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Serious behaviour problems and mental health

Many children’s behaviour can be disruptive and difficult at times. As part of learning how to behave appropriately children may test adult rules at home, school or in the community. Often such behaviour is a reaction to stress or frustration.

For some children serious behaviour problems develop into a pattern that can include acting impulsively, reacting with aggression, refusing to follow reasonable directions and defying adult authority. Children who behave like this usually have trouble with making and keeping friends. They may be the target of bullying because they over-react. Yet they may also bully others to try to get their own way. They are often have trouble with following the rules.

These patterns of behaviour interfere with children’s social and academic development. They often lead to disciplinary consequences, such as school supervision, that interrupt learning. Children with serious behaviour problems often do not feel connected at school. They can experience low self esteem and depression.

Parents, carers and teaching staff who are interested to know about children’s disruptive behaviour in general will find many helpful ideas in several other KidsMatter Primary resource sheets, including 'Learning to manage anger', 'Effective discipline' and 'Building better family relationships'. A separate KidsMatter Primary resource sheet is also provided on 'Children with Attention Deficit Hyperactivity Disorder (ADHD)'.

How do serious behaviour problems develop?

A combination of factors, including individual characteristics, social and environmental influences, may contribute to children developing serious behaviour problems. For example, having a reactive temperament can mean children are quick to get frustrated and their anger may be intense. This can prompt angry or harsh reactions from those who deal with them, which may escalate the child’s reactive behaviour.

The table below lists some of the common factors that contribute to the development of serious behaviour problems. A single factor alone should not be taken as an indication of serious problems. However, when several factors are present behaviour problems are much more likely.

Contributing factors in the development of serious behaviour problems

Factor

What that means

Inherited factors

Some temperament characteristics contribute to behaviour problems. These include being easily irritated, having intense reactions and being difficult to soothe.

 

Ways of thinking

Children with serious behaviour problems often believe others are picking on them. The more they get into trouble the more this negative bias is confirmed.

 

Neuro- psychological problems

Difficulties with the brain processes that organise memory and control attention may be similar to those of children with ADHD. There may also be difficulties with controlling emotions and understanding what other people are thinking and feeling.

 

Parenting practices

Over-reaction to the child’s behaviour, lack of supervision and inconsistent discipline may contribute to serious behaviour problems.

 

Adverse social circumstances

Parental unemployment, financial hardship, poor housing and deprivation are common patterns of hardship amongst families of children with serious problem behaviours.

 

Peer influences

Gang membership or having an older sibling with Conduct Disorder is associated with the development of serious behaviour problems.

 

School

Feeling alienated at school, school failure and inflexible discipline practices from teaching staff, can lead to worsening of serious behaviour problems.

How behaviour problems escalate

Over time children develop particular patterns of thinking and behaving that further shape the ways they interact with others and how others respond to them. For example, they may believe that others are always picking on them and see even accidental mishaps as an indication that someone is out to get them. These patterns of thinking and behaving lead to distress, coping difficulties and/or problems in relationships with others.

Children with severe behaviour problems often trigger hostile responses from others.

Once children come to expect critical or punitive responses, they are less likely to admit failures or problems. They may try to maintain a sense of power or control by distancing themselves from adults and using threat, coercion and aggression to manage social situations. They often try to avoid punishment by denial or lying. They may have strong feelings of anger and resentment. Anger gives a sense of power, but also drives others away, while resentment and mistrust tend to block and distort emotional communication. Many of these children hide feelings of helplessness, low self esteem, and a need for affection.

Children with serious behaviour problems are difficult to parent. Parenting practices that are very effective with other children in the family may not work for these children. Parents may find it hard to provide the extra structure and support that these children need, especially if they are also experiencing a range of social or personal problems themselves. Schools find it difficult to manage repeated rule breaking and aggressive behaviour. As a result of disciplinary problems and failure to be successful at school, children may become disengaged with school, adding to the risk of negative outcomes.

When this cycle of problems is not addressed it can have severe long term consequences for children’s mental health and their social adjustment, as shown in the figure below. (Click to open larger image in a new window.)

Chart showing progression of serious behaviour problems to long term impacts when not addressed

Serious behaviour problems and diagnosis of a mental disorder

When children show persistent and extreme patterns of disruptive behaviours they may be diagnosed by mental health professionals as having a Disruptive Behaviour Disorder. There is debate amongst professionals as to the usefulness of diagnosing Disruptive Behaviour Disorders. Some experts are concerned that mental health labels can cause children to be stigmatised. They argue that the strategies for assisting children with serious behaviour problems are the same for those whose problems may be less severe. They feel that the diagnosis can lead others to see the child rather than the behaviour as the problem. Such negative evaluations can be a significant obstacle to effective treatment of children with behaviour problems.

Other mental health professionals say that the diagnosis helps to identify those children who are most in need of additional help. They argue that early identification and specialist intervention for Disruptive Behaviour Disorders is necessary particularly because these disorders can have very serious long term consequences if not addressed early.

