Maladjusted Children

††††††††††††Children who are having trouble adjusting to their worlds
have specific problems and issues. These arenít the same from
child to child. Even so, children do let adults know that things
arenít going well. Their troubles show in their behavior and in
how they deal with various people and situations. Observing the
signs and understanding their causes are the keys to providing
the children the support and help they need to move past their
problems and get on with their lives.


††††††††††††The signs of maladjustment included in the next few sections
are 'culturally neutral.' This means that they are important
regardless of the child's racial, ethnic, religious, economic, or
geographic background or heritage. Having made that point,
though, the appropriateness of specific behavior and acceptable
emotional expression do vary from place to place and from culture
to culture. For this reason, you need to be particularly
sensitive when interpreting the behavior and emotional
expressions of any child.


††††††††††††Although seeing any of the signs is reason for concern, you
need to combine your concern with your judgement about its
significance, given the child's life experiences and cultural
heritage. Just be sure that you aren't making too much, or too
little, of what you are observing. It will help here to talk with
others who know the child personally or professionally so you can
incorporate their thinking into your perspective.


††††††††††††Both maltreated children and children who haven't been
maltreated have problems and personal issues that 'come out'
through signs of maladjustment. Seeing a sign of maladjustment in
a child doesn't tell you what specifically caused the problem or
what is bothering the child right now. What's more, the signs of
maladjustment in maltreated children arenít significantly
different than those seen in children who haven't been
maltreated, although the signs seen may be more frequent and more
severe.


††††††††††††Your challenge is to understand what is causing or
contributing to the difficulties of a child today. Just keep in
mind that children in care can have problems and issues that
aren't related to the maltreatment they have experienced. They
certainly may have those types of difficulties but also can have
the same troubles other children have.


††††††††††††Signs of extreme behavior disorders such as intense
defiance, intentionally injuring other people, drug or alcohol
abuse, criminal activities, or willful destruction of property
havenít been included. These obviously require professional
intervention. Also, they require individually designed behavior
management plans. If a child in care exhibits these types of
extreme behavior problems, a qualified expert needs to work with
the child and with his caretakers to develop the behavior
management plan. Also, the child should be assessed by a child
psychologist. The child very likely has learning and
developmental disorders that are causing the behavior problems or
making them worse.


††††††††††††Signs of severe emotional disturbance haven't been included
either. These include signs such as hearing voices, extreme mood
swings, suicide attempts, obsession with fire, extreme fears,
intentional starvation or very excessive eating, serious
withdrawal from people and activities, and very strange thoughts
and ideas that are outside of what is real or probable. If a
child in care is having these types of problems, he should be
seen by a psychiatrist and a highly qualified therapist. Also,
the psychiatrist and therapist should work with caretakers to
help them help the child.


††††††††††††A child who has none of the signs in the next three sections
likely doesnít have any serious adjustment problems. This is
especially true if you combine the signs with the areas of normal
adjustment considered earlier. Children who have very serious
adjustment difficulties also have the more typical problems that
are included. In fact, they likely exhibited some of these signs
prior to developing more serious problems.


††††††††††††The progressive nature of behavior and adjustment problems
is, in part, why these signs must be taken very seriously. If
they aren't taken seriously today, they will get worse. More
serious signs will develop as the child gets older. For this
reason, The best help a child can get is the help he is getting
today.


From your point of view:


††††††††††††Write your thoughts after each question.


†††††††††What provisions should the agency make for mental health and
other services for children in care?







†††††††††What provisions should the agency make for mental health and
other experts to be available to caretakers to discuss
children in care and to make behavior, emotional, and
interpersonal management plans for the children?







†††††††††What provisions should the agency make to respond to mental
health and behavior related emergencies that may happen in
your home?








