Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child’s age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are sometimes called externalizing disorders.
Oppositional Defiant Disorder
When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.
Examples of ODD behaviors include
- Often being angry or losing one’s temper
- Often arguing with adults or refusing to comply with adults’ rules or requests
- Often resentful or spiteful
- Deliberately annoying others or becoming annoyed with others
- Often blaming other people for one’s own mistakes or misbehavior
Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.
Examples of CD behaviors include
- Breaking serious rules, such as running away, staying out at night when told not to, or skipping school
- Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals
- Lying, stealing, or damaging other people’s property on purpose
Learn about the guidelines for diagnosing and treating ODD external icon and CD external icon
Treatment for disruptive behavior disorders
Starting treatment early is important. Treatment is most effective if it fits the needs of the specific child and family. The first step to treatment is to talk with a healthcare provider. A comprehensive evaluation by a mental health professional may be needed to get the right diagnosis. Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. For younger children, the treatment with the strongest evidence is behavior therapy training for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child’s behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.
Get help finding treatment
Here are tools to find a healthcare provider familiar with treatment options:
- Psychologist Locator external icon , a service of the American Psychological Association (APA) Practice Organization.
- Child and Adolescent Psychiatrist Finder external icon , a research tool by the American Academy of Child and Adolescent Psychiatry (AACAP).
- Find a Cognitive Behavioral Therapist external icon , a search tool by the Association for Behavioral and Cognitive Therapies.
- If you need help finding treatment facilities, visit MentalHealth.gov external icon .
Managing Symptoms: Staying Healthy
Being healthy is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:
- Engaging in regular physical activity, including aerobic and vigorous exercise
- Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
- Getting the recommended amount of sleep each night based on age
- Strengthening relationships with family members
Prevention of disruptive behavior disorders
It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they are exposed to other types of violence and criminal behavior, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders external icon , depression external icon , or attention-deficit/hyperactivity disorder (ADHD). The quality of early childhood care also can impact whether a child develops behavior problems.
Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:
There are lots of possible reasons for difficult behaviour in toddlers and young children.
Often it’s just because they’re tired, hungry, overexcited, frustrated or bored.
How to handle difficult behaviour
If problem behaviour is causing you or your child distress, or upsetting the rest of the family, it’s important to deal with it.
Do what feels right
What you do has to be right for your child, yourself and the family. If you do something you do not believe in or that you do not feel is right, it probably will not work. Children notice when you do not mean what you’re saying.
Do not give up
Once you’ve decided to do something, continue to do it. Solutions take time to work. Get support from your partner, a friend, another parent or your health visitor. It’s good to have someone to talk to about what you’re doing.
Children need consistency. If you react to your child’s behaviour in one way one day and a different way the next, it’s confusing for them. It’s also important that everyone close to your child deals with their behaviour in the same way.
Try not to overreact
This can be difficult. When your child does something annoying time after time, your anger and frustration can build up.
It’s impossible not to show your irritation sometimes, but try to stay calm. Move on to other things you can both enjoy or feel good about as soon as possible.
Find other ways to cope with your frustration, like talking to other parents.
Talk to your child
Children do not have to be able to talk to understand. It can help if they understand why you want them to do something. For example, explain why you want them to hold your hand while crossing the road.
Once your child can talk, encourage them to explain why they’re angry or upset. This will help them feel less frustrated.
Be positive about the good things
When a child’s behaviour is difficult, the things they do well can be overlooked. Tell your child when you’re pleased about something they’ve done. You can let your child know when you’re pleased by giving them attention, a hug or a smile.
You can help your child by rewarding them for good behaviour. For example, praise them or give them their favourite food for tea.
If your child behaves well, tell them how pleased you are. Be specific. Say something like, “Well done for putting your toys back in the box when I asked you to.”
Do not give your child a reward before they’ve done what they were asked to do. That’s a bribe, not a reward.
Smacking may stop a child doing what they’re doing at that moment, but it does not have a lasting positive effect.
Children learn by example so, if you hit your child, you’re telling them that hitting is OK. Children who are treated aggressively by their parents are more likely to be aggressive themselves. It’s better to set a good example instead.
Things that can affect your child’s behaviour
- Life changes – any change in a child’s life can be difficult for them. This could be the birth of a new baby, moving house, a change of childminder, starting playgroup or something much smaller.
