One of our early referrals was three-year-old Casper (not his real name), a much-loved only child who was experiencing significant difficulties settling in to nursery. Nursery staff found it very difficult to cope with his temper tantrums and screaming. His language skills were delayed, and every day he put himself at risk in the nursery setting, running out of rooms into the kitchen and other off-limits areas in attempts to leave the building. Staff suggested to Casper's mother, Helen, that they seek support from our team.
At an initial meeting to gather background knowledge, Helen recounted the difficulties she was experiencing in managing Casper's behaviour at home.
It soon became apparent that responding to his behaviour created great stress for her. Helen was reluctant to take Casper to parks or playgroups for extended periods for fear that he would run off or throw a tantrum.
When they were out she had resorted to using a buggy to control his movements. Supermarket visits and bus trips with Casper were particularly distressing, especially as strangers would comment on her inability to manage his behaviour. Sometimes she would resort to giving him food to occupy and pacify him. These incidents only served to reinforce her own feelings of inadequacy as a parent.
Being confined to his buggy and having few opportunities for energetic play in open spaces appeared to be a significant factor in Casper being overweight for his age. Observations indicated that he had significant language delay, limited social interactions with peers and underdeveloped gross motor skills.
Casper had undergone the normal developmental health checks, but it emerged that relations with the health visitor had broken down, so Helen had not followed up any clinical support offered. However, the nursery staff had begun to establish an excellent relationship with Helen, on which our team was able to build.
Taking action
It was clear in our formulation that we should work closely with Helen to improve her confidence and parenting skills.
Photographs of Casper participating in a variety of activities were taken in the nursery. These were made into a book for Helen and Casper to share at home. The underlying message was that he was very special and he was at the same time able to participate like any of his peers at nursery.
We advised Helen to get Casper to help her push the buggy to encourage him to walk. A member of the team reflected with Helen on possible responses to unhelpful comments by members of the public. We acknowledged that it would be tempting to respond, but advised her to ignore these comments, which could open her up to a hostile reaction that would only make matters worse for her and Casper.
We also consulted closely with nursery staff to look at some practical ways in which the nursery environment could be organised to safely include Casper. A risk assessment was carried out and a childproof gate was put up, blocking off the main corridor.
Casper's day was extended to include staying for lunch. Consistency is vital to success, so it was agreed with all staff to implement a number of strategies at lunchtime to keep him engaged around the table.
Individualised place mats were introduced to stimulate conversation; Casper was given the responsibility of putting out cutlery and pouring drinks to encourage successful interaction with peers; he was served last to ensure that his interest in remaining at the table was sustained. When possible, staff were asked not to run after Casper if he left the room, as the outside area was now secure. When he did attempt to leave, staff were instructed to call after him with an instruction and the expectation that he would carry it out - for example, 'Casper, give me that cup.'
When staff experienced one of Casper's tantrums, they were advised to ensure that he was safe and remove other children from the vicinity.
Otherwise this behaviour was ignored, although a member of staff was always present and ready to offer reassurance when his temper subsided.
Like many children with a language delay, Casper chose to ride on the bikes during outdoor play. This activity does not require social interaction and enables the child to avoid the challenge of communicating. It was decided, therefore, to reduce the number of times bikes were available to the children.
Supporting hand
Following an assessment, the team's speech and language therapist and the inclusion teacher ran groups to support the development of Casper's language. Children who were models of good language and behaviour were chosen to join the group.
The inclusion teacher also worked directly with Casper and modelled ways of supporting him in the nursery. She followed his chosen activity to encourage his involvement, and through play, invited other children to interact with him, however briefly.
The team organised frequent meetings with Casper's mother and staff members to review the progress he had made. New targets were set for his Individual Education Plan.
As time went on, Casper's tantrums reduced in their frequency and intensity. Children became less wary of him, and his improving language development allowed him to interact more positively with his peers.
However, this progress itself brought new challenges for Casper. Having developed the confidence to engage in more frequent social interactions with peers, his difficulties with sharing, turn-taking and negotiating were revealed and he often resorted to hitting. We were able to use 'time out'
to direct him to another activity with an adult and divert him from potential conflict. The team members reassured his mother that these new challenging behaviours were not regression, but a consequence of practising the skills that were required for building social relationships.
During the months before he was due to transfer to school it was decided, in consultation with the team's educational psychologist and his mother, that a full assessment of Casper's needs would assist in determining the level of support he might need on entering his reception class.
Making progress
The multiprofessional structure of the team allowed us to offer advice to Casper's mother in becoming more confident in her parenting. It increased the range of strategies staff could employ in managing behaviour and encouraging language development. Suggesting a change to the physical environment allowed Casper to be included in his nursery.
And what did Casper think of our intervention? Well, during one of our phone calls to his mother towards the end of his time in nursery, he asked to speak to one of our teachers. 'Nessa,' he said 'I not shout at Jo any more!' There's progress!
All names have been changed
CAMDEN EARLY YEARS INTERVENTION TEAM
Camden Early Years Intervention Team was set up in 1998 by two teachers working for the London Borough of Camden's education department. Initially the team focused on working with children in nursery centres who had been identified as having challenging behaviour. As well as this direct work with children, the team ran training in centres and centrally through the education department on positive and pro-active behaviour management. The team has since expanded to include an educational psychologist, speech and language therapist and area special educational needs co-ordinator, offering a service to all early years settings in the Camden Early Years Development and Childcare Partnership.
The team also supports parents by offering advice and information and guidance around their child's developmental needs.
The relationship we have developed with parents has often been significant in its impact on how their child's needs are met and on the progress they make. The benefit of having team involvement is that we are able to support parents and staff by giving a fresh and multi-disciplinary perspective on the child.
Unfortunately, Camden Early Years Intervention Team cannot enter into personal communication with readers, but letters for publication can be sent to the address on page 3.
