Negative Behavior’s-Why is my Child Misbehaving? Some Facts from A Pediatric Occupational Therapist

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Temper tantrums are probably the first real expression of aggression. Tantrums can be seen in infants as young as 9-15 months. During this age, infants begin to understand that their temper tantrums can express their frustration, and potentially result in getting what they want. Aggression typically becomes a problem around 18-24 months, when children begin playing with peers. At this age, biting or hitting typically occurs in the context of learning to share and take turns. Boys are consistently found to be more physically aggressive than girls. (University of Kansas, Clinical Child Psychology Program Parent Series Editor: Carolyn S. Schroeder, Ph.D., ABPP Negative Behavior/Published April 15, 2016). Some children are simply more irritable, colicky, easily overstimulated, unpredictable, and present more challenges in their internal emotional and behavioral regulation, while others are easy-going. Even the most skilled parent can have problems dealing with the temperamentally challenging child.

Other contributory factors are the medical history of your child, and past or present daily influences. Children who have experienced early adversity (EA) have unique challenges in finding independence, meaning, and satisfaction in activities of daily living. (Anda et al., 2006). EA experience, calculated as an adverse childhood experience (ACE) score, is defined as the personal experience of abuse (i.e., verbal, physical, and/or sexual), neglect (i.e., physical and/or emotional), or trauma associated with proximity to an unstable family member (i.e., a close family member who has a substance abuse problem, has a mental health illness, is incarcerated, and/or is a mother or maternal figure and the victim of domestic violence), or a suddenly departed family member (i.e., divorce, death, abandonment). ACEs disrupt a child’s opportunity to engage in experiences that support typical development the child’s overall functioning, known as “developmental trauma disorder” (van der Kolk & d’Andrea, 2010). EA affects the brain, behavior, and development of occupational performance in infancy, toddler, and pre-school years (Mueller et al., 2010; Nelson, 2012).

Barbara B. Demchick and Kate Eglseder wrote about a boy name Ethan who was described by mother as a “sweet little boy” until age 4, when his behavior changed suddenly. He developed sensory sensitivities almost overnight, causing him, for example, to have a full-blown behavioral outburst if his shirt got a little wet. He was sensitive to light and sound, very picky about what he ate, moody with other children, and anxious about separating from his mother. He was later diagnosed. A series of medical tests from a pediatric psychiatrist diagnosed Ethan with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS), a condition that occupational therapy practitioners may encounter in children they work with in schools or clinics. PANDAS is defined as the rapid onset of OCD or tic symptoms in a previously healthy child, temporally associated with a recent Group A streptococcus (strep) infection (Williams & Swedo, 2015).

Lastly, sensory processing challenges have increased in recognition over the past 10 years as a contributory factor in affecting daily living skills for children. Especially for children with Autism. Participation and skill in everyday activities can be influenced by many factors, one of which is sensory processing. The term sensory processing refers to the receiving, organizing, and interpreting of sensory stimuli using the seven sensory systems (e.g., tactile, vestibular, auditory; Miller & Lane, 2000). Although not diagnostically a core feature of ASD( Autism Spectrum Disorder), sensory processing differences in children with ASD have been well documented (Ben-Sasson et al., 2009; Huebner, 2001; Kern et al., 2006). Symptoms may include unusual responses to sensory stimuli, such as over-responsivity or under-responsivity (Dahlgren & Gillberg, 1989; Dawson & Watling, 2000; Gabriels, Cuccaro, Hill, Ivers, & Goldson, 2005; Lord, 1995). For example, “over-responsivity behaviors such as resistance to touch and sensitivity to noise may limit the child’s participation above and beyond his/her core social deficits” (Ben-Sasson et al., 2008, p. 823).

Who can help? Confiding in your Pediatrician is an important step. The pediatrician can outrule medical underlying conditions with panels of testing and can further assist with referrals to professionals such as Developmental Psychologists, Behavior Therapy and Occupational Therapy. Decreasing a child’s disruptive and non-compliant behavior problems supports the child’s increased participation in daily activities in the home, school, and other settings. Occupational therapists can use evidence from this study to integrate parents’ participation into current intervention practices, building on parent-mediated and education models. In addition, they may inform parents on how best to implement strategies (e.g., visual schedules for routine events, planned to ignore of inappropriate behavior, positive reinforcement for appropriate behavior) to reduce behavioral problems. Journal of the American Medical Association, 313, 1524–1533. .


What has been your experience with negative behavior arising in your child? This is only a superficial review of contributory causes. Please feel free to share your experience with other caregivers or at

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