Behaviour problems in children  

How common is it?
All children have behavioural difficulties
Those seeking medical help
Sleep problems  		1% of children
Enuresis  			1% of 5-14 yr olds
Headaches  			1.5% of children
Somatic symptoms  		2% of children 
The Basic categories
Behaviour difficulties in the normal child
Arising from family dynamics
Due to environmental factors
Behaviour difficulties with a pathological cause
Distinction is very important because management is different.

Environmental factors
marital discord and divorce
child abuse
bullying at school
death or illness of parent or sibling
parental alcohol abuse

‘Organic’ factors
brain damage - hypoxia, AV haemorrhage, trauma
mental handicap
autism
specific learning difficulties

Initial assessment 
What is the behaviour? - History, communication skills
Is the child’s behaviour abnormal?
Could there be a physical reason for it?
How do family dynamics contribute to the problem? (+ve reinforcement)
Which professional group is in the best position to help?

Behaviour problems in the ‘normal’ child
sleeping problems
eating problems
temper tantrums
encopresis + soiling
somatisation - abdominal pain,
headaches.
school refusal 
enuresis
hyperactivity
	
	Boys (%)	Girls (%)	
Conduct disorder	11	8	
Hyperactive behaviour	14	6	
Emotional problems	9	9	
One or more problem	24	17	

Principles of Management
No child is born bad
Children learn attention getting techniques
If they work they will be repeated
If they work they will be repeated.

Management involves
Empathy
Explanation
Parents’ own behaviour
give children love and time
don’t give in and re-inforce behaviour.

Specific Behaviour Problems

Points to take home
Behaviour problems are in the eye of the beholder - history crucial
The family unit must be treated
The handicapped child is a special case
A simple behaviourist approach plus the passage of time usually works.
Sleep problems
Exclude physical cause, e.g. eczema, asthma
A behavioural approach 
establish a regular night time routine
check and return to bed
can leave to cry, but must be consistent

2) Eating problems
Eating problems

3) Temper tantrums +/- breath-holding
every child tries it on once
move to place of safety and ignore 
difficult to do in the supermarket
giving in to prevent a tantrum is a disaster
draw firm boundaries and stick with them.