Case #5: Little Girl with Hitting & Pinching Behavior in Child Care Setting

This video was made of a little girl in childcare who was having some acting out behaviors that were puzzling to the childcare staff. The childcare worker described her as “sneaky” because everything would seem to be fine yet suddenly she would pinch or hit another child. The video was made to observe the child on a typical day to see what might be beneath this challenging behavior.

While watching the video, consider the unmet social-emotional needs she might have.

Resolution

The child care provider was shown the video and was surprised to see how important she was to the child. She had not realized this child needed her and was seeking connection. During the video, the child demonstrated her desire for connection with the caregiver by closely watching her at the beginning of the video and copying the dance movements. She noticed when the caregiver left for her break and went to the gate to watch for her return. Later, when the caregiver returned, the child sought to be reunited and tried to elicit caregiving with gaze, reach and walking toward the caregiver.

The little girl’s “coming apart” behaviors of pinching and hitting were from her feelings of distress when her caregiving eliciting behaviors failed to gain the comfort and proximity that she needed and not from something intrinsically wrong (“sneaky”) with the child.

The child care provider’s sense of safety and self-efficacy were being threatened by this child’s repeated negative behaviors. When any of us feel threatened, we are not able to “see” the whole picture and can revert to more simplistic, often negative interpretations of another’s behavior. In this case, the childcare worker perceived this child as “sneaky”. Attributing this child’s behavior to a negative character trait, ie “sneaky” reflects their perception that the child’s behavior is from an intrinsic quality of the child and not from something fixable in their environment (as it was in this case). When caregivers have negative attributions about a child, it reflects their state of mind about the child and is a risk factor for harsh discipline or neglect.

When the PFR worker and childcare provider had the space and time to watch and reflect on the videotape together, they were able to come to a much more meaningful understanding of the child’s behavior. The childcare provider’s negative perception of this child softened, and she was able to be more intentional about meeting the child’s attachment-seeking behaviors, which helped reduce the negative, “coming apart” behaviors.

With improvement in the child’s behavior, the childcare provider’s need to have a safe classroom and feel effective were met. Feeling safe and competent further reduced the childcare provider’s negative attributions about the child, which resulted in a positive cycle for both of them, where both their needs were met and there was much more mutuality in the relationship.

Translation to the Clinical Setting

Unmet needs of children (which lead to feelings of distress and challenging behavior) are often the root cause of expulsions from childcare or preschool settings. Similarly, a child care provider’s unmet needs can make it very difficult to meet the needs of the children in their care.
In our practice settings, PFR strategies such as Joining and Reflecting Together help us hear the parent’s narrative about their child and can give us very important information.
When we hear negative attributions about a child from parents in our visits, we need to slow the visit down and fully investigate how the parent is feeling to see if the parent was just making an offhand comment or really sees the child in this way. Sometimes negative attributions made about the child (e.g.: child is described as stubborn, bad, ungrateful, spoiled, cry baby, controlling, etc. or in this case sneaky) are a sign about the caregiver’s state of mind about their child and their level of stress and can be a risk factor for harsh punishment/rejection of the child. The parent may need a lot more support to feel less endangered or threatened so that they can be responsive to their child.

Abstract

Parents’ perceptions of child behavior influence their responses to the child and may be important predictors of physical abuse. We examined whether infants 12 months of age or younger who were described with negative or developmentally unrealistic words were more likely than other infants to have been physically abused.

As part of a prospective observational multicenter study investigating bruising and familial psychosocial characteristics, parents were asked to (1) describe their child’s personality, and (2) list three words to describe their child. Four independent raters coded parent responses using a qualitative content analysis, identifying descriptors of infants and classifying each as positive, neutral, or negative/unrealistic. A medical expert panel, blinded to the psychosocial data, separately categorized each case as abuse or accident. We then analyzed the potential association between negative/unrealistic descriptors and abusive injury.

Of 185 children enrolled, 147 cases (79%) were categorized as accident and 38 (21%) as abuse.

Parents used at least one negative/unrealistic descriptor in 35/185 cases (19%), while the remaining 150 cases (81%) included only positive or neutral descriptors. Of the infants described with negative/unrealistic words, 60% were abused, compared to 11% of those described with positive or neutral words (p < .0001; age group-adjusted OR = 9.95; 95% confidence interval [3.98, 24.90]).

Though limited by sample-size, this pilot study informs future work to create a screening tool utilizing negative/unrealistic descriptors in combination with other predictive factors to identify infants at high risk for physical child abuse.
Copyright 2018 Elsevier Ltd. All rights reserved.

Case #5: Little Girl with Hitting & Pinching Behavior in Child Care Setting

Resolution

Translation to the Clinical Setting

Further Reading about Negative Attributions

Abstract