Children/young people acting in ways which are (at least as perceived by adults) argumentative, aggressive, non-co-operative or deceitful has been labelled in many different ways by psychologists over the last 50 years - “externalizing behaviours”, behaviours of concern and challenging behaviours, to name a few.

Although all children and young people (and adults!) act in these ways sometimes and in some situations, these behaviours typically reduce (or are replaced by more socially acceptable methods of aggression!) gradually as children and young people mature.

However, a smaller proportion of young people (between 1-9%) have more persistently and more frequently or intensively challenging behaviour compared to others (and are sometimes provided with MH such as conduct disorders, ODD or other related conditions). Difficulties with challenging behaviours is the most common reason for referral to MH clinics (both in Australia and other countries).

What causes some children to have more difficulties with challenging behaviours than others?

There are multiple casual models, theories, and bodies of evidence we might draw upon as mental health professionals when we are trying to understand the contributing factors to challenging behaviour in children.

We might think about these theories and research in two ways – a) longer term causes and risk factors (more distal factors) and b) more proximal causes or triggers.

There are numerous areas of research and theoretical models about longer term causes and distal risk factors for challenging behaviour. They include those related to neurotoxicity, genetic factors, other biological/physiological factors (e.g., prefrontal cortex structure and function deficits, abnormal (e.g., cortisol) hormone processes, gut microbiome imbalance), past traumatic experiences, mental health diagnoses, neurodiversity, and environmental models citing chronic exposure to damaging environmental toxins such as chronic sleep problems, nutrition models, parenting/caregiver styles, exposure to community violence, peer influences, technology use and others.

Research and theories which relate to more proximal causes and triggers include models related to child distress (anxiety, overwhelm, fatigue, hunger, sadness), conditioning (reinforcement), hostile attribution styles (cognitive interpretation of a situation), social, emotional, executive or cognitive functioning deficits or skill gaps.

As mental health professionals, we understand of course that behaviour is multiply determined and that it is likely that a range of different causal factors will contribute to any one child’s challenging behaviours: in fact, there will be different causal factors for any one incidence of challenging behaviour, even within the same child.

Parents/caregivers understanding about the causes of their children’s challenging behaviours:

Parents/caregivers hold many different beliefs (or ‘attributions for’) about the causes of their children’s challenging behaviours – and they typically cite many of the factors listed above when asked about the reasons their children/young people struggle with disruptive and challenging behaviours.

There is a significant body of research examining how these different P/C beliefs about challenging behaviours relate to a number of constructs in child mental health – including how they relate to the frequency/intensity of child challenging behaviours, to parent/caregiver behaviours and parenting styles and to therapy child outcomes.

A large number of these studies examine the variation in parent/caregiver attributions for disruptive behaviours on a number of specific continuums including the following:

Whether the causes are:

a) internal (within the child - disability, personality, temperament, physiology) – or external (about the environment - parenting, a situation, other people).

b) global (the causes are broad factors – like disability or family environment) or specific (the causes are more narrow – like the child being tired or the presence of one friend)

c) controllable (the behaviours are consciously and deliberately carried out the child) or uncontrollable (impossible for the child to avoid)

d) stable (the child is likely to continue to act in that challenging way, acts this way in all situations and has always done so) – or variable (the child acts in different ways depending on the situation)

A number of studies have suggested parents/caregivers with beliefs/attributions which are primarily internal (it’s all caused by the child), global (the causal factors are very broad), highly controllable (the child did this deliberately and consciously) and highly stable (this is permanent), and for the sake of conciseness - these are sometimes referred to “negative/hostile” attributions - may be more likely to be problematic in a few ways.

Specifically negative/hostile parent/caregiver attributions about disruptive behaviours may be related to children acting in more challenging ways more frequently, to more harsh parenting behaviours and to poorer outcomes of therapy programs.

Conversely, there have also been some studies of children/young people with mental health/neurodevelopmental differences which suggest that when parents/caregivers have very low controllability attributions for challenging behaviours – that this too may result in poorer outcomes for children and parent behaviours (possibly more permissive or lax parenting).

It is important to note that this research is all correlational – and so we can’t say for sure that negative parental attributions are causing poorer outcomes for children. There are other possibilities, for instance:

Perhaps children with more frequent and intense challenging behaviours (or poorer mental health treatment outcomes) cause these parents to have more internal, global, very low/high controllable and stable attributions about their children’s challenging behaviours.
And perhaps these parental attributions are accurate for these children?
If either of the above is true, then these more frequent and intense challenging behaviours may also be causing the harsh/permissive parenting.
Other underlying factors may lead to the more frequent/intense challenging behaviours and the hostile attributions.

