Complete Guide to Managing Behavior Problems

childmind.org/guide/parents-guide-to-problem-behavior

When children struggle with their behavior, it can have a negative impact on everyone
in the family. Parents know they need to respond, but they often aren’t sure what’s the
best strategy, especially if a child is frequently acting out and nothing seems to work.
This guide offers parents a comprehensive look at problem behavior. It covers a
variety of topics, including what may be triggering problem behavior, how to improve
the parent-child relationship when it becomes strained, what to do if kids are
struggling with behavior in school and how to get professional help if you need it.

Why Do Some Kids Struggle With Problem Behavior?

When children have frequent emotional outbursts, it can be a sign that they haven’t
yet developed the skills they need to cope with feelings like frustration, anxiety and
anger. Handling big emotions in a healthy, mature way requires a variety of skills,
including:

Impulse control
Emotional self-regulation
Problem solving
Delaying gratification
Negotiating
Communicating wishes and needs to adults
Knowing what’s appropriate or expected in a given situation

Other children may seem to struggle more with boundaries and following rules. They
may be defiant, or ignore instructions or try to talk their way out of things that aren’t
optional. You may notice patterns of behavior that seem to crop up at certain times of
the day (like bedtime) during certain tasks (like during homework) or with certain
people. You also might notice that your child acts out particularly when she is at home
but not when she is at school, or vice versa.

Tantrums and other kinds of acting out are often a normal and even healthy part of
childhood. They are a sign that a child is becoming more independent — indications
that a child is testing boundaries, developing skills and opinions, and exploring the
world around them.

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But when a child is acting out a lot, it can strain the parent-child relationship, creating
regular frustration and resentment that isn’t healthy in the family. Whether your child is
in the early stages of learning about self-regulation and boundaries, or if your family
has been struggling and you are looking for help, this guide is designed to explain
more about how kids learn to manage their behavior, what parents can do to aid in the
process and how to get more support if you need it.

Tantrums can be a learned behavior

Sometimes parents feel that tantrums and other instances of problem behavior are
intentional or manipulative. However, clinicians who specialize in children’s behavior
agree that tantrums are generally not a voluntary behavior on a child’s part — but they
may be what is known as a “learned behavior.” That means that kids learn that having
a tantrum gets them the result that they want.

In other words, while a child who struggles to control her emotions might not be
consciously calculating her tantrums, she might resort to them because she hasn’t
learned a better way to solve problems or communicate her needs. Well-meaning
parents often respond to tantrums by trying to fix whatever caused the problem — by
comforting the child or giving her whatever she is asking for. Unfortunately, this
reinforces the tantrum behavior, making kids more likely to continue having tantrums
and less likely to develop more sophisticated ways to manage their feelings.

Responding to Problem Behavior

When kids are acting out parents often feel powerless. You may have tried different
techniques for discipline, but without much success. In fact, trying too many different
strategies for managing disruptive behavior can sometimes be part of the problem,
since kids respond better to firm boundaries that are consistently reinforced. But if you
haven’t seen progress before now, don’t feel discouraged, because parents have
more power than they may realize when kids are beingoppositional.

oppositional
Disobedient and often hostile behavior directed towards authority figures.

By using strategies that are informed by child psychologists who specialize in

behavior management, you can begin to improve kids’ behavior and even improve the
parent-child relationship.

This section begins with some general rules of thumb recommended by behavior
experts as effective strategies for responding to problem behavior in the moment.
Next it examines problem behavior in greater depth, which can be helpful for parents

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who want to understand more about why kids act out, and how to tackle specific
behaviors you would like to change.

Tips for responding in the moment:

Don’t give in. Resist the temptation to end your child’s tantrum by giving her
what she wants when she explodes. Giving in teaches her that tantrums work.

Remain calm. Harsh or emotional responses tend to escalate a child’s

aggression, be it verbal or physical. By staying calm, you’re also modeling for
your child the type of behavior you want to see in him.

Ignore negative behavior and praise positive behavior. Ignore minor

misbehavior, since even negative attention like reprimanding or telling the child
to stop can reinforce her actions. Instead, provide lots of labeled praise on
behaviors you want to encourage. (Don’t just say “good job,” say “good job
calming down.”)

Use consistent consequences. Your child needs to know what the

consequences are for negative behaviors, such as time outs, as well as rewards
for positive behaviors, like time on the iPad. And you need to show him you
follow through with these consequences every time.

Wait to talk until the meltdown is over. Don’t try to reason with a child who
is upset. You want to encourage a child to practice negotiating when she’s not
blowing up (and you’re not either).

