Challenging Behaviour

What is challenging behaviour?

Behaviour refers to how a child conducts themselves. It is their actions, reactions and functioning in response to everyday environments and situations. Challenging behaviour is a term used to describe behaviour that interferes with a child’s daily life.

Why is behaviour important?

Health and quality of life: Challenging behaviour may seriously affect a child’s and parent’s/carer’s health and quality of life.
Reduce risk: Some risks associated with challenging behaviour include self-injurious behaviour (including ingestion or inhalation of foreign bodies, hitting the head against hard objects or throwing the body on the floor) can result in serious injuries. Accidental injury is also a common issue in children with aggressive behaviour, not only for them but also surrounding children and more commonly involved adults.
Dietary deficiencies: Oppositional behaviour may result in dietary deficiencies, weight loss or gross obesity.
Social isolation: Challenging behaviour can often lead to social isolation of both the child and their parents.
School transition: Social isolation is likely to impact a child’s sense of well being and transition to preschool or school.
Reduce mental health issues: Research also suggests that lack of social skills can lead to loneliness and depression from an early age.
Maturity: How a child behaves is a direct reflection of their maturity.

What are the building blocks necessary to develop behaviour?

Self Regulation: The ability to obtain, maintain and change emotion, behaviour, attention and activity levels appropriate to the task or situation.
Sensory Processing: Accurate processing of sensory stimulation in the environment as well as in one’s own body, which directly impacts behavioural reactions.
Receptive (understanding) Language: Comprehension of spoken language.
Expressive (using) Language: Producing speech production or language being understood by others.
Executive Functioning: Higher order reasoning and thinking skills.

Emotional Development/regulation: involves the ability to perceive emotion, integrate emotion to facilitate thought, understand emotions and to regulate emotions.
Social skills: are determined by the ability to engage in reciprocal interaction with others (either verbally or non-verbally), to compromise with others and be able to recognize and follow social norms.
Planning and sequencing: The sequential multi-step task or activity performance to achieve a well-defined result.

How can you tell if my child has problems with behaviour?

If a child has difficulties with behaviour they might:

Display opposition to parent or adult requests.
Be quick to get frustrated.
Have tantrums that last for longer than typical.
Display more tantrums or behavioural episodes per day than is typical.
Be difficult to discipline (e.g. are aggressive or not seem to care)
Typical behavioural strategies are ineffective.

What other problems can occur when a child has behaviour difficulties?

When you see behavioural difficulties, you might also see difficulties with:

Self Regulation of physical activity, thoughts or emotions.
Receptive language: Understanding of language.
Expressive language: The ability to use language and communicate needs and wants to others.
Executive Functioning: Higher order reasoning and thinking skills.
Emotional Control: involves the ability to perceive emotion, integrate emotion to facilitate thought, understand emotions and to regulate emotions.
Social interaction: that is appropriate and reciprocal in nature with both same aged peers and adults.
Planning and sequencing tasks or activities (e.g. copying duplo models, drawing pictures).

What can be done to improve behaviour?

Social skills: Teaching social skills with an emphasis on recognition of feelings, play skills, problem solving and self-regulation.
Functional equivalents: Teaching children functionally equivalent skills (e.g. if physical aggression means leave me alone, teach the child the equivalent skill, i.e. ‘go away’ sign).
Early identification of emerging challenging behaviours.
Preschool or School environment: Have a positive and supportive relationship with staff and carers involved.
Consistent and realistic expectations: Ensure that all people involved have the same expectations of the child.
Success: Ensuring that all children encounter (or are actively scheduled) the opportunities necessary for their success.
Eye contact: Get close to the child to ensure they are able to hear you and see your face; get down to their level.
Know the motivators: Behaviour management starts with knowing your child’s “currency” or motivators – the “what’s in it for me?”. These motivators might be: praise, time with parents, IT/screen time, access to special games or toys to name a few. These rewards need to be immediate (when you choose) or at least quantifiable so that child knows when they have earn it. You can either take these rewards away in the event of misbehaviour or take them away ahead of time so that kids need to ‘earn’ them through good behaviour. Where possible, use visuals to support this by adding a counter of some form (e.g. a pom pom) to a jar.
Simple language: Use clear, specific language when making requests and, if necessary, show them what you want them to do.
Tone of voice: Tone and volume of voice when making requests is important (e.g. firm but friendly tone if the request is non-negotiable). Even when a child may not understand the instructions, they often understand the tone of voice.
Boundaries: Both children and parents need to understand the boundaries for what is unacceptable behaviour to ensure the agreed upon strategies are implemented consistently.

What activities can help improve behaviour?

Time out: The purpose is to interrupt a non-desirable behaviour and at the same time provide an opportunity for the child to settle themselves before continuing to act. Time out works best in sight of the parent and should be relatively short.
Choices: If the child is asking for something that is not on offer, it is important that parents put boundaries in place for them. Sometimes this means saying ”NO” and sticking to that. It is ok to say: “That is not a choice. The choice is …….. Or ………. What is the choice your are making?”
Reduce incessant talking: Use talking counters. During a brief period when the child is engaged in a specific activity provide a small number of counters visually (e.g 5 blocks). Each time the child wants to talk with the parent, the child must hand a counter to the parent but parent asks ‘Are you sure you want to use a counter?’. The adult does not respond unless a question is asked and a counter is removed. The adult does not respond to statements. Instead they ignore statements or say “Thank you for telling me. (pause)……….”Oh! Are you asking me a question? What question are you asking me?”. Over time, this can help redirect statements (e.g. “I want food”) to question (e.g “Can I please have a sandwich”), as well as limit excessive talking.
Role Playing: Explicit teaching in structured social situations through modelling and role-plays.
Use role models: Small group cooperative games with good role models to provide opportunities to practice social skills.

Why should I seek therapy if I notice behaviour difficulties in my child?

Therapeutic intervention to help a child with behaviour difficulties is important to:

Determine if there is an underlying reason for the behaviour challenges.
Develop a common strategy to the challenging behaviour by all involved adults.
Educate all involved adults to respond to the challenging behaviours in a way that does not give the child or their behaviour more power over the situation (and to minimise reoccurence of the same behaviour).
School transition may be difficult if they are reluctant to follow instructions within the educational setting (eg classroom instructions, academic task requirements).
Social isolation can impact not only the child, but also the parents if they are unable to venture out or leave children with other carers.
Completing routine and unfamiliar tasks appropriately may be challenging.

If left untreated what can difficulties with behaviour lead to?

When children have difficulties with behaviour, they might also have difficulties with:

Peer rejection and social isolation.
Following instructions from others in a position of authority such as at school or scouts.
Poor academic outcomes as the children are often in a negative state that is not conducive to learning.
Not only does a child become stressed and anxious as their behaviour is out of control, particularly when they are more aware of their behaviour, so too does a parent/teacher.
Limiting a family’s ability to enjoy the day-to-day activities such as attending group swimming lessons or sporting groups as well as going to the movies/ zoo and visiting friends and families.
The longer it is left, the harder it becomes to break the cycle and the longer it is reinforced that the child is able to take control of challenging situations.

What type of therapy is recommended for challenging behaviour?

If your child has difficulties with challenging behaviour, it is recommended they consult an Occupational Therapist. It may also also be appropriate to consult a Psychologist for support. It is important to acknowledge however that in many (but not all) paediatric cases, there is a large overlap in the skills addressed by Psychology and Occupational Therapy.