Overview of Behavioral Problems in Children
Children acquire many skills as they grow. Some skills, such
as controlling urine and stool, depend mainly on the level of maturity of the
child's nerves and brain. Others, such as behaving appropriately at home and in
school, are the result of a complicated interaction between the child's
physical and intellectual (cognitive) development, health, temperament, and
relationships with parents, teachers, and caregivers Other behaviors, such as
thumb sucking, develop when children look for ways to help themselves cope with
stress. Still other behaviors develop in response to parenting style.
Behavioral problems can become so troublesome that they
threaten normal relationships between the child and others or interfere with
emotional, social, and intellectual development. Some behavioral problems
include
Breath-holding spells
Eating problems
School avoidance
Sleep problems
Temper tantrums
Violence
Many of these problems arise out of developmentally normal
habits that children easily acquire.
Some behavioral problems, such as bed-wetting ( see Urinary
Incontinence in Children), can be mild and resolve quickly and spontaneously as
part of normal development. Other behavioral problems, such as those that arise
in children with attention-deficit/hyperactivity disorder (ADHD), can require
ongoing treatment.
Stress-Related Behaviors in Children
Each child handles stress differently. Certain behaviors
that help children deal with stress include thumb sucking, nail biting, and,
sometimes, head banging.
Thumb sucking
Thumb sucking (or sucking a pacifier) is a normal part of
early childhood, and most children stop by the time they are 1 or 2 years old,
but some continue into their school-age years. Occasional thumb sucking is
normal at times of stress, but habitual sucking past the age of about 5 can
alter the shape of the roof of the mouth, cause misalignment of teeth, and lead
to teasing from other children. Occasionally, persistent thumb sucking can be
the sign of an underlying emotional disorder.
All children eventually stop thumb sucking. Parents should
intervene only if their child’s dentist advises them to or if they feel their
child’s thumb sucking is socially unhealthy. Parents need to gently encourage
the child to understand why it would be good to stop. Once the child signals a
willingness to stop, gentle verbal reminders are a good start. These can be followed
by symbolic rewards put directly on the thumb, such as a colored bandage,
fingernail polish, or a star drawn with a nontoxic colored marker. Additional
measures, such as a plastic guard over the thumb, overnight elbow splinting to
prevent a child from bending it, or painting the thumbnail with a bitter
substance can be used. However, none of these measures should be used against
the child’s will.
Nail biting
Nail biting is a common problem among young children. The
habit usually disappears as the child gets older but is typically related to
stress and anxiety. Children who are motivated to stop can be taught to
substitute other habits (for example, twirling a pencil). A reward system in
which the child keeps more rewards for avoiding the behavior reinforces
desirable behavior. For instance, the child is given 10 pennies in the morning,
and in the evening must return 1 penny for each nail that is bitten over the
course of the day.
Head banging and rhythmic rocking
Head banging and rhythmic rocking are common among healthy
toddlers. Although alarming to parents, the children do not seem to be in
distress and actually seem to derive comfort from these behaviors.
Children usually outgrow rocking, rolling, and head banging
between 18 months and 2 years of age, but repetitive actions sometimes still
occur in older children and adolescents.
Children with autism and certain other developmental
problems also may bang their head or make other repetitive movements. However,
these children have additional symptoms that make their diagnosis apparent.
Although children almost never damage themselves by these
behaviors, this possibility (and the noise) can be reduced by pulling the crib
away from the wall, taking off the wheels or placing carpet protectors under
them, and applying padding to the bars of the crib.
Behavioral Problems and Parenting Style
Praise and reward can reinforce good behavior. If parents
are very busy, they may end up giving their children attention only for
negative behavior, which can backfire when that is the only attention the
children receive. Because most children prefer attention for inappropriate
behavior to no attention at all, parents should create special times each day
for pleasant interactions with their children to avoid increases in
inappropriate behavior.
A number of relatively minor problems of behavior may be due
to parenting styles.
Child–parent interaction problems are difficulties in the
relationship between children and their parents, which may begin during the
first few months of life. The relationship may be strained because of
A difficult pregnancy or delivery
Postpartum depression affecting the mother
Inadequate support of the mother by the other parent,
partner, relatives, or friends
Disinterested parents
Contributing to the strain of building a strong relationship
are a baby’s unpredictable feeding and sleeping schedules. Most babies do not
sleep through the night until 3 to 4 months of age. Poor relationships may slow
development of mental and social skills and cause failure to thrive.
A doctor or nurse can discuss the temperament of an
individual baby and offer the parents information on the development of babies
and helpful tips for coping. The parents may then be able to develop more
realistic expectations, accept their feelings of guilt and conflict as normal,
and try to rebuild a healthy relationship. If the relationship is not repaired,
the baby may continue to have problems later.
Unrealistic expectations contribute to the perception of
behavioral problems. For example, parents who expect a 2-year-old child to pick
up toys without help may mistakenly feel there is a behavioral problem. Parents
may misinterpret other normal, age-related behaviors of a 2-year-old child,
such as the refusal to follow an adult’s request or rule.
A self-perpetuating cycle is a cycle of negative
(inappropriate) behavior by the child that causes a negative (angry) response
from the parent or caregiver, followed by further negative behavior by the
child, leading to a further negative response from the parent. The attention
the child receives from the parent often reinforces the child's inappropriate
behavior.
Self-perpetuating cycles usually begin when a child is
aggressive and resistant. The parents or caregivers respond by scolding,
yelling, and spanking. Self-perpetuating cycles also may result when parents
react to a fearful, clinging, or manipulative child with overprotection and
overpermissiveness.