Targeting specific behaviors

When you are trying to manage disruptive behavior, it is helpful to identify specific
behaviors that you are trying to change (or encourage). It’s true that when families are
feeling overwhelmed sometimes it can seem like every interaction is a struggle.
However, identifying specific behaviors is an important first step to effective discipline.
Taking behaviors one at a time allows you to be more focused, gain a better
understanding of why the behavior is happening, and have a greater sense of control.
Of course, there may be multiple behaviors that you would like to change, but
evaluating them one by one is important.

Target behaviors should be:

Specific (so expectations are clear to everyone in the family)

Observable
Measurable (so everyone can agree whether or not the behavior happened)

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An example of a poorly defined behavior is “acting out” or “being good.” A well-defined
behavior would be running around the room (bad) or starting homework on time
(good).

Before the behavior happens

When you are thinking about a particular behavior that you are targeting, it is
important to think about what generally happens before that behavior and may be
triggering it. This helps parents understand not only why a child might be acting out
but also how anticipating certain triggers might help prevent those behaviors from
happening. Parents can also examine the triggers that make positive behaviors (like
obeying a command on the first time) more likely.

Potential triggers to avoid

These things often lead to misbehavior.

Assuming your expectations are understood: Kids may not know what is
expected of them — even if you assume they do. Demands change from
situation to situation and when children are unsure of what they are supposed to
be doing, they’re more likely to misbehave.
Calling things out from a distance: Tell your children important instructions
when you are face-to-face. Directions that are yelled from a distance are less
likely to be remembered and understood.
Transitioning without warning: Transitions can be hard for kids, especially if
they are in the middle of doing something they enjoy. When kids are given a
warning and have a chance to find a good stopping place, transitions can be
less fraught.
Asking rapid-fire questions, or giving a series of instructions: Delivering a
series of questions or instructions limits the likelihood that children will hear,
answer questions, remember the tasks, and do what they’ve been instructed to
do.

Potential triggers to embrace

These are things that can bolster good behavior.

Adjusting the environment: Try to manage environmental and emotional

factors that can make it much more difficult for children to rein in their behavior.
Things to consider: hunger, fatigue, anxiety or distractions. When it’s homework
time, for instance, remove distractions like screens and toys, provide snacks,
establish an organized place for kids to work and make sure to schedule some
breaks.

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 Making expectations clear: You and your child should be clear on what’s
expected. Even if he “should” know what is expected, clarifying expectations at
the outset of a task helps head off misunderstandings down the line.
Providing countdowns for transitions: Whenever possible, prepare children
for an upcoming transition. For example, give her a 10-minute warning when it is
time to come to dinner or start homework. Then follow up when there are 2
minutes left. Just as important as issuing the countdown is actually making the
transition at the stated time.
Letting kids have a choice: As kids grow up, it’s important they have a say in
their own scheduling. Giving a structured choice — “Do you want to take a
shower after dinner or before?” — can help them feel empowered and
encourage them to become more self-regulating.

After the behavior happens

Considering what happens after a targeted behavior is important because

consequences can affect the likelihood of a behavior recurring. That is true for
consequences that are positive (like getting an extra 10 minutes of screen time) or
negative (like getting a time out).

Some consequences are more effective than others. Ideally consequences create
structure and help kids understand the difference between acceptable and
unacceptable behaviors. However, consequences can also do more harm than good
when they are sending the wrong message. Understanding how to use smart and
consistent consequences makes all the difference.

Consequences that aren’t effective

These types of consequences are common, but they generally don’t have the desired
effect.

Giving negative attention: It seems counterintuitive, but consequences that

seem negative to us (like raising your voice or spanking) can sometimes
reinforce the very behavior we are trying to prevent. That’s because children
value attention from the important adults in their life so much that any
attention — positive or negative — is better than none. That’s why negative
attention can actually increase bad behavior over time. Responding to behaviors
with criticism or yelling can also adversely affect children’s self-esteem.
Delayed consequences: Immediate consequences are the most effective.
Children are less likely to link their behavior to a consequence if there is a lot of
time between the two, which means delayed consequences are less likely to
actually change a child’s behavior.

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 Disproportionate consequences: Parents can sometimes become so
frustrated that they overreact when giving consequences, which is
understandable. However, a huge consequence can be demoralizing for
children, and they may give up even trying to behave.
Consequences that are accommodating: When a child is slow to doing
something you want him to do, like picking up his toys, many parents will
become frustrated and just do it themselves. While this reaction is also
understandable, it also increases the likelihood that he will dawdle again next
time.

Consequences that are effective

Consequences that are more effective begin with generous attention to the behaviors
you want to encourage.

