http://www.kennedykrieger.org/kki_touch_article.jsp?pid=6363
kennedykrieger.org
by Courtney Jolley

The moment someone becomes a parent, he or she accepts the tremendous responsibility of doing everything possible to ensure their child’s health, happiness and ability to thrive—to create a safe place where they can learn and grow in peace, enjoying the simple innocence of childhood.

But for children with severe behavioral disorders, their parents face a daily battle to protect them from their biggest threat: themselves. Between 10 and 15 percent of individuals with intellectual disabilities engage in various forms of selfinjury, such as head banging, eye poking, self-hitting and other dangerous behavior. Children and adults with more profound retardation, autism and sensory impairments are particularly prone to these behaviors. Individuals who engage in selfinjury are also likely to demonstrate other reckless behaviors, such as aggression, property destruction, elopement and pica (eating non nutritive substances such as paper, rocks and glass). Left untreated, these behaviors can result in serious injuries, such as broken bones, retinal detachment, open sores and infections. More severe cases can become life-threatening and can also put children at risk for long-term institutional placement.

For more than two decades, Kennedy Krieger’s Neurobehavioral Unit (NBU) has focused on the assessment and treatment of severe behavior disorders. This unique 16-bed inpatient facility often serves as a last resort for families whose children demonstrate particularly entrenched behavioral problems, and for whom less intensive therapies have already failed. The families who come to the NBU face a difficult journey, and one that often requires them to let go of their children for the first time in their lives (see article on “Hope for Hillary,”). But for families like the Calverts, who have struggled for years to give their son Brandon the childhood he deserves, any sacrifice is worth it.

The Calverts, a military family living in Norfolk, Va., were used to facing challenges. At age five, Brandon was diagnosed with Fragile X syndrome, a genetic disorder that causes intellectual disabilities and often, symptoms associated with autism. Although Brandon is verbal, he struggled to fully communicate his wants and needs and often resorted to scratching himself, punching his mother Jayme and kicking his nine-year-old brother Noah.

Although troubling, his behavior remained somewhat manageable until last December. Concerned that Brandon had spent a longer-than-usual time in the shower, Jayme went to check on him and found he had smashed a perfume bottle and used the shards to slice open his arm. The injury required 23 stitches.

“I’ve never moved so fast in my life,” says Jayme. “I don’t know what provoked him—this was just out of the blue.”

After the troubling incident, the Calvert’s insurance company referred the family to Kennedy Krieger because the Institute maintains a clinic devoted to patients with Fragile X. But as soon as the care management counselor who answered the phone heard about Brandon’s self-injurious behavior, she suggested the NBU. Although an initial evaluation revealed that Brandon met the admission criteria for the NBU, his family spent nearly a month trying to get their insurance company to cover his treatment. Eventually, their senator contacted the insurance company and Brandon was admitted in late February.

Treatment in the NBU generally includes four phases. The first phase, involves observing children’s interactions with parents and therapists and conducting a “functional behavioral assessment” to determine the factors that cause the troubling behaviors. A thorough psychiatric evaluation takes place concurrently, explains NBU medical director Lee Wachtel, M.D., in order to diagnose additional psychiatric conditions, such as mood, anxiety, psychotic and hyperactivity/ inattention disorders that may also influence the child’s behavior. This process can take weeks or months, since many patients display several forms of problem behavior, often for several reasons, and may be taking previously prescribed medications. This phase also includes interviews of caregivers and a formal preference assessment designed to determine which rewards are most likely to have a positive impact on the child’s behavior.

The second phase, focuses on implementing therapies based on assessment results. During this time, the team of therapists assigned to each child emphasizes skill building and training to help patients develop more appropriate means of dealing with difficult emotions or disappointments. The third phase, emphasizes fine-tuning successful interventions and making them easier to implement in a variety of settings. For example, if a child initially engages in problematic behavior every time he is asked to do schoolwork, an early intervention might allow him to take a break every time he asks for one instead of acting inappropriately. But as the therapy progresses, the child might be expected to attend for longer and longer periods before being allowed a break. Efficacy of medications is also monitored closely, with particular emphasis on minimization of side effects, to which children with intellectual disabilities are particularly prone.

The final phase calls on parents, teachers and others involved in the child’s care and/or education to learn to implement the interventions themselves. “Parent participation in our interventions is critical,” says Dr. Louis Hagopian, Ph.D, program director of the NBU. “Our experience shows that success after discharge is dependent on the caregivers’ participation during the admission and afterwards. The expectation of intensive parent involvement is actually part of our admission criteria.”

The typical NBU admission lasts from three to six months. “By definition, the patients we serve have very severe conditions, and have demonstrated resistance to treatment,” Hagopian says. “Our program is unique in the intensity of its behavioral programming, and the integration of services across disciplines. Each child has a staff of three behavioral therapists, supervised by a behavioral analyst, working with them for 3.5 hours a day. We’re able to collect behavioral data around the clock.”

The interdisciplinary nature of the program also distinguishes it from lessintensive severe behavior treatment options, which often have a purely psychiatric focus designed to stabilize patients with acute behavior problems. In addition to the behavioral psychologists who focus on helping patients find more appropriate responses, the NBU relies on psychiatrists to address patients’ problem behaviors related to psychiatric disorders such as depression or bipolar disorder. Nurses provide additional medical care for problems related to behavioral issues as well as the management of other medical conditions. Speech-language pathologists work with patients to help develop adaptive communication skills, while educational coordinators provide educational programming and help behavioral therapists generalize interventions for educational settings. Social workers help parents deal with the stress of their child being in the hospital, ease patients back into home and community life and assist families in accessing support resources, which can often be critical to maintaining gains after discharge.

The NBU also maintains a number of research programs—most focusing on developing new assessment and treatment strategies. Since the NBU’s founding, dozens of its clinical procedures have been replicated in other programs and are used around the country. Dr. Hagopian is currently studying why individuals with autism display highly rigid and stereotyped patterns of behavior, while fellow NBU behavioral psychologist Patricia Kurtz is examining how problem behavior progresses when it develops in very young children.

Discharge planning begins even before admission. The team works together to develop realistic goals for each patient. For most patients, the team sets a goal of at least an 80 percent reduction in inappropriate behaviors before leaving the NBU. Over the past eight years, the NBU has achieved or exceeded this goal in more than 88 percent of patients treated. In Brandon Calvert’s case, his team believed he could achieve a 90 percent reduction in the dangerous behaviors that made his admission necessary.

“By the time Brandon got to the NBU, his dangerous behaviors had begun to result in several visits to the ER and considerable disruption at school as he was moved between classrooms in an attempt to manage his behaviors and keep other students safe,” says Lynn Bowman, M.A., the Director of Direct Care Services in the NBU and the Case Manager who led Brandon’s treatment. “We learned that Brandon could respond negatively any time demands were placed on him like ‘it’s time to do your schoolwork’ or ‘brush your hair.’ These common requests could result in Brandon engaging in hundreds of destructive behaviors in a tantrum that would typically last for two hours or longer.” In addition, the team discovered that Brandon’s negative behaviors followed a cyclical pattern with several days of high frequency and intensity followed by several days of much lower rates. This led to trials of various mood-stabilizing medications. Brandon ultimately demonstrated a marked reduction in behavior cycles while taking the medication Seroquel.

