In its many forms, behavior therapy is a powerful tool for treating a wide range of psychological disorders in children, aiming to increase their skills and give them more options for how to respond to situations and events (Stallard, 2021; Corey, 2013).
As counselors and therapists, we can take many of its tools and techniques to create powerful yet fun interventions to help our young clients with depression, anxiety, post-traumatic stress disorder, and more.
This article explores behavior therapy for kids, its modern interpretations, and its potential for working with toddlers, young, and older children to support their mental wellbeing and develop effective coping and behavioral strategies.
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Behavior therapy has developed over many years and takes several different forms, yet it still plays a vital role in treating children’s psychological problems (Corey, 2013; Stallard, 2021).
Indeed, having evolved into Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and mindfulness-based stress reduction, it remains successful in treating behavioral and mental health problems in many young people (Kallapiran et al., 2015; Stallard, 2021; Zalewski et al., 2020).
Such therapy is vital. “Therapists are increasingly called on to provide evidence-based treatments to the children and families with whom they work,” with research suggesting that young minds function similarly to adults in many respects (Flessner & Piacentini, 2017, p. 3).
CBT, in particular, includes various interventions focusing on the “relationship between cognitions, emotions, and behaviors” and is the most well-evaluated and established approach of all child psychotherapies (Stallard, 2021, p. 16).
Research consistently shows CBT’s effectiveness in treating a range of problems in children, including (Stallard, 2021):
Post-traumatic stress disorder
Studies also document the success of third-wave positive CBT interventions, such as mindfulness, DBT, and ACT, in treating children (Stallard, 2021).
Check out this video explaining how behavioral modification can help children make better choices.
Behavioral modifications in kids - just a thought
In the following video, we gain a deeper understanding of behavior therapy as a treatment to improve children’s self-esteem and self-control.
Behavior issue and behavior therapy
3 Helpful Techniques
Behavioral therapy offers a wide range of techniques, many of which are based on classical and operant conditioning.
They support and reinforce helpful, positive ways of behaving and are beneficial for treating children in various challenging situations (Stallard, 2021).
For example, systematic desensitization can help young people confront their fears, while response prevention and exposure treatments can support overcoming obsessive-compulsive disorders (Stallard, 2021).
In more detail, here are several behavioral techniques (Stallard, 2021).
Developing fear hierarchies
Skill development is vital for helping children manage challenging situations and is often facilitated by a process of graded exposure (Stallard, 2019).
“The process of breaking down challenges or fears involves generating a list of the small steps that will take the young person towards their goal of overcoming their fear or challenge” and understanding the situations in which they occur (Stallard, 2021, p. 77).
For example, a child afraid of crowds may avoid busy situations such as boarding a train or going to the movies.
Once identified and understood, the therapist can help the child select a goal they can begin with and work toward, such as meeting a friend for a playdate. The child then rates their anxiety when considering each step or task involved in reaching their goal.
Walking down the street on a quiet Sunday morning may only score 60 out of 100, while entering the playground at peak time reaches 90.
Developing a fear hierarchy helps the child (and their parents) target particular actions and recognize successes one step at a time (Stallard, 2021).
Having established a fear hierarchy, the child can move on to a process of graded exposure, where they begin facing their fears, albeit gradually (Stallard, 2021).
Through slowly and increasingly exposing the child (according to a plan agreed upon by them) to a higher degree of fear, they learn what they can handle without recourse to avoidance (of particular situations or events) or relying on unhealthy habits.
However, the child must be clear on the rationale behind the process and why facing their fear is beneficial. The therapist will help the child understand (Stallard, 2021):
Why they have been avoiding situations and relying on repetitive behaviors to manage their anxiety
How avoidance and habits offer short-term relief but do not ultimately help them cope
How facing their fears is a different approach that may help them reclaim their life
That they can take their fears with them rather than letting anxiety stop them from doing things they want
How learning to tolerate unpleasant feelings will reduce their anxiety
A full explanation of the rationale helps the child feel less apprehensive.
Additionally, each step toward the chosen goal must be manageable and achievable.
The child may wish to rate their anxiety using a score out of a hundred during and after the exposure to increase their sense of control and recognize its decline when they stay in the situation (Stallard, 2021).
