Pediatric Behavioral Issues

Others, such as behaving appropriately at home and in school, are the result of a complicated interaction between the child's physical and intellectual (cognitive) development, health, temperament, and relationship with parents, teachers, and caregivers. Behavioral and developmental problems can become so troublesome that they threaten normal relationships between the child and others. Some behavioral problems, such as bed-wetting, can be mild and resolve quickly. Other behavioral problems, such as those that arise in children with attention deficit/hyperactivity disorder (ADHD), can require ongoing treatment. Most of the problems described in this chapter arise out of developmentally normal bad habits that children easily acquire. The goal of treatment is to change the bad habits by getting the child to want to change his behavior. This goal often takes persistent changes in actions by the parents, which in turn result in improved behaviors by the child.

Parents often have difficulty telling the difference between variations in normal behavior and true behavioral problems. In reality, the difference between normal and abnormal behavior is not always clear; usually it is a matter of degree or expectation. A fine line often divides normal from abnormal behavior, in part because what is "normal" depends upon 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 his intellectual growth, or vice versa. In addition, "normal" behavior is in part determined by the context in which it occurs - that is, by the particular situation and time, as well as by the child's own particular family values and expectations, and cultural and social background. Understanding your child's unique developmental progress is necessary in order to interpret, accept or adapt his behavior (as well as your own). Remember, children have great individual variations of temperament, development and behavior.

Your own parental responses are guided by whether you see the behavior as a problem. Frequently, parents overinterpret or overreact to a minor, normal short-term change in behavior. At the other extreme, they may ignore or downplay a serious problem. They also may seek quick, simple answers to what are, in fact, complex problems. All of these responses may create difficulties or prolong the time for a resolution. Behavior that parents tolerate, disregard or consider reasonable differs from one family to the next. Some of these differences come from the parents' own upbringing; they may have had very strict or very permissive parents themselves, and their expectations of their children follow accordingly. Other behavior is considered a problem when parents feel that people are judging them for their child's behavior; this leads to an inconsistent response from the parents, who may tolerate behavior at home that they are embarrassed by in public. The parents' own temperament, usual mood, and daily pressures will also influence how they interpret the child's behavior. Easygoing parents may accept a wider range of behavior as normal and be slower to label something a problem, while parents who are by nature more stern move more quickly to discipline their children. Depressed parents, or parents having marital or financial difficulties, are less likely to tolerate much latitude in their offspring's behavior. Parents usually differ from one another in their own backgrounds and personal preferences, resulting in differing parenting styles that will influence a child's behavior and development.

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