Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, April 8, 2013

"Chronic Biting Extinguished": Some Useful Ideas About Toddler Aggression



I want to comment today on a most interesting presentation I attended at a meeting of the Delaware Valley Group chapter of the World Association for Infant Mental Health. Lisa Poelle, author of The Biting Solution (see www.stopthefightingandbiting.com) discussed the complexities of toddler biting and offered some approaches to solving this often-difficult problem. Biting is a behavior that deeply distresses parents and caregivers of toddlers . It can be medically dangerous to the bitee, but even beyond that it has an out-of-control, “animal-like” vibe that causes some degree of panic--  and if it can’t be stopped, children are often kicked out of child care programs when care is essential to the family’s working hours and income.

Lisa differentiated between “garden variety biting”--  the occasional chomp that any infant or toddler may take when teething or just experimenting--  and the chronic biting in anger or frustration that may occur many times a day and that gets children thrown out of child care programs. The first will probably resolve by itself; the second needs help and guidance to help the child get back on track developmentally and to prevent either chronic aggressive behavior or other problems that can stem from constant disapproval and punishment.

Why do children bite, not just once but chronically? It’s all too easy for adults asking this question to fall into the “fundamental attribution error”--  the belief that people do things because of their own internal characteristics. They want to bite! They like to hurt people! They want to control everybody and everything! If we think that these are the reasons why toddlers bite, we probably won’t be able to think of any solution except to make them not want to bite, and to accomplish this by punishing them--  even, classically, by “biting them back”.

The title of Lisa Poelle’s talk, “Chronic Biting Extinguished”, immediately puts a very different spin on the biting problem. By talking about extinction of a behavior (the reduction in its frequency when it is not reinforced), she positions problem biting as a learned behavior. From that point she is able to consider not only how a child has learned to bite, but how he or she can be helped to learn not to bite, but to use more mature social skills instead.

Thinking about chronic biting as learned (rather than something fundamental to a child) also opens up the option of considering the difference between learning and performance. There are many things each of us has learned to do, but we don’t do them all the time. We can perform an action under the right circumstances or refrain from performing it under the wrong circumstances, and all this without having to forget how to do it. If the circumstances--  the environmental characteristics—are altered, our learned behavior can become more or less likely to occur. In driving a car, we ordinarily apply the brake only when we want to slow or stop, but if the rear-view mirror shows a truck barreling down on us, we may tap the brake several times to get the attention of the truck driver.  


Because children too perform in different ways in response to the environment, Lisa Poelle discussed many factors that influence the performance of a learned behavior, over and above the fact that it was learned rather than innate. Her handout (and her book) provided an action plan worksheet that guides caregivers to observe multiple factors that can influence the occurrence of biting--- factors that may not be easily observed by busy adults who are responsible for a number of children. Lisa suggested that only by careful observation of contributing factors can anyone create an action plan that will help a child not only stop biting, but start using more appropriate behaviors when frustrated.

Lisa’s action plan worksheet begins with examining the child’s developmental status. Does he  know how to share or take turns? Was the child premature, or is she tall, giving the impression of being more mature than she really is? Do adults expect too much of the child, and do they need to offer guidance in social skills?

A second issue is the child’s recent experience of changes and previous experiences in general. Are the parents either excessively strict or very lax at setting limits? Have they moved to a new house, had Grandma come to live with them, had a new baby, had parent conflict rise to high levels? Has there been a change in child care providers?

What are the child’s verbal skills like? There may be good receptive language but limited expressive language, and there may also be facial expressions that are hard for other children to read.

The child’s physical condition may be an important factor that increases or decreases biting. Toddlers need plenty of sleep and may not get it for various reasons. They may be hungry or thirsty more frequently than many day care centers plan for.

Temperamental differences can make some children need extra guidance with respect to biting. Children who are low in adaptability can be easily frustrated and need extra help around transitions or other challenging situations. Low thresholds of sensory responsiveness can make children generally irritable, as they quickly notice small differences in temperature or taste and are bothered by constricting clothing or tags on clothes. Those with negative mood quality may have blank or sulky expressions that discourage other children (and some adults) from approaching them in friendly ways.

The physical environment of the day care center may create problems for children and make biting more likely. Overcrowding, colors and sounds that are too stimulating, a lack of novelty or challenge in the toys available, a lack of soft things to sit on or play with, too few play spaces--  all of these may cause a vulnerable child to respond with biting to another child who is too close or who interferes with play.

Finally, the child care setting and the parents may be using ineffective practices for limit-setting. Forcing children to apologize may simply lead to continued biting followed by “sorry”. Time-outs may be ineffective and may simply raise the child’s frustration level. Lisa suggested “instructive intervention” both at the time of a bite and planfully at other times, with much emphasis on the child’s understanding how he feels himself--  not so much on the “how did you make Tommy feel?”--  and what he can do to express this without biting or other aggression. (One very practical idea was to provide a damp washcloth or teether that the child can bit on when tense.)

Just a couple of comments from me about the limit-setting issue: one point is that it’s much easier to get someone to do something different than to “just stop”. What do you do when you’ve stopped? That question is more than a toddler can answer. A second point is that when setting limits for toddlers, we need to go to the toddler and get down face-to-face with him or her. Calling from across the room, or looming over the child, is likely to have a frightening and frustrating impact if it has any impact at all. Finally, a little more about “how you feel” rather than “how he feels”: toddlers show the beginnings of empathy and of Theory of Mind, the understanding that other people think, feel, or know things other than what the toddler thinks, feels, or knows--  but they are not very good at this, and months and years will have to pass before they get much better. They cannot effectively perform the mental gymnastics of thinking, “I don’t like to be bitten. Tommy is like me. Therefore, Tommy also does not like to be bitten”. In any case, it doesn’t really matter whether they know how Tommy feels, if the issue is development of their own impulse control and social skills. Those are abilities they can develop best if they are aware of--  and have words to describe and talk about—their own feelings. They didn’t bite Tommy because Tommy felt good or bad, they did it because they themselves were  angry and frustrated. While “thinking how he feels” can be an excellent learning device for 6-year-olds, “thinking how you feel”—and knowing what you can do about it--  is developmentally appropriate for toddlers.

The late, great Sally Provence used to say “Don’t just do something; stand there and watch”. Unless we stand and watch in the ways Lisa Poelle has suggested, chances are that we will not be able to figure out what factors are encouraging a child to bite. And, by the way, unless parents and child care providers can work together cooperatively, and be candid and open about the situations at home and in child care, they will not be able to put together all the information that’s needed to solve the problem of chronic biting.

N.B. I hope everyone has noticed that there is no mention here of “therapeutic restraint” as a solution for toddler aggression.


2 comments:

  1. From a layman: Bites with those devilishly sharp little teeth is excruciatingly painful. I remember, after 25 years, the time my little girl, seemingly out of the blue, bit my posterior a good one while I washed dishes. I howled and teared up. She never bit again, but I've wondered what she was thinking. It seems that observing like an anthropologist is key to being a parent – to understand these small aliens in our homes.

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    1. As Pogo used to say-- "how sharper than a child's tooth to have a thankless serpent!"

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