In pediatric office practice, physicians and nurses are often asked to treat common behavioral problems. Children with a history of abuse, neglect, or abandonment may present to the pediatrician with symptoms including anger, aggressive behaviors, depression, or difficulties sustaining attention. In many cases, the children are no longer exposed to direct threat but present with residual behaviors that can be linked to neurophysiological responses to previous maltreatment. When the children are in foster or adoptive care or when a birth parent's circumstances have improved, caregivers may be attentive and consistent in their attempts to address a child's maladaptive behaviors but still find typical behavior-modification strategies unsuccessful. In many cases, the child's exaggerated reactions to stressful stimuli can cause the caregivers to act in ways that reinforce the child's misbehavior.
When attentive and consistent parenting seems ineffective, the physician would do well to remember that early maltreatment (physical or sexual abuse, neglect, or exposure to violence and fear) can deprive the child of the tools needed to adapt to a larger social environment. In addition to denying the developing child necessary social interactions, early maltreatment can alter the normal child's neural physiology, significantly changing the expected responses to stress and affecting the child's ability to learn from experience.
EMOTIONAL PROBLEMS
Emotional problems in children have become more widely recognized. A child's emotional problem can become a chronic problem if it's not attended to properly and in a timely manner. Many adult emotional problems can also affect children, but these problems may not be as easily recognized in children. Some emotional problems in children can be treated quite easily, but some require long-term care that can be complicated.
PHYSICAL PROBLEMS
Mental retardation, learning disorders, communication skills disorders and pervasive developmental disorders (such as autistic disorder) appear to have biological components. Some psychologists specialize in the identification and treatment of these disorders, but they are not frequently encountered in a general psychological practice because of the need for specialized training and treatment. Therefore, they will not be discussed here. Elimination disorders are encountered in general psychological practice, but are typically seen as a symptomatic expression of other psychological problems.
SOCIAL PROBLEMS
Peer relationships
Are important to children's development. Friends not only provide companionship and recreation, but meet other needs as well. Through interactions with peers, children learn valuable social skills.
Working with Shy or Withdrawn Students
This digest focuses on the middle range of such students, who are commonly described as SHY (inhibited, lacking in confidence, socially anxious) or WITHDRAWN (unresponsive, uncommunicative, or daydreaming) and suggests strategies for working with these student
BEHAVIORAL PROBLEMS
Psychosocial disorders
This range of disorders may be caused by a number of factors such as parenting style which is inconsistent or contradictory, family or marital problems, child abuse or neglect, overindulgence, injury or chronic illness, separation or bereavement.1
The child's problems are often multi-factorial and the way in which they are expressed may be influenced by a range of factors including developmental stage, temperament, coping and adaptive abilities of family, the nature and the duration of stress. In general, chronic stressors are more difficult to deal with than isolated stressful events.
These may manifest as disturbance in:
Emotions e.g. anxiety or depression
Behaviors e.g. aggression
Physical function e.g. psychogenic disorders
Mental performance e.g. problems at school
Habit disorders
All children will at some developmental stage display repetitive behaviors but whether they may be considered as disorders depends on their frequency and persistence and the effect they have on physical, emotional and social functioning. These habit behaviors may arise originally from intentional movements which become repeated and then become incorporated into the child's customary behavior. Some habits arise in imitation of adult behavior. Other habits such as hair pulling or head banging develop as a means of providing a form of sensory input and comfort when the child is alone.
These include a range of phenomena that may be described as:
· Tension reducing habit disorders
· Thumb sucking
· Repetitive vocalizations
· Tics
· Nail biting
· Hair pulling
· Breath holding
· Air swallowing
· Head banging
· Manipulating parts of the body
· Body rocking
· Hitting or biting themselves
Anxiety Disorders
Anxiety and fearfulness are part of normal development; however, when they persist and become generalized they can develop into socially disabling conditions and require intervention. Approximately 6-7% of children may develop anxiety disorders and of this 1/3 may be over-anxious while 1/3 may have some phobia. Generalized anxiety disorder, childhood onset social phobia, separation anxiety disorder, obsessive compulsive disorder and phobia are demonstrated by a diffuse or specific anxiety predictably caused by certain situations.
Disruptive Behaviors
Much behavior, which is probably undesirable but a normal occurrence at an early stage of development, can be considered pathological when they present at a later age. In the young child many behaviors such as breath-holding or temper tantrums are probably the result of anger and frustration at their inability to control their own environment. For some of these situations it is wise for parents to avoid a punitive response and if possible to remove themselves from the room. It is quite likely that the child will be frightened by the intensity of there own behavior and will need comfort and reassurance. While some isolated incidents of stealing or lying are normal occurrences of early development they may warrant intervention if they persist. Truancy, arson, antisocial behavior and aggression should not be considered as normal developmental features.
Sleeping Problems
Sleep disorders can be defined as too much or too little sleep than is appropriate for the age of the child. By the age of 1-3 months the longest daily sleep should be between midnight and morning. Sleeping through the night is a developmental milestone but at the age of 1 year 30% of children may still be waking in the night. Stable sleep patterns may not be present until age 5 years but parental or environmental factors can encourage the development of circadian rhythm.