Positive attention for positive behaviors:Praising children when you “catch

them being good” makes them more likely to repeat that good behavior in the
future. Positive attention is also a good thing for the parent-child relationship,
improves a child’s self-esteem, and feels good for everyone involved.
Ignoring actively: This consequence might seem counterintuitive, but child
behavior experts often teach “active ignoring” as an effective behavior
management strategy. To perform active ignoring, deliberately withdraw your
attention when a child starts to misbehave. As children learn that acting out
doesn’t get them your attention, they will begin to do it less. An important
component of active ignoring is to immediately give a child positive attention as
soon as he exhibits behavior you do want to see, like sitting calmly. Of course,
this consequence should be used only for minor misbehavior — active ignoring
is not appropriate when a child is being aggressive or doing something
dangerous.
Reward menus:Rewards are a tangible way to give children positive feedback
for desired behaviors. Rewards are most motivating when children can choose
from a variety of desirable things: extra time on the iPad, a special treat, etc.
Rewards should be linked to specific behaviors and always delivered
consistently.
Time outs: Time outs are one of the most effective consequences parents can
use, but also one of the hardest to do correctly. It’s very important to balance
them with other nurturing techniques, like providing positive feedback and
modeling emotional regulation for your child. The next section in the guide gives
parents tips on how to have a successful time out.

Example: Targeting a specific behavior

Set a specific behavior that you want to target

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Stop jumping on the couch

Examine triggers

Your daughter often starts jumping on the couch when you go to change the baby’s
diaper or give him a bath.

Possible solution: Come up with ways your daughter can “help” you do these tasks.
Her assistance may slow you down slightly, but it gives her something positive to do
— and it makes her feel like she’s still getting your attention. When she helps out,
praise her for being such a good big sister.

Examine consequences

Ineffective consequence: Yelling, “I’ve told you this a million times, Katie, you can’t
jump on the couch! Why do you keep doing it?!”

Effective consequence: Send to time out immediately.

Why Transitions Trigger Problem Behavior

One common problem behavior trigger for many children is transitions. Whether it’s
getting ready for bed, or coming to dinner, or putting down the video game controller,
in many families transitions can become a flashpoint that everyone learns to dread.

If transitions are a problem for your child, it is important to figure out what about the
transition is difficult. Often kids don’t like stopping an activity that they are enjoying
(like playing on the computer) in order to do something less fun, like getting ready to
leave the house. While no one enjoys stopping fun things, some kids struggle with it
more than others. That can be a sign that they are still developing emotional self-
regulation skills, but it is just one possible cause. Other children struggle to cope
with unanticipated changes in schedule, or moving on from something that they feel
like they haven’t finished.

Struggling with transitions can even be a sign of a mental health disorder in some
children. Children withADHD,

ADHD
see attention-deficit hyperactivity disorder

autism, anxiety andOCD

OCD

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see obsessive-compulsive disorder

are all more likely to struggle with transitions.

Techniques to make transitions easier

Once you’ve narrowed down what you think might be behind your child’s resistance to
transitions, then you can start brainstorming what you think might help. (Note: If you
think your child might have an undiagnosed mental health disorder, taking your
concerns to a clinician is important.)

Here are some techniques that you might want to try:

Preview and countdown: Every morning, lay out what the day will look like. Before
each transition, give a timeframe and description of what will happen along with
countdowns (in 20 minutes, then 10, then 5 it will be time to finish breakfast and head
to school). This helps kids prepare emotionally.

Get their attention: For kids who struggle to regulate their attention, make a
particular effort to capture theirs. Make eye contact, sit next to them, put your hand on
their shoulder, or ask them to repeat back what you have said. It makes them more
likely to follow through.

Use music: Songs can help kids (particularly young kids) ease into transitions. The
“clean up” song is a popular example of this, but there are many songs that can be
found or made up to suit a variety of situations from tying shoes to brushing teeth.

Visual cues: Posting a chart with pictures illustrating what to expect from a particular
transition or the steps involved is a good visual reminder for children to fall back on.

Create routines: If there are transitions that your child struggles with every day, like
going to bed, build some consistency and structure into that transition. For example,
when it’s close to bedtime, your child can pick one last thing she wants to do. Then,
you both go upstairs to brush teeth and read a story, then it’s lights out. Doing this
routine consistently helps kids know what to expect and makes the transition easier.

Use rewards: Rewards can be an effective tool to use for difficult transitions until
children have gotten used to them. Parents can use stickers, snacks, or a point
system that leads to tangible rewards.

Appropriate consequences: If a transition isn’t going well, think about what

consequences you are (or aren’t) giving. Yelling isn’t an effective consequence, but
active ignoring or a time out might be.

