‘Lead Me, Guide Me’: Dealing with Children with Behavior Disorders

    “‘Lead Me, Guide Me’: Dealing with Children with Behavior Disorders,” Ensign, Mar. 1994, 46

    “Lead Me, Guide Me”:

    Dealing with Children with Behavior Disorders

    Like most children, Jared Lambert* came into the world screaming. Unlike most, Jared didn’t stop. “As an infant, he screamed practically twenty-four hours a day,” recalls his mother, Martha.* By age three, Jared was so aggressive and used such violent language that Sister Lambert took him to a psychologist. For a while, Jared took medication for hyperactivity, but it made him more aggressive.

    Jared is now a noncompliant fourteen-year-old. Although he is bright, he cannot function in a regular classroom and is behind his peers academically. He also has trouble at church. Recently, when Jared became disruptive in a Scout meeting, his Scoutmaster ushered him out of the meetinghouse. Jared became irrational and violent, and when the Scoutmaster came to explain the situation to the Lamberts, Jared swore and shouted threats. “I’ve never seen a child that I couldn’t control before,” the Scoutmaster told Sister Lambert as he backed down the sidewalk to his car.

    More Than Normal Misbehavior

    Jared has a serious behavior problem that makes it very difficult for him to adjust in his home, family, church, and school. Yet on the surface, Jared looks like most other children. He has a normal IQ and no visible physical problems that would account for his inappropriate and occasionally bizarre behavior. His five brothers and his sister have no serious adjustment problems. When we see a child behaving as Jared does, we might be tempted to think, If he were my child, I wouldn’t allow him to behave like that. But even the most loving, consistent discipline, while it might suffice for a typical child, would not totally “cure” Jared.

    Most children misbehave at some times. In fact, some forms of “misbehavior”—the tantrum is one good example—are normal at certain stages of a child’s development. But when behavior problems are so chronic, frequent, and severe that they interfere with normal education and socialization, they are called behavior disorders. Relatively rare, disorders of this kind affect a very small number of children.

    Many Problems, Many Causes

    Jared’s behavior problems affect others—his family, teachers, friends, and classmates. Mental health professionals call this an “externalizing” behavior problem. Externalizing behavior problems include delinquency and antisocial behavior, extreme noncompliance or argumentativeness, and aggressiveness. But other behavior problems—called “internalizing” behaviors—mostly affect the child. These include depression, anxiety problems, and obsessive-compulsive disorder.

    Just as every child is unique, each child with behavior problems is unique. Many show less severe behavior problems than Jared’s; many show more severe behavior problems. And many have multiple problems. A child with a learning disability might also start acting up in class, preferring to be labeled “class clown” rather than “class dummy.”

    When a child begins to show serious behavior problems, parents begin to ask why. “These children make you feel like a failure,” says one mother who has two children with behavior disorders. “In the first years after our sons began having problems, I spent so much time praying, asking the Lord, ‘Why are my children having these problems? What could I have done to prevent them?’” Even children from healthy, happy families can have serious behavior problems.

    Much evidence suggests that some children are genetically predisposed to develop serious behavior problems. Further, a recent study has linked conduct disorder with impaired functioning in the frontal lobe of the brain (see Journal of Clinical Psychology, Nov. 1990, pp. 696–706).

    “Some children are temperamentally ‘difficult’ from birth,” explains Dr. Bill Jenson, a professor at the University of Utah and a nationally recognized expert on behavior disorders. These “difficult” babies, like Jared Lambert, have negative moods, don’t operate on regular cycles, and are difficult to comfort. “As many as 70 percent of these babies later develop behavior disorders, whereas only 18 percent of other babies do,” says Dr. Jenson. “Boys are also far more prone to develop behavior disorders than girls.” (Except in quotes attributed to specific sources, all quotes in this article are from the author’s interviews with experts.)