- You’re having a difficult time – children are quick to notice if you’re feeling upset or there are problems in the family. They may behave badly when you feel least able to cope. If you’re having problems do not blame yourself, but do not blame your child either if they react with difficult behaviour.
- How you’ve handled difficult behaviour before – sometimes your child may react in a particular way because of how you’ve handled a problem in the past. For example, if you’ve given your child sweets to keep them quiet at the shops, they may expect sweets every time you go there.
- Needing attention – your child might see a tantrum as a way of getting attention, even if it’s bad attention. They may wake up at night because they want a cuddle or some company. Try to give them more attention when they’re behaving well and less when they’re being difficult.
Extra help with difficult behaviour
Do not feel you have to cope alone. If you’re struggling with your child’s behaviour:
- talk to your health visitor – they will be happy to support you and suggest some new strategies to try
- visit the Family Lives website for parenting advice and support, or phone their free parents’ helpline on 0808 800 2222
- download the NSPCC’s guide to positive parenting
Video: how much does my child understand about being naughty? (6 to 30 months)
In this video, a health visitor explains whether your child understands about being naughty.
This post has been updated as of December 2017.
The average classroom is likely to contain one or more students who demand more attention because of behavioral difficulties. In some cases, hormones, challenges with peers, and home-life problems can make even a “good kid” troublesome. And while some teachers are specially trained to handle special needs children who demand more time, some aren’t. That can hurt both the student and the teacher.
So how do we support these kids while also preserving our own energy, stamina, and patience? Let’s break it down.
First, who needs to learn these strategies?
All teachers need to learn how to teach students with behavior problems. No matter if the child is one student in a classroom with a concern or if the classroom is designed for children with these complex behavioral issues, the methods to teaching and avoiding complications or outbursts are sometimes the same. When teachers learn how to avoid situations that can push the button on these children, it is possible to ensure the classroom’s lesson plan is fully explored and all students get equal attention.
Prior to an occurrence
One of the best strategies for teaching in an environment like this is to learn methods that help to prevent the occurrence of behavioral issues. While every student’s needs are different, there are some simple steps teachers can take to help prevent problems as a group.
- Increase the amount of supervision present during high-risk periods. When misbehavior is likely to occur, such as during group work sessions or at specific times of the day, adding additional supervision can be a helpful step in preventing problems.
- Make tasks manageable. To avoid driving stress factors that can cause a child to begin to misbehave, ensure that all the tasks you assign can provide the student with small bits of information at one time. By dividing a lesson in chunks, you’re less likely to overwhelm the student.
- Offer choices whenever possible. Rather than creating a strict classroom routine, provide the students with choices. For example, let students choose which project they work on rather than having to focus on a specific project.
- Ensure children reach out for help. In some cases, behavior issues occur because the child does not know how he or she can receive help or does not, for some reason, feel that help is available. Reassure children that they can reach out for the help they need. If they feel comfortable coming to you when they’re lost, upset or overwhelmed, they’re not as likely to have an outburst.
Prevention is always the best step, but of course it’s not always possible to stop every occurrence of poor behavior.
Handling in-the-moment concerns
When behavioral problems begin to occur, it’s important for teachers to react in the right way. Here are some strategies:
- Apologies. Apologies help to repair the social conflicts between two individuals. Ensure that apologies are encouraged by all offending parties.
- Ignore. In some cases, the teacher ignores the behavior, meaning he or she does not react to it or reinforce or reward it.
- Reduce privilege access. After defining the privileges that students have, the teacher sets in place a rule system for taking those away. For example, things like having free time or being able to talk with friends are removed when rules are broken.
- Praise. Praising positive behavior (not just expected behavior) is also a way of managing negative outcomes. When teachers praise students more readily than scold them, the student learns that to get attention he or she must act positively.
Dealing with conflict in the classroom is never easy. But by getting parents involved, putting time aside to understand the cause of the problem, and by engaging children in positive rewards, it may be possible to reduce some of the risk that behavior problems will get in the way of learning—for you and for your students.
If you’re a parent, you’ve probably dealt with your fair share of tantrums, meltdowns and freak-outs. Emotional regulation is a skill we all have to learn, and some kids take longer to master self-control than others. But how do you know when your child’s aggressive or violent behavior is not just part of their learning curve, but is getting out of hand? And what can you do to help?
