Tag Archives: Aggression

The Problem of “The Little Girl with a Curl”

Important Note: The image in this post and in all the previous ones are not images of the children discussed in the posting. They are simply children whose photos I have collected throughout my travels.

A particular problem has come to my attention over the years consulting to a preschool – children behaving in controlling and sometimes aggressive ways to parents at school transitions. Teachers report that the child behaves badly with his or her parents at drop off and pick up. Often the teachers express amazement that the children who seems well behaved in school, can change dramatically when they are with their parents – boss them around, even push or hit them. Another behavior characteristic of this problem is the child running away from the parent or refusing to come with them at pick up time. It is difficult for even the most empathic teacher to avoid the suspicion that the parents are somehow allowing their child to mistreat them by not setting adequate limits for the child. Supportive evidence is sometimes found in parents restraining from disciplining their children in the school.

This situation reminds me of a Mother Goose rhyme that my parents read me when I was a young child about a “little girl with a curl”. The rhyme goes, “There was a little girl who had a little curl, right in the middle of her forehead. When she was good, she was very, very good. But when she was bad, she was horrid.” I always secretly worried that I might be that girl.

Perhaps partly for that reason, I have given this problem a good deal of thought. My conclusion is that the answer to the mystery of the “little girl with a curl” mystery is rather complicated. The reason I say this is that when I talk to the parents of these children, I get a wide variety of answers about their child’s behavior in different settings. Some children are relatively well behaved in most settings and become suddenly noncompliant and belligerent at pick up time. Other children are compliant when they are involved in activities but become disorganized and unhappy during unstructured time at home and in school. Some children are usually cooperative but have difficulty with all significant transitions – bedtime, getting up time, leaving an activity, etc. Other children are always a handful.

What ties together all the children who fuss at pick up time and behave defiantly with their parents but not necessarily with their teachers? All these children are expressing difficulty with finding a positive strategy for reuniting with their parent. The subject of reunion strategies falls into the domain of a theory that informs much current developmental research and that has now also become popular in the vernacular – Attachment Theory. I have talked about Attachment Theory in other blog postings, because of its importance in research. The essential feature of Attachment Theory is that it presents the infant’s essential motivation as staying close to the parent in order to feel safe and secure. If the infant achieves the capacity to feel secure in his relationship to his mother, then he is free to explore the world, knowing that he can easily return to the safety of that connection.

We know that an important but primitive response to threat is running away or aggression. Remember that the “fight or flight” response of the sympathetic nervous system is one of the main “bottom up” as opposed to “top down” responses of the stress regulation system. That means that we must feel confident in our capacity to achieve security in order to use our thinking brain to tell us what we should do in a threatening situation. Transitions are inherently threatening, even small ones, because they require us to disorganize ourselves on the way to a new organization. That is, we have to stop playing in the sandbox in order to join Mother, get into the car, stay still in the car seat, etc. Playing in the sandbox is a complex organization involving a cognitive plan (building a castle), a motor rhythm (dig, pour, pat; dig, pour, pat), an affective and physiological state (contented, calm); and maybe even a compelling interpersonal experience (collaboration or competition with a peer). That is a lot to take apart in order to get into the car. And the hardest part is the disorganization in between the sandbox play and the car seat, between one organized state and the other. How do children manage that transition? It starts in infancy with the regulatory aid of the parent.

These interpersonal regulatory patterns that start in infancy gain power and stability as parent and child repeat them over and over again during the course of daily life. One pattern, that Attachment Theory would call “secure”, is demonstrated by the parent-child dyad who are able to support the child in managing all these disorganizing (and therefore threatening) experiences of – letting go his plan of building the castle, discontinuing the motor rhythm, interrupting the calm and contentment, and giving up the competition or collaboration – and maintaining adequate regulation and sense of security until the new car seat organization is established. I say “parent-child dyad” because I do not see this activity of facilitation transition as emanating exclusively from the parent. Although sophisticated advocates of Attachment Theory would probably agree with me, Attachment Theory largely tends to place the responsibility squarely on the mother, who carries attachment patterns within her even before her child is born, according to the AAI.

I will tell you how I use these thoughts about Attachment Theory in my search for answers to the “girl with a curl” problem in my next posting.

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Aggression in Early Childhood

Aggression is a good thing. It motivates initiatives – including learning, athletic effort, and healthy competition. Yet, good outcomes depend on the capacity to regulate aggression, and that is always a challenge. Self-regulation, as we have said many times in this blog, is a developmental competency that we keep working on throughout our lives. Self-regulation is a special challenge in early childhood, when it is just getting established, but it is a challenge at any age when we are under stress.

