How to Help Irritable Children

We all utilize a variety of defense mechanisms in our daily life. Defense mechanisms allow us to regulate our emotions when faced with stress that emanates from our environment or stress that emanates from within ourselves. Some defense mechanisms help us adapt to our social situation more effectively, while others make things worse for us. Clinicians have been aware for a long time that children, especially those who are vulnerable, have difficulty experiencing painful emotions (Hoffman, 2007). To avoid feeling bad, such children protect themselves with a variety of techniques such as isolating themselves, withdrawing from family and friends, or denying that they feel troubled.

It's easier to be mad than to feel sad

Children who have the propensity to be irritable may block out (defend against an awareness) the bad, painful emotions and instead become disruptive. They may yell, get angry, throw objects, or hit their families, friends, and teachers. In other words, the disruptive symptoms enable them to avoid feeling their painful emotions. It's easier to be mad than to feel sad. This kind of defensive action is very maladaptive since it results in more harm to the child. For example, such behaviors may result in severe punitive responses from family, school personnel, or others.

Regulation-focused psychotherapy (https://www.centerforrfp.org/)

The need for a systematic approach to help such children deal with their painful feelings more effectively led to the creation of the Manual of Regulation-Focused Psychotherapy for Children (RFP-C) (Hoffman, et al, 2016). This is a play therapy approach where the clinician forms a bond with the child and observes the child's patterns when they play and speak in the psychotherapy session. The clinician observes situations where children protect themselves by avoiding painful states. The clinician addresses those avoidance mechanisms (defense mechanisms). In this way, children gradually are able to regulate their emotions in a more effective and adaptive manner (Rice and Hoffman, 2014).

RFP-C is an experience-near technique where the clinician observes patterns in the treatment/play of children with irritability. There is an exploration of defenses against painful effects, especially as they are experienced in the relationship between clinician and patient (transference). A triangle of conflict allows for the conceptualization of the patterns, which leads to disruptive behaviors. In children with irritability, there is a repetitive sequence: There is always a triggering stimulus that is experienced by the child as a threat (the stimulus may appear to be trivial to onlookers); then, the child sees the event as the source of their frustration. Temper outbursts may result. Problematic consequences may occur for the child. RFP-C can be utilized by a wide range of professionals, even those without advanced psychodynamic psychotherapy training.

A pilot study (Prout, et al, 2019) and randomized controlled trial (RCT) of RFP-C (Prout, et al, 2021) was recently concluded. It empirically demonstrated the efficacy of the approach. The randomized control trial found an almost 80% response rate among irritable children and very low drop-out rates. In other words, it is both an effective approach as well as one in which parents feel comfortable allowing their children to engage.

Why is it valuable for parents and others to understand the triggers for a child’s disruptive behavior?

It is impossible for parents and teachers to always keep their cool. This is especially true when a child is angry, irritable, defiant, and/or oppositional. This behavior is really challenging to endure and manage—for both parents/teachers and children.

However, it is crucial for the adult to try to become aware that when an irritable child becomes disruptive, something happened to make the child feel very bad. It may be difficult for the adult to empathize with the child’s pain at the moment of such terrible disruption. However, after the event subsides, the adult can try to imagine, perhaps with the child together, what it was that the child could not tolerate. In this way, the adult can help the child appreciate that you, as the adult, understand that it was difficult for the child to express the bad feelings directly. Over time, parent/teacher and child can figure out ways to deal more effectively with emotions that are painful, and see that the disruptive behavior is an ineffective way to avoid the pain.

This way of thinking about the meaning of the child’s disruptive behavior allows adults to be sensitive to the child and to develop more awareness that the child is experiencing painful emotions. Rather than a knee-jerk reaction to the child’s actions, over time, the adult can develop a more reflective stance about their child and their emotional reactions.