N S

Percentage of occurrence over time of the sibling's behaviors in Family A.

zations of his brother. Meanwhile the Family B parents paid somewhat more attention to inappropriate behavior of the target child than did the Family A parents. This may be why the Family A target child's negative verbalizations did not decrease until treated by the sibling, whereas parental treatment alone was sufficient to eliminate all inappropriate behaviors of the Family B target child.

It is essential to take into account the family "dynamics" prior to home intervention. One cannot assume that any given technique will be equally effective when applied without knowledge of the agent's value as a social reinforcer. Nevertheless, employing the sibling as a behavior modifier led to improvement in the behavior of the helper as well as the interaction of the children in both families.

The rate of spontaneous verbalizations (those verbalizations not pre- ceded by others' comments) of the target child and the sibling in Family A, as well as of the target child and the sibling in Family B correlate highly and significantly with their respective rates of positive verbalizations over all 30 sessions. Thus, increases in verbalizations were not merely a result of increased parental elicitation of speech after treatment began.

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FIG. 3.

40 20

u 0 ,

IOO

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40

= 20 = 0

D20

u 16 12

U 8 4

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BASELINE

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TREATMENT tl. TREATMENT i

I I . S S t O N S

Percentage of occurrence over time of the target child's behaviors in Family B.

CONCLUSIONS

Having both siblings and parents act as home therapists is advanta- geous in modifying a child's disruptive behaviors when inappropriate behaviors have a history of sibling reinforcement. Undesirable behaviors may be inappropriately attended to more frequently by parents than by siblings in some families. Much of the literature suggests that the disrup- tive behaviors of a problem child are strongly reinforced by his peer group (Browning & Stover, 1971; Buehler et al., 1966; O'Leary & O'Leary, 1972; Patterson et al., 1967; Patterson, Note 1). However, these studies deal with institutionalized children and their peers who have been of- ficially labeled as deviant or disturbed. The present study deals with siblings within the home environment wherein the behaviors of concern are probably different both in type and magnitude as well as the differing function of adults (who are parents as opposed to mental health workers) in supporting these behaviors.

SIBLINGS AS HOME BEHAVIOR MODIF IERS 611

FIG. 4.

100 ~- POSITIVE VERBALIZATIONS

40

2O

20 NS ' U 16

Z 12

B

4

20 f HELPING

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Z 8

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l 10 II 1~ 16 2{}.21 25 26 30 BASELINE i

J I. l[.

PARENTAL PARENTAL PARENTAL PARENTAL TREATMENT + SIBLING TREATMENT ~ SIBLING

I. TREATMENT II. TREATMENT

S E S S I O N S

Percentage of occurrence over time of the sibling's behaviors in Family B.

The appropriate or prosocial behaviors of the treated child were ma- nipulable by parental management alone in both families.

The benefits accruing to the sibling have been consistently observed. Both increases in the specific appropriate behaviors he was instructed to attend to in the target child and decreases in the specific inappropriate behaviors he ignored were demonstrated. However a more generalized reduction in the inappropriate behaviors of the helper (as predicted by Reisman, 1965) occurred only in the family in which the sibling had been a greater dispenser of reinforcers in the first place and where he was proved to be a more consistent behavior modifier over time. Bolstad and Johnson (1972) indicated that children involved in self-observation and reinforce- ment decreased their disruptive classroom behavior to a greater extent than children who experienced externally managed reinforcement. A child's acting as a behavior modifier, which necessitates his monitoring his own behavior, may result in a more generalized decrease in his or her

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disruptive conduct than would the application of contingencies to specific behaviors.

In the family wherein the sibling was inconsistent in his performance as a therapist, a correction in the preferential parental treatment of the target child (which had resulted from treatment) recovered his performance. The highest rates of appropriate behaviors and lowest rates of inappro- priate behaviors were then observed. Furthermore the children played together more. Perhaps when they were no longer competing for parental attention, i.e., not jealous of each other, more amiable interaction was possible. Parents, worrying about the development of a particular child and putting much effort into helping him, may ignore other children in the family of whose adjustment they are more assured. Employing siblings as therapists, thereby getting them to cooperate in treatment, would seem to be one way around this problem. However, this study suggests that parents may have to be specifically instructed to avoid such pitfalls.

REFERENCE NOTES 1. Patterson, G. State institutions as teaching machines for delinquent behavior. Unpub-

lished mimeo paper, Child Study Center, University of Oregon, 1963. 2. Pearl, A. Youth in lower class settings. Paper presented at the Fifth Symposium on Social

Psychology, Norman, Oklahoma, 1964.

REFERENCES Bijou, S. W., Peterson, R. F., Harris, F. R., Allen, K. E., & Johnston, M. S. Methodology

for experimental studies of young children in natural settings. The Psychological Rec- ord, 1969, 19, 117-210.

Bolstad, O. D., & Johnson, S. M. Self-regulation in the modification of disruptive classroom behavior. Journal of Applied Behavior Analysis, 1972, 5, 443-454.

Browning, R. M., & Stover, D. O. Behavior modification in child treatment. Chicago: Aldine-Atherton, 1971.

Buehler, R. E., Patterson, G. R., & Furniss, J. M. The reinforcement of behavior in institutional settings. Behaviour Research and Therapy, 1966, 4, 157-167.

Charlesworth, R., & Hartup, W. Positive social reinforcement in the nursery school peer group. Child Development, 1967, 38, 993-1002.

Freeman, D. S. Effects of utilizing children with problem behaviors as modifiers for their peers. Dissertation Abstracts International, 1971 (July), 32, (l-B), 557-558.

Hawkinshire, F. Training procedures for offenders working in community treatment pro- grams. In B. Guerney (Ed.), Psychotherapeutic agents: New roles for nonprofession- als, parents, and teachers. New York: Holt, Rinehart & Winston, 1969.

Johnson, S. M., & Bolstad, O. D. Methodological issues in naturalistic observation: Some problems and solutions for field research. In L. A. Hamerlynnck, L. C. Handy, and E. J. Mash (Eds.), Behavior change: Methodology, concepts, and practice. Champaign, IL: Research Press, 1973.

Lytton, H. Three approaches to the study of parent-child interaction. Journal of Child Psychology and Psychiatry, 1973, 14, 1-17.

Patterson, G. R., Littman, R. A., & Bricker, W. Assertive behavior in children: A step toward a theory of aggression. Society for Research in Child Development Mono- graphs, 1967, 32, No. 5.

SIBLINGS AS HOME BEHAVIOR MODIFIERS 613

Reisman, F. The "helper" therapy principle. Social Work, 1965, 10, 27-32. Solomon, R. W., & Wahler, R. G. Peer reinforcement control of classroom problem

behavior. Journal of Applied Behavior Analysis, 1973, 6, 49-56. Wahler, R. G. Child-child interactions in free-field settings: Some experimental analyses.

Journal of Experimental Child Psychology, 1967, 5, 278-293. Weisen, A. E., Hartley, G., Richardson, C., & Roske, A. The retarded child as a reinforcing

agent. Journal of Experimental Child Psychology, 1967, 5, 109-113. Weiss, R. Some determinants of emitted reinforcing behavior: Listener reinforcement and

birth order. Journal of Personality and Social Psychology, 1966, 3, 489-492.

RECEIVED; August 26, 1974 FINAL ACCEPTANCE: September 30, 1975