How to handle an unruly, aggresive child

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

When talking about children's behavior, it is generally helpful to consider three kinds of behavior.

* Behavior that is wanted and approved. This might include doing homework, being polite and doing chores. These actions receive compliments freely and easily.

* Behavior that is not sanctioned but is tolerated under certain conditions, such as during times of illness (of a parent or child) or stress due to a family move, or the birth of a new sibling. This kind of behavior might include not doing chores, regressive behavior such as (baby talk) or being excessively self-centered.

* Behavior that cannot and should not be tolerated or reinforced. This means actions that are harmful to the physical, emotional or social well-being of the child, family and others. These actions may include very aggressive or destructive behavior, overt racism or prejudice, stealing, truancy, smoking or substance abuse, school failure or intense sibling rivalry.

In this article, I only want to talk about the third type of behavior. We have all experienced the feeling of anger and aggression and so has your child. These impulses are normal and healthy. All children are aggressive at times, particularly when tired, hungry or upset. Oppositional behavior is a very normal part of development for children, toddlers and early adolescents.

Some children are naturally aggressive in ways that begin to show during the second year. They want to take charge and control everything that goes on around them. When they don't get what they want, they may turn their energy toward violent behavior like kicking, biting or hitting.

This openly uncooperative and hostile behavior is only a serious concern when it is frequent, consistent and has a negative impact on the child's social, family and school life.

When this behavior is displayed, parents need to take control and help develop sound judgment skills, self-discipline, and the other tools the child needs in order to express feelings in more acceptable ways.

Child and adolescent antisocial behavior is not the result of a single factor or a single defining situation but rather multiple factors contribute to and shape antisocial behavior.

The research on risk for aggressive, antisocial and violent behavior includes multiple aspects and stages in life, beginning with interactions in the family such as weak bonding, ineffective parenting including poor monitoring, excessively harsh, or inconsistent discipline, and inadequate supervision.

Exposure to violence in the home over the course of a child's early development puts children at risk of being violent later in life. Some factors in aggressive behavior are related directly to characteristics within the child, but many other factors relate to circumstances within the social environment of the aggressive child which enable, shape and maintain aggression, antisocial behavior and related behavior problems.

Outside the home, one of the major factors contributing to youth violence is the impact of peers. In the early school years, a good deal of mild aggression and violence is related to peer rejection and competition for status and attention. More serious behavioral problems and violence are associated with small numbers of youths who are rejected by their peers, fail academically and then band together.

A sound stable environment at home increases the likelihood that children will overcome such individual challenges and not become violent. However, exposure to violent or aggressive behavior within a family or peer group may influence a child in that direction.

It is also very common for children with problems to also display symptoms of attention deficit hyperactivity disorder (ADHD), the most commonly diagnosed behavioral disorder of childhood.

The diagnosis is made by the presence of persistent age- inappropriate inattention and impulsivity, often coexisting with hyperactivity. This co-occurrence is often associated with an early onset of aggression and impairment in personal, interpersonal and family functioning. Being the parent or guardian of an overly aggressive child can be confusing, painful and lead to feelings of helplessness.

If you are in charge of a type 3 child, take the time to have an honest look (without guilt, blame or shame) at the social environment, and the personal interaction the child is having. Next week we will talk about how to deal with the problem.