Young children with challenging behavior: issues and considerations for behavior support.

Abstract: The critical importance of intervening early to promote the social and emotional development of young children is a recurring theme in several reports commissioned by national organizations and leaders (i.e., Child Mental Health Foundations and Agencies Network; National Research Council of the Institute of Medicine; U.S. Surgeon General). There is an increasing awareness that social--emotional difficulties and problem behaviors in young children are highly likely to continue in school. In addition, young children who show the most chronicity and stability of problem behavior are more likely to be members of families who experience marital distress, parental depression, and poverty. Young children in urban environments who have problem behavior are likely to also face challenges in health, poverty, and access to quality childcare and other services. In this article, the complexity of the urban context is described with a focus on the lives of young children and their families. The authors present a discussion of appropriate practices and research that provides a foundation for the development of effective early intervention programs for young children affected by environmental and developmental challenges. The emphasis of program recommendations is on comprehensiveness in the design of family-centered behavioral support options.

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There is an increasing awareness among educators, researchers, and policymakers that many young children are beginning their school experiences without the requisite emotional, social, behavioral, and academic skills that will be necessary for success. Recent national organization and commission reports have emphasized the critical importance of early intervention and prevention in the support of young children who have social-emotional difficulties (Child Mental Health Foundations and Agencies Network, 2000; Department of Health and Human Services, 2001; National Advisory Mental Health Council, 2001; Shonkoff & Phillips, 2000). This phenomenon is sharply evident within urban school environments where many of the students are more likely to be poor, have limited English proficiency, move frequently, and live in one-parent home environments (National Center for Education Statistics, 1996), all factors that have been associated with less successful educational outcomes. Research indicates that many children who have difficulty with the successful transition into kindergarten programs continue to show social and emotional problems throughout their school careers and into adulthood (Huffman, Mehlinger, & Kerivan, 2000).

The alarming frequency in which young children who enter school display severe problem behavior has resulted in an interest in providing early intervention to children in the toddler and preschool years (Department of Health and Human Services, 2001; Shonkoff & Phillips, 2000; Simpson, Jivanjee, Koroloff, Doerfler, & Garcia, 2001). A promising approach for delivering early intervention is through the use of positive behavior support. Positive behavior support has been demonstrated to be effective with individuals with disabilities and students at risk for disabilities in a variety of settings with applications of positive behavior support occurring primarily within school or adult service programs where there are professional program staff and mandates for providing behavior support to address challenging behavior (e.g., IDEA 1997).

In this article, we discuss the issues relevant to providing behavior support to young children with challenging behavior. We describe the nature and course of challenging behavior in young children that necessitates a systematic and comprehensive approach to intervention. We also discuss the complexities associated with providing services to young children in urban environments. The article concludes with a description of the elements that must be considered in the design of behavior support models for young children.

Prevalence, Course, and Correlates of Problem Behavior

Challenging behaviors in young children not only occur at significant rates but are also often precursors to long-term, serious difficulties. Although problematic behaviors in toddlers and preschool-age children have often been dismissed as age-appropriate expressions of developmental change or transient responses to adverse environmental conditions (Campbell, 1995), an emerging body of research supports the robustness of early onset externalizing behavior problems.

Findings from prevalence studies vary depending on the sample characteristics and method used. However, a review of studies with community samples of preschool children found rates of oppositional defiant disorder (ODD) between 7% and 25% (Webster-Stratton, 1997). In a study of 3,860 two- to five-year-old children identified through pediatric visits, 16.8% of the children met the criteria for ODD, with half of the cases (8.1%) considered severe (Lavigne et al., 1996). Rates were highest (22.5%) for 3 year olds and lowest (15%) at 5 years. In this study, attention-deficit disorder was identified in 2% of the participants and was almost always co-occurring with ODD.

Problem rates for children living in poverty appear to fall into the high end of the range. Using the Child Behavior Checklist (Achenbach & Edelbrock, 1991), rates of over 25% for parent reported clinical level externalizing problems (Webster-Stratton, 1997) and rates as high as 39% for teacher reported problems in boys (Kaiser & Hancock, 2000) have been found among children in Head Start. A study using classroom observations found higher levels of physical aggression in children in Head Start compared with children in community childcare, although the community participants displayed higher levels of verbal aggression (Kupersmidt, Bryant, & Willoughby, 2000).

Evidence supports the view that early problems often persist and that the roots of later problems are found in the early years. A review of longitudinal studies revealed that approximately 50% of preschool children with externalizing problems continued to show problems during their school years, with disruptive behavior diagnoses showing the highest rates of persistence (Campbell, 1995). There appears to be remarkable stability in the early years, with 88% of boys identified as aggressive at age 2 continuing to show clinical symptomatology at age 5 and 58% remaining in the clinical range at age 6 (Shaw, Gilliom, & Giovannelli, 2000) and into adolescence (Egeland, Kalkoske, Gottesman, & Erickson, 1990; Pierce, Ewing, & Campbell, 1999).

Accumulating support exists for an "early starter" developmental pathway for conduct disorders beginning with aggressive, impulsive, and oppositional behaviors in the preschool years, progressing to conduct disorder symptoms such as fighting, lying, and stealing in middle childhood, and the emerging into serious behaviors in adolescence, including interpersonal violence and property violations (Loeber, 1990; Patterson, DeBaryshe, & Ramsey, 1989; Tremblay, Phil, Vitaro, & Dobkin, 1994). Furthermore, it appears that children who display problems at an early age are most likely to develop serious and intransigent antisocial problems in adolescence and adulthood (Webster-Stratton, 1997).

The risk and protective factors that influence the course of a child's development toward emotional and behavioral well-being or problems are complex, synergistic, and cumulative. The more risk factors a child experiences, the higher the risk for poor outcomes, including emotional and behavior problems (Landy & Tam, 1998; Rutter, 1990; Shaw, Winslow, Owens, & Hood, 1998). Risk and protective factors occur at multiple levels and are generally categorized into child factors, family and parenting factors, school-related factors, and community factors. Children living in persistent poverty, especially those living in poor and violent neighborhoods, have increased susceptibility to emotional and behavioral problems both through direct effects on children and contributions of family stress (Brooks-Gunn, Duncan, Klebanov, & Sealand, 1993; Dodge, Pettit, & Bates, 1994; Klebanov, Brooks-Gunn, & Duncan, 1994; Myers, Taylor, Alvy, Arrington, & Richardson, 1992). Family …