Imagine you have been unwell for several months – intermittent, low level but unpleasant symptoms – stomach pain, headaches and dizziness. A GP can’t find anything wrong with you and so you try diet changes, vitamins and getting more sleep – none of which makes a difference. You start to worry about whether you have a serious illness, – and feel frustrated about having to take time off work/social activities.
Eventually a specialist diagnoses you with a particular medical condition. Unfortunately it can’t be “cured” – but you now know how to manage it, what triggers it and how to make symptoms less severe. Almost immediately, even though you still don’t feel well, your overall suffering eases.
Knowing causes of problems often makes us feel significantly better and helps us manage them more effectively – even if the problems themselves don’t disappear.
The same principle is true for parents/caregivers with children with particularly difficult or challenging behaviors.
When parents have an accurate and thorough understanding of the range of factors which cause children to act in “difficult” ways, they almost always feel less frustrated, more able to respond effectively and more capable of supporting their children to act differently in the long term.
Unfortunately many parents don’t have this kind of understanding. Many parents either feel completely baffled as to why their children are acting in challenging ways (“it comes entirely out of nowhere”) or they explain challenging behaviour as resulting simply from broad diagnoses (it is because he has autism), genetic factors (she was just born that way), historical factors (his Dad used to yell at him and he learnt to do the same), simplistic or singular factors (food colourings make her go crazy) or other factors largely outside of anyone’s control (he watches the older kids at school and copies them).
Although these explanations for challenging behaviours may very well be 100% accurate, they are not a) detailed enough, or b) include enough relevant, current and controllable factors for them to be useful in helping them know what to do next.
One important intervention for parents/caregivers is for us as professionals to help them understand a fuller range of modifiable and moreimmediate causes and triggers which might be underlying their child’s difficult or challenging behaviours.
For example, let’s create the example of a 7 year old child living with ASD and her Mum who has come to see us for help with a range of challenging behaviours. Let’s call her Sophie and imagine her Mum gives us the following example of a difficult situation for them:
We were at the park and I told Sophia we had to go home. She then got very distressed – and started yelling, screaming and crying. She hit me repeatedly saying “I don’t want to go!”.
Imagine we ask Mum why she thought Sophie acted in this way, and she says the following::
“I don’t really know – I think she just wants her own way all the time. She has a very strong temperament – and I think it is also because she has autism, and I know kids with autism have difficulties with change”.
This level of understanding, while probably accurate, doesn’t give Mum any ideas about what to do to help Sophie cope or support her to act in different ways in the future.
Imagine instead, Mum has this understanding of why Sophie acted in the way she did:
· Sophie doesn’t fully understand that she will be able to come back to the park again soon
· Sophie feels overwhelmed by frustration, because it was nearly her turn to be “the queen” in the game she was playing (and she hadn’t had a turn of that role all day)
· Sophie isn’t very good or quick enough at using words to express why she is disappointed and what she wants. So she reverts to the only language she has to express her pain – loud wailing, kicking and screaming.
· Sophie doesn’t have any understanding that her yelling/hitting behaviour is embarrassing or difficult for mum (and so has no reason to try to stifle these instincts).
· In the past, when Sophie has hit Mum and yelled, her mum has usually decided to (understandably, given the difficulty managing these meltdowns) let her have what she wants, which has (probably unconsciously) taught Sophie that this behaviour leads to better outcomes for her.
· Sophie was actually in the early stages of getting mild cold that afternoon and was likely feeling extra fragile and tired.
· Once Sophie started crying, her emotional system quickly went into “overload” and she was even less capable of calming herself down.
With this more detailed level of understanding for the reasons for Sophie’s behaviour, Sophie’s Mum will be less distressed by her challenging behaviours, and better able to identify some helpful parenting strategies she could use with Sophie to support her.
Helping parents/caregivers improve their understanding of challenging behaviour
As professionals working with children and trying to understand their challenging behaviours, we are likely to be drawing upon multiple casual models, theories and bodies of evidence – including behavioural (modelling, conditioning) models, models using attachment frameworks, developmental models of behaviour, models referring to mental health and disability, models which include trauma and life circumstances, cognitive and schema based models, physiological – and many others.
It is difficult enough for us as professionals to be able to distill and consider all of these factors when working with any given child – it is not surprising that it is even more difficult for parents/caregivers to be able to do this.
This is especially true for parents/caregivers who are stressed/tired/have their own mental health, disability or trauma history, have lower level of language skills or lower emotional, financial or other types of resources.
This means therapists are often tempted to either “skip” educating parents about the causes of challenging behaviours and instead move straight to providing advice or interventions. Alternatively, sometimes in order to try to simplify the process, therapists educate parents/caregivers about only one type of causal model (for example, in many child mental health professionals only discuss either a behavioural based model – or an attachment based model – depending on what they think is most important for that family).
While it is necessary for us to provide only a level of psycho-education to parents which they can understand and use – in the long term over-simplifying what is going on for children to their parents doesn’t support them to independently and usefully help their child act in different ways.
I think working to help parents understand a fuller range of potential and nuanced causes of problem behaviour is a worthy task.
There are many ways in which we can do this, but in this article I would like to run through a model I have used with parents/caregivers for many years to help them better understand their child’s behaviours. I call it the “K.I.D” model and it summarises several key models of understanding children’s behaviours into three categories.
This is how I might explain this model to parents/caregivers.
When we are thinking about why kids act in challenging ways, there are a number of background factors which make it more difficult for some children to act in positive ways, to manage their emotions, feel co-operative and to follow instructions.
By background factors, I mean the brains/bodies kids are born with, or the big life situations they have experienced which make it tougher for them to act in positive ways. These might include mental health conditions, disabilities, genetic factors, challenging life experiences and others. In your child’s case, we could point to the xxxx (include relevant causes) as reasons why it is sometimes tough for (child) to act in positive ways.
However, as well as these background causes, there are also some more immediate causes or triggers which can lead to children acting in difficult ways.
These include factors like not understanding an instruction, feeling stressed, not knowing how to do something, or getting something positive from doing something negative.
When we understand all the different kinds of potential immediate causes of challenging behaviour it can help us know how to support kids to act in different ways.
Specifically, we can think about three categories of causes of and reasons for children’s difficult behaviour behaviours. They are as follows:
1. Knowledge and skills gaps.
2. Imbalance in the incentives for acting in certain ways
(I write these down on a whiteboard or piece of paper for parents/caregivers to reduce the load on working memory!)
Let’s go through them and see if and how they apply to XXX’s challenging behaviour.
1. Knowledge and skill gaps.
As you know 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 of 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 about this, they are more likely to do it again.
An second type 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?
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, or coping with their frustration of 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?
I usually explain the above ideas (often takes around 10 minutes) using pen/paper with families. We then spend some time trying to understand examples of challenging behaviour in their children, using the “KID” model as a prompt.
I then set a homework (out of session) monitoring task for parents/caregivers to write down four or five challenging behaviours that week and try to analyse them for skill/knowledge gaps, incentive imbalance (accidental rewards for negative behaviours, missing benefits of the opposite positive behaviour).
It is really important to tell parents that they do not need to continue to comprehensively analyse causes of difficult behaviour in an ongoing way after this first period of learning. It is too time consuming and complex for many parents/caregivers to do this and instead we can simply move on to working on our usual intervention and response options for them.
However I find that doing this initial work on understanding behaviour helps parents/caregivers helps them understand (and put in context) the rest of the parenting interventions I go on to teach.