Child psychiatrist Dr. Nancy Rappaport guides parents whose children struggle with behavior issues

by Karina Coombs

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Dr. Nancy Rappaport. (Courtesy Photo) 

Speaking before a crowd of close to 50, noted child Psychiatrist Nancy Rappaport discussed strategies for working with kids with challenging behaviors at a presentation given on March 8 in the Corey Auditorium. Rappaport gave a similar presentation to school faculty on two occasions. The public presentation, co-sponsored by the School Advisory Council and the Carlisle School Association, aimed to provide parents in Carlisle and surrounding communities with the same information.

Principal Dennet Sidell introduced the presentation, “Caring for All of Our Kids,” with the basic premise that, “children will do well if they can.” Just as some kids might have different educational needs Sidell explained that other kids might have different behavioral needs and some children are simply unable to do what is asked of them because of anxiety and/or other disorders. When working with these children as a teacher, coach, parent or other adult, Sidell emphasized that there needed to be approaches and strategies for helping them,” be successful in all settings.” 

Rappaport is associate professor of psychiatry at Harvard Medical School and director of school-based programs at the Cambridge Health Alliance. With over 20 years of experience working at public schools, she is also the co-author of The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students written with behavior analyst Jessica Minahan. Rappaport is also the author of In Her Wake, which explores her mother’s suicide in 1963.

“Some in attendance may have kids on the [Autism] spectrum or ADHD [Attention-Deficit Hyperactivity Disorder] or are just challenging in their own way,” began Rappaport. “Others may have come because you have a grandchild that might struggle or a friend you want to support and that’s a positive sign of health in the town. If you are saying we need to embrace all of our children, even those marginalized by their behavior, that brings a really strong community.”

Explaining that she wanted the audience to leave with hope and a repertoire of skills, Rappaport provided a number of examples where children might act out in a school setting and offered a glimpse of where behaviors come from. For children with learning disorders for example, being asked to produce work could emphasize the lag time it takes for them to process what they need to do. A child who may be on the autism spectrum and has difficulty navigating social situations might misinterpret a social cue or situation. Rappaport described these examples as the “barrier” for a child who wants to do well, which might lead to a meltdown or other behaviors. 

Rappaport also stressed that not knowing a child’s particular deficit could lead to him or her being reprimanded by teachers or excluded by peers. “Kids are up against their vulnerability every day at school,” she explained. “And to function and perform they have to have the safety of an adult or parent.” Rappaport added, “Having an advocate as a parent for a child is the single most key ingredient for children that are struggling.”

FAIR method

Rappaport explained that behavior is communication and children who are struggling often misbehave. She and Minahan use the acronym FAIR as a tool for helping teachers and other adults to recognize behaviors and develop strategies for dealing with them as they happen in the classroom or at home. The acronym is broken down as: F for understanding the function of a behavior, A for accommodations, I for interactions and R for response. 

Rappaport noted that that behavior analyst Mark Durand suggested four possible functions of behavior or reasons why a child is behaving in a certain way: a child might want to escape a situation; to get something he or she wants; to do something that is sensory-related; or to simply get attention, with negative attention being the quickest to attain. Rappaport emphasized that identifying the antecedent to a behavior, the thing that happened right before, can often show patterns that could help an adult manage the behaviors. 

Once a teacher or other adult has made that connection, Rappaport explained that it is time to think about accommodations. For example, if a child struggles in the lunch room because of the noise or number of students, a school might think of putting the child in a smaller lunch setting or alternative activity. Helping a child learn to transition from one task to the next is another type of accommodation, as is a “tool kit” that could be filled with various things a child could use for comfort during a rough or anxious time. Rappaport also showed a variety of smartphone or computer applications that could be used for self-regulating such as a voice meter, a shredder for virtually shredding negative thoughts or a guided breathing application.

Random acts of kindness, “can fundamentally provide respite in times of crisis,” said Rappaport. She encouraged educators and parents to think of positive interactions they could have with these children, and suggested incorporating more playfulness, empathy and kindness before a situation becomes challenging. She emphasized that accepting a difficult child is not accepting the behavior, but rather the feelings behind it.

Despite the best planning, Rappaport explained there might always be meltdowns or escalation of a child’s behavior and schools should always have a response in plan for managing behaviors. She reemphasized the importance of looking back at the antecedent to a challenging behavior to determine what was going on before the escalation.

Following the presentation, Rappaport led a question and answer session covering topics such as Asperger’s, oppositional and negative behavior and the potential consequences of aggressive behaviors as children get older. To a parent who asked about empathy versus setting boundaries she replied, “I think it’s easy for people on the outside to say you may be too accommodating, but they aren’t managing the meltdowns.” However, she added, “I do sometimes worry when people lower their expectations because they are so worried about a meltdown they stop making demands.” 

Rappaport continued, “You’re walking a tightrope and I have enormous respect [for families] with kids on the [Autism] spectrum or with incapacitating anxiety. It’s constant navigation and constant vigilance. If your child had cancer you would have [people] making you casseroles. Mood disorders are a quiet event.”

Visit the website at www.nancyrappaport.com for more information on her book and the FAIR method. [Edited 3/13/14 to correct misspelled name.]∆