In this newsletter, there are descriptions of challenging behaviors and creative solutions.

This information is meant to support parents and caregivers who have questions about childhood behaviors. This information should not be used to diagnose or treat your child, nor is it intended to be medical advice.

Please reach out to your child's doctor for more information.

"Most children have occasional tantrums or meltdowns. Acting out when it’s time to go to bed or stop playing a game is par for the course. But when kids are having tantrums often, or it seems like they can’t control their temper a lot of the time, you may be seeing something more extreme than typical problem behavior.

Here are some signs to look out for:

• When problem behavior is interfering with his ability to make friends or get along with other kids.
• When problem behavior is causing a lot of conflict at home and disrupting family life

• When your child feels like she can’t control her anger, and it is making her feel bad about herself

• When his behavior is causing trouble at school with his teachers or his fellow students

• When her behavior is dangerous to herself or others

If you are worried about your child’s behavior and are having a hard time managing it on your own, making an appointment with a clinician who has expertise in children’s mental health can be very helpful. A clinician can perform a comprehensive evaluation to determine whether your child may have an undiagnosed mental health disorder that is contributing to her behavior issues, or recommend specific strategies or treatments that might be helpful.

For more information about how to find a clinician who can help, read the Child Mind Institute’s Parents Guide to Getting Good Care."

"Attention-deficit hyperactivity disorder (ADHD)

Children with ADHD find it unusually difficult to concentrate on tasks, pay attention, sit still and control impulsive behavior. While disruptive behavior is not a symptom of ADHD itself, it is often the result of ADHD symptoms. Inattention and impulsivity can make it very difficult for kids to tolerate tasks that are repetitive, boring, or take a lot of effort. Because of this, children with ADHD are frequently overwhelmed with frustration, and throwing a shoe or pushing someone or yelling “shut up!” can be the result of their impulsivity. Some kids with ADHD can also develop negative behavior patterns, which are a response to years of finding themselves in conflict with adults.

Oppositional defiant disorder (ODD)

Children withODD have a well-established pattern of behavior problems, with symptoms including arguing with authority figures, refusing to follow rules, blaming others for their mistakes, being unusually angry and irritable, and more. All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for.

Disruptive mood dysregulation disorder (DMDD)

Children withDMDD experience frequent, severe temper outbursts that seem grossly out of proportion to the situation at hand. In between tantrums they are chronically irritable. Their disruptive behavior is a result of their very big emotions and poor self-regulation skills. Children with DMDD often feel very apologetic after a tantrum is over.

Anxiety

Children who seem angry and defiant may be severely anxious. When children are having a hard time coping with situations that cause them distress, they may lash out. This may happen when the demands at home or school put a pressure on them that they can’t handle. In an anxiety-inducing situation, your child’s “fight or flight” instinct may take hold — she may have a tantrum or refuse to do something to avoid the source of acute fear.

Trauma

Children who have been traumatized frequently mask their pain with behavior that is aggressive. As a result of their trauma they may be struggling with poor emotional self-regulation, negative thinking, and be overly alert to dangers — and more likely to jump into their “fight or flight” response in an effort to protect themselves.

Learning problems

Children who act out repeatedly in school or during homework time may have an undiagnosedlearning disorder. They may be feeling frustrated and ashamed because they are struggling to do things that look easy for other kids, and they don’t know why. Rather than ask for help, they may rip up assignments or act out to create a diversion from their real issues.

Sensory processing issues

Some children have trouble processing the sensory information they are getting from the world around them. Children who are under- or over-sensitive to stimulation can often feel uncomfortable, anxious, distracted and overwhelmed, which can frequently lead to disruptive behavior.

Autism

Children on the autism spectrum tend to be rigid — needing consistent routine to feel safe — and unexpected changes can lead to them having a tantrum. Autistic children can also struggle with sensory issues that leave them feeling overwhelmed. Some autistic children may also lack the language and communication skills to express what they want or need."

"Here are five behavioral strategies to help manage your child's ADHD:

1. Give praise and rewards when rules are followed.

Children with ADHD often receive and expect criticism more so than other children. This can really impact self-esteem. Some days, you might have to really look for the good behavior, but you should praise good behavior at least five times more often than you criticize bad behavior.

2. Give clear, effective directions or commands.

Make eye contact or gently touch on arm or shoulder to get his or her attention. Give brief, simple steps and short commands that get to the point rather than multiple directions or wordy statements and questions.