Once the graded exposure exercise is complete, it may help them to reflect on what they discovered, celebrate their achievements, and set their next goal.
Young people experiencing obsessive-compulsive disorder (OCD) often engage in safety behaviors — repetitive and compulsive habits to prevent bad things from happening (Stallard, 2021).
These might include excessive cleaning (of oneself or objects), endless checking (faucets are off, doors are locked), or counting (performing actions a set number of times).
Such behaviors can bring temporary relief from anxiety but do not last.
The goal of response prevention is to face the fear without engaging in the safety behavior.
The nature of the intervention depends on the fear experienced by the child. Examples for a child with OCD might involve the following (Stallard, 2021):
If they fear contamination, ask them to touch a toilet seat and delay washing their hands.
If they feel the need to maintain order or arrange objects to avoid a bad thing happening, change the sequence of something, such as favorite books or toys.
If they have a fear of a particular event, such as a running faucet causing a flood, leave it on until they have dried their hands.
Again, the child must have a clear rationale and understanding of why the process helps.
For example, explaining that while continually repeating their habits may temporarily make them feel better, they can learn that they don’t need it when they notice their worrying thoughts.
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Behavior Therapy in Schools: 4 Strategies
Addressing mental health issues in schools is recognized as valuable in promoting a thriving learning environment and supporting academic achievement (Crenshaw & Stewart, 2015).
Several well-proven strategies include the following.
“It is common for young people with psychological problems to ignore or overlook their achievements” (Stallard, 2021, p. 88). Without a reward, children may not reproduce what led to the positive outcome.
Therefore, positive consequences can help increase the likelihood of a behavior happening, while harmful consequences can reduce it.
Incentives can take various forms and are not limited to money or prizes. They might include self-praise, recognition from others, extra time for doing fun things, etc. (Stallard, 2021).
The following steps can help set up reward systems in school (or home settings):
Define clear, positive behaviors. Identify specific and positive target behaviors.
Rather than vague or negative terms like “being good” or “not fighting,” use precise, affirmative language such as “sitting quietly during mealtime” or “sharing toys graciously.”
Establish meaningful rewards. Work with the child to choose a motivating and attainable reward, ensuring it holds personal value for them.
It doesn’t have to be extravagant or costly. Consistent praise and recognition are equally crucial in reinforcing positive behavior.
Set achievable targets. Agree on how often the expected behavior should happen and a suitable reward.
Consider the nature of the behavior, ensuring the goals are reachable within a short enough period to hold the child’s motivation.
Be consistent. Maintain a uniform approach by consistently recognizing and rewarding the agreed-upon behavior.
Being consistent can be challenging, as it involves unwavering adherence to the reward system rules, positively reinforcing the desired behavior, and avoiding reward withdrawal due to unrelated misbehavior.
Emphasize importance and encouragement. Use the reward chart to draw attention to progress and offer frequent praise and acknowledgment.
Even on challenging days, it’s essential to encourage the child to persevere. Remind them of their progress and the rewards they can achieve through positive behavior.
While role-play is often used in therapy, it can be helpful in school settings (Saptono et al., 2020).
When used effectively, playing out roles can help practice coping and communication skills and work through what has happened or could occur in the future (Stallard, 2021).
For example, role-play a particular incident: “I got upset when working on the team project last week. What could I do differently next time?” or more generally, “I get annoyed when I don’t get something right the first time, but going forward, I will try to accept that learning takes time.”
Problem-solving is a vital aspect of learning. Frustration, anxiety, and fear may hinder decision-making, leading to emotive rather than rational choices that delay or avoid addressing educational issues and challenges (Juandi, 2021).
For younger schoolchildren, a red, yellow, green traffic light strategy offers a simplified, three-step approach to tackle challenges (Stallard, 2021):
RED – Stop and identify. Encourage the child to pause and clearly articulate their problem. It’s about ensuring they understand the issue before rushing to solve it.
YELLOW – Think and consider. Prompt them to brainstorm possible solutions. They can then evaluate each one, weighing its pros and cons, and decide which seems most promising.
