Behavioral Challenges in Children: Insights for Educators

Is it possible that the symptoms belong to pediatric psychiatry or neurophysiology?

Dear Dr.
Zhang,
I am an elementary school resource teacher, and I have a female student, Xiao Yi (pseudonym), whose behaviors have left both the classroom teachers and resource teachers unsure of how to assist her.
I hope to leverage your expertise for some advice, and I would be very grateful.
Here are some of her circumstances:
1.
Normal intelligence.
2.
A stable family environment; she is the second child, with an older brother currently in middle school performing at an average level.
3.
She tends to get angry due to comparisons with others (such as grades, competitions, friendships, or inability to complete exams) or self-imposed expectations (for example, insisting that the teacher not mark her mistakes, refusing to submit an incomplete exam, getting upset for forgetting school supplies, etc.).
Her mood can shift dramatically, going from happy to angry in an instant.
4.
During her outbursts, she exhibits behaviors such as hysterical crying regardless of the setting, hiding in corners or under desks, throwing nearby objects, tearing up assignments or tests, hitting herself or the floor, and displaying a hateful gaze.
She may throw small objects at classmates or cut herself with a small knife.
These episodes last an average of 2 hours and occur about three to four times a week.
5.
Generally, she is diligent, careful, and responsible, making her a good helper for the teachers.
6.
Educational strategies attempted:
a.
Teaching through reasoning: Effectiveness - ineffective (she is reasonable when calm).
b.
Behavioral modification techniques and contracts (or incentives): Effectiveness - effective during calm times, ineffective during outbursts (which seems pointless).
c.
Scolding: Effectiveness - completely ineffective.
d.
Providing a space to calm down: Effectiveness - she gradually calms down after about 2 hours but still leaves the classroom angrily.
The next day, she is very cautious and avoids discussing it.
e.
Redirecting attention: Effectiveness - successfully redirected her attention once within 10 minutes, but it only worked that one time.
f.
Teaching emotional recognition and role-playing: Effectiveness - her ability to recognize emotions is weaker than that of her peers.
g.
Teaching positive self-talk (e.g., "I did well on the first part, the second part is also good.
Keep it up, I can do it too.
Everyone has strengths and weaknesses.") and problem-solving strategies: Effectiveness - she can accept this, but it is clear that she has not internalized it.
h.
Other observations: When she is obstinate towards person A, she will not listen to A’s words; however, she may listen to B or C.
These behaviors have been present since kindergarten (she is now 11 years old).
I hope to receive your valuable advice, and I appreciate your time and online consultation.
Sincerely,
Gigi

gigi, 20~29 year old female. Ask Date: 2003/06/05

Dr. Zhang Jiexin reply Psychiatry

Hello! Thank you for your letter.
To address this case, it is essential to first understand the underlying causes of the child's issues and explore the formation and development of this behavioral pattern.
Therefore, it is necessary to collect and clarify the following information:
1.
Does the child have a temperament that is inherently characterized by strong negative emotions, a low threshold for stimulation, and high persistence?
2.
Is the child's response pattern to stimuli different from that of typical individuals? For example, does the child have strong reactions to trivial details or specific objects?
3.
What is the child's overall development like?
4.
When did this behavior first appear, and how did the parents react and manage similar behaviors during the child's early years at home?
5.
Throughout the child's growth, have the parents inadvertently fostered expectations for the child that differ from those of others?
6.
When this behavior occurs, what are the positive and negative reinforcements? In other words, what benefits does the child gain, and what aversive stimuli does the child avoid?
7.
Is there a history of brain injury? Therefore, clarifying the diagnosis is crucial.
Next, it is important to observe the child's behavior patterns in detail and record them in an attempt to identify the true causes and functions of the behavior before considering treatment options.
When addressing the behavior, attention must be paid to the following aspects:
1.
Regularly engage in conversations or play with the child to establish a trusting relationship and gain a comprehensive understanding of their internal emotions and behavior patterns.
This can also help alleviate internal tension.
It is essential that this is conducted by a neutral and objective person who does not actively intervene in the child's life or influence their daily activities.

