The “At Risk Child:”

Early Identification
and Intervention

by David Pelcovitz, Ph.D. & Rabbi Shimon Russel L.C.S.W

David Pelcovitz, Ph.D. is Clinical Associate Professor of Psychology in Psychiatry at NYU School of Medicine, and Chief Child and Adolescent Psychologist at North Shore University Hospital, Long Island, NY. He has published and lectured extensively on a variety of issues related to child and adolescent mental health.

Rabbi Shimon Russel, a psychotherapist in private practice with offices in Lakewood and Brooklyn, studied in yeshivos in Eretz Yisroel and Beis Medrash Govoha in Lakewood, where he received semicha from the late Rosh Hayeshiva Rabbi Shneur Kotler zt'l. A board member of Nefesh, The International Network of Orthodox Mental Health Professionals, he recently co-chaired a conference sponsored by Nefesh and Ohel Children’s Home on children in crisis in the Orthodox community.

I. Background

In recent years there has been an unfortunate increase in the number of adolescents from frum families who have been seriously disruptive, rebellious and defiant. Their parents desperately try to understand the source of their adolescent’s problems, which may involve a serious reduction in religious observance, use of drugs or alcohol, refusal to abide by parental rules and/or school truancy. Unfortunately, by the time the situation has grown to such major proportions, it is far more difficult to deal with than had the problem been caught while the child was younger. The purpose of this article is to address some of the ways that parents can identify if their child is at risk for developing such serious difficulties. We will also present some strategies for intervention.

It is critical to recognize that the cause of serious conduct problems in children can rarely be attributed to a single source. Experts in child psychology usually ascribe such difficulties to the interaction of numerous factors such as temperament, poor peer influences, problematic parent-child interactions, and poor self-concept engendered by repeated academic and/or social failures. An understanding of how these factors can place a child at risk for conduct problems can be an important first step in prevention.

II. Risk Factors__Temperament

Even as very young children, differences in basic temperament are evident. While one child can be even tempered, sleep well, and, in general, pose very little in the way of challenge to his or her parents, another child can from infancy on show signs of a difficult temperament. Numerous studies have documented the kind of temperament that places a child “at risk” for later conduct problems. The intense child with a high activity level, distractibility, negative, irritable mood, and difficulty with changes in routine is at greater risk for developing behavioral difficulties than a more placid child. Such children often lack flexibility and have a low frustration tolerance.

Of course, as the Rambam makes clear in Hilchos Dei’os, biology is not destiny. A child with a difficult temperament can be helped to learn to channel his intensity for good purposes. Parents of such a child, however, should be aware that if they find that the negative in their interactions outweighs the positive, they should seek help in learning how to deal with the special challenges presented by such a child. Relatively short-term efforts when a difficult child is young can prevent a problem from developing that is far harder to deal with when they reach adolescence.

It is not at all unusual for children to go through stages where their behavior is mildly defiant or disruptive. In one of the largest studies ever conducted of behavioral difficulties in children, researchers found very high rates of disruptive behaviors in typical children between ages 5 and 9. For example, 46% of the thousand boys in this sample were described by their teachers as at times disruptive, 26% were found to be disobedient and 30% as occasionally “hyperactive.” What differentiates the child who is at risk for more serious and sustained rebelliousness is a pattern of frequent negativistic, hostile, and defiant difficulties that last for at least six months and causes significant impairment in their ability to function well at home, in school or with peers.

This pattern of behaviors, which is called “oppositional-defiant disorder” by mental health professionals, is characterized by some or all of the following: frequent loss of temper, argumentativeness with adults, an active defiance or refusal to comply with adults’ requests or rules, repeated attempts to deliberately annoy people, a tendency to blame others for his or her mistakes or misbehavior, and indifference or resistance towards the performance of mitzvos. Such children are also often described as touchy, resentful and easily annoyed by others. They may respond to anger at others by becoming spiteful or vindictive.

This pattern of disruptive behavior is most likely to be found in children born with difficult temperaments. These children are also more likely to have parents who are inconsistent, punitive, or neglectful. A child with symptoms of oppositional-defiant disorder is at risk for developing into an adolescent and/or adult with more serious conduct problems.

