Challenging Behavior – Unlocking the clues

A few years ago, Susie Turrey’s home had no artwork hanging on the walls.  She and her husband carefully stored personal belongings and didn’t keep any potentially dangerous items in their home. They were concerned about outbursts from their son, diagnosed with autism and anxiety. His school called regularly about behavior issues, either asking a parent to come pick him up or isolating him in an alternative room. After participating in the Arizona Partners in Leadership program, Susie Turrey said things clicked into place. She asked her son, a teen at the time, what he wanted, which was a change to his school. He also wanted outside therapies and programs that were less childish.

After years of counseling and changes to school and therapies, the Turrey family saw positive changes for her son, now 20. Turrey credits a class on intentions, including training for both him and his parents, with helping them to understand each other better.

Jessica Hipskind adopted her half-sister, age 7 at the time, when their father passed away. Her daughter has Down syndrome and had numerous developmental delays. At school, Hipskind’s daughter would run away from teachers and act out on the playground and in the classroom. Setting specific goals and making sure everyone was on the same page at home, school and in therapies, created a successful environment. They achieved this through multiple meetings and sharing goals across the teams at home and school.

Rebecca Wise’s son maintained appropriate behavior at home but not while at school. The family tried behavior checklists and reward systems, which worked temporarily. After trying different school settings and ultimately home schooling, the family found success by learning more about self-regulation. This helped her son’s brain move from “fight or flight” mode to being ready to learn and relax. “Self-regulation helped me realize that my son wasn’t having bad behavior, he’s having stress behavior,” Wise said.

GETTING A HANDLE ON BEHAVIOR

Dealing with children’s challenging behavior looks a little different for everyone, and it can be incredibly stressful for parents. Parents need to know they aren’t alone with their struggles, and that it’s OK — and sometimes beneficial all around — to ask for help. 

While behavior issues might bring to mind a child who throws items, bites others or turns desks over in school, some behavior issues are not as obvious, said Wendi Scharnhorst, director of project development for Raising Special Kids. These less-noticeable behaviors can include noncompliance with requests or failure to finish work at school or home.

Behavior change usually starts with the parent, not the child, which can be hard for parents to swallow, Howe added. Changing the parent’s reaction and response can help redirect a child’s behavior.

Behavior specialists take different approaches, but many agree that challenging behavior is a means of communication for a child. Parents can try to pinpoint what their child is trying to gain from the behavior — escape from a situation, access to a preferred activity or item, attention from a parent or caregiver, or if it’s an automatic behavior. Then parents can alter their response to help guide the behavior.

Paul Carollo, director of specialty clinical services with Child and Family Support Services in Phoenix, compares behavior change to going to the eye doctor and looking through different lenses to get the best view. One view might represent current negative behavior, and the other lens represents positive behavior, or the goal. This perspective can allow parents to look at behavior in a more comprehensive way such as a skill deficit, he added. Parents can then alter their perspective and approach to better support their children.

Strategies include looking at behavior ABCs — the antecedent or what happened right before the behavior, the behavior itself, and the consequences of the behavior.

Consequences are also not one size fits all. Hipskind noted she could take her daughter’s toys away if she acted up, and it wouldn’t bother her at all. A more effective consequence would be time out where she didn’t have the opportunity to socialize with her family.

Calling in a behavior specialist or another trusted ally can assist parents with identifying what’s going on and how they can change their actions in a positive way.

“It’s helpful to have someone give you a bird’s eye-view of what’s happening in a certain situation,” said Mckenzie Bogardus-Murphy, director of ABA services with Gentry Pediatric Behavioral Services in Phoenix. “Once you’re there it’s hard to be objective. A secondary person can help you understand why your child is crying, identify your response and help understand the function. That will guide you to understanding your response in the future.”

She gives the example of a parent frustrated because a child doesn’t follow directions the first time they are asked. But when parents continue to remind their children, the child could be gaining desired attention, or delaying or escaping the demand. The child is also potentially used to an instruction being repeated so frequently that they won’t respond until it has been said multiple times or with a specific tone of voice.

