Behavior difficulties in youth can take on many different forms. Children may present as oppositional, display disruptive behaviors in class or other group settings, and younger children may also have tantrums, hit or show aggressive behaviors. Typically these behaviors are secondary to challenges with mood regulation, anxiety, flexibility, sensory sensitivities, and executive functioning challenges. For example, children with Attention Deficit Hyperactivity Disorder (ADHD) often experience more impulsive behaviors that may present as disruptive to others. Youth with anxiety may present with more oppositionality in certain situations due to fear-based avoidance, and children with autism may have tantrums due to challenges with flexibility or in response to aversive sensory experiences.
A comprehensive assessment of behavior difficulties should always be completed in order to ensure that the treatment plan takes into account all factors that may contribute to disruptive behaviors in youth. Treatment should address the underlying reason for these behaviors and acknowledge that all youth do well if they can. Collaborative and Proactive Solutions is an evidence-based treatment approach developed by Dr. Ross Greene that addresses youth behavioral concerns based on this understanding. Youth are actively involved in identifying and coming up with solutions to the challenges they are facing and the main focus is on addressing the underlying reason for the behavioral concerns.
At times, treatment needs to focus narrowly on the disruptive behavior in addition to the underlying reason. This is especially true in younger children with more extreme behavioral difficulties, such as aggression. In these cases, behavioral interventions are recommended and therapists work closely with parents, teachers, and other caregivers to impart skills to manage these behaviors. Evidence-based treatments designed to reduce behavioral concerns include Parent Child Interaction Therapy (PCIT) and Parent Management Training. Both of these approaches are time-limited in nature and work by imparting skills directly onto care providers. The main difference between these approaches is that PCIT works with parents and children together so that the clinician can provide live coaching on the skills that have been taught.