- What are behaviour problems?
- Behaviour problems to watch out for
- What are some common behavioural disorders?
All children can be distracted, fidgety, naughty, defiant and impulsive from time to time – this is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norm for their age, and impact negatively on all areas of the child’s life (relationships, development, safety, etc).
Normal vs. abnormal behaviour
It is often hard to know whether a child’s behaviour is normal or abnormal. Usually the difference is a matter of degree or expectation. It may depend on:
- the child’s level of development, which can vary greatly among children of the same age
- development can be uneven, too, with a child’s social development lagging behind her/his intellectual growth, or vice versa
- the context in which the behaviour occurs – the particular situation and time
- the family’s values and expectations, and cultural and social background
Knowing the expected social, emotional, intellectual and sexual developmental stages for each age group can give us an idea of what to expect, but all children are different, and these are only guidelines.
As a parent, if you have concerns about your child’s behaviour, it is best to seek professional advice. Only a specially trained psychologist or psychiatrist can diagnose a behaviour disorder through a comprehensive assessment of the child.
- Difficulty managing emotional outbursts
Although it is normal for pre-schoolers to have occasional temper tantrums, older children should be able to cope with and manage their feelings in a socially appropriate manner. If the child can’t control her/his anger, frustration, or disappointment in an age-appropriate manners s/he could have an underlying emotional problem. In pre-schoolers, occasional temper tantrums are normal but they should be shorter and less intense than when they were toddlers, learning to use words instead of violence.
Remember, tantrums happen for two main reasons:—the inability to manage their emotions or an attempt to control the situation.
- Difficulty managing impulses
Impulse control develops slowly over time. Young children may struggle to resist taking a sweet when no one is looking, for example, but as they get older, they learn to delay gratification, and they learn what is socially acceptable. A child who struggles to follow the rules, or to wait their turn, or who does things without thinking of the consequences for themselves or others may have impulse control difficulties.
- Behaviour that does not respond to discipline
It’s normal for kids to repeat their mistakes from time to time to see if a parent or teacher will follow through with discipline. But, it’s not normal for a child to exhibit the same behaviour repeatedly if you’re applying consistent discipline. If the child continues to exhibit the same misbehaviour regardless of the consequences, it could be a problem.
- Behaviour that interferes with school
Misbehaviour that interferes with the child’s education may indicate an underlying learning disorder or behaviour disorder. Getting sent out of class, getting into fights during break, and having difficulty staying on task are all potential warning signs.
- Behaviour that interferes with social interaction
It’s normal for children to have disagreements or arguments (“fall-outs”) with peers, but if the child’s behaviour prevents her/him from having friends, that’s a problem. Children should be able to develop and maintain healthy relationships with their peers.
- Self-injury or talk about suicide
Any child who bangs their head, burns themselves, or cuts themselves should be evaluated by a mental health professional. It’s also important to have a child evaluated by a professional if there is any talk about suicide.
- Sexualised behaviours that are not developmentally appropriate
It’s normal for children to be curious about the opposite sex and to want to know where babies come from. But knowledge of and acting out of sexualised behaviour that is beyond what a child should know, is of concern. In this case, it is essential that you seek professional advice. Also, sexualised behaviour should never be coercive (using force or power), at any age.
It is essential for caregivers and teachers to understand that ALL children’s behaviour is their way of processing and learning, as well as communicating what’s going on inside them and around them.
Behavioural problems are an indicator that something is not okay in the child’s world, and the best way to address them is to look for the cause of the behaviour, and what need that behaviour is meeting for the child.
Sometimes abnormal behaviour is a symptom of a behavioural disorder that needs the attention of a medical practitioner.
If your child’s behaviour is interfering in her/his development, quality of relationships, and/or they are a danger to themselves or others, it is essential that you seek professional advice. Call Childline 0800055555 to find out what resources are available in your area.
Attention Deficit / Hyperactivity Disorder (ADHD)
ADHD is very common neurodevelopmental disorder that affects millions of children and adults. It is a chronic (long-lasting) condition characterised by persistent inattention, hyperactivity, and sometimes impulsivity. ADHD begins in childhood and often lasts into adulthood.