“It’s counterintuitive to wait and not continuously repeat demands, but this could be required to ensure that the request is heard the first time in the future,” Bogardus-Murphy noted. Children also need to be made aware of the expectations behind a request — your idea of a clean room might not match your child’s.

When should parents seek help with their child’s behavior? Certainly, if a child is dangerous to themself or others, go to the emergency room, advised Funda Bachini, MD, a psychiatrist at Phoenix Children’s Hospital. Other behavioral scenarios might not seem as severe, but families could still benefit from help.

“Prolonged behaviors for weeks or months that are not responsive to typical parental interventions and have no clear cause are concerning,” Bachini said. “In these cases, it would be important to check in with a professional. Often, this is your PCP, who can then make other referrals if needed.”

Even if behaviors don’t seem severe but have consequences, such as losing friendships, she added, parents might want to consider outside help.

GETTING HELP AT SCHOOL

If a child displays negative behavior at school, parents can contact the teacher to request a Functional Behavioral Assessment (FBA). This might also involve a meeting of the child’s Individual Education Plan (IEP) or 504 Plan team if applicable to adjust a child’s accommodations. If the child does not have an IEP or 504 Plan in place, it could be a good time to request this.

“Communication among the student, parents and teachers is key,” said Lisa Potts, a parent leader for Raising Special Kids who previously taught grade school in different districts. “I am a big advocate for 504 Plans and IEPs. Everyone who interacts with a child will know their disability and what their responsibility is to help them. Everyone is educated on specific accommodations.” These plans also give school staff strategies for helping future students dealing with similar issues.

Parents also have the right to request an Independent Educational Evaluation (IEE) if they disagree with a school evaluation or plan. “Don’t be scared to challenge anybody about your kid,” Hipskind said. “You are your child’s advocate. If something isn’t right, do something. Stop the meeting or do what you need to do to make a change.”’

MEDICAL CONCERNS

If negative behavior comes about quickly and with no apparent reason, parents might want to take their child to a primary care doctor for a checkup. Certain medical conditions can cause negative behavior, Dr. Bachini said, including thyroid issues, cavities, constipation, or even onset of a cold.

“When things are changing at a pace that is different from the norm, we need to consider looking at medical issues,” Carollo added. Diet and digestive issues can also trigger behavior changes.

RESOURCES FOR PARENTS

Parents seeking help for their children’s challenging behavior should know that they are not alone. “People are uncomfortable asking for help because they think they are being judged,” said Claudia Meza Villari, behavior coach with the Secret Parent Society in Tucson. “We’ve all been there. Or if you haven’t been there yet, you will be in the future. Give yourself some compassion.”

Meza Villari says she’s seen the most improvement among children whose parents try to decipher what their children are communicating with behavior. “De-personalize it,” she said, and make sure your child feels they can come to you with concerns. “It’s important for children to feel safe.”

Parents looking for help can call Raising Special Kids and request a Parent to Parent Connection where they will have the benefit of emotional support by talking with parent volunteer whose been though similar scenarios.

Raising Special Kids also offers a class for parents, Positive Behavior Support, and a section on their website dedicated to behavior issues. Select Raising Special Kids staff have received specialized training to coach families with children age 2 to 12 to address challenging behaviors. The Positive Parenting Program, or Triple P, is an international program that provides in-depth group training to parents. There is no charge to families who use these resources.

Parents can also contact behavior specialists for coaching and assistance with their children’s behavior. Costs will vary based on insurance coverage and the frequency of visits.

Families who live in remote areas like the Navajo Nation have fewer resources available, said Trudy Billy, Tribal Program Manager with Raising Special Kids. Many parents travel an hour or more to Flagstaff or other border towns to access behavior therapy. Some parents successfully access support from their home school district.

While telemedicine also provides a resource for families in remote areas, it isn’t frequently used for behavior counseling, Billy noted. She hopes this will change if parents in these areas continue to request remote services.

Above all, understanding your child can go a long way in guiding their behavior. “Parents need to realize what their child is trying to tell them,” Turrey said. “It might not be specific words, but it’ll come out. If you can figure out what they were trying to get, it can help you decode the behavior.”

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