During behavioral treatment, therapists began offering Brandon tokens for complying with requests, which he could later redeem for toys, healthy snacks and other preferred items. “Over time, we began requiring more and more work to earn rewards, and Brandon’s compliance improved dramatically,” notes Bowman. Brandon was discharged in late July after attaining a 96 percent reduction in negative behaviors with medication and treatment in place. Prior to his discharge, his parents and teachers pariticipated in therapy training.

“Fortunately, Brandon has a wide range of communication skills,” Bowman says. “We can tell more quickly if something’s not working, and he can give us feedback faster.”

As Brandon’s discharge date approached, his teachers planned to visit the NBU to learn more about how to incorporate the successful interventions into the school day. “Our patients’ teachers are usually relieved to learn that we’ve found a plan that works,” Bowman points out. “If they’re struggling to keep a child from hurting himself or his classmates, it’s difficult to make any educational gains.”

Brandon’s parents are committed to continuing his treatment at home. “It was hard to accept him being gone, and another mom on the unit told me it would get worse before it got better,” says Jayme Calvert. “She was right – but I see the change in him. My son slipped away from us last year, and the NBU brought him back to where he used to be. His friends are counting down the days until he comes home. Hopefully, he’ll be able to go back to the Special Olympics and the surfing program for kids with autism that he loves.”

http://www.articlesbase.com/diseases-and-conditions-articles/behavior-disorder-discipline-and-homeopathy-1394195.html
articlesbase.com
Joette Calabrese HMC, CCH, RSHom(Na)

Marjorie, a 70 year old grandmother often weeps softly. Not because someone was diagnosed with a dreaded disease, but because she frequently witnesses her 11 year old granddaughter acting belligerently, defiantly, and with the manners of a Cossack. It is a disturbing scene to witness. The child boldly chastising; her elderly grandmother not looking up from her magazine.

Marjorie’s daughter, Karen, also weeps because it is evident that her child’s problems are serious. Katie had recently been diagnosed with ADD by a school representative. Her consistent behavior of screaming fits in grocery stores and threats to kill herself had not softened after Ritalin and various other drugs. In fact, her anger became more torrential. Her refusal to eat, except stolen candy from the corner store and overt disdain for authority had not budged. Marjorie recalls numerous dramatic events. Once, the police were called by a neighbor because Katie perched herself precariously outside the window of the second story bedroom hurling obscenities at her frightened mother. Another outburst came after her grandmother insisted on her giving a cousin a turn on the computer. This incident ended with Katie wildly threatening her family with a poker.

Karen’s argument is that her daughter is incapable of being restrained by normal parameters and that adults ought to acquiesce to the special needs of her child. Instead of the grandmother’s rule of 30 minutes per child on the computer being adhered to, the child should be allowed, because of her ADD, to stay on as long as she wishes in order to get her “needed own space”. Her grandmother has been stripped of authority by the child and is backed by Karen.

Most mothers certainly understand the sensation of being overwhelmed. Karen is the picture of this. She left a bad marriage, is working full time and presently living with her offspring and elderly parents. The grandparents do all they are capable of in their autumn years to provide support, but Katie has caused more trouble than the total of all the family’s woes combined.

In order for this family and child to find harmony, two areas must change: 1) The child needs to be strongly and consistently disciplined by a take-charge adult. 2) An experienced certified homeopath needs to be sought.

In addressing the behavior with adult control, the impact of the punishment needs to be swift, and without warning in order for it to have value. Anything less dramatic is not sufficient. The discipline will work without the remedy, but not as well. The remedy will not work thoroughly without the discipline. In other words, we need structure for the remedy to take hold and the combination of both will make for a better outcome. The lack of strict adherence to family rules and respect for adults is an “obstacle to the cure”.

The principle of “the obstacle to cure” is one that homeopaths have understood for centuries. To further dramatize this model, imagine a patient suffering from asthma. Homeopathy has been shown to offer dramatic results in asthma, yet if the patient is not willing to quit smoking, the remedy’s ability will be limited. If the smoker quits, without using the remedy, there will be a gain. The combination of both will accrue the best results.

Homeopathic remedies act when parameters are defined and adhered to. Often I’m asked by a mother of a difficult child how she should handle poor behavior while waiting for the remedy to act. My answer is a resounding STRONG DISCIPLINE! Without strict adherence to obedience, a child hasn’t a compass to follow or a course of action for expected behavior. Isn’t it easier to behave within the expectations of the setting?

Years ago I was privileged to attend the gathering of dignitaries at the Iranian embassy in Washington, D.C. It was a formal event in which the Shaw of Iran was present. Before I embarked on the evening, an Iranian friend gave me suggestions as to expected behavior in such a setting. A woman’s hand is kissed by most of the men, so I was instructed to smile, curtsy and extend my hand. How uncomfortable I would have been had I instead reacted with a silly giggle or stiff smile. Being forewarned of expected behavior gave me parameters so that I could adjust my manners accordingly, allowing for comfort and grace.

A well chosen homeopathic remedy by an expert homeopath can, indeed, stimulate a child from ill to well behave. For example, Stramonium, a remedy known for behavioral and psychological issues, frequently tempers a child’s actions. It is chosen based on the symptoms of presenting behavior. The youngster requiring this remedy is loud, with an annoying presence that often includes references to violence and sneering at the adults and their rules. Children needing this remedy exhibit a combination of fear and violence and are often afraid of the dark, especially when alone. They may also become aggressive when provoked. Stammering, cursing, jealousy and rage are common behaviors that are displayed as part of the cluster of symptoms. Often there is a triggering event that has affected the central nervous system and has caused the ensuing violence and anger. In Katie’s situation, she had witnessed her father violently abusing her mother years prior to this new behavior. With this information, the homeopath can determine that Stramonium is indeed the remedy best suited to Katie.

Katie was given Stramonium and her mother was counseled on disciplining her child. Karen has taken away valued privileges, such as her cell phone, social events, credit cards, computer and phone time. Meals are simple and nourishing, but unceremoniously removed from presentation when Katie complains. The combination yielded a marked improvement within six weeks. At first it appeared a coincidence that Katie was more agreeable…perhaps it was that the weather was sunnier, Karen once surmised. But, soon it was evident that her daughter had indeed improved. Her behavior isn’t perfect, as she still has anger; however, it isn’t as long lasting, nor is it as frequent and when she does slip into it, it is no longer rage. Instead of hurling threats and obscenities, her mother sends her to her room and Katie soon follows the directive by stomping upstairs and slamming the door. And that is that.

Her mother, grandmother and even Katie are relieved. Homeopathy gently nudged Katie’s ability to heal herself. And her mother allowed her to understand the parameters by creating boundaries upon which Katie isn’t allowed to cross. This gave her expected behavior clarity.