How do young children express aggression? They express it by running joyfully with their friends through the playground, by throwing a basketball or riding a tricycle fast, by shouting out the words of a song when cued, by laughing at a clown or shrieking with excitement at a magician. They also express it by pushing another child, by screaming, biting, or hitting, or by grabbing a toy away from a friend. What is the difference between these two ways of being aggressive? The difference is that the first way is adequately regulated; the aggression is under control. The second way is poorly regulated and out of control.

If children do not have adequate self-regulatory capacity to manage their aggression, they may express it with aggressive outbursts such as noted, but they also may express it by holding themselves tight – holding their bodies tight and holding on tightly to their emotions. That frightened, too-tight holding-on is intended to guard against an unwanted aggressive outburst and can manifest as excessive shyness or fear of speaking, or even as bodily problems such food pickiness or constipation. The reason that children fear the loss of control of aggression so much is that they are afraid of the destructive force of their aggression. Even if it is completely unrealistic that a small child could hurt an adult with an aggressive attack, children (out of their awareness) fear that this could happen. That can lead to nightmares of bad things happening to them or to their parents, whom they love and depend on. I want to stress that it is not the aggression that is bad, but it is the fear of losing control of it and harming someone that is bad for the child.

Why do some children have more difficulty managing aggression than others? Some children are temperamentally more sensitive, more active, or more intense. Some children have developmental difficulties that make it hard for them to “get it altogether” – from the point of view of regulation in various domains – motor, emotional, cognitive. Imagine how hard it would be to feel relaxed and confident if your body “didn’t listen to your mind”- that is what I sometimes say to impulsive children. Other children come from high conflict families in which overt or covert aggression presents a chronic threat. Still other children have histories of trauma – either directed at them or at a parent or even grandparent. Finally, some children have more than one of these reasons to have difficulty with aggression.

How can we help children develop the crucial competency? We can help them in three ways. First, we can create a safe situation in which both child and caregiver are not afraid. That usually means adequate and predictable adult supervision, predictable routines, and secure boundaries. Second, we can communicate tolerance of aggression and model constructive forms of aggression. For example, teachers who play basketball or tag with the children are helping the child experience the high arousal state of aggressive activity without the fear of losing control. At home, a parent’s skillful rough housing with a child can offer the same experience. Third, we can make it possible for children to practice aggressive activities without getting hurt or hurting others. Children cutting play dough with a wooden knife, crashing small cars into magnet tile constructions, and engaging in active playground activities are just a few ways I observed today at the preschool.

Our society has a strange and highly ambivalent relationship to aggression. Some parents in our culture prohibit pretend play with toy guns and soldiers, while others teach their children to shoot real guns. American television, video games, and movies are full of aggression. That puts parents in a difficult position, having to negotiate a reasonable balance between under and over controlling both their children’s aggressive behavior and the aggressive displays they are exposed to. There is no simple solution, but the guidelines as mentioned above are – demonstrate to your children a healthy attitude towards aggression; offer them a safe opportunity to take risks with their aggression and to practice using it; and give extra support to children with special sensitivities and needs so that they too can try out their emotions and test their bodies with exuberance.

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Sibling Rivalry

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photo_sibs

Here is another question posed to me by a number of parents recently: How do you deal with sibling competition and aggression?

This problem is common and has a simple answer. That does not mean it is easy to “fix”; it just means that it is easy to understand. The answer has three parts: (1) create a comfortable and relatively stress-free family environment; (2) create routines that teach children skills in sharing, turn taking, and negotiating; (3) separate siblings who cannot be together without fighting and then create short, parent-facilitated times together that have maximum probability of successful outcome, and practice them.

I am going to start by answering #2, then #3, and leave #1 – perhaps the most complicated one – for the last.

(2) This answer is a mixture of two of my favorite recommendations for parents – routines and family values. The routines function to put into place and practice the family values of sharing, turn taking, and negotiation. Remember that the power of “family values” is that you can’t argue with them. That is, you could try to argue, but the answer is always unarguable – “That’s just the way we do things in this family.” For example, if one child calls the other child a name or makes an insulting remark that the parents consider unacceptable, the response is, “In our family, we don’t use names like that or say insulting things like that.” That cuts through the child’s argument that another kid said the same thing – even if the other kid was in the same family. Or, if one child insists that he always sit in a preferred seat in the car, the response is, “In our family, we share.” Then the routine that practices the family value is something like – on the way to school X gets to sit in that seat, and on the way home from school, Y gets to sit there, or something like that. Another common conflict between siblings is fighting over the same toy. In that case, the family value of sharing is implemented by a negotiating process that is taught beautifully by the teachers in the Cambridge Ellis School. The child who wants the toy is helped to ask the child holding the toy, “Are you finished with the toy?” If the child holding the toy says no, then the other child is helped to ask, “How many more minutes do you need before I can have a turn – 1, 2, or 3?” (For older children, the time period is usually longer.) This scaffolds both children’s agency in the situation and supports the child who ultimately has to give the toy up.

