Families who have children with behavioral problems often are faced with major challenges as they attempt to set their kids on a path toward a normal, well-adjusted adulthood. Fortunately, there are many professionals and organizations that specialize in treating conditions such as autism, depression, and addiction.
In this episode of Health Three60, host Renee Shaw takes us to Louisville and Northern Kentucky to learn about programs that assist families with unruly children, and also interviews professional therapists, psychiatrists, and juvenile justice reform advocates who are committed to helping children improve their behavior and achieve emotional well-being.
A child’s behavioral problems may not become evident until they are of toddler age and are starting to talk, but neurological studies indicate that humans start forming emotional responses to the world around them well within their first year of life. Dr. Otto Kaak, associate director of the University of Kentucky’s Center on Trauma and Children, says that studies have shown 40 percent of parents have not developed healthy emotional attachments with their children, a shocking number that portends many behavioral problems for children down the road.
This lack of attachment can make parents feel inadequate and guilty, says Kaak, who previously appeared on the KET Health Three60 special “Safe and Sound.” Often, they have not practiced the basic methods of nurturing, emotionally secure parenting – which is something that they themselves may have never experienced.
“I think a lot of parents, obviously, inadvertently replicate those non-healthy or non-attachment behaviors because they are working from models they’ve experienced themselves as children,” explains Christy Leaver, a licensed clinical social worker with Bluegrass Family Therapy. Leaver adds, “so there’s a cyclical, generational nature to the difficulty.”
“Behavioral dysregulation typically stems from emotional dysregulation,” explains Leaver. “Children get out of control when they don’t feel safe, when their brain stem is basically telling them, ‘Fight or flight.’ It feels oftentimes like a life or death situation for them.”
For both adoptive parents and foster parents, who may not have a long history of emotional attachment with their kids, the challenges can be even greater. Kaak and Leaver advise parents of all backgrounds to look at their own upbringing and critically examine their day to day relationship with their children. If they reach a crisis point with their children – when the child’s behavior is constantly repeated and/or increases in severity – it is time to seek professional help.
One Family’s Journey to Effective Treatment
Foster and Nikki McCarl sought help for their daughter Emma after she began having problems managing her emotions at home and school. The McCarls, who moved to Louisville from South Carolina, reorganized their daily lives to help Emma, who would throw unprovoked tantrums and was eventually sent home from school permanently.
The problem worsened over several years, and Emma was diagnosed with a variety of disorders, none of which seemed fit Emma’s condition or lead to effective treatment.
Finally, Emma was diagnosed accurately with Autism Spectrum Disorder, a developmental disability which affects approximately 1 in 68 children and may cause problems with communication and in forming social bonds.
“So many people talk about getting that diagnosis and their world crashing, and when we got that diagnosis it was like the clouds parted,” Nikki said. “There was finally an answer to what was happening.”
The McCarls enlisted the services of the Bluegrass Center for Autism in Louisville, which provides treatment programs using Applied Behavior Analysis. Applied Behavior Analysis has proven to be an effective and widely used method for treating persons with autism, according to Bluegrass Center program director Lauren Elliott.
“All behavior occurs for a purpose… everybody engages in behavior because it provides them access to some type of reinforcement,” Elliott said. “Our goal is to figure out the function of the behavior, and the type of reinforcement a person gets from engaging in a particular behavior, in order to intervene on that behavior.”
Working together, Emma and Ms. Elliott created a plan that rewarded Emma for positive behavior. Emma identified qualities she wanted to be associated with – to be “kind and popular” – and Elliott granted points to the child after she did exercises that exhibited those qualities. These included communicating with fellow students, keeping her voice at a normal level, and participating in group activities.
This more collaborative, goal-oriented approach greatly reduced Emma’s tantrums and improved her social skills. She was then able to transition into a more mainstream school environment.
Applied Behavior Analysis
As the McCarls said, parents who receive a diagnosis of autism for their child may initially feel hopeless. But advances in treatment have changed the outlook considerably. Three licensed behavioral analysts – Ashley Ratliff with the Highlands Center for Autism in Prestonsburg; Molly Dubuque with Spalding University in Louisville; and Elliott – talk about how Applied Behavior Analysis has improved the lives of many autistic children in the commonwealth.
Dubuque says that Applied Behavior Analysis is focused on “increasing adaptive behaviors, and reducing problematic behaviors.” Most autistic children use their behavior – which can be manifested in emotional withdrawal and lack of verbal interaction – to communicate.
“When a child is engaging in a problematic behavior, it’s really our way of understanding what we need to teach them,” Dubuque explains. “When [autistic children] hit or kick or engage in any of these problematic behaviors, it often results in the consequence they’re seeking.”
“Behavior analysts are always looking to see what’s maintaining [a child’s] behavior, what’s driving this behavior, what purpose does it often serve” Ratliff adds. “Some of the things you often see are [a child seeking] access to tangible items, preferred items. Or access to attention, whether it be positive or negative… or to escape or demand, to get out of doing something. Other than that, you sometimes see behaviors that are maintained by automatic re-enforcement, just [a behavior] that is pleasurable, basically.”