††††††††††††With any areas of adjustment for children, if you observe
anything that concerns you or causes you to wonder, take your
reaction seriously. If you are concerned, it's important, whether
the particular sign is included here or not. Just remember that
there aren't any silly questions or unwarranted concerns. The
only bad outcome here would be your not discussing your concerns
with the child and with the professionals who are available to
work with you.


From your point of view:


††††††††††††In each of the next three sections, fourteen signs of
maladjustment are listed (forty-two signs in all). Think about a
child currently in care at your home. Look at the forty-two signs
and simply put a check mark beside any sign that you have
recently seen.


††††††††††††With the specific child and the signs you have seen in mind,
write your responses after each question.


†††††††††What are the most important steps you can take at home to
help the child with the problems that have been identified?







†††††††††What outside resources might be useful to help the child
with the problems that have been identified?







†††††††††How can the staff at your agency specifically help with
these types of problems?










3.2 Signs of stress and depression


††††††††††††Stress and depression in children are caused by a
combination of external and internal factors. Outside the child,
there is perceived turmoil and tension either at home, at school,
or with peers. Inside the child, there is intensely felt
frustration, fear, and uncertainty. For maltreated children,
there are the added elements of horrible past experiences and
possibly the lack of permanence in their lives today.


††††††††††††As the child's fear and frustration increase, the perceived
turmoil and tension increase. This in turn increases the child's
fear and frustration. The vicious circle builds and the child
becomes less able to cope. The result is mounting stress and
deepening depression. To help, you need to first slow and then
stop the vicious circle.


††††††††††††To help a child, the first order of business is to never add
fear or frustration to the equation. To some extent, the child
feels out of control. You must provide the personal and emotional
control the child is seeking, keeping in mind that it will take
time and patience. You certainly can't do that in an hour or a
day and it may take weeks and months.


††††††††††††For a specific child in care, you may need to work with the
available professionals to develop an intervention and support
plan. For all children, though, the plan will include the
following techniques. After each technique, write a sentence or
two about why it is appropriate for children.


†††††††††Patience, patience, patience.







†††††††††Staying calm and open to the child.







†††††††††Being available to sit with and listen to the child. (Note
that this doesn't call for your talking much or offering
advice and suggestions.)







†††††††††Being gentle but firm with the child in terms of your rules
and expectations. ('I know that you are having a rough time
of it; but you still need to. . . .')







†††††††††Trying to understand the external problems and issues from
the child's point of view. (When you can quietly explain
things in a way that fits how the child perceives them and
see why the child is so upset, you have reached empathy: you
and the child are on the same page.)







†††††††††Offering other ways of thinking about or looking at the
situation, without judging or contradicting. (If the child
tells you that you don't understand or that your ideas are
stupid, you can say, 'I guess I don't get it yet. Help me
understand why what I said was stupid. It isn't much fun
being stupid. Will you help me get smart about this?')








††††††††††††If any of the following signs has been noticed within the
past couple of weeks, stress and depression are likely a problem.
Be sure to talk with the child about your observations and share
your concerns. Listen carefully and start developing your plan to
help. After each of the following signs, write a sentence or two
about what you think may help the child with the problem.


Signs:


†††††††††Frequent restlessness and trouble calming down.







†††††††††Frequent sleeping problems or bad dreams. (Also might have
nightmares.)







†††††††††Frequent crying or getting upset very easily. (Also might
have crying spells.)







†††††††††Frequently losing his temper very easily and quickly, with
little to no provocation. (This can be easily misinterpreted
as a behavior problem.)







†††††††††Frequently worrying and fretting about not doing things well
enough and about failing.







†††††††††Frequently not starting things because he assumes that they
will turn out badly anyway. (Also, past life experiences may
cause the child to be afraid of adult reactions if the child
displeases them.)







†††††††††Frequently giving up on tasks and activities too quickly.







†††††††††Frequently not liking himself. (Also might put himself
down.)







†††††††††Frequently not feeling like he fits in or belongs anywhere.







†††††††††Frequently not feeling loved by anyone.







