Children and Youth Who Demonstrate Aggressive Behavior at Church...What to Do?


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Dr. Grcevich's presentation at Bioethics Conference and Through The Roof Summit, Cedarville University, September 17, 2011

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Children and Youth Who Demonstrate Aggressive Behavior at Church...What to Do?

  1. 1. Children and Youth Who Demonstrate Aggressive Behavior at Church…What to Do? Stephen Grcevich, MD President, Key Ministry Assistant Professor of Psychiatry, Northeast Ohio Medical University Senior Clinical Instructor, Child and Adolescent Psychiatry Case Western Reserve University School of Medicine 2011 Bioethics Conference and Through The Roof Summit Cedarville University September 17, 2011Key Ministry, 8401 Chagrin Road, Suite 14B, Chagrin Falls, OH 44023Phone: (440) 543-3400, E-mail: steve@keyministry.orgWeb: Twitter: @drgrcevich
  2. 2. Download the Power Point from today: cevich-cedarville-through-the-roof-summit- 091711-aggression.pptx
  3. 3. Join us for Inclusion Fusion, the FREE SpecialNeeds Ministry Web Summit-November 3-5, 2011 Keynote Speaker:http: Chuck Swindoll
  4. 4. Learning Objectives: Identify situations where kids may be more susceptible to aggressive behavior during church-based activities Share tools for ministry staff/volunteers to reduce the potential for aggressive behavior in church activities Review strategies for communicating with parents after their child demonstrates aggressive behavior Help parents, ministry staff/volunteers appreciate each other’s perspectives in serving kids with aggressive behavior
  5. 5. Subtypes of aggressive behavior:Reactive aggression: Predatory aggression Affect: fear, anger  Affect: self-confidence Arousal level: high  Arousal level: low Outcome: negative  Outcome: positive for Impulsive self Reactive  Controlled Defensive  Predatory Overt  Offensive Hostile  Covert  InstrumentalVitiello B, Stott DM. J Am Acad Child Adolesc Psychiatry 1997; 36(3) 307-315
  6. 6. Definition of maladaptive aggression: Aggressive behavior that occurs outside an acceptable social contextMaladaptive behavior is characterized by:Intensity, frequency, duration and severity are disproportionate to its causesMay occur in absence of antecedent social cuesBehavior not terminated in expected time frame, or in response to feedbackJensen P et al. J Am Acad Child Adolesc Psychiatry 2007; 46(3): 309-322
  7. 7. Characteristics of children, youth whoexhibit maladaptive aggression: More school adjustment problems than anticipated Higher rates of peer rejection, victimization Difficulty in ambiguous interpersonal situations (reading emotion in facial expressions of others) More likely to read neutral facial expressions negatively Poor peer relationships, deficits in problem solving often emerge by age 4 21% of children with impulsive aggression reported to have been a victim of physical abuse (Dodge, 1991)Dodge KA (1991) In: The Development and Treatment of ChildhoodAggression pp 201-218
  8. 8. Maladaptive aggression is frequentlyassociated with these common conditions: ADHD Bipolar disorder/SMD/DMD Autism spectrum disorders/developmental disorders Post Traumatic Stress Disorder Anxiety disorders/depression Iatrogenic causes Aggression often co-occurs with specific disorders, but may not be ameliorated by medications used to treat those disordersJensen et al. J Am Acad Child Adolesc Psychiatry 2007; 46(3): 309-322
  9. 9. What situations at church may increase a child’srisk for aggressive behavior (ADHD)? Transition times before and after children’s worship Christian education activities when environment is more chaotic, unstructured, supervision less consistent Following high stimulation, high energy activities Evening activities (no orally administered ADHD medication has been shown to consistently produce effects longer than 13 hours)
  10. 10. What situations at church may increase a child’srisk for aggressive behavior (Bipolar)? More reactive to seemingly innocuous stimuli than kids with ADHD Episodic irritability in the context of preexisting ADHD Speech: more, louder, faster More distractible, impulsive, hyperactive
  11. 11. Disruptive Mood Dysregulation Disorder (DMDD)proposed in DSM-V: Characterized by severe recurrent temper outbursts in response to common stressors Temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property Response is grossly out of proportion in intensity or duration to the situation or provocation, child’s developmental level Outbursts occur at least three times/week for at least a year in two or more settings Mood between episodes outbursts is persistently negative (irritable, angry, and/or sad) and negative mood is observable by others (e.g., parents, teachers, peers) Chronologic age no younger than 6 (or developmental equivalent), onset by age 10DSM-V Task Force, American Psychiatric Association, 2011