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Do most kids act out like this?
It’s all about knowing what’s developmentally appropriate. “We generally expect toddlers to experience some aggressive behaviors,” says pediatric psychologist Emily Mudd, PhD.
“At this stage, kids tend to resort to physical expressions of their frustration, simply because they don’t yet have the language skills to express themselves. For example, pushing a peer on the playground could be considered typical. We wouldn’t necessarily call that aggression unless it was part of a pattern.”
How do you recognize true aggression?
By the time a child is old enough to have the verbal skills to communicate his or her feelings — around age 7 — physical expressions of aggression should taper off, she says.
If that’s not happening, it’s time to be concerned, especially if your child is putting himself or others in danger, or is regularly damaging property.
Watch for warning signs that your child’s behavior is having a negative impact:
- Struggling academically.
- Having difficulty relating to peers.
- Frequently causing disruptions at home.
“These warning signs are cause for concern and should not be ignored,” she says.
Your child’s behavior may have an underlying cause that needs attention. ADHD, anxiety, undiagnosed learning disabilities and autism can all create problems with aggressive behavior.
“Whatever the cause, if aggressive behavior impacts your child’s day-to-day functioning, it’s time to seek help,” Dr. Mudd says.
Start by talking with your pediatrician. If necessary, he or she can refer you to a mental health professional to diagnose and treat problems that may cause aggression.
What can parents do to help their child?
Dr. Mudd recommends these strategies for helping your child tame his or her aggression:
- Stay calm. “When a child is expressing a lot of emotion, and the parents meet that with more emotion, it can increase the child’s aggression,” she says. Instead, try to model emotional regulation for your child.
- Don’t give in to tantrums or aggressive behavior. For example, if your child is having a tantrum at the grocery store because she wants a particular cereal, don’t give in and buy it. This is rewarding, and reinforces the inappropriate behavior.
- Catch your child being good. Reward good behavior, even when your child isn’t doing anything out of the ordinary. If dinnertime is problem-free, say, “I really like how you acted at dinner.” Treats and prizes aren’t necessary. Recognition and praise are powerful all on their own.
- Help kids learn to express themselves by naming emotions. For example, you may say “I can tell you’re really angry right now.” This validates what your child is feeling and encourages verbal, instead of physical, expression.
- Know your child’s patterns and identify triggers. Do tantrums happen every morning before school? Work on structuring your morning routine. Break down tasks into simple steps, and give time warnings, such as “We’re leaving in 10 minutes.” Set goals, such as making it to school on time four days out of five. Then reward your child when he or she meets those goals.
- Find appropriate rewards. Don’t focus on financial or material goals. Instead, try rewards like half an hour of special time with mom or dad, choosing what the family eats for dinner, or selecting what the family watches for movie night.
If your child is struggling with self-control, incorporating these strategies into your parenting should help you rein in those behaviors.
If the situation seems unmanageable, remember that you’re not the only one struggling with your child’s behavior. Pediatric psychologists are adept at helping children and families solve emotional and behavioral problems. Ask your pediatrician for the names of mental health professionals in your area.
William B. Svoboda, MD, is a retired pediatric neurologist. He is the founder and former Director of Via Christi Epilepsy Center of Wichita, Kansas.
This series of articles about the effects of epilepsy on children’s lives and personalities, and how parents can help their child achieve a happy, independent life, is based mostly on an interview with Dr. Svoboda that was conducted by Shawna Cutting, a writer for epilepsy.com.
How common are behavior problems in children with epilepsy?
Roughly one in four children with epilepsy has significant behavior problems. Another one in four has emotional difficulties that are less severe but still disturbing. In general, behavior problems are more troublesome in children whose seizures began at an early age. This is especially true for boys, who are more likely to “act out,” but girls also are affected. Their emotional problems may be recognized less often.
What causes disturbed behavior? Is it the epilepsy itself?
You may suspect that your child’s behavior problems are related to the epilepsy itself. It is true that behavior difficulties can be caused or worsened by epilepsy. Several aspects of epilepsy can affect the brain and contribute to behavior problems:
- underlying brain damage
- the seizures themselves
- small electrical discharges between the seizures
- the effects of seizure medicines
Any of these can impair normal brain functions or may cause chemical imbalances in the brain that lead to psychiatric difficulties. In some cases, small effects accumulate over many years and cause psychiatric problems to emerge in adulthood.