GREEN – Act and reflect. Lastly is the action phase, where children proceed with the chosen solution. Encourage them to seek any necessary assistance and, importantly, to reflect upon the outcome. Was the solution effective? Would they use it again? Such post-action reflection helps reinforce the problem-solving process.
The easy-to-remember traffic light method structures problem-solving into distinct phases, guiding children through a deliberate thinking process rather than allowing them to act impulsively (Juandi, 2021).
Behavioral aspects of CBT can remove many of the limitations of verbal treatment in younger children (Crenshaw & Stewart, 2015).
Cognitive-Behavioral Play Therapy is a particularly effective treatment for anxiety and, therefore, helpful in school settings. It leverages children’s natural means of expression — play — to help them process and cope with their emotions and experiences, offering (Crenshaw & Stewart, 2015):
Children learn to understand and solve problems on a deeper level through play, gaining valuable insights into various, often complex, situations.
This encourages adaptability, allowing children to approach problems from multiple angles and understand possible ways to tackle challenges.
Children expand their imagination and creativity, exploring possible solutions and ideas.
Alternative coping strategies
Play scenarios and environments enable children to develop different methods of managing daily issues, providing them with practical coping mechanisms.
Positive emotional experiences
Allows children to experience joy, which can be therapeutic and contribute to emotional wellness.
Exploration of emotions
Such therapy creates a safe space for children to express and think about various emotional themes, both positive and negative, helping them process how they feel.
Empathy and perspective taking
During interactions, children learn to understand others’ emotions and view situations from their standpoint, fostering empathy and social understanding.
This supports children’s ability to adapt, helping them become well-rounded individuals capable of handling various social situations and life changes.
Play therapy offers a holistic approach to children’s behavioral therapy by tapping into multiple processes simultaneously, “helping children address emotional and behavioral problems” (Crenshaw & Stewart, 2015, p. 84).
6 Fun Games and Exercises for Your Clients
Games offer young clients a helpful and energizing tool for engaging in things they enjoy, socializing, feeling a sense of achievement, and spending less time on negative thoughts (Stallard, 2021).
The following is a sample of several fresh and fun games and exercises that can be used to encourage engagement, build upon skills, and improve emotional awareness in children:
Future Forecast: Decision Impact Exercise
In this fun exercise, children role-play scenarios and explore decision-making and their consequences. In doing so, they list options, predict outcomes, and reflect on their choices.
Choose Your Path Adventure
In this playful activity, the child embarks on imaginary adventures, facing challenges and making decisions. Along the way, they explore actions, discuss outcomes, and review their journey.
Magic Detective Game
A young client investigates (apparently) “silly” or troubling thoughts, testing their validity. Using detective play, they search for evidence to confirm or refute these beliefs.
Fear Ladder Challenge
For this task, the child identifies fears and sets gradual and incremental challenges to confront them. A ladder helps track their progress and reflect on their bravery.
Fun Detective Diary
During this enjoyable exercise, children become “detectives” to rediscover activities that boost their mood. They document them and observe their impact on emotions.
Body & Mind Superheroes Activity
Clients explore dilemmas based around superheroes, learning to recognize warning signals. Next, they work through positive behaviors to build a helpful toolkit for finding solutions to tricky situations.
Behavioral therapy has proven helpful in clients with autism who experience anxiety during treatment (Stallard, 2021).
Research has shown that approaches such as CBT, ACT, and mindfulness are effective and practical for addressing anxiety, disruptive behaviors, and other symptoms in clients with autism, ultimately enhancing their psychological wellbeing (Danial & Wood, 2013; Byrne & O’Mahony, 2020; Cachia et al., 2016).
A Take-Home Message
As a therapist, understanding and embracing tools and techniques for behavior therapy for kids can be transformative in helping children overcome psychological challenges.
Rewards are powerful for reinforcing positive behaviors in children. They involve using clear definitions, meaningful incentives, achievable targets, consistency, and encouragement to make change appealing to children.
Role-play can also be effective in therapy, at home, and in school. Supporting and engaging with young clients as they act out a scene as themselves or others in their lives can offer helpful insights when trying out coping and communication skills.
