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Help dealing with difficult behaviour 

2010

Hi,
 
I am a CYC working on a psyc. unit in a children's hospital. The unit where I work is a short term stay and during their stay, my goal is to work with the team to build on the child's strengths and areas of need to develop coping methods and aid in growth and development in a positive way. I am currently working with an 11-year-old boy with VERY challenging behaviour and his diagnosis is ADHD and the doctors suspect some trauma (sexual abuse) in his earlier years. He is very argumentative all of the time, gets his way at home, verbally abusive with all authority figures and is only calm when things are going his way. School is a very big stressor for him and he often runs from school or misbehaves until forced to leave, and this is exactly what he wants. The teacher here at the school in the hospital is having great difficulty getting him to do much of anything. We tried a token system with him, which worked for a while and then he manipulated the system and it stopped working after a few passes home with family. Despite all of this, he is VERY smart, charming and is an excellent singer. We have tried him in music therapy, which he finds "okay". He does not like games of any sort because he is unable to sit and focus or follow the rules. I need some ideas of what to do with this child!!!!!! Help!!!!
 
Melissa Loveless
...
 

Hi Melissa,
I can appreciate the challenges in working with a child such as this boy. A few things stood out for me after reading your summary on him, one being the doctors suspicions of early sexual trauma and secondly, his challenges with responding to authority and his argumentative nature. What leads the doctor think that there has been trauma?  I'm assuming that nothing has been verified and may speak to the place to start in terms of confirming or denying their suspicions. My next question is regarding his social history has this behavior always been present?  Was mother drinking during pregnancy as this could factor into his challenging behaviors as well.  I realize that while jumping  ahead with some planned activities might  help with establishing rapport , I think we need be cognizant of a framework to work from otherwise activities will serve only a temporary relief to a longstanding concern that will yield little change. Could you provide further information  for the questions I asked? 
 
Thank you
 
Donicka Budd
Toronto
...
 
Hey Melissa,
 
I am a child protection social worker in BC Canada and we see kids like this. A lot.  When reading your post I almost thought I could name the boy; we have one like this right now!  His mother is mentally ill and not willing to have treatment, his father is passive aggressive blaming the social workers for how messed up his kid is (he does not acknowledge that the physical violence toward the mother has had any effect on his son); and his step father may have sexual assaulted him and his sister.  Zero healthy attachments for this  
little boy and very aggressive ways of dealing with everything.
 
I am wondering if focusing on fixing him is the problem.  What about how people are reacting to him in his various environments?  If school is a stressor, change the school environment to one that does work for him.  He is not going to do well in a class that spends all the time trying to get him to sit down and pay attention right?  If things fall apart at home then maybe focus on family work with them to teach them coping skills to deal with his behaviours.
 
Just my two cents of course, I do not have your job nor do I profess to have any expertise in it.  I see lots of damaged kids and thankfully we have people like you who can try to coax them into some kind of functioning human at some point.
 
Good luck Melissa, please post an update later to let us know how it is going.
 
Tanis Wiersma
Canada
...
 
Hello,
 
I have recently done some work with sensory integration isuses.  Often ADHD children have these sensory issues as well which complicates strategies to help the child concentrate.  Sometimes the problems are sensory, not ADHD at all.  I find that for kids with higher intelligence functioning, sensory issues can be greater - but that is just personal observation.
 
Visit zonein.ca.  I have heard Chris Rowan speak and have tried some of her tactics to great success.  This is a holistic way of viewing a child: food, exercise, no technology like TV, phones, or computer.  Also pay attention to:
 
clothing - does he like the feel of it on his skin - and the brightness of a room - too bright or too dim.
 
Offering a child objects to fiddle with increases their ability to concentrate.  Hand held objects like squeezies, balloons with sand in them, or chewing things like fish tubing.  I use a rubber cushion that is flat on one side and textured on the other for sitting exercises such as circle time or meals.  The child can roll around a little on it to stimulate his vestibular system; standing on his head, bending over, or head rolls can also achieve the same thing.  Pressure on his hands or body can calm him.