- about 8-10% of South Africans have ADHD (ADHASA)
- boys with ADHD outnumber girls diagnosed – 3 to 1
The exact cause of ADHD isn’t fully understood, but most professionals believe that a combination of risk factors is responsible. These risk factors include:
- genetics (this is the biggest risk factor for ADHD)
- brain structure and function
- premature birth (before the 37th week of pregnancy)
- low birthweight
- brain trauma either in the womb or in the first few years of life
- mother drinking alcohol, smoking or misusing drugs while pregnant
- exposure to high levels of toxic lead at a young age
The symptoms of ADHD:
- easily distracted, misses details, forgets things, and frequently switches from one activity to another
- difficulty maintaining focus on one task
- becomes bored with a task after only a few minutes, unless doing something enjoyable
- difficulty focusing attention on organizing and completing a task or learning something new
- has trouble completing or turning in homework assignments, often losing things needed to complete tasks or activities
- seems not to listen when spoken to
- daydreams, becomes easily confused, and moves slowly
- has difficulty processing information as quickly and accurately as others
- struggles to follow instructions
- very impatient
- blurts out inappropriate comments, shows their emotions without restraint, and acts without regard for consequences
- has difficulty waiting for things they want or waiting their turns in games
- often interrupts conversations or others’ activities
Over activity / Hyperactivity
- fidgets and squirms in their seat
- talks non-stop
- dashes around, touching or playing with anything and everything in sight
- has trouble sitting still during dinner, school, doing homework, and story time
- constantly in motion
- has difficulty doing quiet tasks or activities
Note: Hyperactivity symptoms tend to reduce with age and can turn into “inner restlessness” in teens and adults with ADHD.
Other Associated Difficulties
- poor social skills
- anger management issues / aggression
- delays in speech and language as well as motor development & coordination
- sleeping difficulties
- poor organisational skills
- inappropriate sensory modulation and sensory defensiveness
- learning disabilities
- other disorders (as well as the ADHD)
Treatment of ADHD
Treatment is more successful when initiated early and taking into account mental and social factors, rather than just the symptoms of the ADHD.
A treatment plan must include:
- medical treatment (as prescribed by a child psychiatrist; there are a number of options)
- counselling / play therapy to address any additional problems (such as depression or anxiety) and to help the child understand ADHD better and develop strategies for managing it
- educational components – close communication between home and school is particularly important
- family support
ADHD – Helpful Tips for Parents
- assessment: have the child assessed to determine the most appropriate treatment plan, including medication
- treatment: be consistent and holistic in your approach; work out a plan with professionals (psychologist and psychiatrist) in conjunction with the family and school, that meets your child’s individual needs.
- monitoring: regularly monitor the child’s behaviour, performance, and mood; re-assess if necessary
- communication: between caregivers and educators is essential
- schedule: stick to a schedule; keep it visible
- organise everyday items
- use homework and notebook organizers: use organizers for school material and supplies; stress to your child the importance of writing down assignments and bringing home the necessary books
- be clear and consistent
- give praise or rewards when rules are followed: children with ADHD often receive and expect criticism – look for good behaviour, and praise it
- reasonable accommodation: extra time, subject exclusion, seating arrangements, regular reminders
ADHD – Helpful Tips for Educators
- To minimise the impact of the distractibility at school or during homework:
- look at ways to place the child in a less distraction-provoking seat
- allow for increased movement
- break long work periods into shorter chunks
- In the case of interrupting:
- ensure that the child’s self-esteem is maintained, especially in front of others
- praise the child for interruption-free conversations
- use discreet gestures or words you have previously agreed upon to let the child know they are interrupting (so that you don’t humiliate them)
- In the case Impulsivity:
- develop behaviour plans
- apply immediate and positive discipline when they break a rule or disobey
- give immediate praise for desired behaviour
- find ways to give children with ADHD a sense of control over their day (co-developed schedules; routines; choices where appropriate/possible
- In the case of fidgeting and hyperactivity:
- find creative ways to allow the child to move in appropriate ways at appropriate times – releasing energy this way may make it easier for the child to keep his or her body calmer during work time
- ask the child to run an errand or do a task for you
- encourage the child to play a sport, or at least run around before and after school – make sure a child with ADD/ADHD never misses breaks or PE
- provide a stress ball, small toy, or other object for the child to squeeze or fidget with discreetly at his or her seat
- limit screen time in favour of time for movement
- In the case of trouble following directions:
- try to be extremely brief, specific and direct when giving directions, allowing the child to do one step and then come back to find out what they should do next
- if the child gets off track, give a calm reminder, redirecting in a calm but firm voice
- whenever possible, write directions down in a bold marker or in coloured chalk on a blackboard
- Key points to remember:
- keep interest by using new and different ways of doing things
- keep things structure and organised
- remind of rules and have lots of visual cues
- keep work self-paced where possible
- include lots of productive physical movement
- keep involvement active rather than passive
- provide creative distractions
- know your child well enough that you can anticipate when they might struggle, and take preventative steps
Oppositional Defiant Disorder (ODD)
Oppositional Defiant Disorder (ODD) is defined by the DSM-V as a pattern of angry/irritable behaviour, or vindictiveness lasting at least 6 months, and is exhibited during interaction with at least one individual that is not a sibling.
