Journal of Early Intervention

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Addressing Challenging Behavior: Systematic Problems, Systematic Solutions

Ann P. Kaiser
Journal of Early Intervention 2007; 29; 114
DOI: 10.1177/105381510702900204
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Addressing Challenging Behavior: Systematic

Problems, Systematic Solutions
ANN P. KAISER
Vanderbilt

University

Preschool children with significant, persistent

behavior problems are at risk for social and
academic failure in early childhood and
beyond. While research spanning more than
two decades supports this premise, recommendations for systematic strategies to identify and successfully treat persistent behavior
problems are still needed. An analysis of
current policies related to screening, early
identification, and services to remediate
challenging behaviors in early childhood is
both important and timely. It is important
because early behavior problems occur
across social class and ability levels, affecting
children, their families, their teachers, and
their classmates. Because of the current trend
toward universal early childhood services,
a larger proportion of preschoolers will be
entering instructional settings before age 5.
Early identification and treatment of behavior problems can affect positively these
students learning and social development.
The growing numbers of children served by
Part C early intervention services and the
percentage of these children for whom
behavior is a primary developmental concern
also suggest an increasing need for early
behavioral interventions for younger children
and their families.

Powell, Fixen, Dunlap, Smith, and Fox

(this issue) place early identification, systematic intervention capacity, and adequate systems

of

care

for children with behavior

problems in the context of public policy. I

applaud their efforts in analyzing extant path-

ways for screening, identification, and intervention and for summarizing the mandated
services for and barriers to addressing challenging behavior in young children. This
policy oriented paper brings the work of the
Center for Evidence-Based Practice: Young
Children with Challenging Behavior full circle
by examining the capacity of systems to deliver
early behavior interventions. Based on this
analysis, Powell et al. make four recommendations. Before responding to those recommendations specifically, I will address some issues
that are implicit in their report but not fully
discussed.

Why Is Problem Behavior Low

Early Intervention Hierarchy?

on

the

there has been much recent attention to young childrens behavior problems,
the analysis provided in this paper suggests
behavior is relatively low on the hierarchy of
targets for infant, toddler, and preschool
intervention. Recent legislation includes permissive language, allowing behavior to be
included in the definitions of potential de-

Although

velopmental concerns. Functioning systems

for screening and expert early intervention to
prevent and remediate challenging behavior
are missing. Generally, promoting positive
behavioral development is viewed as less
central to the process of early intervention
than instruction to improve pre-reading and
other pre-academic skills in preschoolers or
than specific interventions for motor, language, and cognitive development in infants

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and toddlers. Even when social-emotional

development is included as a target for early
intervention, systematic treatment of behavior problems is often a secondary issue.
Raising awareness about the incidence, prevalence, severity, and long term effects of
challenging behavior in early childhood is
necessary, but probably not sufficient to
promote the relative status of behavior
problems within the hierarchy of early intervention targets and valued outcomes.
There are two possible reasons why behavior continues to be a low priority target for
early intervention: (a) lack of specific criteria
for identifying challenging behavior, and (b)
the need to address the contributions of adults
and settings to childrens behavior problems.
That is, effective intervention requires adult
behavior change and training adults to effectively address behavior problems is a weak
link in the early intervention chain.
Criteria for challenging behavior. Powell
et al. address the issue of definition of
challenging behavior in two ways. First, they
cite the definition of challenging behavior
developed by the Center for Evidence Based
Practice. Second, they recommend the use of
a common language in identifying young
children with challenging behavior. These are
steps in the right direction, but neither
sufficiently addresses the need for valid and
reliable criteria for identifying children who
need early behavioral intervention.
The definition of challenging behavior developed by the Center is exceedingly broad,

