Little Suzy recently started Kindergarten. Within the first several days of school, the teacher noticed that Suzy was quite defiant when asked to follow instructions in the classroom. The teacher would ask the students to gather on the rug for circle time and Suzy would say no, and refuse to stop playing with toys in the corner of the classroom. Suzy has been erupting at school and yelling at other children. The school contacted Suzy’s parents because a situation escalated at school this week and Suzy hit a classmate over the head with a Lacrosse stick while they were playing outside. The bystanders said it wasn’t an accident and that Suzy hit their classmate hard on the head several times with the stick because the classmate wouldn’t give Suzy the ball. Her parents are at a loss. They don’t know what to do. They don’t know why Suzy is acting this way. They have difficulty at home getting her to follow directions. She seemed to not respect authority when they take her to church or anywhere where she is being supervised by other adults, the feedback that they receive is that Suzy doesn’t listen and refuses to follow instructions. She seemed to hear what they would say, but her response is always “no, I am not doing it.” Situations often escalate into Suzy having a temper tantrum. It was also noted by her parents that Suzy has not made any friends during the first month of school. She was doing things to annoy and even bully other children. Instigating arguments and always trying to be right seemed to be her pattern of behavior. She lacked empathy toward her classmates and even blamed them for things that she did. For example, she wrote curse words on the blackboard and blamed another student. She fails to take responsibility for her negative behaviors. The school referred Suzy to a child psychologist the second month of school based on the her behaviors at school including refusing to follow instructions from her teacher, yelling, bullying, not making any friends, and beating a classmate with a Lacrosse stick. The parents are hopeful that the psychologist can understand why Suzy is acting like this and that they can get her the help that she needs. After the psychologist met with Suzy, her parents, and the teacher had some answers. The psychologist asked if the parents had ever heard of the term “Oppositional Defiant Disorder.” The parents said that they had not. The psychologist went on to explain that this disorder, abbreviated as ODD is defined by the presence of at least four of the following behaviors for at least 6 months and these behaviors are noticeably more severe than their peers’ behaviors:
Argues with adults Often defies adult authority and rules Deliberately annoys others Blames others for their mistakes or behavior Often loses their temper Often exhibits anger, irritability, and/or hostility Often bothered by others Acts vindictive
The parents agreed with the psychologist that Suzy had more than four of these behaviors present. They said that the behaviors were present while in preschool as well and that they could see these problems increasing over the past year. They had hoped that a different teacher would be able to better reign in Suzy’s behavior. They felt that it was perhaps the preschool teacher that was too soft on Suzy. Now they realize that they have a real problem, since the behaviors have persisted for over a year and under the direction of a new teacher and school. They commit to a plan to help Suzy. The psychologist refers the parents to a clinician who has parent training classes that will help them learn skills to handle the ODD. The child is entered into a therapy program that includes bio-feedback methods that teach the child emotional self-regulation. One year later, the family is happy to report that Suzy is like a different child. She knows how to control her emotions. Her parents also know how to implement structure and discipline in their household which helps reinforce Suzy’s good behaviors. Suzy is now thriving in school and has friends. The early intervention for Suzy helped with this positive outcome, along with parents who were committed to working alongside their daughter to make the consistent changes they all needed to make to this happen. Suzy’s case is just one example of a childhood behavioral disorder. There are several major behavioral and emotional disorders that can show up in childhood. It is important that parents have a general knowledge of these disorders and their symptoms, so they know when they need to seek professional help. When in doubt, seek out the help of a mental health professional who specializes in childhood disorders, as they can assist in properly assessing your child. If after seeking out professional help you find that your child does not qualify for a diagnosis, the mental health professional can help provide referrals to help with the issues that your child is having. For example, your child may have issues with controlling their temper, but they don’t qualify for an ODD diagnosis. Parents can still be provided with information on parenting groups or trainings that can assist with learning how to handle this issue with their child. Their child could also be referred to play therapy, or another mode of therapy that can help the child learn to control their temper and process their emotions. In this article, you will understand more about child behavior problems and what you can do to help children with behavioral disorders.
What are Some Behavioral Disorders?
The DSM is a diagnosing manual used by mental health professionals to assess behavioral and emotional disorders. The most common major behavioral and emotional disorders that can occur during childhood, which are defined and categorized by the DSM include:
Attention Deficit Hyperactivity Disorder (ADHD) Oppositional Defiant Disorder (ODD) Autism Spectrum Disorder (ASD) Anxiety Disorder Depression Bipolar Bisorder
Below you find a brief description of each of these disorders. Having a general understanding of these disorders can help parents assess whether there is something wrong with their own child’s behavior.
