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Four Severe Children Behavior Problems

Sleep problems

By school age most children sleep through the night. The main sleep problem they have is a difficulty getting off to sleep. This comes from one of three reasons:

1. a poorly disciplined sleep routine

2. a temperament that needs less sleep or

3. a busy mind.

A disciplined sleep routine is essential for all children and adults. Every night we should go through the same sequence of preparation at the same time. Don’t accept procrastination in six- and seven-year-olds; get I them horizontal and hope the eyes glaze and shut. Only allow slight modification of routine at weekends, as late nights and long sleep-ins disrupt the week-day pattern.

The need for sleep is similar in most children at a given age. But there are extremes, where some children need much more sleep and others run happily on less. If a child settles late, yet is fresh and well-rested in the morning, they may be designed for a later bedtime. Often the child with sleep needs will have a late-to-bed, early-riser parent.

A busy mind stops some children from settling at night. They go to with their brains racing and they can’t let go. We see this in busy or anxious children as well as some with ADHD.

With these circling minds we need to help them unwind and establish urine that prepares for bed. Stories seem to relax, particularly when a child is old enough to read to themselves. Video games and television in bedroom tend to stir. Relaxation tapes and gentle music are said to be benefit, but despite all this I still have great difficulty helping this up.

In recent years I have reluctantly sedated some extreme four- to six-year-olds who had never been able to settle before 11pm.

A few five-year-olds still come to their parents’ bed each night. If everyone is happy with this situation there is no need to act. Children get fed up sleeping with their parents in the same way that we get up sleeping with them. If you have had enough of this intrusion, give advance warning and then evict. You can accommodate the occasional by placing a mattress on your floor, but they must he down low and rise to a higher altitude,

Sleep walking

This is not a rare condition, about ten per cent of all children have an occasional walk and two per cent are quite regular. It’s more common and usually occurs in the early part of the night. Jeep walking is not a dream state, these children are in the deepest of sleep. They sit up and start to move in a stiff, robotic manner. Their eyes are glazed, yet they can navigate around obstacles, open doors and perform simple tasks. If addressed, they respond but the words are like computer speech or unintelligible. If woken, they are unaware, and in the morning they remember nothing. Each walk lasts a few minutes, though some can continue for up to an hour.

There is no need to wake the sleepwalker. This can be extremely difficult and causes nothing but confusion. Instead, bring them back to bed and protect them from danger. One of my earliest experiences as a junior in paediatric emergency was treating a seriously injured girl who had walked through an upstairs window. Parents can’t stop sleep walking but they must keep their children safe. This is done with security locks, alarm bells or saucepans balanced on door handles. Sleep walking lessens with age, though some are still on the move as adolescents or adults.

Suicide talk

South suicide is a great concern and any child who talks of self-harm must be taken seriously. Though teens and young adults are at greatest risk, the child of ten years or younger can occasionally commit suicide.

In the five- to twelve-year age group talk of self-harm is a common means of hijacking attention. Children will often say, I’m dumb. I’m bad. I’ve got no friends. What’s the point in living? What would you do if I killed myself?’ The dilemma for parents is to separate these martyr statements from a genuine cry for help.

Though cautious, I generally underplay such comments in these younger ages, but only if all else is on track. The alarm bells ring when mere is a change in personality, loss of interest, and withdrawal from friends, major sadness or an over-focus on the means of self-injury. Children are also at greater risk following the suicide of some major public figure or someone in their close community.

At this young age most of the talk of self-harm has the sole purpose of stirring up mums and dads. But nothing in this world is completely certain, so when in the slightest doubt be quick to ask for help.

Suspension from school

Most suspensions follow unthinking outbursts where a child hits, hurts, insults or gets so angry they refuse to comply.

In my experience most of these children are kind, sensitive kids with no malice in their make-up. They simply have a vulnerable Achilles heel in their volatile temperament. When pushed too far they snap and hit trouble.

With many school suspensions the wrong person has been blamed. One child in my care was suspended for abusing a teacher and kicking the principal. It all started when he was peacefully eating his lunch. A well-known bully pushed over his drink and called him a retard. This ignited the fuse and he went wild. A passing teacher misread the situation and abused him further. The principal intervened clumsily and got a kick for his ineptitude. The boy was banished for a week, the parents, who worked, were disadvantaged and the thug who started it all was never cautioned.

Recently, a seven-year-old was suspended and referred to me for psychiatric assessment. He was seen as severely disturbed as he had tried to hang himself in the school yard. Everyone was so busy psychoanalyzing the child they failed to think back to the previous day’s teaching on the outlaw Ned Kelly and his death by hanging. This ADHD boy, with mild intellectual disability, was playing out a story. His problem was imagination and lack of sense, not a death wish.

When a child is suspended from school, always look past the reported crime to see why it happened. It may not change the decision, but the true culprits should be brought to justice. When suspension results from the impulsivity of ADHD, this is the priority for treatment.

Parents will be annoyed but they must not get too heavy and bully the school. Even in suspension the parent-teacher relationship must be guarded at all costs.

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