(3) The third answer is similar to what I have recommended for play dates. Although parents certainly need relief, play dates are not primarily intended to serve that purpose but instead are meant to provide the child with opportunities to learn how to have fun playing with other children and learn to get along with them, among other things. The same can be said for the time siblings spend together, although sibling relationships are of course much more meaningful and intense than peer relationships. If siblings are going through a period of not getting along (this can happen for many reasons, including one sibling in particular having a hard time and taking it out on his or her brother or sister) then the time they spend alone together should be minimized (I realize this is often difficult) and they should be given short periods of structured play time together with parents facilitating the interaction. For example, the parent might say, “Since you guys have been having a hard time getting along recently, then X is going on errands with me while Y stays home to do homework with Dad, and then later this afternoon we will all go to the park together. It is important for the siblings to have enough good times together for them to want to spend time together in the future, which will motivate them to behave well with each other. While they are together in the relatively short enjoyable times the parent is playing the role of the teacher (above), scaffolding the development of sharing and good negotiating skills, as well as the respect for family values.

(1) Create a comfortable, relatively stress-free family environment. Of course this is not at all easy to implement. The reason I include it as #1 is because it is so important and because parents often forget that a major source of sibling conflict is preexisting tension within the family. Sometimes the original source of tension is in the marriage or between separated parents. Sometimes the tension is related to problems with extended family members, or to financial worries or job dissatisfaction. Other times tension is generated by conflict between one particular child and a parent, and the parent holds the tension within him or herself in between actual times of conflict. Then, when a demand has to be made on that child, the parent anticipates noncompliance and approaches the request in a negative frame of mind. Sometimes this tension is communicated by the parent’s facial expression, tone of voice and abrupt gestures, and aggressive choice of words.
Regardless of the origin of the tension, the children in the family pick up the stress, and often they will express the stress they feel by fighting with each other. Partly, this fighting response emerges from the irritability the family stress causes in the children. Also, the children unconsciously may be distracting the parents from the original source of their tension by calling attention to the problem they are causing in the moment. Interestingly, that can make everyone feel “better” because at least they know what the problem is – “fighting kids” – instead of living in a situation in which the cause of the unhappiness is hidden or unacknowledged. The answer to this problem of tension in the family is to refocus attention on the parents’ need for support. Remember the old directive of what to do with the oxygen mask in the airplane. First put it on yourself and then put it on the child sitting next to you. That is because the child will need you to be alert and strong in order to take care of him or her. In some cases, this need for support means getting more help from extended family and friends, or hiring someone to help take care of the house or the children. In other cases, the parents need professional help to manage the trouble in their lives.

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Bathroom Problems I: Soiling or Encopresis

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Encopresis

Many of the children whose parents consult me suffer from a condition called encopresis, or soiling, a distressing problem that is diagnosed in children older than 4-years old. Encopresis usually starts with constipation. If a child experiences pain when passing a hard or large stool, it is common for the child to tighten up and hold back in response to the urge to defecate. This of course makes the constipation worse, and often soft stool from higher in the gut leaks around the hard mass in the colon, causing soiling.

The first step in dealing with this problem is to go to the pediatrician. Good medical care is essential to the treatment of these symptoms. If the constipation is not treated the withholding is likely to continue and may cause anatomical changes in the gut such as stretching of the muscular intestinal wall. Children who suffer from chronic constipation may also develop a disturbed coordination of muscle function in the anal sphincter. Medical treatment often involves stool softeners that draw water into the gut and soften the stool, making it easier and less painful to pass. There are other more vigorous and more intrusive interventions that can be used if necessary.

Pediatricians also often recommend behavioral plans. The most effective behavioral plan is for parents to gently but firmly insist that the child sit on the toilet after mealtimes – usually breakfast and supper – twice a day for 5-10 minutes. The natural movements of the intestines after meals aid in defecation. Sometimes small rewards or star charts help motivate children to follow through with this plan.

If this is a typical pediatric problem, why is it a concern for a child psychiatrist? The main reason is that there are three groups of children who might come to me for another reason who are also prone to having encopresis. The first is anxious children, the second is aggressive children, and the third is children with developmental problems such as attention deficit disorder (ADHD) or autistic spectrum disorders (ASD).

