Chapter 2: Recognizing Serious Problems
"There is no single piece of behavior, no matter how unusual it seems, that may not be, at one time or other, in the behavioral repertoire of every child." 1.
Nearly everyone can profit from competent help at times. But the question of when it would be merely helpful and when it is essential is a major one. When you suspect that a problem has developed or is developing, there are a number of questions you should ask which will help you decide whether or not to get outside help.
Question One. Is the particular behavior you are worried about age appropriate -- that is, can it be considered normal for a child of this particular age? Neal's parents were worried about his bedwetting. The counselor with whom they talked asked his age. Neal was three years old. The counselor explained that while many little boys have stopped wetting the bed at three, many have not. If the parents can relax and be patient, probably Neal's bed-wetting will stop of its own accord. If the bed-wetting is continuing when Neal is four or five they may want to raise the question again. By this time much depends on whether the issue has become a battleground within the family.
Betsy and the bottle provide another example. Drinking from a bottle can certainly be considered normal behavior for an eighteen-month-old child. The main issue was how her parents felt about it. But a child who is still demanding a bottle regularly when he starts to school, probably needs help with deeper problems. Of course, many young children, right up through elementary school, want to "regress" (play at being a baby again) sometimes. When a new baby comes or growing-up pressures become intense, all children feel like retreating temporarily. It is well to recognize this need verbally and go along with it. An older child allowed to lie down on the floor with the bottle while his baby sister is being fed, will soon leave the need behind if he has his parents' tolerant acceptance. If he doesn't leave it behind, a deeper problem which does need help is there. Allowing the child to try out the bottle again does not cause the problem. (It may give parents a chance to discover if one is there.)
Jack was ten years old when his mother found him taking money out of her purse. It developed that he was also taking things from others at school, and once in a while from a store. Jack's parents did well to seek help. At ten years old, Jack knew better. His behavior was a symptom of deeper disturbance; his taking something his parents would be sure to discover was a cry for help. On the other hand, a three year-old who takes money from mother's purse is usually behaving normally for a three-year-old. Mother merely needs to keep her purse put away.
There are times, of course, when behavior is dangerous, even when it is normal for a particular age. Pete was three when his father got upset over his playing with matches. But three-year-olds are fascinated with fire and not convinced of its danger. If he discovers matches within his reach he is likely to experiment with them. But if Pete were five or six or seven, or older, chronic fire play would indicate that help probably should be sought without delay. With all real or suspected problems in children the relation of age to the behavior is a crucial one.
Question Two. How severe is the problem? The issue of severity includes duration and frequency. How long has the problem been going on? How often does it happen? Is it getting more or less frequent?
Suppose Neal is still wetting the bed at five. Now his parents will ask themselves different questions. Did it stop for a while and begin again when the baby was born or Neal started to school? Does it happen only sometimes when Neal is under particular stress? If the answers are yes, the parents would do well to relax a while longer. Bed-wetting frequently returns temporarily when children are under pressure, even up to adolescence. Is the bed-wetting, though never completely stopped, getting less frequent of its own accord? Again, the parents should relax and be patient. Is the bed-wetting unabated or is it getting worse? Is it an important issue between Neal and his parents? If these two questions are answered "yes," then Neal's parents should check out the problem with a professional.
How about Jack taking money from mother's purse? We have decided that this is not acceptable behavior for a ten-year-old. But before we decide that Jack is a juvenile delinquent or even that his problem is severe enough to need professional help, we need to ask more questions. Is this an isolated incident or has it happened before? How often or under what circumstances? Is Jack angry because his parents refused him something he especially wanted to buy? Is he needing some money desperately for something he knows his parents would disapprove of, but which he feels he must have to keep up his image with his peers? All of us adults, if we allow ourselves to remember our childhood, can recall times when we did things we shouldn't have done. It didn't mean we were on the road to crime, or moral depravity; it simply meant that we were often tempted and sometimes gave in. All children are like that. (How we respond to this human characteristic in our children helps to determine whether it has lasting negative effects.)
Sometimes mild problems which are normal at a particular age develop into severe symptoms that make getting help vital. Think again of Carla. Her feelings of despair and depression were not unusual for her age. Adolescence is a trying time for all young people; they experience a great deal of self-doubt, insecurity and fear as they wrestle with the physical and emotional changes which accompany growing up. But in Carla's case the symptoms were too constant over too long a period of time and became increasingly severe. Prolonged depression, increasing withdrawal, or talk of death and suicide, always indicate a severe problem which needs immediate help.
The question of severity can be asked in practical terms -- to what extent does a problem interfere with our child's normal living and relationships? Occasional insomnia may be a bothersome symptom of fears at a particular stage but if it keeps a young teen-ager from being able to attend slumber parties, it may be interfering with important learning experiences with peers or it may be the symptom of a deeper problem.
