COMMON PHYSICAL PROBLEMS ON CHILDREN
Overview
In honor of World Mental Health Day, United Nations Secretary General Ban Ki-moon stated in 2008, "Let us recognize that there can be no health without mental health." His speech precipitated an appeal by the World Health Organization for countries around the globe to invest in mental health care for citizens. According to WHO, most countries spend less than 2 percent of health care budgets on mental health, yet researchers continue to find evidence that mental and physical health are closely linked.
Brain And Congenital Disorders
A 2007 study of Vietnamese children found that those suffering from long-term physical health problems, such as anemia, birth defects and physical disabilities, were more than twice as likely to have a mental disorder, regardless of socio-economic status. The Royal College of Psychiatrists reports that this comorbidity is especially profound in the case of physical illness affecting the brain, such as cerebral palsy and epilepsy. A Canadian study found that 42 percent of children with developmental delays also had a psychiatric disorder, but concluded that it is unknown "whether the comorbid illnesses share common origins."
PTSD And Physical Health
Post-traumatic stress disorder, or PTSD, is an anxiety disorder that sometimes occurs after experiencing a traumatic event. PTSD is about twice as common in females as it is in males. A study published in "Pediatrics" journal found that female adolescents suffering from PTSD were at an elevated risk for developing physical health problems, including digestive disorders, circulatory disorders and chronic fatigue. The study also revealed that adolescent girls with PTSD "were nearly twice as likely to have a sexually transmitted infection."
Anxiety/Depression and Asthma
A study of Puerto Rican children between the ages of 4 and 17 demonstrates the link between asthma and anxiety/depressive disorders. The report showed that 11.2 percent of children with asthma had also experienced an anxiety disorder, compared with just 5.6 percent of non-asthmatic children. Asthmatic children were also nearly twice as likely as non-asthmatic children to experience depressive symptoms.
Depression And Obesity
Researchers have long known of a link between depression and obesity; this comorbidity extends to childhood obesity as well. Not surprisingly, obese children report low levels of self-esteem; in a 2003 study, they "rated their quality of life with scores as low as those of young cancer patients on chemotherapy." A University of Maryland School of Medicine study of children found that depression was a significant predictor for obesity at the one-year follow up survey. Researchers cannot yet definitively state whether one condition causes the other.
Possible Causes
The Royal College of Psychiatrists speculates on possible causes of poor mental health among children with physical health problems. They believe that the stress of social problems associated with physical health issues may lead to depression and anxiety disorders. These social issues include dealing with numerous health professionals, missing school, experiencing learning problems, feeling that other children see them as different and vulnerability to bullying.
SOCIAL PROBLEMS
The following list of conditions have 'Social problems' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.
A
• Alcohol abuse ... drunkenness
• Alcoholism ... anger when asked about drinking, drinking too much alcohol, guilt when asked about drinking, hiding your drinking from others, need for morning alcoholic drink, drinking whenever you feel stress, drunkenness
• Asperger syndrome ... impaired social interaction, social withdrawal
• Asperger Syndrome, Susceptibility to, 1 ... impaired social interaction, social withdrawal
• Asperger Syndrome, Susceptibility to, 2 ... impaired social interaction, social withdrawal
• Asperger Syndrome, Susceptibility to, 3 ... impaired social interaction, social withdrawal
• Asperger Syndrome, X-linked, Susceptibility to, 1 ... impaired social interaction, social withdrawal
• Asperger Syndrome, X-linked, Susceptibility to, 2 ... impaired social interaction, social withdrawal
• Attention Deficit and Disruptive Behavior Disorders ... alcohol use
• Auditory Processing Disorder ... Listening difficulties
• Autism ... Loss of social skills already acquired, impaired social interaction, not responding to name, lack of social play, inability to make friends, not look at people, avoid eye contact, not liking cuddles, inability to sustain conversation