- this disorder is more common in boys than in girls
- this behaviour typically starts by age 8, but it may start as early as the preschool years
The exact cause of ODD isn’t fully understood, but most professionals believe that a combination of biological, psychological, and environmental factors may contribute to the condition. These risk factors include:
- genetic factors play a part
- brain imaging studies have suggested that children with ODD may have subtle differences in the part of the brain responsible for reasoning, judgment and impulse control
- ADHD, learning disorders, depression, or anxiety disorders could also be strong contributors
- social-cognitive impairments, e.g. immature forms of thinking, failure to use words to regulate his or her behaviour, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act
- family factors, e.g. inconsistent discipline, family dysfunction, parents with mental illness, substance abuse, insecure parent-child attachments, child abuse and neglect
- societal factors, e.g. poverty, culture of violence
The symptoms of ODD include:
- Behavioural symptoms:
- easily losing one’s temper / throwing repeated temper tantrums
- refusing to follow rules
- deliberately acting in a way that will annoy others
- blaming others
- blatant hostility towards others
- being unwilling to compromise or negotiate
- willingly destroying friendships
- being spiteful and seeking revenge
- blatant and repeated disobedience
- Cognitive symptoms:
- frequent frustration
- difficulty concentrating
- failure to “think before speaking”
- Psychosocial symptoms:
- difficulty making friends
- loss of self-esteem
- persistent negativity
- consistent feelings of annoyance about odd children
About children with ODD:
These children have a strong need for control:
- they will do almost anything to maintain control
- if limits are set, they feel compelled to break them
- “You’re not the boss of me” “You can’t make me”
- refusal, endless debates, verbal abuse
They tend to deny responsibility:
- they see their behaviour as reasonable
- they blame others
- they feel ‘picked on’
- they have little insight into the impact of their behaviour on others
ODD can cause kids to be extremely annoying, combative, uncooperative and often hostile.
Children with ODD may seem to thrive on conflict and anger from others, will try to engage in negative battles of will.
NB: Unlike children with conduct disorder (CD), children with ODD are not usually physically aggressive towards people or animals, do not usually destroy property, and do not show a pattern of theft or deceit.
As with any disorder, assessment and diagnosis must be made by a psychiatrist or psychologist.
Treatment of ODD
Treatment for ODD primarily involves family-based interventions, but it may include other types of psychotherapy and training for your child — as well as for parents.
It’s important to treat any other problems, such as a learning disorder, because they can create or worsen ODD symptoms if left untreated.
Medications alone generally aren’t used for ODD, unless your child also has another disorder that requires medication. If your child has coexisting disorders, such as ADHD, anxiety or depression, medications may help improve these symptoms.
The main types of interventions are:
- parent training
- parent-child interaction therapy (PCIT)
- individual and family therapy
- cognitive problem-solving training
- social skills training
Treatment usually lasts several months or longer.
ODD – Helpful Tips for Parents and Educators
- have the child assessed to determine the most appropriate treatment plan, including medication
- be consistent and holistic in your approach; work out a treatment plan with professionals (psychologist and psychiatrist
- communicate regularly, e.g. with teachers and therapist
- create clear, reasonable rules and expectations; try to involve the child/ren in making the rules
- consistently model and reward/praise desired behaviour (remember: specific, subtle & sincere)
- give positive attention or praise at least three times more frequently than reprimands
- increase the ‘reinforcement’ quality of the environment (NB: opportunities for success)
- set clear, reasonable and logical consequences for undesirable behaviour – make it a learning opportunity rather than punitive
- respond to undesirable behaviour immediately and consistently
- set up a “cool down area” – anticipate a meltdown, and allow all children to use it if they are angry or upset
- keep responses calm, brief, and business-like
- avoid getting into conflict / arguments
- ask open-ended questions
- listen actively
- validate the child’s emotion by acknowledging it
- emphasize the positive in all requests – (e.g. Instead of, “If you don’t return to your chair, I can’t help you with your assignment,” word requests in positive terms: “I will be over to help you on the assignment just as soon as you return to your chair.”)
- two-part choice statements (e.g. “You can finish the assignment while your TV programme is on, or you can finish the assignment now and not miss your programme. It is your choice.”)
- offer opportunities to get it right (e.g. “Is there anything that we can work out together so that you can finish your assignment on time” If the child continues to be non-compliant, however, simply impose the appropriate consequences for that misbehaviour.)
- proactively interrupt the child’s anger early in the escalation cycle (redirect or remove)
- for educators – refer when necessary
What makes it worse?
