“Difficult” children (part 2)

Written by: Ms Sophie COURBION and Ms Elise NOIROT, neuropsychologists; Dr Marcelline RENAUD YANG, child psychiatrist

The scientific literature has broadly shown that there are risk factors. We are absolutely not talking here about the causes of behavioural problems in children, but rather about factors that increase the probability that such problems will emerge and persist.

There are four different categories:

• Language risk factors
• Cognitive risk factors
• Educational factors
• Emotional factors

The first category concerns speech delays or problems. A child who finds it difficult to express themselves will find it very hard to negotiate with an adult, and this produces feelings of frustration that can lead to anger and behavioural problems. In addition, a child who does not talk very well will be treated differently by those around them, so the problem can go both ways.

Moving to the second category, intellectual functioning naturally plays an important role since a child who has trouble understanding can behave inappropriately in response. However, it is also important to consider what are known as “executive functions”, notably attention and the ability to inhibit impulses.

The third category relates to how parents educate their child, but above all to their feelings of competence: am I capable of getting my child to do what I tell them, can I project a positive image of my authority?

The final category relates to the feeling of emotional security (attachment) associated with the social and family environment.

It is clear that these factors can be intertwined, even though studies have shown that in 70% of children, educational factors are the main contributor to the emergence of behavioural problems. When problems accumulate, however, the situation deteriorates and parents feel guilty and overwhelmed. It has been shown that once there are three risk factors involved, regardless of their nature, behaviour is difficult to manage and this leads the parents to seek help.

It is well understood that these risk factors are indicators that help to identify children who are likely to experience behavioural problems, but they are by no means predictors of such issues.

It is therefore clear that the aim of interventions is to take action on these risk factors. This will then reduce the likelihood that such behavioural problems will emerge. For example, if issues with executive functions are identified, it is possible to offer inhibition training. It is also possible to stimulate social cognition (act on the attribution of hostility, etc.). Action can be taken with regard to language development and verbal interactions with parents, as well as positive parenting. Work can be done to strengthen attachment.

A whole series of studies have shown that the interventions which work pretty well and perhaps slightly better than others are interventions with parents. This is not because parents are considered to be responsible for the emergence of problems, but because they will be the ones providing the coaching on a daily basis, and can put in place a whole range of relationship habits, adapt their approach to the child, reinforce what is working and thereby reduce the risk factors and help the child with the things he or she finds difficult. These programmes are known as PARENTING SKILLS GUIDANCE (such as Barkley, Non-Violent Resistance, etc.).

But there are also limits to the effectiveness of these interventions, including potential adverse effects on co-parenting. It is often difficult to get both parents to attend these sessions. In 90% of cases, only the mother attends. By working on maternal cognitions, the mother progresses alone, and this can lead to poor communication between the couple. New issues emerge. So, on the one hand, this leads to an improvement, but then something else is altered, something which may not have been so bad before these interventions. The benefits therefore need to be put into perspective...

How can you seek to manage a crisis?

The key word is: ANTICIPATION

For this, it is important to be able to observe methodically and without “too many” negative emotions.

It should be noted that a crisis lasts an average of 20 minutes. While observing, it is essential to have an objective view in mind of which behaviour you want to see change = this is the targeted behaviour

• How does it manifest? (Does the child shout? Hit? Cry?)
• What are the triggers? (Context)
• How frequent is it?
• What resources are available to calm the child? (Do they need to be isolated? Contained? etc.)

It’s also important to have in mind the behaviour you want the child to learn in place of the other: this is the alternative behaviour.

Keeping these ideas clearly in mind helps to coordinate the actions of both parents and to coordinate with the school, extra-curricular activities, etc. (if the problems come up in these environments) to ensure consistency.

How to intervene ? PROACTIVE strategies are by far the most effective. This means being as closely involved as possible in the child’s daily life and adapting interventions depending on the circumstances. This is why parental guidance that incorporates family values and habits is so important.

Establish a framework:

• Provide a clear, structured framework without too many instructions, which can cause cognitive overload for the child
• Identify and set three “non-negotiable and permanent” rules. Frequent reminders are needed, and you can use role play and mime to help integrate them.
• Adopt a good attitude: keep it constant and stick to it! The most important thing is to target one problematic behaviour (not several) from the beginning.

You can check out (or go back to) the first article in this series here.

In the next article, we will look at how to better understand emotional dysregulation and tantrums in young children, and how to help them manage them.

Bibliography

Roskam, I. (2012). Les enfants difficiles 3-8 ans. Bruxelles: Mardage.
Roskam, I. (2013). Mon enfant est insupportable. Comprendre les enfants difficiles. Bruxelles: Mardage.