• Autism, susceptibility to, 1 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 10 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 11 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 12 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 13 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 14 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, Susceptibility to, 15 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 3 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 4 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 5 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 6 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 7 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 8 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, susceptibility to, 9 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, X-linked, susceptibility to, 1 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, X-linked, susceptibility to, 2 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Autism, X-linked, susceptibility to, 3 ... Loss of social skills already acquired, Impaired social interaction, Not responding to name, Lack of social play, Inability to make friends, Not look at people, Avoid eye contact, Not liking cuddles, Inability to sustain conversation
• Avoidant Personality Disorder ... social withdrawal
B
• Behavioral disorders ... social problems
• Bulimia nervosa ... social withdrawal
C
• Charcot-Marie-Tooth disease, X-linked recessive, 4 ... delayed social development
• Chemical poisoning -- Ethylene Glycol ... drunkenness
• Childhood depression ... social withdrawal
• Childhood-Onset Schizophrenia ... social withdrawal
• Classical Hodgkin disease ... alcohol intolerance
• Creatine deficiency, X-linked ... impaired social interaction
D
• Depression ... getting into trouble, social withdrawal, Social problems
• Depressive disorders ... getting into trouble, Social withdrawal, Social problems
• Diseases associated with senile cataract ... alcoholism
• Dysthymia ... getting into trouble, Social problems
• Dysthymia/seasonal depression disorder, PND ... social problems
F
• Female reproductive toxicity -- Alcohol ... fetal alcohol syndrome
H
• Hodgkin's Disease ... alcohol intolerance
• Hodgkin's disease, adult ... alcohol intolerance
• Hodgkin's disease, childhood ... alcohol intolerance
• Hodgkin's disease, nodular sclerosis ... alcohol intolerance
• Hypothalamic hamartomas ... social problems
L
• Lymphocyte depletion Hodgkin's disease ... alcohol intolerance
M
• Mixed cellularity Hodgkin's disease ... alcohol intolerance
N
• Nodular sclerosing Hodgkin's lymphoma ... alcohol intolerance
• Noise-Induced Hearing Loss ... social problems
• Nymphomania ... alcoholism
O
• Obstructive sleep apnea ... social problems
• Occupational Cancer -- Hodgkin's lymphoma ... alcohol intolerance
P
• Panic disorder ... social problems
• Paranoid Personality Disorder ... social withdrawal
• Pervasive developmental disorders ... impaired social interaction, difficulty relating to people
• Physical addiction ... social withdrawal
• Post-traumatic stress disorder ... social problems
• Postconcussive syndrome ... alcohol intolerance
• Psychological addiction ... social withdrawal
R
• Rett's syndrome ... social problems, avoidance of eye contact
S
• Schizophrenia ... social withdrawal
• Schizophrenia 1 ... social withdrawal
• Schizophrenia 10 ... social withdrawal
• Schizophrenia 11 ... social withdrawal
• Schizophrenia 12 ... social withdrawal
• Schizophrenia 13 ... social withdrawal
• Schizophrenia 14 ... social withdrawal
• Schizophrenia 2 ... social withdrawal
• Schizophrenia 3 ... social withdrawal
• Schizophrenia 4 ... social withdrawal
• Schizophrenia 5 ... social withdrawal
• Schizophrenia 6 ... social withdrawal
• Schizophrenia 7 ... social withdrawal
• Schizophrenia 9 ... social withdrawal
• Schizotypal Personality Disorder ... social withdrawal
• Sleep apnea ... social problems
• Social phobia ... anxiety in social situations
• Soto's Syndrome ... delayed social development
INTELLECTUAL PROBLEMS
Intellectual (10 articles)
• Angelman syndrome.
Angelman syndrome is a neurological disorder caused by a missing section of the maternal copy of chromosome 15. Common characteristics include intellectual disability, often with particularly delayed speech, jerky walking style and happy demeanour.
• Angelman syndrome.
Angelman syndrome is a neurological disorder caused by a missing section of the maternal copy of chromosome 15. Common characteristics include intellectual disability, often with particularly delayed speech, jerky walking style and happy demeanour.
• Down syndrome - the school experience.
Your child with Down syndrome may eventually go to a mainstream school to work side by side with other children. This will develop the skills to live and work in the community. Like all children, those with Down syndrome display a wide range of abilities.
• Down syndrome - the school experience.
Your child with Down syndrome may eventually go to a mainstream school to work side by side with other children. This will develop the skills to live and work in the community. Like all children, those with Down syndrome display a wide range of abilities.