Children also benefit from becoming better problem-solvers, particularly in their education. Learning the skills and mindset involved supports deliberate thinking and decision-making and can reduce the likelihood of impulsive actions.
Play helps address anxiety in school and home settings, promoting problem-solving, flexible thinking, emotional exploration, empathy, and general adjustment in children.
Therapists can create engaging, effective, and enjoyable interventions to support children’s mental wellbeing and enhance their coping strategies by embracing these fresh and fun ideas.
Try out several of the fun activities and exercises to empower your young clients on their path to better mental health.
A child behavior therapist works with young people engaged in unhelpful or harmful behavior to give them the required skills to have more options for responding to situations (Corey, 2013; Stallard, 2019).
Does my child need behavior therapy?
When a child is having behavioral issues, such as having more tantrums, withdrawing socially, seeming unsettled and restless, or displaying a sudden shift in usual interests and habits, it could be helpful to seek the support of an expert in child therapy (“6 signs,” 2020; American Psychological Association, 2008).
How do I fix bad behavior in children?
To address serious or severe behavioral and emotional disorders in children, it may be necessary for parents and caregivers to seek professional diagnosis and treatment. Early intervention, evidence-based therapies, and parental involvement are crucial in helping young children overcome such challenges (American Psychological Association, 2008).
6 Signs your child needs counseling. (2020, October 8). Children’s Bureau. Retrieved October 25, 2023, from https://www.all4kids.org/news/blog/6-signs-your-child-needs-counseling/.
American Psychological Association. (2008). What parents should know about treatment of behavioral and emotional disorders in preschool children. Retrieved October 25, 2023, from https://www.apa.org/topics/children/treatment-behavioral-emotional-disorders-preschoolers
Byrne, G., & O’Mahony, T. (2020). Acceptance and commitment therapy (ACT) for adults with intellectual disabilities and/or autism spectrum conditions (ASC): A systematic review. Journal of Contextual Behavioral Science, 18, 247–255.
Cachia, R. L., Anderson, A., & Moore, D. W. (2016). Mindfulness in individuals with autism spectrum disorder: A systematic review and narrative analysis. Review Journal of Autism and Developmental Disorders, 3(2), 165–178.
Corey, G. (2013). Theory and practice of counseling and psychotherapy. Cengage.
Crenshaw, D. A., & Stewart, A. L. (Eds.). (2015). Play therapy: A comprehensive guide to theory and practice. Guilford Press.
Danial, J. T., & Wood, J. J. (2013). Cognitive behavioral therapy for children with autism. Journal of Developmental & Behavioral Pediatrics, 34(9), 702–715.
Flessner, C. A., & Piacentini, J. (Eds.). (2017). Clinical handbook of psychological disorders in children and adolescents a step-by-step treatment manual. Guilford Press.
Juandi, D. (2021). Heterogeneity of problem-based learning outcomes for improving mathematical competence: A systematic literature review. Journal of Physics: Conference Series, 1722(1).
Kallapiran, K., Koo, S., Kirubakaran, R., & Hancock, K. (2015). Review: Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: A meta‐analysis. Child and Adolescent Mental Health, 20(4), 182–194.
Saptono, L., Soetjipto, B. E., Wahjoedi, W., & Wahyono, H. (2020). Role-playing model: Is it effective to improve students’ accounting learning motivation and learning achievements? Jurnal Cakrawala Pendidikan, 39(1), 133–143.
Stallard, P. (2019). Thinking good, feeling better: A cognitive behavioural therapy workbook for adolescents and young adults (2nd ed.). John Wiley & Sons.
Stallard, P. (2021). A clinician’s guide to CBT for children to young adults: A companion to think good, feel good and thinking good, feeling better (2nd ed.). John Wiley & Sons.
Zalewski, M., Maliken, A. C., Lengua, L. J., Martin, C. G., Roos, L. E., & Everett, Y. (2020). Integrating dialectical behavior therapy with child and parent training interventions: A narrative and theoretical review. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1111/cpsp.12363.
About the author
Jeremy Sutton, Ph.D., is a writer and researcher studying the human capacity to push physical and mental limits. His work always remains true to the science beneath, his real-world background in technology, his role as a husband and parent, and his passion as an ultra-marathoner.