Parenting Children with Behavior Problems

The following article addresses the origin of many common behavioral problems in children from birth through the teenage years. Problems discussed include children who can’t stop crying or won’t eat to children who can’t control their emotions to children who exhibit childhood depression and anxiety. All of these problematic childhood behaviors and others can stem from common early life experiences.

Most people think of childhood as a peaceful, even idyllic, time. We expect that infants will be welcomed into their new families with love and care. But this idealization does not always take into account the complexity of bringing a new member into a household, or what this new little person actually requires of his or her parents. Some infants are more neurologically stressed than others at birth because of what happened to them in the womb, during birth, or immediately after they are born and this represents an added challenge for parents.

All parents want to be good parents. They want to provide safety, love and stimulation for their child’s optimal growth and development. New information about the brain’s role in shaping a child’s mental, physical and emotional development adds complicating new elements to this intention. New brain technology shows us how incomplete the human brain is at birth and the degree to which its structure and function can change during the first few years of life. This new information, which dramatically impacts the future of young children, depends on the quality of the relationship between the child and his or her primary caretaker.

To better understand parenting problems and solve children’s behavioral problems from infancy through the teen age years, including more serious childhood problems like childhood depression and anxiety, we have to appreciate how interpersonal social experience shapes the brain in infancy and childhood.

Why are all stages of child development a reflection of brain development?

Human beings are highly social creatures. Our brains are designed to be in relationship with other people. Interactive communication shapes both the structure and function of the brain. The technology that brain scans have made available in the past fifteen years proves this point. The interactive, connective experience between an infant and its primary caretaker, known as attachment experience, directly influences the full spectrum of child development including:

  • They way a child perceives themselves
  • The way a child feels in their bodies
  • The way a child focuses attention
  • The way a child is able to learn
  • The degree of safety and security a child experiences in the presence of others
  • The way a child acts or behaves
  • The way a child thinks and interacts with the world

The attachment experience is responsible for activating or not activating an infant’s genetic potential. Interpersonal relationships and the patterns of communications that children experience with their caretakers have the greatest influence on the development of a child’s mental, emotional, intellectual and physical processes. Failed attachments can result in many childhood problems including behavioral problems and childhood anxiety and depression.

How does the attachment bond differ from love?

Love is an internal experience of strong affection, attachment, devotion and caring that holds tender thoughts and feelings about someone or some thing. Attachment is an instinctive system in the brain that evolved to ensure infant safety and survival. It is a mutual communication process based on moment-to-moment reception of nonverbal cues. The attachment bond springs from caretaker’s ability to align his/her own internal state with that of the infant or child and communicates this alignment in nonverbal ways that the child understands. This nonverbal “communication” forms a bond of trust that makes the infant feel that he/she is felt, known and understood.

Each attachment occurs in a unique way. Infants vary in what it takes to calm and soothe them or what they find most pleasurable. Caretakers also have their own preferences, but the attuned caretaker will observe and follow the lead of the infant.

  • The adult aligns. For example:
    • The child cries; the adult feels concern and acts in ways that communicate this concern.
    • The infant smiles and wants to interact in a positive manner. Seeing this, the adult understands and accommodates the infant’s desire for joyful play.
  • Through this mutually attuned interaction, the infant learns to attain balance in his body, emotions, and states of mind.
  • The comfort, pleasure, and mutuality of the attuned interaction creates a sense of safety within the infant and inspires interpersonal connection to others.

But not all parent /child dyads are able to participate in an aligned way. Infants can be so neurologically stressed by their fetal, birth or after birth experiences that they don’t communicate their needs. Parents who love their children may also be so stressed or overwhelmed that they fail to recognize and respond to their children’s nonverbal cues for outreach to them. Parents who did not themselves experience adequate attachment bonding may be unfamiliar with or unaware of the nonverbal cues communicated by their infants.

