J. T. Fuller | June 26, 2022
During adolescence, unexpected behavior has the potential to become increasingly problematic and can have a significant impact on life trajectory. Adult interpretation and response to this behavior has the potential to either diffuse the problem or exacerbate it across various settings, particularly at home and at school. Adult misinterpretation of behavior often results in predictable undesirable outcomes such as underachievement, delinquency and justice involvement, misdiagnosis and psychopathology, or coercive behavior modification efforts occasionally resulting in death. This paper will explore areas of adult interaction with adolescents where behavior misinterpretation is particularly problematic, significant implications of these interactions and propose an alternative evidence-based approach to behavior interpretation that has been shown to effectively reduce both the incidence and prevalence of problematic behavior.
Through adult perception and reaction, unexpected adolescent behavior is either exacerbated or eliminated. Behavior is a form of communication and will continue to evolve until the underlying need is addressed, which may result in increasingly undesirable. When unexpected behavior occurs, this can be interpreted as a manifestation of incompatibility with the environment, expectation, or skillset, regardless of the intensity, severity, or frequency of the behavior (Greene & Winkler 2019). Until the lagging skill or unresolved incompatibility is identified and resolved, it is unlikely the behavior will change in a meaningful and sustainable way. The primary barrier to this process is adult misinterpretation of behavior and a lack of insight into how the environment is shaping the behavior. The application of behaviorism, a focus on the behavior, combined with adultism, results in the determination by the adult of whether a behavior is acceptable, the adult’s imposition of unilateral resolutions to the problem, and a lack of meaningful incorporation of the perspective of the child who is experiencing the underlying unmet need or lagging skill. This adult-centric process has resulted in behavioral disorders problematic to both adolescents and adults, such as oppositional defiance disorder (ODD) and conduct disorder (CD), underachievement, abuse of adolescents in schools and residential settings, high rates of incarceration and recidivism, and death. Adultism contributes to the development and maintenance of challenging adolescent behaviors, which can be course corrected with the implementation of a collaborative problem-solving approach premised on the understanding that all behavior is communication.
Parental interpretation of behavior shapes their response to behavior, which shapes subsequent behavior they experience. Parents tend to spontaneously generate causal explanations for child behavior; this attribution is the foundation for subsequent parenting behavior and relates to child behavioral outcomes (Colalillo et al., 2015). Negative attribution to behavior reflects causal explanations that are internal, stable, and controllable (Sawrikar et al., 2018). Studies have shown parents attributing responsibility to the child displaying unexpected behavior describe their children as having more externalizing and internalizing problems (Colalillo et al., 2015). Negative behavior attribution may stem from cognitive errors, such as jumping to conclusions, mentally filtering, or personalization (Haack et al., 2016). Negative behavior attributions lead to harsher parenting methods, which causes or increases behavioral challenges (Colalillo et al., 2015). Further, parental feedback implying adolescent responsibility becomes internalized for the adolescent, often resulting in self-blame for negative events outside of the adolescent’s control.
Teacher interpretation of behavior forms the foundation of how a student is perceived and considered, including by the student. In the school setting, interpretation of behavior is also clouded by negative attribution bias, largely thought to be related to discrimination in some form. Students of equal ability or displaying the same behavior are treated differently in many situations (Bruneau et al., 2019). For example, evaluations of IQ matched Hispanic students is less positive than received by their white counterparts; non-black students receive more praise, direct questions, and feedback than their black peers; white students receive milder disciplinary responses for behavior as compared to black students engaging in the same behavior, and minority students are perceived as less competent than majority students. Research has repeatedly demonstrated this is a self-fulfilling prophecy, where student performance over time adjusts to teacher expectation (Halberstadt et al., 2018).
Depending on interpretation of behavior, a student characterized as manipulative, non-compliant, resistant to transitions, argumentative, hyperactive, a “trouble-maker,” a “class clown,” emotionally overreactive, strong-willed, “bossy,” or dominant can be considered potentially gifted or in need of behavior intervention/harsher consequences (Harradine et al., 2013). By reframing behaviors that are not teacher-pleasing manifestations as communicating, for example, boredom, rather than whatever negative attribution the teacher has made for the behavior, an opportunity for the student’s unmet need to be identified and supported is created, rather than a need denied and the student punished for behavior communicating that unmet need.
