Behaviour that is Challenging 

What is behaviour that is challenging? 

Behaviours that are challenging, are defined as “culturally abnormal behaviour of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities”. 

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

What is the impact of behaviour that is challenging? 

• Behaviour that is challenging can have a negative effect on the child and their parents/carers. Unwanted behaviour can make the family feel socially isolated due to reluctance to leave the home. They can have increased stress and anxiety which may also lead to feelings of loneliness and depression.
• They may be reluctant to leave the home and be wary of allowing people into their home.
• Some behaviour that is challenging can lead to physical pain and discomfort. This may include self-harming e.g. self-cutting; ingestion or inhalation of foreign bodies; hitting head on the floor; or throwing body on the floor can result serious injuries. Accidental injury is also a common issue in children with aggressive behaviour, not only for them, but also the parents and carers involved 
• If a child has oppositional behaviour this may result in dietary deficiencies, weight loss or gross obesity. 
• A child may lose their self-confidence and self-esteem impacting on their sense of wellbeing at school and in social activities. 

Underlying skills needed to develop appropriate behaviour

• The child has to have some ability to self-regulate. They need to be able to   obtain, maintain and change emotion, behaviour, and attention and activity level appropriate for the activity or situation.
• The child should have some sensory processing skills which allows them to respond appropriately to stimulation from the environment as well as their own body.
• The child has to be able to understand the instructions given to them either verbally or visually. 
• The child needs to be understood by others either through speech signing or use of pictures to communicate effectively. 
• The child some reasoning and thinking skills. 
• The child should have some ability to perceive emotion; integrate emotion; facilitate thought, and to understand emotions in order to be able to regulate their emotional state.
• Social skills are determined by the child’s ability to engage in reciprocal interaction with others (either verbally or non-verbally); to compromise with others, and be able to recognise and follow social expectations. 
• The child needs to have some ability to plan and sequence an activity in order for it be successful.  

How would I know if my child has behaviour that is challenging? 

• The child has difficulty following instructions or completing tasks that are asked of them.
• The child responds extremely negatively to being told “No”.
• The child’s behaviour causes the parent/carer anxiety or distress when out and about.
• They may be  extremely stubborn and displays opposition to parent or adult requests 
• The child is easily frustrated and responds inappropriately to this
• The child has tantrums that last for longer than most children their own age. 
• The number of temper tantrums or behavioural episodes per day is more than normal for children their own age. 
• The child is  difficult to discipline 
• The child does not respond positively to typical behavioural strategies are used within the home/school environment.
• The child has difficulties with basic social interactions.

What can be done to improve behaviour? 

• Help the child to understand and recognise other people’s feelings, improve play skills, and try to problem solving ability and the ability to self-regulate. 
• Help family/carers to understand what the child is trying to communicate. (E.g. if physical aggression means leave me alone, teach the child the equivalent skill, i.e. ‘go away’ sign). 
• Early recognition that the child is struggling and starting to adapt strategies to improve more effective means of communication is beneficial – the earlier it is addressed the easier it is to change and avoid disruption. 
• Supporting carers/families to understand and cope with the child’s unwanted behaviour on an emotional as well as cognitive manner is important
• It is essential that the child receives a consistent and realistic approach from everybody involved in their care/lives and that everyone has the same expectations.
• It is necessary for that the child has lots of opportunity to achieve success.
• It is absolutely vital that the child understands what is expected of them. 
• It is important to understand and use the child’s motivators i.e. – the “what’s in it for me?” These motivators may relate to being praised, spending time with parents, access to computer, or playing a special games or toys etc. The child needs to understand what they have done to earn their reward. 
• Use clear and concise language when making requests and, if necessary, show them what you want them to do. 
• Use the tone and volume of your voice to make clear requests and emphasise what is important e.g. be firm but friendly; ensure the  tone if the request is non-negotiable. Setting clear boundariesare necessary for both children and parents/carers. Boundaries clear and concise for the child to understand what is and is not unacceptable behaviour.

