Behavioral disorders in childhood can be challenging for families and school professionals and can have lasting negative effects on wellbeing if left untreated. The 2021-2022 National Survey of Children’s Health showed that 7% of children between 3 and 17 years old had been diagnosed with behavioral disorders. Common disorders diagnosed during childhood include Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and Oppositional Defiant Disorder (ODD). Presenting concerns often associated with these disorders include refusing to follow directions, arguing with authority figures, and acting impulsively, as well as more severe behaviors such as emotional outbursts and aggressive behavior. These behaviors can lead to stress for caregivers and significant challenges in the school setting. With early identification, there are opportunities to support these children and their caregivers, families, and teachers through education and skill-building to prevent behavior problems from worsening.
Importance of Early Assessment and Intervention
Before implementing any intervention, a comprehensive assessment should be conducted to establish which interventions will work best. Examining the child’s strengths and needs, developmental and medical history, cultural considerations, and family dynamics can offer insight into possible influences on the child’s behavior and the most appropriate strategies for behavior management. Understanding the functions of the child’s behavior can also help determine what situations may trigger certain behaviors and which preventative and contingency strategies will best meet the function while also increasing positive behavior and reducing negative behavior.
Further, examining school readiness skills can provide key details regarding the child’s functioning that can help identify areas where the child may have difficulty. Child factors as they pertain to school readiness include language development, physical well-being, cognitive skills, and social-emotional development. Promoting school readiness through early intervention can have long-term impacts on academic achievement and overall well-being (Williams et al., 2019). Several evidence-based interventions can be used to support children with behavioral disorders. Although the following list is not exhaustive, it includes certain antecedent strategies, consequence strategies, and skills that can be impactful in managing behaviors in many children.
Choices
Increasing opportunities for children to make choices can be a simple yet effective way to avoid significant behavioral issues. Allowing children to make decisions regularly can increase their sense of autonomy. In schools, providing choices during instruction can also increase their engagement (Ennis, Lane, & Flemming, 2021). Choices can be incorporated in several ways, such as during activities (e.g., giving options for what to wear for the day) and between activities (e.g., doing one type of homework first). When giving a child options and choices, it can often avoid power struggles that tend to occur when demands are placed.
Consistency and Predictability
Establishing predictable routines can support children who struggle with behavior, particularly during transitions between activities. For example, children may have difficulty transitioning away from an activity they enjoy or grow frustrated when they are unable to access a toy or object because it is time to share. Knowing what to expect in various situations can often prevent certain behaviors from occurring. The use of frequent prompts and reminders of expectations before specific situations can help promote positive behavior. Various tools can help maintain routines, including visual schedules and reminders, timers, and checklists. For children who have difficulty remaining seated or attending for extended periods, provide predictable breaks that are built into their routine.
Communication Strategies
Another helpful strategy is to be clear and direct when communicating expectations with your child. When giving commands, be direct and use a warm but firm tone. For younger children or those with language or intellectual delays, using short phrases accompanied by visuals can help them communicate effectively. Sometimes, children have difficulty with waiting or not having access to a preferred object or activity right away (or even hearing the word “No!”), so using other phrases such as, “Not right now, but instead, we can…” or “First/then” or “When/then” can help reduce the likelihood of behavior challenges while also still enforcing boundaries. Relatedly, it is important to use the word “No” when you mean that an activity or object is not available at all and follow through with this directive.
For some children, behaviors are often precipitated by difficulties communicating their wants and needs to others, whether that be due to language or cognitive delays or other impairments that make it difficult to communicate. Functional Communication Training (FCT) is a procedure that teaches an individual how to use an alternative response to achieve their goal rather than engage in problem behavior and has been consistently used as an effective intervention for children, teens, and adults (Tiger, Hanley, & Bruzek, 2008). For instance, teaching a child to point to something they want (like a snack) rather than hit a person or an object and giving the child the snack only when they point allows the child to have their need met while also reinforcing more appropriate behavior.
