Individualized Intervention with Infants and Toddlers ...csefel.vanderbilt.edu/inftodd/mod3/script.pdfprocess for developing and implementing a support plan to respond to challenging

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The Center on the Social andEmotional Foundations for Early

Infant Toddler Module 3

Individualized Intervention with Infants andToddlers: Determining the Meaning of Behavior

and Developing Appropriate Responses

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This material was developed by the Center on the Social and Emotional Foundations for Early Learning with federal funds from the U.S. Department of Healthand Human Services, Administration for Children and Families (Cooperative Agreement N. PHS 90YD0215). The contents of this publication do not necessarilyreflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizationsimply endorsement by the U.S. Government. You may reproduce this material for training and information purposes. s

Brooke Foulds, Linda Eggbeer, Amy Hunter, and Sandra Petersen.

Child Care Bureau

Office ofHead Start

Administration forChildren & Families

7/08 The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel P 3.1

Learner Objectives Suggested Agenda for a Day Training

• Participants will understandand be able to describe therelationship between behaviorand the communication ofdistress for infants andtoddlers

• Participants will identify thecharacteristics of challengingbehavior for infants andtoddlers

• Participants will describeacting out and socialwithdrawing behaviorsexhibited by infants andtoddlers

• Participants will identify familycircumstances, includingmaternal depression, that canhave an impact on the socialemotional development ofinfants and toddlers

• Participants will identify stepsfor working with parents inaddressing concerns aboutinfant and toddler behavior

• Participants will explore theeffect of infant or toddlerbehavior on the caregiver andidentify ways in which thecaregiver can use herreflections to understand andeffectively address the needsof the child

• Participants will describe andhave an opportunity to use aprocess for developing andimplementing a support planto respond to challengingbehavior

I. Introduction and Logistics 10 min. II. Introduction to Individualized Intervention with

Infants and Toddlers 10 min.III. Ways that Infants and Toddlers Communicate

Unmet Needs and Distress 45 min.IV. Examining Acting Out and Withdrawing Behaviors

More Closely 60 min.V. When Behavior Goes Off Track: Using Our

Understanding to Develop 60 min.Initial Responses

VI. Paying Attention to the Effects of Challenging Behavior on the Caregiver(s) 45 min.

VII. Enlisting the Help of Parents/Families 20 min.VIII. Using a Program Process to Develop a Support Plan 60 min.IX. Case Study Activity 45 min.X. Summary and Closing 20 min.TOTAL TIME 5 hrs., 15 min.

Materials Needed

The Meaning of Behavior and Appropriate ResponsesModule 3

� Agenda� PowerPoint Slides� Facilitator’s Guide� Flip Chart or White Board and Markers� Handouts

3.1 Participant PowerPoint Slides3.2 Acting Out and Withdrawing Behaviors 3.3 Strategies for Responding to Infant and Toddlers’ Challenging

Behavior and Supporting Infant and Toddlers’ Social Emotional Development

3.4 Responding to an Infant’s Distress 3.5 What is My Perspective? 3.6 Infant-Toddler Home Environments or Circumstances3.7 Talking with Families about Problem Behavior: Do’s and Don’ts3.8 Infant-Toddler Observation Documentation 3.9 Infant-Toddler Behavior Review3.10 Infant-Toddler Action Support Plan3.11 Infant Toddler Action Support Plan Review 3.12M Case Study Materials (See copying instructions)

Case Study Maria/Child Observations: (Handouts 3.12M)3.13M Trainer Discussion Points for Case Study Maria

Sample Infant Toddler Behavior Review Sample Infant Toddler Action Support Plan

3.14 Session Evaluation Form� Videos

Video 3.1 Looking at behavior that is concerningVideo 3.2 Caregiver conversationsVideo 3.3 More thoughts from caregiversVideo 3.4 Observing MichaelVideo 3.5 A full response to challenging behavior

I. Introduction and Logistics (10 minutes)

A. Show Slide 1 and introduce Module 3 by name. Thenbegin with a welcome to the group; an introduction of allspeakers; and a brief overview of who you are, where youare from, and any background that is relevant to thistraining event.

B. Have each table of participants introduce themselves toeach other. Ask for a show of hands from the group toindicate what role in the early childhood community eachrepresents (e.g., teachers, assistants, home visitors, earlyinterventionists, family care providers, administrators,trainers). Or use another introductory strategy dependingon the size of the group, whether this is a group new toone another, and the time available.

C. Show Slides 2 and 3: Agenda. Review with participants.Show Slides 4, 5, and 6: Learner Objectives and reviewwith participants.

D. Distribute all handouts including PowerPoint Slides(Handout 3.1) and other resources.

E. Address logistical issues (e.g. breaks, bathrooms, lunchplans).

F. Encourage participants to ask questions throughout or topost them in a specially marked place (parking lot).

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A. Point out that as the participants can see from the Agenda,we are going to talk more about understanding andsupporting the behavior of infants and toddlers. Inaddition, we are going to spend time thinking about how todevelop a systematic approach to address infant andtoddler behavior that has not responded to the promotionand prevention efforts we have already incorporated intocare settings.

1. Show Slide 7: CSEFEL Pyramid Model. Point out thattoday training will focus on the top of the Pyramid.

2. Remind the participants that the top of the Pyramid isreserved for the very few children who continue toexhibit behavior that causes them difficulties even whencaregivers have attended to the issues addressed at thebase of the Pyramid: Staff and parents have positive relationships with children; the care setting has beenarranged carefully to promote appropriate behavior; andthere is an intentional approach to supporting thedevelopment of social and emotional skills. The infantsand toddlers we are focusing on are children whodemonstrate behaviors that do not improve over time,on their own, or with the typical level of care provided.

a) Some infants and toddlers may come to us with thesebehaviors while others may develop them in care.

b) Our goal is to address the distress of these veryyoung children and to intervene before the behaviorbecomes entrenched for the child and seriouslyimpacts the family, the care setting, and the child’srelationships.

c) Explain that an important reason to be able torespond effectively to this group of children is that weknow that many of them are vulnerable and are atrisk of being expelled from child care settings.

d) These are often the children (and families) who couldmost benefit from the support of a high quality careand education program.

e) Persistent challenging behavior (i.e. not the normalchallenges that are frequently related to typicaldevelopment) usually does not just go away on its



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II. Introduction toIndividualizedIntervention with Infantsand Toddlers (10 min.)

own but rather continues over time and createsmore problems for the child in his/her relationshipsand development.

f) Research shows that for older children withbehavior problems, these problems were regularlyidentified in the earlier years.

3. Show Slide 8: Social Emotional Wellness. In Module 1, we described the elements of mental healthor wellness in infants and toddlers as their having theability to: • experience, regulate and express emotions; • form close and secure interpersonal relationships; • and explore the environment and learn.

These are the skills infants and toddlers bring to theirability to cope with distress. One of our tasks ascaregivers is to support the development of thesecoping skills that are the hallmarks of early mentalhealth.

In this module we will learn how to support infantsand toddlers who struggle with these tasks to theextent that their overall development is threatened.We will: 1) explore reasons for these struggles, 2) describe strategies for understanding the child’sexperience, and 3) ways of supporting the child’sskills.

A. A major consequence for infants and toddlers is thatchallenging behaviors may interfere with the intimatepositive relationships which are so important to a veryyoung child’s developing sense of him or herself.

An example could be a baby who is extremely fussyand might receive less positive attention and handlingfrom adults and therefore become delayed in hersocial development, (i.e. responsive smiling, waving,responding to her name).

Another example is a toddler who frequently bites hispeers when stressed and, because the other childrenavoid him, doesn’t have as many opportunities to learnto play cooperatively or develop age appropriatelanguage skills.



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III. Ways of CommunicatingUnmet Needs andDistress (45 min.)

A third example is a baby who is quiet and hard toengage and may be left alone too much by caregiverswho don’t feel connected to the child.

B. It may be useful here to look at the CSEFEL Definitionof Challenging Behavior for Children Birth to Five.Show Slide 9: Each of the bulleted points can apply toinfants and toddlers as well as preschoolers. Ask theparticipants if they can think of other aspects ofchallenging behavior that are not listed or covered in thisdefinition. Elicit from the participants the point thatchallenging behavior is often caregiver specific. In otherwords, what is challenging to one caregiver may not bechallenging to another caregiver. Let the group knowthat specific types of challenging behavior will bediscussed later in the module.

What we want to consider are the consequences of notaddressing the problem(s).

a) When thinking about infants and toddlers, ourconcern centers on the price to the child ofcontinued distress. Ask the participants what maybe the price or consequence of not addressingchallenging behavior early on. Elicit responsessuch as:

the behavior may become habitual, more frequent, and/more difficult to change ;

the behavior may impact the quality of thecaregiving (e.g. a child with challenging behaviormay receive less positive interactions);

peer relationships may be impacted (e.g. otherchildren may avoid playing with a child withchallenging behavior);

other developmental areas may be impacted (e.g. achild may be less able to focus on the otheraspects of learning due to expending energy onemotional stress or challenging behavior);

it is more expensive, more intrusive, and lesseffective to intervene later in a child’s life So our problem solving emphasis is typically on



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relieving the distress the child may be experiencingearly on.

b) In addition, with infants and toddlers we seeextreme behavior as an indication that distress mayhave a negative impact on the intimate relationshipsin his or her life. So our problem solving is alwaysdirected at the infant and toddler and his or herprimary relationships.

C. Show Slide 10: Communication Expresses… One wayto frame our thinking about the behavior of infants andtoddlers is to think about behavior as being a form ofcommunication and always having meaning. Slow Slides11 and 12: Infants Communicate in Many Ways, andreview the list with participants.

1. Show Slide 13: Expression of Emotion. When wethink about the behavior of infants and toddlers, muchof the behavior considered challenging is behavior thatexpresses strong emotion or little emotion at all. Thebehavior we are talking about is behavior that may betypical for a child’s developmental stage (e.g.tantrums) but it is the intensity, the frequency orduration of the behavior that causes it to bechallenging to caregivers and that distinguishes it fromtypical behavior.

2. Now, picture an iceberg in your mind and particularlyfocus on the “tip of the iceberg,” the part above thewater. Draw a picture of a large iceberg (or a triangleshape) with a small part of the iceberg (the tip) abovewater and the majority of the iceberg under the waterline.

a) The challenging behavior is what you see above thewater, i.e. the tip. The tip shows the behaviorsinfants and toddlers use when they are not able to:

• Experience, express, and regulate emotions• Form close and secure interpersonal relationships,

and• Explore the environment and learn.



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b) The rest of the iceberg, which is hidden from sightbelow the surface, represents potential needs thatare not being met—what is going on that causes thebehavior. Like the larger portion of the iceberg that isunder the surface, the meaning of extreme behavioris often difficult to see and to understand. Askparticipants to identify some of the key “essentialneeds” of infants and toddlers and write their ideason the flip chart on the bottom of the iceberg. Thislist may include:

• Feeling safe• Ongoing, responsive relationship with one or

more adults• Emotionally responsive social environments• Environmental match to temperament• Structure and consistency• Good nutrition• Good health • Opportunities for movement• Rest• Belonging within family and culture• Engaging/stimulating environments

c) Use the example of a 6-month-old who cries for longperiods of time unless he is held by his caregiver.Ask participants to use the comparison to theiceberg and ask the following questions:

(i) What behavior, in this situation, would weconsider the tip of the iceberg? Look for thefollowing response: crying.

(ii)Which social emotional skills may the child nothave developed or be able to use in thissituation? Self-regulation (i.e. ability to self soothee.g closing eyes, sucking a finger, taking a deepbreath (for older toddlers)).