3. Establish healthy habits.

If your child is on a medication, it should be taken as prescribed. Contact your child's health care provider if problems arise. Make sure your child is getting enough sleep, eating a well-balanced diet consisting of three meals, a snack and adequate fluids daily, and has an outlet for some form of daily exercise. These healthy habits will help your child to feel his or her best and help minimize ADHD symptoms.

4. Develop routines around homework and chores.

Work together to make a checklist of what needs to be done surrounding daily chores, getting ready for bed and school for your child to refer to when he or she gets off task. Encourage your child to use a daily planner so he or she is aware of all homework assignments. Have an established time and location for homework, and use a timer to remind your child to show you how the homework is going two to four times per hour. Factor in brain breaks if your child needs them and movement between tasks or use of an appropriate fidget.

5. Help your child build relationships, strong social skills and maintain friendships.

Be a good role model of behavior you want your child to use. Factor in some special time three to five days a week with your child that is conflict-free and does not involve a screen to help maintain a strong parent-child relationship. Help your child develop at least one close friendship. With younger children, parents may need to take the lead to arrange and host play dates or get kids involved in activities where there are kids the same age. Get tips for helping your child develop social skills."

• "Modified homework assignments, testing and deadlines
• Use of helpful tools (calculator, tape recorder, computer and electric spell-checker)
• A behavioral plan or social skills training
• Continual progress reports assessing behavior and assignments
• Peer, volunteer tutors or working one-on-one with the teacher
• Sitting the student near the teacher and away from doors and windows
• Increased parent and teacher collaboration
• Providing the student with a note-taking partner
• Letting the student run occasional errands for the teacher to burn off some energy"

"Consequences that are more effective begin with generous attention to the behaviors you want to encourage.

• Positive attention for positive behaviors: Giving your child positive reinforcement for being good helps maintain the ongoing good behavior. Positive attention enhances the quality of the relationship, improves self-esteem, and feels good for everyone involved. Positive attention to brave behavior can also help attenuate anxiety, and help kids become more receptive to instructions and limit-setting.
• Ignoring actively: This should used ONLY with minor misbehaviors — NOT aggression and NOT very destructive behavior. Active ignoring involves the deliberate withdrawal of attention when a child starts to misbehave — as you ignore, you wait for positive behavior to resume. You want to give positive attention as soon as the desired behavior starts. By withholding your attention until you get positive behavior you are teaching your child what behavior gets you to engage.
• Reward menus: Rewards are a tangible way to give children positive feedback for desired behaviors. A reward is something a child earns, an acknowledgement that she’s doing something that’s difficult for her. Rewards are most effective as motivators when the child can choose from a variety of things: extra time on the iPad, a special treat, etc. This offers the child agency and reduces the possibility of a reward losing its appeal over time. Rewards should be linked to specific behaviors and always delivered consistently.
• Time outs: Time outs are one of the most effective consequences parents can use but also one of the hardest to do correctly. Here’s a quick guide to effective time out strategies.
• Be clear: Establish which behaviors will result in time outs. When a child exhibits that behavior, make sure the corresponding time out is relatively brief and immediately follows a negative behavior.
• Be consistent: Randomly administering time outs when you’re feeling frustrated undermines the system and makes it harder for the child to connect behaviors with consequences.
• Set rules and follow them: During a time out, there should be no talking to the child until you are ending the time out. Time out should end only once the child has been calm and quiet briefly so they learn to associate the end of time out with this desired behavior.
• Return to the task: If time out was issued for not complying with a task, once it ends the child should be instructed to complete the original task. This way, kids won’t begin to see time outs as an escape strategy."

"The impact of child traumatic stress can last well beyond childhood. In fact, research has shown that child trauma survivors may experience:

• Learning problems, including lower grades and more suspensions and expulsions
• Increased use of health and mental health services
• Increase involvement with the child welfare and juvenile justice systems
• Long-term health problems (e.g., diabetes and heart disease)

Trauma is a risk factor for nearly all behavioral health and substance use disorders."

"What is sensory processing disorder?

Children with sensory processing disorder have problems processing information from the senses. This makes it hard for them to respond to that information in the right way. The senses include touch, movement, smell, taste, vision, and hearing. In most cases, these children have one or more senses that either react too much or too little to stimulation. This disorder can cause problems with a child's development and behavior."

Click the green button above for more information on symptoms, diagnosis and treatment.

"Adults sometimes struggle with how to talk with children following tragic events, such as natural disasters, plane crashes, and school shootings. Below are some guidelines to help in these difficult situations:

1. Children gauge their reactions based on how the adults around them respond to a situation."

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