Case #3: 3-Year-Old About to Be Expelled From Preschool

A family came in regarding their 3-year-old boy who was having difficulty in his preschool. The child was being given frequent time-outs for not listening, and he was listening less and less with this intervention. The preschool suggested he might need to find a different preschool. His parents were very worried about him and did not know what to do next.

Provider Reflective Observations

During the office visit, the boy was observed to be shy, staying close to his parents initially but wanting to engage with the provider. He made frequent eye contact with both his parents, and as he became more comfortable, smiled a lot at the provider. He then got up and went across the exam room to look at books on the other side. He turned around and smiled at both his parents. Then he came over and showed the provider a book that he had found.

Provider Reflections

The provider was feeling unsure during the visit why this little boy would be having difficulty in preschool. The child had good language development and was very cooperative, but parents were very distressed.

Acting Upon Observations and Reflections

The provider decided to go through Handout #18 Reframing Children’s Behaviors with the hopes that looking at this handout together might help the parents shift away from being afraid there was something wrong with their child or their parenting and towards what the meaning of the behavior might be. The provider tried to offer the reframe that the child’s challenging behavior was his “language of distress” which was stemming from his unmet social-emotional needs.

Further Provider Reflections

It seemed like these feelings of having a “bad” kid or their parenting being “bad” were hijacking the parents’ ability to think through what might be happening. Rather than first focusing on the unwanted behavior (not listening), the provider supported the parents to wonder together about what the child’s underlying feeling of distress might be and what his unmet needs might be.

Parent’s Reflections

With just looking at the handout, the parents quickly realized how sensitive their child was to any negative feedback and what a pleaser he was at home. It felt like just seeing the handout with the little cartoons of the acting out behavior normalized for them that all children have “acting out” behaviors at times (with the reframe that this behavior is actually a child’s “language of distress”) which seemed to contain their worries and then they could think more broadly about what might be happening.

They discussed that frequent time-outs would be really upsetting for him. At home, he had the same pattern where if they were angry at all with him, he got more and more upset. He did much better for them when he felt connected to his parents, and they rarely had to redirect his behavior. They realized he’d gotten a new teacher a few months earlier and decided that they would talk to her about how sensitive and shy he was. They hoped the teacher might be willing to try having more connecting times with him rather than time-outs to see if this helped his “not listening” behavior.

Further Provider Observations, Strengths-Based Feedback and Reflections

It felt like the visit switched from the parents wondering what was wrong with their son to feeling proud of him and that they wanted to share their knowledge of him with his teacher. During the 30-minute visit, the provider noticed and pointed out many of the child’s socially engaging behaviors and his connection to them (frequent eye contact, returning from looking at books to sit by them, showing them books he’d found, cooperating beautifully for the exam) to provide contingent, in the moment, real feedback which also was containing and normalizing.

Conclusion

The family returned a few months later when the child had a cold. They hadn’t been able to get the timeouts to stop at school. They realized the class size was too big for this kind of individual modification for him given his sensitive temperament and they had decided to switch to a smaller home-based preschool that one of their friends had recommended.

The PFR skills of making real-time observations in the visit, reflecting together and reviewing the Reframing Challenging Behaviors handout helped contain the parent’s worries and restore their sense of self-efficacy so they could use their knowledge of their son to make things better for him.

This staying in the dance and thinking through things is really the heart of parenting and it is an iterative process ( ie repetitive process which builds on itself) leading to greater parental engagement, self-efficacy and confidence.