(iii) What might be “underneath the surface”? Lookfor the following responses:

• He is scared when he is alone. The child care space is noisy and frightening to him. (Feeling safe)



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• He is lonely. He is held a lot at home because his family believes that an infant should be held close or perhaps he lives in a large extended family where there is always a pair of arms and the floor is not a safe place for a baby. (Ongoing,responsive relationship with one or more adults)

• He is sensitive and is anxious about the roomnoise and the other children. (Environmental match to temperament)

• He doesn’t feel good and may be getting sick. (Health)

d) Make the point that keeping the concept of theiceberg in mind can be helpfulwhen thinking about human behavior.

e) Our efforts to understand the meaning of thebehavior are the first steps to find an appropriateresponse to the child. In other words, ourunderstanding of the meaning of the behavior iscritical in devising a strategy to address thesituation that produces the challenging behavior. Allbehavior has a purpose and for infants and toddlersand young children the challenging behavior is nota manipulation. In other words, a young child is notpurposefully behaving in a way that is meant tocause difficulty.

4) It takes time and effort to understand the intent of achild’s communication and then to find new ways tofulfill the need or teach the child other ways tocommunicate his or her needs.

A. Make the point that infants and toddlers have twoprimary styles of behavior that communicate distress.On a continuum, these behaviors will cluster on the twoextreme ends. Show Slide 14.



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IV. Examining Acting Out and WithdrawingBehaviors More Closely(60 min.)

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B. Show Slide 15: Acting-Out Behaviors. The first groupof behaviors has been termed “Acting-Out Behaviors”.

1. These behaviors have a driven quality that isexpressed either in the intensity, the frequency, or theduration of the behavior.

2. Read through each of the behaviors one at a time.Ask participants if they have seen these behaviors inchildren in their care and take several comments fromthe group. Ask how these behaviors stand out frombehavior that seems more typical. Ask participants ifthere are other acting out behaviors they think of thatare not listed.

C. Show Slide 16: Social Withdrawing Behaviors. Thesecond group of behaviors is termed “WithdrawingBehaviors” or “Social Withdrawing Behaviors.”(“Withdrawing behaviors” are also sometimes referred toas “internalizing behaviors”)

1. These behaviors appear intense because the childuses them so frequently or so consistently. A childexhibiting this type of behavior may appear to havegiven up attempting to get his needs met and to havemoved away from interaction with others.Nevertheless the infant or toddler is expressing hisexperience, and it may appear to be a preference.This type of challenging behavior is often overlooked ina busy childcare setting.

2. Read through the behaviors and ask participants ifthey have seen these behaviors and take severalcomments from the group. Ask participants if there areany withdrawing behaviors not listed.

D. Activity: Provide each table of participants with Handout3.2: Acting-Out and Withdrawing Behaviors. Eachtable will receive either the birth to 9 months chart or the8-18 month chart. Participants will use the scenarios onthe chart to describe what an “acting out” behavior or a“withdrawing” behavior might look like in each of thesedevelopmental elements, within this age group. Remindthe group that we are thinking about behaviors that areintense, frequent, and enduring enough to bechallenging.



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Handout 3.2: Acting Out and Withdrawing BehaviorsModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3.21/4

Young Infants: Birth to 9 months

Difficulty ExperiencingEmotionsMom has left two month old babyJenna in care for the first time. It’sbeen a rough week so far andshe really misses being close tomom all day.

What might be going on for thisbaby?

Difficulty Expressing Emotions

Seven month Isaiah sits with toysin front of him. For a good 15minutes he is really happy andplaying, talking and makingnoises. Isaiah is great at playingby himself for quite some time,but eventually he gets bored anda little bit lonely.


Difficulty Regulating EmotionsFive month old Kayla was born at29 weeks. Right now it is time fora diaper. Her caregiver reportsmost infants are usually calm yetresponsive during this predictableroutine – but it seems to disorientKayla.


Acting Out Behaviors Withdrawing Behaviors

(Handout 3.2)

Ask participants to use the chart Hand-out 3.2 to jotdown some ideas in response to the question, “whatmight be going on for the baby?” Use the “what might begoing on for the baby” section to create moreinformation to the scenario to explain the child’sbehavior. In other words, have participants be creative tocome up with circumstances that may contribute to thechild’s behavior. Hypothesize about what the child maybe experiencing or needing that may contribute to his orher behavior.

Let the group know we will be using the charts and discussing some examples from their responses in a larger group as part of another activity.

The infants in these scenarios range from 2 months ofage to 18 months of age. While it is critical tounderstand that infants under 2 months of age haveacting out and withdrawing behaviors and experienceemotions, we have not included a scenario of a childunder 2 months of age because typical child caresettings do not usually care for children under 6 weeksof age.

For the following activity we chose to include scenariosof infants up to 18 months because we believe the PreKCSEFEL module scenarios are generally applicable forchildren 18 months and older.

The following charts are offered as a guide for thetrainer as possible answers and/or information to elicit indiscussion.

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Acting Out Withdrawing Behaviors

Difficulty ExperiencingEmotionsMom has left two month oldbaby Jenna in care for the firsttime. It’s been a rough week sofar and she really misses beingclose to mom all day.

What might be going on forthis baby?Jenna really misses her mom.She is used to her home whichis quiet with soft lighting and noother baby sounds (like crying).Jenna is far too young tounderstand what is going on –she just knows the feeling ofsecurity when mom is there andshe can’t quite get that safefeeling with these strangers yet.

Difficulty ExpressingEmotionsSeven month old Isaiah sits withtoys in front of him. For a good7-10 minutes he is really happyand playing, talking and makingnoises. Isaiah is great atplaying by himself for quitesome time, but eventually hegets bored and a little bit lonely.

What might be going on forthis baby?Isaiah is great at playing byhimself for quite some time, buteventually he gets bored and alittle bit lonely. He would reallylike his caregiver to come talkand play with him. Right now hedoesn’t know how to show thathe needs adult attention.

Possible responses

When mom leaves or at anymoment during the day, Jennawill burst into tears andscream. She wants to be heldall the time. The caregiverscan tell that Jenna is having anunusually difficult timeadjusting to child care.

When Isaiah becomes boredhe looks around to see who isclose to him, and catches theeye of his caregiver. When heknows she is looking at him hebegins to throw his toys andscreams.

Jenna seems quiet; she staresinto space and sucks on herfingers. She doesn’t seemespecially interested inanything and refuses to makeeye contact with any of thecaregivers. She doesn’t evenreally want to be held. Shedoesn’t seem to be having avery difficult transition intochild care.

Isaiah seems to become quietas he realizes he doesn’t reallywant to be where he isanymore. His muscle tonerelaxes and he seems“droopy.” He sits quietly, nolonger making playful noises.He makes no eye contact andjust seems to be staring offinto space.



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Difficulty Regulating EmotionsFive month old Kayla was bornat 29 weeks. Right now it is timefor a diaper change. Hercaregiver reports most infantsare usually calm yet responsiveduring this predictable routine –but it seems to disorient Kayla.

What might be going on forthis baby?Kayla was born prematurely andseems to have some problemswith certain sensory experienceslike diaper changes, a caregiverstouch, bright lights, surprisingnoises, etc. It is possible thatthings that would not botheranother baby (e.g. diaperchanges, bright lights, etc.) mayphysically hurt her. Or it possiblethat she is overwhelmed bystimulation and has little reactionand/or disengages.

Difficulty Forming Close andSecure RelationshipsNine month old Aliyah came tochild care six months ago andhas very, very slowly come tohave a relationship with onecaregiver. This caregiver is nowabsent and multiple caregiversare subbing in her place

What might be going on forthis baby?Aliyah finds it difficult to bond, orattach to a caregiver. With greatpatience and slow, gentle stepsher caregiver has built up arelationship of trust with her.While this is wonderful, Aliyah hasyet to form a bond with any of theother caregivers in her classroom.

Kayla is on the changing tablescreaming as thoughsomeone has hurt her. Shethrashes around making itdifficult to change her. Whenshe is done, and it is time towash her hands, things onlyget worse. She screams fornearly forty minutes after thediaper change. Everyonedreads Kayla’s diaperchanges.

When Aliyah’s caregiver putsher down Aliyah throws herbody back on the mat whereshe was placed. She howlsand cries forcefully. Whencaregivers attempt to pick herup and soothe her she archesher back and turns her headaway screaming even more.

Kayla often averts her gaze.She seems to feel no pain.She has very little reaction ifany to the diaper change and tothe caregivers attempts toengage her. It seems nothingever bothers her nor doesmuch seem to excite her ormake her smile. She doesn’teven react when otherchildren approach or poke her.*Guidance for trainers,participants may ask aboutautism and/or other significantdevelopmental delays. Askparticipants to hold theirconcerns and thoughts until thenext activity. Let participantsknow that you will discuss howstaff might respond in the nextactivity. In the discussion abouthow staff may respond, you cantalk about how responses orstrategies may or may not bedifferent based on whether achild is developing typically, hasa disability or has a suspecteddisability.

She will not make eye contactwith any of the caregivers andshows very little emotion(neither happy or sad).



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Difficulty Exploring andLearningFour month old Jacksonabsolutely will not tolerate lyingon his stomach during “tummytime”. He does not like to be onhis back much either. He wouldprefer to be held all of the time.

What might be going on forthis baby? Tummy time may beuncomfortable to him until hegains more muscle control. Hemay prefer being held if he isused to be held often.

When Jackson’s caregivers puthim down on his tummy heinstantly falls apart. Hedrops his head, his bodybecomes limp, and hescreams.

If Jackson is not being held, hefalls asleep. He seems unableto play by himself at all. Itseems to be so overstimulating that he just closeshis eyes.

Mobile Infants: 8 – 18 months


Difficulty ExperiencingEmotionsFifteen month old Jasmine seesher teacher set up the watertable, her favorite activity.

What might be going on for thisbaby?Jasmine really seems to lovebeing at school, she loves thetoys and sometimes enjoysplaying with other children.Unfortunately, when she getsexcited she expresses it insocially undesirable ways. Orwhen Jasmine becomes excitedshe doesn’t know what to do toengage in even her favoriteactivities. She may becomeoverwhelmed by her emotionsand be somewhat immobilized.She may need coaching todevelop skills to assist her toexperience emotions differentlyand/or take steps to engage inexperiences.

Jasmine runs to the watertable, bangs on it, runs overto her friend, bangs on him,leaves him screaming, andruns over to the dramatic playarea and throws a plasticchair, narrowly missinganother child. She does all ofthis gleefully with norecognition of the trail of tearsshe leaves behind her.

Jasmine loves the water table;however, she hovers near thetable but does not engage inthe table. She stands off tothe side and watches as otherchildren begin to play at thetable. She spends a great dealof time standing stillwatching others enjoypouring. The teachers onlyknow this is her favorite activitybecause she always chooses it.She reports really liking it butshe rarely smiles and evenwhen she does put her handsin she doesn’t look up muchor engage the other children.

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Difficulty Expressing EmotionsTen month old Josiah’s oldestsister dropped him off thismorning. Usually mom is the onewho brings him. She generallystays to chat with the teachersand read him a book. Today hissister hands him off and leaves ina hurry to get to her job. Hefrequently has a hard time withseparation, so mom and thecaregivers try to schedule themorning routine with predictableactivities every day. While this ishelpful, on the days when theroutine is disrupted Josiah (andeveryone else) suffers.

What might be going on for thisbaby?Josiah has settled in over thepast few weeks with theintroduction of a morning routinehe can anticipate. When thingschange he is upset, confused andfeels disrupted. Perhaps once hebecomes upset it is extremelydifficult for him to soothe himselfand his emotions are intense andsometimes frightening even tohimself. Or when he is upset heshows little reaction and insteadremains quietly sad. He doesn’tknow how to express himself inorder to best get his needs met.

Josiah screams inconsolablyfor nearly an hour. He refusesto be held, crawls to toyshelves to throw things, andcauses an intense morning forthe caregivers and otherbabies.

Josiah watches his sister goand doesn’t react much.Throughout the morning he isunusually quiet. Sometimeshe very quietly whimpers,however, his voice his hardlyaudible. The teacher may noteven be able to notice if she isnot careful.



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Difficulty Regulating EmotionsSixteen month old David cannotseem to adjust to his newclassroom. He has gone frombeing the oldest in a calm, quietclassroom of babies to being theyoungest in a room full oframbunctious toddlers.

What might be going on for thisbaby?David is not just shy or aggressive;he has a very difficult timeregulating his emotions. He wasable to manage as long as he wasin a familiar, quiet environment butthe comparative chaos of a toddlerroom to the infant room has testedhis ability to cope.

