Dr Tahir Saeed, Clinical Psychologist Dr Samra Tahir, Clinical Psychologist Selection of quotes Your children need your presence more than your presents Jesse Jackson. We are apt to forget that children watch examples better than they listen to preaching. Roy L. Smith. Stop trying to perfect your child, but keep trying to perfect your relationship with him Dr. Henker. Praise your children openly, reprehend them secretly W. Cecil. It is better to bind your children to you by a feeling of respect and by gentleness than by fear Terence Behavioural problems Behaviour problems are a major problem in childhood and beyond. More severe, persistent forms affect 5%-10% of children in developed western countries (Rutter, et al., 2008) These behavioural problems are linked to future adult crime, drug & alcohol misuse, unemployment, poor physical health and mental disorders (Cohen, 1998; Moffit, et al., 2002; Odgers, et al., 2007). Environmental vs Hereditary Factors Behavioural difficulties in a children stem from a variety of environmental, emotional and biological issues in a childs life. All children exhibit behavioural difficulties from time to time due to the stresses of daily life. The Colorado State University (CSU) Extension Service suggests that tantrums, one of the most common forms of behaviour, occur in 23 to 83 percent of all 2- to 4-year-olds. When negative behaviours continue or escalate, then parents seek help (CSU). Factors contributing to behavioural difficulties. There could be number of other reasons for behavioural difficulties other than ADHD, Autism, Oppositional Defiant Disorder, Conduct Disorder, etc. Attachment Problems. Specific Learning difficulties. Bullying at school or home. Parental conflicts. Environment and Community. Gifted children. Life Change Differential Diagnosis Prior to arriving at a definite diagnosis, it is important to rule out other possibilities. Multi-D assessment is the only recommended option to rule out other possibilities. Psychological tests including gathering information from multiple sources should be the first recommended line of action. Attachment Disorder Attachment disorder is a broad term that describes a childs difficulty with Mood, Behaviour, and social relationship. The problems mainly arise from a failure to form normal attachment to primary care giver in early childhood. The failure to make secure attachment result from unusual early experiences of neglect, abuse, abrupt separation from caregivers between 6 months and three years of age, frequent change or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts resulting in a lack of basic trust. Attachment Disorder ICD-10 describes Reactive Attachment or (RAD) for the inhibited form and Disinhibited Attachment (DAD). In DSM-IV-TR both comparable inhibited and disinhibited types are called reactive attachment disorder or "RAD". Specific Learning difficulty Specific Learning difficulties of a child can impact significantly the lives of sufferers, their family and friends. These difficulties can be with speech & language, reading, writing, numeracy, coordination, etc. These difficulties often affect people of normal and above-average intelligence, who simply struggle to do those things most of us take for granted. At times simple tasks become major issues, and the knock-on effects can take its toll. Confidence is greatly diminished and feelings of failure and embarrassment become the norm. Individuals can feel alone and sidelined, which can cause frustration and anger. This, in turn, can lead to many more serious behavioural problems. Bullying and Abuse Bullying is another major factor that has a very serious impact on childs behaviour. According to the American Academy of Child and Adolescent Psychiatry, close to half of all children will experience school bullying at some point while they are at primary or secondary school. At least 10 percent of children are bullied regularly. A bullied or abused child is usually too scared to tell a parent or other trusted adult. Their behaviour however, change quite drastically; they may act out in verbally or physically assertive ways. Or they become withdrawn and sullen. Bullying and Suicide Cross-sectional findings indicate that there is an increased risk of suicidal ideation and (or) suicide attempts associated with bullying behaviour and cyberbullying.suicide attemptsbullyingbehaviour The few longitudinal findings available indicate that bullying and peer victimization lead to suicidality but that this association varies by sex. (Brunstein Klomek A, 2010)bullyingvictimization (Brunstein Klomek A Life Changes Professionals agree that Children thrive on routine and stability. Change in a childs life- including a new sibling, starting or changing schools, death of a relative or moving to a different country- may negatively impact on a childs behaviour. An inability to verbalize emotions or a fear of the unknown may cause children to make poor choices. A child may become loud, aggressive, defiant or noncompliant. Parental Abuse and Neglect Abuse by a parent or caregiver can lead to a host of negative behaviours in children. Children who suffer physical, sexual or emotional abuse are at increased risk for developing severe behavioural issues including aggression, lying, stealing, bullying