COMMON PROBLEMS ENCOUNTERD BY ECED CHILDREN
WHAT FACTORS CONTRIBUTE TO PEER RELATIONSHIP PROBLEMS?As adults become aware of children with significant peer relationship problems, their concern should focus on why such problems are occurring. Fortunately, recent research has expanded insight into the following factors that contribute to children's peer relationship problems.
Social Behavior
Some children behave in an aggressive or disruptive manner and, hence, are rejected by peers. Other children withdraw from peer interactions and, in this way, limit their ability to gain acceptance and friendship (Coie and Kupersmidt 1983; Dodge 1983). Each type of ineffective social behavioral pattern can stem from different root causes. One possible cause is a lack of knowledge about effective interaction strategies. Another potential cause relates to the children's emotional states.
Children who are anxious or fearful about peer relations are unlikely to behave in an effective manner. Academic problems also can contribute to ineffective social behavior. Children who cannot engage themselves with classroom work assignments often disrupt and irritate their peers
Sleep Disorders and Sleep Problems in Childhood
Am Fam Physician. 2001 Jan 15;63(2):277-285.
Sleep problems are common in childhood. A distinction is made between problems in which polysomnography is abnormal (i.e., the parasomnias, sleep apnea and narcolepsy) and problems that are behavioral in origin and have normal polysomnography. The parasomnias—sleep terrors, somnambulism and enuresis—appear to be related to central nervous system immaturity and are often outgrown. Obstructive sleep apnea syndrome (OSAS) is frequently missed in children and can often be cured through surgery. Behavioral sleep problems may be overcome after parents make interventions. Physicians can be of great assistance to these families by recommending techniques to parents that have been shown to be effective.
Sleep behaviors are among the most common concerns that parents of young children bring to their physicians. A child who goes to bed unwillingly or wakes frequently during the night can be highly disruptive to a family. Sleep disorders in children, if confirmed by reproducible findings in a sleep laboratory, are not appreciably different from those occurring in adults. However, sleep problems, defined as a sleep pattern that is unsatisfactory to the parents, child or physician, are far more common.
Defining disordered sleep behavior is difficult because of important differences in sleep patterns that occur at different developmental stages. Thus, it is not considered abnormal when a two-month-old infant wakes frequently in the night, but it is considered abnormal in a two-year-old child. To make the definition of sleep problems even more difficult, families vary greatly in their tolerance of their children's sleeping habits; what one family finds problematic, another family takes as a matter of course.
Helping a family resolve a child's sleep problem is satisfying for a family physician and worth the time spent taking a careful history.
Common problem in early childhood
In children from birth to the beginning of the fifth year, common problems include difficulties in feeding and sleeping, as well as clinging to the parents (separation anxiety), temper tantrums, oppositional behavior, and minor degrees of aggression.
Managing early childhood behavior problems
Parents already know that all children occasionally throw tantrums and misbehave. But when does problem behavior cross the line from normal acting out to something more serious, such as a behavior disorder? Especially during certain periods (like the “terrible twos” or adolescence), it is normal for certain kinds of problem behavior to increase. But because all children go through stages of misbehavior, it can be hard for parents to know whether their child is just going through a phase or has a behavior disorder. The good news is that parents can often change their children's behavior by making changes themselves.
What are behavior disorders, and why do they happen?
If you think that your child may have a problem that is more serious than normal misbehavior, your pediatrician may want to rule out behavior disorders such as oppositional defiant disorder (ODD). A child may have ODD if his or her behavior has been hostile, negative, and defiant for at least six months and if at least four of the behaviors listed in the table below are common:
Possible symptoms of oppositional defiant disorder (ODD)
The child often:
§ Loses his or her temper
§ Argues with adults
§ Refuses requests made by adults and refuses to follow rules set by adults
§ Deliberately annoys people
§ Blames others for his or her mistakes
§ Is touchy or is easily annoyed by others
§ Is angry or resentful
§ Is spiteful or vindictive
Most children behave this way from time to time. However, if the description in the table above matches your child's behavior, the first step is to make an appointment with your child's pediatrician, who will help you decide if a mental health specialist could be helpful.
Why do children develop behavior disorders?
Some children are just naturally more fussy and irritable than others, which by itself can be challenging for parents. Attention deficit hyperactivity disorder (ADHD), learning disorders, late speech and language skills, and mild forms of autism can also lead to behavior disorders. Family stress, single parenthood and neighborhood violence can also be risk factors. Sometimes, if a child is reacting to something that is stressful in his or her life, and it is possible to remove the source of stress, the child's behavior may improve on its own.
Of all the factors that can cause misbehavior and behavior disorders, the easiest to change is parenting technique. No matter what is causing the behavior problems, parent training is the only treatment that has been scientifically shown to help. Parent training will not cure ADHD or other disorders, of course, and these must be treated as well. Nevertheless, programs such as the Incredible Years Parent Program, which was created for parents of children between the ages of three and eight, can help decrease a child's behavior problems.
The most important techniques taught by the Incredible Years Parent Program are described below:
Playing with your child
One of the goals of the Incredible Years Program is to strengthen the bond between parents and children. Sometimes children will stop misbehaving as soon as they realize that they don't have to “act up” to get attention. Also, the stronger the bond between parent and child, the more likely it is that children will respond to discipline.
