Behavioral Issues in Children

Childhood can be a turbulent time, not just for the child but also for the parent. This is partly due to many life transitions and developmental changes occurring, as well as the evolving dynamics between the parent and the child. However, behavioral issues in children can make raising kids even all the more complicated, and unfortunately, these are not exactly a rare occurrence. In fact, statistics indicate that one in every five children and adolescents may live with a diagnosable behavioral disorder [*].

To aid parents in supporting their children with such issues, this article will explain the different types of behavioral problems in children, their causes and warning signs, and the treatment options that are available for them.

What Causes Behavioral Issues in Children?

Before diving into the discussion on the causes of behavioral problems in children, it is noteworthy to mention that there is no single identifiable cause as to why some children exhibit behaviors atypical of their developmental stage. Instead, multiple factors influence the development of behavioral issues in children, such as the following:

• Genetics. Some behavioral issues in kids are genetically determined. For example, anxiety disorders are likely to emerge early in childhood if the child's parent has either an anxiety disorder or major depression [*]. Depending on who you speak with, anxiety and depression may be described as either a behavioral or a mental disorder, but they both often underlie behavioral issues. In addition, attention-deficit/hyperactivity disorder (ADHD) may also run in families [*].
• Neurobiological differences. Differences in brain chemistry and structure are also a factor that influences the presence of behavioral issues in children. For example, according to research, many children with ADHD have smaller brains than children who do not have ADHD [*]. Another example would be conduct disorder; it has been found that children with this behavioral disorder have lower physiological arousal than children without conduct disorder [*]. This may explain why they behave as though they do not fear punishment for their deviant behavior.
• Personality. Children who have behavioral problems may have a different temperament compared with children who do not. Specifically, kids with externalizing (acting-out) problems have been described as having a difficult temperament, and kids with internalizing (emotional) problems are more behaviorally inhibited [*].
• Family and other environmental factors. There is considerable evidence that poor disciplinary practices - in the form of either harsh discipline, overprotective parenting, or maltreatment and neglect - can make children susceptible to developing behavioral problems [*,*]. Other environmental risk factors are another one of the causes of behavioral problems in children. For example, poverty and association with deviant peers are possible causes of conduct disorder [*].

What Are the Signs of Behavioral Issues in Children?

How can parents know whether their children have behavioral issues? Some of the warning signs of behavioral issues in kids are the following:

• Getting easily anxious, irritated, or angry, which may manifest into tantrums and outbursts or hostility against parents and teachers
• Difficulty coping with frustration
• Social withdrawal or disengagement
• Academic underachievement to the point of poor school performance and truancy
• Substance use
• Engaging in promiscuous behavior
• Changes in appetite and weight
• Neglect of personal hygiene

What Are the Most Common Behavior Disorders in Children?

There are many types of behavioral problems in children outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), but the most common are the following:

Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD in children is comprised of symptoms that can be classified as inattention, impulsivity, and hyperactivity [*]. Inattention symptoms include difficulty focusing, not following instructions, and jumping from one task to another without finishing the task first. Meanwhile, impulsivity is exemplified by children talking over others and being short-tempered. Finally, hyperactivity manifests as fidgeting behaviors and constant restlessness.

Disruptive Disorders

Behavioral issues in children may belong to the category of disruptive disorders, mainly conduct disorder and oppositional defiant disorder, described as follows:

• Conduct disorder. Because of their disregard for authority, for the basic rights of others, and for societal rules, children with this disorder are often deemed bad kids [*]. The categories of symptoms of conduct disorder are aggression, property damage, theft or deceitfulness, and serious rule violations. It is worth noting that conduct disorder may co-occur with other behavioral disorders; in fact, one third of children who have conduct disorder meet the diagnostic criteria for ADHD as well [*].
• Oppositional defiant disorder (ODD). Oppositional defiant disorder (ODD) in children is characterized by being quick to anger or irritation, frequent tantrums, often arguing with others with the intent to frustrate them, and refusing to obey the rules of the household or of society, among others. ODD is typically diagnosed when the child does not have full-fledged conduct disorder [*].

Depression

Depression is a common mental disorder that can cause behavioral changes in kids. Depression in children shares symptoms with depression in adults, such as profound sadness for most of the day, diminished interest and pleasure in the activities one used to enjoy, significant changes in appetite or sleep, fatigue, and low self-esteem. Sometimes, children may even have suicidal ideations. However, perhaps the key distinction is that for children who live with a depressive disorder, they are more prone to irritability than are adults [*].