Secure attachment doesn’t have to be perfect

Meeting a child’s needs is a complex and difficult process and depends on the individual characteristics of the child and the caregiver. Nevertheless, successful attachment is not an all-or-nothing proposition because the brain remains flexible and resilient throughout life. Relationships with parents can and do change. If communication with the infant is secure at least a third of the time or more, that is enough to support a secure relationship

Repair, an important part of the attachment process, contributes as much to optimum development as joyous interaction. No caretaker will interpret a child’s needs correctly all the time. And, as the child grows, there will be times of disagreement between the pair. The caretaker, who sets limits initiates repair as soon as the child indicates a desire for reconnection, strengthens the child’s feeling of safety within the relationship.

Primary caretakers are usually the natural mothers, but they need not be. A father, another relative or a non-relative can function in the role of primary caretaker provided they sustain a central role in a child’s life for at least three, and preferably five years – the period when a child’s brain develops most rapidly. Each attachment occurs in a unique way. Infants vary in what it takes to calm and soothe them or what they find most pleasurable. Infants and caretakers have individual preferences, but attentive caretakers will observe and follow the infant’s lead.

What is emotional or relational trauma?

Babies are born with their own neuronal patterns of arousal and this determines certain conditions that may either enhance or interrupt the caregiver’s ability to nurture. If the infant and parent make a good match because their nervous systems are aligned, the development may proceed normally. But this is not always the case. We know now that even infants can experience an extreme state of unending stress known as developmental or relational trauma if their caregivers are unable to read their cries and need for attention and securing.

“Ordinary” events involving experiences of loss or separation from a primary caregiver and of unmet needs can cause psychological or relational trauma. A child who goes through loss or who is not appropriately responded to may experience psychologically overwhelming feelings of fear and terror. This activates their Adrenal Stress Response and they begin showing the characteristic biological symptoms of trauma. Cortisol levels rise in their blood, their behavior becomes hyperactive, manic, emotionally dysregulated and they can go into freeze, flight and fight behaviors that reflect those of post-traumatic stress reactions.

Most people recognize the potential for children’s psychological and biological reactions to trauma in “extra-ordinary” events such as abandonment, abuse and severe neglect but fail to recognize that same potential in unremarkable events such as falls, minor hospitalizations or separations. Neglect is especially difficult to identify because “nothing happened.” The covert nature of neglect often appears in adult behaviors as poor self-care habits such as inadequate eating routines and the inability to manage finances, work and relationships.

Relational or emotional trauma can be triggered by a wide range of experiences because of the delicate nature of a young child’s nervous system. These experiences include:

  • Birth trauma
  • A single incident of major proportions such as a serious accident or illness where for medical or other reasons the child is separated from the parent.
  • Instability in the family unit and ambient trauma of the surroundings can interfere with the establishment and maintenance of a safe environment.
  • A situation where a child witnesses abuse.
  • Neglect that results from feeling unnoticed and where loneliness and isolation are common experiences.
  • Death, loss of a caregiver or divorce

The above can create a set of subtle and often invisible psychological and biological reactions that children display when they lose their connection to trusted adult caregivers or when adults do not respond to their needs for nurturing, protection, safety and guidance timely and appropriate ways. A list of emotional or relational trauma signs and symptoms is included below.

What is the difference between normal stress and traumatic stress?

Stress is an essentially normal response to feeling overwhelmed or threatened. Fight, flight and freeze are survival responses that developed to protect us from danger. In moments of stress, hormones release and, as our heartbeat speeds up and blood pressure increases, we breath quicker, move faster, hit harder, see better, hear more accurately, and jump higher than we could only seconds earlier. These neurological and physiological changes enable us to better protect ourselves in the moment. But once the danger has passed, our nervous systems calm down and we return to a state of equilibrium or neurological balance.

If a child can self-sooth to calm stress, or can communicate distress to people who care, and if the child is then able to return to a state of equilibrium following a stressful event, that is in the realm of stress. If instead, the child’s distress is extreme and does not return to equilibrium, the child becomes withdrawn and depressed, or appears to be agitated and acting out. When frozen in this state of active emotional intensity, the child is experiencing emotional trauma – though usually neither the child nor the parent can readily identify the level of distress being experiencing.

