Around 12% of Australian children aged 4–12 years experience externalising behavioural problems such as aggression and hyperactivity. Similarly, around 12% experience internalising problems such as anxiety and depression. Other common behaviour problems, such as temper tantrums, arise as the child strives to achieve developmental milestones.
This article reviews externalising behavioural problems and common developmental behavioural problems in children from toddler to school age. Diagnosis, management and when to refer are discussed.
Behavioural difficulties arise as a result of an interaction between biological vulnerabilities and environmental stressors. In most cases, behavioural difficulties are temporary, and occur as children strive to achieve developmental milestones. General management includes reinforcing positive behaviour, using a consistent approach and setting limits and clear consequences for misbehaviour. Children should be referred when there are concerns about their safety or development.
Nathan, 3 years of age, presents with aggressive behaviour toward his younger sister, aged 2 years. When the sister is playing with a toy he wants, he hits her, sometimes causing injury. When he does this, the family sometimes put him in 'time out' and he emerges from this in a crying and distressed state. Mealtimes are very difficult as Nathan often refuses to sit at the table and eat. Mealtimes last 30 minutes and the television is on in the background. At bedtime Nathan has tantrums and refuses to stay in his bedroom. He runs in and out of his bedroom, trying to get his parents' attention. It can take 2 hours for him to eventually fall asleep. During the day he is tired and grumpy.
Nathan's developmental milestones are within normal limits and his mother says that when he is behaving well, she enjoys him. There is a history of parental depression and recent job loss for the father.
In your office, he plays quietly at first and then begins to throw toys. His examination, including height and weight, is normal.
Management of Nathan would include establishing the parents' goals for his behaviour and using reward charts to reward positive behaviour (eg. sitting at the table for mealtimes). 'Time out' should be reserved for serious behaviour and he should stay in 'time out' until he is calm. Meal times should be limited to 20 minutes with the television off, and the family should eat together. The parents should be supported in seeking mental healthcare.
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