“Difficult” children: who are they?

The Child Psychiatry Service frequently sees parents who come to seek assistance for their children from the age of three years who are exhibiting behavioural difficulties.

Studies suggest that between 2% and 6% of the general population may have difficulties of this nature, ranging from moderate to severe (Roskam I., 2012; Roskam I., 2012). They are particularly common in boys.

The term behavioural difficulty can be used to refer to two sub-categories:

• Internalised behaviours, i.e. those acted inwards towards oneself (such as depression, anxiety, etc.).
• Externalised behaviours, i.e. those acted out towards others (such as agitation, aggression, disobedience, defiance, impulsiveness and emotional instability).

We will address the latter in this article.

Naturally, all children can be somewhat agitated or a little aggressive. These are normal behaviours. The fact that these behaviours are exhibited is not a symptom in and of itself; consideration needs to be given to their intensity and frequency. These behaviours become problematic when they occur repeatedly and/or become excessive in terms of the emotions.

The behaviours under discussion are therefore relative (not absolute, which would, strictly speaking, mean the presence or absence of a behaviour). They are also dependent on the person assessing the behaviour. When observing a behaviour, it is vital to consider it in context.

Let’s take an example: When a child is agitated in a playground, this is consistent with their environment and with the other children in the same context. However, if the child demonstrates the same level of agitation a little later in the classroom, when being assessed, this same behaviour of a similar intensity will no longer be considered a normal behaviour, but will instead be deemed problematic. In addition, if the behaviour gains in intensity or is repeated frequently over time, it will be described as a difficulty.

Thus, it is all a question of the child’s capacity to adapt to the context and to the demands of the environment. A second parameter, which we have already noted, is that of the person assessing the behaviour. Assessment of the intensity and frequency of a behaviour varies depending on the nature of the relationship between the child and the person assessing their behaviour. However, other parameters internal to the person making the assessment also enter into play, including their level of tolerance, culture, personality, etc. It is therefore important to have multiple sources of observation for these behaviours.

Roskam and her colleagues use the metaphor of an iceberg to explain what underlies the child’s behaviour (the tip of the iceberg). In effect, behaviour is a barometer of a young child’s mental health and wellbeing. Children (aged under seven years) have no mental “stop sign” and are unable to self-regulate. They don’t know how to conceal their emotions (unlike adults who can, for example, be feeling sad but be able to hide it). As such, the behaviour exhibited by a child highlights a truth about them. Children also find it difficult to recognise other people’s emotional states, and require time to be able to decode them. Children are primarily focused on their own emotional states, something which evolves as they develop.

Generally speaking, therefore, it is vital to remain cautious when observing a behaviour and not to draw conclusions from it too quickly. The inconvenience that the behaviour causes in everyday life will lead to the choice of one or several ways of dealing with it, depending on the nature of the difficulties encountered. It should be noted that the evolution of these difficulties can vary. This will be the subject of a future article (read here).

Bibliography

Howarth, R. (2012). 100 idées pour gérer les troubles du comportement. Londres: Tom Pousse.
Krotenberg, A., & Lambert, E. (2012). Scolarité et troubles du comportement. Champs Social.
Omer, H. (2017). La résistance non-violente. Paris: De Boeck supérieur.
Roskam, I. (2012). Les enfants difficiles 3-8 ans. Bruxelles: Mardage.
Roskam, I. (2013). Mon enfant est insupportable. Comprendre les enfants difficiles. Bruxelles: Mardage.