Common Problems of Children

Common Problems of Children

It's common for preschool children to exhibit behavioral problems, as the result of increased interaction with others and not knowing how to communicate their needs effectively. The majority of common behavioral problems are exhibited in children 18 months and older.

1. Hitting is often a direct communication of frustration when a child is not getting his way. Young children often hit because they cannot speak the words to communicate their irritation.

2. Biting Typically, this is a developmental teething issue and not behavioral. However, like hitting, it is an easy way for children who do not have verbal skills to express anger or frustration.

3. Taking Toys Children under the age of three are still learning the basic concept of sharing. Children do not share their toys at home in an only-child situation, thereby making sharing in preschool a foreign concept to them.

4. Temper Tantrums are attention-gaining tools for children to get their way. Children realize quickly that teachers are more likely to give in the louder the tantrum is and the longer it lasts.

5. Not Following Directions Following directions is very difficult for children under two years of age as their main focus is to explore and sense the world around them. However, children over two years, while still curious, should understand boundaries and rules when told to do something.

6. Personal Aggression Children who suck their thumb, grind their teeth, pull their teeth or rock or bang their heads include some of the negative habits that puts parents and other adults on edge. What may look like self-aggression is typically a bad habit a child formed and will most likely grow out of it. The article "Bad Habits, Annoying Behavior," published by the University of Michigan Health System, states that calling attention to the offending behavior, shouting or disciplining a child usually does not stop the habit. Instead, they suggest offering praise and encouragement when the child ceases the behavior.

Common Behavior Problems of Children

These can be usefully classified into psychosocial disorders, habit disorders, anxiety disorders, disruptive behaviour and sleeping problems.
Psychosocial disorders These may manifest as disturbance in:
• Emotions e.g. anxiety or depression
• Behaviour e.g. aggression
• Physical function e.g. psychogenic disorders
• Mental performance e.g. problems at school
This range of disorders may be caused by a number of factors such as parenting style which is inconsistent or contradictory, family or marital problems, child abuse or neglect, overindulgence, injury or chronic illness, separation or bereavement.1

The child's problems are often multi-factorial and the way in which they are expressed may be influenced by a range of factors including developmental stage, temperament , coping and adaptive abilities of family, the nature and the duration of stress. In general, chronic stressors are more difficult to deal with than isolated stressful events.

Children do not always display their reactions to events immediately although they may emerge later. Anticipatory guidance can be helpful to parents and children in that parents can attempt to prepare children, in advance, of any potentially traumatic events e.g. elective surgery or separation. Children should be allowed to express their true fears and anxieties about impending events.

Young children will tend to react to stressful situations with impaired physiological functions such as feeding and sleeping disturbances. Older children may exhibit relationship disturbances with friends and family, poor school performance, behavioural regression to an earlier developmental stage, development of specific psychological disorders such as phobia or psychosomatic illness.

It can be difficult to assess whether the behaviour of such children is normal or sufficiently problematical to require intervention. Judgement will need to take into account the frequency, range and intensity of symptoms and the extent to which they cause impairment.
Habit disorders These include a range of phenomena that may be described as tension reducing.

Tension reducing habit disorders
Thumb sucking Repetitive vocalisations Tics
Nail biting Hair pulling Breath holding
Air swallowing Head banging Manipulating parts of the body
Body rocking Hitting or biting themselves

All children will at some developmental stage display repetitive behaviours but whether they may be considered as disorders depends on their frequency and persistence and the effect they have on physical, emotional and social functioning. These habit behaviours may arise originally from intentional movements which become repeated and then become incorporated into the child's customary behaviour. Some habits arise in imitation of adult behaviour. Other habits such as hair pulling or head banging develop as a means of providing a form of sensory input and comfort when the child is alone.

• Thumb sucking - this is quite normal in early infancy. If it continues it may interfere with the alignment of developing teeth. It is a comfort behaviour and parents should try to ignore it while providing encouragement and reassurance about other aspects of the child's activities.

• Tics - these are repetitive movements of muscle groups that reduce tension arising from physical and emotional states, involving the head, the neck and hands most frequently. It is difficult for the child with a tic to inhibit it for more than a short period. Parental pressure may exacerbate it while ignoring the tic can reduce it. Tics can be differentiated from dystonias and dyskinetic movements by their absence during sleep.

• Stuttering - this is not a tension reducing habit. It arises in 5% of children as they learn to speak. About 20% of these retain the stuttering into adulthood. It is more prevalent in boys than girls. Initially it is better to ignore the problem since most cases will resolve spontaneously. If the dysfluent speech persists and is causing concern refer to a speech therapist.

Anxiety disorders

Anxiety and fearfulness are part of normal development, however, when they persist and become generalised they can develop into socially disabling conditions and require intervention. Approximately 6-7% of children may develop anxiety disorders and of these 1/3 may be over-anxious while 1/3 may have some phobia. Generalised anxiety disorder, childhood onset social phobia, separation anxiety disorder, obsessive compulsive disorder and phobia are demonstrated by a diffuse or specific anxiety predictably caused by certain situations.

