Child Behavior Problems: Symptoms, Causes and Treatment Options

By Jamarri Aikins, Ph.D.
Licensed Clinical Psychologist | Dallas, TX

5 min read
Key Takeaways

  • Severe child behavior often signals a mismatch between environmental demands and a child's psychological processes

  • Distinguishing between typical developmental pushback and clinical disorders is the first step toward effective treatment.

  • Evidence-based treatments like Behavioral Parent Training (BPT) focus on strengthening parent-child attachment and achieving a 5:1 positive-to-negative interaction ratio.

What Are Severe Child Behavior Problems?

Severe behavior involves persistent patterns of defiance, aggression, tantrums, or disruption that significantly impair a child's functioning at home, at school, and in social settings. These behaviors stand out due to their intensity, frequency, duration, and pervasiveness (occurring across multiple settings).

Common examples of severe behaviors in children include:

  • Frequent tantrums and explosive anger

  • Refusal to comply with parental instructions

  • Arguing with adults and authority figures

  • School refusal

  • Hitting, kicking, and biting

  • Breaking toys or other household items

Common examples of severe behaviors in teenagers include:

  • Breaking rules at home, school, or in the community

  • Trouble following instructions

  • Arguing with authority figures

  • Violating curfew and truancy from school

  • Lying and stealing

  • Physical aggression

What Are The Most Common Child Behavior Disorders?

Most children display some level of behavior issues at various times, and there are certain developmental stages where an increase in oppositional behavior is to be expected. Typically, when patterns of behavior impair a child’s ability to function at home or at school, they may reflect the presence of one of the following behavior disorders.

Oppositional Defiant Disorder (ODD): Persistent patterns of angry/irritable moods, argumentativeness, and vindictiveness. Children with ODD often struggle with following instructions and accepting feedback from adults and authority figures. It is estimated that ODD is present in 3 to 5 percent of the child and adolescent population (Polanczyk et al., 2015). Children with ODD often struggle with:

  • Following instructions

  • Losing temper

  • Arguing with adults

  • Difficulty letting things go

  • Blaming others for their behavior

Conduct Disorder (CD): Involves more severe and persistent behaviors that violate the rights of others or major societal norms. Conduct Disorder typically develops in the teenage years and is significantly more common in boys than girls. Current estimates suggest that Conduct Disorder is prevalent in 5 to 10% of the child and adolescent population. Conduct disorder is characterized by:

  • Aggressive behavior

  • Destruction of property

  • Lying

  • Stealing

  • Violation of curfew

  • Refusal to attend school

Disruptive Mood Dysregulation Disorder (DMDD): Characterized by severe, recurrent temper outbursts and a persistently irritable or angry mood that is disproportionate to the situation and inconsistent with developmental expectations. Children with DMDD often experience

  • Chronic frustration

  • Emotional dysregulation

  • Explosive reactions

Attention-Deficit/Hyperactivity Disorder (ADHD): While not purely a behavioral disorder, challenges with impulsivity, hyperactivity, and inattention often exacerbate behavioral outbursts and noncompliance. It is estimated that 10% of the child and adolescent population have ADHD (Danielson, M. L., et al., 2024). ADHD is typically characterized by:

How Are Severe Behavior Problems Diagnosed?

A comprehensive psychological assessment completed by a qualified mental health professional is the first step in diagnosing behavior problems in children and adolescents. This helps distinguish between developmentally expected behavior and clinically distinct symptoms. This evaluation typically involves parent and teacher interviews, review of symptom history, measurement of current symptoms , and a Functional Behavioral Assessment.

What Causes Behavior Problems In Children And Teens?

Problematic child behaviors are caused by a combination of factors including:

  • Developmental and social learning history

  • Child temperamental factors

  • Dysfunctional environmental demands

While many families seek an explanatory diagnosis for their child’s behavior, it can also be helpful to view problems as a result of mismatch between environmental demands and innate psychological processes (e.g., emotion regulation, impulse control, attentional control). This process-based understanding makes it easier to identify the precise treatment that will work best for your child and family. This framework also encourages parents to view problematic behaviors as learned responses stemming from external factors rather than from an internal flaw. Much of treatment success is determined by acceptance of this foundational viewpoint.

When Should I Seek Professional Help?

