Most children who are brought to therapy have typical run-of-the-mill issues like low self-esteem or poor peer relations. Sometimes, however, parents bring in a really difficult, out-of-control child who is what we used to call a “problem child.” This child may be angry, moody, aggressive and undisciplined. He has difficulty learning and is unmanageable in school. Often the parents are at the end of their rope, having exhausted their bag of tricks: ignoring, consequences, punishment, and maybe therapy. Sometimes parents are optimistic, or naïve, believing that all they need are some tips to make their child behave.

Parents often consult with a professional because they want “the answer.” It is quite an art for the therapist to convey that there are no simple answers for complex problems. There is no magic pill, piece of advice, strategy, bracha or segulah that can by itself adequately and comprehensively address this situation.

What is needed instead is a process of trying to understand the child – his strengths and weaknesses, his needs and wants – not simply a focus on eliminating his troubling behavior. However, the difficulty, shame and embarrassment of raising a child with challenging behavior may overwhelm the parent; after all, a child is his parent’s report card. So, despite the best of intentions, the parent may fall into the trap of caring more for the behavior than the child himself.

Yet a child is not his behavior. Behavior is simply the language of childhood. Challenging behavior signifies that the child is in pain; he cannot regulate his mood or impulses and he suffers the consequences of adult disapproval and peer rejection. As important as it is to teach him appropriate behavior [and that is important!], his behavior is a symptom and not the issue. The issue is his pain and helping the child deal with it is the first responsibility.

It is axiomatic that children do well if they can and that no child gives more pain than he feels. More than anything, children want approval, and if they can do what is asked of them in order to get it, they will. But when the child cannot do what’s required, he both feels bad about himself and also earns the disapproval and criticism of others. Then, when he feels the pain of rejection, he acts out, or in. Neither giving him medicine nor teaching him to have derech eretz will alleviate his pain.

It takes some skill and training to figure out the puzzle that is the child. There are a number of diagnostic possibilities here, from ADHD to abuse/neglect, from depression to low self-esteem, from ODD [oppositional defiant disorder] to overly permissive parenting. Because there are radically different approaches for, say, a child who is depressed or a child with ADHD, it is essential to determine the nature of the issues before beginning to address them.

Most likely, there isn’t any one thing, but rather a combination of factors that affect the child. For example, a child with ADHD who has permissive, unstructured parents is bound to have disorganized, chaotic behavior [doing whatever he wants] which impacts negatively on his school performance. Or, a child with low self-esteem who feels disliked by his peers may have lots of feelings of anger and depression. And, though it is a consideration to give medication to a child who is depressed, there is no pill in the world that can remedy the pain of abuse or neglect.

What sometimes derails the “understanding” process is that parents feel under the gun; everyone around them is urging them to do something. None of us like to be criticized, but it seems like an out-of-control child invites the well-meaning comments, suggestions, advice and perspective of others. The social pressure this engenders often propels the parent to seek a quick fix solution, rather than work at a comprehensive understanding of their child. It takes a lot of courage and stamina to work at the long-term and not the short-term, the whole child and not just his behavior, and the future – not merely the present.

When the severity of the symptoms and the seriousness of their repercussions call for professional help, both the parents and the child would do well to meet with an experienced, competent mental health professional. Once there is a mutual understanding of a child and his issues, there are a number of strategies that the professional may suggest, like individual or family counseling, parenting classes, or special education. An evaluation for medication by a child psychiatrist may be appropriate; there are medications for depression and ADHD. However, just like antibiotics cannot cure every condition, there is no medication that addresses chutzpah or anger which are more often reactions to the child’s environment.

Last, but certainly not least, may be the need for a behavior modification program or behavior therapy. Everyone must learn appropriate behavior in order to function effectively in our families and social world. No matter what the pressure or distress, disability or challenge – correct behavior is our entry card into the world. We are derelict in our duty if we fail to provide all our children with the tools to manage their impulses and behavior so that they can be welcomed as full-fledged members of society.

It is not easy being the parent of the more difficult child. It’s not something we willingly sign up for or even the cards we expect to be dealt. But when the therapist, parent and child work together on the process of figuring out those cards, that enhances the chances of playing the cards right and getting a winning hand.

Dr. Sara Teichman, PsyD maintains a private practice in Los Angeles, California where she specializes in individual, parenting and marital concerns. In addition, she is the Clinical Director at ETTA at OHEL. She is the author of a bi-weekly parenting column, “Child in Mind – Ask Dr. T” in Binah magazine. Dr T. also gives lectures on parenting and a variety of clinical issues in person and by teleconference all around the United States. To contact Dr. Teichman, email [email protected].