It's tough determining whether a child's challenging behavior is part of normal developmental or a sign of a behavior disorder. Children learn skills at such different rates that it can be hard for a parent to realize that just because her 4-year-old can read chapter books, it doesn't mean the 4-year-old won't have frequent temper tantrums. Intellectual development doesn't usually match up with emotional development. Diagnosing child behavior disorders requires certain steps, assessments and expertise.
All children misbehave occasionally. Many go through more cooperative and less cooperative phases as they develop. If you are concerned that your child has a behavior disorder, you'll notice that aggressive and hostile behaviors continue for at least six straight months. According to the National Institutes of Health, warning signs include harming or threatening themselves, others or animals, persistent nightmares, damaging or destroying property, lying, stealing, skipping school, doing poorly in school, consistent hostility toward authority figures, frequent tantrums and arguments, blaming others for their own mistakes and major disruptions within the family.
According to Boston Children's Hospital, the most common behavior disorders are oppositional defiant disorder and conduct disorder. Children with ODD persistently act out through angry outbursts, arguments and disobedience with parents, teachers and peers. Children with CD can exhibit those behaviors as well as violence toward others and animals. For these children, problems often begin in the toddler years. Experts at the the Boston Children's Hospital say that these children have an unusually hard time separating from their parents when they are young and are not able to resolve normal developmental issues as they grow. For example, a child with these disorders does not outgrow the defiance of the "terrible twos."
Sometimes the difference between normal-range and abnormal behavior is the frequency with which the problem occurs. Many preschoolers have temper tantrums, but they don't have meltdowns 10 times a day. Another aspect to note is the intensity of the problem. Many toddlers and preschoolers go through a biting phase, but if your preschooler draws blood each time she bites or your kindergartener is still doing it, you should be concerned. According to the National Resource Center on Attention Deficit Hyperactivity Disorder, as many as one-third to one-half of children with ADHD also have ODD or CD. So, if a child has already been diagnosed with ADHD and you notice continued behavior problems, a co-existing disorder might also exist.
If you and your child's pediatrician are concerned, a comprehensive psychological evaluation should be done. During this process, detailed records of your child's behaviors will be kept and a child psychiatrist will meet with both you and your child. The psychiatrist will also talk to your pediatrician, your child's teachers and other family members. Psychological and family health histories will need to be shared with the psychiatrist. There will also be a physical screening to check for health-related causes of the problems. After all those factors are considered, the psychiatrist will make a diagnosis and help plan a course of treatment.
Treatment for disruptive behavior disorders incorporates several facets. The American Academy of Pediatrics stresses the importance of teaching the child behavioral coping strategies that can help him manage his own behavior. Parents and teachers should also learn negotiating, compromising, problem-solving and how to anticipate and avoid potentially explosive situations. Lesser problems should be ignored until major issues are addressed. In some cases, medication will also be needed to treat the behavior disorder.
- Healthy Children: Evaluating Behavioral Problems
- Medline Plus: Child Behavior Disorders
- Healthy Children: Disruptive Behavior Disorders
- American Academy of Child and Adolescent Psychiatry: Where to Find Help For Your Child
- American Academy of Child and Adolescent Psychiatry: Comprehensive Psychological Evaluation
- Boston Children's Hospital: Disruptive Behavior Disorders
- National Resource Center on ADHD: ADHD and Coexisting Conditions
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