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How do you know if your toddler has behavioural problems?

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    The Most Common Behavior Disorders in Children

    Raising children is difficult, and raising difficult children can be life-disrupting. But telling whether your child is just going through a stage or if something is wrong isn't always that easy.

    A tantrum doesn't automatically mean your 2-year-old has a problem with authority, and a kindergartner who doesn't want to sit still doesn't necessarily have an attention disorder. However, experts say diagnoses and labels should be kept to a minimum when it comes to an understanding of our children's behaviour.

    Defining "Disorders"

    Child psychology experts from the University of Oxford and the University of Pittsburgh say that the term "disorder" should be used cautiously for children up to 5 years old and question its validity. Professors Frances Gardner and Daniel S. Shaw say the evidence is limited that problems in preschool indicate problems later in life or that behavioural issues are evidence of a true disorder. "There are concerns about distinguishing normal from abnormal behaviour in this period of rapid developmental change," they wrote.

    That being said, a conservative approach to handling behavioural and emotional issues in this age group is best.

    Early Childhood Behavioral and Emotional Disorders

    Rarely will a child under 5 years old receive a diagnosis of a serious behavioural disorder. However, they may begin displaying symptoms of a disorder that could be diagnosed later in childhood. These may include:

    Many of these you've likely heard of. Others are rarer or aren't often used outside of discussions about childhood psychology.

    ODD, for instance, includes angry outbursts, typically directed at people in authority. But a diagnosis is dependent on the behaviours lasting continuously for more than six months and disrupting a child's functioning. On the other hand, conduct disorder is a far more serious diagnosis and involves behaviour one would consider cruel to both other people and animals. This can include physical violence and even criminal activity — behaviours that are very uncommon in preschool-age children.

    Autism, meanwhile, is a broad range of disorders that can affect children in a variety of ways, including behaviorally, socially, and cognitively. They are considered a neurological disorder and, unlike other behavioural disorders, the symptoms may begin as early as infanthood. According to the American Psychiatric Association, about one in 68 children are diagnosed with an autism spectrum disorder.

    What is ODD (Oppositional Defiant Disorder)

    ODD is a type of behaviour disorder. Children with ODD often act out. For example, they throw temper tantrums, defy authority figures, or argue with peers or siblings. These behaviours may happen only at home, around parents. They may take place in other settings, too, such as school. It is estimated between 2 and 16 per cent of school-age children and teens have ODD. Symptoms of ODD can appear as early as 2 or 3 years old. However, it's more likely they'll show up between ages 6 and 8. If ODD is not addressed and treated in childhood, the child may develop long-term, chronic problems. These issues can last through their teenage years and into adulthood. 

    Symptoms of ODD in children?

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    Children with ODD will show several of these behavioural symptoms:

    • inability or refusal to obey rules
    • easily frustrated or quick to lose one's temper
    • repeated and frequent temper tantrums
    • fighting with siblings or classmates
    • arguing recurrently
    • deliberately upsetting or annoying others
    • being unwilling to negotiate or compromise
    • speaking harshly or unkindly
    • defying authority
    • seeking revenge
    • being vindictive and spiteful
    • blaming others for one's behaviour

    In addition to behavioural symptoms, a child with ODD may have one or more of these symptoms:

    • difficulty concentrating
    • difficulty making friends
    • low self-esteem
    • persistent negativity

    Symptoms of ODD may ultimately interfere with learning, making school difficult. In addition, challenges at school may further frustrate the child, creating a cycle that could lead to more symptoms or outbursts.

    Tips for Managing a Child with ODD

    Parents can help children manage symptoms of ODD by:

    • taking part in family therapy if recommended by the child's psychiatrist or doctor
    • enrolling in training programs that teach parents how to manage their child's behaviour, set clear expectations, and properly provide instruction
    • using consistent discipline when warranted
    • limiting the child's exposure to environmental triggers, such as arguments
    • encouraging and modelling healthy behaviours, such as getting proper sleep (if lack of sleep is a trigger for your child's defiant behaviours, for example)

    Behaviour and Emotional Problems

    Far more likely than one of the above clinical disorders is that your young child is experiencing a temporary behavioural and emotional problem. Many of these pass with time and require a parent's patience and understanding.

    In some cases, outside counselling is warranted and may be effective in helping children cope with stressors. For example, a professional could help your child learn how to control their anger, work through their emotions, and communicate their needs more effectively. However, for obvious reasons, medicating children at this age is controversial.

