As a parent, I think behavioural problems are one of the biggest issues, and it seems to be getting worse, it is more important that the issues are treated by the parent then the medical profession. There are a Varying amount of trends (e.g. rising expulsions and reports of disruptive children in primary schools) helping to fuel the idea that many of the young children of today are 'out of control'. An alarming amount of children in steadily growing numbers are being given medication to overcome their 'behavioural problems', and there are different views over how far this is justified or indeed the risks involved is this in fact just becoming an excuse for more deep-rooted causes, is this really just a bad parenting issue?

Bad behaviour?

Where a child's behavioural problem is persistent i.e. lasts longer then 6 months both at home with their parents and at school with other children, and at the request of the parent, and the agreement of the GP, then the child will be assessed to see if they are suffering from one or more problems or disorders before been referred to a specialist, the main categories looked at here would be;

• emotional (phobias, anxiety states, depression);
• hyperkinetic (over activeness, impulsiveness, inattention);
• developmental - delays in acquiring skills, whether specific (E.g. social, educational, bladder control) or more general (E.g. more pervasive conditions such as general learning Difficulties);
• eating (pre-school eating problems, anorexia nervosa, Bulimia);
• habit (tics, sleeping problems, soiling);
• post-traumatic stress and adjustment (e.g. to major Changes in life) disorders;
• somatic (chronic fatigue syndrome);
• Psychotic (schizophrenia, manic depression).
• conduct - children exhibiting extreme (stealing, defiance, Fire-setting, aggression, anti-social, etc.) Behaviour, are Usually classified under the general heading of conduct Disorder if their problems cannot be attributed to any other Diagnostic category.

The detailed diagnosis will depend on:

• Severity - the level of distress caused to the child, or those Around them;
• Complexity - how many different signs or symptoms are present (Including where the child suffers from more than one condition);
• Persistence - how long the condition has lasted;
• Secondary handicap - the extent to which the original problem Is likely to lead to further difficulties (e.g. learning difficulty Contributing towards a conduct disorder);
• Child's stage of development - symptoms that are perfectly 'Normal' at an early age may be indicative of more serious Problems at a later age (e.g. bed-wetting);
• Protective and risk factors - the presence or absence of factors likely to help (e.g. good relationships with family or others) or Hinder (e.g. relationship conflicts at home);
• 'Stress' factors - other factors that may indirectly influence the Situation (e.g. social or economic disadvantage).

Sources:

DH, 1995. "A Handbook on Child and Adolescent Mental Health", DH, London.

Kurtz, Z, 1996. "Treating Children Well", The Mental Health Foundation, London.

Most behavioural problems lie in a grey area between occasional naughtiness and extreme/psychotic behaviour and as such diagnosis depends upon the decisions of professionals such as psychiatrists. These experts are guided by hand books, in the UK this would be the World Health Organisation's (WHO) International Classification of Diseases, 10th edition (ICD 10). These books assist the professional psychiatrist in diagnosing such problems as;

• Phobias and anxiety states (thought to affect ~12% of children)
• Conduct disorders (up to 10%)
• Hyperkinetic disorder (~1% depending on the diagnostic criteria used)
• General (for example autism) and Specific (for example dyslexia) educational/developmental difficulties
• Psychotic disorders such as schizophrenia

Through national studies, estimates reveal as many as 1 in 5 children may be affected by one of these disorders, although this does vary greatly with age and gender. In general both conduct and hyperkinetic disorders (both of which are common amongst boys and girls) tend to reveal themselves at an early age. Where as emotional and eating disorders tend to be more prevalent amongst adolescent girls.

The main focus here I think is on some of the more common problems of behaviour, as these are the problems as a parent most of us can associate with on some level, these would include aggressive, violent and defiant behaviours the kind we associate with the temper tantrums of a toddler. Many of the disorders in the table below can manifest them selves in this manor. For example children with learning difficulties often vent their frustration or disguise their difficulties with unacceptable behaviour, as a parent it is important that we are able to spot this early so it can be confronted. This could also be said for hyperkinetic disorders which are assessed on impulsiveness, inattentiveness and over activity and effects around 1% of children under 10 years old. Where problem behaviour is not so easily defined professionals do have a tendency to classify them as conduct disorders, UK surveys suggest 6-10% of children of primary school age have been diagnosed with this, which is a staggering amount, and as a parent dealing with such problems is never easy.

Source: Hoare, P et al, 1996. "An Audit of 7000 successive Child and Adolescent Psychiatry Referrals in Scotland", Clinical Child Psychology and Psychiatry, 1, 229-249

Guidelines differ for detecting hyperkinetic disorders in the UK and the US; both countries do agree that the three main characteristics of this disorder are over activeness, inattentiveness and impulsiveness. The US criteria for attention deficit/hyperactivity disorder or ADHD are met when a child shows signs of hyperactivity, impulsiveness or inattentiveness in the home or at school providing some of the symptoms are present in both settings. Where as in Europe and the UK stricter guidelines are in place for Hyperkinetic disorders, children must show serious signs of both hyperactivity/impulsiveness and inattentiveness; these must also be shown both at school and in the home. As a result of this only 1% of primary school aged children are diagnosed as opposed to 5-10% of similar aged children in the US.

Problem children

Unruly Children

Behavioural problems in children