Opposition & Aggression
People with Duchenne are at increased risk for having significant problems with arguing, not following directions, temper tantrums, or refusing to do what they are asked. Their oppositional and argumentative behavior may be the result of problems with mental flexibility or inability to be adaptive in their thinking. Adopting an overly punitive discipline style (mostly focused on punishment) with children who have these types of cognitive weaknesses usually results in escalation of conflict, power struggles, and an increase in negative behaviors. Fatigue can contribute to behavior problems in Duchenne. Steroid medication can also contribute to temper tantrums and explosive behavior.
While analysis of parenting strategies is helpful, it is important to understand that behavior problems are not always the result of parenting style, and many children with behavior problems do not respond to “typical” parenting strategies. Behavioral therapies may assist parents in identifying certain situations that are likely to trigger negative behaviors, and assist in developing alternative strategies to try to correct them.
Ways to help
We recommend consultation with a mental health or behavioral therapist. Therapy with a professional for these types of behaviors should always include a large parent-training component, because this approach tends to be much more successful than individual “talk therapy” or “play therapy” with the child.
- Prioritize. You can’t change everything, so focus on one or two of the biggest concerns and go from there.
- Develop and follow a routine as much as possible. Review what is going to happen during the day. Give advance notice of transitions, or changes in routine or expectations.
- Try to keep calm when a child is misbehaving. Angry parents and teachers tend to escalate the situation.
- Focus on the positive. Strategies that only focus on punishment do not promote positive behaviors, increase motivation, or change attitudes. Rewarding/praising/encouraging good behavior is more effective in the long run. Look for opportunities to say “yes” instead of “no.” (“Yes, you can have a cookie, after you…”).
Strategies for managing difficult behavior
Preschool & Early Elementary
- Ignore negative behaviors when the behavior is not aggressive or destructive.
- Praise positive behavior and create opportunities for positive interactions and success.
- Reward positive behavior.
- Break directions up into small manageable steps.
- Be specific and concrete when explaining expectations.
- Use time out for aggressive behaviors (that is, remove the child from any exciting activity and put in a time-out chair alone, until calm).
Classroom management for preschool-aged children involves many of the techniques previously listed for home behavior management. Some teachers find reward charts helpful for children aged three and up.
Older Children & Teens
Strategies to manage difficult behavior in older children typically fall into one of two categories. Depending on the characteristics of the child, one strategy or the other, or a combination of both, may be beneficial.
Behavior modification plan
This type of strategy has elements that are similar to the preschool strategies listed above. Essentially, the goal is to decrease negative behaviors and increase positive behaviors through the use of rewards. This type of plan makes the assumption that a child’s negative behaviors result in some kind of gain (such as getting what he wants or avoiding responsibility), or are due to low motivation or a desire to gain control. Learn more about this strategy (below).
Step 1: Identify behaviors that should be reduced (e.g., angry outbursts), and/or behaviors that should be increased (e.g., time spent on homework). Prioritize and pick only one or two to start with.
Step 2: Examine when and where these behaviors do (or don’t) occur to see if there are obvious triggers, circumstances, or surroundings that need to be changed.
Step 3: Set goals for change.
- Expectations for behavior should be very clear and highly specific (that is, don’t say, “You need to be a good student right now.”)
- Develop a reward system to implement when the child meets the expectations.
- The reward should immediately follow the behavior. Long-range rewards (such as earning a prize at the end of the school year) are too abstract and distant from daily behavior and are not effective. Also, if a child does not meet expectations at the beginning of the program and loses the chance to earn the reward, there is little reason for him to keep trying.
- Always give praise, but other rewards will likely be necessary. Younger children may need things like candy (not too much!), stickers, pennies, or whatever else will motivate them. Older children are more likely to respond to points or stars that can be traded in for bigger prizes.
- Avoid strategies that focus only on punishment. This type of plan does not promote positive behavior, does not change attitudes, and emphasizes failure instead of success. One example of this is to start a child with a certain number of points or on a certain “behavior level”. Points are then removed or his level is downgraded when he engages in negative behavior. This type of strategy will not be effective for most children who have behavior problems.
- Do not give rewards given before the expected behavior occurs (such as, “I’ll give you your reward now, as long as you promise to not have a temper outburst later”).
- Involve the child in developing the goals, expectations and rewards.
- Be realistic in the amount of change you anticipate. Set small goals initially so that everyone can experience some success. For example, if a child is having a temper outburst 10 times a day, it is unrealistic to expect that he can suddenly stop. A more realistic approach might be to identify one time period during the day (such after lunch, or when he gets home from school) that the behavior should not happen.
- Consistency by the parent or teacher is very important.
Collaborative problem-solving strategy
The goal of this strategy is to promote problem-solving skills. It assumes that children want to do well and get along with others if they can. They resort to arguing or having a temper tantrum because they cannot come up with a better way to solve the problem. This plan attempts to improve the deficient skills, thereby resulting in more effective problem-solving and less negative behavior. The process is highly flexible and tailored to each child and the family/teacher, but here is a general overview. Learn more about this strategy (below).
Step 1: Empathy and Reassurance
- Identify and understand the child’s concerns and point of view (such as completion of homework, attending an event, or engaging in an activity).
- Validate the child’s point of view, and help him express himself. This is a chance to encourage collaboration, so don’t argue or tell him that he is wrong. Assure him that the goal is to solve the problem together, not to merely impose the will of the parent (such as saying, “Because I said so!”)
Step 2: Define the Problem
- Identify and explain the adult’s concerns on the same issue.
- Use words the child will understand. Present the adult’s perspective as one point of view, not the point of view.
Step 3: Invitation
- Brainstorm possible solutions.
- Both the adult and child work together to think of possible solutions. The goal is to come up with a plan of action that is realistic and satisfactory for both the adult and child.
Information in this section was contributed, in part, by James Poysky, PhD. Read Dr. Poysky’s entire document, Learning and Behavior in Duchenne (download).