    What other factors may, in some cases, contribute to serious behavior problems? Some researchers think that certain behavior disorders may be linked to significant disruptions or “breaks” in the process by which infants and young children form strong bonds of trust and love with their primary caretakers. It seems that some children who undergo such breaks—often through abuse, neglect, or separation from a parent at a critical point in the attachment process—may later develop conduct disorders, an especially serious type of behavior disorder.

    Thirteen-month-old Amy* had been severely neglected and abused by the time Beth and George Hansen* adopted her. Both her birth parents had used cocaine and marijuana, and her father had physically and sexually abused her. “She had a full set of teeth, yet she didn’t know how to chew because her diet had consisted solely of milk mixed with Kool-Aid,” recalls Beth. Amy’s most basic infant needs had been so completely ignored that she could trust and love no one. She has grown from an uncontrollable toddler who went from room to room destroying things into a child who seems to lack a conscience. Amy is also a child who cannot cry. Sister Hansen feels that Amy’s first year was so traumatic that she just shut off all her feelings. Amy is now twelve. Her lying, stealing, gorging, hoarding, and other antisocial behaviors are typical of children with conduct disorders.

    Behavior problems may also stem from dysfunctional family patterns that are generations old. Children may respond to trauma, nervousness, or sadness by behaving inappropriately. “It is important to try to understand what a behavior may be telling you about how a child is feeling,” says Brenda Reiss-Brennan, a family therapist in Salt Lake City.

    Early Intervention

    The more we learn about the many factors that contribute to behavior problems, the more we realize that there are no innately “bad children” and that not all of children’s problems are caused by “bad parents.” Whatever the cause or combination of causes for a child’s behavior problems, experts urge parents to identify behavior problems as soon as they surface. “Love is necessary, but not sufficient,” says Dean Byrd of LDS Social Services. “Parents should seek help for children who have problems.”

    Children with “oppositional-defiant disorder,” which is characterized by extreme argumentativeness and noncompliance, usually can’t be properly identified before about age five, explains Dr. Jenson. This is because that is the age when children normally gain better control over tantrums. “But don’t wait until the child is ten or eleven,” he urges. “By then, it is much harder to help the child.”

    Parents also need to avoid overreacting to misbehavior, cautions Dr. Brian Arneson, a psychologist who works with adolescents with severe behavior problems. “Most things your children are doing—depending on the frequency of the behaviors—are probably normal, and children will respond best to patience and management.”

    How, then, do parents decide when they need to find help for a child’s troubling behavior? “Mothers are good weather vanes,” observes Dr. Jenson. “They generally know when a child’s behavior is out of the normal range.”

    Parents may want to consider the following list of the most common signs of behavior problems. Remember that an isolated or mild problem with any one item on the list does not indicate a serious behavior problem. But extremes in behavior on this list may indicate a problem requiring intervention.

    • Complying with less than 40 percent of a parent’s requests after the child reaches age five

    • Temper tantrums

    • Excessive arguing and talking back

    • Excessive fighting

    • Social immaturity, difficulty making friends

    • Difficulty getting along at school

    • Problems with basic academic skills

    • Stealing, hoarding

    • Lying

    • Swearing

    • Substance abuse, including use of “gateway drugs”—alcohol, tobacco, cough syrup, glue

    • Poorly developed conscience, disregard for rules or feelings of others

    • Extreme withdrawal, spending excessive time alone

    • Extreme perfectionism, depression, or rage over mistakes

    Array of Resources

    For children who need help, there is a broad array of resources. Many hospitals, universities, and mental health agencies offer parent training courses that teach specific management techniques. Parents can also find help at county and state mental health centers and church, county, or state social services agencies. Pediatricians, psychologists, psychiatrists, and family therapists may also be helpful. And in some cases, hospitalization or special treatment facilities may be needed.

