Understanding the Effect of a Split Household on 5-Year-Old Son

Reader’s Question

My son is five. His father and I separated when he was just a month old, and my son has to go back and forth between the two of us. As parents, we don’t get along.

Here is my concern. My son seems easily distracted when I talk to him. He clears his throat a lot and makes a coughing noise. He moves his fingers while talking and opens his eyes really big. He cries very easily and has started hitting himself when he gets frustrated. When I asked him why he hit himself he said he couldn’t think, then told me evil made him do it.

Am I just an overly paranoid mom, or is there something more here? I was wondering about ADHD and autism, but both pediatricians who have seen him said they didn’t want to label him at such a young age. I will feel horrible if this is the result of being a child in a split household.

Psychologist’s Reply

Psychiatric diagnosis is slippery business with adults, and is that much more difficult with children. There are no definitive tests or biological indicators of psychiatric disorders, which leaves clinicians to rely on symptoms, usually as reported by the patient or the patient’s family. For those reasons, I can understand the pediatricians’ reluctance to diagnose, especially given that child psychiatry is not their specialty. However, beyond the issue of official diagnosis, it’s important to identify childhood problems so that they can be addressed effectively.

Based on your description of your son’s worrisome behaviors, other possible explanations include an anxiety disorder, including obsessive-compulsive disorder (OCD). Anxiety can be distracting and cause problems in maintaining attention. Also, children with OCD may have unwanted thoughts that they perceive as “bad” or evil in nature. Similarly, intrusive thoughts can be very frustrating, especially during times when the child is expected to pay attention or carry on a conversation.

Disorders such as autism, ADHD, and OCD result from differences in brain structures and/or neurochemistry, not what has happened to the child. Symptoms may become worse during periods of stress, but stress is not the basic cause. Because of their biological basis, one frequent diagnostic clue is whether there is a family history of a psychiatric disorder. Having family members with a psychiatric disorder is no guarantee another member of the family will have a particular disorder, but it increases the likelihood that the genes came together in just the right way to result in a similar disorder.

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The emphasis on the biological nature of most psychiatric disorders is not to deny that kids react to their environment; they do, and that’s the first place to look for possible causes. However, if there have not been substantial changes in your son’s living arrangements or the relationship between you and his father, it’s less likely that the cause resides there. Many children grow up under worse conditions and do not experience symptoms of a disorder or any substantial problems.

In the end, it’s probably better to be safe rather than regretful. The key is to have your son evaluated by a well-recommended child psychiatrist or psychologist. Ideally, the evaluation will involve having both parents present to establish what life is like with each parent, how your son’s behavior compares in both households, and what the family history is like on both sides. Regardless of whether your son qualifies for a specific diagnosis, getting professional guidance as to how to help him feel more comfortable is worth the effort.