Cupids Health

Using the science of “Self Monitoring” to help children and teens to change their behaviour — Developing Minds



I’ve recently been undergoing physiotherapy rehabilitation after having tendon surgery.  At my first visit, the physio had me download an “app” which lists my daily exercises, uses an alarm notification to remind me to complete them and has a “tick off” function for each exercise after I complete them daily.   I’m an old hand at rehab and so am generally committed to doing it consistently, but having a visual record of exercise completion over a week in this app has provided extra incentive make sure I don’t miss any days. 

What this clever app is doing is encouraging me to do a form of what psychologists (and others) call “self monitoring”.

Self monitoring is simply paying attention to a specific aspect of our life – usually a behaviour or a mood – and regularly recording whether or when that behaviour or mood happened. 

Self monitoring has been used for decades by psychologists (and other health professionals) to help people change something about their life or emotions.  For example, we might ask people to record – on a daily basis – their mood on a scale of 1-10, how often they used a helpful or unhelpful coping strategy, what they ate, how often they got angry, how often they practiced a meditation task, their thoughts in a difficult situation, their worry behaviours, how often they drank alcohol – and many more types of behaviours. 

Child and adolescent psychologists use self monitoring with children and young people too.  I recently did a quick informal (anonymous) call out for examples from our 21 psychologists and here were some of the types of behaviours/thoughts some of our psychologists – just in this last month –  have asked families to record:

  • The number of times per week a teenager initiated conversation with a peer at school

  • The number of times a parent/caregiver thanked or said something positive to a child during the course of a day

  • The number of times a child used an “empathic” sentence showing understanding and compassion for someone in their classroom who was frustrating them

  • The number of minutes a teenager “focused” in a homework session each night before checking their phone

  • The number of times a child saw or thought about a bug (for a child with a bug phobia) over a week period.

  • The number of “Sad/Mad/Glad” experiences (using smiley faces emoticons) at the end of the day

  • The number of hours a child was able to stay in the classroom each day without getting overwhelmed and needing to leave

  • The number of times a teen used a self harming behaviour during a 2 week period.

  • The number of minutes a child stayed in their own bed before coming into Mum’s.

Why would noticing and recording what happens be helpful? 

We have found that self monitoring can be an effective way of changing young people’s behaviour, mood and the situations in their life –even if they do nothing else to change or manage that behaviour or situation.  In other words, there is something about just “noticing” what happens, which changes what happens.

There are a number of theories as to why this is the case.

Firstmonitoring our behaviour helps us pay attention to and therefore learn about a) the causes or triggers for and b) the consequences of that mood or behaviour.  For children and young people in particular – who might not have as much information about triggers and effects of emotions and behaviours as adults do – noticing this information can be can then help them change their behaviour.

*Hypothetical Example:  Yasmin, 6 – with the help of her Dad, monitored how often and how much she got upset (on a 1-10 scale) in the morning about going to school over one week.  Yasmin noticed that on Tuesday and Friday she had much higher scores, which were both days she had PE.  They realized Yasmin needed some specific strategies to manage that lesson.

Secondmonitoring behaviour often helps increase our feelings of personal responsibility and sense of control over that behaviour.  For children and young people in particular – who are often especially keen for and responsive to feeling independent –  this can lead to better mental health and well-being in general.  This then can positively affect their behaviours and mood. 

Hypothetical Example:  Georgia, 13 – who was struggling with friendships at school, monitored how many times she started a conversation with someone in her year level, over a two week period.  While completing the record, Georgia felt increasingly hopeful – she felt as though she was “working on this problem” and her sadness and worry about this problem decreased.  At the end of this time, her confidence to make friends had increased – even though the number of conversations she had with others did not actually increase.

Thirdmonitoring our behaviour “tricks” our brain into thinking the behaviour is being observed; even though it may only be ourselves who observes it.  When we feel we are being observed, we are more likely to act in ways which are consistent with how we want to behave and feel – which makes us change our behaviour.  Sometimes, this can even be a subconscious process.

Example:  Ben, aged 9, who was having occasional wet beds overnight, kept track (with the help of his parents) of how many times he had a “dry bed in the morning” over 3 weeks.  Although Ben did not have any conscious control over his accidents, just keeping a visual record led to Ben’s dry nights steadily increasing over this time period.

Fourth if we monitor our behaviour and then see any even slight improvement then can leads to a big jump in conscious motivation to try to maintain this “improvement”.  For young people, they often get caught up in a sense of excitement and positive emotion about seeing something change and can help them make more changes.

Example:  Joshua,15, monitored how many minutes he could concentrate for in homework sessions after school before checking his phone over 3 nights.  He started trying to “beat” his record by the 3rd night, and looked forward to extending his record a little more each time.

