Common behavioral disorders in children

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The U.S. Department of Health and Human Services describes behavioral disorders as involving “a pattern of disruptive behaviors in children that last for at least 6 months and cause problems in school, at home, and in social situations”.

This is different from the challenging behaviors children sometimes display. Almost all children will have tantrums, or act in aggressive, angry, or defiant ways at some point.

While challenging, these behaviors are a normal part of childhood development. Often, they are the result of strong emotions that the child is expressing in the only way they know how.

As a result, healthcare professionals only diagnose a behavioral disorder when the disruptive behaviors are severe, persistent, and outside the norm for the child’s developmental stage.

Behavioral disorders are also different from autism spectrum disorder (ASD), which is an umbrella term for neurodevelopmental conditions that affect how some children communicate, socialize, and process sensory stimuli.

ASD may cause behaviors in children that caregivers find unusual or challenging, but these are the result of how they experience the world.

The following sections look at some specific behavioral disorders and their symptoms.

ADHD is a disorder that causes difficulty focusing attention. It can also cause hyperactivity and impulsivity.

There are three ADHD subtypes, with the diagnosis depending on the symptoms the child displays most often. The subtypes are:

• inattentive type
• hyperactive-impulsive type
• combined type

A child with inattentive type ADHD may:

• find it difficult to pay attention
• become easily distracted
• have difficulty focusing on tasks, particularly long tasks such as reading
• start tasks but forget to finish them
• appear not to listen to instructions or to forget them

A child with hyperactive-impulsive type ADHD may:

• find it difficult to stay still or remain seated
• fidget a lot by tapping the hands, feet, or moving around in their seat
• run around or climb things when it is not appropriate
• frequently interrupt conversations or games
• have difficulty waiting for their turn
• have trouble talking or playing quietly

A child with combined ADHD will exhibit a mixture of the above behaviors.

Doctors often diagnose ADHD after the age of 6. This is because the symptoms can be more apparent when a child starts school, and struggles to adjust to more quiet, sedentary activities.

Learn more about how ADHD can manifest differently in girls.

Those with CD tend to violate basic social rules and the rights of others. This can have a significant impact on someone’s academic, social, and home life. It can develop both in childhood or in adolescence.

The symptoms of CD include:

• aggression, which may result in physical fights, bullying behavior, forcing someone into sexual activity, or animal cruelty
• destruction of property, such as setting fires or damaging possessions
• deceitfulness, such as lying or tricking others
• significant rule-breaking, such as not going to school, running away, or stealing

Many young people with CD have difficulty interpreting the behavior of others. For example, they may believe a person is behaving in a hostile way toward them when they are not. This causes them to escalate toward aggressive or violent behavior.

People with CD may also have difficulty feeling empathy, or have another condition, such as anxiety or post-traumatic stress disorder that affects their thoughts and behavior.

According to Mental Health America, CD may affect 6–16% of boys in the general population, and 2–9% of girls. If CD first manifests before age 11, it is more likely to persist into early adult life.

Children and adolescents with ODD display an ongoing pattern of hostile behavior toward authority figures, such as parents, caregivers, or teachers. Unlike conduct disorder, children with ODD tend to violate minor rules, rather than major rules and social norms.

The potential signs of ODD include:

• temper tantrums and irritability
• argumentative behavior, such as constantly questioning rules
• persistent stubbornness, which may manifest as a refusal to follow instructions or apologize for behavior
• provocative behavior, such as intentionally annoying or upsetting others
• spiteful or vindictive attitude

It is worth noting that some clinicians have criticized the concept of ODD, arguing that it medicalizes normal child behavior. It is common for children to behave angrily or defiantly when they are unhappy, so it can be difficult to distinguish between ODD and behavior that is related to stress.

Doctors can only diagnose ODD if the behavior has been persistent for 6 months, causes constant disruption at home or school, and is not the result of another mental health condition.

There is no single cause for behavioral disorders. It is likely that a mixture of physiological and environmental factors play a role.

But it is important to note that a child of any background, sex, or gender can have a behavioral disorder.

The following factors may influence their development:

Brain structure and chemistry

Evidence suggests that changes in brain structure, development, and neurotransmitter levels may influence behavioral disorders. For example, areas of the brain that control attention are less active in children with ADHD.