One way to tell the difference between stress and emotional trauma is by looking at the outcome – how much residual effect an upsetting event is having on the child’s life, relationships, and overall functioning. Traumatic distress can be distinguished from routine stress by assessing the following:

  • How quickly upset is triggered — Does the child become upset very easily over things that don’t seem particularly upsetting?
  • How frequently upset is triggered — Is the child upset much of the time?
  • How intensely threatening the source of upset is – What is the degree of upset, is the child terrified?
  • How long upset lasts – Once upset, does the child stay upset even as pleasant things are happening?
  • How long it takes to calm down — Is the child inconsolable for long periods of time?

What child and parenting problems are triggered by relational trauma?

Relational trauma can cause impaired emotional health in both children and adults. It impacts a whole range of basic psychological functions, such as the regulation of feelings, the ability to have clear thoughts or memories about what happened in the past, the manner in which feelings are stored and expressed in the body and people’s views of themselves, strangers and intimates. It also can disrupt learning and coping skills creating attention and other kinds of learning problems and by adversely affecting the immune system can lead to chronic physical problems. Symptoms can include the following:

  • Low self esteem
  • Excessive shyness
  • Needy, clingy or pseudo-independent behavior
  • Inability to deal with stress and adversity
  • Lack of self-control
  • Inability to develop and maintain friendships
  • Alienation from and opposition to parents, caregivers, and other authority figures
  • Antisocial attitudes and behaviors
  • Aggression and violence
  • Difficulty with genuine trust, intimacy, and affection
  • Negative, hopeless, pessimistic view of self, family and society
  • Lack of empathy, compassion and remorse
  • Behavioral and academic problems at school
  • Speech and language problems
  • Incessant chatter and questions
  • Difficulty learning
  • Anxiety
  • Depression
  • Apathy
  • Susceptibility to chronic illness
  • Obsession with food: hordes, gorges, refuses to eat, eats strange things, hides food

How can relational trauma be prevented and healed?

Children vary in what they find soothing. There is no “one size fits all” for every child. In determining what constitutes “just right” communication for a particular child, it will be up to the adult to follow the nonverbal cues of that child. This is equally important for children who are verbal. When nonverbal communication sets the stage, words have far more impact. Here are some of the most important things to keep in mind as we engage our children in processes that enable them to thrive:

Non-verbal cues are estimated to be responsible for 80 percent of what enables us to feel safe with others. Minute to minute, ever changing subtle nonverbal cues are picked up in eye contact, facial expressions, tone of voice, posture, touch, intensity, timing and pace. The child’s brain is very focused on these cues and instantly knows when the caretaker’s mood or focus changes and contact is cut off. The challenge for parents with kids of all ages is to follow the child’s lead for contact or withdrawal. Example: your first child laughed loudly and enjoyed vigorous play but this child is much quieter and doesn’t seem to enjoy noisy active play –so you damper down your voice and slow down your movements to accommodate her lead and discover the joy of quit intense communication.

Attachment is akin to falling in love, but can’t begin until both parties feel safe in their bodies and safe with one another. When adults are anxious, mad, tuned out or overwhelmed, they will not be able to make an attuned connection with a child of any age. They should calm and focus themselves before attempting to connect. Sometimes something as simple as taking several slow deep breaths or jumping up and down to get blood flowing to the brain can relax and rejuvenate caretakers. If a child is overwhelmed or inconsolable, he may not be available for an attuned emotional connection until he feels safer in his body. Sensory activities such as rocking, singing, moving, touching, and feeding can sooth children, but youngsters vary in their sensory preferences. Older children can sooth themselves with physical activity or sensory input like favorite music. What soothes you may not soothe your child. Thus, parents of infants may have to become sensory detectives to determine the best techniques for soothing their child and soothing themselves in order to make connection with the child. Example: Katy is a four-year-old who becomes overwhelmed easily and breaks down crying inconsolably. When this happens Katy’s mother rocks her and encourages Katy to use words to describe what she is feeling.

