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: Aggressive Behavior In Children Has Many
Causes
DEAR DR. PAUL: My 4 year old daughter has been diagnosed
with ADHD. She is not toilet trained yet and due to early ear
infections does not speak well. She is aggressive and throws many
temper tantrums. We do not want her taking medication, but at
this rate she will not be ready for school next year. Any information
would be greatly appreciated.
PEDIATRICIAN DR. PAUL Answers: I think it is quite
difficult to make the diagnosis of ADHD in pre-school age children.
Also, when we evaluate children for ADHD we want to make sure
that there are no other factors contributing to the child's behavior.
The information you gave leads me to believe that ADHD would not
be on the top of my list of what is causing your daughter's aggressive
behavior. Just because a child is aggressive or has temper tantrums
does not automatically mean ADHD. So to think about medication
at this stage, would be premature.
Aggressive behavior in children has many causes, which can broadly
be divided into:
Family/social problems including divorce, separation
Child related physical or mental conditions
Although both factors frequently contribute, if you look at each
possible category separately, the root of the aggressive behavior
may be found and therefore addressed. From the physical point
of view, children who have developmental delays such as delay
in toilet training or speech tend to be aggressive, because they
can be quite frustrated. They sense themselves as being different
from others and may not be able to communicate their needs. The
same type of aggression and/or frustration can be seen in children
with learning disabilities.
I remember once seeing a family who had a 5 year old girl that
was very aggressive at school. When I first saw the child I noticed
that she could not hear well. Although she had no history of ear
infections, when I examined her ears, I found a lot of fluid behind
the ear drums, a complication of repeated ear infections. The
child was normal otherwise. A hearing test confirmed that she
had a hearing loss due to fluid in her ears. The parents were
shocked that this could cause aggressive behavior, and were even
more surprised that she had repeated ear infections when she never
complained of any ear pain or related symptoms. I explained that
some children can get "silent ear infections" without obvious
symptoms. In your situation, we know she had ear infections. The
bottom line is that silent infections or not, when there is hearing
loss associated with ear infections, this can cause speech delay,
learning problems and of course difficulty in 2 -way communication;
In other words, the child cannot hear nor express him/herself
very well. Not surprisingly, out of frustration, these children
tend to act out, be aggressive and seem at times to be "hyper".
Once this child had her hearing corrected, she began to flourish
at school and her behavior improved dramatically.
In conclusion, the above example demonstrates that getting to
the source of the aggression is the key to addressing it. Aggressive
or misbehaving children do not need to be prematurely "labeled".
They need a comprehensive evaluation. |
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