Thinking about a Preschooler with Behavior Problems

Reader’s Question

My four-and-a-half-year-old daughter has been showing signs of behavioral problems. When she’s mad or gets in trouble she will rip her hair out or punch herself in the face or head. Is this normal? She has also been peeing in her underwear for the past couple of weeks. Should I be concerned?

Psychologist’s Reply

Parenting young children requires many skills, one of which is being a good observer. Noticing changes in your child’s behavior shows that you are paying close attention to her needs. When a child’s behavior changes dramatically or quickly, it can sometimes be indicative of some stress in her life. Sometimes the stress can be normal developmental changes and sometimes the stress can be attributed to an environmental change or event. It can be difficult to determine what might be the cause of sudden changes in a child’s behavior. This difficulty is even greater when we take individual differences into account: what may be stressful for one child may not necessarily be stressful for another.

Many preschool-aged children experience intense and sometimes rapidly shifting emotions. These feelings can be difficult for young children to identify and can also be difficult for them to express in words. For children with delays in language development or in other areas, it is not uncommon to see hitting or other physically aggressive behaviors. Nonetheless, anytime a child is in danger of hurting themselves or another child, it is imperative for the parents, caregivers, and teachers to have a plan to manage the aggressive behavior and keep the child safe. It is also important to teach a child different, safer strategies to use (preferably once the child is calm) when the anger or other feelings come again. If aggressive, harmful behaviors continue, it is important for parents to consult with their child’s pediatrician and discuss these concerns. The behavior you describe (ripping hair out, punching in the head) is very destructive and must be interrupted and redirected. Sharing these behaviors and concerns with your pediatrician is an important first step in identifying the root of the behaviors and finding strategies to change them.

Individual differences also influence the course of potty training in children. Potty training a child is not a linear process — it is normal for children who have had consistent success to suddenly regress and have accidents. Sometimes it is related to changes in their environment or triggered by a stressful event. Sometimes there are no identifiable triggers. Although it can feel frustrating for parents, it is important not to shame a child who is experiencing some setback with elimination. It helps if parents don’t make it into a big deal, normalize it as an accident, and return to the positive reinforcers or rewards that helped shape the potty training success before. Given that your child is also exhibiting some very destructive physical behaviors, it is possible that her accidents are related to something else going on with her emotionally. It is also possible that she may have something going on physically (such as an infection). Starting with her pediatrician to help rule out any medical issues is a critical first step.

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Your concern for your child is very valid — she is communicating her distress to you, but she (and you) need some help translating the meaning of these behaviors. Use your keen observation skills to think through and list any recent changes in your child’s environment (home/school/daycare/caregiver). Next, make an appointment with your child’s pediatrician and discuss these concerns openly, along with the detective work you have done.