Homeopathy has the ability to take us into the future with safe and effective medicines that are not addicting, nor conflicting with other medications. The recipe of a consistent environment of strict parental control, in addition to the correct remedy stimulus, allowed Katie to blossom to her fullest capabilities. Now when her grandmother weeps, her tears are of joy and relief that her granddaughter has come to terms with authority and peace is restored to her family.

http://www.empoweringparents.com/ODD-or-ADHD-Diagnosis-in-Children-Now-What.php
empoweringparents.com
by James Lehman, MSW

A diagnosis is an important piece of the puzzle we are trying to solve when we try to help kids with disabilities learn how to function. Many parents are relieved when they get a diagnosis for their acting-out, “problem child” because they see it as a guideline for the future. They think, “Now we’ll know what to do; this is it— we’ll finally get our child the help he needs.” The truth is that I’ve seen families go through the drudgery of doctors and diagnoses many times. I’ve worked with kids who had Attention Deficit Hyperactive Disorder (A.D.H.D.), Oppositional Defiant Disorder (ODD), Conduct Disorder, Obsessive Compulsive Disorder (OCD), and many others. I’ve also seen individual kids with five different diagnoses: every time they were hospitalized or went to a new therapist, they would get a new one. But sadly, in the end their parents were left with the fact that simply having a diagnosis didn’t necessarily mean they could get help improving their child’s behavior, or get them the skills they needed to learn how to function successfully.

“Believe me, the guy you’re working for at 7-11 doesn’t care if you have ADHD or not.”

A diagnosis doesn’t mean that you are assured treatment for your child from which you will see change. A diagnosis doesn’t mean you’re going to get funding to help give your child the success he needs. And a diagnosis does not mean he’s going to get the services he really needs. Sadly, there are no guarantees. I’ve worked with many parents whose kids had been given multiple diagnoses, but their children were still punching holes in the wall, cursing them out and having meltdowns at home and in school.

So, What Does a Diagnosis Do For Your Child?

Special Education Funding: In the states where I’ve practiced, when your child gets a certain diagnosis, you can often access special education funding. The sad fact is that children with labels attract money; children without labels don’t attract any money. That should not be discounted, because money—the means to get the services that will help your child learn how to manage his life—is a big issue. Many schools and mental health agencies have huge financial difficulties, and children with special needs are competing to get the services they need.

Special education funding often depends on what the diagnosis is. If someone has a diagnosis of ADHD, for instance, they will attract special education funding if it interferes with the child’s education. But if somebody has a diagnosis of Conduct Disorder or Oppositional Defiant Disorder, they usually won’t get any special education funding or services. This is because Conduct Disorder and ODD are behavioral issues, which can be determined not to specifically interfere with learning.

Medication for Your Child: Getting a diagnosis also can lead to a prescription for your child. With ADHD, in many cases medication can be very helpful. For OCD, medication is almost always indicated unless there are other medical concerns. But there is no medication that deals specifically with behavioral issues like ODD or Conduct Disorder, because again, these are cognitive in nature. Doctors may try different medications, including some anti-psychotics, but most often these behavioral disorders don’t respond to medication.

“Someone Finally Understands My Child’s Problem!” Many parents feel lost with their acting-out or learning disabled kids, as if nobody understands their child—or has a solution for them. Many times when you get a diagnosis, you feel as if somebody finally understands what’s going on, and that may very well be the case. Unfortunately, just because someone understands what’s going on, it doesn’t make your child more treatable. While the vehicle of treatment may change from diagnosis to diagnosis, the goal remains the same: to help that child acquire the skills he will need to function as an independent adult. He still needs to be held accountable for his actions.

Getting the diagnosis can affect funding and perhaps get your child a prescription, but it does little else. And parents who feel hopeful when they get that diagnosis have only won half the battle. The sad reality is that our current public and private mental health system do not yet possess the knowledge and theory base to effectively treat their child. I’m sure there has been success out there for many individual cases, but the families I’ve dealt with have experienced a lot of disappointment at the outcome of the treatment milieus they’ve been involved with.

1. A Diagnosis Does Not Relieve Your Child of Responsibility.

In my opinion, there is nothing wrong with saying, “My child behaves this way because he has ADHD.” Just know that does not relieve either the parent or the child of the responsibility of learning how to function appropriately. In other words, if you use the diagnosis as an excuse for not challenging your child’s behavior and not doing things that will promote change, I think you’re making a big mistake. Let’s face it, kids with OCD, ADHD, Conduct Disorder, and ODD are all going to become adults some day, and they’re going to need the skills to make it in the real world. Depending upon the diagnosis, when they turn 18 or 20 any funding that might be available stops. Unless your child has a severe Pervasive Developmental Disorder, a developmental disability, Schizophrenia or some other critical disability, there is no more money for him after he ages out of your health insurance or leaves school.

That is why it is imperative that your child gets the skills he needs to function in the real world as early as possible. Otherwise, success will be very difficult for him to attain in his life. Playing “Catch-up” is a really tough task for kids with behavioral disorders, and a significant number of them are never able to do it.

Let me put it this way: if you don’t know how to manage your feelings, manage your behavior, be productive, and respond to people in an appropriate way – if you don’t learn how to do that by age 18, that diagnosis doesn’t count anymore. Nobody cares. Believe me, the guy you’re working for at 7-11 doesn’t care if you have ADHD or not. He wants you to stock the shelves. And he wants you to do it with a nice attitude and a smile. If you’re not willing to do that, he will get somebody else who will. And I believe in the job market that’s coming, you’re going to have to be really skillful to maintain any kind of decent career. Kids who have disdain for fast food jobs are going to wind up seeking that kind of work just to survive.

It should also be understood that while the juvenile justice system tries to be flexible and understanding about learning disabilities or other disorders, after the age of 18, kids enter the adult correctional system. If you tell a judge the reason you broke into a car is because you have ADHD, he’s going to give you a dressing down you’ll never forget. While kids get a lot of flexibility, the fact is, adults aren’t able to hurt others, exploit others or do mean things and get away with it just because they had a learning disability or conduct disorder as a child. That is probably the rudest awakening I see teens with behavioral disorders go through. One month they’re in juvenile court running everyone around and playing games, and the next month they’re in county jail and nobody but their parents cares about them.

2. Don’t Use a Diagnosis to Make Excuses for Your Child.

Don’t use a diagnosis to make excuse for your child; use a diagnosis to understand him. When you do this, you’ll be able to figure out a way to teach him how to function and how to perform effectively. Certainly, the way you deliver information to somebody with ADHD might be different from the way you deliver it to somebody who has ODD. While your tone may vary, know that both of these kids need the same information, because at 18 or at 20, they are going to have to meet the same expectations.

Let’s be very clear, there’s going to be no free lunch in our society anymore. So kids who aren’t making it are going to be homeless or they’re going to be living in your home. And not only that, their behavior won’t have changed. They’re still going to be demanding, lazy, self-centered and domineering. You’ll constantly hear them making excuses, blaming others and playing the victim. What they won’t do is change on their own.

3. With or Without a Diagnosis, Your Child Needs Skills.

It is very important that parents understand that no matter what the diagnosis is, these kids have to have a bundle of skills if they’re going to make it in the adult world. A diagnosis can help indicate how we deliver those skills to them. So for the girl who has ADHD, the boy who has Conduct Disorder, the teen who has OCD, they all are still going to have to work and support themselves. That’s simply the reality of the situation: that is the way of the world.