including disruptive vocalizations, noncompliance, and self-injurious behavior. While a definition of challenging behavior based on its
effects has an admirable functional emphasis,
it offers insufficient inclusionary and exclusionary criteria for consistent identification.
Challenging behavior is &dquo;any repeated pattern
of behavior, or perception of behavior, that
interferes with or is at risk of interfering with
optimal learning or engagement in pro-social
interactions with peers and adults&dquo; (Powell et
al., 2006, p. 83). Thus, the behavior problem
might be in the &dquo;eye of the beholder.&dquo; This
approach is similar to existing strategies for
identifying behavior problems, and it has the

same inherent difficulties. Most current behavioral assessment scales depend on informant report in which the target child is
compared to other children of the same age
(e.g., Social Skills Rating Scale, Gresham &
Elliott, 1990; Child Behavior Checklist,
Achenbach, 1991). Informants, however, do
not always agree, especially when they experience children in different contexts. In our
research, the level of agreement between
parents and Head Start teachers on the
presence of a clinical/subclinical level behavior
problem was less than 20% (Cai, Kaiser,
Hancock, & Lipsey, 2006). Parents and
teachers reported different child behavioral
symptoms and classified the severity of those

symptoms differently (clinical/subclinical

vs.

typical). Furthermore, in the same sample,

much more of the variance in teacher reports
was associated with characteristics of the
teachers (years of teaching experience) than
was explained by characteristics of the child
(gender and language ability). Similar results
on low levels of informant agreement have
been reported for preschool children in other
studies (Feil et al., 2005).
Both precise definition of challenging
behavior and the use of a common language
require better taxonomies of behavior created specifically for toddlers and preschoolers.
Such taxonomies should specify which behaviors are indicators of challenging behavior
and the relative severity of those behaviors. It
also should differentially weight (rather than
simply count) the occurrence of challenging
behaviors to index severity, and report the
frequency of these behaviors over the last 3
to 6 months across settings and caregivers. In
addition, key features of the settings in which
the behaviors are considered problematic and
characteristics of the informants should be
reported systemically and used to evaluate
the severity, persistence, and context of the
childs behavior. Specific preventative and
intervention efforts that have been implemented also should be reported, using a response to treatment logic whenever possible.
While universal screening necessitates the use
of brief inventories to identify problem
behaviors, determination of the need for
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intervention services and descriptions of

children in research studies require more
thorough taxonomies of young childrens
behavior in context. Discussion of the issues
in assessment instrumentation is beyond the
scope of this paper; however, it is a central
issue in the discussion of next steps in
developing policies for early identification
and intervention. More reliable taxonomies
of childrens behavior must be designed to
guide the intervention process and reduce the
time from identification to treatment.
Changing adult behavior is central to
treating behavior problems. In all aspects
of identification, prevention, and treatment
of child behavior problems, adult behavior is
a factor. Childrens problem behavior usually
is linked to adults behavior. For example,
adults who lack skills for giving instructions
and following through to support compliance
directly contribute to childrens noncompliance.
Even when adults do not cause
childrens behavior problems, they are a necessary part of the solution. Interventions
almost always require adults to change their
behavior in order to change childrens
behavior. Effective interventions must be
implemented with fidelity by adults with
whom children regularly interact in settings
where they live, learn, and play. While some
early intervention therapies can be delivered
by specialists outside childrens every day
environments, effective interventions for behavior cannot. The implementation of behavioral interventions requires systematic,
long term changes in adult behavior.
There are few trained personnel with skills
to teach adults how to design, monitor, and
implement effective behavior change plans in
natural settings. Training parents to implement systematic behavioral interventions is
an important example of a strategy in which
there is sufficient research for it to be
regarded as an evidence-based practice (see
review by Christenson & Carlson, 2005), but
there are few personnel trained to deliver
parent-implemented behavioral interventions. In all service delivery systems (health,
education, child care, early intervention),
there is an absence of professional expertise

to teach

parents, teachers, and other significaregivers strategies to address childrens

challenging behaviors. Philosophically, pragmatically, and politically, we must come to
terms with the key role of adults in childrens
challenging behavior and the need for expertise in teaching adults skills for supporting
positive behavior in young children.
Recommendations for research and polcant