Another factor that places children at risk for serious conduct problems is that of the child who feels himself or herself to be a failure, relative to his peers because of school failure. Children with learning disabilities, particularly those with significant reading problems or language disorders, often experience repeated academic failure. These children are at risk, at least in part, because the poor self-concept which these difficulties typically engender can make them more vulnerable to negative peer influences.

Depression in childhood often takes a different form than it does in adults. In addition to depressed mood, difficulties with concentration, and altered sleep and appetite, depression in childhood may also present in the form of irritable and aggressive behavior. The seriously depressed child can be at risk for later behavioral difficulties. Research shows that many adolescents who develop conduct or drug problems had prior bouts of depression as children. As depressed adolescents, they may turn to drugs as a form of self-medication.

What family characteristics are associated with children who are defiant? Researchers have consistently found that a parental discipline style characterized by high levels of yelling, lecturing, criticism and punitiveness or infrequent expression of unconditional love are associated with a drastically increased chance that a child will be non-compliant and rebellious. Of course, this doesn’t mean that child misbehavior should be ignored. On the contrary, children with difficult temperaments need even more limits and structure than more easygoing children. The key in dealing with such children is to find the balance between “s’mol docheh veyemin mekareves” - setting limits with one hand while providing an atmosphere of love and warmth with the other.

There is an intriguing series of studies on the effects of stress on parenting. Parents who succumb to the myriad of time and financial pressures, which are all too common in our community, are more likely to exhibit parenting practices that are associated with fanning the flames of rebelliousness. Research has documented that parents who feel powerless in their lives are more likely to harshly chastise their children, engage in coercive disciplinary practices and focus on the negative while failing to recognize positive behaviors in their child. Such parenting practices are an almost certain recipe for the exacerbation of behavioral difficulties in at-risk children.

Perhaps the most important stressful situation, which can impact significantly on parenting, is marital difficulties. Children exposed to frequent fights between parents are at risk for a variety of behavioral problems. These children learn from their parents that the way of dealing with frustration and anger is to lash out at others. The parents in families with high levels of marital distress are also more likely to engage in inconsistent discipline, a major risk factor for childhood behavior problems.

Finally, since approximately half of mothers who are in a distressed marriage have been found to be suffering from significant levels of depression, it is important to understand the interaction between parental depression and the development of conduct problems in children. Since irritability is often a component of depression, depressed parents are more likely to respond to misbehavior in an unproductive, emotional manner. Furthermore, the pessimism inherent in depression makes it more likely that there will be a focus on the negative in the child’s behavior. Such children may come to think that they can’t win since any efforts at improvement are squelched when their depressed parent fails to recognize these attempts.

While reacting over-emotionally to defiant behaviors in children can exacerbate their behavioral difficulties, the other side of the coin – not dealing with behavioral problems – is equally dangerous. Furthermore, when parents are unable to give their child a sense of consistent love and attention they may place their child in danger of turning to acting out peer groups as substitute sources for unconditional love and acceptance. Lack of family cohesiveness, insufficient parental involvement, and failure to adequately supervise a child are among the most commonly cited contributors to childhood hostility and defiance. For example, one study that followed children from early childhood to adulthood found that parents who connected to their children by spending time with them, having discussions, and caring enough to supervise their activities with friends were far more likely than other parents to raise children who were well-behaved and respectful.

Notwithstanding the above, we urge parents, friends and mechanchim, to recognize that often times, poor parental treatment of the situation was the result of the problems and not its cause. Remember, ”Al todin es chavercho ad shetagi’a limekomo.” It is impossible to imagine the fear and pain felt by parents, as the crisis develops within their home, and how that fear can cause even the best parents to err in their judgment of and reaction to their children’s behavior. The more supportive and non-judgmental friends, family and mechanchim are of parents going through a crisis with a child, the less the parents will feel ashamed and embarrassed, and their ability to deal with the situation will be enhanced.

III. Interventions:   Identifying the Problem

One of the most effective interventions for the problem of at-risk children is to identify and treat the problem that places the child at risk as early as possible. If, relative to peers, your child is more aggressive or non-compliant, assessment by a qualified mental health professional should be considered.