Symptoms of a Behavioral Disorder and Diagnosing
Diagnosing of a behavioral disorder requires a professional who is educated on the DSM. The DSM is the “Diagnostic and Statistical Manual of Mental Disorders”. This manual provides mental health professionals with guidelines and diagnosing criterion for every mental health disorder. If you think that your child may be suffering from a behavioral disorder, please talk to their primary care doctor and ask for a referral to see a psychologist. A psychologist who specializes in diagnosing behavioral disorders will be most helpful in providing you with answers and directions for specific treatment methods. If you can’t get a referral from your child’s doctor, don’t stop. You are your child’s best advocate. If you think that they have a legitimate issue, then be their advocate and find the help that they need from professionals. See a different doctor, or contact a psychologist directly and explain your situation. There is help available, you have to be the advocate for your child and it begins by getting them appointments to see professionals who can best help your child.
Attention Deficit Hyperactivity Disorder (ADHD)
Let me share another story with you… Dillon is a healthy boy with lots of energy, a cheerful attitude, and seems to be smart. He is now in the third grade and has started to have major issues at school. Increasingly, he is having problems focusing in class. He is always fidgeting with items from inside his desk. Pulling out pens to click continuously, to the annoyance of his teacher. Dillon is always losing his assignments, bus pass, and backpack. His thoughts seemed to be scattered in lots of directions and when it comes time to focus on a particular activity in the classroom, he has an inability to focus in general. His actions and inattentiveness are affecting the other students in the classroom. It is also affecting his ability to learn. Previously, he was getting solid high marks in school. Currently, his grades are slipping and he is at the bottom of his class. His grades are more of a reflection of his lack of focus, losing assignments, and problems following directions. His inability to focus, problems with listening, and his fidgety behavior are greatly interfering with his classroom attentiveness and subsequently negatively affecting his grades. His parents describe his behavior for the past year as hyperactive and inattentive. Dillon is a classic case of ADHD. Healthline explains that there are three types of ADHD: Inattentive, hyperactivity, and impulsivity.[1] Behaviors associated with Inattentive ADHD include missing details, getting bored easily, difficulty focusing on a single task, loses personal items often, difficulty organizing thoughts, problems listening, moves slow or appears to daydream often, processes things more slowly than their peers, and trouble following directions. Some of the behaviors associated with a predominately hyperactive-impulsive ADHD diagnosis include squirming, difficulty sitting still, talking incessantly, playing with small objects with their hands often even when it is not appropriate, act out of turn (not waiting), blurting out answers, difficulty participating in quiet activities, constantly on the go, and impatient. Most people experience a combination of systems and are not exclusively hyperactive, inattentive, or impulsive. There is not a single test alone that determine an ADHD diagnosis. Instead, it is an assessment of patterns of behavior. The behaviors must also be determined to be disruptive to the individual’s ability to function on a daily basis. A psychologist or a psychiatrist can assess whether a child has ADHD. A psychiatrist is able to prescribe medicine for a child with ADHD. Ultimately, it is up to the parent whether they want their child to take a medication for this disorder. There are many children who learn to manage their symptoms of ADHD through regular therapy.
Oppositional Defiant Disorder (ODD)
The symptoms of this disorder and the criterion for diagnosing were discussed earlier in this article. The treatment for ODD often includes therapy and training for parents and the child. Treating the child alone is not typically effective. The parents play a huge role in the life of their child, so their ability to parent them in a manner that works to correct the ODD behaviors and symptoms is imperative. A conduct disorder can develop if a child with ODD does not receive proper treatment. Conduct disorder is another DSM diagnosis, but this one is more often seen in teens who previously were diagnosed or showed signs of ODD. Conduct disorder is like taking the ODD to another level. Empowering Parents explains the difference between ODD and conduct disorder:[2]
Autism Spectrum Disorder (ASD)
Another girl, Kate, began to show signs of developmental delays around 12 months of age. She was not speaking any words yet, and her social interactions seemed to be different than other children her age. She would not make eye contact with people in general, including her parents. She rarely smiles and doesn’t show interest in interactions from others. By the age of 2, her parents describe her to be withdrawn and in her own world. At this age, she is only saying one word responses and her vocabulary is limited to only a handful of words. While at play, she is very focused on one object. Currently, she is fixated on a toy drum and has no desire to play with or even hold another toy. She carries the drum everywhere and is fixated on this object. Kate can often be found rocking from side to side for no explicable reason. She has been doing this behavior increasingly, especially if her daily routine is altered in any way. Having her nap time an hour later or not going to daycare on a regular weekday will upset her and cause a meltdown. Then, she will rock for hours. The effects of the meltdown last for hours, whereas most children recover after five minutes. She is detached from human interaction, which is why her parents sought assessment for autism at age two. She is a child who has ASD. Her parents were wise in getting her assessed at a young age, as they are able to provide her with therapies and interventions very early in her development. There is a great variation or spectrum of behaviors and severity of symptoms associated with ASD. It is called spectrum for a reason. Because some children can have a mild case of ASD, being considered high functioning. Whereas other children with an ASD diagnosis can have more severe symptoms such as mutism and sensory meltdowns on a regular basis and subsequently would be considered low functioning. The Mayo Clinic explains that other disorders, such as Asperger’s syndrome, which used to be a separate diagnosis, are now grouped under ASD.