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Use praise: When a child does follow through with a transition, make sure you give
him some enthusiastic labeled praise to recognize his behavior. For example: “I really
liked how you handed over the iPad right away and started brushing your teeth. Now
we have more time to read!”

Skills: How to Do a Time Out

Critics of time outs argue that they can be emotionally isolating for kids, but research
shows that they are effective and do not cause children harm. (For more on the
debate around time outs, read our full article on the topic.) However, it’s very important
to use them as just one technique in a nurturing, supportive parenting strategy. Be
sure to balance use of time outs with lots of praise for kids’ positive behaviors. It’s also
important to manage your own stress so that kids can learn emotional regulation from
your positive example.

The point of a time out isn’t to shame or punish your child, but to diffuse an emotional
situation and help your child learn to manage frustration and regulate his own
behavior. Using a time out is also a clear way to communicate that a particular
behavior is unacceptable.

Many parents have tried time outs before with varying degrees of success. To be most
effective, time outs need to be done consistently and follow certain steps. Here are
some guidelines to follow if you are learning how to use time outs, or want to
troubleshoot your technique.

Use advance warning: Kids need to understand which behaviors are linked to which
consequences. Work with your child to establish which behaviors (like hitting or not
complying with an instruction from you) lead to a time out so she knows what to
expect.

Establish a pre-determined place: Designating a special chair, or a place on the

stairs, also helps a child know what to expect. It’s a good idea to label the time out
chair just that, and not “the naughty chair” or something similar. Time outs work better
when they are focused on teaching children how to behave, not on punishing them.

Use a quick response: When a kid misbehaves in one of the ways you have
discussed, make sure the following time out is immediate, and that you state the
reason: “No hitting. Go to time out.” Be specific, brief, and unemotional. This helps
ensure that the child is able to link her action with its consequence. Delayed
consequences are ineffective because kids tend to feel you are just being punitive.

Keep it brief: A standard formula for time outs is one minute per year of age. Some
experts recommend a timer so a child can see that the time is being measured.

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Keep it calm: The goal in a time out is for kids to sit quietly. Some experts
recommend not starting the allotted time until your child is quiet. Others feel this is too
hard for young children. They require that the child be completely quiet for 5 seconds
before ending the time out. This way kids learn to associate good behaviors with the
end of the time out and it sends the message that yelling and screaming during a time
out won’t work.

Pay no attention: Kids in time out should be ignored — no talking to them or about
them, even if they’re whining, crying or protesting. By withdrawing your attention
during the time out, you’re sending the message that misbehaving is not the way to
get what they want.

Consistency is key: It’s tempting to put kids in time out whenever they’re acting
inappropriately or pushing your buttons, but using time outs randomly makes it more
difficult for kids to make the connection between specific misbehaviors and their
consequences. Also, it is important that the time out occurs each and every time the
specific target behavior occurs. If not, you are encouraging the child to think that he
might be able to get away with it.

No rewarding stimuli: In the time out chair the child should have no access to
television, electronic devices, toys or games. If you’re away from home, pick any spot
that removes the child from distracting stimulation.

If a child won’t stay in time out: If a child breaks the rules by leaving the time out
chair too soon, put him in a backup time out area that he cannot escape from (like a
bedroom where there aren’t any rewarding stimuli such as television, toys or games).
Briefly explain that he must stay there for one minute and be calm and quiet before he
is allowed to leave. Once he does that he should be returned to the time out chair, and
the time he must stay there is restarted. If he leaves the chair again, the cycle
repeats. Your child should learn quickly that it’s in his best interest to stay in the chair
until the time is up.

After the time out

When kids are given time outs for not complying with your instructions, once a time
out is finished, they should be asked to complete whatever task they were asked to do
before the time out. This helps them understand that time outs aren’t escape routes.

Once the time out is over, you want to resume giving them attention, tuning in to
whatever they are doing/working on/playing so that you can “catch them being good”
and specifically praise them for a positive behavior. For example, if your child
completes her time out and then she plays gently with the dog, you’d want to let her
know what she was doing right (“I love how nicely you’re playing with the dog! You are

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using such nice gentle hands!”) This is reassuring your child that although she had to
go to time out, she also is completely capable of doing good and positive things that
make you proud and loving toward her.

