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Behavioral Disorders: Implications for Children, Parents and Caregivers
Jacqueline Benscoter
University of North Texas

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Abstract:
Children who display challenging behaviors such as physical violence towards caregivers, themselves or the environment, defiance or lack of attention can sometimes have other disabilities such as ADHD or autism that exacerbate their behavior problems.
Past disciplinary measures such as spanking, yelling or hitting have been proven not to work and can actually make the problem behavior worse. Physical restraint, if performed by untrained persons can be dangerous or even deadly to those who are restraining or those who are receiving the restraint. These disciplinary measures do not address the root problems and do little to prevent the problem from occurring. Is medication the only answer? What role does family involvement and parent attitudes play in helping children conquer their challenging behaviors?

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Sometimes children do not act in ways that are socially acceptable for the environment they are in. Sometimes children “misbehave” and do not adhere to parent or teacher requests, and occasional misbehavior is a normal part of social development as children learn boundaries and what is expected of them in different social or academic settings. When misbehavior, defiance, and acting out behaviors become chronic or reach atypical levels of violence, it becomes problematic. Studies have shown that preschoolers who display challenging behaviors that are not addressed or corrected have much higher instances of dropping out of school, juvenile delinquency and social isolation, issues that can last into adulthood (Dunlap & Strain, et al. 2006).
Behavioral problems can be exacerbated by other socio-emotional or intellectual disabilities, such as ADHD and Autism (O’Reilly, 2008, p. 275). Different techniques have been implemented to control misbehavior after the fact, but not much has been done to prevent acting out in the first place. Medication has been a popular option. Physical, environmental and material (ie: straps, tape or other binding methods) restraint has been used to manage severe challenging behaviors. Environmental restraints to manage behavior include locking the child in a room, in a cupboard or designating another space to place the child when they are acting out. According to Allen, Hawkins and Cooper, who did a survey on parental use of restraints for children with severe behavioral problems, parents often must resort to physical restraint to prevent harm to their child or others around them but they rarely have training in how to do so safely. Some of the restraint methods could result in harm of the child or the person or persons restraining the child if done incorrectly. “There are case reports from the United States of children with

Behavioral Disorders 4 behavioral challenges suffering injury or death from inappropriate restraint application by carers,” (Allen, Hawkins, & Cooper, 2006, p. 357). Allen, Hawkins and Cooper’s research indicates a strong need for training on safe de-escalation techniques and safer restraint procedures.
The children in Allen, Hawkins and Cooper’s study had severe challenging behaviors, including self injury, physical aggression and destructiveness towards inanimate objects, which if left unchecked, could result in hospitalization or worse. One parent, for example, describes an incident in which her son attacked her, “I was attacked by my son- punched, kicked, hair pulled- then, in the same incident, pushed against a wall. Whilst I lost consciousness, and was on the ground, I was repeatedly kicked: I was dragged around the floor by my hair….prolonged and deep biting causing bleeding, bruising, infection…I needed hospital treatment and skin grafts,” (Allen, Hawkins, &
Cooper, 2006, p. 359). Allen, Hawkins and Cooper argue that even though restraint techniques such as locking a child in a cupboard or tying them up seem unethical, if the proper supports are not in place, judgment should not be passed on the parents. There are multiple factors to consider, and although the behavior seems abusive, it is often seen as the last resort. issues:
Medication is a popular option, especially for those with the worst behavioral
According to Travell and Visser, in a study involving 17 young people diagnosed with ADHD, diagnosis of ADHD and treatment with medication was a response to perceived severity of social or educational impairment (e.g. challenging behaviour at home; social and academic difficulties at school) rather

