Behavioral disorders and problems in children

Many behaviors of children or adolescents are of concern to parents or other adults. Behavioral disorders or individual actions become clinically significant if they are often repeated or observed continuously and are inadequate (for example, violate emotional maturation or social or cognitive function). Expressed behavioral disorders can be classified as mental disorders (eg, causing an opposition disorder or conduct disorder). Prevalence can vary depending on how behavioral disorders are identified and assessed.

Examination

Diagnosis involves a multi-stage assessment of behavior. Problems that arise in children of the first years of life usually concern functions such as eating, bowel movement, sleep, while older children and adolescents generally have problems in interpersonal communication and behavior (for example, level of activity, disobedience, aggression).

Identification of the violation. Violation of behavior can occur suddenly as a single episode (for example, arson, a fight in school). More often, signs appear gradually and it is necessary to collect information for some time. It is best to evaluate the child's behavior in the context of his mental and mental development, health in general, temperament (for example, difficult, carefree) and relationships with parents and other persons surrounding the child.

Direct observation of the relationship between the child and parents during a visit to the doctor presents valuable information, including the parents' reaction to the child's actions. These observations are supplemented, if possible, with information from relatives, teachers, educators and school nurses.

In conversation with parents or persons caring for a child, you can find out the usual daily routine of the child. Parents are asked to give examples of events that precede and follow certain behaviors or behaviors of the child. Parents also find out their interpretation of actions typical for a particular age, expectations from the child, the level of parental interest in the child, the availability of support (for example, social, emotional, financial) in fulfilling their role as parents and the nature of relationships with the rest of the family.

Interpretation of the problem. Some "problems" represent inadequate expectations of parents (for example, that a 2-year-old child himself will collect toys without anyone's help). Parents misunderstand certain behaviors that are characteristic of a certain age, such as violations (for example, the causing behavior of a 2-year-old child, that is, the child refuses to follow the rules or requirements of adults).

Anamnesis on the part of the child may include elucidating the presence of factors that are considered to increase the likelihood of developing behavioral disorders, such as exposure to toxins, complications during pregnancy, or severe illness of someone in the family. Low level of interaction of parents with the child (for example, indifferent parents) leads to subsequent problems with behavior. Benevolent parents' reactions to the problem may be worse (for example, parents hyperopically shy, do not step away from them or a step of the child or go on about the child manipulating them).

In young children, some problems develop by the vicious circle mechanism, when a negative reaction of parents to the behavior of the child leads to a negative reaction of the child, which in turn leads to an ongoing negative reaction from the parents. With this mechanism of behavior, children react more often to stress and emotional discomfort with stubbornness, sharp objections, aggressiveness, outbursts of irritation, and not crying. With the most common behavioral mechanism of the closed circle type, parents respond to the child's aggressive and stubborn behavior by scolding him, shouting and spanking; after this, the child even more provokes parents, performing actions that caused such a reaction of parents, and they respond in response to it more than initially.

In older children and adolescents, behavioral problems can be a manifestation of the desire for independence from parental rules and supervision. Such problems should be distinguished from random errors in judgments.

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Treatment of behavioral disorders and problems in children

Once the problem is identified and its etiology is determined, preferably an early intervention, since the longer the problem exists, the more difficult it is to adjust it.

The doctor should convince parents that physically with their child everything is in order (for example, that the violation of his behavior is not a sign of a physical illness). After revealing the parents' disappointment and pointing out the prevalence of various behavioral disorders, the doctor can often reduce the sense of guilt of the parents and facilitate the search for possible sources of the problem and ways of treating it. With simple violations, it is often sufficient to educate parents, calm them, and also a few specific tips. Parents should also be reminded of the importance of holding at least 15-20 minutes a day in enjoyable communication with the child. Also, parents should be advised to spend time regularly without a child. With some problems, however, it is useful to apply additional methods to discipline the child and modify his behavior.

The doctor can advise parents to limit the child's search for independence, as well as his manipulative behavior, which allows us to restore mutual respect in the family. It is necessary to clearly define the desired, as well as unacceptable behavior of the child. It is necessary to establish permanent rules and restrictions, parents must constantly monitor their observance, ensuring proper compensation upon their successful implementation and consequences in case of inappropriate behavior. Positive reinforcement of the appropriate behavioral rules is a powerful tool that does not have negative effects. Parents should try to minimize anger by insisting on compliance with the rules, and to increase positive contact with the child ("praise the child when he is good").

Inefficient penalties can lead to behavioral disorders. Screaming or physical punishment can control the child's behavior for a short time, but ultimately can reduce a child's sense of security and self-esteem. Threats to abandon a child or send him away are traumatic for him.

A good way to influence the child's unacceptable behavior is the time-out technique, in which the child must sit for a short time alone in a deserted boring place (corner or room, except the child's bedroom, where there is no TV and toys, but in which should not be dark or scary). "Timeouts" is a learning process for the child, it is best to use them for one misdemeanor or a small number of them at a time.

The mechanism of a vicious circle can be interrupted if the parents ignore the actions of the child that do not disturb others (for example, refusal to eat) and distract attention or temporarily isolate the child if his behavior can not be ignored (public tantrums, outbursts of irritation).

If the behavior does not change within 3-4 months, it is necessary to re-examine such a child by evaluating the problem; an evaluation of his mental health can be shown.

"Time-out" -methodics

This disciplinary method is best used when the child is aware that his behavior is wrong or unacceptable; usually this method is not used in children younger than 2 years. You should carefully use this technique in a children's team, for example in a kindergarten, as this can lead to the child feeling insulted.

This method is used when the child knows that his behavior leads to a "timeout", but still does not correct it.

The child is explained the reasons for punishment and they say to go sit on the "time-out chair" or, if necessary, take them there themselves.

The child should sit on a chair for 1 minute for a year of life (maximum 5 minutes).

If the child rises from the chair before the due time, it is returned to the place and the time is re-marked. If the child immediately rises from the chair, you may need to hold it (but not on your knees). At the same time avoid talking to the child and eye contact.

If the child stays on the chair, but all the time is not calmed down, the time is again marked.

When the time-out expires, the child is asked about the reason for the punishment, avoiding anger and irritation. If the child can not name it, they briefly remind him of the correct reason.

Soon after the child's "time-out," the child should be praised for good behavior, which is easier to achieve if the child engages in another activity than the one at which he was punished.