From the Guidelines
The recommended approach to managing behavioral issues in preschool children involves evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment. This approach is supported by the American Academy of Pediatrics, as stated in the 2011 clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents 1. The guideline recommends that for preschool-aged children, the primary care clinician should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment, with a strong recommendation and high-quality evidence.
Key components of this approach include:
- Establishing consistent routines and clear expectations using simple language that preschoolers can understand
- Implementing positive reinforcement techniques, such as immediate praise and rewards, to encourage positive behaviors
- Using logical consequences that are directly related to the misbehavior, rather than punitive measures, to address challenging behaviors
- Modifying the environment to prevent behavioral issues, such as removing triggers or providing appropriate outlets for energy
- Utilizing parent training programs, like Triple P or PCIT, to provide parents with specific skills to manage their child's behavior
Medication is generally not recommended as a first-line approach for typical preschool behavioral issues, unless there are diagnosed conditions requiring medical intervention, as stated in the 2011 guideline 1. This comprehensive approach works because young children are still developing self-regulation skills and learn best through consistent, positive guidance that helps them understand appropriate behavior while feeling secure in their relationships with caregivers. Additionally, a 2020 narrative review emphasizes the importance of focusing on "good behaviour" and providing praise and social reinforcements to children 1.
It's worth noting that other studies, such as those from 2015, highlight the importance of active family involvement in early intervention for children with autism spectrum disorder, and the effectiveness of comprehensive developmental and behavioral programs in improving adaptive functioning 1. However, the 2011 guideline provides the most direct and relevant recommendation for managing behavioral issues in preschool children.
From the Research
Approach to Paediatric Behavioural Issues
The approach to managing behavioural issues in preschool children involves a combination of strategies, including:
- Helping parents learn effective behaviour strategies to promote desirable behaviours in their children 2
- Assessing the child's development, learning, and behavioural problems through observation and detailed history-taking 3
- Using a multidisciplinary team approach for assessment and early intervention 3
- Implementing a multimodal approach, which may include medication and parent training, for managing attention deficit hyperactivity disorder and other behavioural problems 3, 4
Factors Associated with Behavioural Problems
Research has identified several factors associated with the persistence and development of behavioural problems in preschool children, including:
- Social stressors, environment, and developmental state 2
- Maltreatment and/or neglect 5
- Developmental delays and language delays 5
- Internalising problem behaviours, such as fearfulness and hypervigilance 5
Effective Interventions
Studies have shown that effective interventions for behavioural problems in preschool children include:
- Parent training, which can be combined with medication for improved outcomes 4
- Early intervention and assessment, which can help identify and address behavioural problems before they persist or worsen 3, 6
- A comprehensive approach that addresses the child's developmental, emotional, and behavioural needs 5