Behavioral Disorders 5 than to definitive evidence that severe instances of the core symptoms of ADHD.
... For example, it appeared that a young person having a ‘short temper’ leading to frequent aggressive outbursts towards other young people (e.g. in response to teasing), though not listed in the diagnostic criteria for ADHD, might have been interpreted as a symptom of impulsivity, even when the diagnostic criteria themselves…were not necessarily present, (Travell C. & Visser, J. 2006).
The findings of Travell and Visser’s research are troubling because if true, children are being medicated for a disorder they do not have. Instead, they are being treated to correct behavior problems that are unrelated to symptoms of ADHD, it just happens that the medication works for them, too. Travell and Visser argue against the use of medication without the use of other behavioral modification methods, especially if the final goal is for the child to stop taking the medication.
Travell and Visser also found that parents did not feel as if their child’s doctors or teachers would listen to them when they expressed concerns over their child’s lack of attention and other behavioral problems. Studies have shown that when behavioral problems manifest themselves early, if not addressed before third grade, can become chronic (Dunlap, G. et al. 2006). Students often did not feel listened to, either, and they felt they had no choice in the diagnostic or treatment process. Even when unpleasant side effects of their medicine became apparent, they were assured that they would “go away,” but in some cases the unpleasant side effects of medication did not go away even after five years of treatment (Travell & Visser, 2006, p.211). Travell and Visser’s subjects felt coerced into taking medication, such as doctors or other personnel hinting that their choice was either medication or more trouble in school and more stress for their parents

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(Travell & Visser, 2006, p. 212). Challenging behavior is a stressor for parents and teachers but the ultimatum “medication or more problems” is an unfair one for children.
Travell and Visser mention that medication can have positive short term effects, such as greater attention in school, more rational behavior and better grades, but they point out, “this approach had not solved future issues and might even have made them worse by possibly leaving young people less well equipped to draw upon their own resources to solve their problems,” (Travell & Visser, 2006, p. 212). This observation is important because children who have behavior issues need more than a quick fix for their behavior. Also, the notion that any problems one has can be fixed by taking a pill is a dangerous idea to be teaching children. Perhaps medication should be utilized with study skills training, less distracting settings to improve attention and social skills training so students can express feelings towards others in a healthy way.
Many of the studies involving families with children who display chronic challenging behavior focus on the mother. Over 90% of respondents in one survey study were mothers, and that is a common occurrence (Allen, Hawkins, & Cooper, 2006). The father’s role in parenting has been explored in much of today’s research, and positive paternal roles have been correlated with positive outcomes in children. Burbach, Fox and
Nicholson, authors of a study involving fathers of young children under age five who displayed challenging behaviors found an inverse relationship between father involvement and prosocial behavior in children (Burbach, Fox, & Nicholson, 2004, p.
170). Fathers in the study were asked their expectations of their children, how they discipline their children, and to rate nurturing behavior, which included questions on frequency of performing routine care for their child. They were then asked to rate their

Behavioral Disorders 7 perceptions of their child’s behavior and their own stress levels. Burbach, Fox and
Nicholson found that fathers who were more likely to use corporal punishment were more likely to have children with behavior problems, which might indicate a cyclic relationship. “Even assuming a child’s difficult behavior may precipitate negative responses by some parents, it seems likely that parental responses may not have the desired effect on young children’s behavior but instead exacerbate the very behavior problems that parents are trying to reduce or eliminate,” (Burbach, Fox & Nicholson,
2004, p. 180).
Parental attitudes towards their children’s behavior problems are believed to be influenced by the ideas they have about the origins of their children’s behavior. If the behavior is believed to be externally influenced, parents are more likely to be understanding and not lash out. If the behavior is thought to be of internal origin, though, parents can justify reacting angrily at their children because they feel their children should be in control of their internal feelings (O’Reilly, 2008). O’Reilly points out that children with ADHD and Autistic Spectrum disorders could be at higher risk for a parent overreacting to their behaviors, because these disorders have a behavioral element
(O’Reilly, 2008, p. 275).
“Parents carefully navigate the range of punishment they give their children for
‘naughty’ behaviour. They report shouting, threatening, smacking, punching and other forms of discipline as warranted and necessary, placing the child as the responsible agent,” (O’Reilly, M. 2008, p. 279). At first glance, parents who physically restrain their children or hit them to get them to behave seems as if they are cruel and callous and should not have children, but they do not feel they have any other methods to get their