The self-perpetuating cycle may be broken if parents learn
to ignore inappropriate behavior that does not negatively affect others, such
as temper tantrums or refusals to eat. Redirecting the child's attention to
interesting activities allows for the rewarding of good behavior, which makes
the child and parents feel successful. For behavior that cannot be ignored,
distraction or a time-out technique can be tried.
Discipline problems are inappropriate behaviors that develop
when structure is ineffective. Discipline is more than just punishment. It is
providing children with clear, structured, age-appropriate expectations that
allow them to know what is expected. It is much easier and more satisfying to
both parents and children to reward desirable behavior than to punish
inappropriate behavior.
In older children and adolescents, behavioral problems may
arise as children seek to free themselves from parental rules and supervision
(see Behavioral Problems in Adolescents). Parents should learn how to
distinguish such problems from occasional errors in judgment.
Treatment
Early intervention
Behavior-modifying strategies for parents
The goal of treatment is to change undesirable habits by
getting children to want to change their behavior. This goal often takes
persistent changes in actions by the parents, which in turn results in improved
behaviors by the children.
Behavioral problems need to be addressed early because
behaviors are harder to change the longer they exist. Sometimes, parents need
only to be reassured that the particular behavior is normal or to hear a few
simple suggestions. One simple suggestion is for parents to spend at least 15
to 20 minutes a day in a pleasurable activity with the child or to call attention
to desirable behaviors (“catching the child being good”). Parents are also
encouraged to regularly spend time away from the child.
Additional strategies for modifying behavior include the
following:
Identifying triggers for the child's behavior and factors
(such as additional attention) that may inadvertently reinforce it
Clearly defining for the child which behaviors are desired
and which are undesired
Establishing consistent rules and limits
Tracking how well the rules and limits are followed
Providing appropriate rewards for success and consequences
for inappropriate behavior
Minimizing anger when enforcing rules and increasing
positive interactions with the child
Efforts to control a child’s behavior through scolding or
physical punishments such as spanking may work briefly if used sparingly.
However, these approaches generally tend not to alter the inappropriate
behavior sufficiently and may reduce the child’s sense of security and
self-esteem. Moreover, spanking can get out of hand when the parent is angry
and may send the child the message that physical aggression is an acceptable
way to deal with undesirable situations. A time-out procedure can be helpful.
However, punishments become ineffective when overused or used inconsistently.
Furthermore, threats that the parents will leave or send the child away can be
psychologically damaging.
If a behavior problem does not change in 3 to 4 months,
doctors may recommend a mental health evaluation.
The time-out technique
This disciplinary technique is best used when children are
aware that their actions are incorrect or unacceptable and when they see
withholding of attention as a punishment. Typically, children do not understand
that withholding attention is a punishment linked to undesirable behavior until
they are 2 years old. Care should be taken when this technique is used in group
settings such as day care centers because it can result in harmful humiliation.
The technique can be applied when a child misbehaves in a way
that is known to result in a time-out. Usually, the child should receive verbal
statements and reminders before the time-out technique is used.
The inappropriate behavior is explained to the child, who is
told to sit in the time-out chair or is led there if necessary.
The child should sit in the chair for 1 minute for each year
of age (a maximum of 5 minutes). Physical restraints should be avoided.
A child who gets up from the chair before the allotted time
is returned to the chair, and the time-out is restarted. Talking and eye
contact are avoided.
When it is time for the child to get up, the caregiver asks
the reason for the time-out without anger and nagging. A child who does not
recall the correct reason is briefly reminded. The child does not need to
express remorse for the inappropriate behavior as long as it is clear that the
child understands the reason for the time-out.
As soon as possible after the time-out, the caregiver should
make an effort to identify good behavior and praise the child for it. Good
behavior may be easier to achieve if the child is redirected to a new activity
far from the scene of the inappropriate behavior.
Sometimes, a child's inappropriate behavior escalates when
the child is in a time-out. In such cases, the caregiver may want to redirect
the child to another activity before the full time has run out. Redirections
should be done only after the child understands why the time-out had been
given.
- CORONA VIRUS
- MONKEY POX
- VAGINAL DRYNESS
- FIBROID
- INFERTILITY
- OVULATION CYCLE
- OVARIAN CANCER
- VAGINAL BACTERIA
- MALE INFERTILITY
- BEST DAYS OF CONCIEVING
- MUCUS AFTER OVULATION
- FOODS FOR ERECTILE FUNCTIONS
- PREGNANCY ANEMIA
- DO AND DONT DURING PREGNANCY
- ERECTILE DYSFUNCTION
- U.T.I IN PREGNANCY
- STROKE RISK
- EAT THIS NOT THAT
- HOOKWORMS INFECTION
- OMEGA 3 BENEFITS
- FASTING
- WEIGHT LOSS TIPS
- vitiligo
- ABORTION
- DENGUE VIRUS
- EBORA VIRUS
- FEVER
- URINARY TRACT INFECTION
- HOSPITAL INFECTIONS
- WEST NILE VIRUS
- YELLOW FEVER
- EYE DISEASE
- ZIKA VIRUS
- STRESS
- IRON DEFFICIENCE
- INSOMNIA (SLEEPING PROBLEMS)
- HEART PROBLEMS
- COMPONENTS OF BLOOD
- BLOOD DISORDER
- LABORATORY TEST OF BLOOD DISORDER
- BONE MARROW EXAMINATION
- BLOOD ANEMIA
- ANIMAL BITES
- EYE BURN
- CHOCKING
- HEAT STROKE
- SMOKE EFFECTS
- SNAKE BITE
- MALARIA VACCINE
- BEST WAY TO SLEEP A CHILD
- CHILD FEVER REDUCING
- ELEPHANTIASIS
- WOMEN BEARDS
- DATES
- PAPAYA FRUITS