  12. 12. What will kids with DMDD look like? They have ADHD They have difficulty with transitions that violate their locus of control They tend to “ruminate”…indecisive, think too much about things, perseverate…”meltdowns” occur when they get stuck ADHD medication helps in some environments, may exacerbate meltdowns in other environments They don’t do well with down timeDSM-V Task Force, American Psychiatric Association, 2011
  13. 13. What situations at church may increase a kid’s risk ofaggressive behavior: Autism Spectrum Disorders Initial experiences when family first visits church-environment/routine is unfamiliar Changes in routine/unfamiliar people: “buddy” off on Sunday morning, substitute small group leader Excessive sensory stimulation Group situations may be more challenging for middle school, high school youth
  14. 14. Three basic assumptions aboutstudents in Sunday School/Church: Kids want to be competent, effective learners They feel upset when their behavior gets in the way They fare better when they learn problem- solving strategies
  15. 15. A word from one of our experts:
  16. 16. Keys to Behavior Management Before During After
  17. 17. Before… Pray Create your classroom/respite culture  Encouragement  Expectations Plan proactively  Physical arrangement of the room  Staffing  Content of the lesson  Pace of the lesson  “In the event of an emergency…”
  18. 18. During: First line strategies Proximity Control Distraction Hurdle Help Antiseptic Bounce
  19. 19. During: Next steps “Grandma’s Law” Emotional Labeling Watch YOUR language Managing other students for safety
  20. 20. During: General Rule of Thumb When a child/youth is demonstrating aggressive behavior that is predominantly impulsive in nature, decreasing the sensory stimulation in the environment is generally helpful When a child/youth is demonstrating aggressive behavior that is predominantly perseverative in nature, distracting the child as early as possible before the pattern escalates is generally helpful
  21. 21. After: Non-judgmental conversation Problem-solving Quiet Allow for “busy work” Re-join peers Communicate with parents
  22. 22. Struggles experienced by families ofchildren at risk of aggressive behavior: Demands on parents may limit time, energy for spiritual growth, much less training their children in the faith Finding quality treatment resources for kids with aggressive behavior is extremely challenging Approved treatments for aggressive behavior in kids with ASD, bipolar disorder have very serious potential side effects ADHD treatments are often associated with effects on appetite, sleep, mood that necessitate medication being withheld on weekends
  23. 23. Steps parents can take to enhancecollaboration with church staff, volunteers: Do share information with ministry team about techniques shown to help prevent/reduce aggression at home and school Do administer medication shown to help reduce frequency, severity of aggressive behavior during church activities (with approval of treating physician) Do be aware of the concern that aggressive behavior presents in church settings with largely untrained volunteers Doconsider (for the sake of other youth, volunteers) keeping your child at home when he/she exhibits aggression that you can’t successfully manage at home
  24. 24. What if a child/youth presents too great arisk of severe aggression to attend church? What can the congregation do to support the rest of the family in attending church, participating in activities key to spiritual growth? Relational (home-based) respite Paid in-home child care/buddies with specialized training Scheduling church activities when appropriate care and support for the child/youth is available Church as resource provider to parent…Whose responsibility is the child’s spiritual development?
  25. 25. Conclusions: Kids with reactive aggression can generally be included in existing church programming with appropriate forethought and training Churches may reduce risk of aggressive behavior by designing ministry environments that support kids and youth who struggle to maintain self-control, providing teachers and group leaders adequate training to identify and intervene in potentially risky situations, and by ensuring sufficient staffing at times of enhanced risk Traditional church may not be the “least restrictive environment” for some children/youth especially prone to aggressive behavior
  26. 26. Provides FREE training,consultation, resources andsupport to help churches serve,welcome and include families ofkids with hidden disabilities
  27. 27. Stay in Touch!Church4EveryChild…Steve’s Key Ministry Blog:http://drgrcevich.wordpress.comDiving For Pearls…Katie Wetherbee’s Key Ministry Blog!/drgrcevich!/KeyMinistry
  28. 28. Questions?
  29. 29. Additional Resources:Church4EveryChild…Steve’s Key Ministry Blog:http://drgrcevich.wordpress.comRelational Crisis Prevention and Making Room…Michael Woods