Cambridge Independent Neuroscience and Psychiatry Services
Behavioural disorders
What is a behavioural disorder?

Behaviour is often learnt.  

It takes time for children to learn to behave appropriately for the circumstances, even with a good role model. 

Temper tantrums, aggressive outbursts and destructive behaviour do not mean that a child has a behavioural disorder.

Children often do not have the language or emotional development to communicate emotions or feelings; they often communicate through their behaviour for example, a child might kick a toy rather than say he or she feels sad or anxious.

When behaviour is generalised, severe, constant and longstanding, it can cause significant distress, affect a child's emotional, social and cognitive (brain/mental) development, and interfere with ability to function.  In these circumstances we may consider behavioural disorders.

What causes behavioural disorders?

It is important to not see children with behavioural disorders as 'naughty', as this is a very simplified way of looking at a problem that is often very complex.

It is often helpful to consider bio-psycho-social risk and protective factors.  

Relevant factors that can increase risk:
Defiance or criminality in the family
Conflict and aggression in the family
Drug or alcohol abuse in the family
Psychiatric problems in the family
Social difficulties in the family
Parenting styles
Abuse or neglect
Bullying in School
Bullying in the community
Temperament and personality
Learning difficulties
Developmental disorders such as ADHD
Attachment (early relationships and experiences with care givers)
Emotional disorders such as Depression
Drug and alcohol use

This list is not comprehensive. 

How are behavioural disorders diagnosed?

Child Psychiatrists can arrange an assessment and can make a diagnosis if appropriate.

It is important to know that many conditions can look similar to behavioural disorders, but are not behavioural disorders (differential diagnoses):

Differential diagnoses:
Learning disabilities or difficulties
Neurodevelopmental disorders such as
ADHD and ASD (Autism Spectrum Disorder)
Attachment difficulties
Mood disorders such as Depression and
Bipolar Disorder
Anxiety disorder such as PTSD
Psychotic disorders
Substance abuse
Medical conditions and medications

This list is not comprehensive. 

It is also important to know that children with behavioural disorders are much more vulnerable to develop other mental health problems and that many conditions commonly occur with behavioural disorders (comorbidities).  

Research indicates that up to 60% of children with a diagnosis of Conduct Disorder present with comorbidities.  This is why it is very important that children with behavioural problems are not excluded from specialist mental health services. 

Learning disabilities (very common)
ADHD (more or less 50%)
Emotional disorders (40%) such as 
Depression and Bipolar Affective Disorder
Anxiety Disorders
Substance Abuse problems (60%)
Developmental problems including Autism Spectrum Disorder (more or less 60%)

This list is not comprehensive. 

Child Psychiatrists will assess for comorbidities and complications during appointments.  

Comorbidities need to be identified and managed early as prognosis may be affected.  

How are behavioural disorders treated?

The first priority is a comprehensive bio-psycho-social and risk assessment.  The aim is to gain a good understanding of the behaviour, purpose and gain.  An ABC model is often helpful (the context) and a systemic approach (considering the system around the child) is almost always essential.  

CAMHS teams can offer behavioural programs for parents in the community and they can offer individual work for children.  

Comorbidities should be managed or treated without delay.  

Behavour programs (there are several)
123 Magic
Webster Stratton
Tripple P

Ask your GP for more information on this topic.

There are several books available on behavioural management such as:

Webster Stratton
The Incredible Years:  Troubleshooting Guide for Parents of Children Age 3-8. London: Umbrella Press

Parenting thoughts:

Consider the chronological and developmental age of your child.  Explanations and strategies will vary significantly with age.  Consider a child's ability to understand consequences and reward for self and others, retain information, weigh pros and cons, negotiate, and make and communicate a decision.  

Weigh risks and benefits, and pick battles.   Most parents and carers have priorities for their children which include, safety, health, development, well-being (e.g. not depressed or anxious), general functioning (e.g. socially and emotionally) and independence.

Be consistent and predictable for results. 

Be patient, fair and kind.  Be the adult you want your children to become.  Children learn from example.  

Firm and consistent boundaries often lead to relaxed and happy children.  Boundaries can be negotiated as children develop in ability.

Anxiety or low mood in parents can cause anxiety or low mood in children.  Ensure that you look after yourselves as parents or carers. 

Children who are or who feel as if they are in charge, 'the boss', are often very anxious and unhappy.  They often show this with defiant and controlling behaviour. 

Children often benefit from having age appropriate responsibility and often need an age appropriate part of their lives that they can control, for instance, what they wear, their subjects at school or having a part of the garden that is theirs. 

General food choices during grocery shopping (amount and type) should ideally be part of adult decisions.  Overweight children are never a child's fault.  Children can decide what to eat at restaurants or on holidays, but general day to day food choices should be adult decisions.   A child's health is related to food intake (amount and type) and health is an adult decision and responsibility.  It is usually more harmful than beneficial to put a child on a 'diet' or to 'enforce exercise to lose weight' for a child.  Meals should be balanced and life for a child should be active and fun.  Serious topics such as 'diet' and 'must exercise' should be reserved for adult conversations.  

Exclude children from adult topics, roles and decisions.  Think age appropriateness.  Children can easily become 'young carers' for their parents if they are worried about their parents. Parents might understand this as empathy and caring, but it can be harmful for children's development and well-being.  Children have many opportunities to learn about empathy and caring in a child's world for instance with friends or their pets.  Home and parents much ideally remain a 'safe base' for children, as far possible.  

Enforce positive and negative consequences.  Remember the positive reinforcements (the carrots for good behaviour) are the most powerful reinforcement of all. 

Positive and negative consequences must not come as a surprise to the child, but must be predictable. 

Make things visual and make it fun.  A chart on the wall, clearly visible, with 'good stickers' is often a good start.  The child can get involved, drawing or painting on the chart.

Negative consequences (negative reinforcement) or punishment should not humiliate, harm, hurt or threaten a child or make a child anxious.  Acceptable forms of negative reinforcement include withdrawing a favourite activity or toy (such as 'grounding' or the 'naughty step').  Never act in anger or when irritated or annoyed.  Never make any decisions whilst you are emotional, be it angry, sad, anxious or frustrated.  Practice self restraint and teach by doing.  

Most importantly, children need to feel safe, they need to feel that you as their parent or carer has the wheel and that you see them as positive and love them unconditionally.  They want to see your eyes light up when they enter the room, as Maya Angelou said. 

For more information speak to your GP or Child Psychiatrist.

Please see Helpful Links for more information. 

The content of these pages is intended for general information purposes only.  These pages do not constitute any form of consultative or diagnostic tool or process.  The assessment, diagnosis and treatment of mental health difficulties, particularly in children, is a complex and specialised process and should only be undertaken by individuals with appropriate training and sufficient experience, such as qualified mental health professionals.  If you are concerned about the mental health of a young person, please seek appropriate advice from your General Practitioner, local Child and Adolescent Mental Health Service or Social Care.  Research findings and conclusions can vary between sources, and can change over time. 
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