• Down syndrome and Alzheimer's.
The connection between Down syndrome and Alzheimer's disease is complex. Studies of the brains of people with Down syndrome reveal that, by the age of 40, almost all develop the brain changes characteristic of Alzheimer's disease.
• Down syndrome and Alzheimer's.
The connection between Down syndrome and Alzheimer's disease is complex. Studies of the brains of people with Down syndrome reveal that, by the age of 40, almost all develop the brain changes characteristic of Alzheimer's disease.
• Down syndrome and health.
If your child has Down syndrome, there is a good chance that they will have a normal life span. In the past, many babies with Down syndrome died from congenital heart defects. Many of these can now be corrected with surgery.
• Down syndrome and health.
If your child has Down syndrome, there is a good chance that they will have a normal life span. In the past, many babies with Down syndrome died from congenital heart defects. Many of these can now be corrected with surger
COMMON EMOTIONAL PROBLEMS
Emotional Problems in Children
By R. Elizabeth C. Kitchen, eHow Contributor
Emotional problems in children have become more widely recognized. A child's emotional problem can become a chronic problem if it's not attended to properly and in a timely manner. Many adult emotional problems can also affect children, but these problems may not be as easily recognized in children. Some emotional problems in children can be treated quite easily, but some require long-term care that can be complicated.
Childhood Bipolar Disorder
1. Childhood bipolar disorder is an emotional problem that can affect children. This childhood emotional problem can be hard to diagnose, because its symptoms are also symptoms of many other childhood emotional problems. Common symptoms include mood swings, irritability, episodes of extreme happiness and episodes of severe depression. Childhood bipolar disorder is a serious condition and should be treated as such. Treatment most often includes a combination of medication (sometimes more than one) and behavior therapy (teaching the child how to handle certain situations better).
Childhood Depression
2. Childhood depression is an emotional problem that can affect children. This childhood emotional problem is considered serious, but it can be difficult to diagnose because its symptoms are not unique. Common symptoms include irritability, fatigue, hopelessness, social withdrawal and poor performance in school. Childhood depression is most often treated with medication and behavior therapy.
Autism
3. Autism is an emotional problem that can affect children. This childhood emotional problem is often serious and consists of three distinctive behaviors. These autism behaviors include trouble interacting socially, obsessive and competitive behavior and difficulty with nonverbal and verbal communication. Medications (often more than one) and behavioral and educational therapies and interventions are used to treat autism. Family counseling is also used to help families learn about autistic children and to help them cope.
Childhood Schizophrenia
4. Childhood schizophrenia is an emotional problem that can affect children. This emotional disorder often affects a child's ability to develop normal social, educational and emotional skills and habits. Children with emotional disorder often have difficulty performing daily tasks, think and act irrationally and have delusions and hallucinations. Childhood schizophrenia is most often treated with a variety of treatments including medications (most often antipsychotics) and psychotherapy (teaches the child to cope with the illness and its challenges).
Tourette Syndrome
5. Tourette syndrome is an emotional problem that can affect children. This emotional problem is also considered a neurological disorder. Tourette syndrome is characterized by stereotyped and repetitive vocalizations and involuntary movements referred to as tics. Tourette syndrome is most often treated with a combination of medication and psychotherapy.
Emotion is a complex mental experience involving body and mind. It implies a state of being exited, stirred up and disturbed in one way or another. It is different from ordinary feeling. Emotion is a feeling but not vice versa. Feeling is more localized while emotion is more intense. It is with all humans and animals too. Age is not a factor for emotional disturbance. It is noteworthy that emotional variations can be seen in children from birth itself. Some parents are not aware of the related problems as follows at various stages of growth.
During infancy stage:
At this stage, since the emotions are based on instincts of the growing organism, the emotional responding may not be meaningful. Emotional problems are mostly biological hunger, thirst and fear which can be compensated or subsided by the mother through proper care extended to the child.
