Understanding and Managing the Challenging Behaviours of Young

Report
Speakers
First Speaker: Ms Patricia Ng Mui Hoon, 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 Chia Kok Hwee, 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 Kee Kiak 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
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.
Typology by Actions
Typology by Triggers
1. 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)
Typology by Triggers
2. 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.
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.
Measuring Moral Reasoning – Baron-Cohen (2011)
• Tests with stories – Kohlberg
 Husband who breaks into the chemist’s shop
• Tests with stories – Turiel
1. Moral transgressions
Acts that violate human rights (e.g. hurting another person)
2. 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).
Theories on Aggressive Behavior of Children
FrustrationAggression
Social
Learning
Early-Onset,
Life-Course
Persistent
Aggressive
Behavior
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.
Triggers or Distracters
Examples:
1. Genes and temperament are risk factors that
can trigger challenging behavior to happen.
2. 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.
Biological or Environmental
• Biological risk factors:
– Examples: Genetic influences, temperament,
pregnancy complications, substance abuse during
pregnancy, neurological problems, and emotionalbehavioral 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.
Environmental factors
•
•
•
•
•
•
•
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•
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.
Biological factors
• Gary Mckinnon, Asperger’s syndrome – Baron-Cohen (2011)
• Young man who 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.
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.
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.
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.
Protective factors
Also named as resilience:
 A dynamic, developmental
process which depends on a
given context that:
Involves a strong sense of selfefficacy (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).
4 Levels of Protective Factors
1. Individual, family, and
community.
2. Processes and
mechanisms behind
resilience.
3. Effective preventive and
early intervention
programs.
4. Role of biology in
managing children with
challenging behavior.
Level 1 Factors
•Community clubs
Community •Churches, etc.
Family
• High-quality parenting
• Loving relationships
Individual
• Out-going temperament
• Regulation of emotions
• Sense of humor, etc
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 selfconfidence.
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
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.
Summary of Risk and Protective Factors
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.
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.
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.
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.
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-andbehavior 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.
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.
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; testretest 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 .
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.
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:
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.
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.
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
Data Analysis
For ease of interpretation of CBIF scores (0.00 –
1.00), CBIF sub-scale scores for Risk Factors (0.001.00) 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.
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.
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.
Results: Reliability Results for BRIC & CBIF scales
Correlation of CBIF scales on BRIC
Paired t test of BRIC with CBIF scales
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.
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.
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.”
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.”
Table 1.
Paired t test of Pre-CBIF with Post-CBIF results after intervention (n=49)
__________________________________________________________________________________
Effect Size
Variable Mean
SD
t
CI
Cohen’s d
__________________________________________________________________________________
Pre-CBIF 44.90
20.70
-11.60** -.24, -1.71
-1.18
Post-CBIF 65.62
15.98
_________________________________________________________________________________
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.
The End

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