Behavior problems in children: a family approach to assessment and management

When parents bring a child with a behavior problem to the family physician, he should obtain from them a brief developmental history of the child, a relevant family history, a precise description of the child's behavioral problem and the parents' attempts to solve it. The physician should recognize the different family styles susceptible to maintaining a behavior problem. The physician can help the family anticipate changes in behavior appropriate for the child's age. He can help the parents to agree on what the problem is and how to solve it; to reinforce good behavior by rewarding it; to avoid paying attention to negative behavior and to include the child in discussions about his behavior problem. The physician can also help them to tackle easy problems first so they become confident enough to handle more difficult ones, and advise them to give adolescents responsibility for solving some of their own problems without `bailing them out' if they fail to do so. Sometimes the family physician will have to refer families with complex problems for more intensive or expert guidance. Parents can also be referred to community parenting groups that will help them cope.