Diagnostic bias from clinicians results in the misinterpretation of behavior, leading to the overdiagnosis of willful behavioral problems like ODD or CD. Behaviors associated with ODD and CD are also attributable to mood, anxiety or adjustment disorders (Fadus et al., 2019). Minorites are much more likely to be diagnosed with CD rather than ADHD, which results in fewer prescriptions for medication to support their neurodiversity and create different behavior manifestations. For example, in one study, 17% of adolescents in a population within the juvenile justice system had only a diagnosis of CD, but upon further investigation, 92% met diagnostic criteria for PTSD, major depressive disorder, generalized anxiety disorder, bipolar disorder or panic attacks. A superficial assessment of behavior, which is completely reliant on adult interpretation, can be the difference between an ODD diagnosis and identifying social anxiety, perceived opposition can mean undiagnosed ADHD, emotional dysregulation and pervasive irritability can be ODD, an anxiety disorder, or a mood disorder.
There is no consensus on the cause of disruptive behavioral disorders like ODD and CD, but related disorders, like ADHD, learning disabilities and trauma have clear neurological indicators (Fadus et al., 2019). Some have suggested grouping ADHD, ODD and CD together as a single diagnosis would improve the outcomes for adolescents with perceived willful behavior that could be masking underlying ADHD (Poulton, 2010). This could improve access to care, eliminate the potential for biased interpretation of behavior, and improve educational outcomes for populations negatively impacted by diagnostic bias.
Behavior misinterpretation has huge ramifications for adolescents. Behaviorism, which is the focus on surface behavior rather than the underlying unmet need, results in superficial compliance at best and ignores the root cause of the behavior (Tolley, 2019). Reports show more than 100,000 students per year are subjected to restraint or seclusion in U.S. public schools and the gross majority are students with identified and acknowledged disabilities (Kim, 2022). These environments have resulted in documented student deaths, with unknown counts of related suicides. Restraint and seclusion in response to unexpected behavior in schools has slowly been replaced with positive behavior interventions (PBIS), which in theory is an improvement but still relies on outdated behavior modification efforts without addressing the underlying unmet need (Harkin, 2014; Tolley, 2019). PBIS does not acknowledge that not all behavior is willful, which is inconsistent with current understandings of stress responses (Tolley, 2019). The assumption that all behavior is willful is consistent with negative attribution bias found in parent-child relationship literature and is equally unhelpful in this application.
Outside of the public school system, some adolescents reside in unregulated residential treatment centers, seen as a last resort for high-risk adolescents with complex needs (Harder, 2018). Researchers estimate 57,000 adolescents in the U.S. were placed in for-profit treatment facilities by their parents in 2018 (Chatfield et al., 2020). Although adolescents receiving treatment at such facilities often show behavioral improvement upon discharge, there is limited evidence of sustained change (Harder, 2018). Reports of youth death, heavy reliance on coercive behavior modification like forced labor, extensive use of seclusion and restraint, medical and nutritional neglect, isolation from outside contact including with lawyers, advocates or parents are common experience (Behar et al., 2007). Because of the unregulated and underreported adverse outcomes from such facilities, there is little data beyond survivor reports of the adverse experiences and long-term outcomes from these extreme environments. Consequences to behavior, like seclusion or restraint as administered in such facilities are not permitted in regulated programs. Inhumane treatments reported by many survivors are contrary to standards for prisoners of war and detainees. This parent-sanctioned institutional child abuse allows parents to pass the baton to others to continue to deny the underlying need of the child displaying unexpected behavior.
