Psychosocial etiology of behavioral difficulties in children and adolescents: Challenges in

identifying and addressing them in a timely manner

Diana Monteiro, Ph.D.The Hyderabad Academy of

Psychology

Psycho Social

• According to Wikipedia , “Psychosocial means it relates to one's psychological development in, and interaction with, a social environment”

• As adults we control much of the child’s social environment

Psychosocial etiology

• So what is a child’s social environment?– Other children, adults– Lots of play

• Psychological environment– Temperament– Interaction of biological and emotional needs

Mental health problems

• Occur out of one of three areas or a combination of all three areas:– Biological– Psychological – Sociocultural

Psychosocial

Evidence that social area affects kids

Approximately 10-15% of all typically developing preschool children have chronic mild to moderate levels of behavior problems (Campbell,1995).

Children who are poor are much more likely to develop behavior problems with prevalence rates that approach 30% (Qi & Kaiser, 2003)

Children who are identified as hard to manage at ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., 1990).

What does this mean for the kinds of children we have in our care?

5

Child’s basic needs

• Food• Shelter• Safety• Protection• Emotional connection

• Which are Socially based needs?

So basically

• High quality caregiving + high quality environments ≠ No challenging behavior

Challenges in identifying behavioral difficulties

• Thomas, Chess and Korn (1982)– To debate whether a child’s characteristics or

parental perceptions or other environmental influcences are more important is antithetical to the view which sees them ALL as all-important in a constantly evolving sequence of interaction and mutual influence (p.15).

Thomas , A., Chess, S., and Korn, S.J. (1982). The reality of difficult temperament. Merrill-Palmer Qauterly, 28(1), 1-20.

Challenges for adults

• We are used to labeling difficult children not difficult behavior

• Let’s start by assuming that every child has difficult behavior

• Some pathological and most not• Adult interventions strongly influence how a

child will develop behaviorally

Identify functions of Behavior

Reframing bad behavior: Understand why children “misbehave”

• To escape from doing an activity, task or event that they do not like or feel incompetent in

• To get attention• They may have difficulty in performance and

comprehension • Personal reward and gratification• To be in power, to take control over others, or revenge

Adult must observe children’s behavior to determine possible causes for misbehaving and the “reward” the child is receiving for acting this way.

What are challenging behaviors

• Repeated behaviors that interfere/prevent learning• Repeated behaviors that prevent positive social

interactions• Examples:

– Tantrums– Hitting, biting, pushing, pulling hair, spitting, etc. – Swearing, using negative language, shouting, ridiculing

others, etc.– Destroying property, games, materials, etc.– Withdrawing, not interacting, refusing to obey rules

Challenge is to remember

• All behavior happen within a particular context• All behavior serves a purpose• Children learn to behave or misbehave based on

whether it addresses their needs • Understanding why children act the way they do is

the first step in problem solving• Interventions must have a contextual fit• Interventions must have team-based approach/

process

Addressing behavioral difficulties in a timely manner

Why should we address these behaviors

• Children with serious behavioral problems (who do not receive necessary attention and assistance) are more likely to:– Fail in school– Be less productive citizens– Develop more serious behavioral problems

• Delinquency• Aggression• Anti-social behaviors• Drug abuse

Steps in Analyzing Child’s BehaviorAdult should discuss the following issues in consultation

with other adults who may also be interacting with the child:

• What behavior is of concern to the adults?

• When does this behavior appear:– Identify potential causes for the behavior – child is

frustrated, child is tired, child is uninterested– Who is around the child? Where is this behavior more likely

to take place at?

• What happens after the child misbehaves?– Do other children give the child what he/she wants?– Does the child get to stop doing the activity?– Does the child get more attention?

• Does the child have any kind of disability or learning difficulties?– Is the child hyperactive, impulsive, have difficulty concentrating/

paying attention– Does the child have any kind of physical difficulties – movement,

visual, hearing– Does the child show signs of difficulty in communicating, autism,

mental retardation– Does the child have a learning disability – reading, writing, math,

memory, etc.

• How can you change the behavior?– Discuss approaches to reinforcing child and guiding them towards

appropriate behavior

• Discuss behavior with child, what is expected of them and what actions will be taken when they misbehave

• Assist child in developing skills to carry out activities or perform in a way that is not frustrating or limiting to the child.

Steps in Analyzing Child’s Behavior

• Questions