icy. Powell et al. make four broad recommendations for research and policy: (a)
universal screening should be used to identify
children at risk for behavior problems, (b)
a common language should be used in
identification and reporting, (c) research
must be conducted on systems to promote
the social and emotional well being of
children and families, and (d) effective
policies should be established. Each of these
recommendations has merit.
The validity of results from universal
screening, however, depends on use of valid
instruments that reliably identify significant
behavior problems in young children with
a tolerable rate of false positives. Developing
valid measures to identify early behavior
problems is an important area for systematic
research, although the authors do not suggest
this. Use of a common language also depends
on the development of better assessment
tools and clearer criteria for identifying
challenging behaviors. The widely varied
rates of incidence and prevalence, and the
range of outcomes reported from educational
and social-behavioral interventions, are in part
a result of indefinite and inconsistent criteria
being used to define challenging behavior.
Better empirical knowledge about the nature
and course of early childhood behavior
problems, as well as more accurate identification and evaluation of interventions; depend
on the development and use of consistent
measures, in addition to common language.
The third recommendation for systems
level research merits further discussion.
Powell et al. do not define systems specifically in this paper. Before embarking on
systems research agenda, it might be important to evaluate carefully the findings from
research on mental health systems interven-

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tions for children (Pinkard & Bickman, in

press) and to examine the data from positive
behavior support interventions with younger
school-aged children (OShaughnessy, Lane,
Gresham &
Beebe-Frankenberger, 2003).
Systems of care in childrens mental health
services have proven difficult to administer,
relatively expensive, and no more successful
than less coordinated systems. While positive
behavior support approaches do report
success in reducing childrens problem behavior in elementary schools, the context of
these school-based interventions is quite
different than the home and child care
settings in which children under the age of
3 are served. It would be easy to support the
Powell et al. recommendation if their intended systems research included investigations of parent and teacher training and
research on strategies for training behavioral
specialists to work with adults in natural
settings. Further, it would be ideal if their
definition of system specifically addressed
developmentally appropriate services in environments specific to young children.
The final recommendation for research that
informs policy is extremely broad and, perhaps, not yet well defined. The challenges

posed by definition,

common

language,

and valid measurement of childrens problem

behavior; (b) predictive criteria and assessment strategies that reliably identify children
with the most persistent and problematic

behavior; (c) strategies for preventing problem behavior that

specifically

include train-

ing parents, teachers, child care providers,

and physicians in both identification and
positive support for appropriate behavior;
and (d) development of professional expertise
for dealing with the range of childrens
behavior problems in natural settings and
for training significant adults. The pervasive
stigma for children, families, and teachers
that accompanies referrals for treatment and
cultural differences in the evaluation and
response to behavior problems must be
addressed. Finally, more specific guidance
on linking research on effective interventions
to the development of systems and policies is
needed.
While much research and policy work
remains, the Center for Evidence-Based
Practice: Young Children With Challenging
Behavior has made an admirable contribution to the field of early intervention. The
current paper is one indication of their efforts
and their contributions.

as-

sessment of

context, determination, and provision of adult expertise seem to be implicit in

the assessment of programs that are successful
and less successful in identifying and serving
young children with behavior problems.
Ideally, Powell and colleagues will develop
a prioritized list of policy-relevant research
that includes attention to these key issues.

Conclusions:
Yet Said

Things

Said and Not

There is much to appreciate in the Powell

et al. paper. They provide a useful summary
of current policies and systems that address
childrens behavior. Their brief discussion of
barriers within systems is insightful and
provides a preliminary template for policy
change. Several complex issues must be
addressed to advance the identification and
treatment of young children with challenging
behavior. These issues include (a) reliable

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Correspondence regarding this article should be addressed to Ann Kaiser, Vanderbilt University, Peabody
College, Peabody #328, 230 Appleton Place, Nashville, TN 37203-5721. E-mail: ann. kaiser@vanderbilt.
edu

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