If you make excuses for your child by saying “That’s the diagnosis talking” and if you don’t take any action to get him the skills he needs—and demand that he learns them—you’re giving up. And by the way, giving up is very easy to do. I’m not judging parents, by any means. These kids are overwhelming, and families do give up because they get exhausted. But understand this: these kids still need to get those skills. If they don’t, there’s a good chance they’re going to end up living with you into adulthood, be out on the streets, or in a correctional institution.

4. Kids with Learning or Behavioral Disabilities Need Training the Most, but They’re the Ones Who Get it the Least.

Let’s look at the diagnosis from the child’s perspective. My son was diagnosed with Attention Deficit Disorder as a kid. We worked with the school, but he still always felt “less than” the other children. Understand that at the core of these kids with behavior problems or learning disabilities, they’re angry. They’re ashamed of themselves and they feel like they’re damaged goods. And that just makes them feel more hopeless, which triggers more acting-out. Their perspective on their diagnosis is, “There’s something wrong with me.” That’s why they’re always making excuses, blaming others, and saying, “It’s not me, it’s them.” In this way, they defend themselves from the feelings of shame and anger. They see that the other kids can meet their responsibilities and they know they can’t—or won’t. They see the other kids getting along socially, and they know they don’t get along with anybody. They have a big denial mechanism that neutralizes those thoughts, and many of them end up walking around in their own little self-centered world, acting out and becoming more and more destructive.

In my opinion, if any child needs to learn how to manage their behavior effectively, it is a kid with learning or behavioral disabilities. In fact, they need it more than the other kids who are successfully learning how to do it as they develop. When a child has a learning or behavioral disability, he needs to work harder to be prepared for adulthood. Unfortunately, these kids are the ones that need training the most, but they’re the ones who get it the least.

I used to work with kids in a youth correctional center. Many of them had a lot of learning disabilities. Very few of those youth were what would be considered “normal” school kids. They all had a diagnosis of something like ADD, ADHD, Oppositional Defiant Disorder, or Conduct Disorder, which becomes criminalized when you get into your late teens or even mid-teens. These are the kids – the kids with untreated ADHD, untreated ODD, and Conduct Disorder—who start doing criminal things in adolescence. And if they don’t learn how to manage themselves effectively somewhere along the way, they get lost in the correctional system. Or they become lost in lives of substance abuse because it gives them a release from the pain of not being able to function. So you often see a high percentage of drug addiction and alcoholism amongst these children. And you see a high percentage of people in prison who have learning disabilities. Many, many inmates can’t write and read, and thousands and thousands of people get their GEDs in prison while they’re doing time.

5. To Medicate or Not to Medicate?

My view on medication is that it’s up to the parent to decide what’s best for the child. I urge parents to go into it with an open mind, to weigh out the benefits and the risks. Try to determine ahead of time how you will know if the medication is working or not working, within a proscribed period of time. So it’s not only “Put my daughter or son on medication,” it’s “If we put them on it and it works, what will we see in 4 weeks?” Conversely, ask yourself, “How will we know it’s not working and what will we do?” Parents should be informed consumers of the information regarding what medication their kids are using, and what the therapist hopes to accomplish.

Medication can be over-prescribed. I’ve seen kids on three or four very powerful prescriptions, and unless you have a good doctor who is monitoring everything very closely, know that many of these drugs can be harmful to the liver and kidneys. It’s important that you keep your child’s pediatrician informed of the meds he’s on. That being said, I think medication should be tried if you and your pediatrician determine that it might be helpful, and after a thorough screening and examination. Also, I think that medication should only be prescribed by a child and/or adolescent psychiatrist. Only they have the firsthand knowledge of how these very complex chemicals interact with other chemicals in the brain. I don’t think pediatricians or nurse practitioners or any other professionals who have the right to prescribe should be dispensing psychotropic medication for children.

Personally, I think it’s often worth it to take a chance with medication, if the drugs can support your child’s ability to self-manage sufficiently so he can learn the skills he’ll need. Don’t forget, all these methods we’ve been talking about are different vehicles that work to get information to our kids on how to behave and learn to grow up. They are all, in effect, “service delivery vehicles”. The service is that we’re getting our kids to behave and get some necessary life skills. Medication, special education, therapy, The Total Transformation Program, books and other resources are all examples, different ways to deliver the service of independent functioning to our children. Make no bones about it, as a parent, you need to be proactive and search out the best method for your child, in order to help him function in the grown up world.

I believe these kids can change, and that the process of change works best when it starts at home. I’ve worked with acting-out children for thirty years, and I’ve found that if there’s a culture of accountability at home or in school, it enhances these kids’ potential to respond. Real change does occur, but it takes a lot of work and sacrifice on the parts of all the adults involved. I’ll tell you what I’ve told many parents in my office: “It doesn’t end with the diagnosis, it just starts there.”

http://www.thedisorders.com/Child-behaviour-disorder.php
thedisorders.com

In general it is very difficult to handle people that too children it’s a little tough job. We can’t be very strict or very lenient. We can observe some sort of disorders in some children whose activities make others irritating. Their naughtiness and insurgence will be to the peak.  The types of behavior disorders include attention deficient hyperactivity disorder, conduct disorder, oppositional deficient disorder. Their aggressive and antagonistic behavior will create real pain to their parents and neighbors. This child behavior disorders may be due to mental disturbances or emotional related one. That is it may be due to biological, environmental or both factors. Biological factors such as genitival problem, head wound, chemical disparity or damage to central nervous system. the environmental factors like revelation to violence, family problems, stress to the crest, or absence of special people who are close to their heart also make them to behave very harshly.

The symptoms of these disorders include harming themselves or threatening others, involving in destructive action, telling lies, addiction to drugs, smoking and drinking habits, bunking school, stealing etc. The stress might be because of family problems or due to their inferiority complex. A survey states that one in five children faces this problem in developed countries. This is due to lack of care. The main reason for anxiety disorder is due to phobias, pattern of rhythmic thoughts leading to speedy heart beat and faintness. department of health and human services (united states) conducted a survey which state that this anxiety disorder is common in children in the age group 9 – 17 years. If we take protective measures such as good nourishment before and after birth of child, care and affection will prevent the child facing the problem.

The risk factors include inequity, poverty, prenatal exposure to drugs and other injurious chemicals, ill-treatment.50 percent of the children who has this conduct disorders are affected mentally and the problem continues in adulthood too. The teachers and parents play an important role in bringing out their child from such disorder by cooperating with doctors. They should promote their confidence and should make them to participate actively so that they are out of stress. The important thing is they must get hold of patience even during their disruptive behavior. Talk with them a lot try to grasp what they have in mind. You can change them slowly .impart good characters in them during their recovery. Tell them about their responsibilities, importance of planning, obedience etc. antidepressant, ant anxiety, antipsychotic, mood stabilizing medicines alone cannot cure the child. They may have a partial effect. But care, love, soft words only these have the power to bring your child completely out of these disorders. The treatment also includes medication when the child feels difficult to pay attention. In recent days one more disorder in children found to exist it is “eating disorder”. Many children feel that they will gain weight if they eat so they are not taking the required calories itself leading to lack of nutrition.

http://www.ldonline.org/article/5973
ldonline.org
By: Appalachia Educational Laboratory (1999)

The public expects schools to socialize children as well as to educate them.1 In fact, socialization, rather than academics, is why many parents choose public education over private or home school. However, public criticism of schools’ performance in both roles has increased in recent years. The public wants schools to be responsible not only for improving achievement but also for curbing disruptive, violent, and antisocial behavior. As a result, support is growing for “zero tolerance” discipline policies and alternative school placement for disruptive students.

