Conduct Problems

Is your child:

• Demonstrating extreme behavioral problems?
• Seeking revenge on others?
• Appearing unable to be trusted?
• Starting fights with other children?
• Stealing objects from parents or other children?
• Spending time in the principal’s office?
• Receiving visits from the police or Student Resource Officer (SRO)?

Children with extreme behavioral problems can be challenging to parent. Your child may seem immune to consequences, unable to understand cause and effect, or unwilling to take ownership for mistakes. It may be that your child does not seem to have empathy or to show any concern for the feelings of others. Your child may seem to act without thinking.

You may wonder if your child realizes the impact of his or her behavior on others. When we think about these more extreme behaviors, we are not talking about the child who does not know his own strength and hurts others by accident. Extreme behavioral problems are intentional.

It may be hard to determine whether your child is unaware and acting as “a bull in a china shop” or is actually intending to cause harm. Sometimes parents misunderstand a child’s intentions and may report intentional misbehavior when actually a disability is to blame.

Let’s talk about the intentional misbehavior, but keep in mind that if you are unsure if behavior is purposeful, an evaluation of your child’s cognitive strengths and weaknesses in the areas of attention, mood, behavior, and processing can offer guidance about the underlying causes of behavior.

These intentional rule breaking and law breaking behaviors are also known clinically as extreme behaviors, or conduct problems. Some of these behaviors may be related to trauma, attachment, behavior, mood, or a developmental disability.

Trauma: It will be important to consider whether abuse has occurred. It will also be necessary to consider the consistency of relationships within the child’s life. When a child is displaying extreme behavior, a deep emotional trauma or abuse may be at the helm. Caregivers and clinicians should be careful not to miss cues of physical, sexual or emotional abuse.

Look for bruising, odd extreme behavior, frequent toileting accidents, or a drawing or play that has a very violent or sexualized quality. Sudden and drastic changes in behavior, hiding under furniture and refusing to come out, smearing feces, eating non-food items, spinning wildly, or rapidly switching from very friendly to angry and hostile in a short period of time are red flags for trauma or abuse.

Attachment: Disorganized attachment can also be at the root of extreme behaviors. This term means attachment to caregivers that is not secure, resulting in behavior that can be erratic or extreme.

The key consideration for attachment problems is whether the child is consistently trusting. Secure attachment to a caregiver translates into trust in other relationships. Kids who are close to their moms and dads generally have close friends too. Children who are not securely attached either are extremely distant and disconnected or very inconsistent with their trust. These children may have been victims of abuse or suffered a long period where they were separated from parents. Children who have been abandoned or have simply never connected with any parent or adult, will likely have significant attachment problems.

Behavior: Behavior problems are also important to assess here. Misbehavior, in the absence of emotional symptoms, that only serves to gain a reward or consequence could be Oppositional Defiant Disorder (ODD) or Conduct Disorder. Behavior problems that are of an extreme nature will likely require intervention from a clinical professional such as an Applied Behavior Analyst (ABA).

Mood: If emotional symptoms exist, like depressed mood, sleep difficulty, or lack of pleasure in life, it will be important to determine whether depression or bipolar type symptoms might be present. Bipolar includes a level of impulsivity that could make it appear as though your child does not care about rules or consequences. When a child acts impulsively, he or she may not be able to take the time to consider consequences.

Autism or ADHD: It is possible, but unlikely, that your child may have some symptoms of autism. For example, some children who seem callous or abusive to others are simply not taking the perspective of another person. A child with autism may expect too much of a baby sibling or may be rough with your pet while only trying to play. Some children with ADHD will demonstrate extreme behaviors due to poor behavioral inhibition and impulsivity.

These behaviors are extreme and seeking professional help should be at the top of your list. In the interim, you can develop some proactive supports at home. Target one or two of the most important behaviors to change. If you are targeting “hitting” and “destroying property,” reinforce “respect for family” at home and “taking care of our things.” Reward these behaviors with family activities, extra time to play outside or a trip to a trampoline park or bike park. Always have positive time with your child, despite misbehavior. Do not provide attention for hitting and destroying things.

However, it is possible to find time for closeness, even without providing such rewards. Having a cup of hot cocoa and watching a favorite show, going for a walk, taking a drive to see the fall leaves, or enjoying a quiet dinner of your child’s favorite food can be provided at low cost and are not necessarily contingent on good behavior.

If your child is in school, it is generally a good idea to let the school counselor or psychologist know if your child has an incident of this nature. Collaboration with school professionals, clinical therapists, and parents can be the key to facilitate positive behavior in your child.