Have you heard of 'Stick Kids'?  You can also try http://www.challengingbehavior.org/do/resources/teaching_tools/ttyc.htm.
This is a great website full of free stuff and ideas.
 
It sounds like the child has control issues; fear of losing control to  others.   Reward strategies will not necessarily be effective until you can find how to gain his trust; it sounds like he is motivated by getting stuff rather than pleasing you.  Like most abused children, trust is huge. Relaxation techniques can be effective: massage, if he will let you touch him; water, swimming, hot baths; or highly physical exercises to burn off energy.  Routine and predictability are your best friends for this child.
 
Let him tell you what he needs verbally and physically - pay great attention to his responses.  If he cannot sit still, don't make him.  Alter the teaching techniques creatively to stimulate his interest.  While routine and  
predictability are very important, using spontaneous moments within that will keep him listening.  He is probably capable of high levels of multi-tasking his learning.  Use the music aspect as much as you are able.
Take him to a concert or special music lessons or drums.  Kubuko drums are very cool - lots of control, technique, and noise.  Perhaps music playing while you are teaching him will increase his focus.  Experiment with this as much as possible because I believe that this could be your 'in' to having him accept you.  Find a music role model?
 
Finally, helping him to recognize how his moods affect his actions is very important.  Lots of statements like "I can see you are feeling anxious at this moment because you are biting your nails" or "I can hear a lot of anger in your voice when you tell me about yesterday's events - can we talk about that?"  In sensory kids, there is a great disconnect between feelings and actions; they tend to externalize everything, as in, it's your fault I stubbed my toe because your chair was in my way.  Being conscious of this externalization processing, with the abuse history particularly, will help you to understand why he reacts the way he does.
 
This will take a long time to change.  It is a constant challenge to teach him how to manage his own feelings and emotions.  Take the time to include him in decisions affecting him as much as you are able.
 
Good luck!
Laura.
...

Try using easy board games as an incentive, such as Monopoly or snakes and ladders.  Monopoly is great because it requires people to think, count money and be engaged while having fun.
 
Since you're in a short term care, it may be difficult to develop a rapport with a child who has recent trauma. Go easy, slow, and have low expectations, you're doing a great job!
 
Edwin Lang
...

Hi
 
Some ideas may be:
 
1. Establishing educational level.
2. Forensic issues.
3. Visual cues to reinforce learning at the basic level.
4. Establish a voluntary time out arrangement where they can get some peace and quiet.
5. Continue token economy with incentivisation and as well as negative reinforcers.
6. Work on emotional labelling, abstract reasoning, concrete reasoning ability and goal setting.
7. Establish a protocol for respite and a respite service away from the immediate environment for short stays in a calm as well as serene environment.
8. Complete buy in from the whole team to exact agreed and specific boundaries, sounds obvious but easier said than done.
 
Big picture, I find visual talk very useful with communication employing a lot of agreed visual cues.
 
Hope this offers some small help
 
Ian Gargan
...
 
What if you got him involved in the process?  Things he wants to improve, or things he would be interested in working towards, and negotiating how to reach them, so he knows what he is working towards, yet working with you to reach some goals.  The talents may be your ticket in, as you say, being a good singer...if someone is savvy with technology, have a fun "mixing" time with music, or recording some songs...Karaoke for the lack of anything else....if doable.
 
And with him being very smart, maybe if he felt he had more control over things, and set his own standards, his ears may be open a little more...having said that, you ultimately have the last say and work with him to meet on equal ground and understanding of everybody's roles and goals.
 
I hope that offers some help.
 
Good luck!
 
Tina
...
 
Hi Melissa
 
The child you're working with is a classic. Please read this book:
www.attachment-disorder.net
 
Yours sincerely
 
NielsRygaard
Denmark
... 

Hi Melissa - Despite his negative behaviour at school and with authority figures, the boy might benefit from a positive role model, such as Big Brothers Big Sisters (BBBS) who have a Community-Based program or an In-School Mentoring program. The Caseworkers for BBBS, may have a male mentor/volunteer who could be matched with him. When you list the boy's interests and hobbies, make sure to mention his excellent singing skills.