You may see brief periods of abnormal behavior leading up to a seizure, during a seizure, or for a few days following a seizure. A few children swing back and forth between uncontrolled seizures and bad behavior. Even older children who have had seizure surgery may be extra emotional for up to a half year after the operation.
All types of epilepsy can make children prone to behavior problems:
- Complex partial seizures, especially of early onset—hyperactivity, problems in paying attention or controlling temper
- Seizures from the left side—anxiety and frustration due to problems in understanding and expressing ideas
- Seizures from the right side—social difficulties and impulsive behavior from problems in recognizing social signals
- Seizures from the front of the brain—disorganization, acting without regard to the consequences.
[Editor’s note: Most of the statements in the paragraph above are based on experience rather than research. They are interesting but may not be true of your child.]
Or are behavior problems caused by how people react to the epilepsy?
Epilepsy and seizures themselves probably have had some effect on your child’s behavior. But it is far more likely that most of your child’s behavior problems are related to the way you and others have reacted to the diagnosis of epilepsy. Children experience these reactions more than they experience the seizures.
Like many parents, you first may have felt shocked and overwhelmed by the diagnosis. In the initial stages, parents often are fearful and don’t want to believe it. Next they start to feel guilty or angry. Then they may enter a period in which they desperately search for a doctor who can stop the frightening attacks. If the seizures do not stop, many parents begin to feel depressed and withdraw from active medical care.
It is natural for you to experience many of these feelings, but you should understand that they have affected your parenting and may be reflected in your child’s self-concept. You can help your child most by reaching a stage of acceptance. Then you can work as part of the treatment team to help your child gain seizure control and reach his or her potential.
Of course, your reactions are not the only ones that affect your child. Other people also influence your growing child’s emotional development:
- teachers, who may not expect as much from your child as from others
- playmates, who may reject your child because of seizures
- other family members, who may be jealous of the time you spend with that child
How can parents support and effectively discipline their child?
Treating epilepsy means treating the whole child, not just the seizures. Even if medications or surgery cure the seizures, problems with language, learning, and behavior may remain. We emphasize disciplining the child, not the seizures. Parents will often discipline and parent the epilepsy, not the child. They fear that if they stress the child by scolding too much, the child will have a seizure. Don’t let the seizures change things. If discipline does precipitate seizures, tell the doctor so that can be worked on. Discipline should be pretty much the same whether your child has epilepsy or diabetes or no health problems at all.
Under-disciplining is one reason a lot of kids either end up eternally dependent or go the opposite way and become quite rebellious. If the parents stop their discipline because of the seizures, the child gets the message “I’m special.” The child could even develop non-epileptic seizures later to further control.
Another issue is that parents are prone to see children with epilepsy as having something wrong with them. The parents tend to emphasize the negative: Don’t do this, don’t do that. I ask the parents what they want the child to do instead and suggest that they work on that. The idea of replacing a bad behavior with a good behavior is also very important.
You may need to learn new parenting approaches and behavior modification techniques. One of the most effective approaches is to deal with little problems before they become major difficulties. The doctor and teacher should be alert for the earliest signs of behavior problems. The school especially should look for possible learning difficulties that may trigger frustration behaviors.
Try to put as much effort into developing what your child CAN do as you put into overcoming the limitations that seizures have created. Encourage your child’s doctor and teachers to take the same approach. Instead of seeing your child as a handicapped child with seizures and behavior problems to be overcome, accept the challenge of developing the good qualities of your special child.
There are many reasons behind aggressive behavior in children. As teachers, it’s important to remember that these kinds of issues can spring from a multiplicity of causes. It may be tempting to label this student as “an aggressive child,” yet rarely is the child simply a “bad kid,” and it is important to isolate the child’s behavior from their person.
Even though the aggressive behavior may sometimes seem to be the only prevalent aspect of a child’s personality, it can be addressed with success when teachers are kind, consistent, fair, and relentless in establishing a one-on-one connection.
What Does Aggressive Behavior Look Like?