- losing your temper
- long lectures
- interacting in front of other children
- bribery or persuasion
- adding more consequences
- embarrassing or shaming the child
- not following through with consequences – or inconsistent follow through
- bringing up the past
- allowing the confrontation to go on for too long
- crowding the child
- using negative body language
- getting annoyed by every little thing he or she does
- blaming yourself or others
- making assumptions or labelling the student
What makes it better?
- keep your voice neutral and calm, no matter what
- give clear directions
- use short explanations
- make eye contact
- control your facial expressions
- keep body language neutral
- talk about what is happening now, not past issues
- focus on solutions not problems
- ask questions
- listen to responses
- consider what is being said
- have clear boundaries
- decide on consequences for behaviour before hand
- move away if you feel you are about to lose control
- see the child as a complete person with strengths and weaknesses
- analyse your part in the interaction – check your own behaviour and responses
Conduct Disorder (CD)
Conduct disorder is defined as “a persistent pattern of behaviour in which the basic rights of others or major age-appropriate social norms are violated.” Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children and adults as “bad” or delinquent, rather than mentally ill.
This disorder is marked by chronic conflict with parents, teachers, and peers and can result in damage to property and physical injury to the child and others.
These patterns of behaviour are consistent over time.
Doctors group the symptoms of conduct disorder into four categories:
- aggressive behaviour, such as cruelty to animals, fighting and bullying
- destructive behaviour, such as arson and vandalism
- deceitful behaviour, such as shoplifting and lying
- violation of rules, which may include truancy and running away from home
The exact cause of CD isn’t fully understood, but most professionals believe that a combination of biological, psychological, and environmental factors may contribute to the condition. These risk factors include:
- genetic vulnerability
- brain anatomy and function
- child abuse
- school failure
- peer rejection
- association with deviant peers
- exposure to violence and traumatic life experiences
- poverty and neglect
The symptoms of CD include:
- Behavioural symptoms:
- skipping school
- harming animals
- bullying others
- destroying the property of others
- running away from home
- instigating violent, physical fights
- persistent lying
- forcing someone into sexual activity against the person’s will
- Physical symptoms:
- marks resulting from injuries from a physical fight (e.g. bruises, scrapes, black eyes, etc)
- presence of a sexualy transmitted disease/s as a result of beginning unsafe sexual behaviours at an early age
- burn marks as a result of fire-setting behaviours
- Cognitive symptoms:
- difficulty concentrating
- memory impairment
- inability to “think things through”
- Psychosocial symptoms:
- lack of empathy
- lack of a sense of guilt
- lack of remorse
- false sense of grandiosity
- low self-esteem
About children with CD:
Children with CD struggle to follow the rules and norms set by family, school and society in general. They participate in extremely negative behavioural patterns in a variety of settings, including home, school, and in social situations. These behaviours also cause significant harm/damage in all aspects of the adolescent’s life, including his or her social life, family life, and academic life.
Children and adolescents with CD tend to:
- engage in power struggles
- react badly to direct demands or statements
- challenge class rules
- refuse to do work assigned at school
- fight with, argue, bully or threaten classmates and other students
- have a poor attendance record or chronic truancy
- have a history of frequent suspension
- not show empathy, guilt or remorse
- use bravado to mask their low self-esteem
- lie to family, peers or teachers
- steal from family, peers or the school
- use a weapon/s in fights
- engage in the destruction of property
- hurt animals and people
As with any disorder, assessment and diagnosis must be made by a psychiatrist or psychologist.
Treatment of CD
Treatment is more successful when initiated early and taking into account mental and social factors, rather than just the symptoms of a disease offers a child a better chance for considerable improvement and hope for a more successful future. Research suggests that treating children at home, along with their families, is most effective.
A treatment plan must include:
- medical treatment
- mental health intervention
- educational components
- family support
- close communication between home and school is particularly important at younger ages
- in cases of abuse, the child may need to be removed from the family and placed in a less chaotic home.
Treatment is rarely brief since establishing new attitudes and behaviour patterns takes time.
Conduct Disorder – Helpful Tips for Parents and Educators
- set clear and consistent rules, as well as fair and logical consequences for breaking them
- model and reward positive social behaviour
- act immediately, fairly and consistently when a child breaks the rules
- keep a record of transgressions
- if you are a teacher, communicate with parents about your concerns
- refer for professional assessment if you think the child meets the criteria
- communicate a positive regard for the child, and give them the benefit of the doubt whenever possible
- remember that children with conduct disorder like to argue, so maintain calm, respect, and detachment; avoid power struggles and don’t argue
- avoid escalating prompts such as shouting, touching, nagging, or cornering the student
- consistently teach and model social skills (whether you’re a caregiver or a teacher)
See also Oppositional Defiant Disorder for additional tips.
- Depression and Anxiety
- Learning problems and learning disabilities
- Grief (not available as yet)
- Substance use disorder ( not available as yet)