Difficult Children. Prioritize Personalized Responses

Difficult children. Prioritize personalized responses

Difficult children, hyperactive with or without impulsiveness, child kings or tyrants, future delinquents detectable from kindergarten. There’s no denying it: the education of our dear little darlings regularly causes the ink to flow! And when neurological disorders are excluded, it is not easy to identify the causes to tackle them.

 However, it is to this task that Isabelle Roskam’s team has taken on, following from an early age the children who pose problems for their family and at school.

 Early diagnosis of behavioral difficulties in children: this is precisely the challenge taken up by a multidisciplinary team from the Cliniques Universitaires Saint-Luc (UCL) in Brussels, involving psychologists, of course, neuropediatricians, child psychiatrists, speech therapists, and neuropsychologists.

 “For several yearswe have been meeting a large number of parents and children suffering in their relationshipfaced with their very difficult childthe parents who were no longer coping came to consult specialists in our unit to understand what was wrong with them. Was wrongWhen we had ruled out neurological causes or problematic personal situationsthe only answer we could give was psychomotricityBut by observing the archives of the consultationswe found that this unclear answer encouraged them to embark on medical shopping to obtain a more precise. She and her team then decided to think about the best way to bring real solutions to patients and their families.

Case Study

Hence, the idea of ​​seeking to objectify the types of problems encountered by these families more precisely. “Since 2005, we have been recruiting children aged 34, or 5 who present behavioral difficultiessuch as aggressivenesslack of obedienceimpulsiveness, or restlessnessContact is made via consultations at Cliniques Saint – Luc by parents who are no longer coping and come to ask for helpWe exclude children who have clear neurological problems such as epilepsy, such as those who live in a problematic psychosocial contexthave significant language disorders, or suffer from intellectual disabilitiesThis is why we work together with neuropediatricians or even psychologists who are responsible for detecting these cases,” continues Isabelle Roskam. She notes that while some disorders are now more easily diagnosed thanks to reliable tools, this is not the case for all, particularly motor and cognitive inhibition. They, therefore, had to adapt the tools used for older children to standardize them to be able to carry out reliable case comparisons.

 Based on some 150 children enrolled, compared to 300 to 400 children from a control group recruited from partner schools in the project, Isabelle Roskam’s team determined four factors at the origin of the behavioral problem of these children. “First of alla quarter of them have insufficient language developmentthey, therefore, do not understand the instructionsand thereforewhat the parents or educators expect of themIf these instructions are not clearly stated or the children cannot express themselves correctly, aggression may occur.

 The second factor is the inability to inhibitThat – is governed by a front area of the brainif it is deficientwe can see in these children a failure to inhibit motor movements to respect instructions or wait until the adult has finished speaking to speakfor exampleChildren with ADHD or attention deficit disorder are most at risk in this area.

 The third factor is emotional problems: the child seeks to notice his difficult behavior or an anxious profileChildren who have experienced an attachment disorder are particularly represented in this category.

 Finallythere are the educational problemsoverwhelmed parents do not set enough limits or lack consistency in the different decisions made or between themselves.

Interesting Lessons

Based on regular consultations, all the children are evaluated for three years according to these four criteria. “After the initial complete assessment phasewhich includes a psychological consultationa speech therapy consultation, and a meeting at schoolthe child repeats this same triple consultation every six months for two yearsand during the closing assessment, to observe its evolution. The children will then be seen again at 9, 12, and 15 years old to know their progress.

 The team’s mission is to flush out the most contributing factors in each case and to give parents ways to adapt their attitude according to the situation, individually, even if the guidelines are the same. Indeed, it will be necessary to consider the family, social, educational, the socio-professional status of each family.

 After more than three years of observation of this panel whose first recruits have completed the three years of study, what are the main lines that emerge?

 “Firstwe have seen how difficult it is already to identify the real problem children … According to the person requesting an assessment ( the fatherthe motherthe teacheranother doctor …), the image given of the child can vary very stronglyHence our questionwho to believeWho is the best informant? According to Isabelle Roskam, the parents’ vision is biased, in particular, because they often arrive in her service after a long journey made up of research on educational techniques discussions with relatives: they finally hand it over to a professional.

