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Disruptive behaviors in childhood are a part of growing up. An adult’s perception of the behavior, their tolerance, emotional response, and social expectations often determine whether a child’s behavior comes to the attention of a pediatrician. Disruptive behaviors become a part of pediatric encounters under 3 circumstances: (1) when the behavior is overwhelming to parents or teachers and is interfering with social interactions, (2) when a pediatrician systematically surveys family function and childhood behavior as part of a periodic health supervision visit, or (3) when a disruptive behavior occurs during an office visit.

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Disruptive behaviors in children include temper tantrums, angry outbursts that may be physical or verbal, hitting, biting, pushing, as well as more serious antisocial behaviors such as stealing, setting fires, truancy from school, destruction of property, animal cruelty, and physical confrontations with other people. An understanding of a disruptive behavior begins with an exploration of the nature of the behavior in the context of a child’s developmental stage, the environmental factors that may trigger the behavior, and the adult’s response to the episodes. Each of these elements is critical in addressing the following questions:

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  • Is the behavior a normal variation at a particular stage of development?

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  • Infants are characteristically more irritable in late afternoon and early evening.
  • Strangers may initiate a fear response in some infants at the end of the first year of life and during the second year.
  • All toddlers experience temper tantrums during moments of frustration when their journey toward psychological autonomy is threatened.
  • Separation experiences from parents are commonly associated with emotional outbursts, crying, and sleep disturbances at this age.

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These examples reflect the importance of the developmental tasks of attachment during the first year of life and autonomy in the second year. Exploring disruptive behaviors at this time of life in the context of the continuum from attachment and trust to autonomy and independence provides a clinical framework for insight as well as guidance.1

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What characteristics of the child’s family, peer, and school environments contribute to or modify the behavior? The social context in which behaviors unfold may trigger, exacerbate, or ameliorate behaviors. Emotional responses in younger children may be modified by verbal and nonverbal responses of parents and other caretakers. School-aged children and adolescents are influenced by peers and teachers. The media, the neighborhood, and the expectations generated from school are additional potent environmental influences on the behavior of children.

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How have the parents (and other providers of childcare) responded to the disruptions? Parent responses to disruptive behaviors in their children span a broad continuum, from active intervention to withdrawal. Parent response reflects their own temperament, understanding of developmental expectations, economic or psychological stress in the family, and their experiences growing up and memories of past parent-child encounters. An exploration of these factors often yields insights into the interventions and responses that parents experience as they attempt to alter ...

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