Behavioral Management for a Child: Viewing the Entire Picture

There is nothing quite like being a brand new parent to a newborn child. Excited to start the next phase of your life, you bring the baby home from the hospital and start your routine: feedings, diaper changes, naptime, play time, and bath time. As a parent, you do everything in your capacity to fulfill your child's needs to keep them healthy and growing. When your little one cries, you learn to pick up on what exactly they are crying for. Once their immediate need is met, they predictably calm down...sometimes.

What about the times in which your baby is crying, you have gone through the list of all basic needs, and nothing has been resolved. Your child continues to uncontrollably weep and you are left clueless, not knowing what your next move should be. You grow tired, frustrated, and heart-broken because you feel completely helpless and are at a loss as to knowing how to change your baby's behavior for the better.

Let's view those gambits of emotion as it pertains to a parent of an older child with behavioral issues. This is a parent who has been around the block and probably has read EVERYTHING about good parenting techniques; however, their child still has problems which could include: aggressively acting out towards others, failing in school, having daily meltdowns, inability to verbally communicate their needs, losing friends, yelling at parents and teachers, refusing to complete chores or homework, etc. What worsens the situation is that the child doesn't seem to positively respond to punishments or rewards. This an example in which there is more to this child's story, despite being raised by a good parent.

For parents who have or are currently experiencing this, what is your initial reaction? Is it self-doubt about how you are raising your child? Is it concern that their might be something developmentally wrong with your child? Is it anger and sadness that completely clouds your ability to trace your next steps? Raising a child with severe behavioral problems can be debilitating for you, for your child, and for other relevant family members and friends.

Occupational therapy can effectively address behavioral management for children. Due its holistic nature, occupational therapy can help parents break down behavior triggers by getting them to ask the right questions in order to best help their child. Some of the following areas may come up during OT sessions:

  • Evaluation of developmental milestones: An OT can incorporate several standardized assessments into therapy in order to best identify the child's unique functional abilities. For young children, such tests usually include developmental milestones including motor (movement), language, and cognition. If a child is not up to par with their milestones, then it's a starting point for OT to begin appropriate interventions. Other assessments may include more detailed items such as sensory processing issues, academic skills, etc.
  • Assessment of pertinent medical history: An OT would have to consider the child's medical and psychiatric history prior to starting therapy (i.e., cerebral palsy, autism, Down syndrome, muscular dystrophy, etc.). That way, all health-related factors and symptoms weigh in on the child's therapy sessions.
  • Referrals to relevant disciplines: An OT may find it appropriate to consult with fellow disciplines who can appropriately address the child's behavioral issues (i.e., psychologists, behavior specialists, primary physicians, pediatricians, allergy specialists, etc.).
  • Collecting information about the child's preferences and triggers: The OT would need to conduct an in-depth analysis of the child's interests and distastes to see what specific activities may or may not change the child's behavior for the worst. Favorite foods, movies, music, sports, hobbies, people or least favorite foods, sounds, activities, and people are just some basic examples.
  • Documenting the child's daily routine: The OT would also need to know about the child's daily routine in great detail: waking up in the morning, eating breakfast, bathing, dressing, school activities, extracurricular activities, expected chores and activities at home, dinner, hygiene tasks, free-time activities, etc. Additionally, the OT would probably ask about how the child handles transitions between each activity or how the child responds when their daily routine unexpectedly changes.
  • Analyzing parenting techniques and habits: No parent likes to be called out on their parenting styles, especially if they really are raising their child in the best manner possible; however, behavioral management includes changes in the child, in the child's environment, and in the child's parent's teaching strategies. The OT might talk about what strategies the parents use that positively change the child's behavior and what strategies they use that could make it worse. This will include assessing how the parent communicates with the child during good and bad behaviors, how the parent organizes transitions, how the parent reacts during aggressive meltdown, etc.

Occupational therapy interventions can benefit a child and modify their behavior. However, it is essential for an OT as well as parents to view the entire picture. Rather than focusing on "fixing" the child, acknowledge all environmental and parental factors that may or may not need to change to best help the child.