When I describe anxious and aggressive children as belonging to different groups I am only referring to their outward behavior. Most anxious children are afraid of the destructive potential of their own aggression (even if their general behavior is timid and withdrawn). Similarly, children with aggressive behavior usually struggle with the fear that their aggression will get out of control and hurt someone – especially a family member or themselves. What is a natural response to the fear of something dangerous getting of control? Control it! In other words, hold it in. Since children make meaning with and about their bodies even more than adults do, they “hold it in” concretely and physically. This psychological meaning almost always occurs simultaneously with the biological meaning of the threat of passing a hard stool. In my office practice, it is common for a child who allows himself to freely play an aggressive theme, such as dinosaurs biting each other, to interrupt the play and go into the bathroom to poop.

Children with developmental problems are even more interesting. In addition to all the other reasons mentioned above, they have difficulty picking up their body’s cues such as the urge to defecate. This is because they have trouble paying attention to their body’s signals and also because they sometimes cannot decipher them. Some children with ASD need to be told to put on a coat or mittens when it is cold outside since they don’t notice the cold feeling without help. (Readers may be surprised when I link the diagnoses ADHD and ASD in the general category of developmental problems, but I think that is the most sensible way to understand them.)

Helping children with their fears and helping them learn to pay attention to the signals their bodies send them is very important, but nothing can take the place of a regular bathroom routine of sitting on the toilet for 5-10 minutes after breakfast and supper. So why do parents find this so difficult to do? One reason is that the child who is afraid of passing a painful stool will object, and parents of fearful children often have trouble insisting that they face challenges that frighten them. Another reason is that the child with attentional problems or the child who has trouble reading body cues will often “tune out” while sitting on the toilet (sometimes get lost in a book). While “tuning out” will sometimes not prevent a bowel movement, the child who is not paying attention to his body will not learn how to respond to his body’s signals. That is why I do not recommend letting a child read or play with an iPad while sitting on the toilet. It is difficult, but it is a good exercise for both parent and child to help the child tolerate this routine.

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Another Moment in the Classroom with Ben

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Ben had been having some rough times in school. There were several episodes of his pushing or pulling the hair of some of his classroom friends. The children who were pushed or whose hair was pulled were often his favorite playmates. Though they were upset at the time, they forgave Ben, and afterwards the teachers helped Ben apologize and make a repair, for example, by asking the child what he could do to make her feel better. However, his teachers worried that the behavior continued, the children would become afraid of him and begin to avoid Ben.

These episodes were unpredictable, and even in retrospect the sophisticated and sensitive teachers could not identify the precipitant of the aggressive outbursts. They happened when he seemed tired and when he was well rested, when he was frustrated or when he was having a calm, good time. It occurred to me that these outbursts were most likely as surprising to Ben as they were to those around him. I wondered if they were an impulsive response to environmental stimuli that was perceived as a threat or that suddenly stirred a strong negative affect – such as a noise, or an object intruding into his “space bubble”, or an otherwise imperceptible misattunement by a teacher or another child. If such a stimulus triggered an impulsive aggressive move, Ben might be oblivious to the whole process until it happened and he witnessed the stricken face of the other child. This sight would certainly generate feelings of shame and guilt in Ben. We definitely wanted to break this cycle.

Ben’s teachers had many good ideas about how to introduce a counterbalancing calming stimulus, such as something to squeeze. I wondered if there could be a way to make the link between the feeling and the action more explicit. During the weekend I attended a talk by a sensorimotor therapist, Pat Ogden. She showed a film of a child who threw objects in a similar impulsive gesture. The session was videotaped, which was helpful in identifying several moments when her father – present in the interview – shifted his attention to the therapist at just the time the girl was asking him to look at something she was doing. This was acknowledged. Then the therapist asked the child to make the gesture without the throw – extending her arm in an abrupt movement – and to talk about the feelings she had when she did that. The child was able to talk about her “impulses” and gain insight into them through pairing the pattern of body movement to her new awareness of the feelings. This was effective in changing the problem behavior.

I wondered if we could do something like this with Ben. In another tape in Pat’s talk, the therapist coached the patient to do the movement associated with a problematic affective position and then “slow it down”. I recalled how Bruce Perry has talked about slowing down a movement and then talking about what is going on. This then allows the cortex (thinking part of the brain) to engage with the motor experience of the body into make some kind of integrated meaning of the experience and give the individual more control over his body as well as insight into his feelings. I wanted to try something like this out on Ben. I will let you know how it works out.

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Bullying in Preschool?