The two main diagnostic categories for severe behaviour problems are Oppositional Defiant Disorder and Conduct Disorder. Attention Deficit Hyperactivity Disorder (ADHD) is also sometimes included as a third category (see KidsMatter resource sheets Children with ADHD for more information).

What would you notice in a child with Oppositional Defiant Disorder (ODD)?

Oppositional Defiant Disorder (ODD) is described as a pattern of thinking and behaving that is impulsive and reactive. Children given this label may:

  • argue constantly with adults
  • refuse to carry out requests or conform to rules
  • blame others for their mistakes or misbehaviour
  • have frequent temper tantrums and show resentment
  • behave in a negative, hostile way towards authority figures
  • deliberately annoy others
  • be quick to react when others annoy them.

What would you notice in a child with Conduct Disorder (CD)?

Conduct Disorder (CD) is not usually diagnosed in primary school- aged children. CD is more commonly seen in adolescence when behaviours that were of concern at a younger age have grown to a more serious level. Children and adolescents are diagnosed with CD when:

1. They bully others, start fights, assault others using a weapon, or show cruelty to animals.
2. They deliberately destroy, vandalise or set fire to the property of others.
3. They use deceit. They may steal, shoplift, lie or cheat to manipulate others
4. They break important rules. They may evade school, stay out late without permission, or run away from home. Often they get into trouble with the law.

Diagnosis of these disorders is only made when the behaviours occur far more frequently and are at a more severe level than for other children of the same age, when they interfere seriously with relationships with other children of the same age, when they interfere seriously with relationships with others at home or at school, and when they cause ongoing disruption to learning and to the community around them. They are more common in boys than in girls. Conservative estimates suggest that approximately 3% of 6-17 year olds in Australia, or 95,000 young people, have CD.

Disruptive Behaviour Disorders and other mental health problems

When children have Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) they often have Attention Deficit Hyperactivity Disorder (ADHD) as well. Being impulsive is a common feature in all three of these disorders. It has been estimated that around one third of young people with CD also have ADHD. One in five young people with CD is depressed. When plans to help are devised, it is important that these and other co-occurring problems are taken into account.

Without treatment about half of the children with serious behaviour problems will continue to show the same or more severe problems in adolescence. Over half of adolescents with CD develop ongoing personality problems and behaviours like self-harming, aggression and violence, substance use problems, delinquency and criminality.

What treatments are effective?

Serious behaviour problems can be effectively treated before Conduct Disorder (CD) has developed. A combination of anger management, coping and problem solving skills for children and education and support for parents and carers is likely to be needed. School staff have a significant role in ensuring that management of behaviours at school is consistent and effective. Early treatment is very important as behaviour problems are more difficult to change once they are well established. Early treatment can also help to reduce negative impacts on school learning and on self-esteem.

Relevant and specific social and emotional learning opportunities are needed for children with behaviour problems. These help them develop better ways of relating to others as well as strategies for controlling negative emotions. Intensive learning of anger management, coping and social problem solving skills in small groups has been shown to reduce problem behaviours.

Parents and carers are assisted by learning specific behaviour management skills for dealing with difficult behaviours. Meeting in small groups with other parents and carers whose children have similar difficulties helps to ensure that the parenting techniques learned are effective for their children’s needs. Parenting groups should be facilitated by a skilled parenting educator who has training and expertise in helping parents and carers manage behaviour problems.

How to assist children with serious behaviour problems

Children with serious behaviour problems need lots of assistance to learn more appropriate ways of dealing with social situations and relationships, negotiating ways to have their needs met, and managing their negative reactions. Usually parents and carers will need to fine tune their parenting practices. Schools need to establish specific and individualised strategies to engage students with serious behaviour problems. They also need to ensure that their approach to discipline balances support for positive behaviour with consistent appropriate limit-setting and consistent application of consequences for inappropriate behaviour.

General principles for assisting children with serious behaviour problems:

Build cooperative relationships
Maintaining positive relationships with children whose behaviour challenges adult authority can be difficult, however it is very important. Disciplinary measures need to be directed toward the behaviour, not the child. Cooperation is undermined by negative feelings in the adult-child relationship. When adults’ behaviour towards them is positive, children are more willing to cooperate.

Be clear, consistent and fair
Clear rules and consistent, reasonable consequences for misbehaviour are important. The rules need to be clear and fair to everyone. They should be discussed thoroughly and calmly in advance so that the child understands the rules and the reasons for them before any misbehaviour occurs. This is important to show these children that they are not being unfairly picked on.

Build positive social skills
Children who engage in disruptive or aggressive behaviour usually have few other strategies for coping with difficulties or getting what they want. Helping them build positive social skills provides other ways for them to respond.

Help children to understand and manage their emotions
Feelings like frustration and anger often trigger problem behaviours. Teaching children how to recognise and manage their emotions is very helpful for developing children’s self-awareness and self-control.

Look for further ways to help children with serious behaviour problems in Assisting children with serious behaviour problems – suggestions for parents and carers and Assisting children with serious behaviour problems – suggestions for teaching staff in the accompanying materials. For an example of how parents or carers might recognise serious behaviour problems in children and some suggestions for helping, read the parenting resource sheet titled Sam’s on a short fuse.