Challenging Behaviours

gathered from – Ten things I wish you knew about your child’s mental health – Dr Billy Garvey

Understanding Behavioural Difficulties:

• Behavioural difficulties are common, especially in young children.
• Tantrums start around the second year of life as children develop mobility and speech.
• Emotional regulation and theory of mind are key skills that children need to develop.
• Emotional regulation should be the first step before learning about others’ perspectives.

Addressing Behavioural Issues:

• Scolding children without addressing underlying emotions may lead to further emotional difficulties.
• Strategies include validating the child’s feelings, helping them understand others’ feelings, guiding expected behaviour, and reinforcing positive actions.

Long-Term Impact of Emotional Difficulties:

• Unaddressed emotional difficulties in childhood can echo into adult life.
• They can impact self-esteem, relationships, and mental health.
• Teaching emotional regulation and healthy expression of feelings is crucial for long-term well-being.

Understanding and Addressing Behavioural Issues

Role of Paediatrician as a Detective:

• The paediatrician acts as a detective, uncovering hidden causes behind a child’s challenging behaviour.
• This involves careful observation and interpretation of behaviours as clues to underlying emotional or psychological issues.
• Children’s behaviours are not random or oppositional but are expressions of unmet needs, stress, or discomfort.
• The paediatrician’s role is to decode these signals to understand the child’s internal world.

Behaviour as Communication:

• Children with behavioural difficulties often lack the vocabulary or self-awareness to articulate their feelings.
• Their behaviour becomes their primary means of communication.
• Aggressive outbursts, withdrawal, or defiance are signals that something is wrong.
• Recognizing behaviour as communication allows caregivers and professionals to understand and address the underlying issues rather than simply reacting to the behaviour.

Identifying Triggers and Patterns:

• Detecting behavioural triggers and patterns is crucial for understanding and managing a child’s responses.
• Identifying situations, environments, or interactions that lead to emotional responses can help in anticipating and preventing outbursts.
• Recognizing these patterns allows caregivers to manage the child’s behaviour more effectively.

The Volcano Analogy:

Behavioural Difficulties as Volcanos:

• Kids with behavioral difficulties are likened to volcanoes, with eruptions beyond their control.
• Early warning signs of eruptions are critical to identify.

Three Stages of Eruption:

• The climb: pressure builds, rumbling occurs.
• The explosion: fiery outburst.
• The cool-down: post-eruption calming.

Priority During Eruption:

• Safety is the primary concern during an eruption.
• Safety must be ensured for both the child and those around them.

Importance of Early Warning Signs:

• Identifying signs before the explosion can guide emotional regulation.
  • Subtle Behavioral Changes: These may include signs like
    • tensing of the body
    • clenching fists
    • increased restlessness
    • changes in facial expression.
  • For some children, it could be behaviours like
    • shouting
    • becoming unusually quiet
    • avoiding eye contact.
  • Verbal Cues: The child might start
    • raising their voice
    • using more aggressive or frustrated language or
    • becoming more demanding or irritable.
    • These verbal cues can be early indicators that the child is struggling to manage their emotions.
  • Physical Indicators:
    • Changes in breathing patterns
    • fidgeting, or repetitive actions (such as pacing or hand-wringing) can signal that the child is beginning to feel overwhelmed.
  • Environmental Triggers:
    • Certain situations or environments may consistently lead to emotional distress for the child.
    • Recognizing these triggers as early warning signs can help in anticipating and managing potential outbursts.

Importance of Early Warning Signs:

• Intervention Point: Recognizing these signs allows caregivers to intervene early, before the child’s emotions escalate to the point of an outburst.
• Opportunity for Co-Regulation: By noticing and responding to these signs, caregivers can begin the process of co-regulation, helping the child manage their emotions before they become overwhelming.
• Preventing Escalation: Addressing these signs early helps in preventing more severe behaviours, such as physical aggression or intense emotional breakdowns.

Co-regulation Strategy: see below

Learning Cues and Strategies:

• Over time, recognizing a child’s cues allows for better management of eruptions.
• Experimenting with strategies can help children learn emotional regulation.

Cool-down Phase:

• Not the priority for teaching emotional regulation.
• Post-event discussions can improve understanding and show support but won’t necessarily prevent future eruptions.