During early childhood:
During this stage, problems arise on account of emotional inconveniences as follows.
i) Dominance of unpleasant hazards like anger, jealousy and fear with a little amount of pleasant emotions. This imbalance distorts the outlook of the child on life with pessimism making the child feel the environment unpleasing. The child develops such unpleasant temperament resulting in gloomy facial expressions.
ii) Inability to establish an emotional tie up with significant persons, especially the mother and other family members due to some reason or other. Lack of attachment with mother and absence of cordial relationship with others depress the child without the related pleasure involved. Also lack of affection from others makes the child self bound and have no emotional exchange with others.
iii) Too much affection or over dependence on a single person, probably the mother, makes the child often unsecured and anxious which give the child detachment from peers.
iv) Failure to have attachments to animate or inanimate objects enhances unnecessary anxiety in new situations.
During late childhood:
During this stage, some problems become a little intense and a few new problems starting as listed below.
i) At this period, the children are considered immature when compared with the age-mates and adults in times of unacceptable emotional expressions such as anger, fear and jealousy.
ii) Lack of mind adjustments with and by the peer group.
Iii) Emotional distress and frustration affect effective learning at school. Many teachers fail to convince and guide properly.
iv) Intense, long duration and recurring emotions affect health.
Duties of the parents:
It is the duty of the parents that the age-wise need based problems of the child are understood and measures taken for solving them by giving due recognition to the individuality. The ambitions of the child should be taken into account for proper treatment. Attachment with love and affection reduce the emotions of the child.
SOCIAL PROBLEMS
Social competence deficits and peer rejection
Many children experience difficulties getting along with peers at some point during their youth. Sometimes these problems are short-lived and for some children the effects of being left out or teased by classmates are transitory. For other children, however, being ignored or rejected by peers may be a lasting problem that has lifelong consequences, such as a dislike for school, poor self-esteem, social withdrawal, and difficulties with adult relationships.
Considerable research has been undertaken to try to understand why some children experience serious and long-lasting difficulties in the area of peer relations. To explore factors leading to peer difficulties, researchers typically employ the sociometric method to identify children who are or are not successful with peers. In this method, children in a classroom or a group are asked to list the children they like most and those whom they like least. Children who receive many positive ("like most") nominations and few negative ("like least") nominations are classified as "popular." Those who receive few positive and few negative nominations are designated "neglected," and those who receive few positive and many negative nominations are classified as "rejected."
Evidence compiled from studies using child interviews, direct observations, and teacher ratings all suggest that popular children exhibit high levels of social competence. They are friendly and cooperative and engage readily in conversation. Peers describe them as helpful, nice, understanding, attractive, and good at games. Popular and socially competent children are able to consider the perspectives of others, can sustain their attention to the play task, and are able to remain self-controlled in situations involving conflict. They are agreeable and have good problem-solving skills. Socially competent children are also sensitive to the nuances of "play etiquette." They enter a group using diplomatic strategies, such as commenting upon the ongoing activity and asking permission to join in. They uphold standards of equity and show good sportsmanship, making them good companions and enjoyable play partners.
Children who have problems making friends, those who are either "neglected" or "rejected" by their peers, often show deficits in social skills. One of the most common reasons for friendship problems is behavior that annoys other children. Children, like adults, do not like behavior that is bossy, self-centered, or disruptive. It is simply not fun to play with someone who does not share or does not follow the rules. Sometimes children who have learning problems or attention problems can have trouble making friends, because they find it hard to understand and follow the rules of games. Children who get angry easily and lose their temper when things do not go their way can also have a hard time getting along with others. Children who are rejected by peers often have difficulties focusing their attention and controlling their behavior. They may show high rates of noncompliance, interference with others, or aggression (teasing or fighting). Peers often describe rejected classmates as disruptive, short-tempered, unattractive, and likely to brag, to start fights, and to get in trouble with the teacher.
Not all aggressive children are rejected by their peers. Children are particularly likely to become rejected if they show a wide range of conduct problems, including disruptive, hyperactive, and disagreeable behaviors in addition to physical aggression. Socially competent children who are aggressive tend to use aggression in a way that is accepted by peers (e.g., fighting back when provoked), whereas the aggressive acts of rejected children include tantrums , verbal insults, cheating, or tattling. In addition, aggressive children are more likely to be rejected if they are hyperactive, immature, and lacking in positive social skills.
