Problem Behavior: Reaction to a Situation or a Disorder?

Categories: Childhood Disorders, Family, Mental Health, Parenting, Stress, and Transitions / Change.

Imagine this scenario: A 9 year old boy we’ll call “David” is brought in for counseling.  His parents are concerned about his angry outbursts.  They describe him as usually a mild-mannered and well-behaved child until this last year.  The parents have been getting reports from his 3rd grade teacher that David often fidgets, blurts out answers impulsively, “seems to be in his own world” too much and such things.  They became alarmed when the teacher suggested they have David tested for ADHD.

At home, the mother reports that David has been having trouble sleeping. Most nights David climbs into bed with them at some point.  He tells them he’s having “scary dreams.”  They explain that for the past few months David will have “meltdowns” over the slightest things.  For instance, he was playing with his Legos and when he couldn’t get them to snap together he threw a fit and screamed “I can’t do anything right!”

So what’s wrong with David?  Clearly he’s a stressed out mess.  He’s not succeeding in school, he’s easily frustrated and overwhelmed, and he seems to be very hard on himself.  Maybe he has ADHD.  Maybe he’s depressed or he has an anxiety problem.  Perhaps something bad has happened to him and he isn’t coping well.  The parents don’t have the answers and therefore they don’t know what to do.  This is often the point at which parents bring in their children for counseling.

One of the first things that I try to determine is whether the child’s behavior is 1) a reaction to a situation or 2) a longstanding disorder.  Either the child has experienced something in his or her external environment or the behavior is an ongoing pattern of disordered thought and behavior that is more internal and not just a reaction to outside circumstances.

If a child has experienced some traumatic event (i.e., the birth of a new sibling, moving, being bullied at school, parents divorcing, etc), he could experience a setback in the skills recently learned.  For instance, a child whose parents just separated might start wetting the bed again after several months of having learned not to do that.  Emotionally as well, children can experience a setback in response to stressful events.  Children known to be compliant and easygoing can turn high strung and defiant.  These responses would be considered normal adjustment problems that mostly go away when the stressful issue is resolved.

Just consider your own life as an adult.  How well do you cope with stressful events? We must all admit that there are times when we don’t deal well with stress.  Most of us consider temporary breakdowns as normal and acceptable reactions to life’s troubles.  Do you immediately think you have finally gone crazy, or do you chalk it up to “bad day” or “going through a rough spot?”  I think we have to allow that our kids, who don’t have even the experience that we do in handling problems, will have some rough spots and all they need is some time and a listening ear.  They may need some guidance in how to handle a particular problem, and they generally will succeed in overcoming the obstacle.

There are a few questions you can ask yourself when trying to determine whether your child (or you) is just having a difficult yet temporary adjustment problem or a more serious psychological disorder.  First, how long has the problematic behavior or mood been an issue?  We generally consider it a disorder if the behavior or mood is observed consistently for two weeks or longer.  Otherwise, if the problem goes away in less time then it was a self-contained and short-lived adjustment problem.

Second, does the behavior and/or mood create problems in two or more settings?  For instance, are the symptoms seen only at school or are they also seen at home?  The more pervasive the problem the more likely its also more serious.  Third and final, does it create impairment in social and school or work functioning?  If the answer is yes, then it is likely more than just a short-lived problematic phase.

So if the problematic behavior or mood has lasted longer than two weeks, causes problems in two or more settings, and impairs social and school/work functioning then its time to become more concerned.  What may be going on is a disorder instead of a temporary adjustment problems.  This means the child has developed a maladaptive and unhealthy set of thoughts and behaviors.  Such cases require more than just a listening ear.  They need more intensive help in unlearning the unhealthy behaviors and thoughts, and learning better ways to cope  and overcome problems.

In all cases, children need to know that you believe in them and that with some work things can get better.  The guidelines offered in this article can be used as a way to assess the behaviors and moods that your child may show that give you concern.  Before you give your child a diagnosis, however, make sure you consult with a licensed mental health professional.

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