A child with aggression issues often antagonizes others and is drawn to physical fighting or verbal arguments. They might be the “class bully” and have few real friends. They may prefer to solve problems by winning fights and arguments. Children displaying aggressive behaviors often threaten other students, and these students in turn often fear the aggressor, who delights in showing themselves as a fighter, both verbally and physically.
Where Does Aggressive Behavior Come From?
Children can be aggressive for many reasons. Their behavior, whether inside or outside the classroom, can result from environmental stresses, neurological issues, or emotional coping deficits. Some children have (hereditary) disorders or illnesses, that make it difficult for them to manage their emotions.
Sometimes, a child with these tendencies also lacks self-confidence and aggressive behavior is how they make up for it. In this regard, children who display aggression are first and foremost attention seekers, and enjoy the attention they receive from being aggressive.
The child sees that power brings attention. When they threaten other children in the class, their weaker self-image and lack of social success fall away, and they become a leader of some renown.
These behaviors as well as the reasons behind them may sometimes be connected with lack of connection. The child may not be receiving the sufficient amount of love, connection, or affection that they need, and they try to get at least some of these through aggression. Aggressive behavior is a very secure way of connecting with others—even if it is in a very negative way.
Be it lack of connection of self-confidence, the child usually knows that their aggressive behavior is inappropriate, but the rewards outweigh the disapproval of authority figures.
Are Parents to Blame?
For other children, their living conditions—interactions of and with people around them, as well as the larger environment they live in, or any past trauma—have played a part in behavioral patterns. Children are born with a full range of emotions, and it is the role of their environment—of people around them—to teach them how to navigate their feelings.
So, while parents are not entirely responsible for all facets of their children’s personalities or their actions, parents who themselves are aggressive or have trouble controlling their emotions should be honest with themselves and recognize that they may be part of the problem and certainly can be part of the solution.
Interventions for Classroom Teachers
Be kind, be consistent, and remember that change takes time. All children need to know you care about them and that they can contribute to their environment in a positive way. To deliver this message to them and help to break the cycle, commit to a one-on-one relationship with the child who struggles with aggressive tendencies.
At a Glance
Children with learning disabilities or ADHD may exhibit behaviors that land them in trouble at school. Often times they are punished for behaviors that are symptomatic of their diagnosis. That should not be the case. Simply put, students should not be punished, suspended, or expelled for their disability.
These students’ behaviors may sometimes challenge traditional school norms. They may be impulsive, overreact, fail to exercise restraint, exhibit poor social judgment, and lack emotional control. They may interpret the actions of others as unfair, embarrassing, or threatening, and become agitated. At times, their lack of control can escalate to the point of becoming unsafe to themselves and others, or they may engage in risky behaviors to gain social acceptance.
Ultimately, school personnel have to step in as disciplinarians. Often, their approach focuses on eliminating unwanted behavior through automatic application of increasingly negative consequences. In those circumstances, rigidity meets rigidity, and the opportunity to teach flexibility and self-control skills is lost.
Parents of children with learning differences must know their children’s rights in order to protect them from inappropriate punishments at school.
To formulate an appropriate response to bad behavior, the school needs to understand the behavior in the context of how the child is processing the situation. For example, negative behavior could be triggered by a number of factors: feeling shame, being told to do a particular task, or a simple annoyance such as a classmate tapping a pencil. A student may tolerate something one day and not the next because he’s tired, hungry, upset by a prior event, or he’s simply having a bad day. This variability can be perceived as proof that the behavior is intentional and provocative.
Addressing Behavior Issues
If a child with LD or ADHD has behavioral issues, the IEP should mandate a functional behavior assessment (FBA) leading to a behavior plan that uses positive behavior interventions and supports.
School response to misbehavior of a student with a disability should be proactive rather than reactive. An FBA looks at the root causes of the behavior, both interpersonal and environmental, as well as the effectiveness of consequences imposed. The FBA should result in a behavior intervention plan that both minimizes triggers and equips the student with adaptive skills.
The Most Challenging Cases
Unfortunately, the statutory mandate for positive behavioral interventions and supports is frequently violated as administrators often resort to increasingly severe sanctions, such as suspension, expulsion, police referrals, or arrest in an effort to deal with serious misbehavior.
Parents whose children are arrested need to stress their child’s disability and the obligation of the school to deal with it.
