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Katerina is eleven years old and is failing most of her subjects. She can barely sit still or concentrate and homework is always a struggle. At home, she is withdrawn and seems angry often. She also becomes physically aggressive at times. Her parents note that Katerina hides food in her room and has a tendency to break her toys.

Katerina's parents describe a home that is far from peaceful. As loving parents, they have devoted most of their time, energy, and finances towards helping Katerina. They are left feeling like "failures" and are utterly exhausted. They tell me that they are tired of behavior charts, diagnoses such as ADHD and ODD, medication and poor reports from teachers.

They ask me if I believe their child hates them. I reassure them that she doesn’t.

Unfortunately, most professionals address what's on the surface without considering what's underneath the behavior. It's important to consider challenging behavior as an iceberg. We only see the tip - yelling, aggression, failing grades, and broken toys. However, if we act as if the tip is all there is, we'll head down the wrong path. The wrong path is comprised of misdiagnosis, mistreatment, and misunderstanding. The wrong path results in kids (and parents) feeling ashamed and left in crisis.

If we're conscious of the biggest piece of the iceberg, beneath the surface, it results in a full understanding of the behavior. A better understanding can lead to better treatment and outcomes.

What's under the surface can vary from child to child but can often be found by looking at a child's history. For many of our kids, their histories involve stress and trauma. Research shows nearly half of our nation's children (approximately 35 million) have experienced at least one Adverse Childhood Experience (ACE). According to the Center for Youth Wellness, ACEs are “traumatic experiences [in childhood] that can have a profound effect on a child’s developing brain and body with lasting impacts…through a mechanism called 'toxic stress.'" "Toxic stress" is the extreme, frequent, or extended activation of the stress response, without the buffering presence of a supportive adult. " (American Academy of Pediatrics)

After looking at Katerina's history, her behaviors started to make sense. She was adopted. Prior to her adoption she had experienced abuse, neglect, and relied upon herself to survive. Katerina hides food in her room because she is accustomed to not being fed. She breaks her toys because she feels she is unworthy of positive things and experiences. She has difficulty in school as her brain remains in a hyperaroused state and groups of children trigger traumatic memories from the orphanage. Katerina doesn’t hate her parents. Her anger makes it easy for adults to keep their distance, physically and emotionally, since she does not trust them. It's no wonder why traditional parenting and approaches to her challenging behavior were not working.

It's time we stop labeling kids as "acting out" or "having issues" and ask - what's beneath this behavior? And what can I do to help? All it takes is a simple mind shift.

Fortunately, Katerina's adoptive parents were able to replace their frustration with empathy, access effective services, and help Katerina's teachers see beneath the surface of her challenging behaviors. But what about the other millions of kids who have a history of trauma and/or stress? These are kids we see every day in our homes, communities, and schools. They may not have lived in an orphanage, but chances are they've experienced at least one ACE.

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FROM THE EDITOR
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