Child Behavior

Disruptive behavior tends to worsen with time, but it can be treated effectively. Parent-child interaction therapy (PCIT), an evidence-based treatment for preschoolers with disruptive behavior and their parents, focuses on changing ineffective parent-child interaction patterns. The first phase, focusing on child-directed interaction, strengthens the parent-child relationship, builds the child's self-esteem, and reinforces the child's prosocial behaviors. The second phase, focusing on parent-directed interaction, introduces parent management training. Treatment is guided by assessment and continues until parents master interaction skills and child behavior problems fall within the normal range. Emerging evidence suggests that treatment gains are maintained for several years post treatment. (Neary,2002) A younger age of onset is associated with greater severity of disruptive behavior throughout its course, and disruptive behavior can be reliably identified in children as young as age. Evidence also suggests that intervention is more effective at the preschool age than when children are older. Effective treatment of disruptive behavior prior to school entry may prevent the associated problems with academic performance and peer relationships that require multiple interventions only a few years later. (CampbellSB) Primary care physicians are often the only professionals to see young children before school entry and are thus critical to early identification. Studies have found that at least 20% of the 2- to 5-year-olds seen in primary care settings have Diagnostic and Statistical Manual of Mental Disorders, disorders, yet young children with significant psychopathology are frequently not referred for treatment. Identification of child psychopathology is difficult. Found that pediatricians were, able to correctly identify only 17% of children with mental health problems. With increasing use of the Diagnostic and Statistical Manual for Primary Care recognition of the problems that require referral to mental health providers is likely to improve. Further, due to their effectiveness in screening, behavior rating scales have been recommended for use in primary care settings. The use of rating scales has been shown to improve pediatrician recognition and referral of children who need mental health treatment. (Costello EJ)
ODD and Mood Disorders Mood disorders are also more common for individuals with disruptive behavior disorders, particularly for girls. Children with ODD are two times as likely to have major depressive disorder or bipolar disorder, while children with CD are three times as likely to develop an emotional condition. Depressed individuals may present with less motivation, social withdrawal, and decreased concentration, all of which could be seen as oppositional in certain settings. Additionally, depressed mood, a chief symptom of ODD, is commonly exhibited as irritability in the pediatric population. (Greene RW, 2002) During a manic episode, bipolar patients will have uncharacteristic increased impulsivity and goal-directed behavior that is often disruptive and can go against societal norms. Therefore, diagnoses of ODD and CD should be made cautiously in individuals with mood disorders. (Offord DR, 1992) A key distinguishing factor is the episodic nature of symptoms in mood disorders. A diagnosis of ODD and CD should only be made if the disruptive symptoms occur outside of a disordered mood episode. Prognostically, depression along with either CD or ODD increases the risk of suicide and substance abuse substantially. (Greene RW, 2002)
ODD vs. ADHD Disruptive behavior disorders frequently occur along with ADHD. About half of the children with ODD or CD have ADHD, and about half of children with ADHD have disruptive behavior disorders. ADHD is characterized by symptoms of inattention, impulsivity, and hyperactivity, all of which can promote or be construed as disruptive behavior. For example, an inattentive child with ADHD may appear stubborn or oppositional due to their distractibility. Impulsive or hyperactive behaviors may be seen as defiant if they do not abate despite repeated cues from a teacher. ADHD can fuel antisocial acts when the characteristic impulsivity overpowers inhibitions to shoplift or act out aggressively, making conduct disorder behaviors more common. (Biederman J, 2005)
Making a child behave well make a short list of important rules and go over them with your child. Avoid power struggles, no-win situations and extremes. When you think you've overreacted, it's better to use common sense to solve the problem, even if you have to be inconsistent with your reward or punishment method. Avoid doing this often as it may confuse your child. (American, 2011)
Accept your child's basic personality, whether it's shy, social, talkative or active. Basic personality can be changed a little, but not very much. Try to avoid situations that can make your child cranky, such as becoming overly stimulated, tired or bored. Don't criticize your child in front of other people. Describe your child's behavior as bad, but don't label your child as bad. Praise your child often when he or she deserves it. Touch him or her affectionately and often. Children want and need attention from their parents. (American, 2011)
Develop little routines and rituals, especially at bedtimes and meal times. Provide transition remarks (such as "In 5 minutes, we'll be eating dinner."). Allow your child choices whenever possible. For example, you can ask, "Do you want to wear your red pajamas or your blue pajamas to bed tonight?" (American, 2011)
As children get older, they may enjoy becoming involved in household rule making. Don't debate the rules at the time of misbehavior, but invite your child to participate in rule making at another time. (American, 2011)

References

Neary, E., Eyberg, S. (2002, April 01). Management of disruptive behavior in young children. Infants and Young Children, (4), 53, Retrieved from http://elibrary.bigchalk.com

Campbell SB. Behavior problems in preschool children: developmental and family issues. Adv Clin Child Psychol. 1997;

Costello EJ, Costello AJ, Edelbrock C, et al. Psychiatric disorders in pediatric primary care: prevalence and risk factors. Arch Gen Psychiatry. 1988;

Greene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV . Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. Am J Psychiatry. 2002;

Offord DR, Boyle MH, Racine YA, Outcome, prognosis, and risk in a longitudinal follow-up study. J Am Acad Child Adolesc Psychiatry. 1992;

Biederman J . Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry. 2005;
American Academy of Family Physicians, 2011, http://familydoctor.org/familydoctor/en/kids/behavior-emotions/child-behavior-what-parents-can-do-to-change-their-childs-behavior.html