Behaviour that challenges in the classroom calls for a considered, consistent and whole-school approach. Professor Tamsin Ford is a child and adolescent psychiatrist who leads a research group at the University of Exeter Medical School.
Their work focuses on the effectiveness of services and interventions to support the mental health and wellbeing of children and young people, with a focus on mental health in schools. She gave me her insights into the origins of challenging behaviour and discussed effective strategies for offering support.
Challenging behaviour and mental health
Opinion is divided on whether or not challenging behaviour constitutes a mental health problem.
Prof Ford explained: “That’s a really interesting question and we could talk for an hour about the philosophy of whether or not behaviour that challenges others should be conceptualised as a psychiatric problem.
“What we can say, however, is that children who meet the diagnostic criteria for conduct disorder have a much higher risk of every adult mental health problem. This includes anxiety, depression and psychosis as well as difficulties that might be less surprising, like substance misuse and dependence.”
To meet the diagnostic criteria for conduct disorder children must, explained Prof Ford, have three or four severe problems which persist for at least six months and make it difficult for them to access education and maintain friendships, get in the way of family life and distress people around them.
Whatever the philosophical debate, she emphasised that it is important to have this categorisation so that we can identify and support children who experience these difficulties.
“Having a category through which we can say ‘these children are in difficulty’,” she continued, “seems to me very important.
“If we can get in to find out why their behaviour is happening, to support them and change their behaviour traits, we may have a positive impact not only on their health trajectory, but also on their educational outcomes, their future employment, their intimate relationships, and perhaps their own children’s mental health further down the line.”
Underlying causes
Identifying these children is often fairly straightforward – young people whose behaviour challenges tend to declare themselves because someone is struggling to cope with them, be it their parents or carers, or their teachers at school.
Prof Ford stated that the more important issue is to understand the origins of their behaviour. One of the clearer origins of challenging behaviour relates to literacy. Prof Ford said: “There is a really, really strong overlap between children with behaviour problems and children with reading problems – about a third of the children who have a specific reading disorder will also have conduct disorder and vice-versa.”
In some cases, the behaviour may derive from a child’s stage of development relative to their age, as Prof Ford explained: “There are children who have a global developmental delay, so in other words, it’s not so much that their behaviour is wilfully bad, but it’s that they are in a situation, particularly in a school setting, where actually the expectations are just inappropriate for their developmental level.”
Emotional disorders can also lead to difficult behaviour and should be considered, particularly if the challenging behaviour is a change for that child.
“For example,” Prof Ford explained, “if I have a child who is really anxious about being separated from a parent, getting them into school can be really hard and that anxiety may manifest or be shown to others as temper tantrums and refusal to go to school. The underlying anxiety might be missed.
“Likewise, a teenager who is depressed can be really irritable. They may not have the energy to do their school work and stop handing in their homework; then they may be bolshy, rude and irritable when challenged about it. Children with autistic conditions can struggle with changes in activity, and children with ADHD struggle with sitting still and sustaining concentration.
“So, whenever a child’s behaviour is challenging, it’s worthwhile stopping and thinking: why? What could be going on here? And, thinking about children’s broader mental health – is there a neuro-developmental disorder like ADHD or an autism spectrum problem?
“Might a teenager be anxious about something, or is there a learning problem we haven’t yet found out about? Or is there something going on at home – a divorce or a bereavement? Is there bullying at school? It’s important to explore all these possibilities before concluding that this is ‘only’ a behavioural problem – because it very rarely is.”
The importance of diagnosis
What are the advantages of having a diagnosis for children? Prof Ford says that diagnosis can bring access to resources that can support children: “If you assess a child and find out that they have ADHD or an autism spectrum condition, this can then be the route into an Education, Health and Care Plan (EHCP). That, in turn, may translate into the provision of a person to support a child with autism in the playground or to assist a child with ADHD to sit still in the classroom and actually get some work done.
“I think careful assessment is always important. If having a diagnosis or label would support a child to access the resources and support they need, either within school or outside of school, then that’s a clear reason for having a diagnosis.”
Getting a diagnosis, however, is not just important from a resourcing perspective. Prof Ford continued: “It’s about more than just getting money for a teaching assistant or other support. In the eyes of the school, and sometimes the eyes of the family, it changes a child who is a problem into a child who has a problem.
“This evokes a very different response from people around them. That in itself – the assessment and the explanation of what’s going on and where this behaviour is coming from – can make a huge difference for everybody trying to work with the child and for the child themselves.”
Assessing and addressing challenging behaviour
In thinking about ways to support children whose behaviour is challenging, either at school or at home or both, Prof Ford’s first priority is a clear assessment of what’s going on in the child’s life: “It’s important to think through – how long has this been going on? Is there something that has trickled on for most of the child’s life? Were they a toddler who was quite difficult to manage, who’s turned into a teenager who’s really harder to manage because they’re bigger and there’s more opportunity to do things that are challenging? Or is this a sudden change?
