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There are few subjects as divisive among parents as discipline. All mothers will have heard tut-tutting at the school gates about those children who 'get away with murder'.At the same time, we worry that our own tantrum-prone toddler is suffering from autism - as one in 100 does - or attention deficit hyperactivity disorder (ADHD). Of course, when it's not your own child, it's easy to see these as an excuse for bad parenting.
The expulsion from school of five-year-old Harry Reid demonstrated both sides of this coin. While his mother believes autism and ADHD cause his disruptive behaviour, one teacher was said to have called him the naughtiest child she had ever met. Sadly, everyone involved was struggling to deal with this case.
Roald Dahl's famously bratty Veruca Salt could have had a medical condition
There is a knee-jerk tendency to claim that doctors are bent on giving every stroppy child a 'chemical cosh' - but this is simply not true. Sometimes, naughtiness genuinely is the symptom of a medical condition. And recognising that is the key to getting a child help.
Being defiant and testing boundaries is just a normal part of growing up. Isn't it counterproductive to classify a child as ill?
Of course children have a range of personalities and it is to be expected that some will push boundaries far more than others. Moreover, all children go through phases, whether they are two-year-olds or teenagers, when they defy authority.
This is completely natural. This kind of behaviour can also be a reaction to problems in their environment - is there something distressing going on at home or school, for example?
The mental health of children and adolescents is a complex field and the best general advice I can give is to be watchful, without worrying or being overbearing. However, alarm bells should ring when a child's behaviour goes far beyond that of his or her contemporaries, and continues to a point where life at home and at school is persistently being disrupted. In that case, it is absolutely worth speaking to a doctor, as this behaviour could indeed be symptomatic of a medical condition.
Debbie Reid and son Harry who has been excluded from his primary school
What kind of medical conditions are we talking about?
Today, we believe that up to five per cent of children have ADHD. This diagnosis is made when a child shows a specific set of symptoms that include inattentiveness, hyperactivity and impulsiveness.
It is generally thought to be down to brain function and anatomy, and the condition often runs in families. One possible cause is the mother drinking alcohol and smoking during pregnancy; another is the child watching too much TV. Two-thirds of children with ADHD still have problems as teenagers, and the same proportion continue to suffer as adults. ADHD can often go hand-in-hand with learning disabilities and sleep problems.
It is, however, by no means the only cause of disruptive behaviour. What we traditionally think of as autism is often diagnosed before a child begins education, but it is only part of the range of illnesses known as Autistic Spectrum Disorders (ASD), any of which may cause what looks like naughtiness.
In a child with a mild ASD, the symptoms may have been subtle before starting school, or the classroom setting may actually bring out new, previously unseen symptoms.
Other health problems such as deafness and epilepsy can also be manifested as difficult behaviour before they are diagnosed.
So why are we suddenly giving children these labels - and medicating them - when the conditions used not to exist?
We are more aware nowadays of all learning and mental health problems in children. And this awareness is a positive step towards educating and supporting children who may previously have been disregarded by schools.
The fact that these conditions are newly defined does not mean we invented them for the sake of it. While many children are restless from time to time, a child with ADHD is persistently restless and can't concentrate in any situation.
These diagnoses are not made in a brief consultation. Information is gathered from the youngster's school and GP, as well as observing him or her in different settings performing different tasks. The features of ADHD have to have been present for more than six months for a diagnosis to be made.
On the other hand, children with ASD primarily find social situations difficult. They have trouble understanding other people's emotions, so, for example, may carry on 'misbehaving' even when someone is upset or angry with them.
Children with ASD like routine and can express anger and aggression when these are changed. They often cannot understand non-verbal cues such as tone of voice or facial expression, while they can be blunt when talking, which gets them into trouble.
Isn't it ludicrous to expect a mainstream school to cope with a child with extreme behaviour even if there is a medical cause for it?
If a diagnosis has been made, it is not unreasonable that a school should try to cope. All children with special needs should be 'statemented'. This means a statement of educational need is made and the child is then provided with a plan to meet those needs. They should be assisted within the classroom, which often involves one-to-one help. Properly organised and funded intervention can have a very positive effect. Once a diagnosis is established and a proper plan has been put in place, mainstream schools can cope very well.
The diagnosis of a disorder means that parents, teachers and children can be taught how to avoid triggers and manage problem behaviour.
How can I get help for my child if his or her naughtiness does appear to be excessive?
A proper assessment is vital. This can start with a chat with your GP, who may suggest that a formal examination needs to be made by a community paediatric team, which includes an educational psychologist. In some cases the school will actually initiate this.
Once a child has been assessed, the appropriate measures should be put in place at the school, whether that is help from a classroom assistant or extra one-to-one care. This should occur in conjunction with therapy or medication for the child, as well as a parent training programme to teach effective communication and the skills required to deal with difficult behaviour.
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