If a child is persistently misbehaving it is a sign that something is wrong and the best way of helping them is to find out what is causing the problem and do something about it. Sometimes the issues are solely to do with the home environment, the causes are obvious but the solutions are not easy. A neuro-developmental programme may have limited success if that is the case. It is much more frequently the case that issues blamed on the home environment are in fact mainly due to the child’s own processing difficulties and these have not been properly investigated. There is often an assumption made in school that if a child has no obvious learning difficulties they are just being naughty or there are things going on at home which are at fault. This delays or even totally prevents anything effective being done to help the child and behaviours can become ingrained.

Children with ADHD, Autistic Spectrum or Speech and Language Difficulties are particularly likely to have behaviour problems. However, they can be associated with any of the syndromes on the sensory integration continuum, because children will be on a short fuse when they are overloaded and will easily be pushed into reflex behaviour if unreasonable demands are made of them. Sometimes they will be really good all day at school and explode as soon as they come home, where they feel it is safe to let off steam. Sometimes they will only misbehave at school, where they feel particularly threatened, so parents may be surprised by reports they are getting from school. Sometimes they will only misbehave when they are overloaded, so holiday times are a welcome respite from their difficult behaviour. Some children are difficult all the time.

Oppositional Defiant Disorder

This is diagnosed if children are persistently hostile, uncooperative and defiant towards authority figures, such as parents and teachers, and if it is seriously affecting their learning and interaction with their environment. Typical behaviours are anger, resentment, defiance, persistent arguing and seeking revenge. They may have frequent temper tantrums, set out deliberately to annoy people or say particularly hurtful things when upset. They will often blame others for their mistakes and may be easily provoked by the actions or words of other people.

Suggested action

It is very important to get to the bottom of behaviour problems, and they are so often the result of processing difficulties of which teachers and parents are unaware. Any combination of difficulties can put a child at risk. Boys generally vent their frustrations quite early, but girls will sometimes work for a long time to overcome their difficulties and only explode when they are a bit older and their coping strategies are overwhelmed.

Educational psychologists’ reports consider ability in terms of IQ and attainments, but they do not investigate issues of visual and auditory processing and brain integration. Children under stress lose their brain integration and do not perform well in IQ tests. If a child’s verbal and non-verbal IQ and also their attainments are affected by processing difficulties, they can present as an average child with average ability, whereas in fact they are hugely underachieving and very frustrated. The questionnaires on the website may help to uncover some of their issues.

Some children can be difficult at school because they have a huge drive and potential to achieve in a certain area and their needs are not being met. It is very important to feed children’s strengths as well as to support their weaknesses. This is particularly true of some children presenting with dyslexic, dyspraxic or Enigma/T-type characteristics.

Case histories

ANNA

Presenting problems

Anna was a behaviour problem in school and frequently excluded as a result. No learning difficulties were apparent and there was an assumption that her difficulties must have something to do with the fact that she was being brought up by a single parent who was not in full control. However, she had always been very good at home, her siblings were also well-behaved and her mother was mystified.

Anna’s behaviour was very different in school, because she was being put under pressure all the time and asked to do things she could not do. Her reaction was to withdraw, literally, to remove herself from her desk, and if someone tried to stop her she would hit out. She had struck both her teacher and the classroom assistant. She was seen as defiant and unwilling to follow instructions, controlling and aggressive with her peers and would hurt children for apparently no reason. She had no friends and was unable to work cooperatively. She could easily overreact, be destructive and throw temper tantrums. The school were getting regular complaints from parents and their coping strategies were exhausted. Anna was put on a restricted timetable and it was indicated that she would probably have to leave the school.

Assessment

When Anna was brought for assessment it was clear that she had a large number of issues which would make school very challenging. She was hypersensitive to touch in a number of areas, but she also lacked sensitivity in a number of others. This affected her interaction with other children, because she didn’t realise when she was hurting them. She had a number of problems with 'body in space' awareness, including an inability to accept physical and social boundaries which would also affect her relationships, and she could be hard to control. Her difficulties with lateralisation made it hard for her to accept a change in a rule or decision once it had been made, but she also had a striking problem with social comprehension and this was likely to cause her to misread situations.

