School Based Interventions for Angry, Acting Out Kids

Behavioural Problems and Younger Children, including Temper Tantrums


School has not even started and several parents have come by for advice on dealing with behavioural issues at school. The live in expectation and fear! Most of these kids have Attention Deficit Hyperactivity Disorder, or another executive disorder, sometimes called “EF” problems or “Executive Function” disorders. There are differences between executive function disorders and ADHD, but for the most part the behaviours of either type appear the same in a classroom setting. Sometimes these types of behaviours are called dysfunctions of “self-regulation.” 
So what to do if your child is out of their seat, calling out, talking without permission, fighting, out of line..in the hall...last off the playground and your teacher already needs a vacation in week 2 of school?
Lets start with “Positive Behavioural Supports: Token Systems”
In the classroom and home the most effective intervention for acting out behaviour is a positive behavioural support system - a token system. This provides a mechanism to immediately reinforces appropriate behaviours and increases their frequency. It’s about teaching and reinforcing new skills and not relying on “correcting” misbehaviours that have already happened. For the most part, if a correction was going to work ...it would have worked already!.
Here is a typical plan for using a reinforcement system: Often a timer is set in the classroom and 7-10 times per day the students are reinforced for appropriate behaviours using the token system. Responding to the timer rather than student behaviour increases the positive feedback the student receives and decreases the ineffective “corrective” feedback. The timer is critical! Dr. Barkley’s DVD “ADHD in the Classroom, Strategies for Teachers,” provides an excellent example of using these techniques. Dr. Barkley also has excellent parenting videos such as “Understanding the Defiant Child” which I would recommend to any parent. Token systems have an extensive history and have been proven to be highly effective over and over again. Why don’t teachers use them? Usually because they used them wrong. Watch Dr. Barkley’s video and see them in action. (I also provide training in to schools on the basics of classroom management where I demonstrate the system by using it throughout the workshop...and it’s not disrupting and takes very little time.)
Good behaviours are learned, so teach them!
Modeling, practicing and formally reinforcing appropriate behaviours is another intervention necessary to teach self-regulation skills. Self-talk is a key component to a successful program addressing problems with self-regulation. There are several places schools can get information on teaching self-regulation skills, one is an excellent book by Peg Dawson and Richard Guare, “Executive Skills in Children and Adolescents.”  (The Guilford Press).
A more comprehensive set of materials is “Skillstreaming in Early Childhood,” by Ellen McGinnis and Arnold Goldstein. These materials come from Research Press as part of their “Anger Replacement Training” program, which includes an excellent training DVD. Every middle and senior high school should have staff trained in this method of anger management.
It’s not just good behaviour, but learning problem solving as well!
To decrease the frequency of serious outbursts and tantrums in younger children I recommend Dr. Ross Green’s book “The Explosive Child.” This book teaches a specific interaction style which helps the child stop, think and use collaborative problem solving skills. (These techniques can be highly effective, but are not a primary intervention.) Dr. Green also has a website on his “Collaborative Problem Solving” method which schools and parents could refer to. Lot’s of videos demonstrations are available. Take a look!
Thought Stopping and Cognitive Behaviour Therapy for Children
One simple technique to help children stop the cycle of anger that overwhelms them is teaching them what is called the “Behavioural Call Back.”  Also called the “Behaviour Macarena.”  The class is taught to respond to a teacher’s call, “Stop, Think, Make-a-Choice, Not a Bad Choice, A Good Choice.” This  is done with both the verbal response and hand movements. This complicated hand movement response, practiced many times, and every day, is then used to help a child at the early point of a problem is starting, when it is difficult to stop a cycle of anger. When the teacher observes a problem starting, she signals the child with the hand movements, and in order to signal back the child has to “switch mental sets.” This is a basic “thought stopping” technique used in almost every anger management program. Other thought blocking or stopping techniques can also be taught, and appropriate self-talk helps here as well. These are just a few of the techniques that behavioural therapists use when working with children with anger management problems - or disorders of self-regulation.
Other books I would suggest be read to/with children at home or school include “What to Do When Your Temper Flares,” by Huebner, and “A Volcano in my Tummy,” by Whitehouse.  Teaching a child to understand different emotions and recognizing their varying levels within him or herself is a critical part of any intervention aimed at decreasing outbursts of anger and frustration. Schools often use books such as Kari Buron’s “When My Worries Get Too Big! A Relaxation Book for Children Who Live with Anxiety”  and various forms of Kari’s book “The Incredible 5-Point Scale.”