    Parenting for Childhood Success

    Parenting styles are rarely to blame for childhood behavioural problems. And if you're searching out solutions to help your family cope, that's a pretty good indication that you aren't causing your child's issues. Still, parents play a crucial role in treating early childhood behavioural issues.

    Parenting Styles: Which One Is Right for You? 

    When we talk about parenting styles, there are four main types, one of which is most effective in raising well-adjusted and well-behaved children:

    • Authoritarian parenting: Strict rules with no compromise and no input from the children.
    • Authoritative parenting: Strict rules, but parents are willing to listen and cooperate with their children—more democracy than authoritarian parenting.
    • Permissive parenting: Few rules and few demands put on children. There is little to no discipline in this home, and parents typically take on friends.
    • Uninvolved parenting: No rules and very little interaction. These parents are detached and may reject or neglect their children.

    Authoritative parenting is most likely to raise well-adjusted and happy children. Conversely, uninvolved parents are most likely to raise children lacking self-esteem, self-control, and general competency, say experts.

    We can learn from these parenting styles that children need clear rules and consequences, but they also need a parent who is willing to listen and guide them.

    Be Patient with Your Children

    Empathy, a cooperative attitude, and calm temperament are crucial traits for parents to adopt as their child struggles. Also, knowing when to ask for help is key. If your child's behaviour becomes disruptive to the regular running of your household or their education, or if they become violent, it's time to talk to a professional. Raising children with behavioural problems isn't easy. But before you rush to diagnose them or turn into a strict disciplinarian, reach out for help. Your pediatrician can provide insight into whether your child's behaviour is normal for their age and provide resources for assistance.

    What is normal behaviour for a child?

    Normal behaviour in children depends on the child's age, personality, and physical and emotional development. For example, a child's behaviour may be a problem if it doesn't match the family's expectations or is disruptive. Normal or "good" behaviour is usually determined by being socially, culturally, and developmentally appropriate. Knowing what to expect from your child at each age will help you decide whether their behaviour is normal.

    What can I do to change my child's behaviour?

    Children tend to continue a behaviour when it is rewarded and stop a behaviour when it is ignored. Consistency in your reaction to a behaviour is important because rewarding and punishing the same behaviour at different times confuses your child. When you think your child's behaviour might be a problem, you have 3 choices:

    • Decide that the behaviour is not a problem because it's appropriate to the child's age and stage of development.
    • Attempt to stop the behaviour, either by ignoring it or by punishing it.
    • Introduce a new behaviour that you prefer and reinforce it by rewarding your child.

    What kinds of therapy are effective for preschool children?

    At this age, therapy directed at helping children with behaviour issues centres around parents—teaching them skills to shape a child's behaviour more effectively and reset the family relationships more positively.

    Parent-Child Interaction Therapy (PCIT): 

    In PCIT, parents receive live coaching from therapists behind a one-way mirror. They lead children between 2 and 7 through a series of tasks and practice techniques for setting limits and responding effectively to desired and undesired behaviour. Training usually requires 14-17 weekly sessions.

    Parent Management Training (PMT): 

    In PMT, parents are usually seen without the child present, although children (3 to 13) may be asked to participate in some sessions. The therapist taught and modelled skills to deal more effectively with challenging behaviours and then role-played with parents. After each session, parents practise the skills at home.

    Positive Parenting Program (Triple P): 

    Triple P is designed to treat child behaviour problems from toddlerhood through adolescence and promote positive parent-child relationships. Its focus is on equipping parents with information and skills to increase confidence and self-sufficiency in managing child behaviour.

    When should you start therapy?

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    Evidence shows that children are most responsive to therapy to change behaviour up until age 7. So the younger the kids are treated, the longer the parents have this skill set to apply.

    When young kids behave in ways that parents find troubling, they are often told to wait because kids will grow out of it. But the reality is that when kids cannot act in age-appropriate ways, it's best not to wait. Children are learning all the time, and the longer their out-of-control behaviour is tolerated, the more firmly rooted it becomes. The longer that maladaptive behaviour goes on, the harder and more stressful it is for parents to turn around.

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    Parents also may worry that they'll be criticized for being "helicopter parents," she adds. But parent training helps disruptive or out-of-control kids learn skills they haven't learned—to reel in their impulses and respond effectively to direction. In addition, it helps them avoid being labelled as "problem" kids.