The key to shared emotional experience is not simply to mirror or give lip service to the child, but to share his experience by feeling it to some degree within your own body. This process of shared experience helps children of all ages regulate their feeling states. It is usually more important to share a negative state with a child than to problem solve. Sharing enables older children to learn to problem solve for themselves. Example: Teddy excitedly points to the sparkly light fixture and mom smiles and points to the same fixture imitating and sharing the Teddy’s pleasure in a dance like process following the baby’s lead.

The shared positive emotional experiences of joy are as important to the attachment bond as the shared negative emotional experiences of fear, sadness, anger and shameSome parents are very good at detecting a child’s distress and responding appropriately to it. Other parents share joyous moments but leave or space out in times of trouble and unhappiness. A strong attachment bond includes the full range of shared emotional experience. Infants and toddlers are easily engaged in play, but older children, including teenagers, also thrive in non-competitive playful settings where everyone is stimulated and no one loses.

Rupture and repair is a crucial part of secure attachment. No matter how much we love our children, there comes a point where we are not in agreement with them, a point when we have to set limits, and say “no.” This is usually a point of rupture in the relationship as the child angrily protests. Such protest is to be expected. The key to strengthening the attachment bond of trust is to be available the minute the child is ready to reconnect. It is also important to initiate repair when we have done something to hurt, disrespect, or shame a child. Parents aren’t perfect. From time to time, we are the cause of the disconnection. Again, our willingness to initiate repair can strengthen the attachment bond. Two-year-old Kathy doesn’t want to get ready for bed –neither does eight-year-old Tim or fifteen-year-old Eddy, but sufficient sleep is essential for healthy brain/body development and therefore bedtime is nonnegotiable. Lights begin to go out amid tears and grumbles, but just before you say goodnight, there is a let up in the protest and you immediately respond affirmatively to the bid for reconnection. Example Two-year-old Jackson screams and cries because he doesn’t want to go to bed. There is a little struggle as mom gently but firmly puts Jackson in his bed –still crying; but just as she turns out the light, he stops crying and asks for a glass of water. She immediately brings him the water along with a kiss and a tuck into bed.

What signals from our children tell us it’s time to seek professional help?

Sometime, in spite of our best efforts to calm our children and make them feel safe, we get nowhere after repeated attempts to sooth, calm and help them regulate themselves. Weeks, maybe months, have passed and we have done our best to connect with our children and help them help themselves. We want our kids to be happy, calm and playful, but they are not, and neither are we. When this is the case, and we identify with some of the red flag signals that follow, it is time to explore professional help.

Developmental Red Flags

  • Premature birth
  • Abuse or neglect
  • Prenatal exposure to substance abuse
  • Low–birth weight
  • Prolonged separation from primary caretaker, such as during birth, adoption or illness

Emotional Health Red Flags

  • Chronic sleeping or feeding disturbances
  • Excessive fussiness incessant crying with little ability to be consoled
  • Wide eyed startled or fearful expression with stiff shoulders and tense body.
  • Failure to grow
  • Prolonged glazed eyes with gaze—not alert moving curiously from subject to subject.
  • Doesn’t make eye contact
  • Doesn’t like to be touched

Why is it never too late to repair a poor connection with your child?

Recent studies show that it’s never too late to create positive change in a child’s life, or in an adult’s, for that matter. The learning that accompanies new experiences can alter neural connections in the brain. Relationships with relatives, teachers and childcare providers can provide an important source of connection and strength for the child’s developing mind. Most importantly, as you change for the better, your relationship with your child changes for the better. The older a child is, the harder this will be, but children never lose their need for emotional connection with their primary caretaker so the opportunity for repair remains open. Repair is nurtured by experiences:

  • That feel safe.
  • That are playful and fun for all.
  • That allow for differences and respect individuality.

The following links go into greater detail about developmental markers that suggest a need for intervention to correct a problem before it become severe:

Quickest road to repair:

  • Recognize the need for repair, take a breath and name it “Oops I made a mistake, or “that didn’t go well.”
  • Slow down
  • Lower your voice and speak more softly