Understanding and Managing the Challenging Behaviours of Young Children: Risk and Protective Factors

1. Understanding and Managing the Challenging Behaviours of Young Children: Risk and Protective Factors

2. Speakers First Speaker: Ms Patricia Ng MuiHoon, BA Subtopic: What are challenging behaviours in preschool children? Designation: Part-time Lecturer/M.Ed candidature/Research Assistant (ECRF-13-02) Institution: National Institute of Education Second Speaker: Dr Noel ChiaKokHwee, EdD, FCP, FCoT, FCollP, BCET, BCSE Subtopic: Developing and validating the Challenging Behaviour Impact Factor (CBIF) as a screening tool Designation: Assistant Professor/Early Childhood & Special Needs Education Institution: National Institute of Education Third Speaker: Mr Norman KeeKiak Nam, MEd, MTech, FCollT, BCSE Subtopic: Usefulness of CBIF as a screening tool. Results of a study involving the use of CBIF to detect needs, intervention by counsellors/therapist and post-treatment measurement with CBIF. Designation: Lecturer/PhD (Special Education) candidature Institution: National Institute of Education

3. PART 1: What are the Challenging Behaviors in Preschool Children?

4. What is aggressive behavior? • Aggressive behavior is also termed as challenging behavior in literature. • It is observed in young children as well as adolescents. • It refers to any behavior that is perceived as threatening, provocative and stimulating all at the same time such that it affects children in several ways.

5. Typology by Actions

6. Typology by Triggers • Proactive or instrumental challenging behavior • Resort to such behavior in order to obtain what they want. • These children are not angry or emotional. • Common among young children who have yet to develop fluent speech to verbalize their needs or wants. • Also, when change is “toxic” to children with ASD (Baron-Cohen, 2011)

7. Typology by Triggers • Reactive or hostile challenging behavior: • Occur suddenly on impulse in response to some frustration, provocation or perceived threat. • Results in causing hurt or injury to others. • Such children are disliked by their peers, and in many cases, live in a harsh environment.

8. Attribution Bias & Low SES – Baron-Cohen (2011) • Tendency of those who are aggressive to interpret ambiguous situations as if the other person has hostile intent (Dodge, 1993). • Found in children with conduct disorder (e.g. Columbine High School killers), some of whom go on to become psychopaths who do not learn to fear punishment. • A clear example of the cognitive aspect of empathy not working properly. • Without educational qualifications, crime may be a way to make a living. Low IQ may make it harder for someone to imagine the consequences of being caught, but it does not explain all cases.

9. Measuring Moral Reasoning – Baron-Cohen (2011) • Tests with stories – Kohlberg • Husband who breaks into the chemist’s shop • Tests with stories – Turiel • Moral transgressions • Acts that violate human rights (e.g. hurting another person) • Conventional transgressions • Acts that violate social conventions (e.g. talking in the library). • By age 4, most children can tell the difference between the 2 types. • They also know that rules can be changed for conventions (e.g. allowed to talk), but changing the rules on morals does not make the transgression any less bad than before (Smetana & Braeges, 1990).

10. Theories on Aggressive Behavior of Children

11. What are risk factors? • The elements that cause a child to behave in an anti-social way, act aggressively toward others and/or even harm him/herself. • Two types of risk factors: • Biological • Environmental • Risk factors can also be triggers or distracters.

12. Triggers or Distracters Examples: • Genes and temperament are risk factors that can trigger challenging behavior to happen. • Substance abuse is a risk factor that distracts an expecting mother from her responsibility to protect her fetus to take marijuana or cocaine. • Studies on substance abuse during pregnancy has produced children with poor attention, memory deficits, impulsivity and hyperactivity, and other learning and developmental challenges.

13. Biological or Environmental • Biological risk factors: • Examples: Genetic influences, temperament, pregnancy complications, substance abuse during pregnancy, neurological problems, and emotional-behavioral disorders. • Environmental risk factors: • Examples: Parenting style, family background, peers, child care and school, poverty and the conditions surrounding it, exposure to violence, violent media, and turbulent times.

14. Environmental factors • Norma Jean Baker, borderline personality – Baron-Cohen (2011) • Always claimed she didn’t know who her real father was. • Parents divorced when she was 2. • Fostered out to a family, did not know her real mother till she was 7. Moved in back to real mother. • Mother admitted to psychiatric hospital, so a friend of her mother took care of her. • Sexually molested by the husband of her mother’s friend. • Borderlines hate being alone, are terrified of being abandoned. Will seek out even strangers, but alternate between pushing partner away and clinging desperately. • Norma married 3x. First marriage at age 16. • In and out of psychiatric clinics, attempted suicide at least 3x. Overdosed on barbiturates and died on 5 August 1962.