This does not necessarily mean that regular counseling will be recommended. Recommendations can range from a single meeting, where the counselor will provide guidelines on how to deal with your difficult child, to ongoing sessions, which will combine parenting guidance, individual sessions and consultation with the school. As noted earlier, since marital conflict or parental depression can increase the chances of minor behavioral difficulties in your child becoming major, it is important to deal with these problems, as well. This is clearly a situation where the best way to help your child is to get help for yourself.

Dealing with children calmly but firmly is at the heart of effective prevention of serious behavior problems. Consequently, understanding the source of parental emotionalism is crucial. Perhaps the greatest contributor to excessive anger at children is the tendency to assign blame for the child’s misbehavior either to one’s self or to the child. A belief on the part of the parent that their problematic child is acting that way because something must be wrong with their competence as a mother or father can increase the chance that a parent will respond emotionally and unproductively. It is human nature to respond to feelings of incompetence and powerlessness by lashing out at others – in this case, the child. Unfortunately, such an emotional response typically yields the opposite of what is called for. The solution feeds the problem and the situation is exacerbated in a manner that makes it more likely that the child will misbehave in the future.

Special sensitivity is therefore demanded of mechanchim, who often are in the unenviable position of regularly pointing out to parents their children’s problems. It is critical that in doing so they not make parents feel even more incompetent than they already do.

Similarly, if the parents view their child’s behavior as willful and a reflection that there is something seriously wrong with their child’s middos, this too will fuel a counterproductive emotional reaction. In contrast, if the parent views the problematic behavior as stemming from a biological predisposition rather than from a deliberate, or lazy behavior, then their response is far more likely to be calm and productive in helping their child’s behavior change.

The following interventions can help minimize defiance in at-risk children:

• Try to anticipate which situations are most likely to trigger rebellious behavior by learning the patterns behind your child’s explosiveness. Parents might find it useful to keep a diary of a typical week in your family’s life. The diary would note each episode of misbehavior in your child, with a particular emphasis on what the trigger was for each incident. Eventually, a pattern should emerge which should allow you to anticipate which situations are most likely to elicit explosive or non-compliant behavior. Parents often find that use of distraction, empathy or logic, which typically are ineffective once the child has lost his temper, is far more likely to be effectual if the situation is caught before their child loses control.

• Recognize that while you may have no immediate control over your child’s misbehavior you do have significant control over the consequences. At-risk children do best when expectations at home and in school are clearly spelled out and consequences are immediate, consistent and calmly implemented. It is equally important that positive behavior be consistently recognized and reinforced. A number of helpful parent training books are available (e.g. Greene, R., The Explosive Child; Clark, L., SOS Help for Parents (2nd edition) Parents Press), as are parenting classes. It is crucial to keep in mind, that should behavioral difficulties increase in frequency or severity, consultation with a child mental health professional should be obtained.

• Consider carefully which battles are worth fighting. If the parent-child relationship is dominated by frequent fighting, it is often very helpful to make a list of which behaviors must be dealt with immediately and which can be safely ignored. For example, ignoring verbal bickering between siblings and letting them work out minor differences by themselves frequently reduces the frequency and intensity of sibling fighting. Of course, any issue involving your child’s safety or the safety of others must be dealt with immediately.

Anger Control Strategies For the Child

Children who are at risk often need help in being taught the necessary skills needed to control their anger. Seriously consider seeking professional help to learn how to teach these skills to your child without antagonizing him/her further. Teaching the “right” skills, with the “wrong” attitude always fails.

School-Based Interventions

1. Close cooperation with the school is necessary to diagnose and remediate any learning difficulties. Early identification of language problems, learning disabilities or attention-deficit disorder is crucial. If difficulties are suspected, evaluation by specialists in these areas should be conducted as early as possible. With early intervention there is a greater chance for success.

2. Consider having a tutor/mentor for a child experiencing academic failure. This person can provide the dual role of helping the child cope and improve academically, while at the same time serving as a mature sounding board to help guide the child through difficult relationship issues

IV. Conclusions

Early identification and intervention in dealing with children who present with significant oppositional and defiant behavior in childhood can prevent them from developing into more serious difficulties in adolescence. Most children and families are resilient. Thus, taking a proactive approach in dealing with behavioral problems when they are more easily manageable should B’ezras Hashem spare us from having to deal with rebellious and alienated adolescents. ?

Back to Homepage