Difficulty Forming Close andSecure RelationshipsFifteen month old Arabelle has asignificant reaction to anyone whocomes into her classroom.

What might be going on for thisbaby?Arabelle has spent her life in atransitional housing center forwomen and their children. Thecenter considers child care a choreto be shared by the women likecooking or cleaning, but this hasmeant that when Arabelle goeshome she has a different caregiverevery day. She spends some timewith her mom but mom is veryfocused on improving their lifesituation right now.

Difficulty Exploring and LearningEighteen month old Cameron haslow muscle tone. She cannot sit upwithout support and tires easily

What might be going on for thisbaby?Cameron may have anundiagnosed developmentaldisability. She has difficulty sittingand is immobile.

David is surprisingly strong forhis age and he is showing it.He is biting, hitting andpushing other childrenseemingly without provocation.His face is tight and he has adifficult time engaging in anyactivity for more than a fewseconds.

When a stranger comes intothe classroom Arabelle runsup to them and throwsherself into their arms. She isvery clingy and wants to beheld by any person even ifshe has never met them.

Cameron will play when toysare brought to her. When shebecomes tired or frustrated,she lets her caregivers knowby falling over, and will cryand scream. She cannotchange positions withouthelp.

David has found a place forhimself in his new classroom,unfortunately it is under a tablein the corner of the room. Heis quiet and withdrawn. Ifsomeone comes near him hepulls back and looks away.He seems frightened to bethere and the other childrenignore him so he is notforming friendships.

When a stranger entersArabelle’s classroom Arabellegets back as far from thedoor as she can. If a strangercomes very far into the roomshe hides behind the rockingchair looking scared.

When left on her own,Cameron would spend hoursstaring at the wall, notinteracting with anything oranyone.

Participants will come up with their own examples; thereare many ways to behave that would demonstrate theissues described. Examples of acting out andwithdrawing behaviors are in bold. Consider doing anexample or two with the whole group to demonstrate theactivity.

E. When an infant or toddler displays a pattern ofchallenging behavior of either type – acting out orwithdrawing - the goal for adults must be to understandthe child’s experience, respond to his needs, and helphim use better strategies to meet his needs.

1. Make the point that it is easier (more tempting) toreact to the behavior, particularly to acting-outbehaviors, than to reflect on the meaning of thebehavior. The child’s emotion easily stirs up emotionin us. Of course, a quick reaction is necessary whena child might be about to do harm to himself or others.

2. When we react, we tend to focus on our ownexperience (e.g. frustration, anger) rather than theexperience of the child (e.g. frightened, lonely).

3. Show Slide 17: Focusing on the Child. When wereflect on the meaning of the behavior, we arekeeping our focus on the child’s experience. We aremore likely to be able to respond with empathy for hisneeds and to be more intentional about problemsolving.

a) The goal for intervention must be to restore thechild’s sense of well being and her developmentalmomentum.

b) We want to use the opportunity to respond in a waythat supports the child’s social emotionaldevelopment and relieves him of the need to usehis emotional energy to tell us something is wrong.

When an infant or toddler is constantly feeling stressin his care environment, he uses a tremendousamount of emotional energy to protect himself from



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what might come next (e.g. some activity or eventthat is confusing, frightening, or otherwiseoverwhelming). Instead, that emotional energyshould be spent on developmental growth. It is ourjob as caregivers to see that that happens.

F. Read Slide 18: Responding to Distress. Responses to the challenging behavior should meet the criteria listed:

• Acknowledge distress (e.g. name the feelings; “youseem so sad.” Or “you seem so upset”)

• Offer comfort (e.g. change holding position of aninfant; say, “it will be o.k. We’ll help you feel better.”)

• Use words (e.g. “You look so frustrated right now.You really want that toy.”)

• Be attuned to child’s individualized needs (Explainthat being attuned is the ability to understand thechild’s unique experience. Being attuned to a child isabout being “at one” or in sync with the child. Give anexample of a teacher who knows Elijah is particularlysensitive to other children’s crying. Before Elijah startsto react to the crying of another child the teacherknowingly approaches Elijah to offer her physicalpresence and comfort to the child.)

• Help the child achieve the understood intention (Helpthe child find another way the child can get what he orshe wants e.g. “You want more milk. You can point tothe sippy you don’t need to throw it”.)

• Be developmentally appropriate (Ensure that thestrategies are appropriate for the individual child’sdevelopmental age. Using distraction and physicallymoving a 6 month old would be an appropriateintervention, however, physically moving a 3 year oldmay be a much less appropriate intervention).

1. Activity. Ask participants at their tables to useHandout 3.3 (Strategies for Responding to Infant’sand Toddler’s Challenging Behavior) as a guidelineto devise and select some possible responses toacting-out and withdrawing behavior. Have



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Handout 3.3: Strategies for Challenging BehaviorsModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt edu/csefel

Strategies for Responding to Infant and Toddlers’ Challenging Behaviorand Supporting Infant and Toddlers’ Social Emotional Development

Social Emotional Development Goal

Help Child to: Experience, regulate and express emotions Form close and secure interpersonal relationships Explore the environment and learn

All Strategies for Responding to Infant and Toddler Challenging Behavior Should Meet theFollowing Criteria:

Acknowledge distress Offer comfort Use words Be attuned to (or in sync with) the child’s individualized needs Help the child achieve the understood intention Be developmentally appropriate

Example Strategies:

Systematic strategies • Observe to understand the meaning of the behavior • Track and document frequency, duration, and intensity • Chart time of day behavior occurs • Use self reflection to appropriately respond to behavior • Share reflections/access thoughts and opinions of others • Attempt to understand and empathize with the child’s experience• Monitor progress of social emotional skill development and concerning behavior reduction

Strategies to soothe• Shush (e.g. saying, “shhhhhhhhhh, shhhhhhhh”), white noise (e.g. running a vacuum cleaner, white

noise machine, or hair dryer) • Rock• Hold, carry, use slings or carriers to keep child close to one’s body • Hold baby on side or stomach• Outside time, fresh air• Sing • Encourage sucking (pacifier, fingers) • Swaddle • Encourage transitional objects of comfort (e.g. blankets, dolls, stuffed toy, etc.)• Stay calm• Stay physically close

(Handout 3.3)

participants select examples of acting-out andwithdrawing behavior that were generated from thecharts in the previous activity (Handout 3.2 Acting-Out and Withdrawing Behavior) and use Handout3.4 (Responding to an Infant’s Distress) to begin tocreate and/or describe potential responses to thechallenging behavior. Have each group assign arecorder and a reporter for the group. Afterparticipants have had time to generate a fewexamples of individualized responses, bring the groupback together for a large group discussion. Thereporter from each group can share examples ofpossible responses the group has generated.Alternatively, a couple of participants may want to roleplay some responses to challenging behavior. Forexample, one person may want to role play a cryinginfant while another would role play the strategies shemight use to attempt to respond to the challengingbehavior. Using role play, if participants are willing,may provide new and alternative ways of learning forparticipants.

The following chart is filled out for trainers and offered as aguide for the trainer as possible answers and/or informationto elicit in discussion.There are many effective strategies torespond to challenging behavior. Use the following chart tosupport the large group discussion and/or to help the groupgenerate ideas. Examples of specific strategies are in bold.Consider doing an example or two with the whole group todemonstrate the activity.



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Handout 3.2: Acting Out and Withdrawing BehaviorsModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 31/4


Difficulty ExperiencingEmotionsMom has left two month old babyJenna in care for the first time. It’sbeen a rough week so far andshe really misses being close tomom all day.



Seven month Isaiah sits with toysin front of him. For a good 15minutes he is really happy andplaying, talking and makingnoises. Isaiah is great at playingby himself for quite some time,but eventually he gets bored anda little bit lonely.


Difficulty Regulating EmotionsFive month old Kayla was born at29 weeks. Right now it is time fora diaper. Her caregiver reportsmost infants are usually calm yetresponsive during this predictableroutine – but it seems to disorientKayla.


Acting Out Behaviors Withdrawing Behaviors

(Handout 3.2)

Handout 3.4: Responding to an Infant’s DistressModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt edu/csefel H 3

Responding to an Infant’s Distress

Response demonstrates:• Acknowledgement of distress• Comfort• Words• Attunement (being in sync)• Help in achieving the

understood intention

Response demonstrates:• Acknowledgement of distress• Comfort• Words• Attunement• Help in achieving the


Response demonstrates:• Acknowledgement of distress• Comfort• Words• Attunement• Help in achieving the


Acting Out Behaviors

Describe the behavior chosenfrom the previous chart.

Caregiver Response

Acting Out Behavior

Caregiver Response

Acting Out Behavior

Caregiver Response

Withdrawing Behaviors

Describe the behavior chosenfrom the previous chart.

Caregiver Response

Withdrawing Behavior

Caregiver Response

Withdrawing Behavior

Caregiver Response

(Handout 3.4)



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Responding to Young Infants’: Birth - 9 Months

Acting Out BehaviorResponse Demonstrate Withdrawing Behaviors

Response Demonstrates:

• Acknowledgement of distress• Comfort• Words• Attunement• Help in achieving the


Situation:

Difficulty ExperiencingEmotionsMom has left three month oldbaby Jenna in care for the firsttime. It’s been a rough week sofar and she really misses beingclose to mom all day.

What might be going on for thisbaby?Jenna really misses her mom.She is used to her home which isquiet with soft lighting and noother baby sounds (like crying).Jenna is far too young tounderstand what is going on – shejust knows the feeling of securitywhen mom is there and she can’tquite get that safe feeling withthese strangers yet.

When mom leaves or at anymoment during the day, Jennawill burst into tears and scream.She wants to be held all thetime. The caregivers can tellthat Jenna is having anunusually difficult time adjustingto child care.

Caregiver response:

Jenna’s caregivers keep a veryclose eye on her. They holdher as much as possible andspeak very gently to her.Jenna’s primary caregivertalks to mom to find outexactly what mom does tosoothe Jenna. The caregiverdoes her best to observe momwith Jenna and then matchmom’s tone and style to helpJenna feel comfortable.

Withdrawing BehaviorJenna seems quiet; she staresinto space and sucks on herfingers. She doesn’t seemespecially interested in anythingand refuses to make eye contactwith any of the caregivers. Shedoesn’t even really want to beheld. She doesn’t seem to behaving a very difficult transitioninto child care.

Caregiver response:

Jenna’s caregiver observesclosely and realizes thatalthough Jenna is quiet, shedoes not seem comfortable.Her caregivers take advantageof the moments when Jennalets them hold her, especiallywhen she is eating. Theycarefully make as much eyecontact as she can handleand back off when she looksaway.

The Center on the Social and Emotional Foundations vanderbilt.edu/csefel


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Seven month old Isaiah sits withtoys in front of him. For a good 15minutes he is really happy andplaying, talking and makingnoises. Isaiah is great at playingby himself for quite some time,but eventually he gets bored anda little bit lonely.


Isaiah is great at playing byhimself for quite some time, buteventually he gets bored and alittle bit lonely. He would reallylike his caregiver to come talk andplay with him. Right now hedoesn’t know how to show that heneeds adult attention.

Difficulty Regulating Emotions

Five month old Kayla was born at29 weeks. Right now it is time fora diaper. Her caregiver reportsmost infants are usually calm yetresponsive during this predictableroutine – but it seems to disorientKayla.


Kayla was born prematurely andseems to have some problemswith certain sensory experienceslike diaper changes, a caregiverstouch, bright lights, surprisingnoises, etc. It is possible thatthings that would not botheranother baby (e.g. diaperchanges, bright lights, etc.) mayphysically hurt her. Or it possiblethat she is overwhelmed bystimulation and has little reactionand/or disengages.

When Isaiah becomes bored helooks around to see who is close tohim, and catches the eye of hiscaregiver. When he knows she islooking at him he begins to throw histoys and screams.

Caregiver Response:

Isaiah’s caregiver comes over to himand exaggerates matching his sadfacial expression. She says,“Wow, you look really upset. Can Ihelp you?” She reaches out herarms to pick him up but he throwshimself back, obviously not wantingto be picked up. He lies on the floorcrying and the caregiver lies downnext to him telling him, “I’m righthere if you need me.”

