Short attention span, impulsivity, aggression, not being able to sit still, not obeying instructions, difficulty controlling emotions — these are behavior issues in children that can have parents and caregivers ready to tear their hair out and wondering if something is wrong. However, they are also characteristics found in normally developing kids.
What’s normal behavior?
In a typical classroom of 18-month-olds to 2-year-olds, you’ll find that close to 90 percent of children show symptoms of what would be considered problem behavior in older children — they’re hyperactive, impulsive, noncompliant and have big feelings about what seem like small problems. They don’t engage in much planning or organization, or think before they act. However, for toddlers, these “problems” are often completely developmentally age-appropriate. So how can you tell whether a child’s behavior represents typical toddler antics or whether it has crossed the line into something more serious?
When to take action
I work with many families affected by behavior challenges in young children. These toddlers and preschoolers have long, out-of-control tantrums, won’t comply with instructions and may be aggressive in a way that timeouts just won’t solve. This can cause significant familial disruption, often causing parents to wonder whether their child’s challenges go beyond what is considered normal and, if so, what they can do about it.
Broadly speaking, the younger the child the less likely these behavioral issues are indicative of a diagnosable problem. At this early stage of development, problematic behavior could potentially be an early sign of a behavioral health condition — or can be a completely normal variance in development. Because of the complexity of developmental concerns, consultation with medical and mental health professionals using information from multiple contexts and caregivers is key to an accurate evaluation.
Look for signs
If a child is unusually combative compared to same-age peers, extremely hyperactive and fidgety and can’t seem to pay attention for even a few seconds, is excessively shy to the point of impaired functioning or cannot seem to control emotional reactions at all, it’s worth consulting a professional. Parents need to be particularly concerned about dangerously impulsive behaviors like climbing tall furniture, leaving the house without permission, running away in parking lots or into the street, extreme aggression or other behaviors that could cause harm to the child or others.
Symptoms like these may not yet be enough for the definitive diagnosis of a disorder, but they are indications that action is wise. Early intervention can help families understand what to look out for as their child grows. It’s also a great chance to start learning and practicing parenting and behavioral interventions that may help their child and their household operate with less conflict and distress both now and in the future.
Ways to address
One intervention I use with parents of young children with behavior problems is Parent-Child Interaction Therapy. This treatment approach is an evidence-based play therapy for children as young as 2 that teaches parents skills to help minimize negative behaviors and encourage positive ones. It includes a child-led component based on following the child’s interests and focusing positive attention on activities, praising when a child exhibits desired behaviors (“I love the way you’re sitting so quietly!”) and using attention-limiting consequences to discourage problem behaviors.
The meaning of feeling
Helping kids learn how to deal with feelings can make a big difference. Rather than teaching kids not to feel what they’re feeling, the key is to help them be aware of and identify their emotions, let themselves feel even their negative feelings and develop skills like mindfulness, deep breathing and using words to react constructively. Children can learn to regulate their behavior rather than acting out or having a tantrum, and parents can take advantage of an increasing variety of developmentally appropriate materials to aid in developing these skills in their kiddos.
The toddler years can be a broad mix of joy and frustration. Although disruptive, disobedient, hyperactive and impulsive behavior may drive caregivers crazy at times, much of this behavior is typical and to be expected as children grow, change and learn about themselves and their worlds. Addressing problematic behaviors in mindful, positive ways rather than punishing or labeling a child as “bad” will increase the chances of raising a happy, emotionally healthy, well-functioning child.
Ashley Harlow, Ph.D., NCSP, practices in the Behavioral Health Department at Children’s Hospital & Medical Center in Omaha, Nebraska, with a specialty in Behavioral Pediatrics. Dr. Harlow has a doctoral degree from Indiana University and completed a postdoctoral fellowship at the Johns Hopkins University School of Medicine through the Kennedy Krieger Institute. He provides individual and family therapy and enjoys working with families facing common behavioral problems, including tantrums, aggression, noncompliance, toileting and sleep disruption.