However, what is more compelling – are a small number of studies which find that parental/caregiver negative attributions for children’s challenging behaviour seems to predict more challenging behaviours in children over time. Furthermore, other studies conduct statistical procedures (erm, somewhat beyond me, apologies) which lead them to conclude that this parent negative attribution/increased challenging behaviour in children association is independent of either initial levels of challenging behaviour and independent of parenting behaviours in the intervening time period.

Interventions which attempt to alter parental/caregiver attributions:

Based on the above research, it seems reasonable to think it might be helpful for us as professionals to consider whether in some families – we might intervene and try and change their attributions. In other words, we should consider whether we assist some parents/caregivers to see their children’s challenging behaviours as having at least some external causes, being less stable, less global and possibly having moderately (nor very high, nor very low) controllability.

There has been a couple of studies which have attempted to add a component to behavioural parenting programs which specifically aims to shift parental attributions about their children’s difficult behaviours. One of these studies found that adding this component did lead to improvements in child outcomes, and a second study found it did not.

The lack of research means we probably need to make decisions about whether to directly address parental attributions based on our clinical judgement.

It has been my clinical experience that at least for some parents/caregivers – when they do start to see their children’s difficult behaviours as caused by a range of factors which are moderately controllable, caused by some external factors and changeable over time – that they then:

Feel compassionate and kindly towards themselves.
Act compassionately and kindly to the child.
Feel more positive about the possibility of the change in their parenting practices having a positive outcome on the child.
Be more likely to engage in therapy processes.

However, I have also found that directly targeting attributions is not appropriate for all families – and sometimes it is more efficient and effective to simply go directly to our usual child/parent interventions.

How might we assist parents/caregivers to change their views about contributing and causal factors of their children’s challenging behaviours:

If we do decide we should target parental/caregiver attributions, here are some steps to introducing these ideas to parents/caregivers which might be helpful for some families.

1. Ask about theories about causal factors

It might be important to ask parents/caregivers directly about their theories/reasons. For example, we might as the following types of questions:

It can be helpful to think about some of the reasons and causes for why children act in tricky ways – for example why NAME has difficulties like EXAMPLES. I have some ideas, but I am interested in what you think. Are there many different causes do you think, or just a few? What are these?

Do you think child has much or any control over their behaviours that you’ve described to me?

Do you think what you do as a parent in responding to child’s behaviours makes much difference – or could make much difference?

Do you think the situation your child is in changes how they respond/act – or is it consistent across all situations?

2. Consider provide psycho-education

We might want to provide psycho-education about the range of potential causal factors involved in child behaviours.

If we provide information about the distal and external (genetic, biological, temperament, trauma, neurodiversity, mental health diagnoses, chronic sleep/nutrition/peer influence) contributors – this may reduce problematic high controllability parental/caregiver attributions. In other words, if parents/caregivers understand that some or much of the cause of their child’s behaviours is related to factors which is outside of their direct control, they may be less likely to act punitively and harshly towards their child.

On the other hand, if we also provide information about the more proximal contributors (distress, learning models, triggering parental behaviours, lack of knowledge, skill gaps) to children’s behaviour – this may increase parental motivation to make changes to a child’s environment and their own parenting responses.

For example, we say the following types of statements.

I am wondering what you think about this – it seems that in the background for NAME, we have some factors which make it much harder for them to act in certain ways, compared to other children. For example (list more distal and external causes relevant to the child).

It also seems to me that and then on any given day, there are lots of triggers and more immediate factors which can contribute to NAME having difficult acting in certain ways. For example, we know that there are factors such as (list a few more proximal causes – such as distress, peer situations, lack of skills) which might make it harder for them.

3a) For higher ability families - Provide categories of proximal contributing factors

For some parents/caregivers, it can be useful to spend some time providing sample categories of proximal contributing factors which may impact on their child’s challenging behaviours. This may help some parents/caregivers to be able to remember and keep in mind various contributing factors which may be modifiable.

One example categorization system is the one I have outlined in previous modules – i.e., the KID model:

Knowledge and Skill Gaps – this category reflects skill deficit explanatory models for challenging behaviours, such as a child’s difficult in communicating their needs, their lack of understanding of the implications of their behaviours, their difficulties in social interactions. It draws upon learning and skill deficit models of challenging behaviours.

Incentive Imbalances – this category reflects behavioural explanatory models for challenging behaviours. Specifically – missing benefits (when children do not understand or have experienced the advantages of acting in certain ways) and accidental rewards (when children/young people experience rewards for acting in challenging ways).

Distress – this category reflects trauma-informed, attachment orientated, neurodiversity explanatory models for challenging behaviours, such as children’s anxiety, stress, overwhelm and distress as causes of challenging behaviours.

These categories of course overlap and may not be appropriate for all children/young people. However some parents/caregivers may benefit from hearing about all three. In this case, we might provide the following kind of psycho-education. The script below of course will be modified depending on the family but might provide a guide:

As well as the background factors which make it much harder for (NAME) to act in certain ways, there are also more immediate triggers or reasons for challenging behaviours. Specifically, we might think about three categories of these reasons. They are as follows (using visual prompts/whiteboard):

Knowledge and skills gaps.