15. Biological factors • Gary Mckinnon, Asperger’s syndrome – Baron-Cohen (2011) • Young manwho lived with his parents in North London. • High systemizing drive; hacked into Pentagon from his bedroom. • Obsessed with finding out what was in their computers and whether it was true (about UFOs). • Never attempted to hide his crime – left notes to say he called (suggests he did not feel that he did anything wrong and that he is socially naïve about what others think of him, or the consequences). • Had not been motivated by any sense of malice. • Suffering under physical and social demands in jail.

16. What can be done? – Baron-Cohen (2011) • Offer him a job that can channel his talents to contribute positively to society. • In a civilized, compassionate society, we should be helping them find friendship, companionship, and other forms of comfort without jeopardizing anyone’s safety. • Develop small, calm, compassionate but secure communities as alternatives to traditional prisons.

17. Does feeling good lead to increased empathy? Effect of feeling good on helping: cookies and kindness (Isen & Levin, 1972). • People given extra change from a phone booth helped the girl pick up the papers she had dropped. • Those who did not receive the extra failed to do so. Zero degrees of empathy (Baron-Cohen, 2011) • Empathy is like an internal pot of gold in everyone that can be depleted by early environmental factors.

18. Protective factors • Elements that enable a child to avoid displaying aggressive or anti-social behavior. • Also known as opportunity factors, they are important to counter the negative impact of risk factors. • The more protective factors there are and the better they balance the risk factors, the more likely it is that a child will meet the challenges in his life and turn out to be a competent and caring individual.

19. Protective factors Also named as resilience: • A dynamic, developmental process which depends on a given context that: • Involves a strong sense of self-efficacy (i.e., a belief in self worth and abilities). • Possesses an internal locus of control (i.e., an ascription to own efforts and abilities for success rather than sheer luck).

20. 4 Levels of Protective Factors Individual, family, and community. Processes and mechanisms behind resilience. Effective preventive and early intervention programs. Role of biology in managing children with challenging behavior.

21. Level 1 Factors

22. Level 2 Factors Processes and mechanisms behind resilience, e.g.: • Previous successful stress management prepares a child to meet new challenges. • Strong parent-child bonding prevent a child from spending time mixing with antisocial peers. • Promotion of positive self-esteem, self-efficacy and problem-solving skills to boost a child’s self-confidence.

23. Level 3 Factors Effective preventive and early intervention programs, e.g.: • The Early Intervention Programme for Infants & Children (EIPIC) • http://www.sgenable.sg/Services_Child_Early-Intervention-Programme-for-Infants-Children.aspx

24. Level 4 Factors The role of biology, e.g.: • Integration of neuroscience, genetics, child development and experience to develop preventive or adaptive curriculum to address the aggressive and impulsive behavior. • With the advancement in genetics and genetic engineering, more studies have been done to study the impact of certain genes (e.g., DAT1 and DRD4) on behavior.

25. Summary of Risk and Protective Factors

26. Part 2: Developing & validating Challenging Behavior Impact Factor (CBIF) As a Screening Tool

27. A Brief Introduction The Challenging Behavior Impact Factor (CBIF) was developed as an informal screening tool in 2009. It was based on the risk and protective factors as reported in literature. The CBIF has been used in training allied educators for learning and behavior support (AEDLBS) to identify and help children with aggressive behavior in mainstream primary schools in Singapore.

28. As the screening tool becomes more widely used by AEDLBS, teachers and school counselors, the authors decided that it was time to validate the instrument and a correlational study involving 49 participating parents, whose children were identified by school counselors and teachers as exhibiting aggressive behavior, was done in April 2013. The results of the study suggested that there was a significant Pearson product moment correlation reliability r ranging between .90 and .96 at p < .01 between the CBIF and the Behavioral Rating Index for Children (BRIC) with which the CBIF results were compared.

29. Aim of the Study The aim of the study is to validate the 26-item Challenging Behavior Impact Factor (CBIF) as a reliable screening tool used by allied educators, school counselors and teachers as well as parents in Singapore to identify the risk and protective factors that influence children with aggressive behaviors so that appropriate follow-up actions could be taken to address the various issues of concern.

