Challenging behaviour

A behaviour disorder is characterised as a clinically significant pattern of behaviour associated with distress or impairment in an important area of functioning.

Childhood behavioural disorders include Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Obsessive Compulsive Disorder (OCD), Pathological Demand Avoidance (PDA), and eating disorders.

Does my child has a behavioural disorder?

As children develop, they are constantly growing and changing. It is important to bear this in mind if your child’s behaviour is disturbing. However, childhood disorders are more significant exaggerations of emotional states than the milder forms, which are regarded as normal for their age. If the problem is persistent, seek the help of a trained professional, who can help with diagnosis.

Can children have more than one behavioural disorder?

Yes, two or more behavioural disorders can – and often do – exist at the same time. For instance, research shows that between 35-60 per cent of those with ADHD also have ODD.

Challenging behaviour is conduct that is either a challenge for others to manage and/or puts the young person at risk.

Children with learning difficulties have behaviours that challenge and may include aggression, self-harm; soiling or smearing; shouting; and ‘acting out’ or sexualised behaviour in public.

All behaviour happens for a reason, and understanding the function, as well as finding the ‘trigger’, is key to managing it positively. An outburst may be a known reaction to a daily activity, or sometimes it may be so out of the blue you are struggling to work out what has caused it. It’s a way of communicating.

However, once children learn that shouting and banging their head, for example, gets them attention or gets them out of a situation, positive reinforcement kicks in and they begin to see it as a way of getting what they want. This is called a learned behaviour.

Functions of challenging behaviour:

Social attention, to get noticed
Escape or avoidance
Tangible reward, to get something they want eg food
Sensory, because it feels good
Communication, to express emotions
Pain/feeling unwell or anxious.

Types of challenging behaviour

Self-injury or self-harm: This can present as head banging, hand or arm biting, hair pulling, eye gouging, face or head slapping, skin picking, scratching or pinching and forceful head shaking. ‘About half of all people with autism engage in self-injurious behaviour at some point in their life. People who used these behaviours as children may return to them as adults during times of stress, illness or change,’ says The National Autistic Society.
Being aggressive: Hurting others; biting, pinching, slapping, spitting, hair pulling and screaming or shouting.
Being destructive: Throwing things, breaking furniture, ripping things up.
Pica: Eating or mouthing non-edible items, such as stones, dirt, pen lids, bedding, metal, faeces.
Smearing: Of faeces.
Repetition: Rocking, repetitive speech and repetitive actions or manipulation of objects.
Running away or stripping off.

Triggers:

Hormonal changes may cause aggression during puberty.
Frustration at being told off, not being listened to or not being understood.
Feeling upset or distressed about something, perhaps a change in routine. Or even loneliness.
Depression, anxiety or even excitement. Hand biting may help them to cope with these feelings.
Boredom or lack of stimulation may lead to skin picking.
Lack of understanding. For example, what’s edible or inedible, or what’s the correct way to wipe themselves on the toilet.
Sensory stimulation.
Exploring how things feel or smell, like faeces.
Fear of the unfamiliar.

Managing it in the short term

Learn to recognise the warning signs and intervene early with a distraction or take them somewhere that is calm and away from distractions.
Use simple language and acknowledge their frustration, show them you understand. Be calm but assertive. Keep your face neutral and lower the volume and pitch of your voice.
Minimise the risk. Keep them safe. If they throw themselves to the ground, allow them to do this, but guide them so that they do not hurt themselves. If there is head banging, use a pillow or your hand to keep their head from hitting a hard surface.
Be consistent. Avoid confrontation. Avoid physically restraining unless you believe their behaviour is putting them at risk. Avoid paying too much attention or showing too much reaction.
Exercise can help release the anger and stress. Parents recommend punch bags, trampolines, running round the garden, or going for a long walk. ‘When we can see Matthew is getting heightened, we get him out of the house for a walk, and that invariably calms him down,’ says Louisa Caines, whose son is autistic.
Rewards and praise. Use positive reinforcement through praise when they get things right or are beginning to calm down: ‘You did what I told you to do as soon as I asked’. ‘You’re swallowing your medicine, even though you’re angry’. ‘You’re not grabbing now’. ‘You’ve stopped shouting’.