Imbalance in the incentives for acting in certain ways.

Distress.

You will see the initials of these categories are K.I.D – which hopefully helps you remember them. Let’s go through each of them in more detail.

1. Knowledge and skill gaps

Children have less knowledge about themselves, other people, language, and the way the world works than adults do. They also don’t have as many skills in moving their bodies, expressing themselves, communicating with others and coping with difficult situations as adults do.

Many examples of challenging behaviour in children happen because their smaller brains and younger bodies simply don’t know as much, or aren’t good at something as they need to be yet.

There are thousands of examples we could use, but just a few are as follows:

A child who is loudly crying from a (relatively) minor disappointment may not be very skilled just yet at using language to communicate how they feel and want they want.

A child who hits another child may not fully understand the impact of their hitting on that child.

A child who doesn’t follow an instruction to pack up may not be skilled at switching their attention from what they are doing to a new activity.

It is often very useful – when a child acts in a challenging way – to ask – what skills and knowledge might be missing here which is contributing to this behaviour?

2. Incentive imbalance

A second category of causes and reasons for difficult behaviour in children happens when there are more incentives for the child to do something challenging than there is for them to do something positive – we might call this an incentive imbalance.

An incentive imbalance can happen when a child consistently (usually accidentally) experiences good things after acting in a challenging way. This of course means the child is more likely to keep acting in this same way, to get the same good things.

For example, if a child always gets to go first if they “push in” when in a line waiting for the slippery dip, and there seems no reason for them to stop doing this - they are more likely to keep doing this.

If a child feels much better and less tense after hitting another child and they don’t see anything unhelpful for them or others about this, they are more likely to do it again.

A different kind of incentive imbalance might happen if a child has not experienced (or know of) any or many benefits from acting in a particular positive way. If this is true, they are less likely to do this – or if they do it once – to do it again.

For example, if a child has never been thanked or had anything positive happen after they are kind to someone – they are less likely to act in kind ways.

A child who doesn’t know why it is important for them to get ready in time for school – and hasn’t experienced any benefits from doing this in the past – is not likely to start getting ready early.

It is often very useful – when a child acts in a challenging way – to ask – are there any accidental rewards this child is experiencing for acting in this way? And also – does this child really know the benefits for them of acting in a positive way in this situation?

3. Distress

A third group of causes for challenging behaviour can be called distress. In other words, children act in tricky ways when they are overwhelmed by what is happening, feel insecure in the world they are in and/or are trying to express their feelings in the only way they know how.

For example, if a child is refusing to get dressed when asked, it may be that child is trying to help themselves cope with feeling anxious about going out. It might be they are trying to cope with their frustration when having to stop a particular activity.

If a child says rude or mean things to a friend, it may be that child is trying to express their jealousy, frustration, or sadness about something in the only way they know how.

It is often very useful – when a child acts in a challenging way – to ask – is my child feeling insecure, distressed, unsafe or having any other negative emotion which is contributing to them acting in this way?

These three groups of causes or reasons for children’s behaviour – knowledge and skill gaps, incentive imbalance and distress – often happen together. In other words, children’s difficult behaviour is partly caused by all three of these factors happening together. Remember, as well as these more immediate factors which contribute to challenging behaviour, there are also some background factors which make it much more likely that all of these factors are more intense or difficult for them.

Note: Re-assure the parent they don’t need to do a full causal analysis every time a difficult behaviour occurs

One of the potential risks in providing the above categories of more proximal causal factors to parents/caregivers is that it can be overwhelming, especially for parents/caregivers with lower literacy, or resources.

However, we can overcome this risk to some degree, with some families, by reassuring them that the reason for us to have this conversation is not to identify all of the causes, every time but instead to help parents/caregivers understand the range of complex causes – many of which are external, situationally driven and neither highly or very minimally controllable.

We might use the following kind of language.

The reason we are having this conversation is not to identify the cause of every difficulty that your child is having, but just to get a sense of some of the challenges they are having which makes it hard for them to act in positive ways. Then we can be gently and slowly helping your child to get better at these skills, manage their distress - or change some of the situations they are in for a while until they get a bit older and better at these skills.

3b) For other families – highlight causal factors which target problematic attributions

Instead of providing the full potential range of causes of challenging behaviour in children, we might instead just choose to highlight one or two particular causal factors. We might do this when P/C’s have limited capacity for understanding or monitoring more complex information.

Which factor we might highlight would depend on our case conceptualization of what attributions are problematic.

For example, for a parent who appears to hold attributions with high levels of controllability, we might like to highlight distal factors which are biological/genetic, for example:

Usually there is no one single cause of challenging behaviour in kids. Instead, there are a number of reasons which might increase the chance children have difficulties with challenging behaviours. One of the factors we know can be important are biological/genetic factors.