Several years ago Congress changed the IDEA to provide further protections in the form of “manifestation determination requirements.” If a student is to be suspended for longer than 10 days or expelled, the child’s IEP team must meet to determine whether the behavior was a manifestation of the child’s disability. The team (including parents) must determine if the conduct was caused by or related to the child’s disability, or if the conduct was the direct result of the school’s failure to implement the child’s IEP. In either case, the child should not be subject to discipline in the same manner as a non-disabled child. For a child with a disability, the expert opinion of a psychologist or psychiatrist is needed to determine if the behavior was a manifestation of the child’s disability. Put simply, the usual rules, such as “three strikes and you’re out” don’t apply.
Parents should be aware that children should not be punished for behavior resulting from a disability. You have the right to demand that the school has sufficient understanding to reduce the triggers for misbehavior and to teach the student how to adapt. With education and understanding, the risk can be reduced and positive development enhanced.
However, even the best behavior plan will not guarantee good behavior, so it is important that parents know the systems that exist to protect their children.
Marcia Eckerd is an evaluator, consultant, and therapist who specializes in working with children with NLD and autism-spectrum disorders. Andrew Feinstein is an attorney whose practice focuses on representing children with disabilities and their families in securing a free appropriate public education.
Related Smart Kids Topics
The Journal of Clinical Child and Adolescent Psychology has published a study reviewing the research on treatments for disruptive behavior problems in children aged 12 years and under. This report also updates the evidence for what works best to treat children with disruptive behavior problems. In this study, CDC researchers looked at different approaches to treatment and found the best evidence was for parent behavior therapy, when delivered either as group therapy or individually with child participation.
Disruptive behavior disorders, such as oppositional defiant disorder and conduct disorder, put children at risk for long-term problems including mental disorders, violence, and delinquency. Getting the right treatment early is key, so this new evidence is important for health professionals caring for a child with a disruptive behavior problem. Healthcare professionals can use the information on what therapy works best in order to help parents of children with disruptive behavior problems find the right treatment. Read the article. external icon
About this Study
The authors of the study reviewed every available research report from 1998 until 2016 that looked at treatment for disruptive behavior problems in children up to age 12 years. Studies that used similar approaches to treatment were grouped into categories, for example, behavior therapy, which focuses on changing behavior by building skills and learning to manage behavior, client-centered therapy, which focuses on managing feelings, attitudes, and perceptions of others, or play therapy, which provides a way for children to communicate experiences and feelings through play.
Studies were also separated into group or individual therapy and parent or child therapy. All of the results were reviewed and rated according to different levels of evidence. The highest rating was reserved for studies that had been tested in multiple settings by independent teams of researchers.
Parent behavior therapy has the strongest evidence as an effective treatment for disruptive behavior problems in children.
Treatment approaches with the highest rating for effectiveness are
- Group parent behavior therapy
- Individual parent behavior therapy with child participation
Other approaches like client-centered therapy or play therapy did not have enough studies or strong enough evidence of effectiveness to receive a high rating. More studies are needed to determine whether these approaches are effective for treating children’s disruptive behavior problems.
Parent Behavior Therapy
Parent Behavior Therapy is also known as Parent Training in Behavior Therapy, Behavior Management Training for Parents, or Behavioral Parent Training
The research studies used approaches that involved therapists who were trained in specific behavior therapy programs, and that used a training manual and specific steps to work with parents on skills to help them manage their child’s behavior. During this type of parent training in behavior therapy, parents work with a therapist to learn strategies to create structure, reinforce good behavior, provide consistent discipline, and strengthen the relationship with their child through positive communication. It is possible that therapists who use these behavioral approaches, but don’t use a specific program can also be effective. However, more research is needed to understand what the essential components of the programs with best evidence are, and which therapy works best for different families. You can read more about what to look for when seeking behavior therapy.
CDC’s Activities on Children’s Behavioral Health:
CDC has activities focused on improving the lives of children and families affected by disruptive behavior disorders and related conditions, including attention-deficit/hyperactivity disorder (ADHD). Just as for disruptive behavior, in general, behavior therapy is an effective treatment for ADHD.
Experts recommend that children with ADHD ages 6 and older receive behavior therapy along with medication, and that children under 6 with ADHD receive behavior therapy first, before trying medicine for ADHD. Behavior therapy for young children with ADHD is most effective when it is delivered by parents. Therefore, CDC works to help families get the right care at the right time by raising awareness, increasing treatment options for families and providers, and exploring ways to increase access to behavior therapy.