Children can also have friendship problems because they are very shy and feel uncomfortable and unsure of themselves around others. Sometimes children are ignored or teased by classmates because there is something "different" about them that sets them apart from other children. When children are shy in the classroom and ignored by children, becoming classified as "neglected," it does not necessarily indicate deficits in social competence. Many neglected children have friendships outside the classroom setting, and their neglected status is simply a reflection of their quiet attitude and low profile in the classroom.
Developmentally, peer neglect is not a very stable classification, and many neglected children develop more confidence as they move into classrooms with more familiar or more compatible peers. However, some shy children are highly anxious socially and uncomfortable around peers in many situations. Shy, passive children who are actively disliked and rejected by classmates often become teased and victimized. These children often do have deficits in core areas of social competence that have a negative impact on their social development. For example, many are emotionally dependent on adults and immature in their social behavior. They may be inattentive, moody, depressed, or emotionally volatile, making it difficult for them to sustain positive play interactions with others.
The long-term consequences of sustained peer rejection can be quite serious. Often, deficits in social competence and peer rejection coincide with other emotional and behavioral problems, including attention deficits, aggression, and depression. The importance of social competence and satisfying social relations is life-long. Studies of adults have revealed that friendship is a critical source of social support that protects against the negative effects of life stress. People with few friends are at elevated risk for depression and anxiety.
Childhood peer rejection predicts a variety of difficulties in later life, including school problems, mental health disorders, and antisocial behavior . In fact, in one study, peer rejection proved to be a more sensitive predictor of later mental health problems than school records, achievement, intelligence quotient (IQ) scores, or teacher ratings.
It appears, then, that positive peer relations play an important role in supporting the process of healthy social and emotional development. Problematic peer relations are associated with both present and future maladjustment of children and warrant serious attention from parents and professionals working with children. When assessing the possible factors contributing to a child's social difficulties and when planning remedial interventions, it is important to understand developmental processes associated with social competence and peer relations.
Developmental changes and social competence
The key markers of social competence listed in the previous section are consistent across the developmental periods of the preschool years, middle childhood, and adolescence. Across these developmental periods, prosocial skills (friendly, cooperative, helpful behaviors) and self-control skills (anger management, negotiation skills, problem-solving skills) are key facets of social competence. In addition, however, developmental changes occur in the structure and quality of peer interactions that affect the complexity of skills contributing to social competence. That is, as children grow, their preferences for play change, and the thinking skills and language skills that provide a foundation for social competence also change. Hence, the kinds of interactions that children have with peers change qualitatively and quantitatively with development.
Preschool
During the preschool years, social competence involves the ability to separate from parents and engage with peers in shared play activities, particularly fantasy play. As preschool children are just learning to coordinate their social behavior, their interactions are often short and marked by frequent squabbles, and friendships are less stable than at later developmental stages. In addition, physical rough-and-tumble play is common, particularly among boys. During the preschool and early grade school years, children are primarily focused on group acceptance and having companions with whom they can play.
School age
By grade school, children begin to develop an interest in sports , structured board games, and group games with complex sets of rules. Being able to understand and follow game rules and being able to handle competition in appropriate ways (e.g., being a good sport) become important skills for social competence. Children play primarily in same-sex groups of friends and expect more stability in their friendships. Loyalty and dependability become important qualities of good friends.
During the middle to late grade school years, children begin to distinguish "regular" friends from "best" friends. The establishment of close, best friendships is an important developmental milestone. That is, in addition to gaining acceptance from a group of peers, one of the hallmarks of social competence is the ability to form and maintain satisfying close friendships.
During the preadolescent and early adolescent years, communication (including sending notes, calling on the phone, and "hanging out") becomes a major focus for peer interactions. Increasingly, social competence involves the willingness and ability to share thoughts and feelings with one another, especially for girls. When adolescent friends squabble, their conflicts typically center on issues such as gossiping, disclosing secrets, or loyalty and perceived betrayal. It is at this stage that friends and romantic partners consistently rival parents as the primary sources of intimacy and social support.
