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Child has developed behavioral problems. How to handle this matter?

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Practicing since : 2003
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My son (youngest of 3 children) is 4 years old, turning 5 in XXXXXXX He normally attends full-day childcare then is looked after by my mother-in-law for an hour or so until I come back from work. We went away on holiday in December during which time he was with me 24/7 and was sleeping in our room. I was also off work for a total of around 3 weeks during which time he did not go to childcare.

Since then he has become extremely clingy. For the first 10 days back at childcare he screamed every morning when I left him and whimpered throughout the day. He attends Chinese class on Saturdays with his brother; he had just settled in to the new class just before we went on holiday but now refuses to let me leave if I drop him off. He will have a massive tantrum and it is not fair on the teacher and the rest of the class for me to leave him like that. If my husband drops him off he will let him leave for a while but will still create a fuss. He is also the same at Sunday School. He also now wants to me to sit next to him until he sleeps. Earlier this week my husband and I went out in the evening and my mother-in-law tried to put him to bed but he made so much noise she had to let him go back downstairs as he was disturbing his siblings. As soon as I came back he was fine and went to sleep.

In addition to this, his tantrums seem to have worsened. I say tantrums but they are not really violent or angry, he will just find something that he doesn't like or doesn't want to do then he will just go on & on crying about it. He can keep it up for an hour or more. Ignoring him doesn't help. Threatening punishment doesn't help. Even yesterday when I told him no ice-cream he still carried on.

Part of me thinks that he's just being a typical naughty pre-schooler but part of me wonders if there is something more to it. We do have a full-time domestic helper at home but there doesn't appear to be any issue with her as he still seems to be OK with her and let her get him ready for school, help him get snacks etc so I don't think that is the problem. There hasn't been any major change at home or at childcare. He did change teacher but that was in December.

I thought this was a phase that would pass once he was settled back in childcare from the holiday but it has been going on for 2 months now. Any suggestions?
Posted Wed, 20 Mar 2013 in Mental Health
Answered by Dr. Jonas Sundarakumar 2 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I understand that it can be quite worrying for a parent when a child develops behavioural problems which are difficult to handle. The problem which you have actually described quite well in your query is typical of a Like you have described, this separation anxiety is most prominent with the person whom the child is most attached to (in most cases, the mother).

Though it is normal for small children do have some amount of separation anxiety, the level / intensity of symptoms which your child is displaying is definitely not normal for his dvelopmental level. The crying, tantrums, clinginess, etc. are all reactions to separation. A sudden onset of this problem is often triggered by a change in the home environment or a change in the primary caregiver.

Now, it is very important to tackle this problem as early as possible because prolonged symptoms and absence from childcare will only re-inforce the problem more. The good news is that the earlier the age of the child with this problem, the easier it is to tackle. So, it shouldn't be very difficult to overcome this problem, with appropriate help and the right strategies.

I would advise you to take your child to a child psychiatrist / psychologist for a detailed evaluation of the problem. A detailed assessment of the child is necessary to rule out any other psychological / stress-related problems which the child may be going through (which may not be obvious to you). The first step in management is to plan co-ordinated strategies involving the therapist, parents and the caregivers in the childcare. As a general rule, the child should be returned to childcare or school immediately - even if this would result in severe tantrums, protests and other desparate attempts by the child. This may sound somewhat 'cruel', but this is what is best for the child. At the same time, the caregivers in childcare should also be co-operative in implementing behavioural methods to appropriately handle and retain the child in there. Using a system of positive and negative re-inforcement, the child's inappropriate behaviours should be curtailed. Since it may often be difficult for parents to be firm and implement behavioural strategies, the help of a therapist would be of great help. Once again, I would like to re-emphasize that the longer the child is out of childcare, the more difficult will it be to tacke the problem. In rare cases with severe symptoms, the child may need to be put on a short course of an anti-anxiety medication for a temporary period.

So, don't get too worried or anxious (because the problem can worsen with anxious mothers), but do take quick steps to tackle this problem right away.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
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