Kayla is on the changing tablescreaming as though someone hashurt her. She thrashes aroundmaking it difficult to change her.When she is done, and it is time towash her hands, things only getworse. She screams for nearly fortyminutes after the diaper change.Everyone dreads Kayla’s diaperchanges.

Caregiver Response:

Kayla’s diaper changes arecarefully planned events in thisclassroom. Everyone helps out –the lights are turned off, no musicis playing, a blanket is placed onthe changing table and wipes arewarmed for her. Before the changeKayla’s caregiver holds her andtells her softly, “I have to changeyour diaper now but I promise totake care of you. I know you don’tlike it, we’ll make it as easy aspossible.” Although Kayla stillbecomes very upset, her caregiverknows that her continued calmtone and actions will eventuallyhelp her calm down.

Isaiah seems to become quiet ashe realizes he doesn’t reallywant to be where he is anymore.His muscle tone relaxes and heseems “droopy.” He sits quietly,no longer making playful noises.

Caregiver Response:

Isaiah’s caregiver is carefullywatching the room and quicklynotices that he seems to havelost interest in what he is doing.She comes over to him andgently tells him, “you played withall of your toys, would you likesome new toys?” He turnsaway from her. She says, “Hereare a few other toys. I’ll be nearyou in case you’d like to playwith me.”

Kayla often averts her gaze.Kayla seems to feel no pain.She has very little reaction if anyto the diaper change and to thecaregivers attempts to engageher. It seems nothing everbothers her nor does muchseem to excite her or make hersmile. She doesn’t even reactwhen other children hit her.

Caregiver Response:

Kayla’s caregivers follow hercues closely to make attemptsto engage her yet back offwhen she averts her eyes. Hercaregivers are exploring withKayla’s parents what seems tomake her happy. They will alsosee what the screening resultssay and consider referring herfor a more completeevaluation. They will alsoinquire about potentialtouching or massagetechniques that might helpstimulate Kayla.



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Difficulty Forming Close andSecure Relationships

Nine month old Aliyah came tochild care six months ago and hasvery, very slowly come to have arelationship with one caregiver.She will not make eye contact withanyone else and she insists onbeing held all of the time.


Aliyah finds it difficult to bond, orattach to a caregiver. With greatpatience and slow, gentle steps hercaregiver has built up arelationship of trust with her. Whilethis is wonderful, Aliyah has yet toform a bond with any of the othercaregivers in her classroom.

Difficulty Exploring andLearning

Four month old Jackson absolutelywill not tolerate lying on hisstomach during “tummy time”(placing a baby on his stomach toprovide the baby opportunity tostrengthen is neck muscles). Hedoes not like to be on his backmuch either. He would prefer to beheld all of the time.

When Aliyah’s caregiver puts herdown Aliyah throws her body backon the mat where she was placed.She howls and cries forcefully.When caregivers attempt to pick herup and soothe her she arches herback and turns her head awayscreaming even more.

Caregiver Response:

Aliyah’s caregiver tried to prepareAliyah for being put down on themat before she put her there. Shesaid, “I know you hate to be downon the floor but I have to dosomething. I am right here; I will bewhere you can see me.” Despiteher efforts, Aliyah reacted with hhowling. Aliyah’s caregiver picksher up to soothe her. “I’m goingto help you calm down and then Iwill let you play,” she says. Thistime when Aliyah is calm thecaregiver sits with her on thefloor until she is engaged in anactivity.

When Jackson’s caregivers put himdown on his tummy he instantly fallsapart. He drops his head, his bodybecomes limp, and he screams.

Caregiver Response:

Jackson’s caregivers know that hehas a very limited tolerance forplaying by himself. He wants to beheld but they cannot hold him all thetime. As a compromise they holdhim in a baby carrier so that theirhands are free for much of the dayand he is still gaining strength bycontrolling his body in the carrier.When they try to help him play onthe floor they make sure thatsomeone is right next to him,talking gently and helping himengage. They try tummy time everyday and are noticing that heseems to be lasting longer andlonger, if only by seconds.

Aliyah’s caregiver is out but theother regular caregiver for theclassroom is there. Every timeshe tries to pick Aliyah up,Aliyah arches her back, tries towiggle out, cries and scratchesat the caregiver.

Caregiver Response:

This caregiver is not Aliyah’sfavorite, but she knows her well.“I know how hard it is for youto let me hold you,” she says,“but I promise to take care ofyou and keep you safe.” Thiscaregiver sings the song thatAliyah’s mother sings her andholds her while bouncing.Eventually, Aliyah calms downand allows the caregiver to holdher, but still refuses to make eyecontact.

If Jackson is not being held, hefalls asleep. He seems unableto play by himself at all. It seemsto be so over stimulating that hejust closes his eyes.

Caregiver Response:

Jackson’s caregivers providehim with opportunities forplay that are minimallystimulating. They sit on thefloor with him in their lapsand provide one toy at a timeto explore. When he closeshis eyes they stop and allowhim time to come back tothem when he is ready.



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Acting Out Behavior Withdrawing Behaviors

Difficulty ExperiencingEmotionsFifteen month old Jasmine seesher teacher set up the watertable, her favorite activity.

What might be going on for thisbaby?Jasmine really seems to lovebeing at school, she loves thetoys and sometimes enjoysplaying with other children.Unfortunately, when she getsexcited she expresses it insocially undesirable ways. Orwhen Jasmine becomes excitedshe doesn’t know what to do toengage in even her favoriteactivities. She may becomeoverwhelmed by her emotionsand be somewhat immobilized.She may need coaching todevelop skills to assist her toexperience emotions differentlyand/or take steps to engage inexperiences.

Jasmine runs to the water table,bangs on it, runs over to herfriend, bangs on him, leaves himscreaming, and runs over to thedramatic play area and throws aplastic chair, narrowly missinganother child. She does all of thisgleefully with no recognition of thetrail of tears she leaves behind her.

Caregiver Response

Jasmine’s caregivers will helpJasmine to identify her feelings.Her caregivers will label theemotions they observe herexperiencing and teach her newways to show her excitemente.g. clap her hands, do anexcitement dance, etc. Hercaregivers will also help Jasmine tolearn to calm her body byteaching deep breathing (e.g. herteacher might show her how toblow out like the wind; orbreathe in and watch her tummygo up and down as she breathesout)

Jasmine loves the water table;however, she hovers near thetable but does not engage inthe table. She stands off tothe side and watches asother children begin to play atthe table. She spends a greatdeal of time standing stillwatching others enjoypouring. The teachers onlyknow this is her favoriteactivity because she alwayschooses it. She reports reallyliking it but she rarely smilesand even when she does puther hands in she doesn’t lookup much or engage theother children.

Caregiver Response

Jasmine’s caregivers willprovide gentleencouragement for Jasmineto engage in the activity.Initially Jasmine’s primaryteacher will spend time nextto her while encouraging herto join in with other children.As Jasmine feels morecomfortable her caregivers willmove further away butremain nearby if support isneeded. Her caregivers willalso use books, stories andsongs to encourageJasmine to learn feelingwords and to eventually usethem to express herfeelings.



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Difficulty ExpressingEmotions

Ten month old Josiah’s oldestsister dropped him off thismorning. Usually mom is theone who brings him. Shegenerally stays to chat with theteachers and read him a bookbut today his sister hands him offand leaves, in a hurry to get toher job. He frequently has ahard time with separation, somom and the caregivers try toschedule the morning routinewith predictable activities everyday. While this helpful, on thedays when the routine isdisrupted Josiah (and everyoneelse) suffers.

What might be going on forthis baby?

Josiah has settled in over thepast few weeks with theintroduction of a morning routinehe can anticipate. When thingschange he is upset, confusedand feels disrupted. Perhapsonce he becomes upset it isextremely difficult for him tosoothe himself and his emotionsare intense and sometimesfrightening even to himself. Orwhen he is upset he shows littlereaction and instead remainsquietly sad. He doesn’t knowhow to express himself in orderto best get his needs met.

Josiah screams inconsolably fornearly an hour. He refuses to beheld, crawls to toy shelves tothrow things, and causes anintense morning for the caregiversand other babies.

Caregiver Responses

Josiah’s caregivers use words todescribe what they think he isfeeling, “Josiah your sisterdropped you off today and that isdifferent. You like it when yourmom drops you off. You are MAD”.His caregivers also let him knowthey are available to him and willkeep him safe. His caregivers willtalk with Josiah’s mother abouthelping his sister understand thevalue of the routine.

Josiah watches his sister goand doesn’t react much.Throughout the morning he isunusually quiet. Sometimeshe very quietly whimpers,however, his voice his hardlyaudible.. The teacher may noteven be able to notice if she isnot careful.

Caregiver Responses

Josiah’s caregivers need topay particular attention toJosiah because he does notshow much emotion. Hiscaregivers will use words tohelp describe what Josiahmay be feeling. Hiscaregivers will talk withJosiah’s mother abouthelping his sister understandthe value of the routine.



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Difficulty Regulating Emotions

Sixteen month old David cannotseem to adjust to his newclassroom. He has gone frombeing the oldest in a calm, quietclassroom of babies to being theyoungest in a room full oframbunctious toddlers.


David is not just shy oraggressive. He has a very difficulttime regulating his emotions. Hewas able to manage as long ashe was in a familiar, quietenvironment but the comparativechaos of a toddler room to theinfant room has tested his abilityto cope.

Difficulty Forming Close andSecure Relationships

Fifteen month old Arabelle has asignificant reaction to anyone whocomes into her classroom.


Arabelle has spent her life in atransitional housing center forwomen and their children. Thecenter considers child care achore to be shared by the womenlike cooking or cleaning, but thishas meant that when Arabellegoes home she has a differentcaregiver every day. She spendssome time with her mom but momis very focused on improving theirlife situation right now.

David is surprisingly strong for hisage and he is showing it. He isbiting, hitting and pushing otherchildren seemingly withoutprovocation. His face is tight andhe has a difficult time engaging inany activity for more than a fewseconds.

Caregiver Response

David’s caregivers will attempt tomodify the environment to offersome less stimulating and quietplaces. His caregivers will provideDavid with extra coaching(including using visual andauditory cues) about the routineand how to engage in play in thenew class. His caregivers will usewords to label his experiencee.g. “ You seem upset, confused,mad, scared, etc.” His caregiverswill set clear limits about positivebehavior e.g. “keep your handsto your body” “teeth are forbiting food”

When a stranger comes into theclassroom Arabelle runs up tothem and throws herself intotheir arms. She is very clingyand wants to be held by anyperson even if she has nevermet them.

Caregiver Response

Arabelle’s caregivers make surethey are helping Arabelle to formclose and secure relationships withher primary caregiver. Arabelle’sprimary caregiver tries to spendextra one on one time withArabelle giving her positiveattention. Staff also support momby giving her resources andtrying to support her to spend asmuch one on one time with herdaughter as possible.

David has found a place for himselfin his new classroom, unfortunatelyit is under a table in the corner ofthe room. He is quiet andwithdrawn. If someone comesnear him he pulls back and looksaway. He seems frightened to bethere and the other childrenignore him so he is not formingfriendships.

Caregiver Response

David’s caregivers observe that heis uncomfortable in the new class.They join him in his space underthe table and gently encouragehim to join them in activities.Slowly the caregivers encourageother children to join in anactivity David enjoys. Hiscaregivers use words to describehis experience and provide asmuch physical closeness aspossible. His caregivers alsorespect David’s need to be alone.

When a stranger enters Arabelle’sclassroom Arabelle gets back asfar from the door as she can. If astranger comes very far into theroom she hides behind therocking chair looking scared.

Caregiver Response

Arabelle’s caregivers make surethey are helping Arabelle to formclose and secure relationships withher primary caregiver. Arabelle’sprimary caregiver tries to spendextra one on one time withArabelle giving her positiveattention. Staff also support momby giving her resources andtrying to support her to spend asmuch one on one time with herdaughter as possible



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Difficulty Exploring andLearning

Eighteen month old Cameronhas low muscle tone. Shecannot sit up without supportand tires easily gets easily tired.

