“Behavior is Communication”- How Speech Therapy And Helping Children Get A Haircut Are Connected
“Behavior is Communication”— Daniel J. Siegel, The Yes Brain: How to Cultivate Courage, Curiosity, and Resilience in Your Child
Young children, and in particular children with limited language or special needs, often struggle to communicate what is wrong. The idea of the “Terrible Two’s” is really describing a time when children have ideas and feelings about things that they cannot yet express with words, and this mismatch causes frustration. At this stage of development, their ability to handle frustration and emotions is still a very underdeveloped system, and so something that might seem like a small problem to us, might cause a major meltdown for them. Picture the 2-year-old who specifically asks for a banana but when you give it to them they cry, and throw it- not because they didn't want the banana, and not because they were being naughty. Instead, maybe they wanted to peel it themselves, or they wanted a banana with fewer brown spots, they just couldn't tell you.
I am a pediatric speech-language pathologist with over 15 years of experience working with children, and am now the mother of two young children. In recent years, I have been working primarily with children ages 1-3 through an early intervention program. Therapists in early intervention are often a family’s first introduction into the world of special education and therapy. Therefore, while I am brought in to support a child’s delays in speech and/or language, I often wear many hats to help families navigate a variety of topics outside of speech and language. This can include, showing families age appropriate art materials, how to model new types of play, and how to understand and develop strategies for what may seem like random or inappropriate “behaviors” while in the community, such as screaming and running away when trying to get a haircut, or kicking and biting when at the dentist.
Because early interventionists are supporting families during a time when children are reaching or failing to reach many developmental milestones, the team can uncover new information about how their child learns. It is also a period where children often do not have a formal diagnosis (ex. Autism, ADHD, Sensory Processing Disorder), aside from children diagnosed at birth with a hearing loss or genetic disorder. Sometimes it is during our treatment that I, or the other early intervention team members (such as occupational therapists, physical therapists, and special education teachers), will sometimes note a pattern of “behaviors” that might be consistent with a particular diagnosis. Rather than be afraid to hear that their child might have an undiagnosed disorder, we encourage families to meet with specialists (such as Developmental Pediatricians) to either confirm or rule out certain diagnoses to better anticipate supports that might be helpful for the child, and to help the family access appropriate resources.
When meeting parents or caregivers for the first time, they often describe to me how their child has so-called “bad behaviors” that are unpredictable and disruptive. However, after interviewing the caregiver, observing the child, and making some modifications, together we have often been able to uncover that the “behavior” was actually the child’s way of trying to communicate something that they could not articulate with words. Don't get me wrong, a meltdown in the middle of a restaurant can still be maddening, and embarrassing. But, if we can begin to understand what your child is trying to communicate with you, we can start to problem solve ways to support them, and anticipate issues so that we can hopefully see a reduction in these “bad behaviors.”
Here are some examples of where the “behavior” was actually a child telling their caregivers that they were anxious, uncomfortable, or confused. All names and other identifying information have been changed to protect the child/family's privacy:
A 2-year-old girl with limited language, Maya, refused to wear her winter jacket at daycare. Every time the teachers put her winter jacket on, she immediately took it off, or cried and banged the floor. The staff started to put the winter jacket on backwards so that Maya could not reach the zipper to unzip it as it was very cold outside and the jacket needed to be worn. After speaking with staff and parents, we discovered that this was unusual as Maya typically did not have issues wearing other clothes, she wore other fall jackets without issue, and loved to go outside. We examined what could be causing this to occur. We realized that the winter jacket was made of a swishy/silky feeling material, whereas the other jackets were soft cotton. We guessed that maybe Maya did not like the feeling of the material of the jacket; some children are more sensitive to touch and texture and may not be able to explain why they are uncomfortable. The family then tried a different winter jacket that was soft cotton like her previous jackets and she happily wore her jacket without issue.
A 24-month-old non-verbal child, Jimmy, screamed and squirmed at daycare every time he had to get his diaper changed. Staff were concerned that he would squirm and fall off of the changing table, and so for safety, multiple times each day, two staff members at a time were needed to change him. After observing the diapering routine, and interviewing teachers and parents, we discovered that diaper changes were not as challenging in the home setting. We attempted to distract with singing, books, etc., but the “behaviors” continued. We finally realized that at school they used wipes at each diaper change (not just for bowel movements) and that the wipes at school were kept in a cabinet that was colder than the rest of the room. Unable to communicate verbally, Jimmy’s “behavior” was his reaction to the sensory experience of the cold, wet wipes on his skin. We started to warm the wipes in warm water before using them, and he began to have calm, happy diaper changes.
