What are behavioral disorders?
ALL children will test boundaries and exhibit temper tantrums throughout childhood. This is their way to develop emotional regulation. But when the symptoms become persistently harmful to the child or others, and they are occurring in several different domains of child's life such as home, school and with peers, there may be a bigger underlying problem. Severe behavioral disorders include problems in the self-control of emotions and behaviors and exhibit issues with disruption, impulse control and conduct. They may be diagnosed as oppositionial defiant disorder, intermittent explosive disorder, conduct disorder, pyromania and kleptomania. While they range in severity of symptoms, the similarities across the board are two types of self control: poorly controlled behaviors, and poorly controlled emotions. The symptoms of behavioral disorders often are part of a pattern of problematic interactions with others, and children tend to justify their behaviors as a response to others rather than understanding their role in conflicts. You may look for the following symptoms:
What causes behavioral disorders?
The causes vary with each individual case. However, there is a combination of environment, temperament, and physiological contributors to behavioral disorder. Poor emotional regulation, poor frustration tolerance, and limited pro-social emotions have been predictive of the disorder. Environment is the largest factor- harsh, inconsistent or neglectful childhood experiences are common in families of children with oppositional defiant disorder. While individuals with a history of physical and emotional trauma during first 2 decades of life are at increased risk for intermittent explosive disorder. Family level risk factors include harsh discipline, abuse, frequent change in caregivers, and familial psychopathology; and community risk factors include peer rejection, association with delinquent peer group, and neighborhood exposure to violence.
A number of neurobiological markers have also been linked, such as lower heart rate, reduced cortisol reactivity, and abnormalities in the amygdala.
Unbiased, non-judgmental clinical attention to reducing the contributing factors of the environment is key in determining individual causal factors to behavioral disorders.
What is the typical approach to treating behavioral disorders?
With a thorough assessment, we seek to understand the experiences your child had beginning intrauterine and throughout childhood. This helps us understand how the brain developed and pathways we can work on in therapy to help re-build relationships and teach the child to regulate big emotions. Our focus is on creating a therapeutic environment of trust and openness to change. Dealing with behavioral disorders is challenging and requires a great deal of openness into history of family functioning and childhood development. The assessment includes:
- Review of current symptoms, concerns, duration and intensity
- A thorough review of child development and past medical history
- Review of family systems
- Additional important family background information including history of mental health issues
Then the best course of treatment is decided together with the caregivers. Parents and caregivers play a crucial role in treatment because family plays a crucial role in restoring balance to a child's perceived sense of insecurity. There are 4 dimensions of attachment that we will assess to determine where the imbalance has occurred for the child: Nurture, Engagement, Structure and Challenge. Coping skills and emotional attunement will be learned together with the parents and child, in order to assist in instilling coping skills with the affected child. Treatment may include a combination of the following:
- Theraplay® to learn emotional attunement and regulation
- Play therapy to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.
- Family therapy including play to explore and/or challenge existing family dynamics
- Traditional "talk therapy" to create a therapeutic environment of safety and unconditional acceptance
- Parenting support
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