What might be going on forthis baby?

Cameron may have anundiagnosed developmentaldisability. She has difficultysitting and is immobile.

Cameron can play with what hercaregivers provide her for quitesome time, until she gets tired andfrustrated and lets her caregiversknow by falling over and havinga tantrum.

Caregiver Responses

Cameron’s caregivers watch andmonitor Cameron’s attentionspan and try to catch herwaning interest before shetantrums. Her caregivers workwith the Center Director to obtainan OT evaluation for Cameron.Based on the results of theevaluation they will see if thereare additional strategies theycould try to assist Cameron’slearning and exploring.

When left on her own,Cameron would spend hoursstaring at the wall, notinteracting with anything oranyone.

Caregiver Responses

Cameron’s caregivers watchand monitor carefully toobserve the times when sheseems most interested in toysand interaction. They try tospend extra time providingher with stimulation yet theyare also careful not to overstimulate let her get sofrustrated that she “checksout” or disengages.

Possible caregiver responses:A. The immediate job is always how to manage to care for

a child (and other children who are affected) through anepisode of behavior that is causing concern. Our firstefforts focus on the child’s abilities to cope(experiencing, expressing, and regulating emotion;forming close and secure interpersonal relationships;and exploring the environment and learning) and whatwe understand to be her unmet needs.

When the behavior in question is a pattern, we need tofigure out its meaning for the child, what needs thebehavior represents, and what to do about it. We canwork to cushion ourselves and the child from negativefeelings related to the behavior by establishing the habitof wondering about the meaning of behavior. Thisprocess can help us tap our creativity by leading us toconsider multiple explanations for what might behappening for the child as well as lead to multiplestrategies for dealing with the behavior.

1. Show Slide 19: Hypotheses.Our creativity comesinto play when we create a hypothesis, or best guess,about the meaning of the behavior to the child. Wedon’t always have access to the information aboutwhat is happening in a home. However, when wehypothesize about why a child is acting the way he orshe is, we are using what we know about that child tomake a guess about why a child responds or behavesas they do.

2. Activity: Show Slide 20/Video 3.1 and ask for generalcomments. Then ask table partners to use Handout3.5 What is My Perspective? to generate a bestguess about the meaning of Michael’s behavior. Askthe participants to write down as many “I” statementsas they can think of for Michael on their handout. Forexample: “I want to play with her but she wants thesame toy I want. “Ask them to share their statements.

Go on to develop the point that the problem withattempting to develop these hypotheses and “I”statements is that we really don’t have muchinformation about Michael or any understanding aboutwhat transpired before this snapshot in time. But as caregivers, our job is to carefully observe and



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19

V. When Behavior GoesOff Track: Using OurUnderstanding toDevelop InitialResponses (60 min.)

Handout 3.5: What is My PerspectiveModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3.5

What is My Perspective

I am Michael. What is my perspective? I felt:

I am the child playing with Micheal _______________. What is my perspective? I felt…..

I am caregiver_______________________What is my perspective? I felt……

(Handout 3.5)

(video clip 3.1)

gather information about the child and his or her familysituation in order to generate a hypothesis, test it out,and use what we learn to understand the meaning ofthe behavior in question. This process takes time andthought.

Ask participants if they think it might be valuable tosometimes write these “I” statements from theperspective of a child who is troubling them. Doesanyone have examples to share about a child in theircare? These “I” statements are probably betterinformed because you know about the children in yourprogram.

B. Show Slide 21: Reasons for Challenging Behavior.Remind participants that there are a number of reasonswhy children engage in challenging behavior. Some ofthese include an undiagnosed health problem (e.g. atoddler is not hearing well because of repeated earinfections); a developmental surge (e.g. infant isbeginning to learn to walk); or a developmental problem(e.g. a baby is having difficulty not being overwhelmedby a lot of sensory input). Now, though, we will focus onfamily circumstances, including maternal depression,that can negatively impact very young children. As wehave discussed, a major influence on the child is thesocial emotional environment in which he lives and thequality and responsiveness of important relationships.This includes both current and past experiences. Aninfant has had a short life but it may be that somethingin that infant’s recent experience (separation from aparent or unpredictable environment) has affected his orher current behavior.

We look to families to help us understand what theseexperiences have been as we all know that familycircumstances vary widely. Certainly we know thatexperiences such as divorce or violence will affectbabies negatively, but even positive changes such as amove to a nicer home or an extended visit from a well-loved grandmother can be challenging to an infant ortoddler. Too much excitement or too many changes overa period of time can make it difficult for a very youngchild to maintain a sense of equilibrium. This may resultin behavior that is usually uncharacteristic of that child or



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that is a regression to an earlier developmental behaviore.g. waking in the night for a baby who has beensleeping through the night or toileting accidents for achild who has previously been fully trained

1. Activity: Use Handout 3.6 Infant-Toddler HomeEnvironments or Circumstances.

a) Ask each table of the participants to create a list offamily circumstances that could negatively affect thebehavior of an infant or toddler in their care.

b) Then ask them to fill out the handout to list thesecircumstances, hypothesize about the family’sfeelings, and then the infant’s or toddler’s emotionalexperience. Families and children may have similarfeelings and/or behavior to very differentexperiences. Similarly, different families andchildren may have very different feelings andbehaviors for similar life circumstances.

c) Finally, ask them to list things that caregivers coulddo to help relieve the child’s distress. This mightinclude sharing information or resources.

d) Consider using one example to do with the entiregroup to illustrate how to use the chart.

e) Elicit responses such as:



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Handout 3.6: Home Environments or CircumstancesModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3.6

Infant-Toddler Home Environments or Circumstances

Family Circumstances

Parent’s LikelyFeelings

Identified Child’sExperience

Caregiver Actionsthat Could Relieve

Child’s Distress

(Handout 3.6)



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• Poverty/inconsistentincome

• Lack of transportation

• Poor housing/too manypeople/unsafe fromcommunity violence/lossof home /frequent moves

• Immigration fromanother country /speak adifferent language/

• Social isolation/poorsocial support

• Problem with substanceuse

• Domestic violence/abuse

• Parents or parent figuresrecently divorced orseparated/away in theArmed Services or otherjob/incarceration

• Chronic conflict in thehome/extended family

• Sick parent or sibling

• Recent death ofimportant familymember/

• Miscarriage

• Parent with mentalillness/ developmentaldisability

• Move to a new house

• New Sibling

• Visit from relatives

Responses to the child in thesecircumstance should also include:• Acknowledgement of distress• Comfort • Words • Attunement • Help in achieving the


“Momma was upset this morningand you’re feeling badly. You’resafe here and I’ll take care of you”

Take time to meet with and listento parents.

Have partnerships with communityresources that could be helpful tofamilies in finding housing, helpfor domestic violence, mentalhealth services, translators, etc

Have a protocol for how programswill become involved with difficultfamily circumstances; e.g. only thedirector meets with the familyabout the issue.

Caregiver may reassure the familythat even positive changes, whilewelcome, can be stressful forbabies.

“ Wow, you just moved to a newhouse, have a new baby brotherand your Grandma is visiting.There are so many new thingshappening. It’s fun to seeGrandma, but you look so tired.Let’s just rock a little together.” …

Angry/frustratedHelplessnessFearfulConfusedDepressed/Self-absorbedIsolatedWorried/anxiousAbandoned

Insecure/UnsafeUnregulatedUnnoticedUnacknowledgedLack of controlAbandoned/IsolatedHelpless FearfulConfusedWorriedFrightened

Family Circumstances Caregiver Actions that CouldRelieve Child’s Distress

Parents’Feelings/Behaviors

Identified Child’sExperience or

Feelings

TiredDistracted

UnpredictableTiredAnxiousConfused

2. Make the point that when we talk about challengingbehavior in young children, we always need to thinkabout the capacity of the parent(s) or other familymembers. One of the major public health issues knownto disrupt social emotional development is theprevalence of maternal depression. Show Slide 22:Maternal Depression and Slide 23.

a) The Early Head Start Research and EvaluationProject of 2002 found that 48% of mothers selfreported depressive symptoms indicating theywere depressed at the time of their enrollment inthe project. Show Slides 24 and 25: Symptoms ofMaternal Depression and read through thesymptoms.

b) Research shows that mothers who are depressedexperience significant difficulty when they mustprovide the emotional nurturance, protection, andstimulation that babies need.

c) Research also shows that while a depressedmother may provide basic care (e.g. food andshelter), the emotional unavailability of a depressedmother often limits her interactions with the child tonegative ones (e.g., responding exclusively to herchild’s fussing and crying, while neglecting positiveinvitations for interactions like smiling or cooing).

d) Evidence of infants experiencing symptoms ofdepression has been observed in children as youngas four months of age.

e) In general, infants of depressed mothers may bemore irritable, less active, less responsive, and lessphysically developed than infants of non-depressedmothers.

f) Young children of mothers suffering fromdepression often exhibit poor self-control,aggression, poor peer relationships, and difficulty inschool, increasing the likelihood of specialeducation assignments, grade retention, and schooldropout.



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25

22

23

g) Maternal depression is markedly common amongfamilies of low socioeconomic status and financialstress. Many depressed mothers also suffer from co-occurring conditions such as domestic violence andsubstance abuse. These families with multiple risksare reportedly the most socially isolated and hard toreach.

h) Show Slide 26: A Depressed Woman Might Say…Depression is a complex disorder. Caregivers mustbe willing and able to see parental vulnerabilities andact responsibly on their concerns. We need to beopen to recognizing the signs of depression and bewilling to ask how the parents of the children we carefor are feeling. Say that the slide gives examples ofthe feelings a depressed mother might express.

3. Show Slide 27: Caregivers Can Help By… and makethe following points:

a) It is important that caregivers have a clear ideawhere they can get support if they suspect that depression is a concern for a family.

b) While it is not the responsibility of early care andeducation staff to diagnose or treat complex familyproblems, it is important that program staff know howto identify family circumstances that impact a childand his behavior. Child care programs should notassume the role of the mental health clinician. Childcare programs are strongly encouraged to maintainresources and relationships with communitynetworks to provide help for families in need.

c) We can work to understand the child’s and family’sexperience, referring families to treatment resourcesif needed, and assist children in every way we can todevelop socially and emotionally.

d) Make the point that all Head Start and Early HeadStart programs are required to provide resourceinformation and have existing relationships withcommunity agencies that are accessible and provideassistance for families experiencing thesecircumstances.



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27

4. Another potentially important circumstance that canaffect a child’s behavior is when the experiences thechild has at home and in child care are significantlydifferent or inconsistent.

a) A very young child may become confused whenexpectations are different at home than they are ingroup care – whether it’s Early Head Start, achildcare center or a family childcare home (e.g.when at home, a 4-month-old spends most of hertime on her mother’s back in a backpack but at thechildcare program is usually placed on a blanket onthe floor).

b) Differences in expectations and experiences cancause the child to become upset which may resultin behavior that is seen as challenging by thecaregiver or parent(s). The child may be exhibitingthis behavior (e.g. fussing, inability to go to sleep,etc) just in the childcare setting, or just at home, orboth. It is important to remember, however, that it istypical for young children to behave somewhatdifferently at home than at childcare. For example,many young children, especially infants andtoddlers, “hold it together” all day in a childcaresetting only to “melt down” upon reuniting withparents or other loved ones.

Providers of home based programs (or otherprogram activities or options that provide parentsand their young children opportunity to interacttogether) have the opportunity to see interactionsbetween the two that don’t take place aroundseparation and reunion.

c) It is extremely important that staff and parents takeevery opportunity to communicate about the child(for example: to describe his likes, dislikes,strengths, changes in routines, etc.) and how he orshe seems to be getting along in both settings.Particular stressors either at home or a childcareshould be communicated either verbally or with awritten note so that home and childcare can beoptimally supportive to the child. When childcareproviders and parents work together as partners in



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supporting the child’s healthy development, thechild may attain their maximum potential in allareas of their development.

