Bratty or behavior disorder? Help for parents

'Managing in the moment'
For many kids, though, the most effective therapy is education for parents, Harrison says.

That’s because even the best-intentioned parents may not be up to the demands of a particularly difficult toddler, agrees Patrick H. Tolan, director of the Institute for Juvenile Research and professor in the department of psychiatry and School Public Health at the University of Illinois at Chicago

“We help parents raise challenging children,” Tolan says. “And we teach them how to manage in the moment, when things are particularly difficult or stressful. We teach them to teach their children that aggression doesn’t get you anywhere. We teach them how to be patient and not to lose confidence.”

Another big area for parents to work on is positive reinforcement, experts say. Parents can forget to applaud good behavior, Tolan says, adding that the bad behaviors are the ones that tend to stand out.

Getting help Early intervention can be key in keeping a behavior problem from turning into something worse as the child is older, say experts. Kids who are show signs of a behavior disorder can often benefit from getting professional help in learning to control anger and express their emotions in healthy ways, says Dr. Joyce Nolan Harrison, an assistant professor at the Johns Hopkins School of Medicine. Experts can also help teach parent how to "manage in the moment."  And, in some cases, Harrison says, the child may need medication. Patrick Tolan, director of the Institite for Juvenile Research at the University of Illinois at Chicago, says that if you are concerned about whether your child is exhibiting normal behavior or a sign of something serious: Ask your pediatrician or family doctor for a referral Visit the Web site of the American Psychological Association to find a psychologist in your area.

Gretchen Blitz saw warning signs of big behavior problems in her daughter Kendra at an early age. It routinely took half an hour just to get the toddler settled into her car seat. “She would just fight and fight and fight,” the 30-year-old engineer from Scottsdale, Ariz., remembers.

Things got worse and worse, says Biltz. Kendra was suspended from kindergarten after she slammed a fellow student against a wall. By first grade, she’d developed a reputation as a problem kid, screaming obscenities at teachers and kicking the assistant principal in the stomach.

As with Kendra, parents will sometimes show up in the specialist’s office after having tried over and over again, unsuccessfully, to get their child to stop doing something.

“What we find is that the parent tries to intercede and the kid escalates,” Tolan says. “The parent withdraws and then that increases the probability it will happen again.”

It may help to watch a therapist deal with the child, Tolan says. Once parents see that the battle of wills can be won, they are more apt to succeed themselves the next time.

For Kendra, now 9, the solution turned out to be a combination of therapy for her, parenting help for her mom and medications to help control angry aggressive outbursts. The medications were prescribed after Kendra’s therapist witnessed several exceptionally violent explosions in the office.

These days, Gretchen Blitz has learned to make a fuss over the good behavior and to ignore the bad, though not dangerous, infractions.

“Kendra’s a lot more willing to do things when I ask instead of throwing a fit and screaming and crying,” she says. “She’s starting to recognize her triggers and to walk away when she starts getting angry. Sometimes she’ll verbalize what she’s feeling or sometimes I’ll say, ‘You’re starting to get angry; you need to take some time out and calm down.’ I’d say these days, it’s only about one in four times that she’ll really let it rip.”

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