Many of the positive characteristics that promote popularity (such as cooperativeness, friendliness, and consideration for others) also assist children in developing and maintaining friendships. Friendships emerge when children share similar activities and interests and, in addition, when they develop a positive and mutual bond between them. Group acceptance and close friendships follow different timetables and serve different developmental functions, with the need for group acceptance emerging during the early grade school years and filling a need for belonging and the need for close friends emerging in preadolescence to meet newfound needs for affection, alliance, and intimacy outside the family . Key features of close friendships are reciprocity and similarity, mutual intimacy, and social support.
Common problems
Many children who are rejected by peers have lower self-esteem, feel lonelier, and are more dissatisfied with their social situations than are average or popular children. These feelings can cause them to give up and avoid social situations, which can in turn exacerbate their peer problems. Interestingly, not all rejected children feel badly about their social difficulties. Studies have shown that aggressive-rejected children, who tend to blame outside factors for their peer problems, are less likely to express distress than withdrawn-rejected children, who often attribute their problems to themselves.
Assessing social competence
There is an important difference between not being "popular" and having friendship problems. Some children are outgoing and have many friends. Other children are quite content with just a good friend or two. Either one of these friendship patterns is healthy. Distinguishing normal friendship problems from problem peer relations that signal serious deficits in social competence is an important goal of assessment . There are several key signs that a child's peer difficulties may be more serious and long-lasting rather than temporary. First, the nature of the child's social behavior is important. If children behave aggressively with peers, act bossy and domineering, or are disruptive and impulsive at school, they are more likely to have long-lasting peer difficulties than are children who are simply shy. Children who display aggressive or disruptive behavior often have many discouraging experiences at school, including discipline problems and learning difficulties, as well as poor peer relations. School adjustment can be a downhill slide for these children as teachers may get discouraged and peers may be angered by their behaviors. Peers may attempt to "get back" at these children by teasing, which only increases the frustrations and helplessness experienced by aggressive, disruptive children.
Second, children who are actively disliked, teased, or ostracized by peers are at more risk than children who are simply ignored. It is not necessary for a child to be popular in order for that child to gain the advantages of peer support. When children are ignored by peers and are neither disliked nor liked, teachers and parents can take steps to foster friendship development and peer support. When children are actively disliked by peers and the victims of teasing or ostracism, the task is harder for parents and teachers and the likelihood of the child reestablishing positive peer relations without help decreases.
Third, the stability and timing of peer problems should be considered. It is not unusual for children to experience short-term social difficulties when they are moving into new peer situations, such as a new school or a new classroom. Peer problems may also emerge if children are distressed about other changes in their lives, such as a reaction to parental conflict or the birth of a sibling. When peer problems emerge at a time that corresponds to other family or situational changes, they may serve as signals to let parents and teachers know that the child needs extra support at that time. When peer problems have been stable and have existed for a long time, more extensive intervention focused on improving peer relations may be needed.
A variety of methods are available for the assessment of social competence. When choosing a particular assessment strategy, it is important to consider the nature of a particular child's problem. Some children have difficulty with all types of social relationships, while others do well in their neighborhoods or in one-on-one friendships but experience problems with the peer group at school. When problems occur in the school setting, teachers and other school personnel who have opportunities to see children interacting in several peer group situations (such as the classroom, playground, and lunchroom) are often the best first step in assessment. Teachers can often provide information about how children treat and are treated by peers and can also offer opinions about how typical or unusual a child's peer problems are relative to others of the same age. Teacher assessments can include behavioral checklists and rating scales and direct observations of specific social behaviors.
Similarly, parents can provide information about children's social competence. Parents can help to identify problem behaviors such as aggression, withdrawal, and noncompliance that may interfere with social skills. In addition, parents are usually more aware than teachers of their children's social activities outside of school, such as their participation in sports, clubs, or hobbies.
Because they do not have access to the full range of situations in which children interact, however, teachers and parents may not always be the best source of information on children's peer problems. In some cases, it is most helpful to get information directly from peers themselves. One method of obtaining such information is the use of sociometric ratings and nominations. With these procedures, all of the children in a classroom are asked to rate how much they like to play with or spend time with each of their classmates. In addition, they nominate specific peers whom they particularly like or dislike, and they may be asked to identify peers who exhibit particular behavioral characteristics (e.g., nice, aggressive, shy, etc.). The sociometric method, although cumbersome to administer, identifies children who are popular, rejected, and neglected by their peers more accurately than parent or teacher reports and provides useful information about the reasons for peer dislike.