A 2-year-old boy with limited language, Malcolm, would scream, cry, and throw his shoes every time the family tried to leave the house. The parents described that he usually liked wherever they went, and was happy once they got there, but that leaving the house was extremely frustrating. We added a visual schedule (pictures in sequential order) to help Malcolm know what to do to leave the house to show that it was the same routine each time (ex. put on socks and shoes, put on a hat, go into the garage, get into the car). Then, we added visuals (pictures) of the places that Malcolm would typically go so that the family could both tell him where they were going, as well as show him a picture. This resolved the tantrums when it was time to leave. Malcolm was able to follow the visual schedule and help get himself ready to leave, and then happily climbed into the car to head off to his favorite places. He even independently started using the visuals to tell his family where he wanted to go by holding up the pictures! In the end, we realized that Malcolm was confused about what the “getting ready to go” routine was, and was feeling stressed about not understanding where they were going and what to expect.
A 3-year-old boy with limited language, Ben, screamed, ran away, kicked, and cried when it was time to get his haircut. The family was embarrassed and started having a family friend come to the house to cut his hair. Even in the home, the haircut was exhausting and upsetting for everyone involved. The hairdresser would use clippers to try and get it done as quickly as possible, but was worried that Ben would get hurt because he squirmed so much in the chair. Before the next haircut in the home, the family and I showed Ben videos about getting a haircut and narrated what was happening. We told Ben that he would be getting a haircut that day, and we practiced pretending to cut hair on a doll. When the hairdresser came, we showed Ben the tools that would be used, and let him play with the spray bottle (this was a big hit!). Instead of sitting on the chair by himself, he was held by his mother, and instead of the silky feeling cape, we placed a large bath towel around his neck. These modifications helped to create a child who was calm, and not afraid of the tools being used. Since clippers vibrate and can be loud, we instead had the hairdresser use scissors for the entire haircut. Ben then sat in his mother’s arms watching a tablet, eating a lollipop and calmly got his haircut.
Of course, the above examples are all success stories, and the reality is that sometimes the child’s true message is very difficult to uncover. While we can’t prepare children for every scenario, and we as caregivers can’t possibly predict everything that might feel overwhelming and alarming to our children, the good news is, there is a lot of research about what we can do to support all children. Whether or not your child has a diagnosis (ex. ADHD, autism, anxiety, sensory processing disorder), a developmental delay, or appears to be developing on schedule, using a few guiding principles we can try to help all children, and especially children with special needs, learn and try new things. This website uses these principles to provide parents and caregivers with step-by-step guides, books, toys, and resources to help children prepare and participate in new experiences (i.e. get a haircut, get their nails trimmed, learn to swim, use the potty). Additionally, each “I Can…” topic includes a “Behavior Decoder” section to help break down the process of analyzing a “behavior” to help figure out what your child is trying to tell you, and therefore which modifications and supports might be beneficial for your child:
Guiding Principles To Support Learning For All Children:
Children learn through play- Researchers have known for a long time that children learn better through play and hands-on experiences rather than workbooks and lectures. This includes not only academic knowledge, but social skills, communication skills, motor skills, emotional skills, and more. Picture a preschool classroom with a water table where children are mixing pitchers of yellow water and red water to learn about color theory, as opposed to having them just memorize that yellow and red make orange. And, consider how young children have played with baby dolls for generations as a way to learn about caring for others, develop empathy (“My baby is sad. I will give her a hug.”), and how to cooperate and negotiate (“You were the Mommy last time, I want to be the Mommy today.”).
Children benefit from knowing what to expect- Even as adults we often like to know what our schedule will be for the day. Most days we get up, get ready, get our kids ready, drop them off at school, go to work, etc. If, seemingly randomly, instead of at work we ended up at a new building where strangers were trying to look into our mouth, we would be panicking. But, if your calendar had “Dentist Appointment- 9:00am” on it, and we got notifications the day before to remind us, it wouldn’t be as surprising. Similarly, we as adults know what to expect will happen at the dentist because we have been there many times before and know what tools will be used and what sounds to expect. Children do not yet have that experience, and so they benefit from having exposure to what new things they might see, hear, feel or smell, and exposure to what the sequence of events will be.