5. Make the point that, in addition to each of the factorswe’ve discussed, there is also the possibility of acombination of more than one risk factor contributingto the challenging behaviors exhibited

a) A family issue can combine with a temperamentissue. For example, a toddler whose homelanguage is Spanish and who is also slow-to-warm-up or shy may have particular challenges inadapting to a childcare setting where the primarylanguage spoken is English. Her difficulty inadapting to new situations makes dealing withunfamiliar caregivers and another language morestressful than it might be for a child with an easy,flexible temperament. This child might have moredifficulty responding to the caregiver’s attempts tocommunicate and find more difficult to interact withother children who don’t share her language.

b) A family issue can combine with a health issue. Forexample, a child who is experiencing multiple earinfections may have greater difficulty in a familywhere his mother has to wake him at 5 a.m. todress, eat and catch a bus to the childcare settingby 6:30 a.m. His poorly regulated sleep patternsand general irritability create difficulties for hisalready stressed young mother who may havelimited family support and be struggling to be astudent and a new mother at the same time. Shemay become irritable and impatient or may bedepressed and unresponsive. This circumstancemay significantly affect the child’s ability to copewell in the childcare center.

c) A community issue can combine with a family andtemperament issue. For example, a mother andbaby living in a crowded housing project whereepisodes of violence occur on a regular basis canexperience such a living situation in different waysdepending on the mother’s level of social supportand the match between the mother’s and baby’stemperament (e.g. easy, feisty, fearful).



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6. Activity: Show Slide 28: Reasons for ChallengingBehavior. We’ve concentrated on strategies torespond to family and community circumstances thatmay have a negative impact on a child’s earlydevelopment. Let’s review a list of issues which maythrow development off-track and share somestrategies you have each found effective before wemove on.

Listen for:

• Child’s lack of skill in communicating andinteracting with others — supporting experience,tuning into facial expression, regulation ofemotion; developing secure relationships;exploring and learning; acknowledgement of achild’s distress; offer comfort; use words todescribe feelings

• Developmental surge — supporting child’sattempts; providing anticipatory guidance to childand parent

• Medical/health — daily health checks; discussionwith family

• Temperament — looking at the match betweenthe adult and child; adjusting environment andinteraction to support ability or temperament

• Social emotional issues (including maternaldepression) with parent(s) — develop/maintainstrong relationship with parent; refer toappropriate resources

• Discontinuity between childcare program andhome — open discussion with families, respectfor child’s expectations; incorporate experiencesfrom home into childcare setting

• A combination of more than one above



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A. Point out to participants that it’s important that they tunein and pay attention to how they feel when a child orchildren are exhibiting behavior that they findchallenging. Remind them that behavior that maychallenge one caregiver may not necessarily challengeanother. For example, a toddler with a loud voice andexuberant disposition may be difficult for one caregiver,but not another, to be around for long periods of time.That’s not what we are talking about here. Rather, weare focusing on behavior that seems to be having anegative impact on the child’s development and that allcaregivers can agree needs to be addressed.

B. It is worthwhile to keep in mind that an important clue towhat the child is experiencing is our own emotionalreactions to the child. For example, if we are frustrated itis highly likely that the child is also frustrated. Often ouremotions can help us tune in and empathize with thechild’s experience.

C. It is a challenge for the child’s caregiver, yet important toempathize and understand the child’s perspective whenhe or she is communicating negatively when wishes arethwarted or sadness that occurs when a parent leaves.Sharing these experiences with an infant or toddler canalso evoke sympathetic feelings of frustration, sadness,helplessness, or anger in the provider. Sometimeslistening to our reactions is a good way to collectinformation.

Activity. Ask participants to watch a video of caregiverstalking about what they experience when they encountera child with challenging behavior. Show Slide 29/Video3.2. Ask them to divide into groups of 4 and give themabout 10 minutes to discuss the caregivers’ conversationamong themselves and identify a list of the reactions orfeelings the caregivers expressed. Pull the group backtogether and ask for a spokesperson from each group toidentify what they heard (and saw). Use the Flip Chart torecord the comments.

1. Ask the group if they think that these caregivers are intouch with the perspective of the children about whomthey are speaking. Make the point that responding toa child communicating emotional distress is difficultand that it is important to reflect on our own emotions



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(video clip 3.2)

VI. Paying Attention tothe Effects ofChallengingBehavior on theCaregiver(s) (45 min.)

29

so that we can use them to understand the child’sexperience and create space to tune into theemotions of the child. One of our most importantstrategies is acknowledging the child’s emotions, toyourself and to the child.

2. Make the point that the caregivers in the video weresimply responding to a question from the interviewerthat was focused on their emotional reactions andthey were generous to answer so honestly. Thisvideo was used to demonstrate the fact that to workwith very young children is to work in the world of raw,undiluted emotions of children and frequent stress(Johnson & Brinamen, 2006).

3. Continue and say that while we have talked aboutcaregivers’ feelings before, we have not reallystressed the need to be self aware as an interventionin itself. Becoming self aware means askingourselves:

a) What is this child’s behavior bringing up for me asher caregiver? What might these feelings tell meabout what this child is feeling?

b) What emotions come up for me when this behavioroccurs (e.g. a baby cries incessantly? What mightthese feelings tell me about what this child isfeeling?

c) Am I feeling the way I am (e.g. when Terra bitesOmena and I can’t stop her) because of issues ofmy own that are cropping up or am I just concernedabout Omena?

d) Do I respond differently from day to day to thesame behavior?

e) Is there something about my culture or familybackground that makes me more or less tolerant ofcertain kinds of behaviors?

f) Am I temperamentally similar or very different fromthe child I’m worried about?



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4. Let’s look at more of the video with caregivers (showSlide 30/Video 3.3).

D. Show Slide 31 (Reflection: Self Awareness). Reviewthe elements of self reflection as they relate tochallenging behavior. Activity: Ask participants to workin pairs and role play a caregiver and colleague. Theone playing the role of caregiver talks about heremotional response to behavior a particular child isexhibiting that is causing her concern. Her colleaguehelps her “wonder” about why this particular child orbehavior is so distressing (e.g. “What do you think it isabout Terra’s biting that makes you so upset?” or “Whatcomes up for you when Terra bites?”). Allow about 5minutes for this conversation. Then ask participants toswitch roles and go through the role play again, this timediscussing another behavior/child.

Pull the group back together and ask for volunteers totalk about how it felt to engage in such a conversationand how it might help in responding to the behavior inquestion.Listen for:

• Being aware of my own reactions or how my ownpast experience comes up when I see this behaviorhelps me to put the behavior in perspective

• Self reflection helps me remember that the child’sexperience is different and separate from my own

• Being aware of my own “hot buttons” helps me tonot overreact

• Being aware of my own issues helps me respondmore thoughtfully versus just reacting withoutthinking

• Being aware of my own issues helps me choose aresponse to the behavior that might be different fromwhat I experienced growing up

• Being able to look at behavior from the child’sperspective does not come naturally to everyone nor can we always find the emotional calm



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31

(video clip 3.3)

and energy to try. When we are in a program servingyoung children, we are faced with the needs ofmultiple children at the same time. This makes itdifficult to find the time to reflect on how we ascaregivers are experiencing the behavior. It mayrequire extra effort to set the time aside for selfreflection or for reflecting with colleagues orsupervisors.

A. Make the point that parents are essential to the processof understanding a child’s experience and thinkingthrough how to respond to behavior that is troubling inthe childcare setting. This is why it is so important tonurture the relationship with parents from the first daysthe child is in care. A trusting, respectful series ofinteractions over time will allow the childcare provider tobring up concerns she has about a child and engage thefull participation of the parent(s) in responding to thedifficulties the child is having. If the provider/parentrelationship is not seen as an important aspect of careand the parent is actively engaged only when there is aproblem, there will be less of a foundation to build on tohelp the child.

B. Activity: Ask participants to think for a moment about aninstance in which they had a strong relationship with aparent and found it relatively easy to bring up an issue ofconcern with a child. Ask several participants to sharetheir experience. Now ask them to think of an instance inwhich they had a concern about a child but didn’t feel ascomfortable in bringing it up with parents. Why not? Askfor several participants to share their thoughts.

a) Point out that when there is a child with challengingbehavior in a group setting, parents need to bebrought into the process as quickly as possible.They may be asked to observe behavior with a staffperson via video, through an observation window orthey may share their thoughts through a parentinterview.

b) Remind participants that parents may be verysensitive to hearing that their child’s behavior isconsidered challenging by staff.



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VII. Enlisting the Help ofParents/Familieswhen Behavior is aConcern(20 min.)

c) On the other hand, parents may be the first toidentify a pattern of behavior that is challenging, atleast for them, and to seek help from staff. Thisprobably indicates the existence of a trustingrelationship between the two.

d) Refer the group to Handout 3.7 (Talking withFamilies about Problem Behavior: Do’s andDon’ts) and take a few minutes to discuss it.

e) Point out that we will be talking more about howparents should be involved when we discuss aprogram protocol for responding to challengingbehavior.

A. Show Slide 32: Primary Characteristics of a ProgramProcess. The primary characteristic of a programprocess for understanding and responding tochallenging behavior is that it is a reflective, rather thanreactive, process.

1. The focus is on assisting the child in getting his needsmet rather than eliminating the challenging behavior.

2. The goal is to assist the child with developmentallyappropriate self-regulation so thatthe developmental momentum is not slowed down ordisrupted.

B. Show Slide 33: Program Protocol. Make the point thata program needs have a program protocol in place toaddress challenging behavior.

1. The protocol should outline clear steps to be followedin developing a plan to address the behavior. Thiscommunicates the importance of working quickly torespond to the needs of the child.

a) It indicates that the program is concerned aboutchildren and their well being.

b) It helps everyone know what to expect, what theircontribution to the process will be, the sequence ofthe steps in the process, and how decisions will bemade.



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VIII. Using a ProgramProcess forResponding toConfusing orChallenging Behavior(60 min.)

Do

1. Begin the discussion by expressing concern

about the child.

2. Let the parent know that your goal is to help

the child.

3. Ask the parent if he or she has experienced

similar situations and are concerned.

4. Tell the parent that you want to work with the

family to help the child develop appropriate

behavior and social skills.

5. Tell the parent about what is happening in the

classroom but only after the parent

understands that you are concerned about the

child, not blaming the family.

6. Offer to work with the parent in the

development of a behavior support plan that

can be used at home and in the classroom.

7. Emphasize that your focus will be to help the

child develop the skills needed to be

successful in the classroom. The child needs

instruction and support.

8. Stress that if you can work together, you are

more likely to be successful in helping the

child learn new skills.

Handout 3.7: Do’s and Don’tsModule 3

Don’t

1. Begin the discussion by indicating that the

child’s behavior is not tolerable.

2. Indicate that the child must be punished or

“dealt with” by the parent.

3. Ask the parent if something has happened

at home to cause the behavior.

4. Indicate that the parent should take action

to resolve the problem at home.

5. Initiate the conversation by listing the

child’s challenging behavior. Discussions

about challenging behavior should be

framed as “the child is having a difficult

time” rather than losing control.

6. Leave it up to the parent to manage

problems at home; develop a plan without

inviting family participation.

7. Let the parent believe that the child needs

more discipline.

8. Minimize the importance of helping the

family understand and implement positive

behavior support.

Talking with Families about Problem Behavior:Do’s and Don’ts

(Handout 3.7)

32

33

c) A protocol establishes the fact that all personsinvolved in the child’s life are included in theinformation gathering and are part of the decision-making process.

d) It documents that there is consent from the familyas well as from the staff who will be implementingthe intervention plan to be developed.

e) The protocol should establish a timeline forimplementing the process and the person or persons responsible for each step.

f) The protocol should establish a process forregularly reviewing progress, making changes inthe intervention plan, if necessary, and decidingwhen and how a determination will be made todiscontinue or modify the intervention depending onthe response of the child to the intervention.

g) The information that is gathered and the decision-making process itself should be consideredconfidential. It will only be shared with the familyand staff directly involved.

2. Show Slides 34 and 35: Sample Protocol. Suggestto participants that we look together at a sampleprotocol for addressing challenging behavior in infantsand toddlers. Tell participants that we are going towork with a case study to practice using the elementsof a protocol. They have a copy of the forms in theirHandouts that they will be using for the case study.