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First of all, it is important to define what you mean by bullying. One definition found on the internet that allows the observer to immediately identify bullying behavior is “chronic, frequent behavior that has at its core the intention to harm or intimidate”. However, as is usually the case, things are not that simple, as I will explain.

I will first address what to do in concrete terms if you think your child is being bullied. Then I will discuss the roots of bullying behavior, because understanding these is the best way to really stop bullying. Finally, I will consider a more comprehensive approach to prevent bullying – teaching friendship.

First of all, how do you know if your child is being bullied? It is not obvious. Preschool children are learning how to behave in groups of peers, and this requires learning how to communicate their desires and needs to other young children and learning how to make sense of the communications they receive from their peers. Children are learning how to share, how to play together, and how to compete. All of these activities involve exercising initiative and assertiveness, and this engages aggression. Aggression is not all bad. However, when you are just learning how to do these things in a group of peers, it is also not always smooth, and other kids are often intruding into your territory in one way or another. Your impulse control is not yet great, and you may push or pinch to get someone out of your space. When you want something that someone else has, it may be too hard for you to wait, and you may grab it away or “be mean” in some other way. This is not bullying. It is typical preschool behavior.

Lists of “warning signs” that your child is being bullied can be problematic because they include behaviors that are not at all specific to being bullied, such as suddenly being scared to go to school, or acting clingy and whiny. Even coming home with unexplained injuries or talking about one particular child doing mean things to him does not necessarily mean that your child is being bullied. This ambiguity should not present a particular problem, however, since if your child displays any of these behaviors it is a signal that something is going on that you will want to address, and the first step in doing that is to understand your child’s mind. Whether it turns out that your child is being bullied or having a big reaction to the birth of a sibling, you will want to know about it.

In the case of bullying, finding out whether or not bullying is really going on presents an important complication in itself. If the parent has some reason for believing the child is being bullied, then the parent’s questioning of the child may generate in the child the same belief. Children are very suggestible, especially to the words of adults in authority. This is not only a problem in terms of misidentifying a bullying situation and perhaps falsely accusing another child – which is bad enough. It is also a problem because in making these suggestions (often in the form of repeated questioning), the parent unwittingly usurps the agency of the child, overwhelms his mind, so to speak, and this works against the child developing a mind of his own.

In the next posting, I will discuss what to do if you decide your child is being bullied.

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Roughhousing: Helping Children Manage Aggression

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Before I complete the “4 R’s” I promised after the “Ten Ideas for Helping Children Behave” posting, I wanted to offer some brief thoughts about roughhousing. Roughhousing is a valuable tool for helping children manage aggression. All children learn to manage their aggression first in the context of their caregiving relationships. Children who have had fortunate lives need help from their caregivers with this important developmental task, and children who have experienced maltreatment or abuse need even more help from their caregivers with this task.

I often recommend roughhousing, or horseplay, to caregivers who come with concerns about their young children, especially little boys who get into trouble with aggressive behavior. This family activity, obviously limited to young children – usually between about 3 and 8-years old – is a powerful learning experience for children, as well as an enjoyable time for the family.

It involves a caregiver, usually a man, wrestling with the child in a playful way. The wrestling gives the child a chance to experience and express his physical aggression safely in the context of a trusting caregiving relationship. In roughhousing, the child can try out the full extent of his physical strength in competition with a human “adversary” (this is different from trying it out in relation to an inanimate object) without getting hurt and without hurting the other. It is the caregiver’s job to maintain the boundaries and keep both the child and himself safe. Roughhousing usually works best one on one. If there is more than one child interested in rough housing, there is a great opportunity to practice respecting boundaries in the form of taking turns.

The first step in setting up a roughhousing event is to establish the house rules with respect to rough housing. These will always include: (1) Roughhousing always stops when one player calls out “No!” or “Stop!”; (2) There is no touching the face, head, or private parts; (3) Roughhousing has a declared beginning and end, and the time limits are established by the caregiver (unless the child declines the initial invitation to rough house or wishes to stop early, in which case the child’s wishes are respected); and (4) The second child who wishes to play must wait his or her turn. There can be other rules, such as no jumping on the caregiver’s back or no roughhousing in a particular part of the house, depending on the particular family situation.

It is important to note that if the child has a history of abuse or has extreme anxiety about physical contact, roughhousing should not be tried without professional consultation, and even then not without the utmost care and attention to the child’s cues.

Here are some of the valuable lessons a child can learn from rough housing:

Physical aggression can be expressed in a relationship without fear of destruction.
Aggression can be constructive and enjoyable if well intentioned, in control, and responsive the other’s cues.
Boundaries must be respected.
Turn taking is an essential part of human relationships.

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