Discussions about discipline have especially focused on special education students. Some teachers and parents are against the inclusion of potentially disruptive students in regular education classrooms and schools. They want to change laws and policies that discourage exclusion, suspension, and expulsion of such students. However, for children suffering from disabilities and other risk factors like poverty, crime, and abuse, traditional discipline methods and policies may exacerbate rather than remedy problem behavior.2

Discipline reacts to behavior that has already occurred. Schools may also need to focus their efforts on prevention. David Hawkins, professor of social work and director of a 10-year delinquency prevention study at the University of Washington in Seattle, worked as a probation officer in the 1970’s. He says,

Dealing with [delinquent teenagers] as a probation officer, I saw my job something akin to operating an expensive ambulance service at the bottom of a cliff. The probation staff were the emergency team patching up those who fell over the edge. Many of us who have worked in juvenile corrections have come to realize that to keep young people from falling in the first place, a barrier is needed at the top of the cliff. In short, we believe that prevention is more effective and less costly than treatment after the fact.3

Research has identified risk factors that contribute to the development of antisocial behavior as well as protective factors that help children develop resiliency to overcome risk. This paper examines the research on these factors, especially in regard to Attention Deficit/Hyperactivity Disorder (ADHD) and learning disabilities (LD); presents a model that promotes pro social behavior; and suggests considerations for preventive practice and policy making.
Risk and antisocial behavior

Research shows that most antisocial behavior develops from a combination of risk factors associated with individuals, families, schools, and communities.2,3,4 The same factors apply across races, cultures, and classes, and their effects are cumulative exposure to multiple and interacting risk factors exponentially increases a child’s overall risk.3,4 Also, antisocial behavior evolves over the course of childhood, often beginning in the preschool and elementary years and peaking in late adolescence/early adulthood. Direct, early intervention can halt its progress; once firmly established, however, antisocial patterns become more difficult to change and can persist into adulthood.2,4
General risk factors for antisocial behavior

Several general factors put all children at risk for antisocial behavior, including children disabled by ADHD and LD. The presence of multiple factors increases risk; conversely, their elimination reduces risk.
Individual risk factors.

Several inborn traits and characteristics related to personality, temperament, and cognitive ability have been identified as risk factors for later delinquent behavior. These do not doom children to misbehavior or crime, but they do make them more susceptible to other risks in the environment. In addition, several factors other than inborn traits are known to place individuals at risk. (See box.)
Family/community/societal risk factors.

Family characteristics, as well as community and societal factors, can increase risk for antisocial behavior. (See box.)
School-related risk factors.

An array of school factors can be linked to delinquent behavior. (See box.)
Risk Factors for Antisocial Behavior Individual Impulsivity; the inability to adopt a future time perspective or to grasp future consequences of behavior; the inability to delay gratification; the inability to self-regulate emotions, especially temper; the need for stimulation and excitement; low harm avoidance; low frustration tolerance; central nervous system dysfunction; low cortical arousal; a predisposition to aggressive behavior; low general aptitude or intelligence; exposure to violence and abuse (as either a victim or a witness); alienation; rebelliousness; association with deviant peers; favorable attitudes toward deviant behavior; peer rejection; alcohol and drug abuse; and early onset of aggressive or problem behavior.2,3,4,5,6,7,8,9,10
Family/Societal Economic deprivation and unemployment that limit access to food, shelter, transportation, health care, etc.; parental history of deviant behavior; favorable family/community attitudes toward deviant behavior; harsh and/or inconsistent discipline; poor parental and/or community supervision and monitoring; low parental education (especially maternal education); family conflict; disruption in care giving; out-of-home placement; poor attachment between child and family; low community attachment and community disorganization, as evidenced by low parent involvement in schools, low voter turnout, and high rates of vandalism and violence; parental alcoholism; social alienation of the community; availability of drugs and guns; high community turnover; and exposure to violence, including violence in the home, community, and media.2,3,4
School-based Academic failure beginning in elementary school; poor academic aptitude test scores especially in reading beginning in Grades 3 and 4; lack of commitment to school; lack of belief in the validity of rules; early aggressive behavior (in Grades K-3); lack of attachment to teachers; low aspirations and goals; peer rejection and social alienation; association with deviant peers, including grouping antisocial children together for instruction and/or punishment; low student/teacher morale; school disorganization; ineffective monitoring and management of students; and poor adaptation to school, as evidenced by retention and attendance rates, assignment to special education, and student reports of not liking school, lack of effort, alienation, and punishment.2,3,4,11

Chronic school failure demoralizes children, can cause loss of status and rejection by peers, destroys self-esteem, and undermines feelings of competence. As a result, it can undermine a child’s attachment to teachers, parents, school, and the values they promote. It also generates hopelessness and helplessness. Children cease to believe that their efforts make a difference in outcomes.12,13,14 For delinquent youngsters, “school is not a place of attachment and learning, but of alienation and failure.”15

In addition, an analysis of disruptive behavior in 600 schools revealed that schools with discipline problems tend to be large and urban; lack teaching resources; lack fair, clearly stated, consistently enforced rules; have students who do not believe in the rules; lack leadership and cooperation among staff; and have punitive teachers.16 One study found punishment and lack of praise by classroom teachers to be main factors related to delinquent behavior.17
Risk factors specific to ADHD and LD

Children with inadequately treated ADHD and LD are especially at risk for developing antisocial behavior–oppositional defiant disorder, conduct disorder, and delinquency.3,5,6,18,19 Those with ADHD experience “high rates of suspension and expulsion from school,”20 50 to 70 percent develop oppositional defiant behavior, and 20 to 40 percent show symptoms of the more serious conduct disorder.21,22

Wexler estimates that up to 70 percent of juvenile offenders and 40 percent of adult prisoners may have ADHD7–a significant percentage, considering that only three to seven percent of the general population have ADHD.23 Likewise, from 30 to 50 percent of adjudicated juveniles and adults have been found to have LD, compared to a five to ten percent prevalence in the general population.8 Learning disabilities increase a child’s risk of adjudication by 220 percent.5 Studies of children with ADHD reveal that 23 to 45 percent have juvenile convictions.24 The relationship between ADHD and antisocial behavior is so strong that some consider ADHD to be a predisposing risk factor.3,4,6,25

ADHD and LD represent not one risk factor but a constellation of pervasive, interacting factors that multiply risk. The underlying neurological dysfunctions that cause these disabilities impair performance in cognitive, social, and emotional domains.18,26,27,28 This impairment too often snowballs into academic and social failure and, ultimately, into behavioral and affective disorders unless the environment eliminates compounding risk factors and puts protective factors in place to prevent it. The following specific risk factors contribute to negative outcomes.
Individual characteristics and innate traits.

