Hesperian Health Guides

A Behavioral Approach to Child Development and Learning New Skills

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HealthWiki > Disabled Village Children > Chapter 40: Ways to Improve Learning and Behavior > A Behavioral Approach to Child Development and Learning New Skills


In this chapter we have talked mainly about correcting ‘bad’ behavior. However, the behavioral approach can also be used to help children learn basic skills for their continuing development. The approach is often useful for children who are slow to develop—for either mental or physical reasons.

In Chapter 34 on child development, we introduced the key features of a behavioral approach: (1) make messages clear, (2) consistently reward things learned, and (3) advance toward new skills through small steps. You will also recognize this behavioral approach in the chapters on ‘feeding’, ‘dressing’, and ‘toilet training’. Here we would like to review ways of applying a behavioral approach to a child’s basic development and learning.

Looking at the whole child to decide where to begin

In considering how to help a child’s development, start by looking at what the child can and cannot do. In terms of behavior, we can group our observations into 4 sections:

someone speaking to a child.
Good boy!
  • Positive behaviors: Skills and characteristics the child now has—particularly those that may help him in learning something new. (For example, he enjoys being praised.)
DVC Ch40 Page 358-2.png
  • Negative behaviors: Things he does that are dangerous, disturbing, or prevent his progress. (For example, breaking things, hitting people, screaming when bathed, throwing toys rather than playing with them.)
DVC Ch40 Page 358-3.png
  • In-between behaviors: These have both positive and negative aspects, and need to be worked with to make them more positive. (For example, for a child who is beginning to feed herself, but who smears food all over: we encourage feeding herself (which is positive), but not smearing (which is negative). Even screaming or crying in order to express a need might be considered positive for a child who has great trouble communicating. We need to help this become more satisfactory communication.)
DVC Ch40 Page 358-4.png
  • Key needs: These are problems in the child’s behavior that need to be solved to make progress with learning. They differ depending on the stage of development. (For example, for a child to learn from his mother, he needs to respond to his own name, to look at her when she speaks to him, and to stay still and give attention for at least a few seconds. These ‘key needs’ suggest the first steps in learning to speak, play, or develop new skills.)

It may help to write a list of these different behaviors. Here is a list that a little girl’s mother made with the help of a village health worker who studied this book.

Child: Celia
Age: 4
POSITIVE BEHAVORS
— ones she now has that we can build on
IN-BETWEEN BEHAVIORS
— ones that have both good and bad points.
NEGATIVE BEHAVIORS
— ones that prevent her progress or disturb the family.
Celia yelling while she holds a bottle and kicks someone.
NO!
  • smiles when praised
DVC Ch40 Page 359-2.png
  • plays only a moment with toys—then throws them
  • kicks people when she gets upset
  • can feed herself with her fingers
  • says ‘pee-pee’, then wets her panties
DVC Ch40 Page 359-4.png
  • carries around a baby bottle all the time, and screams when it is taken away
  • spits her food at others
  • can put 3 rings on a page
DVC Ch40 Page 359-3.png
  • undresses herself
  • enjoys rough play
  • enjoys being bathed
  • says 6 words: mama, dada, bottle, sweets, pee-pee and NO!
  • will not sit still for a minute — except for food
DVC Ch40 Page 359-5.png

KEY NEEDS (in order that new skills and behavior can develop)

  • sitting down and giving attention for a longer time
  • getting rid of the baby bottle to free hands for other things.

Deciding where to begin

After they listed these behaviors and considered Celia’s key needs, the health worker helped her mother plan where to begin. He explained that, since we cannot change everything at the same time, we need to decide what things need to be done first (choose priorities for action). So we choose the behavior we most want to introduce or change.

  • If we are trying to introduce a new behavior or skill, we need to think of all the different parts that make up the behavior. Next we plan the separate small steps that lead to the skill. We encourage the child to advance step by step, making clear what we expect for each step and consistently giving praise and small rewards.
  • To improve an ‘in-between behavior’, we can help the child by working with a skill she has already developed a little. First we need to think about the various parts of her behavior that concern us. Then we decide which parts seem helpful and which do not. We then reward the good behavior and ignore the bad. As the child gradually improves, we can expect more of her before giving a reward, until the whole improved behavior is achieved.
  • If we are trying to reduce or stop an old behavior we need to do 2 things. First we note when and where the behavior happens, and what happens before, during, and afterward. We observe carefully both what the child does and what we ourselves do. Second, we try to guess what the child gains from her ‘bad’ behavior. We can then try to change things so that ‘good’ behavior is more worthwhile than the ‘bad’. To do this we reward the new ‘good’ behavior and refuse to give attention for her ‘bad’ behavior.


