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INTRODUCTION

This chapter reviews common childhood behavioral problems and suggests some management guidelines. Pediatric behavioral medicine cannot be easily disassociated from child development because many problematic childhood behaviors have developmental roots. Clinicians who work with children need to identify parents’ behavioral concerns, even if these are not brought up as problems by parents. Clinicians also need to develop strategies they are comfortable with to address childhood behavioral issues with parents, so that they can lead to resolution.

UNDESIRABLE BEHAVIOR: PART OF NORMAL CHILDHOOD DEVELOPMENT

A child’s ability to understand and interact with the environment is constantly evolving. To learn more about the world, a child experiments with ways of interacting with it. Most often, children test the reactions of the people to whom they are closest, their parents. Colloquial phrases such as “the terrible twos,” “she’s going through a stage,” and “boys will be boys” indicate that undesirable childhood behaviors are commonly accepted as “normal.” But when an undesirable behavior is manifesting in your child, the normalcy can be difficult to accept. And even when the cause is well understood, many parents still need the knowledge and skills to respond to the problem behavior.

Extraordinary Stress

Behavioral problems associated with normal childhood development must be distinguished from problems with more complex causes. Aberrant childhood behaviors are often secondary to extraordinary life stresses. This applies to children who witness violence, are members of communities that have experienced a natural disaster or catastrophic event, are exposed to continuous marital discord, have a frequently absent parent (such as military deployment), have a chronic illness or a chronically ill sibling, or who do not feel wanted. Children living under any condition that seriously threatens healthy and successful transition through a developmental stage are likely to pose serious behavioral problems.

Children, like adults, may appear to be the dysfunctional member of an otherwise healthy family unit even though the problem actually stems from family issues. This is particularly the case with childhood behaviors, because children are dependent on adults in almost every way. Take, for instance, the child who refuses to attend school. Classically, this behavior occurs when one or both parents send subliminal messages to the child to remain home. Although the primary problem is parental anxiety about separation, it is the child who exhibits the apparent symptoms.

Stresses causing unwanted childhood behavior may be relatively more subtle than those described above. For example, children of immigrants often successfully acculturate to the prevalent culture. But when these children’s attitudes and behaviors are not culturally acceptable or understood by their parents, children can be perceived to be behavioral problems. Or, they may manifest true aberrant behaviors as a result of the stresses of this culture clash.

Inherent Disorders

In addition to childhood behavioral problems stemming from normal development and extraordinary life ...

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