Warning signs that may indicate a need for professional help include

  1. Persistent behaviors that are resistant to parental intervention

  2. Frequent altercations or conflicts with peers or authority figures,

  3. Intense, explosive, or overwhelming reactivity that is disproportionate to the situations.

  4. Problematic behaviors that impair functioning at home, school, or in the neighborhood.

When a child consistently resists natural parenting attempts, this is often an indication that specialized, professional services may be warranted. A qualified mental health professional can help you determine the root cause of problematic behaviors and available treatment options.

Treatment Options For Severe Behavior Problems

Treating severe behavior problems requires interventions that look distinctly different from those used for anxiety, depression, and trauma. A comprehensive clinical assessment is the crucial first step to determine the level of care and specific intervention needed.

While diagnostic labels can be helpful, they don’t always provide good insight into what treatment approach is best for child behavior problems. A more effective, process-based approach involves identifying core processes in the individual, family, and school environment, pinpointing the functional components of the behavior, and matching interventions specifically to those functions.

When treating externalizing disorders, families should expect to be heavily involved. Effective intervention typically requires a comprehensive approach that targets emotional regulation skills, parent-child interactions, environmental stressors, and consistent behavioral supports across settings. Consistency and fidelity are paramount: it is often better to stick with strategies you can implement consistently than to search endlessly for a "golden" intervention.

Individual Psychotherapy 

Individual sessions allow the child to work one-on-one with a therapist to address emotional regulation and behavioral challenges. Children and teens work to process core patterns of thinking and behaving to identify the root cause of behavioral manifestations. It is particularly effective for children whose externalizing behaviors may be fueled by underlying internalizing issues like anxiety or depression. Individual sessions are most effective when they are paired with family-based interventions to provide a holistic, well-rounded treatment approach. Treatment strategies include:

  • Cognitive-Behavioral Therapy (CBT)

  • Acceptance and Commitment Therapy (ACT)

  • Dialectical Behavior Therapy (DBT).

Behavioral Parent Training (BPT)

BPT is the gold standard for many externalizing behaviors, equipping parents with specific, empirically-supported strategies to manage difficult behaviors while strengthening the parent-child relationship.Training focuses first on strengthening attachment in the parent-child relationship prior to implementing more punitive strategies that can often impair that bond. We help parents work toward achieving a 5:1 ratio of positive interactions to negative interactions in the household, which is often severely strained when a child is struggling. Achieving this involves intentionally increasing positivity and strategically decreasing conflict by choosing to disengage from interactions that have the potential to spiral. A crucial component of BPT is recognizing that a child’s behavior is often a function of modeling and spillover effects. If parents are not appropriately managing their own emotions and behaviors, it is unfair to expect their child or teen to do the same. We work with parents to establish an environment that allows for the child’s innate strengths to flourish. The following treatment programs have been shown to be effective:

  • Parent-Child Interaction Therapy (PCIT)

  • The Incredible Years

  • Positive Parenting Program (Triple P)

  • Defiant Children and Defiant Teens

Systemic and Family-Focused Therapies

For highly complex and severe cases, especially those involving the community and school environments, a systemic approach is necessary. This approach focuses on the systems within the family and seeks to identify those that are healthy and functional, and those that are dysfunctional. Families work with therapists to identify underlying processes contributing to conflict and replace them with more adaptive ways of existing. Multisystemic Therapy (MST) focuses on the systems at play in a child’s life, acknowledging that a child’s behavior is learned and maintained within the home, school, and neighborhood environments. MST works with a team of providers across these systems to help children and teenagers unlearn unhealthy patterns. Functional Family Therapy has also been shown to be effective for reducing problematic behaviors in high-risk adolescents by addressing dysfunctional family dynamics and building on the family's existing strengths.

  • Multisystemic Therapy

  • Functional Family Therapy

Specialized Mentoring Programs

In some cases of behavior problems, mentoring programs (such as Big Brothers Big Sisters) can be an effective approach for exposing teens to more positive influences. Credible Messenger Mentoring pairs teens with individuals they admire who have similar life experiences. This connection allows the teen to be more receptive to advice, recommendations, and treatment, effectively complementing formal therapy.

  • Big Brothers Big Sisters

  • Peer-to-Peer Mentoring

  • Credible Messenger Mentoring

Dr. Jamarri Aikins is a licensed clinical psychologist with over 15 years of experience working with disruptive behavior disorders. He earned his Ph.D. in Clinical Psychology from Louisiana State University and completed his postdoctoral residency at the Kennedy Krieger Institute at the Johns Hopkins University. He is the owner of Atlas Clinical and Performance Psychology in Dallas, TX. He currently accepting patients for in-person and virtual appointments.