Question Three. Does the behavior you are concerned about represent an obvious personality change? Did it appear suddenly or for no apparent reason? In Carla's case there was a definite personality change in a fairly short period. A vivacious, outgoing, and active adolescent had become consistently depressed and withdrawn. Her parents commented frequently, "It isn't like Carla." Whenever that statement can be made unequivocally over a period of time, it is likely that help is needed. All of us have our ups and downs. But the ups and downs fit into our basic personality pattern. When "it just doesn't fit," then it may be that a child with a deeper disturbance is calling for help.
Alex's father was upset because his son fought all the time. "He didn't used to be like that at all. He got along fine in school last year. He's always had lots of friends. Everyone used to like him. But now he picks a fight with anyone who comes near him. The teacher at school says she can't even let him on the playground anymore." Although a certain amount of fighting is normal for school age boys, Alex's problem sounds severe and reflects a definite change in his personality. Alex needs help.
Even when the problem is not severe and can be considered normal for the age, any sudden or obvious change in personality should be watched. When in doubt, talk it over with a competent professional person.
Question Four. Is the child's behavior a reflection of other painful problems within the family? This is the hardest of the four questions. Parents often wonder why a counselor suggests that they themselves get help when it is obvious that the child has the problems. In any family, when one person is upset, all are upset. If the marriage is under stress, the family is under stress. If the children are upset, the marriage is put under additional pressure. A family is like an intricately spun web. When the entire web is disturbed, one strand may vibrate violently. A disturbed child is usually vibrating with the pain of the entire family network. He reflects pain in family relationships but his problem also increases the family pain.
Since the quality of the marriage sets the feeling tone for the family, parents should look at their own relationship when they are considering whether something is wrong with their child. Betsy's parents discovered this when they began to argue about the question of weaning. It was not so much Betsy's problem as theirs. At the same time, it created an opportunity for them to improve their marriage, for their sakes and for Betsy's. They dealt with their own problems in a marriage counseling relationship with their pastor. For Betsy it was fortunate that her parents had the courage and strength to get help early in her life. She might otherwise have increasingly become the focus of their battles. Couples often fight over a child in order to avoid facing the real issues between themselves. This is destructive to the child as well as to the marriage.
It is surprising how often what appears to be the child's problem turns out to be merely the symptom of an unhappy marriage. Alex's parents sought help for him because of the unhappiness evident in his inability to get along with other children. But the clinic where they took Alex also worked with his parents. There they were able to talk of their own problems -- the fact that their marriage had been unhappy for some time, that they talked of divorce but felt they should stay together "for the children's sake." Although they had not talked directly with the children about it, Alex had sensed his parents' unhappiness. He didn't know why, but he felt frightened and angry. When he was asked why he got in so much trouble his reply was, "I don't know." And he didn't.
In play therapy sessions, his feelings began to come clear, even to himself. As he played with the doll family one day he described aloud what was happening. "The father learns to fly. He flies right out of the house. The boy can't fly like the father can." Suddenly Alex stopped, a look of surprise and fear on his face. He turned to the therapist: "Sometimes I think my father will go away and I'll never see him again."
T.: "Things have been sort of unhappy at your house and you're afraid you might lose your father."
A.: "Yeah, my parents might get a divorce!"
No wonder Alex fought all the time. By keeping his parents' attention on himself, he may also have felt that he was "keeping them together." Getting the worry out in the open where it could be seen and understood was a great relief to Alex. In the meantime his parents had made some progress in working out their problems. Family sessions were arranged where parents and children could talk out their fears and angers with the help of a neutral person who could help them communicate effectively. When the parents could say, "Yes, we have some serious differences, but we're working on them," the children could also begin coping with their feelings. In this case both the marriage counseling and the play sessions for the children were continued for a while, with occasional meetings together, until the family felt they could continue the new communication patterns at home on their own. A blocked family had learned how to grow; mutual need satisfaction was replacing mutual starvation.
Of course it doesn't always work out so happily. Alex's parents might have decided that their differences were too great, that a divorce was the best course. Then it would be important for Alex and the other children (and adults) in the family to have help in dealing constructively with their feelings about that.
It is always possible that parents themselves can help their children in this way if they are skillful in dealing with their own feelings. If they have trouble with this, professional help is essential in order for family members to learn the communication skills they need to help themselves.
In the past, professional counselors assumed that a person with a problem needed to have one-to-one counseling or therapy. Most child guidance clinics have been organized on this basis -- the child had a problem; maybe the mother needed help in learning how to handle the child, but it was essentially the child who needed to be changed. That attitude has altered dramatically within the last few years. Nowadays, many professional counselors believe that when one family member is in pain, all family members are also suffering and need help. Abnormal symptoms in one member may be the result of his expressing the pain or acting out the hidden feelings in the whole family. This was true of Alex. Often it is true that the individual himself needs help -- but he can change more easily (and stay changed) if the family pattern which to some degree causes and continues his problem is dealt with, too.
