Toddlers are naturally curious about the world. They learn behaviour and social skills by testing and experimenting with everything around them. Good self-esteem helps them try new things without too much fear of failing. Constantly telling your toddler ‘no’ can pour cold water on this natural curiosity. You might want to try some other ways to change behaviour you don’t like.
Nobody’s perfect and all children will have bouts of bad behaviour. They may have temper tantrums, or talk back to their parents or teachers. When things start to get out of hand, however, it may be a clue that something in the child or teen’s life needs attention. Children and teens can seem irritable or even hostile when they are tired or aren’t feeling well. They may argue with parents or disobey them.
Young children may lie because they are too young to understand the difference between the truth and a lie. Sometimes they lie to get themselves out of trouble. This is normal. When they act this way all the time, or when this behaviour gets them into trouble all the time at home, at school, or with other kids in the neighbourhood.
These may manifest as disturbance in:
• Emotions – e.g.: Anxiety or depression.
• Behaviour – e.g.: Aggression.
• Physical function – e.g.: Psychogenic disorders.
• Mental performance – e.g.: Problems at school.
This range of disorders may be caused by a number of factors such as parenting style which is inconsistent or contradictory, family or marital problems, child abuse or neglect, overindulgence, injury or chronic illness, separation or bereavement.
The child’s problems are often multi-factorial and the way in which they are expressed may be influenced by a range of factors including developmental stage, temperament, coping and adaptive abilities of family, and the nature and the duration of stress. In general, chronic stressors are more difficult to deal with than isolated stressful events.
Children do not always display their reactions to events immediately, although they may emerge later. Anticipatory guidance can be helpful to parents and children in those parents can attempt to prepare children in advance of any potentially traumatic events –like, elective surgery or separation. Children should be allowed to express their true fears and anxieties about impending events.
In stressful situations, young children will tend to react with impaired physiological functions such as feeding and sleeping disturbances. Older children may exhibit relationship disturbances with friends and family, poor school performance, behavioural regression to an earlier developmental stage, and development of specific psychological disorders such as phobia or psychosomatic illness.
It can be difficult to assess whether the behaviour of such children is normal or sufficiently problematical to require intervention. Judgement will need to take into account the frequency, range and intensity of symptoms and the extent to which they cause impairment.
Oppositional Defiant Disorder (ODD): Oppositional Defiant Disorder (ODD) is a type of behavior problem in which children are openly hostile, uncooperative, and irritable. They lose their tempers and are mean and spiteful towards others. They often do things to deliberately annoy other people. Most of their defiant behaviour is directed at authority figures, but they also sometimes behave the same way towards their siblings, playmates, or classmates. Their home life, school life, and peer relationships are seriously negatively affected because of the way they think and behave.
Conduct Disorder (CD): Conduct Disorder (CD) is sometimes a later, more serious, phase of Oppositional Defiant Disorder (ODD). A child with CD is not just a child being “bad”; CD is a serious psychiatric disorder that requires professional help.
Children with this condition are aggressive all the time in a way that causes problems for them and their family. They may threaten or actually harm people or animals, or they may damage or destroy property. They may steal or shoplift, or even be involved in breaking and entering. They often lie or try to “con” other people, and frequently skip school.
Children with Conduct Disorder often have trouble understanding how other people think. They may have trouble talking to others. They may think that other people are being mean to them or wish them harm when that isn’t the case at all. Their language skills may be impaired, which means they have trouble using words and may act out instead. They may not know how to make friends with other children, and may feel sad, frustrated, and angry as a result.
Disruptive behaviour: Many behaviours, which are probably undesirable but a normal occurrence at an early stage of development, can be considered pathological when they present at a later age. In the young child, many behaviours such as breath holding or temper tantrums are probably the result of anger and frustration at their inability to control their own environment. For some of these situations it is wise for parents to avoid a punitive response and, if possible, to remove themselves from the room. It is quite likely that the child will be frightened by the intensity of their own behaviour and will need comfort and reassurance. While some isolated incidents of stealing or lying are normal occurrences of early development, they may warrant intervention if they persist. Truancy, arson, antisocial behaviour and aggression should not be considered as normal developmental features.
Attention deficit hyperactivity disorder: is characterised by poor ability to attend to tasks (e.g. makes careless mistakes, avoids sustained mental effort), motor over activity (e.g. fidgets, has difficulty playing quietly) and impulsiveness (e.g. blurts out answers, interrupts others). For the diagnosis to be made, the condition must be evident before age 7 years, present for >6 months, seen both at home and school and impeding the child’s functioning. The condition is diagnosed in 3-7% of school-age children.
Anxiety disorders: Anxiety and fearfulness are part of normal development; however, when they persist and become generalised they can develop into socially disabling conditions and require intervention. Approximately 6-7% of children may develop anxiety disorders and, of these, 1/3 may be over-anxious while 1/3 may have some phobia. Generalised anxiety disorder, childhood-onset social phobia, separation anxiety disorder, obsessive-compulsive disorder and phobia are demonstrated by a diffuse or specific anxiety predictably caused by certain situations.
School phobia occurs in 1-5% of children and there is a strong association with anxiety and depression. Management is by treating the underlying psychiatric condition, family therapy, parental training and liaison with the school in order to investigate possible reasons for refusal and negotiate re-entry. Behavioural and cognitive treatments show promise, although most evidence-based trials involve children with mental health problems rather than the general population of school refuses per se. More research needs to be done in this area.
Habit disorders: These include a range of phenomena that may be described as tension-reducing. All children will at some developmental stage display repetitive behaviours but whether they may be considered as disorders depends on their frequency and persistence and the effect they have on physical, emotional and social functioning. These habit behaviours may arise originally from intentional movements which become repeated and then become incorporated into the child’s customary behaviour. Some habits arise in imitation of adult behaviour. Other habits such as hair pulling or head banging develop as a means of providing a form of sensory input and comfort when the child is alone.
Thumb sucking – this is quite normal in early infancy. If it continues, it may interfere with the alignment of developing teeth. It is a comfort behaviour and parents should try to ignore it while providing encouragement and reassurance about other aspects of the child’s activities.
Tics – these are repetitive movements of muscle groups that reduce tension arising from physical and emotional states, involving the head, the neck and hands most frequently. It is difficult for the child with a tic to inhibit it for more than a short period. Parental pressure may exacerbate it, while ignoring the tic can reduce it. Tics can be differentiated from dystonias and dyskinetic movements by their absence during sleep.
Stuttering – this is not a tension-reducing habit. It arises in 5% of children as they learn to speak. About 20% of these retain the stuttering into adulthood. It is more prevalent in boys than in girls. Initially, it is better to ignore the problem since most cases will resolve spontaneously. If the diffluent speech persists and is causing concern refer to a speech therapist.
Tension reducing habit disorders: thumb sucking, nail biting, pulling hairs, banging the head, repetitive vocalization, biting or hitting themselves and breathe holding.