and other antisocial behaviours. Additionally, children who are physically or emotionally neglected may have difficulty forming meaningful relationships and as a result, they may act out aggressively. Contradictions Parents of children who exhibit negative behaviours may struggle with feelings of guilt. They feel that they are somehow at fault. But by exploring and understanding the roots of a childs negative behaviours, parents can often address the behaviours more effectively. In most cases, no single factor is responsible for a child's negative behaviours. Rather, behavioural issues usually stem from a combination of environmental and biological factors. Since many of these factors are closely connected, parents may have difficulty determining why their child is acting out. Parenting style Research has strongly supported that a negative parenting style characterised by more harsh, inconsistent discipline was clearly associated with more severe child misbehaviour. This is true even when a range of child and family socioeconomic factors were taken into account in different research. Negative discipline is usually associated with having twice the rate of severe child behaviour problems in the clinical range (rising from 21% of children in families who didnt use it, to 40% if they did). Parenting Style Parenting style Harsh and inconsistent parenting is associated with child behaviour problems (Scott, 2008; Finzi- Dottan, Bilu, & Golubchik, 2011; Dadds, 1995). Other factors that feed into this directly and indirectly include: domestic violence, parental drug abuse, maternal depression, family poverty, parents with low education, stressed families and single parent status (Webster- Stratton & Reid, 2008; Bloomquist & Schnell, 2005). Parenting style There is significant relationship between high levels of parental warmth and lower levels of externalising behaviour problems in children (Garber, Robinson, & Valentiner, 1997). Lack of involvement, as well as poor monitoring and supervision of childrens activities, strongly predicts behaviour problems (Loeber & Stouthamer-Loeber 1986). Parents of children with behaviour problems are likely to be less positive, more permissive and inconsistent, and use more violent and critical discipline (Reid, Webster-Stratton & Baydar 2004). In an influential review Rutter, Giller & Hagell (1998) concluded that behaviour problems are associated with hostile, critical, punitive and coercive parenting. Parents mental health Parental wellbeing (depression and stress), and partner violence each are additionally associated with child difficult behaviour over and above the effect of negative parenting. Environment and Community The community in which a child resides can impact his behaviour. Children who grow up in communities marked by violence, poverty or substance abuse may act out in response to the environmental stressors they may be experiencing. Similarly, children often emulate the behaviours of adults in the community, so witnessing violence, aggression or substance abuse may lead children to imitate such behaviours. Children are especially apt to imitate their parents behaviours, so setting a good example through appropriate conflict-resolution skills and language can help children learn appropriate social skills. Gifted Children The characteristics of gifted children often lead to social and emotional problems that can affect their emotional and social development. Boredom can be a major factor for their behavioural difficulties. Gifted children can intellectually understand abstract concepts but may be unable to deal with those concepts emotionally, leading to intense concerns about death, the future, sex, and other such issues. They may talk rapidly or compulsively, have boundless energy, display compulsive habits or tics, or have obsessive thoughts about a single idea or goal. Very bright children can be unusually strong willed, negotiate like lawyers, or use sarcasm to make a point. Common Causes Of Disturbing Child Behaviour 1. The child is tired. 2. The child is physically ill. 3. The child is angry or unhappy. 4. The child is very happy and excited. 5. The child's parents (married or divorced) are arguing on trivial issues. 6. A major change disrupts stable routine. 7. Surrounded or "pushed" by intense, nervous, rushing adults. 8. Exposed to too much anger, disapproval and unhappiness from others. 9. Too much time separated from home or parent. 10. Someone (another child or an adult) modelling inappropriate behaviour. 11. Parents too disconnected from the child on an emotional level. 