C. Show Slides 36 and 37: Questions to Ask About theMeaning of the Behavior and say that we are nowgoing to spend some time on the very important processof carefully gathering data to aid in understanding andaddressing the behavior of a particular child. It needs tobe a systematic and organized process.

1. Early care and education programs, including thosethat are home-based, should have a process in placeto gather ongoing observation and documentation ofprogress for each child in care on a regular basis.This may consist of short anecdotal notes, results of



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36

35

34

screening measures, information from parents, videoof the child with adults and peers at different times ofday, etc.

2. These observations should be used regularly by staffin group by home visitors in consultation with theirsupervisor as a part of the staff member’s ongoingprofessional development/supervision. This regularlyscheduled time for reflection on the meaning ofchildren’s behavior can be used to initiate an inquiryinto the behavior of a specific child who is exhibiting extreme or confusing behavior.

3. In the case of a child with challenging behavior,additional observations are required to collect detailed information.

4. Observations should be initiated quickly so that thechild doesn’t have to wait for help.

5. Observations should be conducted by more than oneperson and may include any person who interactswith the child. It may be helpful to have observationsdone by someone who does not typically interact withthe child but has strong observation skills. It may alsobe useful for the care provider to do the observationside-by-side with a director, a more experiencedcaregiver, or a consultant from mental health or theresource and referral agency.

6. Observations should be done at various times of thechild’s day on multiple days. They should focus onhow the child functions in a variety of activities duringthe day with a variety of other people.

7. All documentation should be recorded in a similar wayso that the information from multiple sources can beeasily compared and analyzed.

8. Activity: Review Handouts 3. 8 (Infant ToddlerObservation Documentation), 3.9 (Infant ToddlerBehavior Review), 3.10 (Infant Toddler ActionSupport Plan) and 3.11 (Infant Toddler ActionSupport Review).



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Handout 3.8: Observation DocumentationModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H

Infant-Toddler Observation Documentation

Date of Observation _______________ Day _________ Time _________ Child’s Initials _________________

Child’s Name ______________________________________ Child’s DOB _____________ Age __________

Observer’s Name _____________________________ Observer’s Role ______________________________

Location of Observation _____________________________________________________________________

Adult or other children in the observation by order of appearance (note initials):

1 ____________________ 2 ____________________ 3 __________________ 4 ____________________

Describe the behavior you observe? (e.g. child turns away from caregiver)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

(Handout 3.8)

Handout 3.9: Behavior ReviewModule 3


Infant-Toddler Behavior Review

Child’s Name: _____________________________________ Date of Birth __________ Age ____________

Review Contributors Date of Review _______________________

1._____________________________

2._____________________________

3._____________________________

4._____________________________

Information Gathering

1. What is the behavior of concern?

2. What happens? What are the frequency, intensity and duration of the behavior?

3. When does it happen? Consider writing out daily schedule.

4. Where does it happen?

5. With whom does it happen?

6. How long has the concerning behavior been going on?

7. How does the caregiver feel about the behavior?

8. Has the child had a recent physical? Are there any physical/medical concerns?

9. What happens (right before) before the behavior occurs? What are the triggers?

(Handout 3.9)

Handout 3.10: Infant-Toddler Action Support PlanModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3.31/2

Infant-Toddler Action Support Plan

Child’s Name: _____________________________________ Date Plan Developed ____________

Team Members:

1 ._____________________________

2. _____________________________

3. _____________________________

4. _____________________________

Parent’s Name______________________________ Signature _____________________________

Behavior Hypothesis (the meaning of the behavior):

Prevention Strategies:

Skill to Develop Strategy to Support Development Person Responsible When

(Handout 3.10)

Handout 3.11: Action Support Plan ReviewModule 3


Infant-Toddle Action Support Plan Review

Child’s Name: _____________________________________ Date Plan Developed ____________

Team Members:

1. _____________________________

2. _____________________________

3. _____________________________

4. _____________________________

Parent’s Name______________________________ Signature _____________________________

Date of review___________

Evaluation of Progress:

Modifications to Plan:

On a scale of 1 to 10, how would you rate the child’s behavior?

1 2 3 4 5 6 7 8 9 10

Parent Signature __________________________________________

(Handout 3.11)

a) Review the four Handouts. Handout 3.8 InfantToddler Observation Documentation records theactivities exactly as observed. Handout 3.9 InfantToddler Behavior Review is used to gatherinformation, hypothesize about the behavior, andbegin to plan and develop strategies. Handout3.10 Infant Toddler Action Support Plan is aplanning form to document the plan of actionincluding strategies for prevention and strategiesfor intervention. Handout 3.11 Infant ToddlerAction Support Review is used to evaluate theprogress of the action support plan and makemodifications to the plan.

b) Have participants watch Slide 38/Video 3.4Michael once and create initials for the individualsin the scenario.

c) Show the video a second time and haveparticipants record what happened on Handout 3.8 Infant-Toddler ObservationDocumentation

d) Give the group 2 or 3 minutes to discuss theobservation and comment on the observationdocumentation form.

e) Review Handout 3.9 Infant Toddler BehaviorReview. Discuss with the group how this formmight be helpful in this observation. Look atHandouts 3.10 Infant Toddler Action SupportPlan and 3.11 Infant Toddler Action SupportReview and discuss how useful they might be.Comment that they may want to create their ownforms. Note that forms of this type can be used inthe classroom or home.

f) Ask participants how many of them use videoobservations in their work. Ask if they have foundthem helpful in understanding behavior and inadvancing the skills of staff in working with infantsand toddlers. Take several responses from the group.



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(video clip 3.4)

g) Note that many home visitation programs use videoobservation not only for staff to better understandthe work but for parents to understand more abouttheir own interactions with their children.

D. Now let’s talk about another very important step in theprocess – building a team. A collaborative team needs tobe assembled. Begin with the staff who directly work withthe child and his/her director or supervisor who is in aposition to approve additional staff time and/or resources.Other staff such as aides or bus drivers may be broughtin to contribute their perspectives. Staff with the mostestablished, trusting relationship with the family shouldbe included on the team.

Staff should meet with the family, at the center or athome, to share concerns and learn what family memberscan contribute to an understanding of the behavior. Oneor more family member should be invited to become afull participant on the team that will address the behavior.

Show and discuss Slides 39, 40, and 41: ParentInterview Questions which list some importantquestions to discuss with family members during one ormore conversations. There will need to be some thoughtgiven to which staff member has the most comfortablerelationship with the family in order to decide who shouldspeak with them. Staff should be sensitive to andrespectful of cultural issues and to the impact of cultureon parenting behavior, perceptions about behaviorproblems, and perceptions about the helping professions.Ask participants if they have questions to add to this listand record them on the Flip Chart. Answers that familymembers provide should be carefully documented, withtheir permission, and added to the information the teamreviews and considers.

For a center-based program, the team should include, ata minimum, the caregiver(s) and the director who is in aposition to approve additional staff time and resources. Ifa program has a mental health consultant, s/he shouldalso attend. A family child care provider may requestsupport from the local resource and referral center or aninfant-toddler specialist to meet with the family. A home-based program may include the home visitor, asupervisor, and the family as the core team.



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39

40

41

1. Activity: Look at Slide 42: Potential Team Membersand ask participants to identify what each teammember might bring to the process. Recordresponses on the Flip Chart. The team should includeall relevant people, including the bus driver, forexample, who is likely to be able to shed light on thechild’s behavior during the trip to and from the center.

2. Make the point that it is very important to determine aconvenient time for all parties to come together toreview the information that has been gathered and todevelop a plan that everyone can agree to.

3. In some programs, a mental health consultant will bepart of the team from the beginning. In others, amental health consultant may be brought in if there isnot timely improvement in the child’s behavior or it isclear that the family needs a more intense focus thanthe program can provide.

a) Exactly when a mental health consultant is broughtinto the process will vary from program to program.However, all programs should have access to amental health professional. Public mental healthclinics and resource and referral agencies may beable to provide that support to home providers.Mental health providers provide a third partyperspective and have the primary focus ofunderstanding the child’s perspective.

b) EHS/HS are required to have a licensed mentalhealth professional fully integrated into theoperation of the program and quality childcareprograms should have a relationship with acommunity agency or individual that they can refer to. Show Slide 43: Additional ProtocolComponents.

c) Show Slide 44/Video 3.5. Discuss as a wholegroup the following questions and add comments ifthey not brought up:



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42

44

43

(video clip 3.5)

• Why do you think the parent was willing to acceptthe help of a mental health consultant? - Staff had already discussed the biting with her

- Parent has trusting relationship with staff

- Parent is experiencing the problem at home

• What did the mental health provider do to learnabout the issue?

- Observed child in care setting

- Met with staff and parent to discuss their thoughts

- Helped develop a support plan for the child

• What effect did having a specialist and a supportplan have on staff and parent?

- Enabled them to consider the meaning of thechild’s behavior

- Helped them notice things about the child theyhad not noticed before

- Encouraged them to work together as partners tosupport the child

• What would you do if you did not have access to amental health specialist?

- Ask the director, supervisor or another staffmember to confer about the child

- Identify resources in the community (e.g. mentalhealth center, resource & referral agency) thatcan be called on for consultation

E. Show Slide 45: What Goes into a Support Plan whichdescribes the ways in which the intervention or supportplan for the child is developed.

1. The support plan begins with a hypothesis about thebehavior and its meaning for the child.



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45

2. The team may decide during the first meeting thatthere are some specific changes they would like tomake in the environment (e.g. creating a quiet spaceespecially for that child in the book corner) or the wayin which caregivers relate to the child (rescheduling aspecific staff member so that she is there to greet thechild every morning).

3. The team may ask the parent to take the child to thedoctor to rule out physical/health problems that maybe contributing to the behavior (e.g. a persistentearache.)

4. The team may ask for a developmental andbehavioral assessment if initial attempts to supportthe child are not effective or if the child’s behavior istoo confusing to the team to even plan anintervention.

5. Handout 3.10 The Infant-Toddler Action SupportPlan as an example of a document that can be usedto identify the specific action steps that need to betaken before the support plan is implemented.

6. The team will need to decide who, what, when, whereand how the support plan will be implemented so thatthe strategies and responses to the child will beconsistent. For example, a two-year-old bites otherchildren in the group and siblings at home. The teambelieves one of the causes of the biting is herfrustration at having to share toys and space withother children all of the time. The family and theprogram staff agree that they will:

• Try to provide protected space and toys for her touse for periods of time

• Notice when she is feeling crowded or stressed

• Encourage her to say “no” when she wants otherchildren to go away

• Provide a biting pad for when she feels she mustbite



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• Use words such as, “No biting. I know you want toplay with this toy. I’ll help you keep your toy – butno biting. That hurts your friend (sister).”

All of this information should be documented on theplan.

7. The team will need to agree on how each person whointeracts with the child will respond to the behavioronce the support plan is implemented. The responsesection of a support plan should have specificresponses identified for all to refer to. For example;when Damon starts screaming when his motherleaves, Judy will hold him and then try to interest himin an activity. Sara will manage the needs of theother children and will allow Judy to support Damonuntil he is involved in play. When he cries again, Judywill respond immediately and Sara will take the leadwith the other children.

8. The team will need to establish a defined timetableand process for reviewing how the support plan hasimpacted the child’s challenging behavior. The Infant-Toddler Support Plan we are using has a place for ateam to rate the progress of the child at two pointsafter the plan is implemented. If there is no mentalhealth consultant on the team from the beginning, oneshould be called in if the intensity, frequency, and duration of the behavior is not improving. The teamwill need to determine if further community referralsare necessary to resolve the challenging behavior.

F. A simple protocol which addresses the issues we havenoted will generally be appropriate for use with infantsand young toddlers. A more detailed process such asPositive Behavior Support found in the original CSEFELModules 3a and 3b may be more appropriate for oldertoddlers, especially when acting-out behaviors are theidentified problem.



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A. Let participants know that the last activity in the day is todiscuss a case study with their colleagues.

