BEHAVIOR PROBLEMS IN YOUTH
DEFIANT BEHAVIOR CONDUCT DISORDER
ATTENTION DEFICIT DISORDER [AD/HD]
Youths with behavior problems need help to change their behavior and to stop alcohol and drug use. Their families often need help to reorganize in order to make a positive difference.
Parents can feel hopeless, guilty, or hurt. Sometimes nobody in the family feels understood or happy. All feel powerless to stop doing what has not been working. Therapy can help families try new, positive, more effective approaches to change behavior.
When children show these symptoms or changes, careful assessment in individual, family, school, and medical settings are required. Psychotherapy with the youth, family therapy, and medication often help. These are the three main categories of behavior problems in children and adolescents.
I. AD/HD ATTENTION DEFICIT HYPERACTIVITY DISORDER
In AD/HD these behaviors appear prior to age seven. Do you see a majority of these? Check the ones you observe.
- easily distractible
- fidgets, restless
- mood swings
- dangerous behavior
- hard to discipline
- defiant, oppositional
- interrupting in class or home, blurting out answers, difficulty waiting his/her turn
- shifts activities rapidly from one incomplete activity to another
- symptoms worse when long attention is needed
- symptoms better when well supervised or one-on-one
- symptoms better in stimulating setting, e.g., video games
- may lose self-esteem, perceived as dumb or lazy
- peer relations are strained, can't follow rules, interrupts others play, not waiting turn, grabbing
- spaces out
- low tolerance for frustration
- gives up on hard tasks without trying
- symptoms worse in unstructured settings
- work is often messy, careless, unfinished
- difficulty maintaining attention
- fails to finish chores and assignments
- academic underachievement
II. OPPOSITIONAL DEFIANT DISORDER (ODD)
AD/HD is a kind of disability these children can't purposely maintain attention or shift attention to whats important without outside help and direction. They are often misperceived as willfully misbehaving rather than unable to meet expectations for behavior. With help getting organized and with hard work, AD/HD children can turn their problem into an asset due to their creativity and energy.
When we find five or six of these behaviors, lasting six months or more, we think of it as Oppositional Defiant rather than just a temporary reaction to life stressors.
- angry, resentful, negativistic
- swears - touchy
- blames others for own mistakes and deeds
- may be verbally abusive and may fight
- deliberately annoys people
- refuses to follow adult rules or structure in school and/or home
- actively defies authority
- loses temper at the drop of a hat
ODD often starts with changes in the family (e.g., divorce, a move, a parent drinking, a parent remarrying, disagreements between parents) or a conflictual period in school. It may begin as depressed mood or anger over changes in life. Eventually, the childs angry behavior and defiance become the main way of coping. Anger mismanagement and explosive temper are common behavior problems. Understanding the childs view of these changes and developing new family patterns for handling the child usually make a positive difference.
CD is a very serious problem. It usually does not go away without help, but evolves into adult antisocial behavior and chemical dependency.
When ODD and CD behaviors mostly occur when the youth is with friends, and start after age fourteen, sometimes behavior improves when new friends and activities are arranged.
When we find three or four of these for six months or more, we consider CD.
- stealing more than once, perhaps committed forgery
- enraged by frustration
- destroyed property, vandalism
- cruel or callous to people or animals
- used a weapon in a fight, initiates fights
- mugging, armed robbery, purse-snatching
- violates others rights and social norms
- considers feelings and warmth as weaknesses
- drug and alcohol problems, tobacco use, often beginning age eleven to thirteen
- often truant
- cons others
- running away
- makes excuses for the behavior
- acts with bravado
- underachieving or disruptive in school
- harms animals
- sets fires
- broke into a car, home, building
- forced someone into sexual activity
- temper outbursts
CAUSES OF DISRUPTIVE BEHAVIOR DISORDERS
- Sometimes the behavior is age-appropriate, such as in a two-to-four year-old, but it is a concern if it continues beyond age five. After that, a careful assessment of the child, and the family too, may uncover reasons why the behavior continues.
- Tantrums, destructiveness, and defiance begin as a child's way to tell us of distress or depression about changes in the family, such as a divorce, loss of a loved one, remarriage, the stress of a parent drinking, or the illness of a parent. In these cases, the behavior problem usually slows down when the problem is discussed openly and resolved. Crisis counseling and brief family counseling is usually effective in these situations
- Traumatic events, such as abuse, molestation, and catastrophes, can trigger many coping reactions in a child who cant resolve the trauma on his or her own. Anger and defiance may the youth's way to respond to it. Brief trauma healing therapies, such as EMDR, can be helpful in restoring emotional health.
- Medical causes should be evaluated. These include head injuries, some epilepsy, shortage of certain brain chemicals, neurological problems, and certain allergies. Psychotropic medications can often help improve overall functioning.
- Family stress may cause family patterns which increase behavior problems before anyone realizes how it happened. These include lack of supervision, abuse, changes in who takes care of a child, changes in whom the child lives with, overly harsh discipline, overly lax discipline, parental inconsistency and giving in, parents who cant get together about discipline, or accepting the boys will be boys idea when really the aggressive behavior should be curbed. Others include loss of positive role models for the youth, children seeking necessary attention but in negative ways, lack of recognition for the child's positive qualities and behavior, families in which conflicts usually escalate, children feeling weak inside but putting on a tough exterior. Family therapy can help get the family on the right track.