[3] When a child has autism, the symptoms usually appear at a young age and are especially noticeable as they become ages 2-3. Autism Speaks is an organization that helps to research and provide solutions for people diagnosed with autism. They provide a wealth of information for parents and caregiver on their website, to keep people informed. Here is some pertinent information from Autism Speaks: Diagnosis and treatment for autism is not a one size fits all. There is no single test that can be given to diagnose this disorder. It is an evaluation process and an overall assessment of the individual’s behaviors and development. The treatment can include a variety of modalities including occupational therapy, play therapy, speech therapy, and more. Treatment is dependent on the identified developmental issues and problematic behaviors that the child is experiencing. Because autism is a spectrum disorder, each person with autism has a distinct set of strengths and challenges. The ways in which people with autism learn, think and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently. To read more about autism, check out this LifeHack article about the signs of autism.
Anxiety Disorder
Let’s take a look at another case. Sam has been increasingly agitated and anxious over the past year. He is now ten years old and has begun to have difficulties sleeping. He is anxious about his school work, and he discontinued soccer because it caused him such high levels of anxiety. His parents decided to take him to see a psychologist because he no longer wants to go to school. His parents have to prod, encourage, and threaten him in order to get him to school each morning. His anxiety levels seem to be increasing over the past year. His extreme levels of worry are affecting every area of his life. He is no longer enjoying life because everything in his life seems to cause him anxiety. His parents learn from the psychologist that Sam is likely suffering from GAD, but it is treatable and Sam will be able to resume activities in the near future with improved coping skills to better handle the stress of life. Generalized Anxiety Disorder (GAD) is a condition that children can have if they exhibit extreme worry and angst about their family relationships, friendships, school work, and/or extra curricular activities. With individuals diagnosed with GAD, their daily life is affected by their anxiety and it can negatively affect their sleep, relationships, schoolwork, and ability to participate in social activities. Some other symptoms of GAD include irritability, easy to upset, headaches, stomachaches, feeling overwhelmed with worry, and avoidance of school or social activities that cause the anxiety. There are other types of anxiety disorders that can be experienced in childhood. These can include panic disorder, separation anxiety disorder, and phobias. Anxiety disorders are diagnosed by assessment from a mental health professional who will utilize the DSM for diagnosing criterion. Therapy is the first course of action for children with anxiety disorders. Many children with anxiety disorders benefit from medication (typically short term 6 months to a year). Each child is different, as is their treatment plan. If a child has an anxiety disorder, the parents should work with the child’s doctor and a mental health professional to properly diagnose the child and create a treatment plan that is customized for this child’s situation. For many children who are properly treated for their anxiety, they are able to overcome the anxiety entirely. Each child is different, but professional help can increase the probability that the child will overcome their anxiety and be able to resume normal activities. A reasonable time period for treatment outcomes, and to see dramatic positive results, is approximately six months to one year. This means that the child has weekly counseling sessions with a mental health professional that specializes in treating anxiety disorders in children in order for these kinds of results to be seen.
Depression
Here is another case study. Sally is a 9 year old who is having a hard time following the death of her brother. He was killed in a bike accident when he was hit by a car over a year ago. Sally seems to have lost all joy in her normal activities. She once enjoyed artwork and gymnastics. Now she has no interest in participating in these activities. When asked why she doesn’t want to do them anymore, her response is “what is the point?” She is very irritable toward her parents. When they try to help her “get happy” by taking her ice-skating and to the county fair, she is crabby, irritable, and moody the entire time. Her parents express to a psychologist that they just can’t seem to make her happy. They also inform the psychologist that Sally doesn’t play with her friends anymore, she has trouble sleeping at night, and has a dramatic loss of appetite. Sally is suffering from depression. She had not attended any counseling following her brother’s death. His death caused her to fall into an emotional depression. With counseling, she can overcome the depression and learn to cope with loss in the future. Childhood depression is characterized by feelings of loneliness, sadness, and/or hopelessness. Childhood depression often presents very similar as adult depression. However, one major difference is that the sadness in children is often projected as irritability. Depression affects the whole child including their behavior, social interactions, thoughts, physical health, and mental well being. For a complete listing of symptoms associated with depression in children, see my other article on the signs of depression in children. Depression in children is best diagnosed with a mental health professional. They will be able to assess the child according to the DSM diagnosing criterion to determine whether the child is clinically depressed. The treatment plan involves therapy when a child is depressed. In some cases, medications are recommended as well. Each child is different, so they should be assessed on their individual behaviors and presenting issues for a customized treatment plan. Many children who are provided with proper treatment for their childhood depression are able to overcome their depression and go on to lead normal, healthy lives.
