GETTING IN CHARGE OF BEHAVIOR

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GETTING IN CHARGE OF BEHAVIOR

• PATRICIA MCGUIRE MD, FAAP
• DEVELOPMENTAL BEHAVIORAL PEDIATRICIAN

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What is developmental behavioral pediatrics?

• Development Understanding how kids learn how to
  do anything
• Behavior Understanding why kids do things the
  way they do

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Temperament The HOW of behavior

• Temperament consists of nine traits
• Traits are inherited
• Traits with life experiences help mold
  personality
• These traits can become a good or poor fit with
  others in the environment

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The 9 Traits

• Activity Level Rhythmicity
• Approachability Adaptability
• Intensity of response
• Mood Persistence
• Distractibility Sensory threshold

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Other Factors Affecting Behavior

• Health acute and chronic
• Family dynamics
• Developmental issues delays, autism spectrum
  disorder, etc.
• Tiredness, hunger
• Others in childcare environment

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Now lets relate to problem behaviors

• Meltdowns
• Running out of the room
• Transition problems
• Hitting, slapping, throwing

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MELTDOWNS

• Need to look at what antecedent environment was
  doing
• Need to understand if child has any communication
  problems (either developmental or a delay)
• Need to understand if child experiences any home
  stressors
• Need to determine if child is slow to adapt to
  change, intense in his responses, and/or negative
  in mood

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Lets pretend

• 3 year old male, former preemie
• Doesnt like change, gets upset when parents,
  especially Mother drops him off
• Has many areas where he is picky regarding
  taste, smell, and touch
• Has chronic lung problems due to his prematurity,
  so is on meds
• Has problems with sharing this is meltdown major

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How could these factors play into meltdown?

• Preemie possibly damaged nervous system, and
  developmental delays
• Has some separation anxiety problems and
  transition problems
• Medications may make him more irritable and
  impulsive
• He may have some sensory problems that make him
  not like to share (only certain things feel,
  smell, or taste okay)
• He may also be slow to warm up and so would
  rather play alone
• He could have some autism characteristics

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How to handle him

• With this information in hand, first give him the
  opportunity to calm down if you are starting
  from the meltdown
• Let him know that you understand sharing is hard
  to do sometimes and offer to help him get
  comfortable with it
• Do some one-on-one sharing training, until he is
  comfortable with the fact he will get something
  back
• Note if he has sensory preferential toys/objects

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How to handle him

• Once he is comfortable with this bring in another
  child, preferably one who is easy going and
  tolerated by the first child
• Play a sharing game with them, with you being the
  referee or mentor
• Give lots of positive feedback about how he is
  trying and making progress

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What if there are language delays or autism
characteristics?

• Many of the previous suggestions will still work
  you will just have to work longer at them
• If there are delays, etc., it would be useful to
  have GWAEA involved with their speech, OT, PT,
  and Autism Resource Team to provide tools, such
  as picture communication systems
• These can be used to help provide a visual for
  what you are teaching

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Running Out of the Room

• First question Why is the child running out of
  the room?
• Afraid
• Wants you to play catch
• Overwhelmed by noise/action/stimulation
• Avoiding consequence for behavior
• Sees someone he likes

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What was happening before he ran?

• What type of noise/action/stimulation was
  occurring
• Was he tired, hungry, ill, afraid, mad
• If he was mad, why
• How had his day been going
• Was it a routine day or had there been changes

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How to Handle

• Need to have plan ahead of time of what to do
  with runners be consistent
• Think about the profile of the runners
• Developmental, health, etc.
• Position yourself between the child and door
  before engaging the child
• Get down to his level and speak softly and
  encouragingly about helping him, even if he is in
  trouble (Gee you are so mad, you hit Tommy. Can
  you tell me what he did?) This may require
  someone to tend to the victim while you learn
  about how he ended up hurting his peer

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Consequences

• There needs to be a written plan, posted to point
  to for the children, of the consequences for
  inappropriate behaviors
• These need to be immediate, not in a few hours,
  the next day, or to be implemented by the parents
• It should be preceded by the above determination
  of what caused the behavior
• The child is then told that you will help him
  with the problem, but he does have the
  consequence for the behavior
• Once the consequence has been served, there is no
  discussion of why he had it, but rather the offer
  to work on the problem that created the behavior

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Transition Problems

• Are we dealing with a child who is slow to adapt
  to change?
• This would be the child who asks why why
  me, why now, and why this way.
• They wont stop what they are doing until they
  are done or they receive a logical (to them)
  answer from you to their why
• Many tend to frustrate more easily or meltdown

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How to help the child

• The more predictable the environment, the less
  the problems with transitions
• Give individual heads ups about changes a few
  minutes before the other kids
• Help him decide if he can finish in the time
  allotted or should put aside for later (may
  require hands off from other kids)
• Lots of reinforcement for working on getting
  transitioned
• Answer his why questions if you can!!
• This is not Because I said so or Because I am
  the boss. He already knows that, he wants to
  know why
• Provide choices when you can
• Have a picture schedule that he can refer to
  regarding routine and times of changes

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Hitting, Slapping, etc.

• This is never appropriate
• We do need to understand why it was used, however
• Is it the means of punishing in their home?
• Is it a means of communication that they are mad,
  frustrated, confused, etc.?
• Think who the child is (strengths/weaknesses) as
  you address the behavior
• Think about the situations where this occurs most
  often
• Think of other ways to help the child complete
  what is needed without these behaviors

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Consequences (here we are again)

• There needs to be a written plan, posted to point
  to for the children, of the consequences for
  inappropriate behaviors
• These need to be immediate, not in a few hours,
  the next day, or to be implemented by the parents
• It should be preceded by the above determination
  of what caused the behavior
• The child is then told that you will help him
  with the problem, but he does have the
  consequence for the behavior
• Once the consequence has been served, there is no
  discussion of why he had it, but rather the offer
  to work on the problem that created the behavior

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Develop a Profile on each child

• When they first enter center
• At major changes e.g., infant to toddler room,
  toddler to preschool room
• List what may be needed to be preventive/intervent
  ive
• Review frequently
• Remember to also focus on the strengths and use
  them to help the areas of struggle

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Useful Resources

• The Difficult Child, Stanley Turecki, MD
• Raising Your Spirited Child, Mary Sheedy
  Kurcinka, M.A.
• The Temperament Guides, Catherine J. Andersen,
  M.Ed
• Temperament in the Classroom, Barbara K. Keogh
  Ph.D
• A Practical Guide to Solving Preschool Behavior
  Problems, Eva Essa
• How to Talk So Kids Will Listen Listen So Kids
  Will Talk, Adele Faber Elaine Mazlish