I mentioned in a prior post that I had recently spent a day at the Nurturing Developing Minds Conference, hosted by the Greenville Health System Division of Developmental/Behavioral Pediatrics. The conference was a great opportunity for me to learn new things, as well as new ways to think about things I already knew. One of my favorite talks was by Daniel Crimmins, PhD, who gave a presentation entitled “What to Do for Children with Persistent Challenging Behaviors.” Sound familiar?
Dr. Crimmins focused on a behavioral management plan that involves understanding the reason for the behavior, preventing it from occurring, and then replacing the undesired behavior with a more acceptable one. One of his points that resonated the most with me was that the appropriate intervention for a child’s behavior is based on the cause of the behavior, not the behavior itself. Your child may be on the floor, kicking and screaming, but it’s understanding why your child is acting that way that allows you to address the behavior in the most effective way. Here are some common reasons that kids do the things they do, along with suggestions for how to address them:
1: Attention-seeking: This one of the most common reasons for children to act out. I discussed this in a prior post here. When dealing with these behaviors, the most important things to remember are: never reward the behavior unintentionally by giving them your attention, and that–to your child–negative attention is more valuable than no attention. Somewhat counterintuitively, one of the key preventive steps is to give your child what he wants. But (here’s the catch…) give it to him before the bad behavior starts. If you have a child that acts out because he wants attention, be sure to schedule time every day (or better, several times a day) to give him your undivided attention. This is especially important when a new sibling enters the home, or when a child has to compete with multiple siblings for your time and attention.
2. Desire for tangible items: This one is similar, but distinct in some key ways. Instead of seeking your attention, your child may act out in an attempt to obtain a new toy, an item that another child is playing with, a cookie, or (a few years later) a new car. If your child seems driven by getting new toys, establish a system that allows her to earn toys for good behavior. Star charts and other “token economics” strategies are great for these children. It’s important to be consistent, while still providing sufficient motivation in the form of tangible gifts. Be sure to keep the expectations appropriate, the waiting period reasonable, and the payoff worthwhile. (Don’t expect a 4-year-old to wash your car twice a week for 6 months to earn a box of crayons–you get the point.) Once you establish the system, when your child pitches a fit because you refuse to buy her the Barbie she picked up in the store, hold your ground and remind her that there is a method for her to get toys that she wants; it’s just not the one she’s using.
3. Avoiding: This refers to bad behaviors that stem from NOT wanting to do something (come inside for dinner, eat your kale, get in the pool, put your shoes on, etc.). Preventing these types of behaviors involves having reasonable expectations for your individual child, as well as handling these situations in tactful ways. For instance, expecting a hyperactive 3-year-old to sit quietly for a 2-hour church service may be beyond his current ability; a more active, age-appropriate children’s service would likely be more palatable. If your child struggles with transitions, such as coming inside for dinner or going to school in the morning, these can be approached by giving a verbal warning several minutes before the transition (“Five more minutes, then you need to come inside.”), and then enforcing the transition when it’s time; delaying it because of poor behavior only reinforces what you’re trying to eliminate. [Note that the warning came before the instruction; I’ve never been a fan of “counting to 3” after telling your child to do something. In addition to sending the wrong message to a child, there are times where this can be a safety concern–such as when your child takes off running through the parking lot, thinking that he still has several seconds before mom gets serious.] Picky eaters also fall into this broad category of avoidance behaviors, and I’ll address them more fully in a future post; good places to start are allowing them to help pick out foods at the grocery store, having them help you prepare the food, and offering a variety of healthy (but realistic) choices.
Of course, some avoidance is based on fear or anxiety, and it’s important to handle that delicately. If your child has tantrums before swimming lessons, they may very well be based on a fear of water. Try introducing the pool slowly–watching others in the pool for a few weeks, then putting his feet in, meeting the teacher outside the pool, sitting on the steps, etc. until you have worked up to full participation. If your child has multiple fears like this (or one persistent fear), talk to your pediatrician about the possibility of an anxiety disorder.
4. Sensory: This category is seen frequently in children with autism spectrum disorders, but may be seen in other children as well. Examples are spinning, hand-flapping, touching objects as they walk by, fidgeting or tapping in class, etc. Good strategies to try are to allow your child a time and place when these behaviors are allowed; take frequent breaks from work at school and allow them to run/spin/bounce/etc.; or replace the behavior/object with a more appropriate or less obvious one. I recently had a patient whose school performance had improved dramatically when his teacher stuck a piece of Velcro to the bottom of his desk so that he could feel the texture while paying attention in class. Stress reliever balls and other similar items are great as well.
In summary, remember that tantrums and other “persistent challenging behaviors” are functional communication tools. The reason that children use them (instead of more desired methods, like asking politely) is because THEY WORK! It’s your job to make them ineffective and provide your child with more appropriate ways to obtain the things that she needs or wants. Find out what makes your child tick (think: love languages), and feed her enough to keep her from starving.