Risks of Only Helping After Eruption:

• Kids may learn that eruptions are the only way to get help.
• Bright, articulate children may explain what happened but struggle to manage differently in the future.
• Emotional regulation is learned during the climb, not the eruption or cool-down.

Co-Regulation as a Key Strategy:

Regulation vs. Reflection:

• Reflection:
  • Realizing after an event (e.g., getting cut off in traffic) that your reaction was excessive.
  • It’s a post-event analysis, not emotional regulation.
• Emotional Regulation:
  • The skill of managing your emotions in the moment, particularly when faced with stress or frustration.

Importance of Connection in Emotional Regulation:

• Human brains are wired for connection, which is crucial for emotional and social development.
• Children acting out are often seeking connection, and need guidance on healthier ways to achieve it.
• Co-regulation, where a caregiver helps a child calm down, is essential in teaching self-regulation.

1. Stay Calm: Self-Regulation:

• Self-regulation involves being aware of and controlling one’s own emotions and behaviour.
• Effective self-regulation varies among individuals, often linked to temperament and upbringing.
• Use deep breathing or a moment of pause to ensure that your response is measured and composed.
• Key points include:
  • Staying Calm: Before attempting to help a dysregulated child, the caregiver must first ensure that they themselves are calm. This is essential because a caregiver’s emotional state can significantly influence the child’s ability to calm down.
  • Managing One’s Own Emotions: Self-regulation involves the caregiver recognizing their own emotions and controlling any impulses that might escalate the situation, such as frustration or anger.
  • Providing a Model for the Child: By self-regulating, the caregiver models the calm and composed behavior that they want the child to emulate. This sets the stage for effective co-regulation, where the child can begin to mirror the caregiver’s calm state.

2. Connect with the Child:

• Get down to the child’s level physically, making eye contact and using a calm, soothing tone of voice.
• Offer a reassuring presence by saying something simple and supportive, like “I’m here with you.”

3. Validate Their Feelings:

• Avoid using phrases like “It’s okay,” as it may invalidate the child’s feelings.
• Instead, use phrases like “I’m here,” which reassures the child of your support and acknowledges their emotions.
• For older children, validating their experiences and offering support with phrases like “I can see you’re upset. I’d like to understand so I can help,” is crucial.

4. Offer an Outlet for Emotions:

• Provide the child with a safe way to express their frustration, such as suggesting they squeeze a cushion, draw a picture, or jump up and down on a soft mat.
• Engaging in a physical activity can help release built-up energy and reduce tension.

5. Use Co-Regulation Techniques:

Co-regulation

is the process where a caregiver or adult actively helps a child manage and regulate their emotions during moments of distress or dysregulation. It involves the caregiver staying calm, providing support, and guiding the child through their emotional experience to help them return to a state of calm.

• The key aspects of co-regulation include:
  • Self-Regulation of the Caregiver: Before attempting to help the child, the caregiver must ensure they are calm themselves. This is crucial because a dysregulated caregiver can inadvertently escalate the child’s emotions rather than soothe them.
  • Connection with the Child: The caregiver connects with the child through both verbal and non-verbal cues, such as maintaining a calm tone of voice, relaxed posture, and reassuring facial expressions. The goal is to help the child feel understood and supported.
  • Guiding the Child to Calmness: Through this calm and supportive interaction, the caregiver helps the child navigate their emotions and gradually return to a state of regulation. This process often involves recognizing the child’s early signs of distress and intervening before the emotions escalate into an outburst.

• Model calm behaviour that the child can mirror
• Maintain a calm tone of voice, relaxed posture, and open body language to reinforce the verbal message and support the child in calming down

Mirroring:

• mirroring refers to the process where a caregiver or adult models calm, regulated behaviour in response to a child’s distress or dysregulation.
• The goal of mirroring is to help the child achieve a similar state of calm by reflecting the caregiver’s emotional state.
• When a caregiver remains calm, uses relaxed body language, and exhibits slow, steady breathing during a child’s emotional upheaval, the child’s brain can subconsciously pick up on these cues.
• This helps the child to regulate their own emotions, as their brain attempts to “mirror” the calm state of the adult.

6. Redirect Attention:

• Gently guide the child’s attention away from the source of frustration to a different, more manageable task or activity.
• This could involve starting a new game, reading a book together, or working on a puzzle that they enjoy.