Low serotonin and high sensitivity to cortisol, a stress hormone, may also play a role in aggression.

Additionally, conditions that affect learning ability may have an impact, as children with intellectual disabilities are twice as likely to have a behavioral disorder.

Pregnancy complications

Behavioral disorders appear to be more common in children with a low birth weight, or who were born prematurely.

ODD may also be more common in children exposed to toxins in the womb, such as tobacco smoke, or in children whose parents or caregivers have substance abuse disorders.

Genetics

Behavioral disorders can run in families. This could indicate a genetic predisposition for some people to develop them.

But in the case of ODD, scientists have not identified a specific gene that could explain this. Older studies have shown that people with ADHD, ODD, and CD share similar genetic traits, but none were unique to these disorders.

Sex or gender

Male children are more likely to have behavioral disorders than female children. It is unclear if this is due to biological differences, or whether differences in gender norms and expectations influence how male children behave or develop.

For example, girls with ODD may be more likely to express aggression through words, rather than actions. This may mean the behavior is less obvious, and so less likely to receive a diagnosis.

Trauma

Psychological trauma is a complex emotional and physical response to severe or chronic stress. Early exposure to trauma can impact child development.

Any experience that causes significant distress can be traumatic, but common examples that may affect children include:

• an unstable home life
• difficult relationships with parents or caregivers
• inconsistent or harsh discipline
• physical or emotional abuse

Behavioral disorders are more common in people from low-income backgrounds, which may be due to increased levels of stress.

It is also possible to confuse child traumatic stress with a behavioral disorder, as they have overlapping symptoms.

It is important to consult a mental health professional if a child may have a behavioral disorder. A specialist can diagnose the disorder through an assessment process. This may include:

• child observation
• behavior checklists
• standardized questionnaires
• interviews with parents, caregivers, or teachers

It is not possible for parents or caregivers to diagnose behavioral disorders themselves. An early diagnosis can significantly improve the effectiveness of treatments.

But many child psychologists will not diagnose a behavioral disorder in very young children, particularly those of preschool age or younger. This is because it can be challenging to distinguish between normal and abnormal behavior in this age group.

Over 80% of preschoolers have mild tantrums occasionally. Because young children experience huge developmental changes in a short period of time, they may outgrow short-term behavioral difficulties.

The management of behavioral disorders can vary depending on the child’s needs, their family’s needs, and the type and severity of their disorder. Approaches that may help include:

• Parent management training: This helps parents and caregivers manage their child’s behavior, learn effective ways of communicating with them, and effective ways of setting rules and boundaries. For young children, this is often the main approach.
• Individual therapy: This can help older children and adolescents learn techniques for managing their emotions and responding to stressful situations.
• Family therapy: This may help household members learn how to talk to each other about emotions and problems, and find ways to solve them.
• Social or school-based programs: These programs help children and adolescents learn how to relate to peers in a healthy way.
• Support for learning difficulties or disabilities: Professional support with learning difficulties may improve the child’s well-being and help them get on better at school.
• Medication: If a child has a coexisting disorder, such as ADHD or a mental health condition, medication can reduce the symptoms. But medications do not cure behavioral disorders.

Patience, empathy, and encouragement are important for helping to boost self-esteem. An authoritative parenting style, which involves listening to children whilst also setting reasonable rules and boundaries, is also helpful.

It is important to note that bootcamp-style programs and “tough love” are not effective for behavioral disorders. In fact, they can be very damaging.

Caregivers should speak with a pediatrician if they think their child may be showing signs of a behavioral or developmental disorder. The doctor may refer the child to a specialist, such as a:

• developmental-behavioral pediatrician
• child psychologist
• child psychiatrist
• pediatric neurologist

It is also important for caregivers to seek support for their own well-being. They may wish to make use of respite care, if available, or to speak with a therapist. There are also support groups where caregivers can connect with others raising children with behavioral disorders.

Most children have temper tantrums or display impulsive or defiant behavior at some point. These are usually a normal part of child development.

But in cases where the behavior is persistent and constant, or outside the norm for the child’s age and level of development, it may be a sign of a behavioral disorder.

With early and appropriate treatment, families can learn to manage the behaviors. In many cases, careful treatment improves behavior over time.