Thinking about Celia’s behavior, her mother realized that she already has the beginnings of many valuable skills. She uses her hands well and has begun to develop skills for feeding and dressing herself. She also speaks a few words — although it would be nice if she could say “yes” as well as “no.”

Celia's mother speaking to her.
Good girl!

It is important that she likes praise and hugs, and bathing, and rough play. This means she will probably learn well with a reward-based approach.

DVC Ch40 Page 360-2.png

However, certain things seem to be stopping Celia from developing her skills more. Not being able to sit still and give attention makes it hard for her to learn from other people, or even to learn to enjoy her toys (which she always throws). Also, her baby bottle is a big problem. She is much too old for it, but her mother is afraid to take it away because Celia screams. Her mother fills the bottle with sweet drinks (which have already begun to rot Celia’s teeth). The biggest problem is that by always holding her bottle, Celia’s hands are not free to do other things—such as play with her toys or take down her panties when she has to pee-pee.

For these reasons, Celia’s mother decided that the ‘key needs’, which need to be solved in order to advance in other areas, are:

  • helping Celia learn to sit quietly and give her attention to something
  • helping Celia grow out of her need to always hold her bottle


The health worker discussed with Celia’s mother what she might do. To help Celia learn to sit quietly and pay more attention to things, her mother decided to start with the times when Celia was already willing to sit fairly quietly—which was mealtime and bathtime. For example:

After giving Celia her food, but before her final ‘sweet’, her mother or her older brother, Oscar, plays quietly with her for 5 minutes or so, praising her whenever she gives attention. Her mother also uses bathtime as an opportunity to help her concentrate on toys and to give attention to words and sounds.
Celia and her brother speaking while they play with a doll.
Pee-pee.
That's right! Dolly has to go pee-pee! Help him pull down his pants.
Good girl!
Tell Dolly he is a good boy!
Say "Good boy."
Celia's mother speaking with her while she sits in a tub.
The boat goes Brrrr.
BRRRRR
Good girl!
Now you wind it up!
Good Celia! Now watch it go!


Celia's mother speaking while Celia screams and kicks her.
No, I am not going to fill your bottle. But if you are quiet I will give you a nice glass of lemonade.
If you kick me again, I will have to ask you to stand outside again, for 5 minutes.

Celia’s mother decided to help her outgrow the bottle little by little. For a start, she filled it with water only. After a few days, she refused to fill it at all.

At first Celia screamed and kicked. But her mother did her best not to give Celia any attention when she acted that way. As soon as Celia was quiet, however, she would give her a tasty drink from a glass, or some other reward.

Sometimes Celia would throw her empty bottle in anger. But after a while she began putting it down, more and more often, to pick up other toys or objects. Finally, her mother simply removed the bottle from sight.

After Celia had forgotten her bottle, she started to explore more with her hands. When she needed to go ‘pee-pee’, she began to lower her panties by herself; in a few weeks she was ‘toilet trained’. She also began to play with her toys more, instead of just throwing them. As she learned to give longer attention to things, she discovered lots of things that gave her pleasure. Many of her behavior problems such as screaming, spitting food, and kicking began to disappear. Her mother, father, and brother spent more time playing and talking with her. They praised her when she behaved well, and did their best to ignore her ‘bad’ behavior.

DVC Ch40 Page 361-2.png

Where it seemed necessary, her mother began to use a behavioral approach to help Celia develop other skills: dressing, eating, and talking. To increase her language skills, together they looked at picture books and listened to songs.

As a result of her family’s efforts, Celia has grown up a lot, and is a much happier and more able little girl. Thinking about the changes that took place, her mother said, “I think my behavior has changed as much as Celia’s. I was still treating her like a baby—bottle and all! Now that I expect more from her and show her how much I appreciate her effort, she has developed a lot faster, and is a lot easier to live with. She and I have both come a long way!”

Examples or methods for helping children develop basic skills using a behavioral approach are discussed in other chapters: Feeding, Chapter 36; Dressing, Chapter 37; and Toilet Training, Chapter 38. We suggest you also read again the chapter on child development, Chapter 34, and consider how a behavioral approach can be useful for helping a child through many difficult areas of development.


This page was updated:21 Nov 2019