If you are concerned about safety, work to remove items that could harm to others and stay close by to reinforce calming behavior. Make sure you keep sharp knives or anything else dangerous under lock and key. Modeling a calm demeanor by deep breathing, sitting calmly (versus standing in a defensive posture), and looking out the window can help your child regain composure. Stay quiet, do not raise your voice or become elevated.If you begin to have serious concerns about safety, call 911 or visit the nearest emergency room.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Social skills problems (Socializing): conduct problems can be related to difficulty with social perspective taking, understanding what reactions are appropriate in a situation and reading other people’s reactions
• Emotional problems (Feeling): conduct problems such as the tendency to be irritable and explosive can be related to underlying feelings of sadness and depression
• Suicidal ideation: conduct problems can be related to dangerous behavior and suicidal thoughts. Take your child’s statements seriously and seek help immediately if your child talks about dying or suicide. If you have immediate risk, think your child has a plan, or have worries about safety, call 911 or visit the nearest emergency room. You or your child may also call: National Suicide Prevention Lifeline Phone Number at 1-800-273-8255.
• Self-Esteem: sometimes conduct problems occur due to a child’s low self-esteem. Academic, social, and relational failures can lead to a sense of hopelessness and a child may ‘act out’ as a result
• Attachment: conduct problems can be related to a lack of trust and connection to caregivers. If the child has been abandoned by a parent or has simply never connected to an adult, attachment problems are likely
• Aggression or antisocial behavior: often, children with pent up anger or low self-esteem may get into physical fights. In extreme circumstances, they may also have anti-social behavior which involves intent to harm others without empathy or remorse

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Disruptive Mood Dysregulation Disorder (DMDD): depressed mood or, in children, irritability that is pervasive; leads to behavioral outbursts or behavior challenges that are rooted in depression

• Attention Deficit Hyperactivity Disorder (ADHD): impulsivity, disinhibition, inattention, and possibly emotional regulation problems. Children who are impulsive tend to make some poor behavior choices that are not volitional, but rather related to their failure to ‘stop and think’ before acting

• Attachment Disorder (Trauma and Attachment Disorders): rigidity and extreme behaviors that stem from trauma history or interrupted attachment to primary caregivers (death of a parent, change of caregivers, or abuse)
• Behavior Disorders: behavioral disorders that are created by poor parenting, a history of abuse, or accidental reinforcement of bad behaviors
• Depression: depressed mood or, in children, irritability that is pervasive; decreased interest in activities that used to be enjoyable
• Bipolar Disorder: depressed mood or, in children, irritability that is pervasive; alternating with periods of elevated mood, pressured speech and goal-directed activity; in children cycles tends to be less differentiated; they may blend together
• Autism Spectrum Disorder: deficits in social communication and restricted interests or behaviors; challenges with social perspective taking or seeing another’s view

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• Clear Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Psychotherapist or Play Therapist: to treat emotional symptoms, teach adaptive coping techniques, and practice social skills
• ABA Therapist: to treat behavior, analyze the function of poor behavior, create appropriate systems for reinforcement of positive behavior, and to develop a home behavior management system
• Psychologist or Neuropsychologist: to conduct a full assessment to look at symptoms in mental health and/or behavioral context
• Psychiatrist: to prescribe and manage psychotropic medication for depression or bipolar, impulsivity or aggressive behaviors

These professionals may recommend or administer the following tests for this symptom:

• Roberts, BASC-3, Clinical Interview, RCMAS, CDI-2, Human Figure Drawing, Brief Projective Measures: emotional assessment of behavior, emotions, personality, and adaptive skills (Neuropsychological or psychological evaluation)
• WISC-V: cognitive assessment which can help caregivers understand a child’s intellectual strengths and weaknesses; this information can help guide treatment planning (Psychological or School Psychological evaluation)
• TOL-2, CTMT, WCST, TOVA: assessment of attention and executive functioning (Neuropsychological evaluation)
• ADOS-2: social assessment for related concerns in social communication indicating an autism diagnosis should be considered

[1] Siegel, Dan (2013): Brainstorm: The Power and Purpose of the Teenage Brain.

Amazon: https://www.amazon.com/dp/0399168834/ref=rdr_ext_tmb

[2] Greene, Ross W. (2001). The explosive child: A new approach for understanding and parenting easily frustrated, chronically inflexible children. 

Amazon: https://www.amazon.com/Explosive-Child-Understanding-Frustrated-Chronically/dp/0060931027/

[3] Barkley, Russell A. (2013). Taking charge of ADHD, 3rd edition: The complete, authoritative guide for parents. 

Amazon: https://www.amazon.com/Taking-Charge-ADHD-Third-Authoritative/dp/1462507891/

[4] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

• Springer
• Amazon

[5] Papolos, Demitri & Papolos, Janice (2002). The Bipolar Child: The definitive and reassuring guide to childhood’s most understood disorder.

Amazon: https://www.amazon.com/Bipolar-Child-Definitive-Reassuring-Misunderstood/dp/0767928601

[6] Cooper-Kahn, Joyce & Dietzel, Laurie (2008). Late, lost and unprepared: A parent’s guide to helping children with executive functioning. 

Amazon: https://www.amazon.com/Late-Lost-Unprepared-Executive-Functioning/dp/1890627844/

For kids:

Esham, Barbara (2015). Mrs. Gorski, I think I have the wiggle fidgets. (New edition) (Adventures of everyday geniuses.) 

Amazon: https://www.amazon.com/Gorski-Fidgets-Adventures-Everyday-Geniuses/dp/1603368175/

Smith, Bryan & Griffen, Lisa M. (2016). What were you thinking? Learning to control your impulses (Executive function). 

Amazon: https://www.amazon.com/What-Were-You-Thinking-Learning/dp/1934490962/

Image Credit:
Description: Young Caucasian Man In Handcuffs Under Arrest
Stock Photo ID: #155140166 (iStock)
By: grandriver
Youth-breaking-the-law
Previously Licensed on: May 14, 2017
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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