Health News
Health News
March 21, 2019
Children’s Behavioral Health

All children occasionally experience behavioral challenges – it’s part of growing up.  Every parent knows that an occasional temper tantrum or period of hyperactivity is to be expected.  But sometimes, children have sustained and frequent behavioral challenges that require a proper diagnosis and medical treatment.  The pediatricians of Privia Medical Group North Texas want parents to know what to look out for. 

According to the U.S. Centers for Disease Control and Prevention (CDC), as many as 20 percent of children experience some type of mental disorder in a given year.  “It is not uncommon at all for a child to experience some sort of behavioral health challenge,” says Dr. Chris McGonnell, a Plano-based pediatrician.  “One of the most important things for parents to remember is that a mental health condition should be viewed no differently than if the child has a physical illness.  Both require proper diagnosis and treatment by a medical professional.  We don’t ever want there to be any stigma associated with behavioral health.”

Below is a look at some of the more common behavioral health issues that can affect children: 

ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental (relating to how the brain grows and develops) conditions affecting children.  A child with ADHD may have difficulty concentrating, be frequently hyperactive or behave impulsively.   While most children will occasionally display these characteristics, parents should know the signs of a more serious problem. 

Symptoms

Symptoms and signs of ADHD may include:

  • Inability to sit still; fidgeting

  • Easily distracted or forgetful

  • Frequent daydreaming

  • Overly talkative

  • Risky behavior

  • Not getting along with others

“While all children will display some of these characteristics from time to time, they will affect a child with ADHD more frequently,” says Dr. McGonnell, who has specific expertise in ADHD.  “It’s important for parents to understand that children with ADHD do not simply outgrow the condition; it must be treated by a physician.”

ADHD is thought to be influenced by genetics and researchers are studying several additional factors to better understand the causes. “What is known is that the myth about ‘bad parenting’ being the cause is just that – a myth,” continues Dr. McGonnell.  “ADHD is a medical condition and it is not the fault of the parents if a child has it. And, contrary to what some may think, diet has not been proven to play a role in whether a child has ADHD.”  

Diagnosis

There is no single test or exam that can diagnose ADHD, and there are several steps in the process to determine if a child has ADHD.  The first step is for parents to visit with their pediatrician about their concerns and the behaviors they have observed. 

A pediatrician or a psychiatrist can make a diagnosis.  The doctor will likely want to visit extensively not only with the parents, but also with other adults who spend a lot of time around the child, such as a teacher or child care provider. 

From there, the physician will observe the child over a period of time and in different situations. A diagnosis can be made if the child displays a multitude of behaviors indicative of ADHD and it is documented that these behaviors have been present for six months or longer and they are interfering with school or other normal activities. 

Treatment

If your child is diagnosed with ADHD, it is important to remember this is a condition that can be successfully and effectively managed.  “There is no reason for an ADHD diagnosis to hinder your child’s growth and development, or his or her ability to enjoy childhood,” says Dr. McGonnell.

ADHD treatment often starts with behavior therapy, a process designed to encourage and reinforce positive behaviors and discourage and reduce negative behaviors.  Behavior therapy can involve the child working with a therapist, behavior therapy training for parents or a combination of the two. 

When parents participate in behavior therapy training sessions, they learn strategies to cultivate and encourage good, positive behaviors from their child at home, while also learning techniques to discourage unwanted behaviors.  These are approaches that should be continued at home even after the formal therapy sessions are completed. 

Behavior therapy is generally the first treatment option used for ADHD.  For young children (ages 4-5), behavior therapy is the recommended treatment and has been shown to be as effective as medication.  For children 6 and older, behavior therapy combined with medication is generally the recommended treatment. 

There are medications that will help to control ADHD symptoms.  Stimulants have been shown to reduce symptoms in up to 80 percent of ADHD patients.  Non-stimulants do not work as quickly but remain active in the body for longer periods of time. 

“Parents should also have a conversation with their child’s teacher about ADHD,” advises Dr. McGonnell.  “Teachers are not generally trained specifically on the best ways to instruct a child with ADHD, and your physician can provide resource materials for the teacher to help teach the child effectively.”

Other Conditions

It is not unusual for a child with ADHD to also suffer from additional conditions.  These are some of the more common conditions that may occur, both in children with and without ADHD. 

Oppositional Defiant Disorder (ODD)

ODD can commonly occur with ADHD.  Signs of ODD may include:

  • Frequent loss of temper

  • Argumentative and angry with adults

  • Blaming others for their own mistakes

Conduct Disorder (CD)

CD is characterized by serious behavioral problems that may well endanger the child and/or others.  These may include habitually breaking important rules, skipping school, bullying, cruelty to animals, fighting and stealing.

Anxiety and Depression

Children with ADHD are more likely to suffer from an anxiety disorder than those without ADHD and about 20 percent of those with ADHD have also been diagnosed with an anxiety disorder. 

It is normal for children to at times be fearful, sad or worried, just as it is normal for adults to experience those feelings.  However, if these emotions are so frequent and overwhelming that they interfere with the child’s ability to participate in school or other activities, this may be indicative of an anxiety disorder or depression. 

Examples of an anxiety disorder include separation anxiety, in which the child is very afraid when away from his or her family; social anxiety, in which the child feels apprehensive around other people; and general anxiety, in which the child is always worried about bad things happening. 

Depression can be characterized by recurring feelings of sadness and hopelessness, being withdrawn and a sense of worthlessness. 

With any and all of these symptoms, it is very important for parents to discuss their observations with their pediatrician so the child is able to get the best treatment and help for their situation. 

Dealing with Stress and Tragedy

Children experience stress just like adults do.  This is especially true in times of tragedy, when the child is aware something terrible has happened but does not have the ability to fully process or understand what has taken place.  While these situations can be more acute in children with a behavioral condition, they can have an adverse impact on any child. 

Many parents can recall having to explain a terrible event to their young children, such as the terrorist attacks of September 11, 2001 or a school shooting, like at Newtown, Connecticut or Parkland, Florida.  Experts have several pieces of advice for parents when a tragedy occurs:

  • DO talk to your children about it. If a high-profile event is dominating the news, your child will find about it at school or from friends.  It is better they hear it from a parent, who can put the event in the proper context. 

  • DO try to answer their questions with factual information while omitting graphic details.

  • DO emphasize to your children they are safe. They are safe at home and at school.  Their family, teachers and others are there to make sure nothing bad happens.

  • DON’T let your child see TV news after a tragedy. Children can believe that an event is happening over and over again, not realizing the TV is replaying a single event.  This was a frequently-reported problem following the September 11 attacks – children thought planes were crashing into skyscrapers for days because the TV networks were showing the same footage repeatedly. 

“These types of tragic events are scary for adults; just think how frightening they are for young children,” explains Dr. McGonnell.  “It’s important for parents to talk about these tragedies with their kids, emphasizing to them that they are safe, they will be protected and that they are loved.” 

Help is Available for Children – and their Parents

A mental health or behavioral challenge is nothing to be ashamed of.  These are conditions that affect many people, young and old.  For parents, it’s most important to know how to recognize warning signs and always be prepared to ask your pediatrician when you have questions.  Even if you are not sure, it’s best to tell them what you have observed and ask questions. 

Left untreated, childhood behavioral health conditions can create recurring problems at home, school and into adulthood.  However, with your pediatrician’s help, most of these challenges can be managed and effectively overcome in time. 

This article contains information sourced from:

The U.S. Centers for Disease Control and Prevention

The American Academy of Pediatrics