Skills: How to Give Effective Instructions

Children will be more likely to understand and comply with your instructions if you
follow these guidelines:

Be direct. Make statements rather than asking questions: “Please sit down,” as
opposed to “Are you ready to get out your homework?”
Be close. Give instructions when you are near your child, rather than calling out
from across the room.
Use clear and specific commands. Instead of “Go ahead,” say, “Please go
start your reading assignment.”
Give age-appropriate instructions. Speak to your child at a level he will
understand. If your child is younger, keep things simple and use words you know
he knows: “Please pick up the ball.” With older children, it’s important to be clear
without being patronizing.
Give instructions one at a time. Especially for kids who have attention
challenges, try to avoid giving a series of instructions: “Please put on your
sneakers, get your lunch off the kitchen counter, and meet me in the front hall.”
Keep explanations simple. Giving a rationale can increase the likelihood
children will listen to a command, but not if the commands gets lost in it. For
instance: “Go get your coat on because it’s raining and I don’t want you to catch
a cold.” Instead, try: “It’s raining and I don’t want you to catch a cold. Go get your
coat on.”
Give kids time to process. After you give an instruction, wait a few seconds,
without repeating what you said. Children then learn to listen to calm instructions
given once rather than learning that they don’t need to listen because the
instructions will be repeated.

Improving the Parent-Child Relationship

One of the most unpleasant side effects of behavioral problems is the toll they take on
the family dynamic. When a child haschronic

chronic
A continuing or recurring condition that can be characterized by either persistent
symptoms or the reappearance of symptoms after periods of otherwise normal
function.

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behavior issues parents often aren’t enjoying the time they spend with their child. This
can be both frustrating and guilt-inducing. Children are also negatively affected when
they receive frequent criticism or pick up on their parent’s irritation, which can lead to
resentment and may damage their self-esteem.

Improving the parent-child relationship should be a priority for all families dealing with
chronic problem behavior. To that end, try to increase the number of interactions you
have with your child that are positive and don’t promote conflict. For example:

Use behavior management strategies that reinforce what you do want to see
(like giving clear instructions in a neutral tone of voice or using lots of labeled
praise) instead of comments that are critical or focus on what you don’t want to
see.
Pay attention to your own emotions and look for healthy ways to deal with
stressful situations without escalating them. Use your own emotional self-
regulation skills or give yourself a time out if you need a moment to cool down.
Like in any relationship you want to nurture, think about how you can build on (or
create) meaningful bonds. Are there common interests you can cultivate? New
relationship rituals you can establish?
Set aside a small amount of time every day to be present and nonjudgmental
with your child.

How to establish daily quality time

Even a small amount of time set aside reliably every day can become something
children and parents learn to look forward to. This should be a time for positive
connection, without rules or commands, to help everyone in the family defuse stress
and appreciate each other’s company. This should be considered special time and
should not be contingent on a child’s good behavior. Here are some tips for success:

Aim for 5 minutes per day with younger kids, 15 minutes with teens
Let your child choose an activity she enjoys and you join in
Actively listen and let her lead the conversation
Validate her choices and interests
Focus on giving positive attention to good behavior
Ignore minor misbehavior
Avoid directing the activity or criticizing

Helping Kids Deal With Big Emotions

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Some children act out because they have a hard time regulating their own emotions.
This is a common problem for young children who haven’t yet developed the ability to
cope with big emotions in a constructive way. Some children continue to struggle with
self-regulation as they get older. Parents and teachers may notice that they seem
particularly sensitive and have outsized emotional reactions compared to their siblings
or peers.

The good news is that self-regulation is a skill that can be taught like any other, and
parents can play a big role in helping kids learn how to handle their emotions, even
very big emotions. Here are some techniques for helping kids calm down instead of
act out.

Developing emotional IQ

Taking the time to notice and label emotions helps kids begin to pay attention to how
they are feeling. This is important because paying attention to our emotions is the first
step to learning how to manage them. Sometimes just articulating an emotion helps to
defuse it. Too often we try to pretend we aren’t feeling negative emotions until it’s too
late and we are feeling terrible. Acknowledging a negative feeling can make it seem
less powerful and helps you begin to think constructively about what to do with that
feeling.

Parents can help teach children to do this by modeling it in their own behavior. For
example, if you are upset because you forgot something at the grocery store, share
that feeling: “I’m so frustrated right now! I forgot to get milk!” Then, after you’ve
acknowledged how you feel, you can model coping and problem solving skills. You
might say, “I’m going to take some deep breaths to calm down — that often helps me.”
Then once you’re feeling better, you can say, “Now how can I solve this problem?” and
brainstorm ideas.

Children will begin to pick up on the skills that you are modeling for them, but they
might also need some extra support as they begin to learn how to deal with their
emotions. If you notice your child is beginning to look upset, ask her to describe how
she is feeling. Can she label it?