Most of the individual traits associated with risk (listed above) characterize many children with ADHD and/or LD.2,3,5,6 Recent brain imaging studies of children with ADHD support previous evidence of under arousal and impairment in frontal regions of the brain thought to help individuals monitor and control behavior, strategize, and set goals.29,30 In addition, children with ADHD have been shown to be less responsive than other children to environmental feedback–reinforcement, consequences, and punishment.31. Finally, some children with ADHD and reading disabilities may also be predisposed to aggression.31,32

These traits may be physiologically and biologically based and therefore resistant to change. However, as Goleman points out, “genes alone do not determine behavior; our environment, especially what we experience and learn as we grow, shapes how a temperamental predisposition expresses itself as life unfolds.”33 Unfortunately, ineffective and punitive responses from their environments have taught many antisocial children “that they do not like school or their parents and that following conventional rules does not yield rewards.”34
Academic failure.

Cognitive impairments in children with ADHD and LD frequently cause serious academic problems–low reading scores, language impairment, and poor grades.35 If unaddressed, these impairments increase the risk of school failure, amplifying any innate risks for developing antisocial or delinquent behavior.2,3,4,5,6, 36
Social failure.

Despite their social natures and pro social intent, 50 to 80 percent of children with ADHD and LD experience significant peer problems and social failure.37,38,39,40 They tend to be lonelier, have fewer friends, and participate in fewer extracurricular and community activities than their non disabled peers. Social problems are so prevalent in children with ADHD that some consider them a hallmark characteristic.37

For disabled children, “reading” social cues may be as difficult as reading words.41 Both academic and social tasks require children to process and respond to cues and information in the environment, but unlike books, which are inanimate and static, interpersonal communications are dynamic and emotionally charged. Subtle nonverbal cues, timing, and affect–facial expression, posture, and tone and volume of voice–can determine how others interpret meaning and perceive intent. Disabled children are more likely to misperceive or miss social cues and to perceive hostile intent where it doesn’t exist.28,42 On the other hand, they are less likely to “get” jokes or to discern when others are joking.43 Lack of inhibition can cause children with ADHD to behave tactlessly and intrusively, dominate and interrupt conversations, and not listen.43 As a result, they may be seen as obstinate, bossy, insensitive, and rude.39,44,45,46 Finally, many children with ADHD and LD have significant impairment of the skills needed to modulate behavior in response to changing demands, and so their behavior may often seem inappropriate for a particular situation.37,40,47

Recent studies of children with ADHD with normal I.Q.s revealed below average scores on the Vineland Adaptive Behavior Scale48–an assessment usually used for students with developmental disabilities. The children scored poorly in subtests of socialization, communication, and daily living.49 Surprisingly, the discrepancy between adaptive behavior and intelligence worsened, rather than improved, with age, underscoring the need for early intervention and treatment.50

Emotional impairment. Children with ADHD and LD may exhibit poor emotional regulation, resulting in outbursts, temper tantrums, overreaction, impatience, and limited self-awareness.43 The lack of emotional control increases the risk of behavior problems, anxiety, and depression.28

In addition to prevalent conduct problems, 20 to 30 percent of children with ADHD experience anxiety disorders and up to 75 percent experience depression.20,31 Chronic stress at school and home can interfere with academic performance by destroying brain cells and impeding brain functions involved in learning and memory.51,52 Schools that are “highly evaluative and authoritarian” increase such nonproductive stress.53

Differential treatment. Children with ADHD and LD are more likely to be arrested and convicted than their non disabled peers for the same delinquent behaviors.5 This may be because they lack the cognitive and language skills to avoid detection, conceal intent, and respond to questions and warnings by police. It may also be due to poor social skills and emotional regulation. Children with ADHD and LD tend to be “awkward and abrasive in social interactions. Demeanor of the arrestee is an extremely important factor in determining whether an arrest will be made in routine encounters with the police.”54

Captain Susan Rahr, commander of the Gang Suppression Unit in Seattle, Washington, agrees that poor social skills can contribute to higher arrest rates for children with ADHD. Her experience shows that a child’s social skills play a part in determining whether police take an offending child home to parents or to the station for booking, thus beginning a juvenile record. The child who can “fake the socially desirable response”54 is more likely to be taken home; the child who responds inappropriately is more likely to go to jail for the same offense (Rahr, personal communication, November 9, 1995).

A similar phenomenon may occur in schools, contributing to high rates of punishment, suspension, and expulsion for children with ADHD and LD. Research shows that children with ADHD elicit more negative reactions from teachers, parents, and other adults, and can cause more negative treatment for an entire classroom of students.37,38

Low self-esteem. Brooks explains that “assaults to their self-worth as a consequence of the behaviors associated with ADD” cause children “to believe that their mistakes and failures are some kind of character flaw, a flaw that cannot be modified. The result of such thinking is a child who may give up and resort to ways of coping that are ineffective and self-defeating.”55 Goldstein and Goldstein state that the child with ADHD is more at risk for oppositional behavior because he “often cannot meet the demands of others, he fails frequently, and as a result becomes frustrated, unhappy, and more negative.”56 Fouse and Brians suggest that well-meaning but “frustrated parents and teachers may push these children to the brink of despair.”57 Some think that the defiant child may be fighting for self-preservation, while the depressed child has given up.
Resiliency: Overcoming risk

The majority of children do well in life despite adversity and exposure to multiple risks.3,58 Children who are able to thrive despite risks are said to be resilient.3,13,58,59,60,61,62,63 Researchers have identified certain protective factors that like barriers at the tops of cliffs–can help promote resilience and prevent negative outcomes.
General protective factors

Protective factors, like risk factors, can be located within individuals, families, communities, and schools. They apply to all children, including those who are disabled and otherwise at risk. The effects of these factors are cumulative–the more factors present, the greater their influence.4
Individual traits.

Resilient children tend to be socially competent, autonomous, not easily frustrated, able to bounce back, not quick to give up, good natured, optimistic, intelligent, appealing to adults, and able to elicit positive attention and support. They have good problem-solving skills, a sense of purpose and personal control, a future orientation, and high self-esteem.3,4,13,58,59,64 Resilient children learn to define themselves by their strengths and talents rather than their weaknesses, are valued by others for their talents, develop a sense of personal mastery, and contribute to society by performing socially desirable tasks.13,60 Females in general have less proclivity for disruptive behavior.3
Families/communities.

Families of resilient children exhibit warmth, affection, and emotional support.4,13 Children and parents or caretakers form mutual attachments, and children are monitored and supervised. Likewise, communities can nurture, monitor, supervise, and convey pro social values to children.
Schools.

Rutter says, “Schools that foster high self-esteem and promote social and scholastic success reduce the likelihood of emotional and behavioral disturbance.”65 These schools, according to Benard, “establish high expectations for all students”–including those with disabilities–and provide students “the support necessary” to achieve them.66 They convey compassion, understanding, respect, and interest for children and families; and present opportunities for meaningful participation. They identify children’s strengths and talents–their “islands of competence”14–and organize learning accordingly, incorporating learning styles, multiple intelligences, and an accelerated, rich curriculum that includes art, music, and athletics. They design classroom instruction to accommodate various ability levels, and maximize learning time.3,59,60,61,62

Research shows that school organization–management, governance, culture, and climate–can reduce overall measures of student disruption as effectively as individual treatment programs.11,67 Effective schools involve “community agencies, students, teachers, school administrators, and parents” in decision making,68 and focus “on improving communication, building trust and cooperation, enhancing the organization’s problem-solving and decision-making capabilities, and strengthening [the] planning process.”69 Through cooperation and collaboration, schools can draw on internal and community resources to meet students’ needs.