1. They are going to work as collaborative groups(teams) to practice a process designed to gain abetter understanding of a child’s behavior and todevise a plan to address the situation.

2. The purpose of the case study activity is to providethem an opportunity to think about how such aprocess might improve their practice. They should beencouraged to be creative about adapting theprocess so that it is useful to them in their worksetting.

B. Activity. Show Slide 46: Case Study Instructions.Ask participants to divide into groups of 4 or 5 people orgroup together at their table. Within their groups, askthat they select the role each would like to play (teacher,supervisor, parent, mental health consultant, etc.). Theywill use Handout 3.9 Infant-Toddler Behavior Reviewand Handout 3.10 Infant Toddler Action Support Planfor this activity as well as Handout 3.12M Case Studyof Maria.

1. Ask each group to read their case study materials,Handout 3.12M and discuss the information with theirgroup. Handout 3.13M provides case study trainerdiscussion points.

2. Have participants use Handouts 3.9 Infant-ToddlerBehavior Review and Handout 3.10 Infant ToddlerAction Support Plan to gather information aboutMaria’s behavior and make a plan for supportingMaria. Instruct participants to use the information inthe case study to fill out the handouts as best as theycan. If there are questions that they don’t have ananswer to, instruct participants to note the questionswhere they may need to obtain more information.Obtaining more specific information can be a valuablepart of an action plan.

3. Encourage the participants not to move to thehypothesizing and planning stage until they havereviewed all the information. Add that their team can



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IX. Case Study Activity (45 min.)

46

Handout 3.12 Observation DocumentationModule 3


MariaMaria is a 16-month-old girl who attends the Happy Elephant Child Care Center. She is new (she began twoweeks ago) to the class of 12 toddlers who range in age from 12 to 24 months. Maria has been biting andhitting the other children in the classroom and none of the efforts to stop her biting have been effective. In themorning Maria runs ahead of her foster mother and quickly grabs toys away from other children. She seemsunaware that another child is playing with the toy. If the other child tugs back on the toy that Maria hasgrabbed, she will bite the child’s arm or hit the child on the head and shoulders. She has also bitten a caregiverwhen the caregiver attempted to intervene. This pattern of behavior may take place several times a day. Boththe biting and hitting are done with intensity and have left bruises and marks on other children and staff. Thecaregivers in the classroom report that they have never had a child who bites as frequently as Maria. When sheis unsuccessful in getting the object that interests her, she collapses on the floor and screams for up to 30minutes at a time. During her tantrums she is inconsolable. She is difficult to hold and she will not allow herselfto be cuddled. Eventually she calms down and is able to be distracted or engaged with an activity or toy. Thestaff at Happy Elephant have told Ms. Carter, Maria’s foster mother, that one of the other parents hasthreatened to withdraw her child if the staff cannot stop Maria from biting. The staff is very concerned abouttheir ability to help Maria.

Information Gathered from Discussion with the FamilyMs. Carter has been Maria’s foster mother for 3 weeks. Ms. Carter is actually a cousin of Maria’s mother. Sheand 3 other family members have agreed to take Maria and her 7 siblings who were removed from the home oftheir mother by Children’s Protective Services because the mother failed to sever her ties to a boyfriend who isknown to traffic in heroin. Maria’s mother was investigated by Children’s Protective Services regarding concernsabout her neglect of her 8 minor children. The condition of the home, the presence of the boyfriend, theimpending birth of another child, and her failure to attend parenting education classes resulted in the removal ofthe 8 children.

Ms. Carter works during the day. She is the single mother of five children of her own. She agreed to takeMaria because the family did not want to see the children go into homes with strangers. Ms. Carter reports thather children are all in school now and she has never had a child that bit others. She is very worried that she willlose this child care placement for Maria. It is convenient and she is able to bring Maria by bus and drop her offon her way to her job in an office a few blocks away from the center.

During the intake interview Ms. Carter is concerned because Maria has used little or no language to date.Her primary communications seem to be grunts, inconsistent babble or screaming and frequent collapses to thefloor if her wishes are thwarted. Ms. Carter notices that Maria watches her when she talks but does not tryeven simple words herself even when she is prompted. Ms. Carter reports that she had talked with thepediatrician about Maria’s lack of language in either her native language or English, but the pediatriciansuggested that they give Maria at least 6 months to adjust to her new environment before “they put her throughan assessment.”

Ms. Carter reports that Maria has had little contact with her siblings since she was placed with her. She hasseen her mother once in the three weeks since she was removed. Her elderly grandmother has come by to visitbut she does not seem to be able to contribute to Maria’s care and she does not have her own car so she hasto be driven over by another daughter. This family is not sure what will happen to all of the children if theirmother does not get them back. Ms. Carter doesn’t know how long she will provide care for Maria. She ishoping her cousin will follow through on the plan worked out with CPS so that she will get her children back. Ms. Carter reports that Maria has few toys at the house but that she does like her blanket and a soft baby doll.Ms. Carter has been leaving both at home during the day. Ms. Carter reports that Maria has not been biting inher home and she doesn’t believe she was biting in her previous day care.

Ms. Carter’s home is busy and Maria has a crib in a room with two older children. Ms. Carter has beenletting her stay up until the other children go to bed and then she puts Maria to sleep in the living room on thecouch, because she will not fall asleep in her crib. Maria is expected to feed herself in her high chair. She eatsslowly with her fingers and still uses a bottle before she goes to sleep.

(Handout 3.12M)

Handout 3.13 Trainer Discussion PointsModule 3


(For Trainers Use Only/Points to Elicit in Assisting Participants Use the Form with Case Study Maria)

Sample Infant-Toddler Behavior Review

Child’s Name:_____Maria_______ Date of Birth __________ Age____________

Review Contributors Date of Review_______________________

1. _____________________________

2. _____________________________

3. _____________________________

4. _____________________________

Information Gathering

1. What is the behavior of concern?

Biting, hitting, tantrums, possible delayed language skills

2. What happens? What are the frequency, intensity and duration of the behavior?

Bites and hits several times a day; bites and hits caregivers and other children; biting and hitting is severe (leaves marks and bruises on others and frequent (multiple times a day); tantrumsoccur multiple times a day and are of long duration (approx. 30 minutes)

3. When does it happen? Consider writing out daily schedule.

Frequently; when she wants to play with toys or other children When caregivers try to intervene *(need more specificity from staff/ a chart of times/daily schedule noting occurrences would be useful) (considerthis as part of Action Support Plan)

4. Where does it happen?

@ child care center Not at home

5. With whom does it happen?

Other children and caregivers @ child care center

6. How long has the concerning behavior been going on?

Foster mother reports the behavior was not happening in previous care centerWe don’t know much about previous care arrangements or other environmentsBehavior has been occurring since the beginning of starting this class in this center (2 weeks)

(Handout 3.13M)

agree to add data to either the child description or theobservations. They can feel free to embellish thecontext for the child or the behavior as they wish.The goal is that once they have the informationidentified, they will use that information to develop thesupport plan. Give the group approximately 30-35minutes to work on this activity.

4. After 30-35 minutes, suggest the group move on tothe planning step if they have not already done so.Ask that they use the Action Plan form to identify whatwill need to be done before a plan is put in place toeliminate or reduce the child’s distress.

5. Move among the tables to answer questions andfacilitate team work. Record the time allotted andending time for each section of the activity on the FlipChart. Give the groups a 10 minute warning beforethe end of a section and ask them to wrap up theirwork.

6. Bring the group back together to talk about the casestudy and to share and compare thei Action SupportPlans.

7. Ask participants to provide some feedback about theactivity and to report what they have found helpful anddifficult. Encourage them to take these materials backto their work settings and continue to use and modifythem.

A. Show Slide 47: Major Messages to Take Home as asummary of the day’s training. Review each message.Ask if participants have others to add.

B. Thank participants for coming and fortheir attention and participation.

C. Ask participants to complete theEvaluation, Handout 3.14.



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X. Summary and Closing(20 min.)

Location: Date:

Program Affiliation (check one);❑ Head Start ❑ Early Head Start ❑ Child Care ❑ Other (please list)

Position (check one):

❑ Administrator ❑ Education Coordinator ❑ Disability Coordinator ❑ Mental Health Consultant

❑ Teacher ❑ Teacher Assistant ❑ Other (please list)

Please respond to the following questions regarding this training:

(8) The best features of this training session were….

(9) My suggestions for improvement are…

(10) Other comments and reactions I wish to offer (please use the back of this form forextra space):

Session Evaluation FormModule 3

The Center on the Social and Emotional Foundations for Early Learning Vanderbilt University vanderbilt.edu/csefel H 3:149/07

Please take a moment to provide feedback on the training that you received. Check the box that corresponds inyour opinion to each statement or check N/A if not applicable. Please add any additional comments that youmay have at the bottom of the page. When the survey is completed, leave it with your trainer.

Please put an “X” in the box that best describes your opinionas a result of attending this training…

(1) I can describe the relationship between behavior and thecommunication of distress for infants and toddlers.

(2) I can identify the characteristics of challenging behaviorfor infants and toddlers.

(3) I can describe the key elements of a process for under-standing behavior that is confusing or may be disruptive ofsocial emotional development.

(4) I can identify some of the common signs of maternaldepression and understand the potential impact of maternaldepression on the social emotional development of infantsand toddlers.

Strongly Somewhat Somewhat Strongly N/AAgree Agree Disagree Disagree

(Handout 3.14)

47

Resources

Butterfield, P., Martin, C., & Prairie, P. (2003). Emotionalconnections: How relationships guide early learning.Washington, DC: ZERO TO THREE Press.

Chazan-Cohen, R., Ayoub, C., Pan, B., Roggman, L.,Raikes, H., McKelvey, Whiteside-Mansell, L. & Hart, A.(2007). It takes time: Impacts of early head start that leadto reductions in maternal depression two years later. InfantMental Health Journal 28(2), 151-170.

Early Head Start National Resource Center, (2006).Strategies for understanding and managing challengingbehavior in young children: What is developmentallyappropriate and what is a concern? Technical AssistancePaper No. 10. Head Start Bureau, Administration forChildren and Families, Administration on Children, Youth,and Families, U.S. Department of Health and HumanServices. Washington, D.C.

Gladstone, T. & Beardslee, W. (2002). Treatment,intervention, and prevention withchildren of depressedparents: A developmental perspective. In S.H. Goodman &

I.H. Gotlib (Eds.) Children of depressed parents:Mechanisms of risk and implications for treatment. 277-305.Washington, DC: American Psychological Association.

Im, J.H., Osborn, C.A., Sanchez, S.Y. & Thorp, E. K. (2007).Cradling literacy: Building teachers’ skills to nurture earlylanguage and literacy from birth to five. Washington, D.C:ZERO TO THREE Press.

Johnston, K., & Brinamen, C. (2006). Mental healthconsultation in child care; Transforming relationships amongdirectors, staff, and families, Washington, DC: ZERO TOTHREE Press.

Kostelnik, M., Whiren, A., Soderman, A., Gregory, K., &Stein, L. (2002). Guiding children’s social development:Theory to practice, Fourth Edition. Albany, NY: Delmar.



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Onunaku, N. (2005). Improving maternal and infant mentalhealth: Focus on maternal depression. Los Angeles, CA:National Center for Infant and Early Childhood Health Policyat UCLA.

Parlakian, R., & Seibel, N. L. (2002). Building strongfoundations: Practical guidance for promoting the social-emotional development of infants and toddlers.Washington, DC: ZERO TO THREE Press.

Sroufe, L., Cooper, R., DeHart, G., & Marshall, M. (1996).Child development: Its nature and course. McGraw-Hill,Inc.

Wittmer, D.S. & Petersen, S.H. (2006). Infant and toddlerdevelopment and responsive program planning: Arelationship-based approach. Upper Saddle River, NJ:Merrill Prentice-Hall.

ZERO TO THREE (2005). Diagnostic classification ofmental health and developmental disorders of infancy andearly childhood (revised edition). Washington DC: ZERO TOTHREE Press.

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Documents

Individualized Intervention with Infants and Toddlers ...csefel.vanderbilt.edu/inftodd/mod3/script.pdfprocess for developing and implementing a support plan to respond to challenging