E.g., Research finds that some kids for example, are born with brains which have a stronger tendency to “fire up”. Some kids are born with a highly sensitive “reactivity” system which leads them to act in ways to protect themselves.

E.g., I hope you already know this, but I think it is worth saying that XX is not a bad kid, and you are not a bad parent. We have lots of research to show that some children are born with different types of bodies which make it harder for them to XXXX. For instance, some research shows even different heart rate responses, and different digestive systems which are linked to an increased likelihood they struggle with XXX.

For example, for a parent who appears to hold attributions with very low levels of control, we might like to highlight proximal factors related to skill gaps, for example:

Usually there is no one single cause of challenging behaviour in kids. Instead, there are a number of reasons which might increase the chance children have difficulties with challenging behaviours.
One of the factors we think is important is skill and knowledge gaps.

E.g., Children who struggle to stay calm and feel like hitting, often don’t have the skills to know how to manage or respond to conflict. They don’t understand the social cues around them, for example that suggest people are angry, or don’t have the language yet to know what to say which is helpful when they are angry.

This means that we have an opportunity to slowly coach children in these skills, which often leads to them improving their ability to stay calm and resist hitting others.

4) Ask parents/caregivers to look out for causes of challenging behaviour occurs during the week

As always when we are working with families, it is important to ensure the psychoeducation we provide results in changes in the way they think about or respond to their children in their daily life, outside the therapy room.

One way of helping parents/caregivers think about the concept of skill gaps leading to challenging behaviour during their week is to ask them to complete a checklist or monitoring record – just for a short period of time. This may then lead to a fuller understanding of what the range of causal factors are which lead to challenging behaviours.

It can be helpful to try to identify some of the contributing factors which might be contributing to NAME doing (challenging behaviours). Just for the next week or two, would you be able to record some examples of times when (challenging behaviour) happened on this sheet, and next to each one – tick some of these factors which might have contributed - skill or knowledge gaps (thinking/communicating, emotional management, physical skills, social/relationship skills), incentive imbalance (accidental reward or missing benefit) and distress (physical, emotional) – or some other factor. If you are not sure, you can also ask NAME questions (don’t do this in the heat of the moment, but later) about was most tough for them to do or understand about that situation.

Another attribution (aside from high/low controllability) which is problematic is global/stable. To shift these, we might ask parents/caregivers to monitor for positive behaviours too – and potentially the causes of these positive behaviours.

This week, would you be able to record some examples of times when some positive behaviours happened? And again, next to each one – tick some of these factors which might have contributed – good skills or knowledge, absence of accidental rewards, presence of benefits and no distress or distress well managed. If you are not sure, you can also ask NAME questions (don’t do this in the heat of the moment, but later) about made it easier for them to do so well in that situation.

5. Elicit new beliefs and behaviours from monitoring behaviours

We can ask parents/caregivers about their learnings and ask them how this might influence future behaviours or goals.

What did you learn from doing this? Anything new – or was it a reminder of something old?
If you had to describe something you want to keep remembering from doing this activity – what would it be?
Does this information suggest anything that you might want to do slightly differently going forward – or suggest something we should work on with the child?

Finally

Remember, how much work we do on parental attributions will depend on our conceptualization about how important we think they are in determining problematic child or parent behaviours. It is not always appropriate or needed to focus on this with any individual family. However, this is an area which I think sometimes we overlook, and it is worth considering this type of psycho-education and intervention routinely when we work with families.

Some key references:

(See Colalillo, Miller, & Johnston, 2015)
(See Williamson and Johnston, 2015)
Sawrikar, V & Dadds, M 2018, ‘What Role for Parental Attributions in Parenting Interventions for Child Conduct Problems? Advances from Research into Practice’, Clinical Child and Family Psychology Review, vol. 21, no. 1, pp. 41–56.
Hoza, B., Owens, J.S., Pelham, W.E., Swanson, J.M., Conners, C.K., Hinshaw, S.P., Arnold, L.E. & Kraemer, H.C. 2000, "Parent Cognitions as Predictors of Child Treatment Response in Attention-Deficit/Hyperactivity Disorder", Journal of abnormal child psychology, vol. 28, no. 6, pp. 569.
Hartley, S. L. , Schaidle, E. M. & Burnson, C. F. (2013). Parental Attributions for the Behavior Problems of Children and Adolescents With Autism Spectrum Disorders. Journal of Developmental & Behavioral Pediatrics, 34 (9), 651-660. doi: 10.1097/01.DBP.0000437725.39459.a0.
The Relation of Parental Transitions to Boys' Adjustment Problems: 2. A Test of an Attributional Model" by Nicholas J. Nix, et al. published in the Journal of Abnormal Psychology in 1999.