Therapy for Challenging Behavior

Is your child often angry or strong-willed? Do they refuse to do things, or get upset at the word “no?”

Challenging behavior is the single most common issue I treat, and probably the most common problem in child therapy in general. Nearly all children will hit, push, kick, throw, yell, argue, swear, name-call, refuse to listen, backtalk, and throw tantrums; the challenge is always to determine whether it is beyond what is typical. I like to ask these questions when parents are not sure:

Are explosive behaviors happening daily?
Do they last longer than 2 minutes?
Do they happen around other adults, too?
Is there habitual, frequent aggression?

Survey data suggests that these things are not typical of very young children, and you might consider consulting a pediatrician or child psychologist.

There’s usually no single cause. Behavior can be affected by temperament, stress, changes at home, learning difficulties, language issues, trauma, or unmet needs. There are certainly parenting strategies that can help, but that doesn’t mean your parenting caused it in the first place.
The most common early-childhood behavior disorder is Oppositional Defiant Disorder (ODD), which sounds really scary but it is very treatable and typically temporary. There are others, like Conduct Disorder or Intermittent Explosive Disorder, though these are less common. I tend to focus less on the label, and more on specific behaviors and strategies.
This is a tricky question to answer, because I don’t know your child! Statistically, some kids do mature out of these behaviors, but waiting it out isn’t always the best plan. Researchers have followed children with challenging behavior early in life, and found that problems can get worse as they grow up. Thus, early intervention can make a big difference.
I use evidence-based strategies that are practical and doable. You’ll walk away with a plan and real tools, not just advice to “stay calm” or “be consistent.”

How is challenging behavior treated?

The standard of care for challenging behavior is behavior therapy, usually following what is called a Parent Management Training, Behavioral Parent Training, or Parent Behavior Therapy approach. This approach is sometimes called Parent Coaching or Parent Consultation, and teaches parents techniques for establishing a warm connection, teaching boundaries, and managing difficult interactions. This is not because challenging behavior is the parent’s fault, per se, but it does capitalize on the parent’s role as mentor and teacher in supporting new skills and abilities for their child. After all, you are the most important person (or one of the most important people) in your child’s life, and should be directly involved in this important part of their growth and development. One-on-one therapy for challenging behavior is usually not recommended, which may surprise parents (particularly because there are other therapists who may have already attempted or recommended this). Many therapists may have different training, or different goals, and the type of therapy that I do is very outcome-focused and evidence-based. Please feel free to ask me about this and I can explain in more detail; I love talking about the science in our field.