A third approach to assessment of social competence involves children's self-reports. Although input from parents, teachers, and peers can provide valuable insight into children's social behavior and their status within the peer group, information regarding children's thoughts, feelings, and perceptions of their social situations can be obtained only by asking the children themselves. Depending upon the age of the child, information about social competence can be obtained through the use of questionnaires and rating scales that measure children's self-perceptions of their peer relations, the use of stories and hypothetical social situations to elicit information about the child's social reasoning, or simply talking with children to determine their perspectives on their social situations.
Because children may have different experiences in different kinds of peer settings and because no one particular method of assessment is entirely reliable or complete, it is desirable to use a variety of sources when attempting to assess children's social competence. Teacher, parent, peer, and self-reports may yield distinct but complementary information, so by gathering multiple perspectives a more complete picture of a child's social strengths and weaknesses can be obtained.
Interventions to promote social competence
Different strategies may be needed to help children develop social competencies and establish positive peer relations depending on the age of the child and the type of peer problem being experienced. Different children have different needs when it comes to helping them get along better with others and making friends. The age of the child, the kinds of behaviors that are part of the problem, and the reasons for the friendship problem may all affect the helping strategy.
One strategy involves social skill training. Observations have revealed that children who are well liked by peers typically show helpful, courteous, and considerate behavior. The purpose of social skill training is to help unpopular children learn to treat their peers in positive ways. The specific skills taught in different programs vary depending upon the age and type of child involved. Commonly taught skills include helping, sharing, and cooperation. Often children are taught how to enter a group, how to be a good group participant, how to be a fair player (e.g., following rules, taking turns), and how to have a conversation with peers. The skills might also include anger management, negotiation, and conflict resolution skills. Problem-solving skills (e.g., identifying the problem, considering alternative solutions, choosing a solution, and making a plan) are often included in social skill training programs. Sometimes social skill training is done individually with children, but often it is done in a small group. A particular skill concept is discussed, and children may watch a short film or hear a story that illustrates the usefulness of the skill. They then have the opportunity to practice the skill during activities or role-plays with other children in the group. A trained group leader helps guide the children in their use of the skill and provides support and positive feedback to help children become more natural and spontaneous in socially skillful behavior.
Another intervention strategy focuses on helping children who are having trouble getting along with others because of angry, aggressive, or bossy behavior. It can be difficult to suppress aggressive and disruptive behaviors in peer settings for several reasons. For one thing, these behaviors often "work" in the sense that they can be instrumental in achieving desired goals. By complaining loudly, hitting, or otherwise using force or noise, children may be able to get access to a toy they want, or they may be able to get peers to stop doing something obnoxious to them. In this type of situation, an adult's expressed disapproval may suppress the behavior, but the behavior is likely to emerge again in situations where an adult supervisor is not present. Often contracts and point systems are used to suppress aggressive behavior and bossiness; however, positive skill training must be used in conjunction with behavior management in order to provide the child with alternative skills to use in situations requiring negotiations with peers. Often parents are included in programs to help children develop better anger management skills and to help children reduce fighting. Trained counselors, educators, or psychologists work with parents to help them find positive discipline strategies and positive communication skills to promote child anger management and conflict resolution skills.
A third helping strategy focuses on finding a good social "niche" for the child. Large, unstructured peer group settings (such as recess) are particularly difficult situations for many of the children who have peer problems. These children need a structured, smaller peer interaction setting in which an adult's support is available to guide positive peer interaction. Finding a good social niche for some children can be a difficult task, but an important one. Sometimes a teacher can organize cooperative learning groups that help an isolated child make friends in the classroom. Sometimes parents can help by inviting potential friends over to play or by getting their child involved in a social activity outside of school that is rewarding (such as a church group, a sports group, or a scouting club). Providing positive opportunities for friendship development is important, as it provides children with an appropriate and positive learning environment for the development of social competence