Children’s Mental Health
Learn more about children’s mental, emotional, and behavioral health and CDC activities.
Mental, emotional, and behavioral disorders in childhood can cause long-term problems that may affect the health and well-being of children, families, and communities. Treating a child’s mental health problems as soon as possible can help children reduce problems at home, in school, and in forming friendships. It can also help with healthy development into adulthood.
A public health approach to children’s mental health includes promoting mental health for all children, providing preventive intervention to children at risk, and providing treatment for children with identified disorders. Psychological therapy is a key component to improving mental health. Depending on the type and severity of the problems, psychological therapy for children may be used in combination with medication. 1
A brief overview of therapy
Psychological therapy is meant to treat a mental health condition or help a child manage their symptoms so that they can function well at home, in school, and in their community.
When children are young, it is common for therapy to include the parent. Sometimes therapists work with the parents alone. Older children may meet with a therapist alone as well. Some types of therapy include working with the whole family or other important adults in the child’s life (for example, a teacher).
Parent-focused approaches typically mean that parents talk with the therapist about the child’s behavior and feelings. Psychological therapy with children can include talking, playing, or other activities to help the child express feelings and thoughts. Therapists may also observe parents and children together and then make suggestions for finding different ways to react.
Psychological therapy for children can be done one-on-one or in groups. Sometimes, a combination of therapies is the most effective for helping a child.
What types of therapy are most effective for mental disorders in children?
Behavior therapy teaches children and their families how to strengthen positive child behaviors and eliminate or reduce unwanted or problem behaviors.
One type is parent training in behavior management. The therapist works with parents to learn or improve skills to manage their child’s behavior. Parents are encouraged to practice the skills with their child, either during the therapy session or at home. Teachers can also be trained in behavior management to help the child at their childcare center or school.
With older children or adolescents, the therapist usually works directly with the child to teach them how to choose positive behaviors. Parents can be involved to support and strengthen the skills their child is learning.
Cognitive-behavior therapy focuses on changing the thoughts and emotions that can affect a child’s behavior negatively.
The therapist helps the child become aware of their thoughts and feelings. The therapist also helps the child evaluate if feelings or thoughts may be distorted or illogical, and then helps the child through the process of changing the thoughts as well as the emotional reactions and behaviors that go along with them.
Cognitive-behavior therapy often works directly with the child, but can also include parents.
For the most common childhood conditions, like ADHD, behavior disorders, anxiety, or depression, approaches using behavior therapy and cognitive-behavior therapy are more likely to reduce symptoms, but there is limited information about which type of therapy is best for treating each specific childhood mental disorder.
Based on the scientific evidence available, different therapies seem to work well for different types of problems:
Parent training in behavior management works well for
- ADHD; and
- Disruptive behavior disorders.
Child behavior therapy works well for
- ADHD; and
- Disruptive behavior disorders.
Cognitive-behavior therapy works well for
- Disruptive behavior disorder;
- Anxiety; and
Additional types of therapy can be effective for adolescents.
- Adolescents with disruptive behavior disorder may respond well to family therapy, an approach that includes multiple members of the family and focuses on learning better communication skills and ways to settle conflicts.
- Adolescents with depression may respond well to interpersonal psychotherapy, an approach in which the therapists help the adolescents learn ways to handle relationship problems.
Other therapy approaches may also be effective but have not been studied enough for researchers to understand if they work well. Information on what works best for which family is also still limited. Read more about which types of child therapy have been found to work. external icon
Finding the right therapy for your child
Therapy is most effective if it fits the needs of the specific child and family. You can talk to your child’s healthcare provider as a first step. Sometimes, health problems such as poor sleep, trouble breathing, poor vision, difficulty hearing, or learning problems can cause behavioral or emotional symptoms, or make them worse. Your child’s healthcare provider may want to find out if your child has any health problems before referring your child for therapy.
Before starting therapy, a mental health provider typically conducts a comprehensive evaluation external icon of your child’s mental health to figure out what type of therapy might work best.
Here are some tools to help find a healthcare provider familiar with treatment options:
Information about Medication
1 Read about medications used to treat children and adolescents