Any comprehensive intervention for anger issues and problems with self-regulation must provide a student with psychoeducation about emotions, and skills to “self sooth” such as the “Turtle Hug.” Examples of these can be found in the various “Incredible 5-Point Scale” books and classroom materials. Using these with the entire class makes then the norm.
As you can see, there are dozens of well known, scientifically validated interventions for anger, aggression, temper tantrums and emotional meltdowns at school. Classroom teachers are often not aware of these techniques, but  with training and consultation any classroom can become a more pleasant and positive experience for a child with an executive dysfunction....even those with problems of self-regulation and anger management. One thing we know for sure, getting angry back, and using punishment doesn’t work...or there would be no problem. These are skills that need to be taught. And that’s what school is for.
"ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
KEY WORDS: ADHD, ADD, Attention Deficit Hyperactivity Disorder, School, Behaviour, acting out, temper tantrums, classroom management, Vancouver, Seattle, New Westminster, Coquitlam

ADHD and Executive Function

Dr. Russell Barkley is a leading expert in ADHD/ADD and Executive Function Disorders. In this short video Dr. Barkley addresses this critical issue for everyone with ADHD. Executive Dysfunctions have been found to be a critical part of ADHD, and may even be THE critical issue at the heart of ADHD. The "Executive Functions" that we talk about are those that help us maintain goal directed or related behaviour. If you have ADHD, or your child has ADHD, you will know what this means because you know "what's missing." Dr. Barkley, in this short video and in his books and articles, suggests that there are five essential "Executive Functions": 1. The ability to "inhibit your behaviour,":stop what your doing, and stay on task by not reacting to other outside, distracting stimuli; 2. The ability to use non-verbal working memory- visual memory- in order to imagine working your way through a task. This is especially true with math. Often individuals with ADHD score lower on tests of visual memory than what would be expected by their overall intellectual capabilities; 3. The ability to "talk to yourself," to have a voice in our head to instruct ourselves- also called "verbal working memory." Most of us have this inner voice, and we use it to guide our behaviour throughout the day. Those with ADHD do not seem to have this skill (but it can be practiced and learned!); 4. The ability to control our own emotions, and to moderate those emotions so that we want to stay on task, and are able to maintain mental and emotional energy throughout the stages of longer, more complex tasks; 5. The ability to plan and problem solve - to manipulate information to figure out how to get complex things done. This, like many of the other skills listed above, are not simply fixed with medication, but instead need to be worked on individually through education, modelling, practice and reinforcement. These are the "mind tools" Dr. Barkley and others suggest we focus on when addressing ADHD in counselling, therapy and coaching. Most of them are addressed through basic behavioural therapy and interventions, as well as Cognitive Behavioural Therapy. Below is a link to Dr. Barkley's brief, but informative video. In addition to the video there is also a more in-depth written explanation of these "executive skills" and how they effect ADHD. That can be found by clicking here: http://www.russellbarkley.org/content/ADHD_EF_and_SR.pdf For more information on ADHD services I provide in my offices in Burnaby, Vancouver and San Francisco, please check my website at http://www.relatedminds.com or http://www.adhdhelp.ca This page is not meant to offer diagnostic services or suggest specific services to address ADHD. ADHD is a complex disorder, and many symptoms and behaviours taken for ADHD can actually be signs and symptoms of other disorders such as anxiety, depression, Autism spectrum disorder, Asperger's or even depression. See a licensed or registered mental health professional for an appropriate diagnosis.