Just make sure if your child tells you that she’s feeling sad, or anxious, or angry, you
don’t immediately try to talk her out of it. Sometimes hearing “Oh, it isn’t that bad!” can
make kids feel like their emotions are wrong and inadvertently teach them that they
shouldn’t share how they are feeling. Instead, you can validate the emotion (“Yes, that
does sound frustrating” or “You do look disappointed”) and then encourage healthy
ways of dealing with that feeling.

Heading off big emotions

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Another important part of a child learning to consciously label his emotions is that it
encourages him to start paying attention to how he feels, which means that he might
notice an emotion earlier, before it starts to feel overwhelming.

Parents can sometimes be blindsided by the strong emotions children show during
tantrums. But kids don’t go from calm to sobbing on the floor in an instant — even if it
seems like that. Emotions build over time, like a wave. Kids can learn to manage
those emotions that seem overwhelming by noticing and labeling them earlier, before
that wave gets too big.

Many kids benefit from ranking how strong their emotions are on a scale of 1 to 10,
with 1 being calm and 10 being furious. You can model doing this, too. When you are
feeling frustrated because you forgot to get milk at the grocery store, you might
announce that you’re at a 4. It might feel silly to do this at first, but it teaches kids to
pause and notice how they are feeling. For kids who appreciate visual aids, something
like a “feelings thermometer” might help.

Getting Help

When to get help

Most children have occasional tantrums or meltdowns. Acting out when it’s time to go
to bed or stop playing a game is par for the course. But when kids are having
tantrums often, or it seems like they can’t control their temper a lot of the time, you
may be seeing something more extreme than typical problem behavior.

Here are some signs to look out for:

When problem behavior is interfering with his ability to make friends or get along
with other kids.
When problem behavior is causing a lot of conflict at home and disrupting family
life

When your child feels like she can’t control her anger, and it is making her feel
bad about herself

When his behavior is causing trouble at school with his teachers or his fellow
students

When her behavior is dangerous to herself or others

If you are worried about your child’s behavior and are having a hard time managing it
on your own, making an appointment with a clinician who has expertise in children’s
mental health can be very helpful. A clinician can perform a comprehensive evaluation

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to determine whether your child may have an undiagnosed mental health disorder that
is contributing to her behavior issues, or recommend specific strategies or treatments
that might be helpful.

For more information about how to find a clinician who can help, read the Child Mind
Institute’s Parents Guide to Getting Good Care.

Possible causes and diagnoses

Below is a list of some mental health disorders and other challenges that may be
associated with disruptive behavior.

Attention-deficit hyperactivity disorder (ADHD)

Children with ADHD find it unusually difficult to concentrate on tasks, pay attention, sit
still and control impulsive behavior. While disruptive behavior is not a symptom of
ADHD itself, it is often the result of ADHD symptoms. Inattention and impulsivity can
make it very difficult for kids to tolerate tasks that are repetitive, boring, or take a lot of
effort. Because of this, children with ADHD are frequently overwhelmed with
frustration, and throwing a shoe or pushing someone or yelling “shut up!” can be the
result of their impulsivity. Some kids with ADHD can also develop negative behavior
patterns, which are a response to years of finding themselves in conflict with adults.

Oppositional defiant disorder (ODD)

Children withODD

ODD
see oppositional defiant disorder

have a well-established pattern of behavior problems, with symptoms including

arguing with authority figures, refusing to follow rules, blaming others for their
mistakes, being unusually angry and irritable, and more. All children can have these
symptoms from time to time. What distinguishes ODD from normal oppositional
behavior is how severe it is, and how long it has been going on for.

Disruptive mood dysregulation disorder (DMDD)

Children withDMDD

DMDD
Short for disruptive mood dysregulation disorder, DMDD is a disorder in which a child
is chronically irritable and experiences frequent, severe temper outbursts that seem
grossly out of proportion to the situation at hand.

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experience frequent, severe temper outbursts that seem grossly out of proportion to
the situation at hand. In between tantrums they are chronically irritable. Their
disruptive behavior is a result of their very big emotions and poor self-regulation skills.
Children with DMDD often feel very apologetic after a tantrum is over.

Anxiety

Children who seem angry and defiant may be severely anxious. When children are
having a hard time coping with situations that cause them distress, they may lash out.
This may happen when the demands at home or school put a pressure on them that
they can’t handle. In an anxiety-inducing situation, your child’s “fight or flight” instinct
may take hold — she may have a tantrum or refuse to do something to avoid the
source of acute fear.

Trauma

Children who have been traumatized frequently mask their pain with behavior that is
aggressive. As a result of their trauma they may be struggling with poor emotional
self-regulation, negative thinking, and be overly alert to dangers — and more likely to
jump into their “fight or flight” response in an effort to protect themselves.