30. Research Design In order to validate the CBIF as a reliable screening tool to identify Singapore children with aggressive behavior, we have found the correlational research design most appropriate. The CBIF scores can be used to compare with the scores of another validated behavior screening tool to determine the reliability of the CBIF.

31. Participating Subjects • Parents from higher income families • Their children identified as having aggressive/challenging behavior by school counselors, allied educators and/or teachers; currently undergoing certain behavior therapy and counseling at various private learning-and-behavior management clinics and counseling centers. •  Reasons why convenience sampling was used: • Firstly, it has allowed us to select our subjects, who are readily available and also be willing to participate in the study (Creswell, 2008); and • secondly, it has also allowed us to collect the essential data in the shortest possible time. •  Recruited 89 parents from three private learning-and-behavior management clinics to participate in the study. • Narrowed target group to focus on parents with children between the ages of 7 and 10 years old. • Managed to get 49 parents to participate in our study. We do acknowledge that this sample group may not be representative of the entire population in Singapore.

32. Procedure The 49 participating parents were required to complete two simple tasks. • 1st task: Participants to complete the 13-item form from the Behavior Rating Index for Children (BRIC) (Stillman et al., 1984). • 2nd task: Participants to complete the two parts of the Challenging Behavior Impact Factor (CBIF) form: (1) 13-item Risk Factor yes/no checklist and (2) 13-item Protective Factor yes/no checklist. We gave our email addresses to all the participating parents should they want to contact either one of us for any clarification about the research study or if they wanted to know the results of the two screening tests.

33. Instrumentation: Behaviour Rating Index for Children • A 13-item rating scale; measure the degree of children’s behavioral problems; brief, easy to use; can be used by multiple respondents to evaluate children of all ages; can be used in group and classroom settings. Score on a 5-point Likert-type scale (1 to 5), omitting items 1, 6 and 10, (not problem-oriented items) • Scores transform into a range of 1-100 by adding up all the item scores; subtract from that figure the total number of items (out of 10) completed; multiply that figure by 100; & divide that result by the total number of items completed times 4. High scores indicate more severe behavioral problems. • Has been compared with 118-item Child Behavior Checklist & correlation between them was found to be .78. • Fair to good internal consistency: alphas ranging from .60 to .70 for children; test-retest correlations ranging from .71 to .89, but only .50 for children. • Good concurrent validity; correlation between children’s scores completed by parents (with/without children receiving treatment) was .65 (p < .001). A .76 (p < .001) correlation between scores on the BRIC and scores on the CBCL. • Use a score of 30 as an estimated clinical cut-off point, with higher scores indicating more challenging behavioral problems .

34. Instrumentation: Challenging Behaviour Impact Factor • This instrument was first developed by Chia (2009) and used in training allied educators for learning and behavior support (AEDLBS) to identify and help children with aggressive behavior in mainstream primary schools in Singapore. • From the literature review on children with aggressive behaviors, risk and the protective factors that influence the behavior development in children were identified & selected key items for each of the two factors in the development of CBIF. • CBIF was designed to reflect the number of risk and protective factors used in predicting the probability of a child having aggressive or challenging behavior. • The screening tool is divided into two scales: Risk Factor Scale & Protective Factor Scale. Each scale consists of 13 items and there is a total of 26 items from both scales put together for the instrument.

35. The CBIF is scored by adding together the number of NO (+) items on the Risk Factor Scale (YES/NO checklist) and the number of YES (+) items on the Protective Factor Scale (YES/NO checklist). Using the following equation, the CBIF score is computed:

36. Example #01 on CBIF Interpretation For example: The sub-total of NO (+) items scored on the Risk Factor Scale is 13 and the sub-total of YES (+) items scored on the Protective Factor Scale is also 13. The sum of the sub-total from the two scales equals to 26. The sum of the sub-totals from the two scales is then divided by the total number of items on the Risk Factor Scale and the Protective Factor Scale altogether, i.e., 26÷26=1. A CBIF score of 1 means there is no evidence of challenging behavior.

37. Example #02 on CBIF Interpretation For example: The sub-total of NO (+) items scored on the Risk Factor Scale is 3 and the sub-total of YES (+) items scored on the Protective Factor Scale is 5. The summation of the two sub-totals of both scales equals to 8. The sum of the sub-totals is then divided by the total number of items on the Risk Factor Scale and the Protective Factor Scale altogether, i.e., 8÷26=0.31. A CBIF score of 0.31 means there is evidence of severe challenging behavior.