Strategies that can help promote behaviour that is appropriate include: 

Time out

The purpose is to disrupt unwanted behaviour immediately while also giving the child the opportunity for the child to calm down. Time out is most successful when parent/carer remains in view of the child. It may be useful to provide a visual aid to represent a “time out space” e.g. a red circle that can be used in any location. The “time out” period should be relatively short, the general recommendation is to use 1 minute for each year of age. When it is finished it is important to reiterate why “time out” was used. It is also important to recognise that that incident is finished and will not be addressed again. 

Choices

Children like to be given a choice but at times children will push these boundaries e.g.  by asking for something different that they know is not on offer. It is essential that that parents/carers have clear boundaries in place, and understand that sometimes saying “NO” and not relenting is necessary. It is ok to say: “That is not a choice. The choice is …….. Or ………. What is your choice?”

Use of tokens to reduce incessant speaking

If a child has a habit of incessant talking, it may be worth introducing a “talking counter” system.  Provide the child with a certain number of counters. Each time the child wants to talk with you they take a counter but the parent/carer asks “are you sure you want to use this counter now? Do not respond unless a question is asked. Do not respond to statements. Instead ignore the statement or say “Thank you for telling me. (pause)……….”Oh! Are you asking me a question? What question are you asking me?

Use of “House Rules”

As a family it might be useful for everyone to get together and create a group of “house rules” that everyone has input into and agrees to follow. This helps everyone understand what is and is not allowed to happen. This is useful for both children and adults in the family. It should be written up and displayed somewhere in the house – possibly on the kitchen fridge.

Use of “Role Play”

Role Play can be used to do teach children how to respond to specific situations. It can also be used to help the children learn how to behave in social situations through modelling and practicing. Small group games with good role models provide good opportunities to learn social skills. 

What are the benefits of therapy for a child with behaviour that is challenging?

• Therapy can help the child ability to access the school curriculum. It can help the child to understand their emotions more effectively and reduce unwanted behaviour which will result in more inclusion in the school day. Therapy will also help the child break down the instructions so that they can understand what is being asked of them – the teacher will be given advise on how to present work to the child
• Therapy can help the child avoid the risk of becoming socially isolated. By promoting positive behaviour the child and family can engage in “normal” activates this improves the quality of life this not only the child, but their families.
• Therapy can assist families establish and manage a routine. Help to establish and identify how unfamiliar tasks should be approached in order to minimise distress to the child and family/carers.
• Therapy will help the child have the ability to engage with their peers thereby reducing peer rejection and social isolation. By helping children understand what is “acceptable” and “unacceptable” behaviour they will be included in games and sports with their peers.
• Therapy can help the child learn and follow instructions from others especially those in a position of authority.
• Therapy can help the child meet their academic potential. The child will be more able to engage in a learning program.  
• Therapy can improve the child’s health and well-being by reducing the likelihood of negative thinking and reduced confidence, self-confidence and self-esteem.
• The child become less stressed and anxious as they become more in control and understand their own behaviour patterns. They will feel more in control, and the parent/carer will develop an understanding of why their child is behaving in a particular manner.
• Therapy will help a family’s to enjoy the day to day activities that they want to participate in (e.g. going to the movies, zoo, visiting friends and families).

If left unaddressed, difficulties with behaviour can lead to: 

• Social isolation for the child and families. 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. 
• The child will have difficulties following instructions especially from authority figures.
• Unwanted behaviours can lead to poor academic performance for a few reasons including the inability to cooperate in the structured activity/lesson and as the child may have developed a negative self-image state that is not conducive to learning. 
• Limiting a family’s ability to enjoy the day to day activities that many families do (going to the movies, zoo, visiting friends and families). 
• Home and family life can feel like a constant challenge – it may be difficult for them to leave the house and participate in an enjoyable daily activities or “treats” like days out. The longer this is left untreated, the harder it becomes to break the cycle, and difficult for the parent/carer to regain control.