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When Do Parents Need Professional Help for a Child’s Behavior Problems?

Probably a lot sooner than most do.

All kids misbehave. Every child acts out. There isn’t a toddler today who doesn’t throw tantrums, hit and kick, or scream “butt” a hundred times just to egg their parents on. Bad behavior, testing boundaries, and pushing limits is a natural part of childhood development. And managing those emotional outbursts is one of the hardest parts of a parent’s job. But what happens when those seemingly normal tantrums start to feel decidedly abnormal? When disruptive behavior persists, gets aggressive, or crosses a line? At what point does a parent acknowledge that this may be more than just pre-school acting-out and that their child could use some help control their impulses and emotions?

Unfortunately, knowing when to contact a behavioral expert isn’t easy. Differentiating between what’s normal kid behavior and what’s a behavioral disorder, unless you’re a trained professional, can be difficult. Sure, your toddler’s repeated outbursts may be frustrating, but are they any worse than their classmates’? And what if you and your partner disagree on what actually constitutes bad behavior? It’s not uncommon for one parent to view an especially prolonged tantrum as a serious problem while the other thinks it’s business as usual.

On top of that, one of the biggest impediments parents face when it comes to seeking help for their kids is their own insecurities. Many view having a child with discipline issues, and seeking help for them, as a reflection of their parenting and conclude that they have somehow failed. In addition, there’s the worry that their child may actually have a behavioral disorder ⏤ be it autism spectrum disorder or Attention Deficit Hyperactivity Disorder ⏤ and dealing with the stigma that is often attached.

But how can frustrated parents whose attempts at discipline consistently fall short ⏤ but who are open to help ⏤ tell if their child’s inappropriate outbursts are out of whack? What warning signs should they look for? While there are red flags for identifying certain behavioral conditions, says Dr. Elizabeth Harstad, a developmental-behavioral pediatrician at Boston Children’s Hospital, warning signs for general bad behavior are less pronounced, other than obvious ones like a child putting themselves or others at physical risk.

Still, she says, there are questions a parent can ask themselves about their kid’s tantrums or disruptions: Are they getting worse or increasing in frequency? Are the problems happening in multiple settings like home and school? And are your discipline strategies working? If the answers to any of the questions are ‘yes,’ or even ‘maybe,’ it’s time to seek the advice of experts. In fact, if you’ve ever even thought your child might benefit from some help then they probably would. It’s as simple as that.

“If you feel the behavioral strategies you’re trying at home just aren’t helping and the behaviors are worsening or escalating,” says Harstad, “If the tantrums seem to go on longer 30 minutes, or if they are happening in multiple settings ⏤ in daycare or school, as well as home ⏤ I don’t think there is a downside to seeking input or suggestions. Even if the experts or the specialists recommend you continue the current strategies, there’s no downside to asking.

“It’s never too early to seek outside expertise,” adds Harstad. “If the child is in school, talk with the teachers about what they’re seeing ⏤ are they the same issues the parent is seeing at home ⏤ and what strategies are working at school. Talk with the child’s pediatrician about their concerns and get some strategies about how to move forward.”

The most significant benefit of early intervention is that doctors can screen for developmental problems, which tend to be difficult for parents to identify, but are a major source of discipline issues. By giving an expert the chance to observe your child’s behavior, ask questions, and see your interaction with them, they can get a better picture of what might be causing the issues. As well as offer a plan of attack.

“Does the child have a developmental condition such as autism spectrum disorder or ADHD or speech delay?” says Harstad. “That would be important to know and might influence what behavioral strategies you might use or how you best want to interact with your child.

“The most common behavioral disorders in children are neuro-developmental conditions: Attention Deficit Hyperactivity Disorder, Autism spectrum disorder, and global developmental delays, where their attainment of cognitive, language, motor milestones is slower than their peers, and are more likely to manifest with behavioral difficulties,” says Harstad, “As are children who have language delays because they often experience more frustration and difficulty communicating their needs. I think sometimes it might be hard for a parent to differentiate the two.”

But who should you see to help identify the differences? In addition to a teacher or the child’s pediatrician, there are a number of child behavioral experts out there with a variety of titles and accreditations.

“I’m a pediatrician, an MD, who’s trained in development and behavior,” says Harstad, “So you could see someone like myself. We often help to diagnose so we help to figure out if there’s something diagnostically going on. There are also behavioral therapists who might be trained in psychology or who might be social workers and can provide a range of behavioral supports or strategies. There are lots of different specialists that might provide some support.”

In addition, there are also Board Certified Behavioral Analysts who have expertise in managing the behaviors of children with autism spectrum disorder, including overseeing specialists trained in Applied Behavioral Analysis. While they generally work more with behavioral disorders, their expertise in modifying behavior can be helpful in developing overall behavioral strategies.

No matter where you seek help, though, the key is to find an expert with whom you, as well as the child, feel comfortable.

“The parent has to feel that they have enough of a connection with the behavioral expert that the expert is hearing their concerns,” Harstad says, “And that if the strategies that they’re recommending aren’t successful, the parent feels comfortable to relay that. Communication is really important because you’ll need to try out a few strategies to see what’s working and what’s not.”

And the reason that’s so important is that modifying a child’s behavior falls on the shoulders of the parent, not the expert. An expert can provide strategies and offer guidance, but it’s the parents who are responsible for putting them into action and sticking with them on a daily basis.

“Behavioral supports are beneficial because they provide parent management strategies,” says Harstad. “So, if the child does this, I would respond in this way. And then supporting the parents to help change the child’s behavior. It’s unrealistic to think that a child could just work with a therapist briefly and that would translate to a behavioral change in the home setting. Parental involvement is essential.”

In fact, Harstad offers a final word of warning to parents who might be at the end of their rope and willing to try anything. “I would be concerned about any group that says we’ll take your kid and fix them and send them back to you fixed because,” he says. “That’s not usually a principle of behavioral therapy.”