Anxiety Disorders

According to studies, anxiety disorders are quite common in children; indeed, they are one of the most prevalent childhood disorders following ADHD and conduct disorder [*]. Anxiety often causes behavioral changes in children as a form of coping mechanism, such as avoiding situations that cause anxious feelings. Anxiety in children can manifest in different forms, such as separation anxiety disorder and generalized anxiety disorder, described as follows:

• Separation anxiety disorder. Thoughts that something bad might happen to their loved ones, leading to excessive anxiety about being separated from them, are indicative of separation anxiety disorder. It is worth mentioning that this anxiety should be inappropriate for the developmental stage of the child and that this separation anxiety should persist for at least 4 weeks. An example of such anxiety being excessive is seen in children who refuse to attend school so that they can stay at home with their parents [*].
• Generalized anxiety disorder. Generalized anxiety disorder (GAD) is also a common anxiety disorder in children, wherein the child is constantly worried about different aspects of their lives, such as their academic performance, relationships with peers, health, and the past or the future. In children, at least one of the following symptoms must be present: restlessness, susceptibility to fatigue, difficulty concentrating, irritability, difficulty sleeping, or muscle tension [*]. However, if the child is younger, it is less likely that somatic symptoms are present.

Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) in children is quite similar to that in adults. Children with this disorder may suffer from intrusive thoughts (obsessions) and repetitive behaviors or rituals (compulsions), just as adults do. However, the difference is that kids with OCD are unlikely to possess insight that their obsessions and compulsions are irrational. This is due to the lack of mature development of their cognitive skills [*].

How Are Behavioral Issues in Children Diagnosed?

Behavioral issues in children are often observed in their relationships with others and at school. Thus, they may be referred to a mental health professional. In cases where they see pediatricians before a mental health professional, pediatricians can assess for behavioral disorders by ensuring that their problems are not explained by mental, sensory, or intellectual factors, as well as by physical disabilities, also known as differential diagnosis. Children being assessed for behavioral disorders must also show distress or impairment in functioning at home, school, or in the social environment.

How Are Behavioral Issues in Children Treated?

Fortunately, there are many options for treatment for child behavioral problems that are available not just to the child but also to the entire family that is affected by extension. Generally, though, behavioral issues in children are treated via multimodal therapy [*]. This entails medication, individual psychotherapy, and family interventions.

Medication

Medication can help manage symptoms of behavioral issues in kids. Examples include methylphenidate for ADHD, antidepressants for childhood depression, and anxiolytics for anxiety in children.

Therapy

The most commonly used therapy approach for children with behavioral disorders is cognitive-behavioral therapy (CBT). This therapy modality places emphasis on changing cognitive distortions, as well as some social skills training. Research has proven its effectiveness for anxiety disorders in childhood and adolescence and OCD [*,*].

Family Interventions

Family interventions are also available as treatment for child behavioral problems in that they help the family become more aware of the disorder that the child has [*]. One example of a family intervention is parent management training, where parents are taught a variety of techniques to modify parent-child interactions, to facilitate prosocial behavior, and to minimize deviant behavior [*].

How Can Parents Support a Child With Behavioral Issues?

Now that the types, causes, and treatment of behavioral issues in kids have been discussed, how can you support your child with a behavioral disorder? The following are just some of the tips that can assist you in being a more supportive parent:

• Don’t give in to children who throw tantrums because this will reinforce the belief that they can get their way by throwing a tantrum.
• Stay calm to avoid enabling the child to become more aggressive and to model calm behavior.
• Ignore minor bad behavior but give praise for specific good behaviors.
• Only reason with a child once they have calmed down.
• Be consistent with not just the household rules but also the consequences of both bad and good behavior.

The Bottom Line

There are many types of behavioral problems in children, such as ADHD, anxiety, and conduct disorder. However, the good news is that there are also several options for treatment for child behavioral problems. One helpful treatment option is CBT. Our CBT worksheets help supplement this type of intervention. Although behavioral issues in kids are fairly common, it is important to know that there are ways to support children with such problems.

References:

1. Maria Z and Lyudmila P. Behavioural disorders in child. 2014.
2. Asbahr FR. Anxiety disorders in childhood and adolescence: Clinical and neurobiological aspects. 2004.
3. Purper-Ouakil D, Ramoz N, Lepagnol-Bestel A-M, and others. Neurobiology of attention deficit/hyperactivity disorder. May 2011.
4. Tripp G, Wickens JR. Neurobiology of ADHD. Neuropharmacology. December 2009.
5. Puzzo I, Smaragdi A, Gonzales K, and others. Neurobiological, neuroimaging, and neuropsychological studies of children and adolescents with disruptive behavior disorders. February 2016.
6. Bayer JK, Ukoumunne OC, Lucas N, and others. Risk factors for childhood mental health symptoms: National longitudinal study of Australian children. 2 June 2011.
7. Grillo E and da Silva RJM. Early manifestations of behavioral disorders in children and adolescents. 2004.
8. Krebs G and Heyman I. Obsessive-compulsive disorder in children and adolescents. 2015.
9. Estrada A.U. and Pinsof W.M. The effectiveness of family therapies for selected behavioral disorders of childhood. Journal of Marital and Family Therapy. 1995.