Behavior Problems in Young Children

Linda Grossman, MD

Developmental-Behavioral Pediatrician and Director, Clinical Services

Baltimore County Department of Health

Key points

Young children (ages 3 to 5) - different developmental stage than school age

Need more active, child initiated learning experiences

Affected more by external factors than older children

“Imprinting” of behaviors has major impact

Case #1 - - Refusal to join activity Sarah just turned 4 and is enrolled in a

pre-K program She refuses to join the group for circle

time despite multiple efforts by her teacher to get her to join the group

Possible role for developmental issues Erik Erikson –

– School age – age of industry– Pre-school age – age of initiative

Selma Fraiberg - “The Magic Years” – development of imagination and mastery of imagination

More on pre-school development

Child initiated learning Multi-sensory and active Interest in peer interactions - need to

develop social skills to foster peer interactions

Input from key adults besides parents is very important but not as much so as for school age

Potential strategies

Invite to join group but avoid pressuring Set limits about staying in classroom and

playing quietly Feel free remind that she needs to be

thoughtful and not be too noisy so the other children can’t hear the story

Then ignore child totally or include comments referring to child but not directed at child– “Let’s read our story and maybe Sarah will join us later”– “Boy this sure is fun, I hope Sarah joins us tomorrow”

Usual outcome

Sarah usually will gradually move closer to listen to story or group interaction

She may call out an answer – if this happens, you can re-invite her to join in or tell her you are glad she was listening (don’t criticize her behavior or actively exclude her)

Eventually she will join in – welcome her but don’t give her too much attention linked to joining the group

Case #2 – Aggressive youngster

Thomas is a large youngster in the pre-school He just turned four but looks much older He is playing with a group on the floor with

blocks and trucks He knocks over another boy’s tower and

grabs his car This behavior seems to happen often but

especially on Mondays

Factors

Physical appearance and developmental level out of sync – people’s expectations are too high for him

Crowded conditions Inadequate supervision Stresses out of school

Stresses and other factors out of school Basic needs

– Not enough sleep– No breakfast– Inappropriate food (sugar, caffeine)

Family stresses – Financial – Work schedules or overscheduled child – Divorced parents - weekend visitation

More out of school factors

Exposure to violence– Family violence– TV and other media

Parenting style– Authoritarian parents – Indulgent/permissive parents– High level of parent conflict over child

rearing

Emotional disorders

Possible ADHD – but less than 40% of 4 year olds who are given ADHD dx still have that diagnosis at age 7

Possible ODD – usually more related to home and school management

Possible language disability – lack of language skills to manage social interactions

Possible autism spectrum disorder

Possible management strategies

More space between children – less crowding

More supervision – adult proximity and positive input for pro-social play

Duplicate toys

More on management – talk with parents about Importance of sufficient sleep Value of good role models for conflict

resolution Having opportunities for physical activity

each day Limiting exposure to media – especially

media with violent themes

Most important component of management Supervise and intervene before misbehavior

occurs Provide positive feedback for pro-social

behavior Anticipate and redirect (if don’t tell child why

redirecting, child will not develop habit of misbehavior to get attention)

Prevention and reinforcement of positive behavior patterns is most valuable thing you can do for a youngster like this

If misbehavior has occurred

Correct behavior but keep any punishment to a very small amount

Consider “reframing” – tell boys that you are sure Thomas did not mean to knock over the tower (that helps reinforce that he is not a bad kid) but encourage him to say he is sorry and help build it back again

Encourage use of words – “Thomas, please use your words when you would like a turn with the truck – say ‘may I have a turn? Or “my turn, please’”

Case #3 – Eloping

Gordon is a four year old new to your school

He has run out of his classroom three times since school started

One time he headed out the door, saying that he was going to walk home

Possible ideas

Previous experiences – including minimal experience with limit setting

Feels like he has no opportunity for choices in classroom and/or lesson plans are very teacher directed

Feeling overwhelmed School is not fun for him

– Nothing of interest– High demands in areas of relative weakness

Management

Set clear limits on staying in classroom Give more active role in lesson and provide

more supervision at the same time Provide more flexibility for him within

classroom if he is feeling overwhelmed Provide more choices for him among

acceptable alternatives Consider his interests in planning day

Summary

Pre-school is a different developmental stage than school age– Need child directed learning– Need more active and more multi-sensory

learning– Need help in developing social skills– May have trouble with confusing

imagination and reality

Summary continued

Pre-schoolers affected more by external factors– Less ability to process external things– Less coping skills– Imagination may lead to misinterpretations of input

Best thing can do is to build positive experiences for child – anticipate and redirect from misbehavior whenever possible and verbally reinforce positives

For more information The Incredible years: A Troubleshooting Guide for

Parents of Children Aged 3-8. By Carolyn Webster-Stratton, Umbrella Press, Toronto, Ontario, 2005

Young Children’s Behavior: Practical Approaches for Caregivers and Teachers. Louise Porter, MacLennan and Petty Pty Limited, Sydney, Australia, 2008 (3rd Edition)

Toddlers and Preschoolers. Lawrence Kutner, William Morrow and Co, New York, NY, 1994

1, 2, 3 Magic: Effective Discipline for Children 2-12. Thomas Phelan, Parent Manage, Inc., Glen Ellyn, IL, 2010.