Problem Behavior in Preschoolers

Most children who are treated for disruptive behavior problems are school-age: They’ve been acting out in class, ignoring or defying teachers’ direction, or being too aggressive with other children. But in many cases these children have been exhibiting problematic behavior for years before they start school. Signs that preschool kids might need help learning to manage their impulses and regulate their behavior include:

• Maybe they’ve been having more—and more serious—tantrums than typical kids their age
• Maybe they’re extremely hard for exhausted and frustrated parents to manage
• Maybe they’ve been kicked out of preschool or excluded from play dates
• Their behavior may be disrupting family life and and putting serious strain on other family members
• Conflict over behavior may be creating negative relationships with parents
• Parents might be concerned that they might hurt younger siblings

At this age, therapy directed at helping children with behavior issues centers around parents—teaching them skills to shape a child’s behavior more effectively, and reset the family relationships in a more positive way.

• Parent-Child Interaction Therapy (PCIT): In PCIT parents receive live coaching from therapists behind a one-way mirror as they lead children between 2 and 7 through a series of tasks and practice techniques for setting limits and responding effectively to both desired and undesired behavior. Training usually requires 14-17 weekly sessions.

• Parent Management Training (PMT): In PMT parents are usually seen without the child present, although children (3 to 13) may be asked to participate in some sessions. Skills to deal more effectively with challenging behaviors are taught and modeled by the therapist and then role-played with parents. After each session, parents practice the skills at home.

• Positive Parenting Program (Triple P): Triple P is designed to treat child behavior problems from toddlerhood through adolescence and promote positive parent-child relationships. Its focus is on equipping parents with information and skills to increase confidence and self-sufficiency in managing child behavior.

Evidence shows that children are most responsive to therapy to change behavior up until age 7. The younger the kids are treated, the longer the parents have this skill set to apply with them, explains behavioral psychologist Melanie Fernandez, PhD. “You have time to lock in the gains, to entrench these positive types of interactions, to improve a child’s long-term trajectory.”

When young kids are behaving in ways that parents find troubling, they are often told to wait, because kids will just grow out of it. But the reality is that when kids aren’t able to act in age-appropriate ways, it’s best not to wait, says Dr. Fernandez. Children are learning all the time, and the longer their out-of-control behavior is tolerated, the more firmly rooted it becomes. “The longer that maladaptive behavior goes on,” says Dr. Fernandez, “the harder and more stressful it is for parents to turn around.”
Parents also may worry that they’ll be criticized for being “helicopter parents,” she adds. But parent training simply helps kids who are disruptive or out of control learn skills they haven’t learned—to reel in their impulses and respond effectively to direction. It helps them avoid being labeled as “problem” kids.

All two-year-olds, all three-year-olds, have tantrums, and can resist parental direction, notes Dr. Fernandez. It’s natural at two for kids to be saying no to many things. The behavior really deserves attention when “no” is the only response you’re getting, and it doesn’t change without a huge fight. With tantrums, it’s a matter of frequency, but also how impairing they are. You may need help if you’re seeing not only frequent temper tantrums but full-blown tantrums, where the child is upset, crying for a long time, and inconsolable.

Parents all feel like pulling their hair out at moments, but you should think about getting help when difficult behavior becomes a regular thing, when it’s causing distress in the family, when you’re starting to get depressed, or so stressed that you’re having trouble liking your child. It’s not uncommon to hear parents say, “I love my child, but it’s hard, because everything’s a fight.”

Another sign of a problem is if you find yourself having to adjust you lifestyles because you can’t really go many places—not even kid-friendly places. If you can’t make a trip to the grocery store because it will end with yelling, crying, or fighting, it might be time to get help.

Another problem is what behavioral therapists call “passive noncompliance”—when you have told your child to do something six, seven, eight times, and he’s just not doing it. He says, “One more minute,” or “I’m coming,” or “I’m playing,” or just flat-out ignores you when you know he’s heard you. That gets problematic, because school is not going to work down the road if the child doesn’t comply with teachers’ requests. Even things like crossing the street are dangerous if the child is passively not complying to, “Please hold my hand.”

Programs vary in approaches, but what they have in common is that parents are taught how to interact with their child in a positive way that is developmentally appropriate, and then to set reasonable expectations for their child, and communicate those expectations in a way that makes it more likely their kids will listen to them. Parents learn a very consistent and predictable way to follow through when their kids do and don’t listen. They practice so often the response becomes automatic so they know how to react even in iffy situations or situations that seem like exceptions.

Early intervention is important because it helps kids learn new behaviors before they’ve built up a whole lifestyle around bad habits and behaviors that create a very negative experience both at home and later at school. Kids need and want to have a positive relationship with their parents, other adults, and other kids, too. The earlier we can help them be effective at that, the happier and more successful they’re going to be.