Challenging Behaviours during Therapy Sessions
What does it look like, why your child does it, & what can we do to manage it?
Challenging or difficult behaviour is a normal part of child development. Challenging or difficult behaviours can also frequently be observed in therapy sessions – however, sometimes, these behaviours can hijack the therapy session and therefore impede your child’s opportunities to gain the most out of their therapy sessions.Research has shown that repetition of an activity or movement is a key ingredient to your child successfully learning a new skill or task – your child needs to practice a new skill or task over and over and over again before they will learn how to do it for themselves. However, challenging behaviours during therapy sessions (and also when practicing activities at home) can significantly limit the repetitive practice of a task that is necessary for your child to progress their skills and abilities.What might challenging behaviours during therapy sessions/home programs look like?
Distraction/inattention – your child might move quickly between different activities, and it might be difficult to keep their attention on one activity for any length of time
Refusal to do an activity
Throwing
Biting or hitting
Crying
Tantrums
Why might your child be behaving like this?It is important to realise that these challenging behaviours indicate your child’s attempts to demonstrate their emotions, feelings or choices – your child is not using these behaviours to be intentionally be naughty or disruptive. Some reasons why your child might show challenging behaviours during a therapy session or when doing therapy activities at home include:
They are tired…
They are hungry…
The activity is too easy or too hard for them – either physically or mentally - which can lead to boredom or frustration…
They are seeking control of the situation…
They have learned that this behaviour can help them get what they want – when they behaved this way last time, they were able to stop the activity, so they are trying the same strategy again
What can we do to help manage these behaviours?
As best as possible, ensure your child is ready for their therapy session
Prior to their therapy session (as best you can manage) try and make sure your child is fed and rested. We will try and schedule your child’s therapy sessions around their rest times, because we know that we won’t get the best out of your child if they are tired. However, we also understand that sometimes life doesn’t work out as planned – your child might have missed their sleep, they might be teething, or they might be coming down with something – on these days we will just get done what we can in the therapy session, and can try again next session.
Respect your child’s need to build rapport and trust in their therapists
Your child might need some time to develop trust in their therapist before they will happily engage in a therapy session. This can especially be the case during sessions when your child’s therapist wants to be able to hold your child to help them to learn to move. Your child may have a shy personality and take longer to warm to ‘strangers’, or for some children it can be due to previously traumatic experiences with health professionals (eg: during hospitalisations or medical procedures). You and your child’s therapist can develop strategies to help your child build confidence in their therapist. I have spent a whole week seeing a client every day and just playing alongside him before he was comfortable enough for me to put my hands on him – these sessions are not wasted time, but instead allow for better outcomes in the future.
Establish and be consistent with rules and expectations
You and your child’s therapist might need to discuss your child’s behaviours (or to discuss what behaviours you can expect when they are being challenged during therapy) and to prepare together how you will manage these behaviours. You will need to agree on which specific strategies you will use, and you may need to practice some strategies with your child’s therapist before commencing the therapy sessions. Being consistent across therapy sessions and home will enable your child to more quickly understand what is expected of him/her.
Accept that challenging behaviours will sometimes occur
During therapy sessions your child will be challenged physically and mentally. This means they might get tired and frustrated. As a result, challenging behaviours are inevitably going to occur at some point during your child’s therapy journey. Try not to take it personally and try not to react to it.
Ignore and distract
Of course we need to be sensitive to your child’s frustrations and feelings; but we also don’t want your child to be rewarded by paying attention and reacting to their challenging behaviours. Ignore any unwanted behaviours – try not to make eye contact or make facial expressions and try not to respond verbally – instead, focus your attentions and interactions on the activity and the child’s participation in the activity. If the child tries to bit or hit, avoid it, ignore it, and refocus the child’s attention on the task.
Use positive reinforcement and praise
Equally as, or maybe more important than ignoring and distracting is ensuring you use positive reinforcement and praise for when your child demonstrates the behaviours and actions we are wanting them to do. This type of positive feedback can be difficult to do initially, and requires some concentration – but research has shown that positive reinforcement of positive behaviours has more success than punishing negative or unwanted or ‘bad’ behaviours, so it is definitely worth practicing!. It will be obvious to praise good behaviour or a learning or developmental achievement, but you should also consider praising your child for other little victories, such as listening well to instructions, completing a task when asked, or settling down after an outburst.
Choose a ‘Just Right’ challenge
Feeling overly stressed because the activity is too hard, or bored because the activity is too easy can cause disruptive and challenging behaviour. Our job as therapists and parents is to find the ‘Just Right’ challenge – an activity that is challenging, and stretches the child’s abilities, but also achievable. If you choose an activity you find it is too easy or too hard for your child – you can also try to adapt the activity ‘on the spot’ to make it harder or easier for your child, and therefore suitably engaging.
Allow some choice and compromise
This is especially important for older children who want some sense of control over what they do in a therapy session. My favourite strategies to allow choice and compromise include:
(a) Giving two options of activities or games that your child can choose from, or
(b) Acknowledging that the child has had enough of a certain activity, and then asking the child to complete eg: 3 more reps to finish off, or to help pack away the activity (which allows another few repetitions of the activity to be completed while they are packing up)
If you are concerned about your child’s behaviours during therapy sessions or when completing therapy activities at home, please discuss these with your child’s therapist. If the above strategies don’t work, or if you and your therapist think your child needs further help with their behaviour, we can organise a referral to a behavioural specialist to help you and your child with this.