 “And since they want their request to be taken seriously, they expose the problems from their worst angle, recount the most negative experiences. These isolated problems give a picture that sticks to their representation, but is it reliable?

 Teachers then? Often more structured, because they are not emotionally involved like the parents, their request differs and their judgment. But there is no bad point of view, hastens to add Isabelle Roskam: “The child is a synthesis of everything that his entourage tells usSometimes the child is difficult at school and not at home and vice versa. It is also different at the consultationeven if there are cases of difficult children always and everywhere …” But she underlines that the problem of the specialists consulted is that they can only trust the person who comes to consultation for lack of time and money: ideally, it would be necessary to have the “sound of a bell” of various speakers…

 “We did not expect to note so many differences. For example, for the diagnosis of ADHD, if the specialist sticks to a single version, the disorder would affect 25% of 3-year-old children; if the child is studied in two different settings, the figure drops to 2.5%! We must therefore remain humble….”

Tailor-made Solutions

Another important lesson: the impact of language disorders. 25% of difficult children would be concerned. However, simple measures can already have a considerable effect, such as effective communication with these children: getting down to their level to capture their attention, giving clear instructions, communicating simply and effectively teaching them these stepsAnd when the situation normalizesthe behavior of many of these children improves.

 With the idea of ​​stating clear instructions, these must be clear in their verbalization and consistency. “Parents sometimes use different techniques to make themselves obeyAs a resultthere is a lack of educational consistency, and the child will always know how to get what he wants from one or the otherLikewisethese parents make unrealistic threatstherefore, the child remains insensitive and does not change his behaviorAnother scenariothey simultaneously try all sorts of techniques to gain respectso that there is no guideline anymore .”

 In some cases, it will even be necessary to break down a negative image that the parents may have of their child, for example, if he was not wanted, or if it was a boy when the parents wanted a girl or vice versa. It will then be a question of working on the representation of the child, for example, by emphasizing his skills recognized by the teachers or his progress.

 For its part, speech therapy will be useful for correcting language disorders. “As for the lack of inhibitionpsychomotricity can be usefulbut also small games that are very easy to play with the family, such as “neither yes nor no” to exercise cognitive inhibition or, “Jacques said, “for motor inhibition . What’s moreit’s a positive moment in the relationship with the child …”, stresses Isabelle Roskam. And if these measures are not enough, if the child’s behavior impacts his school career, medication may be considered for children over six years old on the decision of the neuro pediatrician, and sometimes on the advice of the research.

 And then, there are the cases of affective disorders. “This is the most difficult aspect to work onit requires a lot of questioning during family sessions. Mother-child therapy is also considered if there has been a bonding problem..”

 Finally, parental guidance sessions are organized for parents ready to question their attitude to reframe education methods. In short, a form of educational coaching is scheduled for 5 to 10 evenings, individually or in groups. Important clarification: it is essential to have the support of both parents so that they form a team to deal with the problems, that they can pass the baton when necessary and decide on appropriate measures. It has the effect of restoring confidence: the parents feel able to act again. The child will benefit from these therapies and will no longer feel rejected, positively affecting his self-esteem.

Review Every Three Years

The children supported in this study who followed these corrections adapted to their specific problem are now six years old. “Good newsno difficult 3-year-old child is condemned to remain soThere is a potential for help for everyone“, likes to underline Isabelle Roskam.

 Therefore, the theory of future delinquents from kindergarten is erased with a sweep of the broom! “We need to develop tools to work with parents and networksbut also to reduce stress in the family or the coupleso as not to remain in a vicious circle. General interventions such as psychomotricity now offered must be replaced by targeted measures.

 A study like the one conducted by Isabelle Roskam and her team, as useful and effective as it is, has a significant cost “The parents did not have to pay anything , and around 85 % stayed with us . If we had made them pay , those who would have gone had it not been – what a little better would have already left … We therefore need funds to continue this study , to find financing .”

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