Why Is My Child Misbehaving?

One of the biggest challenges that parents face with children who act out, display oppositional behavior, or are generally resistant to authority is deciding when it is appropriate to seek help from a mental health professional. The reasons for which children and adolescents misbehave are complex and highly idiosyncratic. There is no single answer to account for all the various forms and causes of recalcitrant behavior.

To make matters more complicated, a number of different pediatric disorders may present with similar instances of childhood disobedience, and so a psychiatric evaluation is recommended in order to determine the underlying source of the misbehavior. A psychiatrist can identify the presence of comorbid, sometimes subtle, symptoms, and is therefore in the position to develop the most comprehensive differential diagnosis.

The following is not meant to be an exhaustive list of disorders in which childhood disobedience can manifest. Instead, it is included here to suggest the highly circumstantial nature of diagnosis, and to stress the importance of seeking psychiatric consultation, even in potentially benign cases, so as to rule out anything more serious or pathological.

For children or adolescents that suffer from adjustment disorders, which are defined by a significant impairment in social or academic functioning due to an identifiable stressor, there may be associated disturbances in conduct. These can include fighting, violation of rules and misbehavior towards others. Typically, this occurs because children may not have the requisite coping skills to manage their reactions to the negative events they experience. They may not be fully able to understand the complex feelings and thoughts that arise in relation to these events, and so the maladaptive response surfaces in the form of acting out.

In other cases, children may struggle with mood disorders, such as depression. Typically, depression presents with feelings of sadness or being “down,” however, in children it can sometimes assume the form of irritability and anger. This, in turn, leads to increased argumentativeness, tantrums, moodiness, etc. When misconduct is associated with pediatric depression, there will be other signs and symptoms that a psychiatrist can identify and properly diagnose.

Similarly, children with untreated ADHD may shows signs of misbehavior, mainly because it is difficult to control their impulsivity and hyperactivity. Parents and teachers may find children blurting out answers, not waiting their turns, and not following directions. While sometimes these misbehaviors are secondary to untreated ADHD, this is not always the case. All too frequently, children that present with oppositional and/or defiant behavior are misdiagnosed with ADHD, even though they do not display the highly specified core symptoms of the disorder. When this level of diagnostic nuance is required, a psychiatrist should be consulted.

More often than not, childhood misbehavior is not ancillary to another, primary condition; instead, it constitutes its own disorder. And of these behavior-related disorders, oppositional defiant disorder (ODD) is one of the most common. Because some degree of oppositionality and defiance is normal for children and adolescents, to merit a diagnosis of ODD, other criteria must be met, such as frequent anger, touchiness, often losing one’s temper, and displaying deliberately annoying behavior. Among other requisite symptoms, the misconduct must be extreme enough to cause significant impairment in social or academic functioning. This level of severity is even more concerning in the case of conduct disorder, in which misbehavior can include cases of aggression, violation of the basic rights of others, and a marked absence of remorse or sensitivity to the feelings of others.

Children with behavior-related disorders may seem out of control, resistant and fractious, and so, understandably, parents look for answers to account for the misbehavior. Regardless of whether a child’s disobedience and defiance is secondary to an underlying disorder or whether it is ODD or conduct disorder, a psychiatrist can help parents and children to better address the situation. Family therapy is the most efficacious treatment because children can be taught problem-solving skills, while parents are taught behavior modifying skills. An important part of this is teaching parents how to avoid unintentionally reinforcing negative behaviors. While there is obviously no magic pill or medication to make a child choose right over wrong, family and individual therapy with a psychiatrist can help provide the necessary tools to promote better choices and improve behavior.