    Treatment of behavior disorders may or may not include medications, which Dr. Jenson says gives professionals a “window for working with problems” that may otherwise be unmanageable. With children whose problems have a physiological base, medication may be combined with therapy as a part of long-term management of behavior disorders. One mother describes the marked decline in her son’s aggressive behavior after taking a medication used for hyperactivity. “He said in amazement, ‘Look, Mom, I’m not being mean to the other kids,’” she recalls.

    “It is a constant struggle with prayer and fasting to figure out how this child should be reared,” says another mother. “I believe Heavenly Father expects us to do our homework. Ever since our son was six, we have invested in books, counseling, tutoring, and special programs. Now I go to the Lord to find out how to use the good things I have learned to help my child.”

    Positive Ways of Helping

    The fact that serious behavior problems may stem in part from biological factors does not mean that we can do nothing to improve them. According to Dr. Richard Young of Utah State University, “Much of the behavior that children struggle with is learned—from peers, school, and television, as well as from parents. And if you can learn bad behavior, you can also learn to replace it with positive behavior.”

    Unfortunately, says Dr. Young, the ways we instinctively try to correct children’s problem behaviors often worsen them. “Parents and teachers get trapped into thinking that kids need a stern voice,” notes Dr. Young. When we try to control behavior by punishing, threatening, and taking things away, we create what Dr. Young calls a “coercive environment” that children want to escape.

    “Children need two things,” says Dr. Dave Ericksen, a neuropsychologist from Salt Lake City. “One is a good, positive relationship with parents or teachers, and the other is clear limits. Children without one or the other don’t do nearly so well as children with both.”

    Dr. Young tells of working with an aggressive, drug-using teenager who had almost no communication with his mother. As a starting point in healing their relationship, Dr. Young asked the mother to stop criticizing and to start making a positive comment whenever she was in the room with her son. It could be a compliment on the color of his shirt or praise for completing a simple task, but her comment had to be pleasant. Within a few weeks, the son began to communicate with his mother and even confided in her about some of his problems.

    It also helps children when parents and teachers allow very little misbehavior. “No one rises to low expectations,” says Dr. Young. “But adults also need to handle misbehavior as an opportunity to teach,” he suggests. His technique for handling misbehavior positively was developed for severely delinquent juveniles. (See sidebar, “Tips for Teaching Children with Behavior Disorders.”)

    Dr. Jenson focuses on helping parents learn how to give specific requests and use meaningful rewards for compliance. Noncompliant children typically ignore requests, delay, argue, or throw tantrums—gradually “upping the ante” until the parent withdraws the request. Dr. Jenson says that parents need to apply basic, consistent limit setting.

    “I Can’t Tell You How Draining This Is”

    Families of children with serious behavior problems face challenges as deep and sorrows as profound as those caused by any serious chronic illness. These challenges and sorrows are best expressed in the words of the parents who bear them:

    1. Guilt and sorrow. “We often hear that if we attend the temple, read the scriptures, pray, and have family home evening, we will have peace in our homes. We are doing all these things, and I know that they are important and that we are blessed for doing them, yet we do not have peace. I have spent most of my life as a mother crying.”

    2. Isolation. “Sometimes when my son has caused a problem in the neighborhood, I sit in my house waiting for my neighbors to come to my door to complain. I feel barricaded in my home. I don’t want to answer the phone or the door.”

      “People don’t really say it,” another parent notes. “But more and more they seem to feel that we are bad people. They don’t want their children associating with our child.”

    3. Marital distress. “My husband doesn’t want to admit that our son has a serious problem. He will not talk about it or let me talk to our son’s teachers. He says if I could just treat our son differently, he would not have behavior problems.”

    4. Family distress. “Our son’s problems are ripping our family apart at the seams. I once asked our daughter to leave the house when our son was becoming violent. ‘Mom, where should I go?’ she asked. ‘What should I tell the neighbors?’”

      “After paying for several hospitalizations, we are financially, as well as emotionally, bankrupt.”

