Child Behavior Disorders

The vast majority of children display a range of behavior problems such as whining or disobeying; however, some children experience more severe behavior problems, known as behavior disorders. There is not always consensus on when a problem becomes a disorder. The field of child behavior disorders is a relatively new one and the study of childhood disorders from a developmental perspective has become known as developmental psychopathology. It is now recognized that the developmental level of the child is a prime consideration in assessing and treating behavior problems in children. It is often less the behavior per se and more the appropriateness of the behavior for a child of a certain age that makes a behavior problem a behavior disorder. Adult models of psychopathology may not be relevant for childhood problems; however, many adult problems stem from childhood disorders and many childhood disorders have lifelong consequences. With better attention to child behavior disorders, children may lead better lives and adult psychopathologies may be reduced.

Estimates suggest 10 to 20 percent of children have a behavior, emotional, or learning disorder at any one time. These developmental disorders are most often diagnosed when the child is school aged. Children undergo rapid change physically, psychologically, and cognitively and their behavior needs to be evaluated in a developmental context compared to their peers. To determine whether their behavior is a developmental variation or pathological depends on the child's age, the frequency and intensity of the behavior and the overall environment. For example, hitting to resolve a dispute, temper tantrums, or bed-wetting are not unexpected at age 2, but most inappropriate at age 12.

Unlike adults who may self-refer, children are usually referred for assessment by parents. Parents’ own emotional states and tolerance for disruptive behaviors [Page 384]influence whether they will refer. Further, the younger the child, the more information comes from the parent about the child, rather than directly from the child.

One of the most widely used tools to classify childhood disorders is the Child Behavior Checklist developed by Thomas Achenbach. Two factors on this scale are involved in the majority of behavior disorders. First is externalizing behavior such as aggression and hyperactivity, while the second is internalizing behavior such as depression and anxiety. This approach is based on large-scale normative data and the rating scales are available for parents, teachers, and youth.

A clinical approach to diagnosis of childhood disorders is found in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, technical revision (DSM-IV-TR). The DSM recognizes several broad classes of childhood disorders including intellectual problems such as developmental delays, developmental problems such as autism, behavior problems such as conduct disorder, emotional problems such as anxiety, and physical problems such as bedwetting. Child behavior problems may exist on their own or with other problems.

The most common developmental disorder is attention deficit disorder with or without hyperactivity (ADD or ADHD). Because children with ADD/ADHD may be difficult to discipline, parenting may be affected. Equally common are anxiety disorders, with separation anxiety unique to children. Disruptive behavioral disorders include aggression, conduct, and oppositional defiant disorder. Mood disorders including depression are less common in children but increase during adolescence. Other major categories include sleep, eating, and tic disorders.

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