38. Classification of CBIF Scores and Descriptors of Severity • The lower the CBIF score is, the higher is the risk that a child has aggressive or challenging behavior. • The CBIF scores can range between 0 and 1. Classification of CBIF Scores and Descriptors of Severity

39. Data Analysis For ease of interpretation of CBIF scores (0.00 – 1.00), CBIF sub-scale scores for Risk Factors (0.00-1.00) and CBIF subscale scores for Protective Factors (0.00-1.00) for comparison with BRIC scores (0 to 100), they were first converted to scores ranging from 0 to 100 by multiplying the derived score by one hundred. The derived CBIF scores were then deducted from 100 so that higher CBIF scores would imply more serious behavioral challenges as BRIC higher scores implicate higher behavioral challenges.

40. The normality of the distribution of BRIC and CBIF scores were examined by considering estimates of univariate normality of skewedness and kurtosis to test assumption of normality. As recommended by Kline (2005), the cut-offs of 3.0 and 8.0 for the absolute values of normalized estimated of skewedness and kurtosis respectively.

41. For determination of the internal consistency reliability of BRIC and CBIF scales, all the items of each scale were computed using Cronbach’s (1951) coefficient alpha method. Bivariate analysis of the correlation between BRIC and CBIF was used to determine the validity of CBIF scale in relation to BRIC scale, a published and validated tool. As for the determination of whether BRIC and CBIF scores will yield similar or significantly different scores, paired t test was used.

42. Results: Reliability Results for BRIC & CBIF scales

43. Correlation of CBIF scales on BRIC

44. Paired t test of BRIC with CBIF scales

45. Part 3: Usefulness of CBIF as a screening tool. Results of a study involving the use of CBIF to detect needs, intervention by counsellors/therapist and post-treatment measurement with CBIF.

46. Usefulness of CBIF as a screening tool • In the current study, CBIF has been found to be useful in that it reveals valuable information for professionals and parents on the status of the risk and protective factors of the child. These helps professionals to be aware of the degree of the condition and advise with conviction. Parents on the other hand will be more perceptive and more willing to follow through with the advise when the professional shows persistence.

47. Usefulness of CBIF as a screening tool Professionals are alerted to the seriousness of the situation and persist in getting parents co-operation. “The counsellor is quite persistent and has been calling me to follow up with help from a psychologist. But I didn’t have the time to follow through.” My counsellor strongly advised me to seek medical help for my son because of his disruptive behaviour, I didn’t follow his advice. I asked a nutritionist for advice and was recommended to put my son on Omega-3 and Omega-6 tablets as well as evening primrose oil. It works well for him. “The therapist is quite persistent to want me to bring my child to seek medical help. Although I am very busy with my work, I managed to find time to do so. The psychiatrist prescribed Ritalin for my child and he has shown a great improvement.” “The counsellor has taken the trouble to keep in touch with me just to make sure I followed through his advice. I did and yes, my son is better now in behaviour. Less aggressive but he can still be inattentive and mischievous.”

48. Usefulness of CBIF as a screening tool Parents are more willing to act when they have a sense of urgency developed through communicating with professionals. “The counsellor has taken the trouble to keep in touch with me just to make sure I followed through his advice. I did and yes, my son is better now in behaviour. Less aggressive but he can still be inattentive and mischievous.” My counsellor strongly advised me to seek medical help for my son because of his disruptive behaviour, I didn’t follow his advice. I asked a nutritionist for advice and was recommended to put my son on Omega-3 and Omega-6 tablets as well as evening primrose oil. It works well for him. “Yes, yes. The therapist is quite kind enough to call me every now and then to check on my daughter’s progress. After going through several session of behaviour therapy, she is quite well-behaved now.” “The counsellor has taken the trouble to keep in touch with me just to make sure I followed through his advice. I did and yes, my son is better now in behaviour. Less aggressive but he can still be inattentive and mischievous.”

49. Table 1. Paired t test of Pre-CBIF with Post-CBIF results after intervention (n=49) __________________________________________________________________________________ Effect Size Variable Mean SDt CICohen’s d __________________________________________________________________________________ Pre-CBIF 44.9020.70-11.60**- -.24, -1.71 -1.18 Post-CBIF 65.6215.98 _________________________________________________________________________________ Note.The CBIF values were multiplied by 100 for clarity and ease of viewing the data. **p <.001 The higher the value of CBIF the better the prognosis. Max is 100 A large effect size is any value above .50. Thus the absolute value of Cohen’s d of 1.18 shows that the treatment not only is significant but also has great impact on the results.

50. The End