Anna had major central auditory processing difficulties and was under so much auditory stress that she tested deaf on audiometric testing This would be a reflex shut-down, rather than a physical dysfunction. It was not surprising that her sound discrimination in the classroom was very poor indeed. She had a slow speed of processing on all auditory circuits. She found it very hard to follow instructions, was inattentive and became confused if a number of people talked at once. She found it very hard to listen effectively and express herself adequately. There were no significant visual problems, so she could read and spell well and her maths didn’t appear to be a problem either, but she had very poor comprehension of what she read and no ability whatsoever to make inferences. The biggest problem in school, however, was that, Anna had an active withdrawal reflex

The withdrawal reflex is an early uterine reflex which should be inhibited within three months of conception. If this does not happen for any reason, the individual will find it hard to cope with stress in later life. It can lead to oppositional or controlling behaviour and aggression, resulting from frustration and confusion. A child is likely to be hypersensitive, clingy and crave attention. All of these characteristics were true of Anna, but if she was not put under pressure she was the most delightful child and  there was never so much as a hint of a behaviour problem.

Progress

It was not until Anna was moved to a new school that arrangements were made for her to be properly tested. This time the educational psychologist found major expressive and receptive language difficulties. Her listening comprehension score put her in the bottom 5% of the population and her oral expression was below the first percentile, even after several months of therapy. In her new school her difficulties were immediately recognised as educational rather than behavioural, she was given appropriate support and she was no longer a behaviour problem. Three years after she finished the programme she had continued to be well adjusted in school and she was doing very well academically.

JOHN

Presenting problems

John was a behaviour problem. At home he was angry and aggressive, a constant whiner. He would throw temper tantrums and he could be destructive. He was being accused of bullying other children in the playground at school and would get involved in fights. He had once bitten a teacher who took his toy away from him. In the classroom he would often refuse to do work and if the classroom door was open he would just take off. Things had got so bad that his hours had been reduced, and when he was in school he had his lessons with a support teacher in a separate room. John had always been an anxious child, and this new arrangement heightened his insecurities.

He was a bright boy, but very distractible and inattentive. He would rarely pick up on instructions at first hearing, so if they were not repeated he was unlikely to comply. He also had some difficulty with articulation and his handwriting was a bit messy.  He had some odd repetitive and compulsive behaviours that he would resort to when particularly stressed. It was becoming very difficult now to get John to school. He had a huge fear of being separated from his mother and she was very worried about him. A psychologist had been consulted and he felt that problems had been caused by a painful and extended stay in hospital which had drastically reduced John's ability to make choices.

Assessment

John had significant difficulty with all the tests of central auditory processing so he was bound to have difficulty with paying attention and responding to instructions. His problems with auditory integration were so great that he  was only listening with his left ear, directing all incoming auditory information to the emotional right side of his brain. It was clear from his behaviour that everything was being processed emotionally; logical reasoning just didn’t apply.

John had a particular developmental difficulty with body-in-space awareness. When he was born he wouldn’t stop crying and the midwife had to swaddle him tightly to get him to sleep. Immaturity in this area tends to cause children to be anxious. He also had a mixture of oversensitivity and insensitivity in his sense of touch. This is often associated with hurting other children because the child does not have the same perception of pain and does not realise the effect they are having. His motor skills were poor, which accounted for his messy handwriting. He had a number of visual processing difficulties which would affect literacy skills. His reading and spelling were a few months behind his age, but this had not attracted much attention because it was assumed that slow progress was the result of his behaviour problems. Like Anna (above) he had an active withdrawal reflex which explained why he refused to do work and ran off when he felt he could not cope.

Progress

John was taken out of school for the last few weeks of his infant school. The provision of a fresh environment often makes it much easier to deal with behavioural problems where children and teachers have become very stressed, even in the best of teaching environments. The interplay between child and teacher gets stuck into a certain pattern, which can be very hard to change because the responses are subconscious. When he started at Junior school the support he received was excellent. He was given the opportunity to work outside the classroom when he was stressed, which was a perfect way of dealing with a child suffering from a withdrawal reflex. There was a lunchtime club where the children could play games with one another or do colouring and this made break times much easier. His teacher understood his auditory processing problems and made sure that he always understood what he was supposed to be doing.

As his stress reduced John began to behave much better at home and was no longer aggressive. He was soon taken off the behavioural register at school and displayed none of the problems which originally caused concern. He no longer displayed obsessive/compulsive traits. He started to love playing football instead of hiding behind a tree to avoid it. He was no longer distracted by background noise and had stopped daydreaming. His teachers describe him as ‘just like everyone else in the class’ and they were delighted. He still needed instructions repeated and struggled a little with English. His therapy programme took a year to complete, but he came back a year or two later when he was suffering from some anxiety and this was successfully addressed. He continues to do very well at school and now has no particular problems with English or with following instructions.