Criminalizing developmentally appropriate and disability-related behaviors in minors results in the legally sanctioned misinterpretation of behavior disproportionally impacting minority students (Hughes et al., 2020). Juvenile justice systems and prisons are filled with students with hidden disabilities such as ADHD, dyslexia and trauma, whose behavior was denounced rather than supported (Barra et al., 2020; Baggio et al., 2018; Cassidy et al., 2021). The school-to-prison pipeline has been extensively researched, but with minimal connection to the lagging skills often found in justice-involved youth that can relate back to adult misinterpretation of behavior (Greene & Winkler, 2019). The diagnosis of ADHD is heavily reliant on an interpretation of behaviors as reported by adults, and racial bias in these reports and their interpretation has been repeatedly demonstrated in the literature (Fadus et al., 2019).
An alternate approach to challenging behavior is to disregard the behavior as the primary concern, and instead use the unexpected behavior as an indicator of expectation and skill incompatibility (Greene & Winkler, 2019). With the foundational reframing of all behavior as communication and communication only, adult misinterpretation of the willfulness or negative attribution bias is eliminated. Using the Collaborative & Proactive Solutions (CPS) treatment model, the unbiased adult engages in a collaborative exploration process with the adolescent to identify the lagging skill or unsolved problem and engage in a proactive collaborative course of action together with the adolescent.
The standard intervention for adolescents with challenging externalized behavior is Parent Management Training (PMT), which is based on the premise that ineffective parenting has resulted in coercive behavior from the child (Greene & Winkler, 2019). It has elements of behavior modification with incentivization, which is reliant on outdated theories of motivation and does not address lagging skills or include collaboration with the adolescent. Various studies have demonstrated CPS is at least as effective as PMT in settings including outpatient family interventions, schools, and restrictive facilities. In psychiatric facilities and detention centers, restraint/seclusion episodes and durations were significantly reduced, staff and patient injury rates were significantly reduced, and recidivism was reduced from 65% to 15%.
The CPS model demonstrates the potential for significantly reducing unexpected behavior when behavior is viewed as communication rather than as the problem (Greene & Winkler, 2019). This reframing requires adults to set aside their interpretation of behavior and instead engage in a collaborative problem-solving process including the adolescent and allowing the adolescent to participate in a meaningful way to come up with a solution to resolve the problem with the support of a facilitating adult. This requires the adult to be willing to accept a solution potentially different from their own solution, and to be willing to set aside their preconceived notion of the source of the problem. In doing this, not only are the adults enabling the identification of unmet needs, they are also demonstrating how to solve a problem incorporating the perspective of another person, rather than the coercive models typically employed by adults in response to unexpected behavior from adolescents lacking effective communication skills. Systemically replacing the adult’s conclusion about the meaning of the behavior with an inquiry into the cause of the behavior is likely to improve the outcomes for all adolescents, but particularly those most at risk for remaining misunderstood and punished for their lagging skills.
There is an opportunity to significantly reduce undesirable behavior by adjusting the perception of behavior from a behaviorism perspective of a problem requiring change to the communication of an unmet need (Greene & Winkler, 2019). Negative behavior prevents parents from recognizing unmet needs communicated by behavior, and ineffective parenting results in escalating problem behavior (Colalillo et al., 2015). Negative behavior attribution from teachers results in unequal treatment between similar students, often leading to significantly worse outcomes for minority students (Halberstadt et al., 2018). Diagnostic bias and criminalization of developmentally appropriate or disability-related behavior disproportionately impacts minority adolescents and has very significant implications on life trajectory (Fadus et al., 2019; Hughes et al., 2020). Founded on behaviorism, restraint and seclusion in schools and care facilities may serve to create short-term behavior modification but does not address the underlying unmet need and its application has resulted in adolescent death (Tolley, 2019). Setting aside any interpretation of the behavior and instead focusing on the cause of the behavior is an alternative way to address the concern in a proactive, collaborative way that is expected to greatly improve life trajectory for adolescents (Greene & Winkler, 2019). This collaborative process may be difficult for some to implement and there are challenges with institutional application fidelity, so it would be beneficial to develop framework to implement in the simplest and streamlined way possible. However, simply putting aside conclusions on what behavior means and instead listening to discussion of the underlying reason for the behavior would be a significant improvement over current typical exchanges around unexpected behavior.
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