Bipolar Disorder
Another story I want to share with you is about Linda. Linda is a 13 year old girl who has just entered puberty. Her parents have noticed that over the past year, Linda’s behavior is either depressed or manic for stretches of days and/or weeks. They describe her moods to be cycles. For example, they say for the past week she has been high energy, with no need for sleep, hyper focused on a science fair project, and is easily irritated with everyone around her. They said that the previous two weeks before this high energy phase, she appeared very sad and depressed. They said that these cycles have been going on for more than a year and are disruptive to Linda’s school, social, and family life on a daily basis. After further assessment by a psychologist, it is determined that Linda has bipolar disorder. Her parents elect to treat her with weekly therapy and medication. Bipolar disorder in children will typically emerge around adolescence, however, there are instances of children being diagnosed younger. Children with this disorder will exhibit cycles of manic behavior and then cycles of depression. The signs of bipolar disorder are similar in children and adults, however, as WebMD explains, there is one major difference between childhood and adult bipolar disorder:[5] When a child is in the depressed phase of their bipolar disorder, they will exhibit the signs of depression, as explained previously. When they are in a manic phase, they exhibit behaviors such as irritability, decreased need for sleep, mind racing, extremely talkative, and easily distracted. They also can become hyper focused on a particular activity. Many of these same behaviors are exhibited with children who have ADHD. This is why a professional assessment is needed for diagnosing. They can help determine whether there are cycles of depression and mania present that fit the diagnosing criterion for bipolar disorder. Treatment can include therapy and often includes medication combined with consistent therapy. There is no cure for bipolar disorder, but with help, the symptoms can be managed.
What Causes a Child to Have Behavioral Problems?
A combination of genetics and environmental factors cause behavioral problems in children. For example, a child who has parents going through a divorce and is already predisposed to bouts of anxiety, may develop GAD because of these circumstances and the predisposition. It depends on the child, their ability to cope in the situation, and their genetic makeup. It is not a debate over nature versus nature. Most clinicians believe that both play a role in the development of behavioral disorders in children.
How Do I Fix My Child’s Behavioral Problems?
Professional help is imperative when a child has serious behavioral problems. If you are uncertain, then the best policy is to talk to your child’s primary care doctor. They can provide you with insight and referral if needed. Don’t be afraid to take your child to get evaluated because you don’t want them to be labeled. Labels don’t have to be permanent. However, behaviors and problems that are left untreated can become more permanent than any label. For example, a child with ODD that goes untreated can develop into a teen and young adult with a conduct disorder that lands them in prison. All of which can be avoidable if treatment is sought during childhood. The purpose of a diagnosis is so that professionals know how to develop a treatment plan. For example, they know that children with ODD respond well to biofeedback methods and cognitive behavioral therapy methods. Following a diagnosis, the psychologist or psychiatrist treating your child can refer you to professionals that provide these treatment modalities. Professionals also know that parental training is especially helpful in ODD cases. Parents can be taught ways to minimize the symptoms and behaviors associated with ODD. However, if the child doesn’t get a diagnosis for their problem, their likelihood of getting treatment for their specific problem is diminished greatly.
Final Thoughts
If you know that your child has problematic behaviors, please get them assessed by a professional, preferably a psychologist or a psychiatrist who specializes in diagnosing children. They can help direct you to the counseling and resources for your child’s specific problem. Leaving a condition untreated is liking giving permission to the disorder to flourish and thrive. It will likely not change or improve through hope alone. Professional help is best for children who have serious behavioral problems. Don’t take on your child’s problems alone. There are professionals who want to help you, your child, and your family go from surviving to thriving. If you don’t know where to even begin finding the right kind of help for your child, then start with contacting your child’s primary care doctor. Make an appointment to discuss the issues and problems that your child is experiencing. Treatment is not a one size fits all. Finding professional help will best assist your child in getting the treatment plan that best fits their situation. Featured photo credit: Caroline Hernandez via unsplash.com
