children s health issues
Overview of Behavioral Problems in Children
Treatment
Early intervention Behavior-modifying strategies for parents The goal of treatment is to change undesirable behavior by getting children to want to change their behavior. This goal often takes persistent changes in actions by the parents, which in turn results in improved behaviors by the children. Behavioral problems need to be addressed early because behaviors are harder to change the longer they exist. Sometimes, parents need only to be reassured that the particular behavior is normal or to hear a few simple suggestions. One simple suggestion is for parents to spend at least 15 to 20 minutes a day in a pleasurable activity with the child or to call attention to desirable behaviors (“catching the child being good”). Parents are also encouraged to regularly spend time away from the child to help the child learn to be secure and also independent. Additional strategies for modifying behavior include the following: Identifying triggers for the child's behavior and factors (such as additional attention) that may inadvertently reinforce it Clearly defining for the child which behaviors are desired and which are undesired Establishing consistent rules and limits Tracking how well the rules and limits are followed Providing appropriate rewards for success and consequences for inappropriate behavior Focusing on the behavior itself and not equating it with the child (for example, saying "that was not acceptable behavior" instead of "you're a bad kid"). Minimizing anger when enforcing rules and increasing positive interactions with the child Child health experts recommend healthy forms of discipline, such as positive reinforcement of appropriate behaviors, limit setting, redirecting, and setting future expectations. They recommend that parents do not use spanking, hitting, slapping, threatening, insulting, humiliating, or shaming. If a behavior problem does not change in 3 to 4 months, doctors may recommend a behavioral health evaluation. This disciplinary technique is best used when children are aware that their actions are inappropriate or unacceptable and when they see withholding of attention as a punishment. Typically, children do not understand that withholding attention is a punishment linked to undesirable behavior until they are 2 years old. Care should be taken when this technique is used in group settings such as day care centers because it can result in harmful humiliation. The technique can be applied when a child misbehaves in a way that is known to result in a time-out. Usually, the child should receive verbal statements and reminders before the time-out technique is used. The inappropriate behavior is explained to the child, who is told to sit in the time-out chair or is led there if necessary. The child should sit in the chair for 1 minute for each year of age (a maximum of 5 minutes). Physical restraints should be avoided. A child who gets up from the chair before the allotted time is returned to the chair, and the time-out is restarted. Talking and eye contact are avoided. When it is time for the child to get up, the caregiver asks the reason for the time-out without anger and nagging. A child who does not recall the correct reason is briefly reminded. The child does not need to express remorse for the inappropriate behavior as long as it is clear that the child understands the reason for the time-out. As soon as possible after the time-out, the caregiver should make an effort to identify appropriate behavior and praise the child for it. Appropriate behavior may be easier to achieve if the child is redirected to a new activity far from the scene of the inappropriate behavior. Sometimes, a child's inappropriate behavior escalates when the child is in a time-out. In such cases, the caregiver may want to redirect the child to another activity before the full time has run out. Redirections should be done only after the child understands why the time-out had been given. 