Learning problems

Children who act out repeatedly in school or during homework time may have an
undiagnosedlearning disorder.

learning disorder
A disorder characterized by difficulty in learning primary skills such as reading, writing
and arithmetic.

They may be feeling frustrated and ashamed because they are struggling to do things
that look easy for other kids, and they don’t know why. Rather than ask for help, they
may rip up assignments or act out to create a diversion from their real issues.

Sensory processing issues

Some children have trouble processing the sensory information they are getting from
the world around them. Children who are under- or over-sensitive to stimulation can
often feel uncomfortable, anxious, distracted and overwhelmed, which can frequently
lead to disruptive behavior.

Autism

Children on the autism spectrum tend to be rigid — needing consistent routine to feel
safe — and unexpected changes can lead to them having a tantrum. Autistic children
can also struggle with sensory issues that leave them feeling overwhelmed. Some

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autistic children may also lack the language and communication skills to express what
they want or need.

Parent training programs

Parent training programs are designed to bolster the skills parents may need for
managing a child’s problem behavior and improve the parent-child relationship. These
programs are led by psychologists and social workers and are evidence-based, which
means they have been thoroughly tested and found to be effective for many families.

Below is a list of different kinds of parent training, including what makes them different
and which families they may work best for.

Parent-Child Interaction Therapy (PCIT)

Parents and children both participate in PCIT sessions, during which a clinician
teaches them skills to interact in a positive, productive way. It is effective for kids
between the ages of 2 and 7, and usually requires 14 to 17 weekly sessions.

In PCIT, parents receive live coaching (via a bug in the ear) from a therapist who
watches from behind a one-way mirror as they and their child perform a series of
tasks, and parents practice specific responses to both desired and undesired
behavior.

Parent Management Training (PMT)

In PMT, which is for children ages 3 to 13, parents are usually seen without the child
present, although children may be asked to participate in some sessions. Skills to deal
more effectively with challenging behaviors are taught and modeled by the therapist
and then role-played with parents. After each session, parents are expected to
practice the skills at home. Families usually participate in at least 10 sessions.

Since PMT is appropriate for all ages, it’s a good choice when kids are too old for
PCIT. It can also be a good option for families where the parent-child relationship is
strong, but children might be struggling with things like anxiety, extreme impulsiveness
or explosive anger.

Defiant Teens

Defiant Teens is for parents of teenagers who are 13-18 years old. The first half of this
program involves only parents, and focuses on teaching more effective tools
for interacting with their teenager, specifically for handling noncompliance or defiant
behavior. But since teenagers are more autonomous than younger children and less
influenced by their parents’ guidance, the program also includes training for the
adolescent to help him become a participant in changing the family dynamic.

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In the second half, parents and teenagers are both trained in problem-solving
communication. The aim is to provide family behavioral resources to help each family
member develop more effective problem-solving, negotiation and communication skills
and to correct any unreasonable beliefs that might be impeding their interactions.

Positive Parenting Program (Triple P)

Triple P’s focus is on equipping parents with information and skills to increase
confidence and self-sufficiency in managing child behavior. It can be utilized with a
wide age range of children from toddlerhood throughadolescence.

adolescence
Generally, the period between puberty and legal adulthood. By some standards this
includes the teenaged years, from 13 to 19.

With Triple P families can participate in different levels of intervention according to

their needs. In some sessions clinicians will meet one-on-one with parents to discuss
skills and strategies, and in some sessions kids with be included and the therapist will
be provide live coaching.

The Incredible Years

The Incredible Years offers small-group-based training for parents of kids from infants
through age 12. The programs are broken into four age groups (baby, toddler,
preschool and school age) and they range from 12 to 20 weeks.

The program starts with a focus on improving parent-child relationships and positive
attachment before moving on to consistent routines, rules and limit-setting. Finally it
covers child management strategies such as ignoring, redirection, logical and natural
consequences, time to calm down and problem-solving.

For children from four to eight years old, Incredible Years offers children’s groups that
focus on helping them acquire emotion regulation strategies and social skills.
Research shows that the kids’ group works well at improving pro-social behavior and
decreasing problem behaviors. Parents find that they learn not only from therapists
but from other fellow parents in the group.

Medication
Parent training and behavior therapy are considered a more effecting and longer
lasting way to help children learn to manage their difficult emotions and rein in
disruptive behavior. But medications are sometimes used as an adjunct tobehavioral
therapy.

behavioral therapy

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A form of treatment that focuses directly on reducing or managing problematic
behaviors without particular attention to thoughts, events or circumstances that
prompted the behaviors.

Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperdone), which

have been shown to reduce aggression and irritability, may be used in cases where a
child is at risk of being removed from the school or home. Stimulant medication may
be used if a child has excessive impulsivity, including those who have an
ADHDdiagnosis.
diagnosis
A specific set of signs and symptoms that together define a disorder. For psychiatric
disorders, the criteria are based on standards established in the Diagnostic and
Statistical Manual (DSM).

Antidepressants (SSRIs) may be helpful if a child has underlying depression or

anxiety.

It is important to talk with your doctor about any concerns you may have about your
child’s treatment plan, progress or any side effects that you may be seeing. A good
clinician will be ready to discuss the symptoms you are seeing and explain potential
options for changing dosage or medication. If you don’t feel that your child’s doctor is
taking your concerns seriously, or your doctor is not following best practices for
changing dosage, or adding new medications, you should get a second opinion.

If you believe your child should stop taking a particular medication, make sure you tell
your doctor, and discuss the pros and cons. Don’t make adjustments or withdraw the
medication without consultation. Many medications should be reduced gradually, and
children should be monitored for side effects of withdrawing too quickly.

Note about Risperdal

Risperdal can have serious side effects, including substantial weight gain and
metabolic, neurological and hormonal changes that can be harmful. Children taking
Risperdal or another atypicalantipsychotic

antipsychotic
A class of medications designed to treat psychosis, most commonly associated with
schizophrenia and bipolar mania; despite the name, antipsychotics are also used to
treat a wide variety of conditions not associated with psychosis, including autism
spectrum disorders, Tourette’s and OCD. Also known as “neuroleptics.”

should be monitored by their doctors regularly over the course of treatment. Before
treatment begins, they should be tested to establish baselines for height, weight, vital
signs and levels of prolactin and blood fats and sugar. During the first few months of

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treatment, a child’s levels should be measured frequently. If the child is using the
medication long-term, he should continue to be monitored on a yearly basis.

Behavior Issues in School

For kids who struggle with their behavior in the classroom, establishing some school-
specific behavior management strategies is important.

The first step is often asking the school to provide a functional behavior assessment.
The goal of an FBA is to gather more information about when and why your child is
acting out in class. This information is then used to come up with a plan for how to
help. A school psychologist or behavioral specialist typically leads the FBA, and may
speak to you, your child’s teachers and your child as part of the assessment, as well
as do some in-class observation.

Determining which specific things that your child struggles with is important. Just like
in behavior management at home, it helps to get as much information as possible
about the real-life situations that seem to lead to disruptive behavior, paying attention
to what happens immediately before, during and after the behavior. Paying attention
to when your child isn’t acting out can also be informative.

Once this information has been gathered and analyzed, the school psychologist or
behavioral specialist can work on creating a behavior intervention plan (or BIP) with
ideas for preventing problem behaviors and rewarding positive behavior. This may
include different teaching strategies, different consequences for misbehavior or
changes to typical routines. Checking in periodically to monitor the effectiveness of
these strategies (and make updates accordingly) is important.

How parents can support school behavior goals at home

Parents can also play a role in helping reinforce good behavior at school. You might
tell your child’s teacher that you want to be a partner in helping improve your child’s
behavior and select one or two goals at a time to work on, like turning in homework
and not calling out in class, for example. Then you can ask the teacher to give you
periodic reports on your child’s progress. You don’t want to overwhelm the teacher,
but if you get a progress report every few days or every week then you can help
reinforce the school’s goals by either rewarding good school behavior at home or
setting up appropriate consequences.

For example, if you hear that your child is doing a good job turning in his assignments,
you might give him some extra screen time that weekend in recognition of his efforts.
If he’s doing a particularly good job then you might give him a bigger reward, like an

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outing to his favorite restaurant. Conversely, if you get a report that he isn’t doing his
homework, you might let him know that he won’t get any screen time for the first two
days of the upcoming week because he needs to prioritize homework.

For more information about working with schools on behavior issues, see our
recommended reading list in the next section.

Recommended Reading

Behavior Interventions at Home

The Everyday Parenting Toolkit, by Alan Kazdin

The Kazdin Method for Parenting a Defiant Child, by Alan Kazdin

Taking Charge of ADHD, by Russell Barkley

Behavior Interventions at School

Behavioral Interventions in Schools: Evidence-Based Positive Strategies, by

Angeleque Akin-little, Steven G. Little, Melissa A. Bray and Thomas J. Kehle

Managing ADHD in School: The Best Evidence-Based Methods for Teachers, by

Russell Barkley

This guide was last reviewed or updated on August 3, 2023.

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