Sounds like a good theory – but what does the research show? 

There have been many studies examining self-monitoring over the last few decades – both with adults and with young people – in areas related to education, learning, health and well-being –here are a just a few focusing on children/teens and mental health concerns specifically.

Bastiannsen et al (2018) asked teenagers to record their mood, daily activities and thoughts for 14 days and compared them to teenagers who only recording their daily activities.  Those who recorded their mood, thoughts and daily activities had a more significant reduction in depression than those who just recorded daily activities.  I suspect this might have been due to these teens learning more about their triggers and what helps them feel good.

A meta-anlysis by Trout and Schwartz (2005) of 16 studies looking at self monitoring in children with ADHD found that self monitoring of “off task” or “inattentive” behaviours reduced these behaviours in this particular group of children.

A review by Bruhn et al (2015) of 41 self monitoring studies in children with difficulties managing challenging behaviour found that in all 41 studies, there were improvements in challenging behaviours associated with the self-monitoring – including decreases in negative interactions with peers and increases in school work completion. 

It’s important to note that there is still more research needed about self-monitoring.  Some studies have found that self monitoring of some behaviours had no effect (for example, a study by Fernandez (2001) looking at self-monitoring episodes of “anger” in college students). 

I have also noticed that for some families, monitoring some behaviours can lead to increase in frustration or decrease in self-esteem – so this strategy is definitely not something we would use for every child/teen in every situation.

However overall, I think the research – and my own clinical experience – suggests that for many young people and in many situations self monitoring can often be a really useful way of helping young people act and feel positively in many areas of life. 

How to start in using self monitoring strategies to help your child or teen 

However, one of the best and easiest ways to start to use self monitoring with young people, is to monitor and change a specific, positive behaviour.   Here are some steps to take to do this.

1.    Identify a specific, positive target behaviour you and your child/young person would like to notice, work on or change. 

Note my emphasis on “specific” and “positive” in the sentence above. Unfortunately although it’s much easier to identify a general problem, self monitoring is about noticing a specific behaviour related to the general problem.    

Also, although again it’s often easier to identify what we think the child/teen should “stop” doing, monitoring often works better if we identify a “positive” behaviour we want them to increase – in other words, to start or do more of a positive behaviour which is the opposite of the “problem” behaviour.

It’s important to recognize that this target behaviour will not be the complete answer to the underlying problem.  However, if the behaviour is a positive one in the first place, then it often won’t hurt – and will sometimes be a great step towards broader progress.

If you need some inspiration for target behaviours, here are some examples:

General area of concern:  gaming.
One specific, positive behaviour:  Number of minutes the child/teen spends on physical activity each day

General area of concern:  separation anxiety.
One specific, positive behaviour:  Number of times the child says a cheerful goodbye in a week

General Area of concern:  remembering to do homework tasks in a timely way.
One specific, positive behaviour:  Number of times the child/teen looks at their diary/online learning management system/to do lists in during the course of a week

Area of concern:  conflict with siblings
One specific, positive behaviour:  Number of times child/teen says:  “let’s compromise” to their sibling

Area of concern:  depression/negativity
One specific, positive behaviour:  Number of times the child/teen says something positive about the day.

Area of concern:  Episodes of overwhelm/frustration/”melt-downs”
One specific, positive behaviour:  Number of times the child/teen used their (practiced in advance) “slow breathing strategy” during a 2 week period

If you are having difficulties thinking about a specific, positive behaviour, try this strategy:  Think about your general area of concern.  Then, thinking about this concern, visualize (yes, go ahead and close your eyes!) your child/teen acting in a way which you feel is healthy, and positive for them and others. What is your child/teen actually doing or saying?  Now pick one of those actions or sentences – that is your “target behaviour”. 

2.    Discuss the self monitoring with the child/teen

The word “self” in “self-monitoring” is crucial; we are trying to support young people to notice and change behaviour which they care about, for their benefit and not just ours as parents/caregivers.  This means we need to help young people understand and be invested in both wanting to make changes and secondly in recording how they are going.

Here are some sentences which might help engage older children/teens:

  • In a perfect world, would you be managing this differently?

  • Is there anything you think would be helpful for you, and for others – to be doing more of, or more often?

  • If you could pick one thing you might say or do more often which might make just a small “dent” in this situation, what would they be?

  • Here’s an idea (this is the time to share your idea for a target behaviour) – what do you think?  If you did more of this, do you think it would help you in the longer term or not?

  • Here’s an idea (again share your ideas) – would you be prepared to try an experiment to see if you might be able to do more of it?