†††††††††Becoming extremely embarrassed over something and not being
able to deal with it or get over it.







†††††††††Not getting over a serious loss or disappointment.







†††††††††Feeling unable to do anything about what happens to him.







†††††††††Talking about or threatening suicide. (This isnít normal
behavior and must never be disregarded as something the
child is just doing for attention.)








Discussion point:


†††††††††How might differences such as racial, economic, religious,
language, developmental, or disabilities contribute to
stress and depression for children in care?










3.3 Signs of school and learning problems


††††††††††††For children in care, school attendance may have been a
problem. The children also may have missed some school between
coming to live with you and when they were able to get into their
new school. Since missing only a couple of weeks of school can
lead to behavior and performance problems for children, the
difficulties of a child in care may be a result of missing
school. If so, extra help, patience, and a few weeks to get into
the rhythm of school will usually get the child back on track.


††††††††††††When a child in care is having performance or behavior
difficulties at school, it's appropriate to start by assuming
that the child can improve, with a little firmness and assistance
from you. Focus first on the behavior problems.


††††††††††††Talk with teachers to work out a way to get some feedback
about the child's behavior, daily if possible. Calmly but firmly
tell the child that the behavior isnít acceptable and that there
will be consequences at home whenever there are behavior problems
at school.


††††††††††††After each technique, write a sentence or two about why you
think it is appropriate.


†††††††††Take away a privilege or two for one day or perhaps two
whenever you receive negative feedback from school. This
might be something like watching TV or being allowed to
spend time with friends.







†††††††††Don't punish the child or become frustrated or angry. There
just needs to be a relatively mild, predictable consequence
that is consistently repeated whenever the child misbehaves.







†††††††††Don't increase the consequences over time. This never helps
and will tend to make things worse.








††††††††††††If the behavior of a child at school doesn't gradually
improve over three or four weeks, you need to discuss the
problems with teachers and with mental health professionals.
Don't put this off. The sooner you get a handle on the problem,
the sooner things will improve. The longer you delay, the harder
it will be to ever correct the problem.


††††††††††††With performance problems, talk with teachers to be sure
that you understand exactly what the child isn't doing and then
consider these techniques. After each technique, write a sentence
or two about why it is appropriate.


†††††††††Be sure that the child works on homework every evening but
not for more than forty-five minutes each evening. Any more
wonít help and will likely cause more frustration and
performance problems. (For first and second grade children,
thirty minutes is enough.) For high school students, a
little more time may be necessary. Help the child learn
where to study and how to pace himself.







†††††††††Before the child starts homework, have him explain to you
exactly what the assignment is and how he will go about
getting it done.







†††††††††Check the child's work two or three times during the study
time, offering help and suggestions.







†††††††††If it's clear that the child doesn't know how to do part of
the assignment, calmly explain how but don't push or get
frustrated. The child is already frustrated enough for both
of you.








††††††††††††If the child's performance doesn't improve noticeably within
a month or so, talk with the school's psychologist or mental
health professionals about the problem. The child's trying harder
or your trying harder won't help until you understand why the
child isn't doing better. This likely isn't related to real
ability. It's more likely related to a minor learning problem or
to other issues neither you nor the child can directly control.
Just be clear about the fact that it isn't the child's fault and
that pushing, punishing, or blaming the child will make things
much worse, very quickly.


††††††††††††If you have followed the suggestions and you still are
seeing these signs, professional help is required, including
immediate evaluation by a qualified school or child psychologist.
The psychologist should then explain to you and the child exactly
what the child's problem is and specifically how you and others
can help work through the difficulties.


††††††††††††After each sign, write a sentence or two about what you
think may help the child with the problem.


Signs:


†††††††††Often can't express his thoughts and ideas.







†††††††††Often doesn't understand assignments and what people expect.







†††††††††Often doesn't understand what he reads.







†††††††††Trying harder usually doesn't lead to his work and skills
getting better.







