When a child acts up

Generally, behaviour that does not comply with social norms and rules becomes a problem.

So when does a child's behaviour become a behavioural problem?

Clearly, it depends.

A child may or may not behave differently at home, in school and in social settings. Acceptable behaviour may also be influenced by the child's age and gender.

Experts may delve further, looking at his developmental phase and even his environment.

For instance, what's acceptable for a five-year-old may not be deemed appropriate for a 10-year-old.

Finally, when certain psychological and psychiatric conditions predispose a child to display behavioural problems, that behaviour may be a disorder.

Indeed, until medical researchers became aware that there are children with Attention Deficit Hyperactivity Disorder (ADHD), parents of such kids were often at a loss.

Today, we know that a child with ADHD, a neurodevelopmental disorder, lacks an internal ability to inhibit his physical activity and control his attention span. As a result, he may appear restless or even aggressive.

Depending on the child's level of impairment and the severity of the behaviour, professional help may be necessary.

Sometime ago, an eight-year-old boy with ADHD was brought to my clinic.

He could not sit still in the classroom and he would run about unrestrained at shopping malls. His impulsiveness and inability to behave 'acceptably' got him into disciplinary problems in school.

We used behavioural modification techniques that helped him pay attention in class. His seat relocated nearer the teacher's desk and practical strategies were tried out to get him to carry out his assignments.

His parents, now better prepared, spent time encouraging him and helping him understand the positive impact of his changed behaviour and the consequences of less desirable behaviour.

All this worked in his case. For some ADHD children, medication could be helpful too.

Inappropriate behaviour

Apart from those with disorders, some children and teenagers may use socially or age-inappropriate behaviour to communicate needs, express feelings, obtain wants, get attention or to avoid tasks.

For instance, one teenage girl refused to go to school because she was afraid that her teachers would scold her for being tardy in her homework.

Another teenage girl began to cut herself when her boyfriend left her for another girl. Self-mutilation was her way of relieving her inner emotions, with physical pain substituting her emotional pain.

The break-up was a devastating blow to her fragile self-image, aggravated by her strained relationship with her parents. She required a lot of psychotherapy before she regained adequate self-esteem to finally stop hurting herself and to learn more adaptive approaches to resolving problems.

Fortunately, most childhood behavioural problems are minor and do not last. Setting clear rules and limits at home at an early age is extremely important.

Praise, reward and punishment need to be carefully utilised so that they will not turn into bribery or abuse. Behavioural problems will require parental attention when they become persistent, increasingly intense or cause reasonable distress to the child and people around him.

Often, consulting a family doctor or a school counsellor may help. For others - like the girl who deliberately hurt herself - urgent professional help is recommended.

Parents need not panic when their child suddenly shows a behavioural problem. They should first see the situation in context and perhaps consult other adult caregivers, teachers, a counsellor or the family doctor.

Tackle one problem at a time and take small steps to achieve success.

Parents should accept their child and review their own expectations. A child's growing years will have highs and lows. By keeping a positive attitude, persevering and keeping an open mind towards change, you will be doing your best to help your child overcome his problems.

Dr Ong Say How is a consultant child psychiatrist and deputy chief of the department of child and adolescent psychiatry, Institute of Mental Health. Besides being a trainer and lecturer, he engages in outpatient services for children and adolescents with psychological problems. He also does research work in mood disorders and schizophrenia.

This article was first published in Mind Your Body, The Straits Times on Sep 18, 2008.

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