Dear Dr. Michelle:
My niece’s 4-year-old toddler has become so aggressive that daycare has put him on probation. It breaks my heart when she calls me crying, thinking that she is not doing enough. He is the only child of two military parents, and they have tried to work with him. She has requested an appointment for behavioral health, but the wait is too long. What can she do in the meantime? His behavior is random, some days he is very sweet and other days he is so angry that it scares his mom. He also begun to have sleeping problems. How can we help him and her?
Anna
Dear Anna:
I am so sorry that your niece is going through this difficult situation. It is good she has you and your support. It is unfortunate that the behavioral health wait is so long. She should consider putting her family on a few waitlists because therapy is the right step for her son and her family.
There are many things that could be going on for your niece’s son. It is important to get a comprehensive assessment once your niece starts the therapy process. Areas that will be important to assess are: his medical conditions, cognitive functioning, any potential brain injury, any ongoing witnessing of aggression between others and then an assessment of any personal experiences of trauma such as physical, emotional, or sexual abuse. These assessments will rule out any possible contributing factors to her son’s behavior so that the right treatment inventions can be utilized. If she has not already done so, she could take her son to a pediatrician that specializes in child behavior. The wait for such doctors may be shorter than a therapist and they can often start the evaluation process while waiting for therapy. They may also have partnerships with behavioral providers that can accommodate faster appointments.
Be a Role Model
To help get started before therapy can occur, understand the power of adult role-modeling. Children will mirror the actions and behaviors of those around them. How are the adults around him managing stress, solving problems, or expressing their feelings? If adults are yelling, or being aggressive, or not managing their own feelings in a calm and positive way, then your niece’s son will follow suit because he won’t know any other way to deal with his own feelings. Have your niece determine if there is room for improvement in how the adults act, and then have her do all she can to support herself and others in displaying the behaviors that she wants her to son to exhibit.
Have the parents monitor who their son spends time with. Notice if he acts out or displays difficult behavior before and/or after seeing certain individuals. If this is the case, then decide if you can eliminate or reduce contact with those individuals until therapy can start.
Create Family Rules and Intervene When Necessary
She could also start attempting to reshape her son’s behavior. After learning from the daycare provider the concerning behaviors he is displaying, they could sit down together as a family and identify the rules for how everybody in the family will act. They should focus on the most basic rules that relate to the problematic behavior that has been identified.
Make sure that during this exercise they do not call the child out. Don’t make this about him and his behavior at daycare. Instead talk about how the family wants to act and make family rules. Only do this when the family is in a calm place, and they should repeat the exercise at least once weekly so that everybody can be reminded. Parental interventions like this need a lot of repetition over a long amount of time to take hold. Their son can get involved in identifying the rules. Children love to make rules for other people, and this will get him engaged in a healthy way.
Rule examples might include:
- No aggression like hitting, kicking, pushing, or biting
- Following through with cleaning up when being asked
- Sharing toys or other household items
- Not disturbing other people
After identifying what they won’t do, they need to identify together what they will do. Examples may be:
- Instead of hitting we will tell the person we are angry and then we will go ask an adult for help
- Instead of taking something away from someone we will pick a different toy
- Instead of saying no, we will ask for help to do what we need to do
The next step is to have the parents identify one behavior, the most important behavior that needs to stop, perhaps aggression, and anytime their son shows aggression, one of the parents needs to immediately intervene and stop the behavior. In a calm but confident voice, the parents want to tell their son that the family has agreed that nobody will be aggressive and that such behavior is not allowed. They will then tell their son what they think he is feeling, and finally, what he should have done differently instead of being aggressive.
For example:
When I told you that you could not have the candy you kicked me. We agreed that we are not going to be aggressive in this family and you are not allowed to kick me. I think you are mad at me because I won’t give you what you want and I am sorry, but you cannot have the candy. Instead of kicking me, you should tell me that you are mad and then you can ignore me instead of kicking.
After they complete this intervention, have them follow up on having the child take a time out by sitting on the steps or at the table, anywhere that works, even if they need to start by letting him identify where he will sit. If time out is a new thing for your niece’s son, they need to start very small because his behavior could become more disruptive with this approach until he learns that they are serious and will follow through. Starting small could mean only requiring 5 second or 10 second time outs which after success could increase up to 30 seconds or a minute. Over time, if they stick to it, he will begin to respond. If their son refuses to take a time out, and they are unable to make him, then they need to tell him that he cannot play or do other fun things until he takes his 5 second time out.
Praise Positive Behavior
Another important element is to have the parents praise their son every time they see him doing something positive. They want to be specific when they do this, for example, “I really liked that you just picked up your coat when I asked you, thank you.” Or something like this, “I know it was hard to pick up your toys, but you did it and you asked for help. Great job asking for help and doing something you didn’t want to do.”
They can also talk out loud to themselves in front of their son when they do something positive to control their own behavior. For example, “Wow I really wanted to sit down and watch T.V. but I had to do the laundry first. I am proud of myself for doing the laundry when I really didn’t want to.” Or “I am so mad at the dog for making a mess with the water, but I am just going to clean it up and really, it is going to be okay.”
Help Identify Feelings
Given the behavior that you have described, your niece’s son might need to learn more feeling words and how to tie them to certain events. Aggression is a sign of anger, but anger is just a surface feeling, meaning that there are usually other feelings underneath, like sadness, fear, loneliness, feeling hurt, or disappointed. To help him learn a wider variety of feelings and how to use his words instead of behavior to express himself, see if they can get him to watch TV shows like Thomas the Train, Daniel Tiger, and Sesame Street. They will need to introduce these shows subtly because most likely if asked, he will say he does not want to watch them. Just stream the shows and have them on in the background while he is around. If need be, they can pretend that they want to watch the show. These types of shows specialize in using feeling words and working out conflict in healthy ways and they want to expose their son to as much of that behavior as possible.
Participate in Parent Play
A last technique to use for disruptive behavior is to have a parent play with their child at least once a day and make believe or role-play the successful resolution of conflict. Don’t have them tell their son directly what they are doing. Rather, they should use toys as characters and act out a scene where there is conflict. Have the characters make the right choices to work out the conflict. This kind of play talks to the child’s “third ear” and will help him witness healthy ways to do things without him being told directly how he should behave. It is also the most powerful when a child witnesses such play coming from their parent because they believe it more.
Establish a Bed Time Routine
A final comment about this child’s sleep difficulties. If he is not getting adequate sleep, it will certainly play a factor in his behavior. A lack of sleep will cause a child to lose their temper and make poor choices. Have the parents do anything they can to help the child sleep, even if this requires more time on the part of the parents. What does their child identify as something that would help him sleep? Can they accommodate any of his wishes safely? Could a parent sit in his room when it is bedtime and stay there until he is asleep? Does he need a nightlight? Be creative and agree to do things that can be done regularly.
In addition, if they are not already doing so, have them start a bedtime routine, which should start 30-60 minutes before bedtime and exclude the use of any electronics (computers, tablets, phone. TV). It has been shown that electronics right before bed disrupts a person’s ability to fall asleep, and this includes children. The bedtime routine could include a bath, playing with toys for a few minutes in his room, followed by a story read by a parent, and then a fun tuck-in ritual.
Remember that none of this behavior is going to change overnight. These interventions will require patience, consistency, and not giving up even if it looks like it is not working.
Dear Dr. Michelle blog posts are informational in nature. The posts are not meant to take the place of consulting your physician, mental health professional, or other qualified health providers regarding your well-being or the well-being of others. Submitting a question does not establish a client/therapist relationship.
