Many, if not most, children can be naughty and will misbehave. There are some children, however, who go beyond naughty.

About six percent of children will show a consistent pattern of breaking rules, being overly aggressive, and generally show disregard or lack of caring for others. Their impaired pattern of disruptive behavior creates problems at home, at school, and possibly even in the community. Psychologists may classify their difficult-to-control behavior as being oppositional and defiant, or as a conduct disorder. The child may end up in the mental health system, special education services in school, and/or in the Juvenile Justice System.

Psychologists know that for a child to develop appropriate self-regulation they have to develop a healthy empathic concern for other people. To show empathy a person will try to understand what another person feels and why they feel that way. This involves the ability to see what’s going on from another person’s point of view.

Being able to understand somebody else’s emotional experience at the time is very important. It may involve wanting to help another person who is having an unfortunate emotional experience, and then to try to make him or her feel better. Empathy is very necessary if a person is going to build strong relationships or simply get along with other people. Healthy relationships do not exist without appropriate empathy.

It is believed that there are at least two types of empathy. Affective empathy involves an emotional response in a person that is triggered by seeing emotions expressed by another person. Cognitive empathy involves the ability to clearly recognize and be able to identify what another person is feeling, to understand his or her perspective, and how that other person thinks about things. Interestingly, each type of empathy involves different parts of the brain.

Some of these unfortunate children start to show problems in childhood, while others begin to show them as they begin to approach adolescence. It is believed that children who do not show these problem behaviors until they are entering adolescence tend to be less aggressive and less likely to develop behavior that could ultimately lead them into the adult court system. It is thought that their rebellious behavior tends to be more in the normal or expected range of adolescent behavior issues. They may be trying to develop a sense of autonomy, a sense of self, and/or a unique identity by rebelling against authority figures, such as their parents.

When the problem behavior starts in early childhood, and the behavioral disturbances begin earlier, that can lead to problems across many stages of life. The problem behaviors will increase in frequency and severity, right on through adolescence. They may also tend to have more impulsive anger and be more aggressive verbally and/or physically. They may have difficult relationships both inside, as well as outside of the family. Regulating their emotions and their behavior can lead to rejection by others, and ultimately problems with self-esteem.

The most difficult category of this type of behavior is called the callous-unemotional type. This unfortunate child shows little concern or distress about the effects of the things they do to others. They tend to be unconcerned about the effect of what they may have done. The problematic behavior will tend to be more severe, stable, and aggressive.

They have significant difficulty benefiting from the type of mental health treatment for typical oppositional or conduct-disordered children. They may not anticipate or benefit from the consequences or punishments for their actions. The child may have no motivation to understand the feelings or perspectives of others, and not be the least concerned by distress expressed by someone else.

lt has been suggested that if the child’s parents are able to provide an environment that is both responsive to the child and warm, that may help. Then the child may find a way to overcome some of his or her temperamental behavior, learn to regulate that behavior, and develop the ability to take the perspective of another person. Appropriate empathy development is important for reducing or inhibiting aggressive behavior. The ability to recognize pain, suffering, and distress in other people is critical for that child to learn to inhibit doing things that would cause negative feelings in others.

The earlier that therapeutic intervention begins with these children, the better. It is important to target the risk factors that lead that child to violate the rights of others and/or violate major social expectations and norms. Therapy should not be a one-size-fits-all approach. Interventions should be tailored to the unique needs of that child.

Parents need to be encouraged to engage in warm appropriate emotional responses to the child. They need to shift, if possible, away from focusing exclusively on punishment for the child’s bad behavior. They need to learn to reward and encourage the good things that the child does. Reward the behaviors that they want to see.

Sometimes that may be asking a lot depending on what the child has done. Even the littlest things can have a big impact. For example, trying to teach a child to remember and recognize facial cues that indicate distress, pain, or sadness may go a long way.

— Dr. Joseph Switras provides clinical psychological services at United Health District in Fairmont to people age 5 and up.