Childhood behavioural disorders and how to positively treat them
Written by:Disruptive and seemingly uncontrollable behaviour can cause concern for any parent. Consultant paediatrician, Dr Rahul Bharat is an expert in child and adolescent developmental, neurological and behavioural problems. Here, he shares his expertise in the form of explaining common causes and signs of behavioural disorders, plus coping strategies for assisting children and young adults who have them. He currently practises at the Dementech Neurosciences clinic.
What are the common causes of behavioural disorders in children?
Behavioural problems are relatively common in children and adolescents. These problems are usually temporary and appropriate for their stage of development. Also, they can reflect stressors around the child and their attempt to adjust to their environment, such as at school, at home and with their friends.
For instance, it’s relatively normal that a child’s behaviour worsens as a result of:
- Parents separating
- Changing schools
- When a close relative passes away
Parents need to know that childhood is a phase of rapid development. Children are facing new experiences, learning to regulate their emotions and learning to control their behaviour.
What are the signs of behavioural problems?
When difficult behaviours are an ongoing issue and persist, parents can struggle to understand and manage them.
When a behavioural problem is ongoing, it might reflect that the environmental stressor still persists and that the child is not able to cope with that situation or problem. For example, if the child is constantly being bullied or there are difficulties in the family environment.
In addition, some of these problems might reflect symptoms of a neurodevelopmental disorder:
Or internalising problems:
Or any underlying medical condition.
How is a behavioural disorder treated?
Firstly, it is important to understand where these behavioural problems stem from as much as possible. It’s also important to identify events that pave the way for episodes of difficult behaviour and/or triggers.
Secondly, parents and the child’s school should provide a structured setting which promotes positive behaviour. This means setting clear boundaries that the child understands and discussing expectations as well as the immediate consequences of their actions.
Parents need to understand that boundaries are positive for their child’s emotional development, and that calm, firm and fully consistent communication is required for the message to be clear to their child (Spender, 2013). Rewards can also be useful in order to promote positive behaviours.
Creating a “special time” or allocating at least 10 minutes a day to an activity with the child has proven to improve positive behaviour. Also, rewarding the child can be valuable in reinforcing the positive behaviours they’ve learned.
For negative behaviours, light “punishments”, such as losing privileges, and having time outs can be useful. In very young children, it’s recommended to limit time out to five minutes or less. A way to measure how long is suitable for time out is to consider one minute per year of age, meaning a 12-year-old will be left in time out for 12 minutes. Most importantly, time out should never be recognised as a traumatic experience for the child but rather, a moment in which they can calm down and think about their actions (Corralejo et al., 2018).
There are parenting programs, such as The Incredible Years, or the Triple P parenting program, which have shown to be very effective when consistently applied. Positive effects of parenting programs can be maintained in the long term (Webster-Stratton et al. 2011). Many books, manuals and parent training courses are available to access and buy online. There was a scientific Cochrane review about the efficiency of these programs by Furlong and colleagues in 2013 that found them to be cost-effective as well as effective in improving the mental health of parents and children.
When should I refer a child to a specialist?
A referral to a child specialist might be necessary when:
- The initial strategies fail
- When the behaviour is impacting on the child’s functioning and development (e.g., affecting family life, the child’s self-esteem or their social or academic development)
- If parents suspect any neurodevelopmental, psychiatric or medical condition
In these circumstances, a much more specific assessment and approach might be needed.
If you would like to book a consultation for your child with Dr Bharat, do not hesitate to do so by visiting his Top Doctor's profile today.
References:
- Corralejo SM, Jensen SA, Greathouse AD, Ward LE. Parameters of time-out: research update and comparison to parenting programs, books, and online recommendations. Behav Ther. 2018;49:99–112.
- Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review). Evid Based Child Health. 2013 Mar 7;8(2):318-692. doi: 10.1002/ebch.1905.
- Spender Q. A short guide to understanding behavioural difficulties. Arch Dis Child. 2013;98:625–8.
- Webster-Stratton C, Julie Rinaldi J, Reid J. Long-Term Outcomes of Incredible Years Parenting Program: Predictors of Adolescent Adjustment. Child Adolesc Ment Health. 2011 Feb; 16(1): 38–46. doi: 10.1111/j.1475-3588.2010.00576.x
