5 Common Clinical Traps When Addressing Children’s Behavior
Many healthcare professionals are often quick to make assumptions that physical complaints are due to a mental health problem. This is not limited to medical settings. It can happen in educational and mental health settings too. This is just one clinical trap in which professionals can fall.
Professionals can get stuck in other traps as well, particularly when a child is having issues with behavior. As a result, there may be wasted time as the wrong issues are addressed or the wrong treatments are provided. Most of the time these traps keep professionals from considering all possible factors influencing the child’s behavior or they keep them from using other strategies that may be effective.
Examples of some common clinical traps:
Assuming the Doctors Have Explored Everything
Professionals may hear parents say that they've taken their child to the doctor and it's assumed that all possibilities have been explored. However, sometimes doctors aren’t given all of the information they need to make or explore a possible diagnosis.
For example, a child may describe stomach pains after they eat. Because it happens most commonly after they have their cereal in the morning before they go to school it is assumed that it’s anxiety about going to school. Well, they may have anxiety about going to school, but that doesn’t necessarily mean there isn’t something else going on. In fact, if you don’t feel well, you may not want to go to school so it can’t be assumed that it’s the anxiety. Maybe they have lactose intolerance, maybe they are sensitive to gluten, or it may be something else entirely. As an occupational therapist I would most likely assume that if the child had been seen by the doctor then a medical reason for their symptoms was ruled out. However, if the parent believes that it's likely anxiety and says this during their medical visit, the chances aren’t high that the doctor will explore other possibilities.
This is troubling because the patient is often left feeling as though they have responsibility for their physical ailments and no solutions.
In children, there are conditions that are fairly rare, but that doesn’t mean they don’t exist, and they often aren’t assessed early in the process of seeking help.
Relying on the Opinion of a Parent to Explain the Symptoms
If a parent describes their child’s behavior and what they believe the cause to be, professionals often tend to take that at face value and trust that they know their child best, because they do. More often than not they are probably right. However, it does not mean that they have considered all possibilities because they may not connect symptoms that a professional might to find a cause for behavior.
Explaining Behavior as Being Manipulative
It is not uncommon for parents or people new to working with children to describe a child’s “bad” behavior as willful, that they are doing something wrong just to be bad. There are a lot of people who think a 3 year old can be manipulative, like they have the cognitive development to make an elaborate plan to get something they want. You may hear “they throw their food away because they want to make me mad.” No, young children don’t do that; they aren’t out to get you. I recall someone describing a similar scenario to me once, and the parent was making all kinds of guesses as to why her child threw his food away. This apparently had gone on for some time when I suggested she ask him (he was 4 and did not have any significant delays). It turns out he just wasn’t hungry at the time she fed him!
Getting Stuck on One Mindset or Methodology
Sometimes we therapists fall in love with different treatment modalities and strategies and we want to do them with everyone. I have been an occupational therapist long enough to see trends with how behavior problems are treated in OT. First, nearly everything was explained as being an issue with sensory integration and required sensory-based interventions. Then reflex integration therapies became popular. Now executive functioning tends to be the common reason for all of the issues. The reality is that there is rarely one thing that helps when a child is having behavior issues or mental health struggles.
Being a specialist can be great, but it can also be very limiting or misleading. Sometimes these special treatment strategies are used for every possible diagnosis. However, there may be other things that are tried and true that may not be considered if there is a hyperfocus on the specialty strategy.
For example, I saw a physical therapist who did postural restoration therapy, a specialty that was the focus of the practice. And while there were some strategies that really helped me with my pain, finally after several sessions, she had me do a basic stretch, and that helped a lot. It can be easy to be enthusiastic when we find something we really believe in, but the more tools we have in our toolbox the more we are going to be effective at what we do.
Dismissing or Not Seeking Input from the Child
Children are not always part of the conversation. In fact, as I describe in this blog, adults are often trying to problem solve behavior issues without ever consulting the child. They try to solve problems strictly based on what they observe, but adults aren't privy to the internal experiences and feelings of a child if they haven’t taken time to learn them. Getting a child’s input can be all that is needed to find ways to truly support them.
If the child has the verbal skills to describe how they feel they should be asked. This may be straightforward if the issue is related to a physical complaint like pain, however, mental health issues are less concrete. This is one area in which the Clue Cards can provide some insights. If there are signs of stress the Clue Cards can help identify problems so that adults can help with problem solving.
When professionals get stuck in these traps it can result in clients feeling as though they have been gaslit, abandoned, and left to fend for themselves and whatever issue they are facing.
