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.
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:
- Is the behavior a normal variation at a particular
stage of development?
- 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
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
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.
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 ...