Other school-related, protective factors identified through research include boosting achievement in mathematics and reading (especially 4th-grade reading scores), commitment to school, and attachment to teachers.59,61,70
Specific protective measures for ADHD and LD

Because of the pervasive effects of ADHD and LD on cognitive, social, and emotional performance, disabled children may require specific interventions in addition to schoolwide protective factors. These should be multi disciplinary and multi-modal–involving parents, teachers, medical and mental health professionals, and other support personnel in schools and communities–in addressing the whole child’s needs: academic, social, emotional, and physical.6,18 Multi modal treatment has been shown to dramatically reduce antisocial behavior by reducing risk factors.71

For disabled children, comprehensive assessment and individualized education programs (IEPs) can help identify and maximize children’s strengths while detecting and accommodating weaknesses that add to risk. Although schools cannot change underlying neurological impairments that affect children’s cognitive, social, and emotional performance, they can help prevent impairments from causing academic and social failure by providing appropriate accommodations and early intervention.

Children with ADHD and LD have many strengths that can help them learn. They can be very intelligent, funny, social, energetic, passionate, and highly talented in art, music, and athletics. Children with ADHD exhibit many characteristics attributed to creativity and giftedness.72,73,74 Studies have shown them to be adept at imagery and symbolism, able to assimilate information by scanning, and able to process information below the threshold of consciousness.73,74 High-IQ children with ADHD are better than similar non-ADHD children at nonverbal problem solving and score higher on measures of nonverbal creativity.74

To succeed in school, many disabled children need to learn strategies for improving social performance and controlling emotions.3,28,75,76 Early intervention programs to improve social competence and meet physical and emotional needs have been shown to increase academic achievement and to prevent later delinquent behavior.77 Other programs to teach coping strategies, and academic, social, and life skills to disabled juvenile and adult offenders have been shown to substantially improve behavior and reduce criminal recidivism rates.8,78 A remedial program for juvenile offenders with previously undetected disabilities reduced recidivism rates to an astounding two percent.79

Although research on the effectiveness of social-skills training with ADHD-diagnosed children is contradictory and inconclusive, several school-based programs have been successful in helping children learn social competence and emotional regulation.3,28,77 Goleman believes that school-based programs to teach “emotional literacy” can help children learn to control impulses and emotions, especially anger and aggression, and develop self-awareness.28 To be most effective, programs should begin early–even during the preschool years; be integrated into the context of daily school life; provide immediate, salient reinforcement and feedback, including lots of praise for appropriate behavior; and use simulations, role-playing, and other hands-on, experiential methods to rehearse real-life experiences.80 School activities that emphasize social interaction–cooperative learning, field trips, drama, dance, music, and physical education–provide opportunities for developing social competence while learning, and instruction that incorporates metacognitive activities helps students increase self-awareness.52

To boost self-esteem, children need support in opportunities to develop responsibility; to contribute to school, family, and community life; to make decisions and choices; to nurture self-discipline; and to deal with failure and mistakes.12 These help build feelings of self-competence, restoring children’s belief that their efforts can make a difference in their lives.
A model for promoting pro social behavior

Perhaps the most critical factor influencing the development of pro social behavior is attachment to at least one pro social adult who believes in the child and provides unconditional acceptance and support.3,12,13,59,60 Hawkins explains that pro social behavior results when children bond with pro social adults and peers and adopt their beliefs and values.3 Conversely, antisocial behavior results if children bond to antisocial individuals, such as gang members, and adopt their beliefs and values instead.

For bonding to occur, three conditions must be present:

* an opportunity for bonding to take place;
* cognitive and social skills to help children succeed in bonding opportunities; and
* a consistent system of recognition and reinforcement for accomplishments.3

A resilient temperament, social competence, and cognitive skills are protective factors that help children participate successfully in pro social bonding opportunities. Recognition reinforces what children are doing right, plus provides an incentive to persist in bonding activities and relationships.

Many experts agree that attachment to even one caring, responsible–adult whether a teacher, administrator, bus driver, custodian, relative, or community member–can help children become pro social.3,12,13,59,60 A study of the effects of remediation on delinquency showed that the child’s bond with the tutor affected school attitude and behavior more than improved grades.5

The important role of bonding in the development of pro social behavior offers schools an avenue for effective prevention and intervention. Mentoring and similar one-on-one programs and group activities can help children develop relationships that foster self-esteem, social attachment, and pro social behavior. A promising new strategy for individuals with ADHD pairs children with “coaches” who help define goals, objectives, and plans to achieve them, while providing support and encouragement.81,82

Children seek to imitate and gain approval from their role models, whether good or bad. Once children bond with antisocial peer groups, their behavior becomes more difficult to change. Schools, families, and communities can work together to ensure that all children are cared for and have pro social adults to emulate, thus assuring the transmission of pro social beliefs and values to the next generation.

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Prevention: Policy and practice

Gottfredson says that “the task of educating and socializing children requires that [schools] be arranged in ways that successfully produce the desired result.”83 To improve student behavior and school safety, policy must address prevention as well as treatment of misbehavior and support practices that both reduce risk and cultivate resilience in children.
Reducing risk

Reducing risk requires a collaborative, comprehensive effort to consider and minimize individual, family, community, and school-based risk factors. Each of these facets of risk suggests broad areas for preventive policy action: school organization and effectiveness, student achievement and early intervention, parent/community partnership, and professional development. (See box below) For example, one such action could be to require schools to assess risk as a component of safe schools or school improvement plans; however, specific strategies for reducing risk must be tailored to unique student, school, and community needs.
Areas for Preventive Policy Action: Does policy encourage prevention of problem behavior?

I. School Organization and Effectiveness (management, governance, culture, and climate)

* Do schools involve teachers, students, parents, and community members in decision making?
* Do schools have high expectations for learning and behavior for all children and help all
* children achieve them?
* Do schools clearly communicate expectations for learning and behavior to students?
* Do schools have a consistent system of reinforcement and recognition to help shape behavior?
* Do schools provide alternatives to suspension and expulsion?
* Do school practices promote student engagement and attachment?
* Do schools conduct risk assessment as part of safe schools/school improvement plans?

II. Student Achievement/ Early Intervention

* Do schools intervene early to identify and assist students who fail to meet expectations for learning and behavior?
* Do schools evaluate students’ social, emotional, and adaptive functioning, as well as cognitive functioning, as part of multidisciplinary evaluation?
* Do IEPs address social, emotional, and adaptive problems as well as academic problems?
* Do schools provide assistance to non disabled students with learning and behavior problems?
* Do schools include special education students in regular education classrooms?
* Do schools include special education students in performance accountability measures: statewide testing, attendance, and dropout rates?
* Do schools disproportionately discipline students with disabilities?

III. Parent/Community Partnerships

* Do schools work with parents and communities to educate and care for children?
* Do schools involve parents/communities in safe schools/school improvement plans?
* Do schools provide information to parents about how to help their children learn and behave appropriately in school?
* Do schools collaborate with other agencies to meet family/community needs?

