Acting out





Definition

Acting out is defined as the release of out-of-control aggressive or sexual impulses in order to gain relief from tension or anxiety . Such impulses often result in antisocial or delinquent behaviors. The term is also sometimes used in regard to a psychotherapeutic release of repressed feelings, as occurs in psychodrama.

Description

Infants and toddlers

The earliest acting out behaviors are often referred to as temper tantrums . These behaviors are usually first observed in infants between the ages of 12 and 18 months of age. At that point, temper tantrums can be considered a normal part of growth and development. These early tantrums are simply an infant's attempt to communicate feelings of dissatisfaction or extreme disappointment. Observed behaviors in infants trying to express their anger or frustration usually include patently angry-sounding crying, kicking hands and feet, and possibly even trying to strike out. For toddlers, such violent outbursts of temper often include hitting, kicking, and biting others; and possibly self-injurious behaviors such as head-banging. The child's reaction to the supposed cause of the tantrum is often markedly disproportionate to the precipitating incident. An example would be the child who is told that he or she cannot have a lollipop and then proceeds to violently attack the mother, hitting and kicking her, while screaming as loudly as possible.

Acting out conduct can include any highly emotional, disruptive, and unacceptable outburst that appears to be the child's reaction to unmet needs or wishes. A primary reason for such emotional lack of control in a child, especially above the age of three or four, is having not learned how to cope with their own frustration. Such temper tantrums usually peak between the ages of two and three. Because under normal circumstances the child has learned the necessary lessons in how to deal with disappointment by the time he or she has reached the age of four, there is then a noticeable decrease in this sort of acting out behavior.

Preschool and school age children

When no medical or psychological determination is discovered for acting out behaviors in young children above the age of four, the assumption can be made that the temper tantrums are a learned behavior. Toddlers and preschool children very rapidly learn the effectiveness of such acting out. If parents or other caregivers acquiesce to the child's wishes each time to avoid the occurrence of a tantrum, it quickly becomes obvious to the child that this is the most successful means of getting his or her wishes fulfilled. Acting out quickly becomes a time-honored response to the word "No."

More critical negative behaviors including aggressive or abusive actions toward other children, animals, adults, or even themselves are usually a more serious and longer-lasting form of acting out. These are usually related to more momentous causes including mental illness or pathological conditions in the child's life, either in the home or in some other facet of the child's environment. Such negative childhood conduct is often seen in children who have been the victims of physical and/or sexual abuse or of severe neglect. Such acting out for this group of children is often referred to among mental health professionals as "a cry for help." Though certainly significant problems, acting out in the form of various rebellious behaviors that are not self-injurious or life-threatening is considered the less serious form of this "cry for help." These actions include disobeying parents and teachers, non-life-threatening alcohol or drug use, promiscuity, and exercising poor judgment in relationships and activities.

Common problems

High-profile crimes such as the Columbine High School shootings have made most people much more acutely aware of the potential danger involved in young people acting out in a highly antisocial manner. In 2000, the National Institute of Mental Health (NIMH) began to study child and adolescent violence in the United States. One of NIMH's initial findings indicates that though youth violence is indeed a serious problem, events such as Columbine are a rare occurrence. On average across the United States, every day six to seven young people are murdered by their peers. The overwhelming majority of these homicides occur within the confines of inner cities, and the average victim is a member of a minority group. These teenagers' deaths for the most part do not occur on school grounds. Moreover, many factors other than those that cause acting out may contribute to these crimes.

The NIMH found in its research that causes for serious acting out include the following:

  • weak bonding with parents, caused by parents being physically or emotionally unavailable to the child
  • impotent parenting as manifested by failing to watch over children, by being excessively strict, or by providing harsh and inconsistent discipline
  • a home environment that exposes children to violence and supports and models aggressive and violent behaviors
  • the impact of rejection by or competition with peers in early school years (In some cases this experience results in children who do not succeed socially or academically banding together to act out. This tendency to band together appeared to be true of the Columbine High School perpetrators.)
  • gender (From approximately the age of four years, boys were found by the NIMH study to be more likely than girls to engage in aggressive, acting out behaviors.)
  • child psychopathology (The NIMH study suggests that children with behavioral difficulties are likely to have two or more psychological problems such as conduct or anxiety disorders or depression.)
  • lower socioeconomic status (A correlation between low family income and antisocial acting out has been repeatedly noted.)
  • heredity (Perhaps the most surprising factor of the NIMH study has been the possibility that genes may indeed influence behaviors. Exactly how genetics affects personality and mental illness is not clearly understood. How the environment interacts with this genetic component also remains a mystery. However, in 2004 this genetic ingredient in acting out behaviors was a topic of study for the NIMH.)

