Supporting Children with Challenging Behaviours
Kirrilie Smout, clinical psychologist
What do we mean by challenging behavior?
o Disobedience/non-compliance Lying or being deceitful
o “Tantrums”/loud crying or yelling Verbal fighting/insults with peers
o Arguing back with adults Physical aggression
o Excessive interrupting Purposefully annoying or teasing others
o Excessive negativity/whinging/whining Stealing, cruelty to animals
Challenging behavior is very common in children
o Almost all children show physical aggression in the toddler years and more than 60% of 5- to 11-year-olds show physical aggression to their peers at least once in the last 12 months.
o 69% of parents report feeling “stressed” by child/teen’s behaviour weekly.
o 50% of parents in the community report that noncompliance (not following instructions) is a “problem” for their family.
o Challenging behaviour is the most common reason for referral to mental health services.
However, some children do act in more challenging ways,
more frequently than others
o Between 1 and 16% percent of children repeatedly and consistently show argumentative, aggressive and non-compliant behavior - beyond what would normally be expected for their age.
o About 1/3 of parents say they are having to think about managing challenging behaviour on a daily basis, and feel overwhelmed by it.
o Around 3-4% of children are “diagnosed” with a disorder called oppositional defiant disorder, intermittent explosive disorder or conduct disorder (happens more commonly in US than in Aus).
Why do some children act in more challenging ways,
more frequently than others?
o Biological factors are important – we know this from research on:
· Twin studies and heritability research
· Physiological differences between children with more/less challenging behaviours (eg Cortisol, testosterone levels and other differences)
· Infant temperament research
o Environmental factors may also be important. For example research has been conducted on:
· Exposure to family violence
· Experience of trauma or other difficult life circumstances
· Absence of strong friendships
· Peer rejection or bullying
· “Contagion” effect of peers who act in challenging ways
· Caregiver styles (eg experiencing parenting which child perceives as harsh, abusive, or very ‘permissive’, disconnected.
o Individual child factors also lead to challenging behaviour, for example children with challenging behaviours are more likely to also have difficulties with:
· Difficulties with focus and attention
· Difficulties with “response inhibition” (stopping impulses/urges)
· More difficulties with social skills
· Hostile Attribution Style
· More likely to over-estimate benefits of challenging behaviours
· More likely to under-estimate the costs of acting in challenging ways
· Less able to generate multiple solutions to social problems
Interactions with other disorders
o 60% of children with particularly challenging behavior have also diagnosed been with another disorder.
o For example:
· Learning disorder
· Anxiety disorders
· Depression
· Autism spectrum disorder (ASD)
· Attention Deficient Disorder (ADD) or Attention Deficit and Hyperactivity Disorder (ADHD).
o These disorders may be a cause of challenging behavior, the consequence of challenging behaviours or simply exist alongside the challenging behaviours.
What does this all mean?
o Children who act in challenging ways are not “bad kids”:
· They have a multitude of challenges and difficulties (some of them biological) which make it much harder for them to act in positive and co-operative ways.
o Children who act in challenging ways do not have “slack” or “bad” parents/caregivers:
· It is much harder to parent and care for children with the challenges above.
What types of treatments do psychologists use when supporting children with challenging behaviours
Parent/Caregiver Treatment Approaches
Some therapy approaches for children with challenging behaviours are designed to support caregivers to relate to and support their child in particular ways.