Behavioral Disorders 8 children to behave. Oftentimes, in instances where severe self injury or violence towards another person is taking place, it is hard to determine what intervention methods to use.
When a child is banging his or her head against a window, what is the correct thing to do? A desperate, untrained parent may resort to disciplinary or restraint methods that seem unethical, but without training to help them, who is being unethical?
One of the most successful guidance methods is allowing children choices at home and at school and altering the environment to eliminate stressors and distractions.
Parental involvement also plays an important role in a child’s success. As mentioned before, father involvement has a positive outcome, and whole family therapy when a child is at risk has been the best practice according to research (Keen & Knox, 2004, p.
53). A common theme of why parents use punishments such as physical restraint and corporal punishment is that they don’t know what else to do. In a survey of fathers who had children who displayed challenging behaviors, “the first theme that emerged with a significant response rate was the need for more parenting knowledge and skills and included comments such as ‘I need parenting classes, I ask questions of people who raised me, I would like classes on how to react when a child is misbehaving and to learn why,” (Burbach, Fox & Nicholson, 2004, p. 178). This quote is significant because it indicates that there is a major lack of resources for parents to parent their children. Many times, they parent the way they were parented, and that often included corporal punishment and yelling. However, we have proven through research that these methods do not work (Dunhap & Strain, et al. 2006, Burbach, Fox, et al. 2004, O’Reilly, 2008).
In O’Reilly’s study, “Parental Accounts of Punishing Children,” she states, “Even when physical punishments are not used by parents they often express a desire to do so

Behavioral Disorders 9 and have a fear of inflicting harm on the child. This suggests that parents are feeling unsupported in their coping with a child with mental health needs and shows more needs to be done to provide help early on to prevent later risk of child abuse,” (O’Reilly, 2008, p. 291). Contrary to some beliefs, these parents do care about their children and want what’s best for them. The education to help parents needs to be available and free for those who cannot afford to pay for services. Perhaps programs could be implemented through the child’s school, where either online or face to face classes can take place.
Support groups for parents who have special needs children with behavior issues could be helpful as well, to help ease frustrations and share strategies that worked for their children. A partnership between parents, school personnel and therapists needs to be implemented so that parents who need extra support can get it. Those who are at risk of hurting their children should be identified and taught more proactive disciplinary methods. Similarly, those children who need extra academic or behavioral support and stress management techniques need to be referred for those services and supported with medication if necessary. With understanding, education and creative solutions, children and families with behavior difficulties can succeed in ways they never thought possible.

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References:
Allen, D., Hawkins, S., & Cooper, V. (2006). Parent’s use of physical interventions in the management of their children’s severe challenging behaviour. Journal of
Applied Research in Intellectual Disabilities, 19, 356-363. Retrieved from
Ebscohost database on October 2, 2008.
Burbach, A., Fox, R., & Nicholson, B. (2004). Challenging behaviors in young children:
The father’s role.
The Journal of Genetic Psychology , 165(2), 169-183. Retrieved from Ebscohost Database on October 2, 2008.
Dunlap, G., Strain, P., Fox, L., Carta, J., Conroy, M., Smith, B., et al. (2006). Prevention and intervention with young children’s challenging behavior: Perspectives regarding current knowledge. Behavioral Disorders , 32 (1), 29-45.
Nicholson, B., Fox, R., Johnson, S. (2005). Parenting young children with challenging behaviour. Infant and Child Development, 14, 425-428. Retrieved from
Ebscohost Database on October 2, 2008.
O’Reilly, M. (2008). I didn’t violent punch him: Parental accounts of punishing children with mental health problems. Journal of Family Therapy, 30(3): 272-295.
Retrieved from Ebscohost Database on September 8, 2008.
Travell, C., & Visser, J. (2006). ADHD does bad stuff to you: Young people’s and parents’ experiences and perceptions of Attention Deficit Hyperactivity Disorder
(ADHD). Emotional and Behavioural Difficulties , 11(3), 205-216. Retrieved from Ebscohost Database on October 2, 2008.