7. Encourage Communication:

• Help the child find words to express their feelings by saying, “Can you tell me what’s bothering you?” or “How can I help you right now?”
• Teaching the child to verbalize their frustrations can reduce the likelihood of physical outbursts and encourage healthy emotional expression.

8. Offer Choices:

• Giving the child simple choices can help them feel a sense of control, which can reduce frustration. For example, “Would you like to take a deep breath with me or go for a short walk?”
• Empowering the child to make decisions can diffuse tension and promote cooperation.

9. Follow Up After the Frustration Has Passed:

• Once the child has calmed down, gently discuss what happened, emphasizing understanding and support rather than punishment.
• This can help the child reflect on their emotions and consider alternative ways to handle frustration in the future.

Challenges and Misconceptions

Safety as a Priority During an Outburst:

• Why Safety Matters Most:
  • Safety is crucial during an outburst because children are not in control of their actions and may engage in harmful behaviours.
  • Ensuring safety prevents physical harm and helps avoid escalating the situation.
  • Prioritizing safety creates a sense of security, essential for the child’s emotional recovery.
• Consequences of Neglecting Safety:
  • Without prioritizing safety, the situation can worsen, leading to more severe behaviours such as property damage or violence.
  • Neglecting safety can result in long-term emotional trauma and a cycle of fear, avoidance, and further emotional difficulties.

Misconceptions About Addressing Behaviour Post-Eruption:

• The Limitations of Post-Eruption Discussions:
  • Discussions after an outburst, often paired with punishment, are not sufficient for teaching emotional regulation.
  • While helpful for understanding what happened, these conversations do not equip the child with the skills needed to manage emotions differently in the future.
• Risks of Relying Solely on Post-Eruption Interventions:
  • Reinforcing Negative Behaviour:
    • A child may learn that outbursts are an effective way to receive attention or help, unintentionally reinforcing the behaviour.
  • Failure to Teach Emotional Regulation:
    • Bright children may explain their behaviour after the fact but still lack the emotional skills to manage feelings in the moment.
    • True learning occurs during the early stages of distress, not after the explosion.

Importance of Early Intervention:

• Learning in the Climb:
  • Early intervention during the emotional build-up (the climb) is key to teaching emotional regulation.
  • This stage allows caregivers to help the child recognize and manage emotions before they become overwhelming.
  • Techniques like deep breathing, calming words, or soothing activities can be introduced to equip the child with healthy coping mechanisms.
• Long-Term Benefits of Early Intervention:
  • Early intervention helps prevent immediate outbursts and contributes to the child’s overall emotional development.
  • Children who learn to manage their emotions early are more likely to have positive relationships, better mental health, and greater resilience.
  • Proactive intervention breaks the cycle of negative behaviour and fosters a supportive and nurturing environment.

Key Lessons:

• Behaviors as Expressions of Emotions:
  • Challenging behaviors in children are often signals that they need help, akin to sending up flares.
  • The role of caregivers is to identify what kind of help the child needs and provide it.
• Safety and Support During Outbursts:
  • When a child acts out, the primary response should be to ensure safety and offer support.
  • Real skill development in emotional regulation happens when a child first starts to express challenging emotions.
  • Recognizing early signs of distress allows caregivers to intervene before behaviors escalate.
• Shifting Focus from Stopping to Guiding Behavior:
  • Instead of focusing on stopping a behavior, think about what you want the child to do instead.
  • Provide the necessary support to help the child achieve the desired behavior, and then reinforce it.
  • The two common mistakes are making the expectations too difficult or not providing enough support.

Strategies for Parents:

• Understanding Outbursts and Aggression:
  • Children and teenagers do not intentionally create difficulties; their challenging behaviors are cries for help or attempts to end uncomfortable situations.
• Self-Regulation Before Child Regulation:
  • The first step for adults is to ensure they are calm before trying to calm a child.
  • If the adult is not calm, they risk escalating the situation or causing the child to suppress their feelings.
• Connecting to Help the Child Find Calm:
  • After calming themselves, the adult’s goal is to connect with the child to help them find calm.
  • This connection is achieved through awareness of both verbal and non-verbal communication.
  • The skill of co-regulation is developed through repeated practice and partnership with the child.