As much as parents do their best, constant good behaviour in children is impossible. However, there are times when ordinary naughtiness becomes something more serious. Psychologist Dr Stephanie Bartolo tells Ramona Depares what parents should do in case of worry.
Nowadays there is a lot more awareness about behaviour disorders in children – however, there is also a risk that parents mistake normal naughtiness and tantrums for a behaviour problem. At which point should a parent start to worry and follow up certain behaviour issues?
It is very common, perhaps especially as a parent, to become concerned with tantrums and to worry that normal naughtiness is actually a behavioural issue.
In my experience, most parents have concerns that their child may suffer from Attention Deficit Hyperactivity Disorder. It is important to remember that temper tantrums and naughtiness are, to a certain extent, a normal part of the grow process.
Parents should, perhaps, be mindful and start becoming a bit more concerned if the behavioural issues start becoming a constant pattern, causing disruption in the child and parent’s life. This is particularly true if it happens to the extent that it makes it difficult for the child to function in certain environments, such as in the classroom, at home, with friends and so on.
Would you say there has been an increase in behaviour disorders in children? If yes, to what do you attribute this?
In 2006 a national study by Cefai, Cooper & Camilleri reported that there was a 9.1% incidence of socio-emotional behavioural disorders in primary schools. Although one cannot primarily state that there has been an increase in prevalence, I feel that there has been an increase in children being diagnosed with a behavioural disorder. Thanks to this, many more children are receiving the help that they need at an early age.
According to this same study, students’ social, emotional and behavioural difficulties increase as they enter secondary school. However, the prevalence rate in primary school, especially among boys, is comparatively high, highlighting the need for preventative, early intervention work in the first years of primary school.
It is not easy to say if anything has attributed to this increase. The increase in diagnosis may be due to the increasing knowledge that emerges from research.
A few decades ago, parents would attribute certain characteristics of behavioural disorders to bad behaviour, and therefore not seek help for their child. Most were at a loss of what to do due to lack of information and support.
What are the most prevalent behavioural problems in Malta?
From what I see, some of the most prominent are Attention Deficit Disorder (ADD), Attention Deficit Hyperactive Disorder (ADD) and Autism Spectrum Disorders (ASD).
ADHD is one of the disorders that is mentioned most commonly. What are the true symptoms?
It is very important to know the true symptoms of ADHD and be able to decipher when a child is simply acting out in a one-off situation, or whether parents need to seek a professional opinion.
According to the Diagnostic and Statistical Manual of Mental Disorders, ADHD is characterised by a persistent pattern of hyperactivity and impulsivity. The manual lists how children often: fidget with/tap hands or feet or squirm in their seat; leave seat in situations when remaining seated is expected (e.g., leaves his place in the classroom, in the office or other workplace, or in other situations that require remaining in place; run about or climb in situations where it is inappropriate; are unable to play or engage in leisure activities quietly; are on the go, acting as if driven by a motor; talk excessively; blurt out an answer before a question has been completed; have difficulty waiting for their turn; interrupt or intrude on others.
Students’ social, emotional and behavioural difficulties increase as they enter secondary school
For the condition to be classified as ADHD, the symptoms need to be present before the age of 12 and be present in two or more settings. There also needs to be evidence that the symptoms interfere with the child’s functioning.
What should parents who suspect that their child is suffering from ADHD do?
The first thing parents should not do is panic. I have had parents phoning me, sounding distressed. There is a lot of information online nowadays about medical and psychological conditions. However, many websites are unreliable.
If a parent is truly concerned, they should seek professional help from a psychologist and/or psychiatrist. Such services might be offered within the child’s actual school.
If not, there are services offered by the government through the Child Development Assessment Unit. Once parents receive a professional opinion, I would then encourage them to make the child’s teacher aware of the situation to ensure the child and the parents get as much support as possible.
What kind of treatments are available?
Nowadays there is a lot of support one can offer a child with ADHD or other behavioural disorders, depending on the child’s needs. Usually, the best approach to treatment would be to tackle the issue holistically from a medical, psychological and social approach.
This approach has proved the most useful for both parents and adults. The important thing is that all aspects of the child’s needs are being taken care of, but this differs from child to child. For example, some children might need medication to help stabilise the hyperactivity, while others might not. Some children might benefit from play therapy or other forms of counselling, while others might not.
Apart from medical help or counselling, how can parents help their children?
While at times medical and psychological interventions are vital, parents at home need to do much of the work with the child.
Parents can make a big difference by trying to listen and understand what the child is trying to communicate through his behaviour. For example if the child is rocking back and forth, does this mean that the child is upset and trying to soothe himself?
Again, depending on the child’s needs, things like routine daily or weekly charts can be helpful for a child that finds it difficult adjusting to change, or has difficulty in waiting for things.
I would always recommend speaking to a professional in the field, assessing the child’s needs. From there, they can becoming pro-active and decide on activities and on little changes at home that could help the child communicate his feelings more effectively, while hopefully reducing any temper tantrums.
Many parents are also concerned when they catch their children lying. When does lying become a disorder?
Lying is a skill all children learn. It is a tool for avoiding blame or punishment, and for boosting up a poor self-image.
While all children lie, some do it much more than others. The crucial difference appears to be the emotional well-being of the child.
Children who are chronic liars do not feel good about themselves. Repeated lying can also be a sign of several underlying problems, each of which requires a different response from parents.
It is important to remember that temper tantrums and naughtiness are, to a certain extent, a normal part of the grow process
The most common reason for lying is fear of punishment or critical responses from parents. This is especially true if punishment is excessive, or parents are overly-critical and rejecting.
Older children or adolescents might lie to boost their self-esteem or social status, for example by saying they met certain important people or local celebrities, or by exaggerating their parents’ wealth.
While the occasional lie is nothing to worry about, repeated or chronic lying about social status might be a cause for concern, and one should question why they feel the need to exaggerate the truth. Are they not feeling good about themselves? Do they feel small next to their peers? Are they being bullied or belittled?
I’m unaware that there is a disorder for lying. However, if the lying becomes chronic I would always question why this is happening. Lying is a child’s defence mechanism in order to avoid being hurt, rejected, punished or criticised.
If lying becomes a common issue it would be worth seeing if there have been any major changes in the child’s life. If in doubt consult a professional.
What about children who have trouble recognising authority figures and seem to make it a point to do the opposite of what parents, teachers or other authority figures expect of them? Is there any advice that can help parents solve this?
Sometimes failure to recognise an authoritative figure can be a sign of rebellion. This can happen at home if the child perceives a parent’s questions to be intrusive. As children grow older, they realise that they have the power to control information.
Oppositional behaviour could also be the child’s way of trying to regain some form of control in an otherwise uncontrollable and unpredictable environment.
The first thing parents may try to do is focusing on what the child is trying to tell them about how he is feeling by engaging in this behaviour. As a parent, this can be quite difficult especially if the child becomes verbally or physically aggressive. If the behaviour reaches a point which is too difficult to handle, always consult a professional.