Troubleshooting Challenging Behaviors
Every child is different. Use your judgment and expertise to make knowledgeable decisions. Remember, parents are the experts on their own child. We must work together for optimal success and the child’s best quality of life. Pull from the concepts in this program as you desire. Although I encourage you to attempt to address all of the underlying principles, this should not be a strictly prescribed program. You should seek opportunities to incorporate the targets in everyday tasks.
Now, let us troubleshoot some challenging behaviors. We start with difficulty sleeping and eating, followed by self-injurious and risky behaviors.
Following are some ideas to improve sleep hygiene.
1. Every person has a “sweet spot” of timing for optimal sleep. Our bodies naturally release melatonin. Melatonin does not put us to sleep—it prepares our body for rest by causing it to slow down the amount of stimulation it receives. Sleep is optimal 30 minutes after melatonin is released.
Have you ever heard of someone saying that a baby is overtired? Well, that means that the baby’s body released melatonin, but the environment is not supporting the body’s attempt to rest, resulting in an internal conflict that leads to overactivation of the RAS. The baby becomes aroused and starts receiving a lot of sensory information. When the baby is later put down for sleep, it is too late: They are now cranky, and their body is uncomfortable.
2. Try identifying the “sweet spot” when melatonin is released. This requires “backward chaining” (working backward from the goal). Try allowing the child to stay awake a little later than you desire. Observe and see when they appear to get tired. You may initially observe an increase of energy followed by a slow-down phase. They may rub their eyes or yawn. At that moment, attempt to place them in bed or ask them to lie down. This may happen very late, past the ideal bedtime.
If trying to put a child to bed at your desired time leads to worse sleeping patterns, you may need to compromise. Identify that optimal time, and try putting the child to bed at that time for a few days using a bedtime routine (e.g., bath time, deep pressure massage, then calming aromatherapy). Then, attempt to start your routine an hour earlier every few days to a week. You may want to talk about the use of melatonin supplements for additional support.
3. Our bodies naturally respond to certain positions. When our arms and legs are extended away from our bodies, we are alert and allow sensory information to enter our bodies. When our arms and legs are flexed toward our bodies, we allow less stimulation to come into our sensory system. The RAS, along with another brain structure called the cerebellum, responds to these positions. In addition, when your feet leave the ground, the RAS and cerebellum communicate to prepare the body for rest. For children with extremely poor sleep habits, you may want to explore using a hammock swing or hammock bed. Rocking is another technique that often works.
4. Ear and scalp massage may be helpful. Slow, rhythmic, gentle stroking and massaging of the scalp and ears may slow down brain waves and signal the body to rest. Nerves in the external ear connect to the vagus nerve. If you recall, the vagus nerve is also connected to our system for rest and digestion. The vagus nerve is very powerful: Stimulation can lead to decreased arousal. Slow rhythmic strokes over the scalp are very relaxing. Be sure to use your fingertips only. Children will sometimes bang their head in an attempt to slow down their brain waves for rest. Scalp and ear massage may act as a safer replacement for head banging.
Following are some ideas for addressing difficulty eating.
1. Allow the child time to explore food without eating. Let them use their hands to play and sculpt figures with pureed food. Encourage them to be silly and smear food on the table then on their hands, then arms, and then face.
2. Present food from in front of the child. Do not try to trick them. They are very aware of unwanted stimuli! Sit in front of them and start by showing the food before placing it into their mouth.
3. Stimulate the hands and mouth with vibration, which may desensitize the area. If possible, combine vibration with ice (e.g., use a vibrating frozen teething device). Our body naturally decreases the pain and tactile responses when cold and vibration are presented.
4. Sometimes, hypersensitivity to sound (e.g., chewing) can cause challenges with eating. Try addressing the child’s auditory system. If the child wears headphones with preferred music at a high volume (remaining safe for their ears) while eating, they may not be bothered by the sound of their chewing.
Following are some ideas for addressing self-injurious behaviors.
1. Children who self-injure typically have a high threshold. Ice therapy should be attempted. Remember that pain and temperature are neurologically connected. Review the target activities for ideas. When using ice therapy, allow the child time to hold, manipulate, and even eat ice chips. You want to meet their high threshold.
2. Try to identify the trigger. Is the child presenting such behaviors without any catalyst? For example, are they banging their head during independent play? Perhaps they are in need of a sensory approach. Weighted caps, head wraps, and deep-pressure massage may be warranted. If they are biting their hands, you may want to try tight-fitting or weighted gloves, such as boxing gloves. Pressure and weighted vests can be used as well.
If you do notice a trigger, such as your asking the child to do work, try changing the routine. Perhaps a change of environment or having the child perform a task at a different time of day can help. If there is an object that triggers the response, such as a plate during mealtime or a book during class, try to change the object; for example, use a different plate or copy pages from the book and present single pages.
Following are some ideas for addressing risky behaviors.
1. Some children are risk takers. Remember that the IC teaches us what is right and what is wrong. In working with children who like to take risks, start with the SAM practices in an attempt to slow down the seeking parts of the brain. When we meditate or perform other activities that connect the mind and body, our IC gets stronger. Be sure to have the child do deep belly breathing, as that has an impact on the IC.
2. Try to incorporate intense activities to meet the child’s threshold. Avoid offering short bursts of vestibular activities, such as bouncing on a trampoline, swinging, or freeze dance, which enhance the child’s arousal without meeting their needs or threshold. This may only make things worse. Try more controlled movement breaks with heavy work and weights. You must combine the activities with stimulation of multiple sensory areas. For example, if the child is swinging, use a blindfold, turn up the music, and push them intensely. Seek out a sensory gym to allow for climbing and crashing. Rock climbing and swimming are great activities.