School phobia occurs in 1-2% of children of which an estimated 75% may be suffering some degree of depression and anxiety. Management is by treating underlying psychiatric condition, family therapy, parental training and liaison with school to investigate possible reasons for refusal and negotiate re-entry.
Disruptive behaviour

Many behaviours, which are probably undesirable but a normal occurrence at an early stage of development, can be considered pathological when they present at a later age. In the young child many behaviours such as breath-holding or temper tantrums are probably the result of anger and frustration at their inability to control their own environment. For some of these situations it is wise for parents to avoid a punitive response and if possible to remove themselves from the room. It is quite likely that the child will be frightened by the intensity of their own behaviour and will need comfort and reassurance. While some isolated incidents of stealing or lying are normal occurrences of early development they may warrant intervention if they persist. Truancy, arson, antisocial behaviour and aggression should not be considered as normal developmental features.

Attention deficit hyperactivity disorder This is characterised by poor ability to attend to tasks, (e.g. makes careless mistakes, avoids sustained mental effort) motor overactivity (e.g. fidgets, has difficulty playing quietly) and impulsiveness (e.g. blurts out answer, interrupts others). For the diagnosis to be made, the condition must be evident before age 7 years, present for >6 months, seen both at home and school and impeding the child's functioning. The condition is diagnosed in 3-7% of school-age children.

Methylphenidate (initiated by specialists only) is a stimulant medication that provides reduction of symptoms, at least in the short term.2 Management usually includes family therapy (a programme of behavioural modification for the child and the parents), although further research confirming its benefits is needed. 3,4,5 Essential fatty acids may alleviate some symptoms.
Sleeping problems

Sleep disorders can be defined as too much or too little sleep than is appropriate for the age of the child. By the age of 1-3 months the longest daily sleep should be between midnight and morning. Sleeping through the night is a developmental milestone but at the age of 1 year 30% of children may still be waking in the night. Stable sleep patterns may not be present until age 5 years but parental or environmental factors can encourage the development of circadian rhythm.

Sleep disturbance can have a deleterious affect on the cognitive development of children, as well as the functioning of the parents. One study of 2-3 year olds found a significant link between sleep disturbance and emotional and behavioural disorders.7 Other links include memory loss and obesity.

Regular bedtimes, quieter activities and the creation of marked differences between the sounds, activities and light levels associated with night time sleeping and daytime activities may help to encourage better sleep patterns. A solid evidence base now supports the use of behavioural treatments in infants and pre-school children (under 5).All of these are based on the objective of the parents gaining control of the bedtime routine. They include unmodified extinction (ignoring the child's cries but monitoring for illness or injury), modified extinction (ignoring the child for a specified period of time) and positive routines (doing some quiet pre-sleep activity and ensuring that falling asleep is associated with a positive parental-child interaction). One study found that parental interventions that encourage independence and self-soothing were associated with extended and more consolidated sleep compared to more active interactions that were associated with shorter and more fragmented sleep.

Hypnotherapy has been found to be of benefit in school-age children.

The BNF for Children states that the use of hypnotics, except for occasional short-term treatment of night terrors and sleep-walking, is never justified.However, it is recognised that the treatment of paediatric insomnia is an area that needs further research.

Melatonin is sometimes of benefit in sleep disorder associated with visual impairment, cerebral palsy, attention deficit hyperactivity disorder and autism. It is unlicensed for this indication and specialist supervision is recommended for initiation and monitoring.

Emotional Problems in Children

Emotional problems in children have become more widely recognized. A child's emotional problem can become a chronic problem if it's not attended to properly and in a timely manner. Many adult emotional problems can also affect children, but these problems may not be as easily recognized in children. Some emotional problems in children can be treated quite easily, but some require long-term care that can be complicated.

Childhood Bipolar Disorder

1. Childhood bipolar disorder is an emotional problem that can affect children. This childhood emotional problem can be hard to diagnose, because its symptoms are also symptoms of many other childhood emotional problems. Common symptoms include mood swings, irritability, episodes of extreme happiness and episodes of severe depression. Childhood bipolar disorder is a serious condition and should be treated as such. Treatment most often includes a combination of medication (sometimes more than one) and behavior therapy (teaching the child how to handle certain situations better).

Childhood Depression
2. Childhood depression is an emotional problem that can affect children. This childhood emotional problem is considered serious, but it can be difficult to diagnose because its symptoms are not unique. Common symptoms include irritability, fatigue, hopelessness, social withdrawal and poor performance in school. Childhood depression is most often treated with medication and behavior therapy.

Autism
3. Autism is an emotional problem that can affect children. This childhood emotional problem is often serious and consists of three distinctive behaviors. These autism behaviors include trouble interacting socially, obsessive and competitive behavior and difficulty with nonverbal and verbal communication. Medications (often more than one) and behavioral and educational therapies and interventions are used to treat autism. Family counseling is also used to help families learn about autistic children and to help them cope.
Childhood Schizophrenia

4. Childhood schizophrenia is an emotional problem that can affect children. This emotional disorder often affects a child's ability to develop normal social, educational and emotional skills and habits. Children with emotional disorder often have difficulty performing daily tasks, think and act irrationally and have delusions and hallucinations. Childhood schizophrenia is most often treated with a variety of treatments including medications (most often antipsychotics) and psychotherapy (teaches the child to cope with the illness and its challenges).

Tourette Syndrome
5. Tourette syndrome is an emotional problem that can affect children. This emotional problem is also considered a neurological disorder. Tourette syndrome is characterized by stereotyped and repetitive vocalizations and involuntary movements referred to as tics. Tourette syndrome is most often treated with a combination of medication and psychotherapy.