In addition to helping autistic children, all three panelists say that Applied Behavior Analysis is often useful for aiding children who need to improve their academic habits or develop self-reliance. Both programs at the Highlands Center and the Bluegrass Center offer one-on-one intervention that is based on a thorough assessment of each child’s specific behavioral problems.
Dubuque says that the Applied Behavior Analysis discipline works most effectively when all people involved in a child’s upbringing – from parents to teachers and even babysitters – are knowledgeable about ABA methods and committed to staying the course of treatment. A statewide directory for behavior analysts can be found here.
Alternatives to Traditional Juvenile Justice Approaches
Renee visits Campbell County district court Judge Karen Thomas, whose own efforts in providing a holistic framework for dealing with juvenile offenders have served as a model for reforms in Kentucky’s juvenile justice system. Those reforms, passed as Senate Bill 200 in 2014, establish a pre-court process that identifies support services and takes a proactive approach in encouraging families to use them.
Thomas says that through all of her years on the bench, she has seen several recurring traits that cause juveniles to commit crimes. These include mental health issues, domestic violence, and addiction. Many of these conditions are passed through generations in families. Thomas feels that it is her responsibility to, as much as possible, find out the reasons that brought each juvenile before her in court and to address those issues in order to make sure they never return.
“There’s always something more to the story – there’s a reason things are happening,” she says. “There are very few people in this world who are evil. Very few. So, a lot of what I do is, I spend a lot of time when finally I do see kids in criminal court trying to figure out why – ‘Why did you do this?’… And a lot of it is discussing with the family, ‘How did this get so out of control that you didn’t know that this child was stealing from this person, or that this was going on inside of the home?’ Let’s talk about those parenting issues as well.”
Thomas instituted reforms that rely on a multidisciplinary team of professionals to address each juvenile offender’s particular set of circumstances, in order to divert him or her from the criminal justice system. These teams notify parents about support services for issues such as addiction or mental health and, more importantly, regularly encourage and monitor each family’s progress.
“A family in crisis and a family in need, they very rarely can function on their own – that’s why they’re here in the first place,” she says. “So they come to us because they need our help, and they need what we can do for them. We started calling [our program] the ‘warm handoff.’… Literally, instead of saying to the families, ‘Here’s the list of people you can go to,’ [we said] ‘Let’s make a phone call now.’ We literally did help them manage the system.”
Thomas’s reforms are now practiced in every juvenile court system in the commonwealth. This approach may seem like coddling to some, but Judge Thomas also demands responsibility from juvenile offenders to change their behavior. Ultimately, she says that “You’re never going to stop that cycle, unless you treat what causes the underlying issue.”
Louisville’s Darryl Turpin leads The Pinwheel Group, a nonprofit devoted to counseling African-American males involved in the criminal justice system. Along with colleagues, Turpin created a therapeutic model called HEAT, which stands for Habilitation, Empowerment, and Accountability Therapy. The model focuses on helping young African-American males overcome both specific personal issues and long-term, systemic factors such as institutional racism and poverty in order to exit the criminal justice system and lead productive lives.
Turpin’s approach to behavioral therapy is inspired in part by a quote from the late Maya Angelou: “There is no greater agony than bearing an untold story.” Many of the young African-American males Turpin encounters, he says, have accumulated years of oppression due to the systemic factors mentioned above. The Pinwheel Group provides a forum for these young men to share their experiences and help one another in order to start a path to recovery.
“What we use is an Afrocentric approach,” he says. “We use story circles, where each of these men are able to tell their story – and not only tell their story, but the other participants listen and offer feedback that is supportive. I think it is important for the healing of trauma, [for each person] to be able to tell that story.”
This then leads participants toward advocacy, Turpin says. By sharing their stories, the young men in Pinwheel can form alliances and become empowered to tackle the larger problems within their communities in a positive, far-reaching manner. Those problems are centuries in the making, Turpin says, and their effects persist today.
“There have been lots of studies that show now that historical trauma is real,” he says, “and that it has clinical implications on behaviors that we see not only in our criminal justice systems but even in our schools. And our rehabilitative efforts have really fallen short.”
Turpin believes that the overall criminal system in the United States is in dire need of reform, and that it is evident in the disproportionately high number of African-American young men who are incarcerated. To help drive reform, Turpin calls for more emphasis on habilitation, rather than rehabilitation. His work with Pinwheel aims to engage young African-American males at an early age, to “build from the ground up” and mold young men who have a sense of personal responsibility and pride in their community. Culture and spirituality are emphasized in Pinwheel’s HEAT model, Turpin says, because they are enduring foundations of African-American life.
“Culture is so important because it’s rich, it’s a strength, it has substance,” he says. “And it’s a way to embrace something that’s fundamentally true within an individual, [helping] them to heal and be a whole person.”
Health Three60 is a KET production, funded in part by the Foundation for a Healthy Kentucky.