    5. Feeling judged. “My daughter’s behavior has improved since being on medication. But a neighbor of mine disapproves, and she clips every newspaper article about the dangers of this medication and brings them to me.”

      “My daughter looks normal and can act sweet. One good friend in our ward said, ‘If you would only treat her as you do your other children, I think she wouldn’t have these problems.’”

    6. Constant stress. “Our daughter sometimes makes improvements, but I can never get excited about it. It always blows up in my face. I feel like a rubber band.”

      “One day our son started beating his sister because she was in ‘his’ sandbox. When I tried to pull him off her, he threw a lawn sprinkler at me. I can’t tell you how draining this is.”

    7. No respite. “Some of these behavior problems don’t get better as children get older. Summertime is very difficult because our son is at home all the time. My husband works at night. I have no respite from constant stress.”

      “I love my child, and I will not give up. I may not do everything right, but I will never give up.”

    Toward a Community of Compassion

    How would a compassionate community of brothers and sisters in the gospel respond to children with serious behavior problems and their families?

    1. Suspend judgment. Remember that behavior disorders can happen in any family and that they may be caused by factors out of our control. Elder Boyd K. Packer of the Quorum of the Twelve taught: “There is little room for feelings of guilt in connection with handicaps. Some handicaps may result from carelessness or abuse, and some through addiction of parents. But most of them do not. Afflictions come to the innocent” (Ensign, May 1991, p. 8).

      “Before we had two children with behavior disorders, I would probably have looked with judging eyes at someone whose children were misbehaving in church,” says one mother. “Now, if I see someone with behavior problems, I wonder what that person’s story is.”

    2. Children of God. Remember that children with behavior problems are children of our Heavenly Father first and foremost. One mother relates, “The key for me is to try to imagine what my son is really like spiritually. I want my son to have a testimony, and I want him to learn how to have a friend. I pray in faith, ‘Help me to know how to help him do these things.’”

    3. Be a caring adult friend to a child with behavior problems. These children usually do not have friends. Take a child on an errand with you. Let him come to your home to help with a task. If you teach a class with a child who has serious behavior problems, pray about him and learn techniques that will help him.

      If you are the parent of a child with a behavior problem, don’t wait for someone to notice that your child needs special help. Pray about the matter and ask an adult to be a caring friend for your child.

    4. Ask the parents of a child with a behavior disorder to help you find ways to include the child in class or group activities. One mother describes a Young Women “secret sister” project as one of the highlights of her daughter’s life.

    5. Offer to help the parents. They often desperately need respite from caring for their children.

    6. Learn positive techniques for dealing with misbehavior. One such technique is described in the sidebar “Tips for Teaching Children with Behavior Disorders.” Remember that criticism and physical punishment are not helpful in the long run. Speak to the child in a calm, pleasant voice. Avoid insulting remarks, accusations, and blaming statements.

    Turning to the Lord for Peace and Guidance

    “We work and work with our son,” said one mother, “and success comes in very small increments. But I can feel peace from the Spirit, even when I see no results.”

    “When I sing ‘I Am a Child of God,’” says another mother, “I usually think of the chorus as the child’s plea for her earthly parents’ guidance. But I also think of it as my plea to my Heavenly Father to be beside me, helping me as a mother. Those of us whose children have any kind of problem are especially aware of how much we need our Father’s constant guidance as we struggle to care for his children.”

    Tips for Teaching Children with Behavior Disorders

    When children misbehave, consider using the following steps:

    1. Look at the child and say something positive or empathetic.

    2. Briefly describe the problem behavior.

    3. Describe the behavior you want the child to use.

    4. Briefly tell why the new behavior is better.

    5. Have the child practice the new behavior.

    6. Praise the child for trying the new behavior.

    Make clear family and classroom rules and consistently follow through on enforcing them, using the six steps shown above. Maintain a ratio of ten positive interactions for every one criticism or reprimand. Remember that criticism always alienates, rather than motivates.

    Photography by Craig Dimond