“If it’s a sudden change, what has happened at home or at school that might explain that? What are the situations in which things go right and might those be possible ways of understanding what’s going on or perhaps even be levers for change?”
It is particularly important, says Prof Ford, to find out whether the child has a mental health problem such as anxiety, depression or ADHD: “For all of these there are evidence-based interventions that can help support these children and which will have an impact on their behaviour. There are likewise effective, evidence-based interventions for conduct disorder also.”
Prof Ford believes that having clear, realistic targets for achievement is key when teaching children whose behaviour challenges, as is making a point of giving praise for a job well done.
She said: “If a child gets a reputation for always behaving badly, you can get a ‘give a dog a bad name’ phenomenon – there may be other children who are behaving badly, but not quite so often, who just get away with it and the child with the reputation can’t even breathe loudly without being pulled up all the time.
“If you could reverse that so that you really jump on the things they do right and give them lots of praise and encouragement, that can be hugely effective in turning the situation around because they realise that actually people notice them – they notice when I come to school, they notice when I hand my homework in and they notice when I do things right.”
It’s also good to spend some time thinking about how to reward positive behaviour for individual children, as well as on a class and whole school level, says Prof Ford: “Remember, it’s got to be a reward for the child and not the adult. What the adult might think is a really good reward might not motivate the child because it’s not what they’re into.”
A whole-school approach
A consistent, school-wide approach to behaviour management is key, says Prof Ford: “The vast majority of children go through their school career and develop into healthy adults without any major problems with their behaviour. There is also a small number who are very vulnerable because they have a learning disability, a mental health problem, a very difficult social situation or some combination of these.
“Such children may never cope in a mainstream school, whatever support you put in. It’s really important that those children are identified early and if support in mainstream education is failing, that wherever possible, the move to specialist provision is planned and to support their needs.
“It is crucial that they’re not left to fail in mainstream and then excluded so that they end up in a specialist school as a result of failure – that in itself has a detrimental effect on children’s mental health.
“However, between those two groups you have a population of children who are vulnerable and it’s for these children that schools who are well-organised can make a real difference to educational outcomes and mental health. I think it’s about having a really good whole-school approach to behaviour management which is consistent.”
Similar messages need to be put out to the entire school. This can be done through a variety of means – through assemblies, for instance, through a consistent approach to bullying, and by having ground rules on how staff interact with each other and with students.
Simple, traditional techniques for managing behaviour can be really effective – for example, having a daily report card that children take round the school with them and then take home, so it’s not so much what’s written on the card that counts, it’s the fact that the child is aware that everyone’s speaking to each other and that it opens up channels of communication.
Teacher-pupil relationships: a vital link
Prof Ford is firmly of the opinion that we should not underestimate the importance of teacher-pupil relationships when it comes to challenging behaviour.
She explains her thinking: “From the British National Survey Data of school-aged children we have demonstrated that teacher-pupil relationships, if poor, predict the new onset of behaviour problems and other psychiatric issues and they also predict exclusions.
“While this may be a difficult thing for educators to hear, it demonstrates that what teachers and teaching assistants do is really important. There is work from the 1970s which demonstrates that, for really vulnerable children, having one interested adult – which was often a teacher and a fleeting relationship – can make the difference between whether or not they succeed in terms of educational outcomes. It can also make a major difference to their mental health.
“So, teacher-pupil relationships should be fostered to be as positive as they possibly can. In terms of managing behaviour, spending time developing a good relationship is like putting money in the bank: when you then have to say, ‘no, actually that behaviour is unacceptable because...’ and impose a sanction, the child is likely to be more receptive if a positive connection has already been established.”
Prof Ford acknowledges that managing children’s behaviour is one of the toughest things about the job: “Having to deal with behaviour problems and not feeling supported is quite often what causes people to leave teaching. Teachers have quite high rates of depression and often feel unsupported – we really need to think about how we look after our teachers.”
Challenging behaviour: Eight tips
- Be aware of possible underlying causes, such as anxiety, neuro-developmental or learning disorders, or issues at home.
- Recognise the importance of getting a diagnosis where relevant.
- Have clear, realistic targets for achievement.
- Pay attention to and really encourage positive behaviour and work.
- Have a consistent, whole-school approach to behaviour management.
- Think about the best way to reward positive behaviour for children who are struggling, at class level and at school level.
- Have strong and consistent implementation of anti-bullying programmes.
- Look after your own mental health.
- Clare Stafford is CEO of the Charlie Waller Memorial Trust, a charity that provides fully funded mental health training to schools. Visit www.cwmt.org.uk
Further information
- The Charlie Waller Memorial Trust’s Stella Project has been working with professionals to provide mental health training in order to better support vulnerable learners. This series of articles is part of the legacy the year-long project hopes to leave. For more information, see The Stella Project: Supporting vulnerable learners, SecEd, February 2018: http://bit.ly/2qY0FFV. To read previous articles in this series, go to http://bit.ly/2JSreYn