A 2001 Carleton University (Ottawa, Canada) study published in the Journal of Research in Childhood Education attempted to look at means of predicting which preschool children would be more apt to act out or experience academic or social difficulties in school. The study entitled "Solitary-Active Play Behavior: A Marker Variable for Maladjustment in the Preschool?" concluded that young children who play alone in a very active and boisterous manner were more likely to have adjustment problems in school.

Problems identified for this group of children include the following:

  • exhibiting a lower attention span
  • being more difficult to comfort
  • being more timid and bashful
  • showing more aggression and acting out
  • doing poorer on academic testing for early skills
  • showing a less positive response to being in school
  • showing less ability to form positive relationships with other children

The Carleton study asserted two points: first, their research gave no evidence that these children had less learning ability than other children, but rather that they simply experienced problems with adjusting to school; second, it is normal for preschool age children to engage in solitary play. However it is the mode in which a child plays alone—in an overly boisterous, hyperactive manner—that seems to provide the marker for potential acting out problems later. The Canadian researchers undertook this study not to merely identify future acting out children, but to find those children who could benefit from specialized and comprehensive educational programs that address both academic and social needs.

Parental concerns

When to call the doctor

The parent whose child exhibits the negative behaviors called "acting out" probably wonders what is normal and what is not. Well-meaning friends and family may assure them that the child "will grow out of it" when the acting out behaviors are clearly not a normal part of growth and development. Some people consider acting out behaviors as simply part of the learning process for young children not requiring professional help. The results of appropriate parental intervention may suggest the real severity of the behavior. For example, the child who ceases having temper tantrums once he or she realizes that the tantrum will not get him or her the desired result has both identified the severity of the problem and resolved the identified problem for their parents.

Temper tantrums after the age of four or in children younger than four when very frequent and/or prolonged (that is, lasting longer than a half hour) should be evaluated by a healthcare professional as there may be a other medical or psychological causes. Any type of acting out behavior that can be termed unsafe, damaging to others, or self-injurious will probably need to be evaluated by the child's healthcare provider.

Among the forms of acting out behavior seen in children and teens that warrant professional attention are the following:

  • pathological lying
  • bullying others
  • self-injury, such as cutting self or head-banging
  • alcohol or drug abuse
  • truancy
  • running away
  • participating in unsafe sexual activities
  • getting into fights
  • assault
  • vandalism
  • fire-setting
  • stealing
  • rape
  • homicide

Coping with acting out in toddlers

For toddlers, most childcare professionals recommend that parents make it obvious that temper tantrums are not an appropriate way to handle disappointment. Giving a "time out," having the child go to his or her room or another quiet area for a set period of time or until able to interact in a socially acceptable manner, is an effective means of dealing with this form of acting out. Though small children often do not appear able to hear or comprehend reason, it is perfectly appropriate for parents to note that they understand the child's disappointment or frustration but that the child's negative behavior will not alter the situation. Some parents combine time outs with the message, "Deal with it." As time has gone on, the time outs become less necessary, and the direction "Deal with it" is enough for the child to regain self-control. The child learns that people do not always get what they want.

A research program under the auspices of NIMH has as of 2004 two decades of experience in the prevention of serious childhood acting out. The Nurse Home Visitation Program operates in Colorado, New York, and Tennessee. Nurses visit high-risk families beginning during a pregnancy and continuing through the child's second birthday. The selected families are considered at-risk because they have low income and/or a single parent. The goals of the visits are to improve the outcome in childbirth , promote the child's health and development, and aid in increasing the family's financial self-sufficiency. Follow-up of these children to the age of 15 show them to have fewer behavioral problems than comparable 15-year-olds without the service. Behavioral problems studied included use of drugs and alcohol, running away, sexual acting out, and arrests and convictions for crimes.