They may not have a male volunteer who would want to be matched with a boy who is verbally abusive, etc., but it's worth asking. I worked for a few years matching up school-aged children with mentors with BBBS, so I saw the many positive rewards of matching a child with a positive mentor. It's an amazing organization. 
 
Has the boy ever tried martial arts? Or some other sport where you require a lot of moving? Boxing is great, carpentry, building things, gardening, or planting a veggie garden? I am DEFINITELY not gendered, into bigotry or racist, but I think he needs a male to hang out with. I recall a mom said "my son needs a dude," so we were able to match him up with a dude.
 
Well, I hope from all the other replies, you find what will work -
 
Dean
...
 

Hi Melissa:
Is this young boy on ADHD medication? I only say that because of the way you have described his behaviour which is identical to the behaviours of the kids I work with at my practicum. The junior high school kids I interact with are supposed to be on medication for their ADHD and take it, but from my experiences that does not happen all the time. This is when their behaviours escalate and they act and react verbally and aggressively with people. They are argumentative with teachers or classmates, do not sit still, and refuse to do their school work. This is the sort of behaviour you seem to be experiencing with this child.From my experiences those behaviours seldom happen if they are medicated. Also, maybe you can advocate for the boy and get his school's behavioural support worker to talk with the teachers in charge of the schools sports programs to see if they are willing to let him tryout for their teams. We have advocated on behalf of these children and not only have some of the boys made the teams, it has given them a sense of belonging with peers and the school.
 
Debbie Hackman
...

Hi
 
I am in my practicum as well working with children in a domestic violence shelter. I have a young boy that has been diagnosed with ADHD and has been medicated for a few years now. I do one-on-one counselling sessions once a week with him, mainly doing play therapy. My first session with him, I let him explore the play room and pick what he wanted to do, and I would just incorporate questions into our conversations so I could start getting to know him. He was fine with this and had a really good session.
 
The next week, I had a session all planned out, and when he came in he was extremely hyper, as well was getting angry at mom, who said he wasn't allowed to have his drink at the time. I was able to compromise with him about the drink, but not my session plan. He refused to do it and just wanted to play with dinosaurs. My session plan was about anger management, so I tried out of the top of my head to come up with a game about anger. He is a smart boy and caught on to what I was doing, and would not follow my lead or any questions I had asked him.
 
 What I noticed about his behaviour with mom is that she doesn't give him consequences and will let him throw a tantrum and give into his demands. He has also attempted to do this with me in session. He would sulk, whine, cross his arms over his chest etc. I would compromise with him, and we would carry on. I knew that was only going to work for a short period of time.  I had discussed this boy with my supervisor and we had decided to give him choices in the activities. I will come up with 2 different activities and he gets to pick one. I will also provide structure, such as coming on the same day and same time, with me only. At the beginning of our sessions, we start off by going over the rules of the play room and the consequences. At the end of our session, I will let him know his appointment for next time as well what we are going to discuss. 
 
I do believe that he will gain a sense of independence as well as belonging if I use these strategies with him. I also believe that in order for this boy to thrive, mom has to be more involved and needs some help in doing that. The outreach counsellor is going to try to assist her and counsel her as well, but I think it would be great to have mom come in on some of my sessions with her son and just play together. Learn strategies for herself. I think that would be amazing.

Nikki Kaufeld
...  

Replying to Nikki Kaufeld at the end of the month ...
 
Nikki
I'm unclear as to what you are expected to accomplish with him. Parenting skills would help Mom and bringing her into the sessions would help that by focussing on relationship skills and behaviour management skills. If that's not your purpose you might want to contract with him so you are both clear what the sessions are hoping to achieve.
 
BTW I have used the game Sorry for years to teach dealing with anger, taking turns, how to stay focussed, how to win and how to lose. Conversations can revolve around things that got me into trouble this week with a focus on him seeing how he might learn for that experience and how to do things differently. Role play the new behaviour.
 
Good luck 
Peter Hoag
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