IV. Professional Development

* Have teachers been trained to use a variety of instructional and classroom management strategies to prevent academic failure and problem behavior with all children, including those with disabilities?
* Do preservice programs in state schools of education provide this training?
* Have state department of education inservice programs provided this information?

In his “Communities that Care” model, Hawkins suggests the following steps to systematically minimize risks:

* develop a vision and goals,
* assess existing risk factors,
* collect data on current efforts to address them,
* create an action plan to target unaddressed risks, and
* develop a way to evaluate results.3

Cultivating resiliency

Policies and practices that promote the transfer of pro social behavior and beliefs to children (1) maximize opportunities for bonding; (2) increase academic, social, and emotional competence and self-esteem; and (3) create a consistent system of expectations, reinforcement, and recognition to shape behavior.(3)
Maximizing opportunities for bonding.

If students are to form attachments to school and pro social role models, then policies and practices should ensure that teachers, students, parents, and communities have the time and means to get to know each other. For example, policy actions might involve extending the school year or the school day, revising consolidation plans and class size limits, adding community service to graduation requirements, or creating a program to assign personal coaches or mentors for students with IEPs or recurring discipline referrals. Related school practices might include improving school attendance, looping (teachers and classes stay together for two or more years), block scheduling, teaming, cooperative learning, mentoring or coaching, and one-on-one tutoring.61,70,84,85

Policies and practices that support pro social bonding do not isolate and alienate children unnecessarily through tracking, special education placement, suspension, or expulsion, and do not encourage the formation of deviant peer groups by placing “problem” children together for instruction or discipline.
Increasing academic, social, and emotional competence and self-esteem.

Because social, emotional, and cognitive skills are essential for achieving academic and behavioral expectations, policies that support the development of personal competence and self-esteem should provide the impetus to identify and address the whole child’s needs. For example, multidisciplinary evaluation to determine exceptionality–especially ADHD and LD–should include assessment of adaptive, social, and emotional functioning as well as cognitive functioning.

Policy actions should encourage and support practices that allow for student diversity–different ways and rates of learning, as well as strengths, talents, and weaknesses. For instance, preserving budgets for athletics and the arts not only supports achievement86 but also provides opportunities for children to develop and showcase strengths and talents that foster resilience,61 increase self-esteem, and boost social standing.13 Use of individual instruction, alternative assessments, cross-age grouping, and well-designed supplemental and resource programs; and attention to multiple intelligences and learning styles allow children to achieve basic skills at their own rates while avoiding the negative outcomes associated with retention.59,87 Cooperative learning groups, conflict resolution and anger management training, group activities, and counseling help children to learn alternatives to antisocial behavior, to deal with their emotions, and to get along with others.
Creating a consistent system of expectations, reinforcement, and recognition.

Environments that get desired results define desired and undesired behavior, determine when they occur, and apply consequences–rewards and punishments–that influence the rate at which they are displayed.2 Such environments establish high expectations for all students; a clear system of rules and consequences that are consistently, fairly, and equitably enforced; and cooperative, collaborative, and caring climates.11,67

State policy can influence whether school discipline systems balance traditional reactive and punitive measures with proactive and preventive ones. For instance, preventive systems create alternatives to suspension and expulsion–like community service–for all but the most serious offenses, to keep from further isolating and alienating children who are already marginally attached to the school culture. Policy can also promote equity in expectations and treatment for poor, minority, and disabled children by focusing attention on performance indicators for at-risk groups. For example, including children with disabilities in statewide testing and aggregating their attendance, suspension, expulsion, and dropout rates can provide accountability data to policy makers and help to evaluate program effectiveness and school reform efforts88

Although state policies define standards for learning and behavior, local school practices determine whether students have the means to achieve them. Strategic planning for school improvement, shared decision making, and collaboration among school and related staff, families, and communities help design and build the structure children need to achieve state standards and meet academic and behavioral expectations.89
Conclusion

No silver bullet can eliminate behaviors resulting from neurological impairment, disadvantage, and social disintegration. But those who care for the nation’s children–schools, families, and communities–can pull together to consider what is going wrong and what can be done to prevent it, based on solid knowledge of how children develop antisocial or pro social behavior. By identifying both risk factors and protective factors, research has given us the tools to build solutions–barriers at the tops of cliffs that keep children from falling–and has restored our hope that we, collectively and individually, can make a difference.

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A child is said to be suffering from a behavior disorder when he displays a behavior that is markedly different from that exhibited by his peers. He refuses to abide by the expectation of his parents, school or society, in relation to the standard behavior. Behavior disorders are difficult to diagnose, since there are no visible physical symptoms associated with them. Rather, it is only by observing the behavior pattern of a child over a period of time that one can identify the problem. Behavior disorders are believed to be the result of brain injury, child abuse, trauma, or even a genetic disorder. However, the parents need to understand that the disruptive behavior of a child is an involuntary response to such experiences and only understanding, love, care and patience can help him deal with it.

Characteristics/ Warning Signs
* Your child is aggressive towards people and is often found to play wicked tricks on them.
* There is a general aggression towards animals, which manifests itself in the form of cruelty.
* You have hardly found your child being affected by the pain of others or showing regret for mean actions.
* There have complaints of your child destroying property, like defacing school desks, drawing graffiti or indulging in vandalism.
* Your child tends to show little or almost no empathy, compassion and concern for others.
* There have been instances of your child lying, cheating and even stealing, without taking any responsibility for his mistakes.
* Your child shows open defiance and refuses to adhere to any rules and regulations, be it in the home or school.
* There have been instances of your child being involved in smoking, drinking, drug usage or early sexual activities.
* Your child has been not doing well in school, be it in studies or sports, since quite sometime.
* There are frequent tantrums by your child and he often has severe arguments with you or your spouse.
* Your child does not have any friends in school. Rather, the other children prefer to stay away from him.
* There has always been hostility in your child, in relation to the authority figures in his life.

Helping Your Child
Condemning your child, punishing him or using harsh words is not going to lead you anywhere, as far as his behavior problems are concerned. Rather, you need to be patient, understanding and gentle with him. In this context, the following tips will come handy.
* Many of the behavioral problems arise from an inferiority complex buried deep within your child, be it in relation to his looks, intelligence, finances, or something else. You need to develop self-esteem and confidence in your child, by praising him for doing something good.
* Give your child lots of opportunities to become responsible, so that he knows that you consider him to be dependable. Even if he makes a few mistakes, don’t take back the responsibilities. Rather, tell him how to do better the next time.
* Never ever let patience leave your side, even when you become extremely frustrated. Refrain from scolding or punishing your child on the slightest of mistakes made by him. Rather, gently make him understand where he went wrong.
* Indulge in role play. Switch over your roles, with your playing the child and your kid playing the part of his parents. Now, indulge in the same behavior as he does. When he finds himself in the position of the victim, he will understand the hurt he is causing to others.
* Teach your child the concept of ‘what you sow, so shall you reap’. He needs to know that every good act is always rewarded, but even every bad act gets paid back in full. However, mistakes can be pardoned, if they were unintentional.