How to treat troubled children

Every early childhood teacher knows a child who is hard work. Dr Georgie Fleming’s research focuses on them, and here she offers a few practical management strategies – and hope.

Whenever I run a workshop for early childhood teachers, I describe the kind of child who is the focus of my psychological research and clinical practice. I give examples such as “the child who always says ‘no’ or asks ‘why?’ when you give an instruction” or “the child who annoys other people on purpose”. I describe a child who is quick to anger, starts fights, breaks things. The liar and the thief. The rule breaker.

During this introduction, I invariably notice my audience begin stealing glances with their colleagues. They start mouthing names to one another and get fervent nods in return. When I ask if anyone has worked with children like that, the chorus of affirmations is resounding. This lets me know I’m in the right place. If understanding and managing this kind of child were easy, there wouldn’t be a need for a workshop.

Here’s the thing: anyone who works with children knows this child. The easiest way to describe them? They are hard work.

In clinical psychology research, we describe the difficult children as having disruptive behaviour problems. I am working to understand and help this group of children and the people around them. Which begs the question: what’s the key to working effectively with hard children?

Recognise complexity

The first key to working with children with disruptive behaviour problems is to recognise that not all disruptive children are created equal. Although professionals use labels such as “oppositional defiant disorder” and “attention-deficit/hyperactivity disorder”, it is unhelpful, not to mention unscientific, to assume that two children with a single label experience the same difficulties for the same reasons. In fact, we know that children with disruptive behaviour problems are a mixed bag.

A considerable portion of my research is dedicated to understanding how some disruptive children differ from others. Scientists have tried various methods of dividing a group of disruptive children into smaller, more homogenous subgroups. This is essentially taking the mixed bag and separating it into smaller bags filled with the same kind of stuff.

I’m most interested in a subgroup of disruptive children who not only show the defiance and rule breaking typical of disruptive behaviour problems, but who also have limitations in their ability to experience “moral emotions”.

Moral emotions are the feelings we typically experience as accompanying our conscience. Guilt – that aversive feeling we get when we break a rule or hurt someone – is a moral emotion. Empathy is another – recognising and taking on the feelings of someone else. We start seeing evidence of moral emotions early in child development, often as young as two years. These emotions are important because they motivate moral behaviour. They function as an internal ‘stop gap’ against breaking rules and can motivate reparative behaviours when rules get broken.

The moral emotions of many disruptive children are fully intact. In response to their angry outbursts or aggressive behaviour, they often feel shame and remorse. They can be kind and caring to others. However, the development of moral emotions can sometimes go awry. When disruptive behaviour co-occurs with underdeveloped moral emotions, the disruptive behaviour problems are often more severe and longer lasting than for other children. This makes sense: if I don’t feel guilty after punching you and I don’t empathise with your distress, I’m unlikely to care about doing it again.

The upshot is that this subgroup of disruptive children is at the greatest risk of long term problems and thus is most in need of intervention. However, some research shows that children with disruptive behaviour and underdeveloped moral emotions gain significantly less benefit from interventions than others. We think this is because interventions don’t usually address the unique characteristics of this subgroup.

Prompt children to pay attention to others’ feelings and help them identify the facial and bodily expressions that correspond with sadness and fear.

Tailor your solutions

We need to tailor our behaviour management approaches to the individual characteristics of children whose moral emotions are underdeveloped. Children with disruptive behaviour problems have different difficulties for different reasons, so it makes sense that we need to support them in different ways. We need a mixed bag of strategies.

The team at the UNSW Parent-Child Research Clinic developed and tested an intervention aimed to help parents and early childhood teachers manage the disruptive behaviour of children with underdeveloped moral emotions.

Here are my top three tips

Use reward-focused behaviour management strategies rather than consequence-focused strategies. Research shows that children with underdeveloped moral emotions don’t learn from consequences as well as typical children. On the flip side, they are very motivated by rewards. This may mean prioritising strategies such as token economy systems over the “thinking chair” or removing privileges. (In a token economy system, children earn tokens for doing specific behaviours such as complying or sharing and can trade their tokens for personalised rewards such as making slime or going out first to play.)

As difficult as these children can be to like sometimes, try to show them warmth and affection. The science is fairly clear that warm and affectionate caregiving is protective for children with underdeveloped moral emotions: when they experience warm and affectionate caregiving, they are less likely to develop severe and long lasting disruptive behaviour problems.

Increase the amount of feelings talk. Some theories suggest that moral emotion development goes awry because some children pay less attention to others’ feelings and, even when they do, are less able to identify the feeling. Prompt children to pay attention to others’ feelings and help them identify the facial and bodily expressions that correspond with sadness and fear. Reward children for doing this ‘emotion work’, especially if they do something kind in response to others’ distress.

Consistency is key. These practical strategies are the tip of the iceberg for tailoring behaviour management approaches. However, regardless of your approach, there is one thing that will increase the likelihood of success: consistency – over time, among people, and between settings.

Holistic approach

Working on school grounds, our research is trying to provide tailored behaviour management support for disruptive children that is used every day by parents and teachers, both at home and at preschool.

We anticipate that this holistic approach will result in improvements in child behaviour that occur more rapidly and are longer lasting than traditional avenues of support. Not only that, we expect to see improvement in family and school outcomes, too.

We intend for this holistic approach to become the standard model of care for children with disruptive behaviour problems. Ultimately, we hope the children who are hard work become much, much easier.

Dr Georgie Fleming is a Postdoctoral Research Fellow in the School of Psychology at the University of NSW. She completed her combined PhD/Master of Psychology (Clinical) at UNSW, and she is a registered psychologist. Georgie’s research is concerned with treatment for young children with clinically significant conduct problems. She is also interested in the role of callous-unemotional traits in the development of conduct problems, and exploring how callous-unemotional traits impact the efficacy of treatment for childhood conduct problems.