Supporting a child with a behavioral disorder

Editor's Note: Through a collaboration between Blanchard Valley Health System and Nationwide Children's Hospital, this article was provided courtesy of Nationwide's 700 Children's blog, written by pediatric experts. Defiant behavior among toddlers and young children (commonly known as "the terrible twos") is a normal phase of child development. Children might throw temper tantrums or have rapid mood changes. They want to do things by themselves. Their favorite word is "no." Similar developmentally appropriate behavior often shows up again during the teen years. Teens may rebel against household rules or act frustrated or angry. Some of this behavior stems from hormonal changes associated with puberty, as their bodies and minds develop. Temper tantrums are usually triggered when a child is frustrated, tired or hungry. As children learn more appropriate ways to communicate their wants and needs, and when clear limits and behavioral expectations are consistently set, these outbursts tend to become less frequent. However, some children continue to struggle with aggressive or impulsive behavior. Sometimes these actions may pose a threat to their safety or the safety of others. For some people, the behaviors can continue through childhood and even into adulthood. For some children, their frequent disruptive behavior may be more frequent and severe than same-age peers. In such cases, a mental health professional (e.g., social worker, counselor, psychologist, psychiatrist) may diagnose the child with a disruptive, impulse control or conduct disorder. This grouping of behavioral health disorders can include elevated levels of aggression, behavioral and/or emotional regulation difficulties and non-compliance. Two common diagnoses include conduct disorder and oppositional defiant disorder. Children and teens diagnosed with conduct disorder are generally characterized as having a disregard for others, may show a lack of remorse for their behavior, and typically display serious physical aggression towards people or animals, illegal activity such as vandalism or stealing or intentional acts of violence such as bullying or threatening others. Younger children may push, hit or bite, while teens might bully others, pick fights or vandalize property. Children diagnosed with ODD display repeated defiance of rules and may respond to adults and peers in a hostile manner. They may argue with adults or authority figures, frequently lose their temper over small requests for compliance, and often blame others for their mistakes. While most children will act this way at some point, the difference with ODD is the frequency and severity of the behaviors. Only a qualified healthcare practitioner can diagnose these conditions. Because many of these behaviors may be learned and inadvertently reinforced, most effective treatment methods include parent-focused behavioral therapy as a large component of the intervention. Medication may also be prescribed in some cases. There are things you can do to support your child at home. Be positive Rather than focusing on negative behaviors, help your child focus on what they do well. Praise them immediately when they make good choices and provide meaningful rewards for desirable behaviors such as compliance, even for simple tasks such as putting on a coat before going outside. Be patient Your child may not be able to control their behavior at first, but you can control your reaction. Set clear, simple expectations for your child and make sure these expectations are something they can actually meet so they feel successful when making an effort. Remind them what happens if they misbehave, but also the rewards they can earn for compliance. Be present Make sure your child knows you are there to support them. Let them know you are available to talk. Remind them that you love them and are there to help. Don't be discouraged or take it personally if your child pushes back when you make an effort to support them. Children will often push back when praise is provided and are the ones who need this praise the most to help build their self-esteem. Be consistent The best interventions are the ones that you can actually do on a regular basis. Set simple goals and reward plans to make it easier to track progress, such as focusing on one or two behaviors at a time. If you have concerns about your child's behavior or mental health, speak with their pediatrician. Flores is in outpatient behavioral health with Nationwide Children's Hospital.