2.
Subsequently, establish behavioral therapy strategies through detailed observational records and develop a behavior contract.
The most important principles of behavioral therapy are consistency and immediacy.
Possible approaches include:
a.
Stimulus control or desensitization techniques, meaning if the child has a strong reaction to a specific stimulus, it can be addressed beforehand or gradually exposed to prevent intense emotional responses.
b.
When emotional reactions occur, implement temporary isolation, meaning when the emotional response arises, the child should be temporarily removed to an appropriate location for a period of time.
c.
This approach can also be combined with reward systems; for instance, if the duration of crying is less than the set time, the child can be encouraged (e.g., earning points, exchanging for gifts).
d.
These behavioral therapy strategies must be quite nuanced and require close daily observation, adjusting strategies based on the child's actual condition to achieve effective results.
3.
Sensory integration or relaxation therapy.
4.
Pharmacological treatment should be based on clinical diagnosis and is, of course, a last resort.

Reply Date: 2003/06/05

More Info

Dear Gigi,
Thank you for reaching out and sharing your experiences with your student, Xiao Yi. It’s clear that you are deeply invested in her well-being and are seeking effective strategies to support her. Behavioral challenges in children, especially those like Xiao Yi who exhibit emotional dysregulation, can be complex and require a multifaceted approach. Below, I will outline some insights and strategies that may help you in your role as an educator.

Understanding the Behavior
Xiao Yi’s behaviors, such as mood swings, self-harm, and difficulty managing frustration, suggest that she may be experiencing emotional regulation challenges. These behaviors can stem from various factors, including anxiety, perfectionism, or even underlying sensory processing issues. It’s important to recognize that her reactions are likely not intentional but rather a manifestation of her internal struggles.

Strategies for Support
1. Establish a Safe Environment: Create a classroom atmosphere where Xiao Yi feels safe to express her emotions. This can involve setting up a designated calm-down corner with sensory tools (e.g., stress balls, fidget toys) where she can retreat when feeling overwhelmed.

2. Routine and Predictability: Children with emotional regulation issues often benefit from a structured environment. Establishing a consistent daily routine can provide a sense of security and help her anticipate transitions, which may reduce anxiety.

3. Emotional Literacy: Since you’ve already begun teaching emotional recognition, consider incorporating more activities that promote emotional literacy. Use visual aids, storybooks, and role-playing scenarios to help her identify and articulate her feelings. This can empower her to express her emotions verbally rather than through outbursts.

4. Positive Reinforcement: Continue to reinforce positive behaviors. When Xiao Yi manages her emotions well, even in small ways, acknowledge and praise her efforts. This can help build her self-esteem and encourage her to use appropriate coping strategies.

5. Mindfulness and Relaxation Techniques: Introduce mindfulness exercises or breathing techniques that she can use when she starts to feel overwhelmed. Simple practices like deep breathing or guided imagery can help her calm down and regain control over her emotions.

6. Collaboration with Parents and Specialists: Engage with Xiao Yi’s parents to ensure consistency between home and school. They may have insights into her behavior and can reinforce strategies at home. Additionally, consider collaborating with school counselors or psychologists who can provide further assessment and support.

7. Behavioral Interventions: Given that traditional behavioral contracts have had limited success during her outbursts, consider implementing a more flexible approach. Instead of strict contracts, focus on developing a “toolbox” of strategies that she can choose from when she feels upset. This empowers her to take ownership of her emotional regulation.

8. Gradual Exposure to Challenges: Since Xiao Yi struggles with self-imposed pressure, gradually introducing her to challenging tasks in a supportive manner can help build her resilience. Celebrate small successes to foster a growth mindset.

9. Peer Support: Encourage positive peer interactions. Pairing her with a buddy during group activities can provide social support and help her feel more connected to her classmates.

Conclusion
It’s commendable that you are seeking ways to better understand and support Xiao Yi. Remember that progress may be gradual, and setbacks are a natural part of the process. By fostering a supportive environment and employing these strategies, you can help her navigate her emotional challenges more effectively.
If her behaviors continue to escalate or if you have concerns about her safety, it may be beneficial to refer her to a child psychologist or counselor for further evaluation and support.
Thank you for your dedication to your students, and I hope these suggestions prove helpful in your efforts to support Xiao Yi.

Best regards,
Doctor Q&A Teams

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