12. The child is not provided with appropriate boundaries and lacks sufficiently close supervision. Line of Action Parental training Comprehensive assessment Functional analysis of the behaviour. Positive reinforcement strategies. By setting boundaries, children learn that with every action comes a reaction. Be connected with your child. Understand him and his needs. Maltreatment or mental illnesses can lead a child to exhibit negative behaviours. And in such cases, a simple lesson in boundaries will not suffice. Many times, a child will need professional help in learning the life lessons that other children have learned rather easily. Growing Mindful Growing Mindfullness Thank you so much Child maltreatment has been called the tobacco industry of mental health. Much the way smoking directly causes or triggers predispositions for physical disease, early abuse may contribute to virtually all types of mental illness. Now, in the largest study yet to use brain scans to show the effects of child abuse, researchers have found specific changes in key regions in and around the hippocampus in the brains of young adults who were maltreated or neglected in childhood. These changes may leave victims more vulnerable to depression, addiction and post- traumatic stress disorder (PTSD), the study suggests. Harvard researchers led by Dr. Martin Teicher studied nearly 200 people aged 18 to 25, who were mainly middle class and well-educated. They were recruited through newspaper and transit ads for a study on memories of childhood. Because the authors wanted to look specifically at the results of abuse and neglect, people who had suffered other types of trauma like car accidents or gang violence were excluded. Child maltreatment often leads to conditions like depression and PTSD, so the researchers specifically included people with those diagnoses. However, the study excluded severely addicted people and people on psychiatric medications, because brain changes related to the drugs could obscure the findings. Overall, about 25% of participants had suffered major depression at some point in their lives and 7% had been diagnosed with PTSD. But among the 16% of participants who had suffered three or more types of child maltreatment for example, physical abuse, neglect and verbal abuse the situation was much worse. Most of them 53% had suffered depression and 40% had had full or partial PTSD. The aftermath of that trauma could be seen in their brain scans, whether or not the young adults had developed diagnosable disorders. Regardless of their mental health status, formerly maltreated youth showed reductions in volume of about 6% on average in two parts of the hippocampus, and 4% reductions in regions called the subiculum and presubiculum, compared with people who had not been abused. Thats where this study begins to tie together loose ends seen in prior research. Previous data have suggested that the high levels of stress hormones associated with child maltreatment can damage the hippocampus, which may in turn affect peoples ability to cope with stress later in life. In other words, early stress makes the brain less resilient to the effects of later stress. We suspect that [the reductions we saw are] a consequence of maltreatment and a risk factor for developing PTSD following exposure to further traumas, the authors write. Indeed, brain scans of adults with depression and PTSD often show reductions in size in the hippocampus. Although earlier research on abused children did not find the same changes, animal studies on early life stress have suggested that measurable differences in the hippocampus may not arise until after puberty. The new study suggests that the same is true for humans. The findings also help elucidate a possible pathway from maltreatment to PTSD, depression and addiction. The subiculum is uniquely positioned to affect all of these conditions. Receiving output from the hippocampus, it helps determine both behavioral and biochemical responses to stress. If, for example, the best thing to do in a stressful situation is flee, the subiculum sends a signal shouting run to the appropriate brain regions. But the subiculum is also involved in regulating another brain system that, when overactive during chronic high stress such as abuse, produces toxic levels of neurotransmitters that kill brain cells particularly in the hippocampus. It can be a counterproductive feedback loop: high levels of stress hormones can lead to cell death in the very regions that are supposed to tell the system to stop production. What this means is that chronic maltreatment can set the stress system permanently on high alert. That may be useful in some cases for example, for soldiers who must react quickly during combat or for children trying to avoid their abusers but over the long term, the dysregulation increases risk for psychological problems like depression and PTSD. The subiculum also regulates the stress response of a key dopamine network, which may have implications for addiction risk. It is presumably through this pathway that stress exposure interacts with the dopaminergic reward system to produce stress- induced craving and stress-induced relapse, the authors write. In other words, dysregulation of the stress system might lead to intensified feelings of anxiety, fear or lack of pleasure, which may in turn prompt people to escape into alcohol or other drugs. With nearly 4 million children evaluated for child abuse or neglect in the U.S. every year a problem that costs the U.S. $124 billion in lost productivity and health, child welfare and criminal justice costs child maltreatment isnt something we can afford to ignore. Even among the most resilient survivors, the aftereffects of abuse may linger. Not only are such children at later risk for mental illness, but because of the way trauma affects the stress system, they are also more vulnerable to developing chronic diseases like diabetes, high blood pressure, heart attack and stroke.