  • I have read that just noticing how often we do something as humans, can help us do it more often – would you be prepared to do an experiment for a few days to see if this might help?

  • I would like to try us keeping a record of how many times this happens, to help me/you learn about how to make this better/easier for you – how do you feel about that?

And for younger children…

  • What could you do which would might make everyone feel happier?

  • What could we help you practice to help you feel better in this situation?

  • What is something you might do more often that

  • We are going to keep a record of how you are going, would you like to help me do that?

  • We are going to do some noticing of how often you can do this and this will help us learn.

3.    Set up practical and easy ways to record behaviour – and how long to do it for

I’ve learnt the hard way that if I set up a complicated and time consuming record sheet system with families, they invariably come back without having completed it!  Any system we use to record behaviour needs to be quick and easy.  A chart, notepad or other way of recording needs to be accessed quickly and easily.  In addition, we usually need to set up some kind of reminder/cue to have the child/teen do their recording, otherwise it will get forgotten. 

Here are some examples.

Pen and paper visible by the bed, with M/T/W/Th/F – and a space next to each one: before turning the light off, the child estimates the number of minutes of physical activity they did that day.

Piece of paper on the fridge with a series of boxes drawn on it, and a set of round stickers attached to the paper.  Child puts a round sticker in each box after a “dry night”.

Yellow sticky pad by the computer.  Teen writes down numbers of minutes of focused homework on one piece of the yellow sticky pad, peels it off and puts it on the wall or at the bottom of the yellow sticky pad.

Tracking App – in car on the way to school (alarm set at 8.15 as a reminder), older child/teen enters Y/N to having on their phone made a positive comment about their day, the previous evening (there are many variations of free tracking apps in app stores).

Notes section in parent’s phone – after dinner, child tells parent how many arguments they had that day and parent puts it in the phone.

A warning:  In my experience parents/caregivers normally have to gently take the lead on initiating self monitoring, as young people are often not overly interested.

Partly for this reason, it is a good idea to make self-monitoring a short term (for example 1-4 weeks) project.  In addition, the benefits of self monitoring often disappear anyway after more than a few weeks. 

4.    Decide on whether to have goals and acknowledgement for goals

Here is an important point:  Self monitoring does not have to involve goals or rewards.  In other words, self monitoring is not necessarily the same as a “star/reward chart” for the child/young person achieving a change in their behaviour.  In fact, sometimes having goals can increase anxiety and backfire for young people.

In other words, self monitoring can be just a “let’s watch and learn” approach than a “you have to get to this level” and “if you do get X, then you get Y” approach.

This is not to say we should never set goals or targets, or use “incentives” for any behaviours – but this is a slightly different type of strategy, and one which is the focus of another article.

If you are going to add targets/goals or rewards, please do watch out for two potential problems: 1) an increased pressure and anxiety which makes things worse, and 2) a decreased motivation for doing the behaviour once the rewards have been withdrawn.

5.    Review learnings and think about what is next

Once the period of self-monitoring is over, it is really important to review what the young person has learnt from the experience and to think about what to do next.

Here are some example review questions:

What did we learn about when this happened, what happened beforehand and what happens afterwards?
What did you learn about yourself, your life or your situation?
Is there anything you want to try next or do differently?

If you could continue to increase or decrease (the target behaviour) what would happen then?

Would you like to try to do this?

I hope this article inspires you to do some self monitoring within your family. 

Best wishes

Kirrilie

*The examples in this article are fictional – based on a mixture of the types of young people we have worked with in the past.

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Questionnaire and Free “When Life Sucks E-book” for Parents of 4-12 year olds

For many years, I have quietly (and sometimes not!) grumbled about the questionnaires psychologists have available to them to “track” the progress of kids learning skills to manage tricky life situations and big emotions.  I’ve finally decided to do something about this, and together with my partner Dr. Matt Smout (psychologist) at the Uni of SA have developed a new questionnaire to do this.  Unfortunately, he tells me (with his statistician hat on) that we need 600 parents/caregivers (entirely anonymously of course) to complete the (approximately 20 minute) questionnaire to see if it is a valid and reliable measure!!  I have no idea if we can get this many, but I’d love your help.  I’ve decided to send a free copy of my When Life Sucks for Kids e-book to everyone who completes the questionnaire.  Could you help?   If so, I would be most grateful.

Here is the link to the information about the questionnaire – please feel free to share widely to all parents/caregivers of 4 to 13 year old children (the child doesn’t need to be in therapy/have any particular challenges) and advertise the link wherever and however you like! 

Thank you so much:

https://developingminds.net.au/parent-questionnaire-study





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