Children thrive in routines, and having consistency- Does your child want you to read the same book every night, or watch the same movie 100 times in a row? Children like predictability, and the fact that the book and movie consistently end the same way each time is soothing and helps to give children a sense of control. Similarly, children benefit from knowing routines so that they can predict what they will have to do, where they will be, and how long it will last. For example, the bedtime routine always includes potty, pajamas, brush teeth, read a book, then snuggle with a parent. When you tell a child it is time for bed, a child who has learned the routine is able to picture what they should do, and can start to independently take on some steps themselves. While all children thrive in routines and consistency, for a child with an underlying anxiety disorder or undiagnosed autism, for example, routine and consistency become even more imperative.
Children process the world through their sensory system-
This seems like an obvious statement. Of course we process information through our senses. However, every person is wired slightly differently, and so the way that each of us processes sensations can vary. As adults, we tend to know what sensations make us feel calm and safe (i.e. regulated), and which are unpleasant or uncomfortable. We have learned coping strategies to help us process incoming sensory input to keep our bodies regulated. For example, as adults, some of us know that we need quiet to be able to focus and find noise to be distracting and overwhelming. But, others know that they need to blast loud techno music to be able to concentrate, and cannot think in silence.
Children are still learning how to interpret sensory input, and some children have difficulty processing sensory input in general. Their bodies are reacting to touches, sounds, smells, tastes, and what they see, and trying to make sense of it to respond appropriately. For some children, especially children with autism, or a sensory processing disorder, their sensory system misinterprets a sensation, and then we often see an unexpected reaction or negative “behavior” to the sensation. This can look like a child covering their ears when the toilet flushes, or screaming/crying when gently bumped into by another child because to them it felt painful. These children will sometimes benefit from occupational therapy to help “rewire” their brain’s ability to process sensations.
Children who are young and especially those who have limited language do not yet know how to tell us what is wrong, and sometimes they would not even know how to explain it if they could! So, they use their “behavior” as a way to communicate that something isn’t right. That is where we can try to figure out what is pleasing and what is overwhelming for our children, and help make modifications to support their sensory system. They will be much more likely to learn and experience their world if they are feeling safe and their body is feeling calm!
All children have their own unique set of strengths and weaknesses, but unfortunately, they do not come with an individualized guidebook for what types of supports they might need. Even children who are intelligent, articulate, and seemingly typically developing might surprise you when they struggle with something that their peers might do easily (picture the happy, outgoing preschooler who hides and screams when you take them to get a haircut, or an adventure seeking 4-year-old who sits in a corner on the playground and won’t climb on the play structure because of fear of unexpectedly getting bumped into). It is therefore our job as caregivers to try to understand what that child might need to help them learn and thrive. Just as you would of course provide glasses for a child who couldn’t see, and a hearing aid for a child who couldn’t hear, we can also provide supports for a child who might be anxious or have sensory aversions to touch or sound. All children can benefit from the resources on this website, but it is even more crucial to use these strategies to support our children who might otherwise miss out on life experiences due to frequent meltdowns, which then causes the family to avoid going out into the community. Some parents are afraid that getting a diagnosis will label their child and be limiting moving forward, but to me, getting an early diagnosis or starting therapy when the child is young means that we get a jumpstart on finding the right supports that will help a child learn, increase their confidence, and be successful.
I hope that you are able to find resources here to help your child succeed. Please keep in mind that sometimes you might need some extra help to understand how to support your child. That is by no means a reflection of your parenting, and lots of families tap into resource networks outside of their family/friend bubble. This could be asking the daycare teacher for suggestions, talking to your pediatrician, or reaching out to your local early intervention program.
You know your child better than anyone else, and so if your instincts are telling you that your child’s ability to process new things, or experience the world seems different from their peers, please reach out to an expert in that area who can help guide you.
Some days are hard, and it can feel relentless. But, I am here to tell you that there are people, resources, and therapists who can help you and your child say, “I Can Do This!”
Please see the RESOURCES section for some wonderful books that provide a deeper understanding of “behavior” and the importance of play for children.