Normality isn't Problem-Free: Normal Problem Behavior from Infancy to Adolescence.

Children across the world seem to pass through the same sequences of development within the same broad developmental schedule. Although the pattern is generally the same for all children, it is important to remember that each child is different. Different areas of development are interrelated. The ideas, the language, the communication, feelings, relationships, and other cultural aspects among which each child is brought up influence his or her development profoundly.

Children with special needs or suffering from some kind of psychological pathology often seems to dance the developmental ladder as they move through developmental stages in unusual ways. For instance, they might learn to sit and walk on right time but not talk at the usual required age.

However, the question arises whether certain kind of portrayed behavior comes under normal development or is it a pathology?

Psychologists when consulted help out parents in ruling out the normal from the deviant development. Normal development also has some problem behaviors since normality never means problem-free. Many parents or teachers find normal behavior as abnormal or pathological and seems very concerned.

In my professional experience, the following normal problem behaviors were referred to me as pathological by either teachers or parents. The idea for this write up was also conceived through frequently referred cases as abnormal or deviant for which all of us need to know that problem behaviors are inherited in normal development.

In a series of studies conducted by Campbell (2002, 2000), it was found out that half the children in kindergarten through grade two were described as "restless" while another study found out that a similar percentage of 6 to 12 years old were described as "overactive"

Whereas both of these behaviors are part of the syndrome of hyperactivity, it would be incorrect to assume the half of the children were hyperactive since they neither have the clustering nor the intensity and chronicity of problems that would interfere with adaptive functioning. On the other hand, it would be equally foolish to deny that restlessness and over-activity constitute a problem both at home and in school.

Campbell (2002, 1986), over a series of studies classified the following typical normal developmental problems during the infancy, preschool period:

1. The "Difficult" Infant: Some infants are difficult to care. They tend to be irritable, slow to adapt to change in routine, intense and negative in their reactions and irregular in their biological functioning. If cared for sensitively, infants can outgrow this difficult phase, however, if care-takers are impatient and intolerant, or change routines abruptly then chances of behavior problem in later life are increased.

2. The Defiant Toddler: Disciplinary problems and uncertainty about when and how to set limits are the major concerns of parents of such toddlers. In most cases, problems are stage-specific, leaving no residue. However, parental mismanagement, for instance, in the form of over-control may increase the likelihood that problems will develop and persist

3. The aggressive or withdrawn preschooler: Aggressive behavior towards peer is a common complaint of parents and teachers of such preschoolers, with boys being more aggressive than girls. However, as with other behavior problems, there is no need to read warning signs into such aggressiveness unless its coupled with mismanagement by parents or conflicting family situation. Social withdrawal, unlike aggression is relatively rare. There is tentative evidence that the shy, quiet child is less at risk for developing behavior problems than the disruptive one.

The following are the normal problem behavior in adolescents:

4. The Oppositional Adolescent: Adolescents often practice their new higher reasoning skills by engaging adults in debates, arguing persistently and taking an oppositional side over matters that may seems trivial to their parents. Similarly, they are often highly critical of adults (teachers in many case) around them, seeming to intentionally search for differences, contradiction or exceptions to what adults say. Parents or teachers who take personally this excessive fault-finding might experience raising an adolescent as a highly frustrating experience. However, the teenager's argumentativeness is best viewed as a form of cognitive exercise that helps adolescents to develop their critical thinking skills.

5. The Overly Dramatic/Impulsive Youth: The teenage years are a time of heightened emotionally and sometimes, impulsive thinking. Adolescents may appear to jump to conclusions, stating extreme opinions that startle and concern the adults around them. Similarly, adolescents may have a tendency toward over-exaggeration and dramatic because they are experiencing their world in a particularly intense way. While adults may complain that everything seems to be a big deal to teens, to the youths themselves, what is happening in the moment indeed appears dire.

6. The Egocentric Teenager: As adolescents focus inward in order to explore such stage-salient issues as identity, and gender role, they may appear to adults to be excessively "me-centered-person". With time, they can be expected to develop a more reciprocal orientation. Where perspective-talking abilities do not develop naturally, these skills can be taught intelligently by parents as well as teachers.

There are numerous other normal problem behaviors which are present in every culture. A behavior cannot be considered abnormal or pathological until it creates distress for the child or individual (for example a painful symptom) or disability (for example impairment in one or more areas of adaptive functioning). Adaptive functioning can be considered as age-specific routine task in school or at home.

Psychologists can be consulted for both normal problem behavior and pathological behavior. In normal problem behavior, teachers and parents are counselled in managing a child to resolve this issue as well as including child in the process. Whereas for pathological behavior, proper protocol is followed in order to treat or manage the deviant issue. However, it's very important to know the normal problematic behavior which should not be labelled as abnormal or deviant since it can turn out to be dangerous to child's personality and future life.