Examples of these evidence based approaches:
• Parent Management training (Parent Child Interaction Therapy (PCIT), Triple P, Kazdin Approach)
• Attachment orientated interventions (Circle of Security, Tuning into Kids)
• Collaborative Problem Solving Approaches (Ross Green Model)
Important note: these programs are not “parenting” programs – but instead programs to specifically support parents of children with higher than average rates of challenging behaviours
What types of strategies and skills are often included in parent directed programs:
• Helping caregivers to understand the different causes behind their own child’s difficult behaviours (including distress/needs, any accidental rewards, skill and knowledge gaps – and background factors – differences/disorders, biological factors, environmental factors)
• Why – and how - to show ongoing empathy and compassion towards children with challenging behaviours (words to say, strategies to avoid)
• Why – and how to use praise, thanks and affirmation to children with CB
• Why – and how to spend short periods of time in ‘child directed’ activities
• Problem solving and communication skills to address child/parent conflict (teaching what types of questions to ask, how to express concerns in neutral ways, how to generate problem solving in advance)
• Helping parents/caregivers to assist their child to more calmly express their emotions (giving children the words to say, practicing, thanking)
• Helping parents/caregivers to give instructions in ways which children with CB are more likely to respond to
• Helping parents/caregivers to coach emotional management skills with their children at home (identifying emotions, having strategies to manage emotions)
• Helping parents/caregivers to coach social skills with their children at home (identifying specific social problems, inviting children to choose which to work on, practicing)
• Helping parents/caregivers to decide which behaviours to focus on, and which behaviours to ignore
• Helping parents/caregivers to advocate for accommodations for their child or reduce expectations in some situations
Child Directed Therapy Programs
• The other primary category of treatment approaches for children with challenging behaviours is child focussed treatments – where a therapist works directly with a child (often with a parent in the room)
• Most child focussed treatments used cognitive behaviour therapy as a basis – and are often supplemented by social skills training (with relationship, and developmental focus).
What types of strategies and skills might psychologists be working on as part of these programs?
• Awareness of emotions (self and others)
• Lowering physical tension and arousal
• Calming and coping statements
• Perspective taking and increasing understand and empathy for others
• Social problem solving and conflict resolution skills (in advance of problems)
• Self compassion and self care skills
• Improving skills to constructively communicate their own needs and distress
• Attention redirection skills
Is therapy for challenging behaviours effective?
Parent directed treatments
• 66% of families report significant improvement after therapy
• Some families don’t experience much immediate change in symptoms but report helpful for learning – positive impact on other siblings and has long term “sleeper” effects
• However, many families will often have ongoing challenges (or “differences”?)
Child directed treatments
Also effective but some research suggests parent directed treatment is more effective
Research on both child or parent directed treatments
• Parents/children completing out of session activities and therapists doing in session practice with parents and children – both associated with better effects
• Purely play based or ‘non directive’ child therapy appears to be less effective
Note – all these results are based on studies which usually have 12-24 fortnightly sessions
What does therapy actually look like?
• Therapists (in government and private settings) are usually working from a “case formulated” approach – informed by a range of Parent Directed and Child Directed treatments – but using individual therapy components according to the needs of the individual child
• Note - in Australia, Medicare only provides rebates for 2 parent only sessions
• This means in some contexts (ie private psychologists) – therapists may be providing parent directed treatment together/at the same time as child directed treatment components
How do I know whether to seek help or not?
There are no simple answers – parents/usually have to weigh up the possible benefits and possible costs/challenges:
Possible benefits
- Often effective and helpful
- Children learn skills and get support
Possible costs/challenges
- Financial costs (Difficult (or impossible) to find gap free services)
- In between sessions ‘work’ – life changes, activities.
- Children can find the sessions hard work sometimes – therapists make as enjoyable as possible – but not ‘play therapy’
- However if you have any safety concerns for your child – important to seek help.
Finding a therapy services
- Psychologists in private practice, government based mental health programs or school based psychologists
- GPs are a great place to start to get individual referrals
- The Find a Psychologist service run by the Aus Psych Society
- Family, friend and school referrals
- Our services: Developingminds.net.au. For information about our therapy services – please click here - https://developingminds.net.au/information-about-therapy
Online or self help programs
For parents:
- Triple P online
- Circle of Security Resources
- Tuning into Kids online program
For children:
Our program: Calm Kid Central (www.calmkidcentral.com)
Important note
o This is all much harder to do when supporting children with challenges than for the “average” child.
o It is important to not expect too much of ourselves as parents/caregivers- instead we should be as kind and gentle with ourselves and our journey – as we want to be with our children.
o Remember, at least half of what children do and how they cope with life – is not determined by us, but by other genetic, biological and other environmental influences (less guilt!).
Resources
For a short period of time, we have a webinar on this topic on Calm Kid Central.
We also have a range of modules for caregivers – and for children themselves (on following tricky instructions and managing frustration) on Calm Kid Central.
You can ask our child psychologists questions about any of the ideas above and how they might apply to your family.
Calm Kid Central – please click here to learn about this - https://www.calmkidcentral.com/