The Incredible Years Program tells parents to think of their relationship with their child as a bank account. A parent makes deposits into the bank by playing, paying positive attention, talking, and empathizing with the child. A parent can make a withdrawal (for example, setting a limit), as long as there is a positive balance in the bank account. Sometimes parents are either not making enough deposits (for example, they are too busy for play or do not allow enough playtime), or they are making too many withdrawals.
You can remedy this situation by taking time every day or a few times a week to play with your child. Parent-child play is important to children because it makes them feel loved and important, improves their self-esteem, helps them to feel competent and sets the stage for further emotional development. Children often imitate their parents' behavior, and during playtime parents can model important social skills, such as taking turns, asking and cooperating with others. Without even trying, parents can also help children improve their vocabulary skills, and encourage imagination and problem-solving.
It can be hard to find time and energy to play with your child. Many times, parents of children with behavior disorders find it very stressful to play with their children. It's not uncommon for parents to be angry and frustrated about their child's misbehavior, and children can be mad at parents in return. But these families can benefit the most from playtime. Playtime can break the cycle of bad feeling and create attachment and warmth between parents and children.
Studies have shown that children tend to be more creative, more self-confident and have fewer behavior problems if their parents play with them often. Parents should remember to let the child direct the playtime. They should not be too concerned with rules or teaching either. This time should be relaxed and enjoyable.
Using the power of praising
Parental attention is a powerful tool that parents often don't even know they have. When children misbehave, parents give them negative attention such as yelling or scolding. For many children, this kind of attention is better than no attention at all. As long as the child gets attention for misbehaving, he or she will probably continue the behavior. Also, once children understand that they have a chance of getting their way by throwing a tantrum or misbehaving in some other way, it can be very hard to stop this behavior.
Parents can turn this situation around by giving a child attention for positive behavior and ignoring minor misbehavior. The use of praise is a way to deposit into a child's bank account. Praise encourages a child, and improves his or her feelings of self-worth and accomplishment. Children are more likely to repeat behavior that has been praised.
Parents should praise their children for everyday behaviors as well as big accomplishments. Many parents just expect their children to behave well and do not believe that this should be praised. However, children need to feel appreciated just as adults do. Parents should “catch their children being good” by looking for positive behaviors. Examples of positive behavior are: listening to parents, obeying requests, getting dressed on time, sharing, doing chores, playing quietly and talking nicely. Praise is most effective when it describes the good behavior (for example: “Nice job putting all your toys away!”). Praise should also be given immediately after the good behavior and should be genuine, enthusiastic and warm. Do not spoil the praise with criticism or sarcasm (for example: “Why can't you always act that way?”), and don't save praise only for perfect behavior.
Parents of children with behavior disorders need to work especially hard at finding positive behaviors to praise. Often, parents of these children are so frustrated that they do not notice their child's positive behavior. But the benefits of praising good behavior can be dramatic.
Yet another reason to praise children is that it teaches them polite language. Children who are praised frequently are more likely to praise others, including their peers, which improves their other relationships.
And the power of ignoring
Praising positive behavior is the first step, but it is also necessary to ignore negative attention-seeking behavior as long as it is safe to do so. For instance, whining, tantrums, swearing and arguing are not harmful or dangerous and can be safely ignored. Although it may feel that by ignoring misbehavior, you are allowing it to continue, parents can find out if the child is only trying to get attention by ignoring the behavior. If the child is looking for attention, the behavior will decrease and eventually disappear.
Ignoring misbehavior allows parents to avoid a power struggle by giving children control over their own misbehavior. The child decides whether to continue to act out or to stop. Some parents welcome the use of ignoring and are relieved to be given “permission” to ignore bad behavior.
However, ignoring bad behavior can be much harder than it seems. Consistently ignoring bad behavior takes a great deal of effort. To be effective, bad behavior must be ignored by every caregiver every time the behavior occurs. Otherwise, if a child is “rewarded” once in a while with attention for misbehaving, he or she may continue the behavior even longer.
Be prepared for an increase in misbehavior. If a child is used to getting his way by whining, and parents begin to ignore the whining, the child may start yelling, then screaming and may even explode into a tantrum. If the parent gives in, he or she is telling the child that worse misbehavior will be rewarded. On the other hand, if the parent can continue to ignore the misbehavior, the long-term results will be worth the struggle. It may take only a few times for a child to learn that the parent will not give in no matter how upset he or she gets, and once this happens the whining will stop altogether.
It is best to begin by choosing a single behavior to ignore. While ignoring the behavior, you should avoid eye contact and discussion and possibly move away from the child. The key to successfully ignoring misbehavior is to consistently praise the positive behavior you want to encourage. For example, in the case of whining, the child should be praised when he or she asks for things politely. Parents should especially look for opportunities to praise their child soon after they have ignored the negative behavior.
By consistently using the above techniques, many parents will find their child's behavior improving without a trip to the doctor. If after trying these techniques the child's behavior continues to worsen, or if it doesn't improve at all, parents may want to consider seeing a pediatrician for further testing.
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