References:
Campbell, S, B. (2002). Behavior Problems in Preschool Children: Clinical and Developmental Issues. Advances in Clinical Child Psychology, 9, 1-26.
Campbell, S. B., Shaw, D.S., & Gilliom, M. (2000). Early Externalizing Behavior Problems: Toddlers and Preschoolers at risk for later maladjustment. Development and Psychopathology, 12, 467-488

The article was originally published in The Proseed Educational Magazine: https://proseedmag.com/normality-isnt-problem-free-normal-problem-behavior-infancy-adolescence/

The Case of Daydreaming or a Falling Sickness?

In 2.5 years of my practice as an educational psychologist, majority of the referrals i received had only concern: "Child's weak in academics" or "Child takes no interest in academics" or if the matter has worsen: "Child has failed in previous Grades". Sometimes these complaints are accompanied by behavioral issues- which are bound to happen because if child is not comprehending anything in the classroom, he has to do something to "spend" his time in class/school. As a psychologist to figure out the cause and then to help a child, takes some time and a lot of effort. 

Recently, i received a referral about a child who needs counseling with his academics as well as his punctuality. His academics were weak in the grade he was, and got worse when due to irregularity and (Ofcourse) weak academics he was detained in the same grade. He was absent in most of the days entire year. However, his parents came to request on his behalf for his promotion. His parents who hardly came entire year despite several calls of teachers, seems very concerned as soon as child was detained (Natural, right?)

According to parents, child had an epileptic seizure almost 6 years ago, he had his treatment followed by termination stage. According to them it's time that he's fully recovered; However, the news of detention might pull his seizures back and they were afraid he might relapse. (Parents reassured several times that child has completely out grown his seizures and has been stable since a very long time). Provided that, there was no record of any medical application, test reports or any written/verbal form of communication with any teachers/headmistress (even of previous grades) where his medical issue/history was conveyed. Listening to parents' concern it was mutually decided that next class' burden might stress him even more, so I as a psychologist will help him understand his current situation and take a decision himself.

I had a meeting with his teachers who reported that his irregularity and being lost suddenly in class is a major concern. Irregularity wasn't even answered even when parents came, except a vague answer: "Flu, fever, seasonal stuff etc". His sudden loss in class during lecture, or suddenly losing track while doing written work was questionable. His past record showed a gradual decline, probably an aftermath of what happened 6 years ago? Could it be due to the medication he was on? If yes, He's not on medication any more, is it the side effects? Is it the relapse God forbid? If yes, What kind?

Caesar's seizure referred as falling sickness (Shakespear's character) is not a sign but a moment that collect the multiple meanings we may take of a disability. 

After probing into further details, and going in details myself i found that the child was suffering from what we call "Absence Seizures" also known as petit mal seizures. They are a type of generalized onset seizures (begins in both sides of the brain simultaneously). These type of seizures lasts from 1-30 seconds, beginning and ending abruptly. Their occurrence is so brief that they might be mistaken for daydreaming and goes undetected for a really long time. In a day, a child might have 10, 20, 50 or even 100 absence seizures. They're most common in children from age 4 to 14, they outgrow by the age of 18 and do not need medication as an adult. However if the onset is 10 or above 10 years of age, then even as an adult medications are recommended

Absence seizures are characterised by sudden, brief loss and returning to consciousness right away. A child may look like staring blankly into space for few seconds, causing lapses in awareness. No first aid is needed for absence seizures. These seizures do not cause any long term problems. Children with these seizures are otherwise normal however, they're a trouble in learning and concentrating in academics and school generally. Furthemore, complications of Social isolation or behavioral problems are common. This is why prompt treatment is important. 

A child may have absence seizures repeatedly for years before being headed to a doctor for medications. The child may have "staring spells" without thinking of them as a medical problem. This however affect child's ability to perform in academics. An EEG is a test most often used to diagnose these seizures, followed by anti-seizure medicines. Child requires proper sleep, rest and diet, support in managing the stress of academics or social aspect of his life and exercising regularly. 

You and I, are in no position to diagnose anyone with these seizures, however having knowledge about problems a child in your class, home, or neighbour might have- will not only lessen his distress but also guidance in right direction for consultancy will also be fruitful. These absence seizures are mostly mistaken with daydreaming (note that a child from his day dreaming might come back any second if called upon, but a seizure cannot be interrupted). Several of my students in university asks for internship venues to have an exposure- Let me spoil it for you: You might not get to see atypical cases internship or you might get to see such a case right as your first case in a new job. Internships/Exposure does help you a lot only if you're equipped with knowledge enough and deep down inside a concern to help people out there.

For everybody out there, It's not your fault that the child has a problem. It's dawned upon you to go out, seek help and be out of stigma "Log kia kahenge". Many a times parents are afraid to speak about since people might say their only son or a daughter/Children are defected. What's pathetic is to make sure that a child gets disability by not given necessary help out of the fear "Log Kia Kahenge".

Seek help, Make environment favorable for your child's health and academics. 

[PS., Due to confidentiality i cannot reveal detailed aspects of the case. The primary purpose was to help spread awareness about "Absence Seizures". You may ask questions if any, in comments below]