Challenging Behaviors

How do I Manage Challenging Behaviours?

Behaviour management is one of the most commonly asked questions from practitioners before doing my course. Let's face it, when we are dealing with complex behaviours and multi-faceted conditions it can be quite confronting for everyone and it is crucial that we set ourselves and our families up for success.

First, Seek to Understand

When a child misbehaves, the first step is to define the reason behind the behaviour. Misbehaviour can stem from various underlying issues, including but not limited to weak core strength, sensory preferences, sleep, mental health, neurological and developmental challenges and conditions. It's essential to look beyond the surface and understand what is actually going on for the child. Following the principle of "Seek first to understand" and looking at the child through a lens that they are perhaps struggling, can be a very helpful first step.

Catering for Complex Behaviours

Children with challenging or complex behavioural presentations require a nuanced approach. It's crucial to discuss the specific conditions, symptoms and associated behaviours of each child individually. By doing so, we can tailor our strategies to manage their behaviour effectively. The goal is to avoid negative experiences and create a positive environment where the child feels nurtured and safe.

Collaboration is King

As I always say reach out to treating providers and approach through a multidisciplinary team approach. Find out what assessments have been done, what they know about the diagnoses, preferences and what does and doesn't work so you can set your sessions up for success.

Developing Child Specific Strategies

A clinical plan should be in place to manage behaviour. This involves starting with clear expectations with caregivers and developing a trustful relationship. Collaborative conversations and approaches with caregivers might be necessary to get everyone on the same page. Find out what their approach is on rewards and appropriate rewards for children as this will vary from person to person. Flexibility and the ability to modify the environment are key components of an effective strategy.

Setting up the Environment

Building a safe space is paramount. This involves creating a safe space for your child's needs and creating safety through routines, connection and creating an emotional bank account where trust can flourish. Sometimes, following the child's lead can be more beneficial than it seems. Knowing with they are interested in and being flexible is really important and allows you to improvise and layer in clinical methods to play. Parents might feel like a clinical approach is abandoned, therefore communication and education is paramount to establish that connection is more important than clinical outcomes as one will lead to the other.

Preparation and Responsibility

Set yourself up for your first session. Making sure you have all necessary information and mentoring prior to the first session with not only set you up for success but your child as well. While you may have administrative support, you are ultimately responsible for your clients. Calling caregivers before their appointment, or having a parent session first to get a good understanding of a child's needs can help set the stage for success.

Coordination and Considerations

Take into consideration the schedule and load of the child and when it is going to be the best for them to attend the session. Perhaps start of day sessions will work better than afternoon, or work it around medication timing so that you are setting the child up for a good session. Additionally if you have children that experience both positive and negative outbursts being mindful of other children in and around your client in the clinic can be really important so that you can make it appropriate and safe for all clients.

Time Management and Positive Reinforcement

Sometimes it might be best to allocate more time for children with challenging behaviours and set clear expectations with parents and caregivers. Transitions before, after and within the session might be difficult so layering in positive reinforcement and transition exercises that they relate to can be helpful. We have included screen time (shock horror) for some of our PDA (Pathological Demand Avoidance) clients to aid with transitions and compliance. This is something we agree on with the caregivers ahead of time. Avoid reprimanding behaviour directly; instead, get to know the child and their interests and use this to aid during outbsurts or difficulty. Use positive reinforcement, praising the child 3-5 times for every correction. Be mindful of your language, avoiding the word "no" when possible.

Engagement and Role Modeling

Engagement and behaviour are closely linked. Positive reinforcement and role modeling can significantly impact a child's behaviour. By understanding the root causes, developing tailored strategies, and maintaining open communication with caregivers, we can create a supportive and effective environment for the child.