†††††††††Does some assignments very well and others very badly.







†††††††††Often forgets what to do or what people expected.







†††††††††Often doesn't follow instructions and directions.







†††††††††Gets bad grades.







†††††††††Doesnít ask for help or let others help.







†††††††††Regularly has excuses for not doing well.







†††††††††Thinks his not doing well is someone else's fault.







†††††††††Has to have an adult standing over him to be sure his work
gets done.







†††††††††Disrupts the class or the activities of others.







†††††††††Doesn't make much effort to cooperate and get along.








Discussion point:


†††††††††How might differences such as racial, economic, religious,
language, developmental, or disabilities contribute to
school and learning problems for children in care?










3.4 Signs of interpersonal (relationship) problems


††††††††††††Before dealing directly with the signs in this section,
consider the possibility of school and learning problems.
Interpersonal difficulties in children are very often accompanied
by learning and performance problems at school. Helping the child
with those problems usually leads to improvement in interpersonal
areas, without specific attention to the interpersonal issues.


††††††††††††You will recall that the social dimension of development
normally comes into focus after the emotional and moral
dimensions are more fully developed. The child has learned to
manage his feelings fairly appropriately, without tantrums or
pouting, uncontrolled excitement or unwarranted fear. Children do
certainly get excited, unhappy, frustrated, upset, bored, and are
clearly emotional people. Still, they manage all of these
feelings and intense emotions reasonably well.


††††††††††††From a moral perspective, young children have learned a lot
about right and wrong, good and bad, appropriate and
inappropriate. They also have learned to 'read' the emotions and
feelings of other people and can decide about things based on how
others feel about them. 'I won't do that because Mom will be
upset.' 'I will do this since it will make Dad happy.' Getting
Mom upset is 'bad' and making Dad happy is 'good.'


††††††††††††Children also learn to apply these simple notions of good
and bad to their interactions with other people. The process is
complex; but they take the other person's perspective. 'If this
would make me unhappy, it will likely make others unhappy too.'
'If this would hurt me, it would hurt other people too.' 'If I
would like being treated this way, it would be a good way to
treat my friends.'


††††††††††††When emotional management and moral judgement are combined,
the result is a child who has the developmental skills and
attitudes needed to be interpersonally successful. This success
plays out in the context of the child's personality which varies
a lot from child to child. Some children are more outgoing while
others are more reserved. Some are more bold while others are
more timid. Some are talkative while others are more quiet. The
point is that these characteristics have a wide normal range and
only the extremes are anything to be concerned about.


††††††††††††As you look at the signs of interpersonal difficulties,
then, you can see that they do reflect problems getting along
with other people. More importantly, though, they reflect
deficits in the children's emotional and moral development.


††††††††††††For the first eight signs of the fourteen in this section,
the primary emotional management issue is how the child deals
with anger and frustration. Things happen that can frustrate the
child and he may not handle it appropriately. This emotional
mismanagement can range from pouting and being hateful to more
open aggression and uncontrolled anger.


††††††††††††Assuredly, children in care may have a lot of reasons to be
angry and frustrated. Further, it's likely that they haven't had
constructive, positive emotional and moral examples set for them.
Even so, they must learn better interpersonal approaches to
people and frustrating situations.


††††††††††††After each technique, write a sentence or two about why the
technique is appropriate.


†††††††††Never add anger to the equation. You certainly need to be
firm and clear about what you expect; but getting angry
models the very behavior you want to change.







†††††††††To the extent you can, don't try to stop the inappropriate
behavior while it's happening. Do what is needed to be sure
other people or the child don't get hurt; but try to let the
episode run its course. Attempting to stop the behavior
while it's happening usually only intensifies the child's
reaction.







†††††††††Once the episode has passed, calmly tell the child that the
behavior was unacceptable and why it was inappropriate. Ask,
'Did you have better choices? How else could you deal with
those situations?'