KEY TERMS

Antisocial —Actions described as impulsively aggressive, sometimes violent, that do not comply with established social and ethical codes.

Anxiety disorder —A mental disorder characterized by prolonged, excessive worry about circumstances in one's life. Anxiety disorders include agoraphobia and other phobias, obsessive-compulsive disorder, post-traumatic stress disorder, and panic disorder.

Attention deficit hyperactivity disorder (ADHD) —A condition in which a person (usually a child) has an unusually high activity level and a short attention span. People with the disorder may act impulsively and may have learning and behavioral problems.

Conduct disorder —A behavioral and emotional disorder of childhood and adolescence. Children with a conduct disorder act inappropriately, infringe on the rights of others, and violate societal norms.

Delinquent —A term applied to young people who behave in a manner in defiance of established social and ethical codes.

Depression —A mental condition in which a person feels extremely sad and loses interest in life. A person with depression may also have sleep problems and loss of appetite and may have trouble concentrating and carrying out everyday activities.

Psychodrama —A specific form of role play that focuses on acting out "scripts" of unresolved issues within the family, or helping family members adopt new approaches and understanding of one another.

Psychopathology —The study of mental disorders or illnesses, such as schizophrenia, personality disorder, or major depressive disorder.

Psychotherapy —Psychological counseling that seeks to determine the underlying causes of a patient's depression. The form of this counseling may be cognitive/behavioral, interpersonal, or psychodynamic.

Coping with acting out in preschool and school age children

The Administration on Children, Youth, and Families (ACYF) has collaborated with NIMH in developing several assessment tools to identify children at risk for behavioral problems. Many of these tools are designed to pinpoint even preschool children at risk, and are provided within such programs as Head Start. It is now known that 70 to 80 percent of all children provided services for mental health problems in United States schools have these services delivered by the school system itself, by school guidance counselors and psychologists. Several recent initiatives by the NIMH have as their goal working with the child, classmates, parents, and teachers to reduce disruptive behavior. The Families and Schools Together (FAST) Track Program currently operates in North Carolina, Pennsylvania, Tennessee, and Washington. FAST Track has studied aggressive children from the age of six on for several years now, providing intervention as necessary. Follow-up studies have shown that those FAST Track Program children who received intervention required less special education services by grade 3 than children that did not participate in the program.

The Coping with Stress Course is a group educational program as of 2004 provided to adolescents in Maryland, Ohio, and Oregon. Its purpose is help young people develop strategies for coping positively with their negative thinking, tendencies toward depression, and acting out behaviors. Initial results from this course have shown successful outcomes for course participants. Among teens who did not take the course, symptoms of depression were reported twice as often. Adolescents taking the Coping with Stress Course showed a reduction in depressive symptoms and an increase in overall positive adjustment. However, it appears that time reduced the potency of this learning experience. Research over a longer period showed less difference between the two groups.

The NIMH study of acting out concluded that it is a multi-faceted problem involving the interactions between the child and his or her family, friends, classmates, school, and community. Children who have a warm, loving, and supportive childhood are far less likely to act out as a cry for help or to act out in a violent manner. Two types of teen antisocial behavior have been identified by NIMH: life course persistent and adolescence limited. Teens with life course persistent behaviors act out in violent ways from early childhood on, in a variety of situations. They are considered to have psychopathology, often including attention deficit hyperactivity disorder (ADHD). They usually continue with negative behaviors into adulthood. Those young people with adolescence limited behaviors typically act out in specific defined social situations and usually stop acting out behaviors before reaching adulthood.

See also Antisocial behavior .

Resources

BOOKS

Kelly, Kate. The Baffled Parent's Guide to Stopping Bad Behavior. New York: McGraw-Hill, 2003.

Swanson, Noel. Good Child Guide: Putting an End to Bad Behavior. London: Aurum Press, 2000.

WEB SITES

Association for Childhood Educational International (ACIE). Available online at http://www.acei.org (accessed October 15, 2004).

National Institute of Mental Health. Available online at http://www.nimh.nih.gov.htm (accessed October 15, 2004).

Joan Schonbeck, R.N.



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