Managing it in the longer term

Recognise that the behaviour may often be a result of fear about the unknown. Use social stories to prepare your child for any new experiences or activities they are worried about.
Keep a diary: look for patterns or contributing factors – what was going on at the time, or directly leading up to the incident? Look for the positives as well as the negatives –what worked to quickly calm your child?
Monitor medications: something could be making them feel groggy or hungry, and some medications can affect continence.
If your child has disturbed nights, look into strategies to improve their sleep, which can have significant effects on behaviour.
Make sure they eat regularly: low blood sugar can cause mood swings and tantrums. Prepare a meal or a healthy snack every three hours. Include some protein, some fibre and some complex carbohydrates for energy. If your child is a fussy eater it is better they eat something, even if it is not a healthy choice.
Cut down on screen time: Noel Janis-Norton, a learning and behaviour specialist and author says, ‘Too much time in front of a screen often makes children angry, reactive and uncooperative. You may find that in the first week or two of this new limit on electronics they may be even angrier but stay strong because your children will get used to the new rules, and soon you’ll see the benefits.’
Try relaxation techniques: bubble lamps, smelling essential oils, listening to music, massages, or swinging on a swing are all worth trying.
Try also some sensory toys and devices: Rompa has a range of products to help with sensory integration such as fidget toys, weighted blankets, and compression tubes.
Encourage independence: allow your child to make their own decisions or try doing things for themselves. Reduce the number of demands placed on them. Encourage them to make friends, join a club or group.
Rule out any medical problems, oral pain or nutritional deficiencies: see a GP, dentist, nutritionist or occupational therapist if you think this may be the cause.
Help them to understand: if smearing is the problem, focus on toilet training. If pica is the issue, use visuals to learn what’s edible and what’s not. If it is a sensory-based issue, try replacing inappropriate items with an appropriate alternative of a similar texture, eg a crunchy carrot stick, popcorn, chewing gum.
Get support contact your local community support networks. Discuss your child’s behaviour with a GP, professionals and therapists.

Conduct disorder

Conduct Disorder (CD) is a serious mental health condition which affects the child’s development and can interfere with their leading a normal life.

Children and adolescents with CD tend to be repeatedly and persistently physically aggressive and/or antisocial, beyond what is expected of their age. In a younger child, where the difficulties are happening within the home, this may be called Oppositional Defiant Disorder.

Young people with CD may fight, bully, be cruel to people and animals, destroy other people’s property (possibly including arson), lie and steal, this may range from ‘borrowing’ others’ possessions to shoplifting, forgery, car theft and burglary.

Children with this disorder often lie, are truants, cheat at schoolwork and display callous behaviour. They may misuse tobacco, alcohol and other drugs at an unusually early age and be sexually precocious. Around five per cent of pupils are reported as having conduct disorder – although the actual figure may be higher because many are undiagnosed

The cause of CDs is unclear, possibly a combination of biological, genetic and environmental factors. More boys than girls are diagnosed and increasing numbers as children reach adolescence.

CD is often accompanied by other conditions, such as ADHD, autism, anxiety disorders, depressive or bipolar disorders, and substance misuse. These disorders are the most common reason for children being referred to mental health services.

Before diagnosing, a professional will talk to parents, teachers and others in the child’s life to rule out other potential conditions before diagnosing CD. The earlier the diagnosis, the better the likelihood of treatment working.

Currently, the best treatment for CD is considered to be long-term psychotherapy and behavioural therapy, with the entire family and support network involved.

Schools employ a variety of strategies when working with these youngsters, including behaviour management, social skills (often through enhanced personal, social and health education [PSHE] input), strategies to improve self-esteem and self-control, and close liaison and involvement with parents and safeguarding professionals. Nevertheless, children diagnosed with CDs often fail at school or college and become socially isolated.

In recent years there has been some criticism around how CD is dealt with in schools.