It is by no means always the case that a child's problems reflect obvious or overt marital conflicts. Empty marriages with little depth relationship and those engaged in a quiet "cold war" also produce disturbed children. But the children of relatively healthy marriages also have problems. There are powerful outside influences. Disturbing things happen at school. There is television. There are anxieties about war and nuclear holocaust and poisoned air. One television newscast can stir up tremendous anxiety even in adults. Children tend to sense these anxieties and internalize them. For young people there are the problems of peer relationships and the anxieties and risks involved in changing sexual standards. A family which communicates freely often becomes aware of potential problems (inside or outside the family) before they get out of hand. But not always. And no parents are always fully sensitive to each other and their children. (The tendency of some parents, of course, is to blame "outside bad influence" and ignore the problems within their marriage which are disturbing the child.)
Types of Problems
Specialists in child therapy often separate childhood problems into (1) those which are expressed outwardly in troubled and troubling behavior, (2) those which are experienced inwardly as troubled, conflicted feelings such as extreme fears or shyness, and (3) those in which tensions and conflicts interfere with the functioning of some system of the child's body producing psychosomatic problems. These are not clear-cut or exclusive categories; a child may combine all three -- behavior difficulties, neurotic problems, and psychosomatic symptoms. Recognizing some of these symptoms early often prevents more serious problems in the future.
The majority of parents who seek help for a child do so because the child's outward behavior worries them or someone outside the family, often the school authorities or law enforcement officers. Here are some frequent behavior problems:
Aggressive and destructive behavior: almost all children are aggressive and destructive at times but children who constantly pick fights with other children, hurt themselves or others, or consistently disrupt the classroom in defiance of authority, need help. When strenuous efforts by both parents and teacher prove ineffective it is essential to get the help of a specialist in child or family therapy.
Lying and stealing: the age of the child and the frequency and severity of the behavior determine when these symptoms point to the need for help. All children tell untruths at times, often to protect themselves from punishment; some children have spells of telling wild stories which are simply fantasies; many children sometimes take something they shouldn't. But persistent lying and stealing at any age is a cry for help; professional counseling should be obtained.
Excessive preoccupation with sex: all children are interested in their own and each others' bodies; all children are interested in what goes on in their parents' bedroom. All children experiment sometimes. People are fascinated by sex at any age. But if free and open communication about it or relaxed handling of normal but inappropriate behavior does not suffice, then help is needed. Masturbation is normal at any age. But if it is excessive or produces guilt or interferes with a child's normal activities, it is symptomatic of a deeper unhappiness.
Learning problems are sometimes called inadequate functioning rather than behavior problems. They may stem from unrealistic adult expectations, from inadequate intellectual stimulation or from emotional conflicts. If extra tutoring and a relaxed attitude do not change the situation, help should be sought.
Children who are disturbed or unhappy do not always act in ways that upset adults. Quiet, shy children are sometimes simply that -- there's nothing wrong with being quiet or shy. But if this quietness is excessive, it may mean there are problems
Inadequate relationships are involved in all the problems we have discussed. But this may be the primary focus of the problem if the child is unable to establish close relationships with either adults or peers. People are different. Some need many friends. Some need a few. But all of us need someone. A child who is a "loner" or who is happy only with adults needs help.
Extreme withdrawal is a symptom of deep disturbance. A child who does not seem interested in anyone, who stays alone too much, or who suddenly withdraws when he has always been outgoing is in need of help.
Extreme fears always indicate need for help of some kind. Often parents can help their children simply by listening, understanding and reassuring. But when the fears consistently interfere with normal activities -- sleeping, going to school, doing the things required by the child's particular life stage, accomplishing the things he wants to accomplish -- then help should be sought. School phobia, the child's refusing to go to school, is an example of extreme fear which interferes with functioning; parents should seek help at once.
Speech problems vary in seriousness. Many, sometimes even stuttering, are passing problems. But if they go on too long and interfere with the child's functioning or relationships he needs help.
Bizarre behavior should never be ignored. It may indicate the onset of severe mental disturbance. A child who acts inappropriately to the objective circumstance, who deliberately injures himself without complaint, or engages in repetitious motions such as head banging or rocking should have help at once.
Children often express their conflicts in living through their bodies. Asthma, rashes, hay fever, colitis, frequent colds, stomach aches, headaches, and other ailments may have their roots in emotional conflicts as well as physiological weaknesses in that particular organ system. Children frequently develop physical symptoms when they have big feelings which they cannot express openly (and of which they may not be consciously aware).
It is important to check out all physical symptoms with a pediatrician or family doctor. If no physical basis is discovered for the problem, and it persists, the services of a child therapist or a family therapist may be what is needed. Emotions have a powerful effect on the body and the realm of emotions is the realm of relationships -- the improvement of which is the goal of counseling. It is important, of course, to have regular medical checkups -- even if a child's problems don't express themselves physically. Sometimes medical problems are hidden behind behavior and personality problems. Sometimes, also, a doctor can help to decide whether the problem needs attention or is simply a stage of normal development.
Chess, Stella et al., Your Child Is a Person (New York: Viking Press, 1965). Understanding your child's individuality.
Gruenberg, Sidonie M., The Parents' Guide to Everyday Problems of Boys and Girls (New York: Random House, 1959). Covers ages 5 to 12.
1. Howard M. Halpern, A Parent's Guide to Child Psychotherapy (New York: A. S. Barnes and Co., 1963), p. 36.