†††††††††Be clear about what the consequences of such behavior will
be in the future. Those consequences need to be fairly mild,
not lasting for more than a day or two, consistently
applied, and something that you can control. Again, taking
away a privilege for a specific amount of time is best.






††††††††††††Remember that these problems are developmental and that
changing the behavior will take time. The goal is to gradually
see fewer, less intense reactions from the child. It will help to
keep in mind that not dealing successfully with these
developmental issues is the single most common reason why
placements disrupt and children are moved.


††††††††††††If the child's behavior and relationships don't gradually
improve, talk with the mental health professionals to develop a
specific behavior management plan for the child. That plan
shouldn't include any 'threats' to quickly increase consequences
or to move the child. Additionally, the plan must include rewards
or positive consequences for 'improved' behavior and for 'fewer'
negative episodes.


††††††††††††Although the first eight signs do reflect a lack of social
skills, emphasis needs to start with work on the emotional and
moral developmental deficits children in care are likely
experiencing. For the last six signs, emphasis needs to be on
social skill development. When these signs are seen, children
need help with relating to people in more assertive,
self-determined ways. This starts with the child's relationships
with you and other people at your home.


††††††††††††After each technique, write a sentence or two about why it
is appropriate.


†††††††††Don't tell the child that what other children think and feel
don't matter. They do matter, a lot, especially to the
child.







†††††††††Talk with the child about social behavior and approaches
that may be 'putting off' other children. 'When you do or
say this or that, children probably think. . . .'







†††††††††Encourage the child to be more assertive. 'When you don't
stick up for yourself or don't say anything when children
treat you that way, they will keep trying to get a reaction
from you. It's your job to let other people know what you
will and won't put up with.'







†††††††††Help the child set better personal boundaries. 'When you cry
or get upset, other children will keep tormenting you. You
might try either calmly telling them that they are being
stupid or maybe you can just ignore them. If they can't get
you upset, they will work on better ways of getting your
attention.'







†††††††††Help the child understand relationships better. 'Your
friends don't want to just have you as their friend. They
also want to spend time with other children. When you try to
keep them to yourself, they don't like that and won't want
to spend time with you.'








††††††††††††With all of the signs, 'teach' children the things they need
to know about the give and take of relationships and about the
skills they need to be interpersonally successful. Also, play
with them, do things with them, and help them develop related
skills such as playing ball, just sitting and talking, and
whatever else they need to be able to do to participate
effectively in their social worlds. Just keep in mind that a very
normal part of this learning process for children is trying most
of the interpersonal strategies that don't work, discarding those
approaches, and coming up with ones that do work. Doing it wrong
and then finding a better way is one of the most effective
learning strategies for children, and for adults too, for that
matter.


††††††††††††After each sign, write a sentence or two about what you
think may help the child with the problem.


Signs:


†††††††††Frequently pouts and is hard to live with.







†††††††††Is often hateful and in a bad mood.







†††††††††Gets very angry when things donít go his way.







†††††††††Frequently screams and yells at people. (This is a problem
unless the adults are screaming and yelling as much as or
more than the child.)







†††††††††Frequently breaks or damages things.







†††††††††Hits or hurts people.







†††††††††Starts or gets into fights.







†††††††††Bullies and picks on others.







†††††††††Has a lot of trouble making and keeping friends.







†††††††††Wants to keep his friends all to himself.







†††††††††Frequently gets his feelings hurt.







†††††††††Frequently is the brunt of teasing and put-downs.







†††††††††Regularly tries to please everyone and keep everyone happy.







†††††††††Most children his age donít like him.








Discussion point:


†††††††††How might differences such as racial, economic, religious,
language, developmental, or disabilities contribute to
interpersonal problems for children in care?

For more information and additional foster care resources, visit American Foster Care Resources (AFCR)





By Gary A. Crow, Ph.D.; Letha I. Crow, MSW March 23, 2017