Children’s Behavior Problems: Not Always What They Seem

Figuring out and helping young children with “bad” behavior

Julie Maccarin, Ph.D., OT/L

 

In my work, I am often asked to see young children with behavior problems. I like to think of my work as a bit like the job of a detective. What is underlying the behavior? What is contributing to it? What is provoking it? What is sustaining it?

 

“Bad” behavior may be anything from being uncooperative; whiny and complaining; having frequent crying jags, outbursts or tantrums; being defiant and oppositional; overly fearful; angry and aggressive; avoidant or withdrawn; mean or bullying.

 

My skills as both a child psychologist and a pediatric occupational therapist contribute to my reasoning.  My first order of business is to meet with the parents and get a picture of the family situation and the problem as it presents – When does it occur? How often? What is the intensity? What are the antecedents? What are the responses to the behavior from the various family members? How does the child react to those responses? How does the child feel after it’s all over – is she sad, sorry, resentful, still angry, or is she calm and able to move on? How are other family members functioning and how are they contributing to or helping alleviate the problem?

 

Joey* would have a melt down every day in the car when his mother picked him up from school. He would cry, yell and hit his sister. Simply bringing a snack for Joey in the car quickly eliminated the problem. Being “hangry” (hungry and angry) often leads to meltdowns in young children, as does being over tired and over stimulated.

 

Eli * would also have a meltdown every day in the car when his mother picked him up from school. He would also cry, yell and hit his sister. Eli’s problems were much more pervasive.  Eli was a fussy, highly sensitive, “high needs” child who had never adjusted to the birth of his sister when he was two and a half.  Now at six, he frequently hits his sister, criticizes her and calls her names. His parents are at their wits end after repeatedly trying to teach him to be a “good big brother”, and running through numerous strategies to change his behavior, from rewarding and punishing to ignoring.

 

Eli was on the “high needs” end of the spectrum. This is also known as having a “difficult” temperament, which may include such characteristics as being highly sensitive to environmental input, such as sound, movement, light, smells; being slow to adjust to new situations; being moody or intense; etc.  Children with this type of temperament are often highly emotionally sensitive as well – quicker to react to emotional slights, easily getting their feelings hurt, and generally having poor self regulation. These children are the opposite of the easy going child, who seems much more likely to let things roll off his back and not get upset in the first place. Children with a “difficult temperament” need a different type of parenting then “typical” children.

 

When Eli learned to express his feelings and needs about some of the things that “bother” him, he was able to find ways to help himself feel more comfortable and to ask for help when he needed it. Eli’s parents were assisted in learning ways to acknowledge and validate Eli’s feelings, provide him with one-on-one time, and support him in finding solutions. As Eli was able to feel more at ease and more competent, his self esteem improved, he was less resentful of his sister and he was able to develop a healthy relationship with her.

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Elizabeth* was a child who had difficulty socially. In second grade, she was rarely invited to birthday parties and although she invited other children for play dates, they often declined. Worried that she was not liked, Elizabeth often asked children if they liked her. Elizabeth’s single mother suffered from significant untreated anxiety and frequently shared with Elizabeth her own experience of feeling unlikeable and suffering because of being

unpopular with schoolmates when she was a child. She repeatedly asked her daughter about her friendships at school, transmitting her anxiety onto Elizabeth who, for reassurance, often asked others if they liked her, making them uncomfortable.

 

While Elizabeth’s social difficulties could have resulted from an autism spectrum disorder, a developmental lag, a language disorder, ADHD, low self esteem or other issues, in this case, parenting was creating the problem. Parents who are overly stressed, anxious, depressed or have other emotional baggage may transmit their emotional state to their child, both verbally and non-verbally. Parents who lack attunement and are unable to give their child unconditional love and focused attention, or otherwise are unable to meet their child’s emotional needs, may be preoccupied with other matters such as their job or their need to attend to younger children, or they may be reacting to their own painful experience in childhood of neglect, abuse, indifference, etc.  Some parents, even those who aren’t terribly wounded themselves, just lack parenting skills or have expectations that are mismatched with the child’s developmental level, abilities, or personality. Sometimes parents are misaligned with each other, giving mixed messages to their child.

 

In Elizabeth’s case, once her mother worked on her anxiety in her own therapy, she was able to stop transmitting it to Elizabeth. At the same time, Elizabeth developed better social skills through play therapy and was able to be more successful in her social relationships.

 

Five year old Milo* had a great fear of bad weather. He didn’t like to leave the house if there was even one dark cloud in the sky. It appeared that Milo was suffering with an anxiety disorder, however, as it turned out, his older brother had informed him that he could get hit by lightening if he went out on a cloudy day. His literal interpretation of this information turned out to be a function of his belatedly recognized high functioning autism. Once the misunderstanding was cleared up, using multiple sources and modalities of information, Milo was fine going outside, even when there were clouds in the sky.

 

Many difficult behaviors that children exhibit can be the result of any number of different underlying etiologies. For example, aggressive behavior can be a manifestation of a mood disorder, attachment issues, sibling rivalry, ADHD, inconsistent or harsh parenting, an Autism spectrum disorder, or even psychosis.  Sometimes, aggression is the only way a child knows how to communicate what they are feeling.  The impulsivity, distractibility, and high activity level that looks like ADHD may actually be coming from underlying anxiety. For each child who is avoidant, controlling, distracted, socially inept, perfectionistic, anxious, withdrawn, or otherwise exhibiting problematic behavior, the job of the child psychologist is to determine what is going on for that particular child. With a good understanding of what is underlying the behavior it is possible to provide the intervention that is needed to help the child feel and behave better and improve family relationships. 

 

* Client’s names and identities have been disguised in this article.

 

J