The Power of Positive Reinforcement
One especially effective method for increasing positive behavior is through the use of positive reinforcement. Positive reinforcement uses various strategies to reinforce wanted behavior by adding something likely to increase that behavior. For example, giving specific and labeled praise after a child shares their toy with another child (e.g., “Nice job sharing your toy!”) is likely to increase that child sharing again. In addition to praise, other examples of positive reinforcement include extra privileges, social rewards such as approval from others, and tangible rewards like stickers.
Supporting Social-Emotional Skills
Building social-emotional skills can also improve both short and long-term emotional and behavioral outcomes. Social-emotional learning (SEL) encompasses a broad range of skills, behaviors, and attitudes that fall under five interrelated competency areas: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making (CASEL, 2020). Research has consistently highlighted the importance of SEL skills and their positive impacts on academic achievement and attitudes toward school, as well as their influence on reducing emotional and behavioral problems (e.g., Cipriano et al., 2024; Durlak et al., 2013). Supporting the development of SEL skills can involve teaching children to accurately identify and express their emotions with others, understand the impact their actions have on others, learn coping skills to manage their emotions, and improve their ability to make better choices.
Seeking Out Help
For families who continue to struggle with managing their children’s behavioral challenges, seeking out the support of a mental health professional may be needed, as there are several evidence-based therapeutic approaches to promote positive parent-child relationships and reduce problem behaviors. Parent training programs can be helpful to build parents’ skills in changing their child’s behaviors. For instance, Parent-Child Interaction Therapy (PCIT) is a structured treatment approach originally intended for children ages 2-7 presenting with emotional or behavioral difficulties. In PCIT, both parents and children participate in treatment, with the therapist acting as the parent’s coach to teach effective skills and assist the parent with implementing skills in vivo (or in real-time) with the child. Another effective treatment option is Behavioral Parent Training (BPT). BPT involves a therapist who works primarily with parents to target and define specific behaviors to address, learn the possible functions of these behaviors, identify prevention strategies to decrease the likelihood of the behavior occurring and implement consequence strategies to effectively increase or decrease the behaviors.
With the use of early strategies, children and families can learn more effective ways to interact and manage problem behaviors. Importantly, understanding the aspects of the whole child, which includes their strengths, challenges, and the environment in which they live, can help inform interventions and lead to healthier, happier lives.
Jeniffer Cruz, PhD, NCSP, is a Licensed Psychologist at Behavior Therapy Associates. To learn more, please visit behaviortherapyassociates.com, or call (732)-873-1212. Email inquiries can be sent to jcruz@behaviortherapyassociates.com.
References
Child and Adolescent Health Measurement Initiative. (2021-2022). National Survey of Children’s Health. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved March 11, 2025 from https://nschdata.org/browse/survey?s=2&y=51&r=1&#home
Cipriano, C., Ha, C., Wood, M., Sehgal, K., Ahmad, E., & McCarthy, M. F. (2024). A systematic review and meta-analysis of the effects of universal school-based SEL programs in the United States: Considerations for marginalized students. Social and Emotional Learning: Research, Practice, and Policy, 3, 100029. https://doi.org/10.1016/j.sel.2024.100029
Collaborative for Academic, Social, and Emotional Learning (CASEL). (2020). The CASEL framework: What is SEL? https://casel.org/casel-sel-framework-11-2020/
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82, 405-432.
Ennis, R.P., Lane, K.L., & Flemming, S.C. (2021). Empowering teachers with low-intensity strategies: Supporting students at-risk for EBD with instructional choice during reading. Exceptionality, 29(1), 61-79
Foote, R. C., Schuhmann, E. M., Jones, M. L., & Eyberg, S. M. (1998). Parent-Child Interaction Therapy: A guide for clinicians. Clinical Child Psychology and Psychiatry, 3(3), 361–373. https://doi.org/10.1177/1359104598033003
Tiger, J. H., Hanley, G. P., & Bruzek, J. (2008). Functional communication training: A review and practical guide. Behavior Analysis in Practice, 1(1), 16–23.
Williams, P. G., Lerner, M. A., AAP Council on Early Childhood, & AAP Council on School Health. (2019). School readiness. Pediatrics, 144(2), e20191766. https://doi.org/10.1542/peds.2019-1766
