Discerning Manipulative Behavior From Stress Episodes in Children

PTSD

Children who have experienced interpersonal trauma often also come out of family of origin situations where there were poor boundaries and limits. The child may have learned many manipulative techniques in order to get their basic physical and emotional needs met. As such, these layers of behavior become complex and difficult to separate out into what is simple childhood misbehavior, what is manipulation, or what is stress episode behavior. On top of this, a child who is actively in a stress episode may be engaging in highly manipulative behaviors. It is important to keep in mind why the child has this behavior set when in a stress episode: these skills may have been quite useful in avoiding further interpersonal trauma, or they may have even served to save the child’s life. That make the child very reluctant to give them up.

The adult caregiver with the child must have the skills and the willingness to work at making a differential diagnosis of what they are seeing: is this simple manipulation, or the onset or active process of a stress episode?

Despite any clear manipulations observed, if the child is entering into or is actively in a stress episode, simply treating the manipulation with behavioral modification strategies will not work. The stress episode must take precedence, as it is the primary problem. Don’t get stuck on treating the manipulation inside the stress episode, it is just a symptom of a bigger problem!

Careful and extended behavioral observation is key to being able to identify the differences. Many stress disordered children will have unique physiological signs, such as agitation, flushed skin, pupil dilation, and noticeable increase of respiration when they are entering or in a stress episode. Some children will have a subtle (or not so subtle) change in affect or personality presentation. Remember the idea of differential diagnosis: all of the above signs could be mistaken for “oppositional defiant”. The difference is, you have a history and diagnosis of interpersonal trauma/abuse

Further, most children will display small behaviors prior to the stress episode’s full onset. These may be things like pacing, pulling at their hair, sucking their thumb, or engaging in manipulative behaviors. Early intervention is possible if the adult helper is willing to learn the child’s early behavioral “tells” and to respond to them appropriately. This does not mean using a high force, consequential behavior modification to stop the manipulation, it means that you target the stress as the priority of what to treat.

If the adult helper is still confused as to what is being observed, they can experiment by comparing the child’s response to behavioral modification interventions when there is certainty that he child is not in a stress episode and the response when a stress episode is suspected. The result will be that the child will clearly escalate in agitation when in a stress episode. When not in a stress episode, the behavior modification interventions will be effective with the child.


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