    How can a parent know when a child might benefit from parent therapy?

    All two-year-olds, all three-year-olds, have tantrums and can resist parental direction. It's natural at two for kids to be saying no to many things. The behaviour deserves attention when "no" is the only response you're getting, and it doesn't change without a huge fight. With tantrums, it's a matter of frequency, but also how impairing they are. You may need help if you're seeing not only frequent temper tantrums but full-blown tantrums, where the child is upset, crying for a long time, and inconsolable.

    Parents all feel like pulling their hair out at moments. Still, you should think about getting help when difficult behaviour becomes a regular thing when it's causing distress in the family, when you're starting to get depressed or so stressed that you're having trouble liking your child. It's not uncommon to hear parents say, "I love my child, but it's hard because everything's a fight."

    Another sign of a problem is if you find yourself adjusting your lifestyles because you can't go many places—not even kid-friendly places. So, for example, if you can't make a trip to the grocery store because it will end with yelling, crying, or fighting, it might be time to get help.

    What about kids who don't act up but don't obey orders?

    Another problem is what behavioural therapists call "passive non-compliance"—when you have told your child to do something six, seven, eight times, and he's just not doing it. "One more minute," or "I'm coming," or "I'm playing," or just flat-out ignores you when you know he's heard you. That gets problematic because the school will not work down the road if the child doesn't comply with teachers' requests. Even things like crossing the street are dangerous if the child is passively not complying to "Please hold my hand."

    What happens in parent training?

    Programs vary in approaches, but what they have in common is that parents are taught how to interact with their child in a positive and developmentally appropriate way, and then to set reasonable expectations for their child, and communicate those expectations in a way that makes it more likely their kids will listen to them. Parents learn a very consistent and predictable way to follow through when their kids do and don't listen. They practice so often the response becomes automatic, so they know how to react even in iffy situations or situations that seem like exceptions.

    What if my child's behaviour is caused by attention deficit hyperactivity disorder or sensory processing disorder?

    If your child has sensory issues (sometimes called sensory processing disorder or SPD) or attention deficit hyperactivity disorder (ADHD), they may be unable to sit still. Children with SPD and ADHD also may have very limited self-control. This can make parenting more challenging. Children who have these disorders often do not respond to punishments or rewards.

    Most often, parenting a child with ADHD and SPD requires you to deal with their emotions first and behaviour second. There are many ways to help teach a child with ADHD or SPD to deal with their feelings. These include breathing exercises, using an emotional levels chart, and using deep pressure to calm them. Only after your child is calm can you begin to explain why their behaviour was not appropriate or unexpected. Over time, they may start to learn self-regulation of emotions. This may help with behaviour.

    Things to consider

    Parents may choose to use physical punishment (such as spanking) to stop undesirable behaviour. The biggest drawback to this method is that although the punishment stops the bad behaviour for a while, it doesn't teach your child to change their behaviour. Disciplining your child is just teaching them to choose good behaviours. If your child doesn't know good behaviour, they are likely to return to the bad behaviour. Physical punishment becomes less effective with time and can cause the child to behave aggressively. It can also be carried too far into child abuse. Other methods of discipline are preferred and should be used whenever possible.

    Early intervention is important because it helps kids learn new behaviours before they've built up a whole lifestyle around bad habits and behaviours that create a very negative experience both at home and later at school. Kids need and want to have a positive relationship with their parents, other adults, and other kids, too. The earlier we can help them be effective at that, the happier and more successful they will be.

    That's why early treatment is so important. Therapy can help your child learn to respond better to their emotions and better shape their communications with you, teachers, siblings, and other authority figures.

    For example, aggression that causes a persistent problem at your child's daycare or preschool is cause for concern. If you're worried about your child's behavior or other developmental milestones, Dr. Marks recommends talking to your child's pediatrician or other healthcare provider right away.

    Putting blame on othersRefusing to follow rules or questioning authorityArguing and throwing temper tantrumsHaving difficulty in handling frustration.

    Signs to look for include: tantrums that consistently (more than half the time) include hitting, kicking, biting, or other forms of physical violence toward the parent or caretaker. tantrums in which the child tries to injure themselves. frequent tantrums, defined as tantrums that occur 10 to 20 times a day.

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