International Journal of Scientific & Engineering Research Volume 2, Issue 8, August-2011 1

ISSN 2229-5518

Children’s behavioral disorders, symptoms, prevalence and its problems with a brief overview of family-based therapeutic intervention

Saeedeh Motamed, Dr.Shohreh Ghorbanshiroudi, Dr.Javad Khalatbari, Mohammad Mojtaba Keikhayfarzaneh

AbstractNo society can claim that it is a healthy one, while it does not have healthy families. Undoubtedly, none of the social damages are free from family influences. Today, behavioral disorders in children and the factors underlying in family and society has attracted the attention of many educational and psychological experts. Hence, in this article, it is tried to initially review the various definitions mentioned in this context and then have an overview of the prevalence and complications of these disorders, and in the end family-based treatment interventions, which can be helpful in reducing child behavioral disorders will be discussed.

Index Termsbehavioral disorders, child, family-based therapeutic intervention, psychology.

—————————— ——————————


AMILY is the most fundamental institution in socia- lizing of children, especially in his/her sensitive early life. Family can prepare the children to identify their
potential abilities under proper conditions and take bene- ficial roles in society as mature people. Children are able to learn do’s and don’ts of parents, imitation and replica- tion in socialization process in family, which are the most important ways in transmission of values, norms, and social traditions. In fact, it is in family that children are learning what is right and what is wrong. Naturally speaking, family has a significant role in shaping the child’s personality and behavior. The ways parents apply in their children’s upbringing are divided into three cate- gories named facilitated, authoritative and democratic or rational authority. In facilitated way, children are allowed to do whatever they like or feel rational by their parents and there is no observation upon their behavior; in au- thoritative way, only parents have right to make an opi- nion, and children are not allowed to make opinions, oth- erwise, they will be punished by their parents; and in a democratic way, children are reasonably supervised by their parents and they are allowed to have a comment in


Department of Psychology, Young Researcher Club, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran. Email: saee-

Department of Psychology, Islamic Azad University, Tonekabon Branch,

Tonekabon, Iran.

Department of Psychology, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran.

Department of Psychology, Young Researcher Club, Zahedan Branch,

Islamic Azad University, Zahedan, Iran.

its appropriate time [1].
High risk behaviors are the ones which put at risk the
health and welfare of adolescents and youths. According-
ly, high risk behaviors are divided into two groups: group
one consists of the behaviors put at risk the individual’s
health whenever outbreaks, and group two includes the
kinds of behaviors that threaten the individual’s health of
the society. Therefore, because of the fact that the risk
rates of adolescents and the youths are higher than other
age periods, there is greater tendency to this type of be-
havior. Of high-risk behaviors that are threatening to oth- ers can be anti-social behaviors such as robbery, aggres-
sion, escaping from school, running away from home, and abnormal behaviors. Of threatening behaviors that can be risky for individual are alcohol, smoking, and un- safe sexual behavior [2].


The attempts to define and review the child behavior problems in school are limited in extensive consideration of children who known diagnostic syndrome are oc- curred. DSM-IV is an example of such an approach. This conceptualization of child behavior problems limits the scientific efforts only to considering dichotomous va- riables named presence or absence of impairment in children. Compared to psychiatric classification, in di- mensional classification, the attentions are paid to the extent that children show special patterns or syndrome.
In this system it is assumed that every child has some
behavioral characteristics [3]. Here, children’s turbulent
behavior is different from so-called normal behavior in terms of quality. Both normal and abnormal behaviors are parts of a continuum, and only judging the size or

IJSER © 2011

International Journal of Scientific & Engineering Research Volume 2, Issue 8, August-2011 2

ISSN 2229-5518

amount of behavior (i.e. too high or too low), which is based on the referee’s degree of tolerance, takes apart the clinic child from school one [3]. Dimensional approach provides the possibility of considering the behaviors that are grouped by the helping of dimensions (or structures) in behavioral problems in children. Considering the fact that dimensional approach does not take a side children due t lack of disorder, it provides a greater understanding of the full range of child behavior. In addition, dimen- sional approach has a more narrative approach than cate- gorical approach and has a better understanding of the commorbidities. Although both systems (dimensional classification system and psychiatric classification sys- tem), dimensional classification systems are based on the classifications derived from experience, and it has been reported that it is more stable than psychiatric classifica- tion systems.
Quay and Peterson (1987) have distinguished six types of dimensions which are related to each other using be- havioral rating scales which have been set through teach- ers and their mothers, the features that children have written in their autobiography and the answers they have given to the questionnaires, including conduct disorder [1], anxiety-withdrawal [2], attention-immaturity prob- lems [3], social aggression [4], psychotic behavior [5] and additional motors [6].
Achenbach and Edelbrock (1997), have also presented
different dimensions of children’s behavioral disorders.
They achieved the two dimensions named ―externaliza- tion‖ and ―internalization‖. Children who have externali- zation types of behavior are aggressive and invasive ones and are close to the types of behaviors described by Quay and Peterson (1987) concerning conduct disorder and social aggressions.
Children who classified as internalizing ones have immature behaviors and are often withdrawal ones. These children’s behavior are similar to those children who described by Quay and Peterson in anxiety, with- drawal, and immaturity.


Behavioral problems syndromes are obtained by grad- ing children through teachers in regular school classes [5]. The reporters of child behavior are typically parents and teachers who grade their observations from child’s beha- vior in a scale and then compare it with that of normal group’s behavior. Of rating scales which is applied in recognizing the dimensional classification systems are Child Behavior Checklist (CBC) [6], Children Behavior Questionnaire (CBQ) [6], Behavioral Dimensions Rating Scale (BDRS) [7], Children’s Patient Symptoms Checklist (PSCL) [8] and Revised Behavioral Problems Checklist (RBPC)[4]. Using additional behavioral checklists for identifying children’s emotional and behavioral disorders have some benefits, including saving assessing time, de- sired validity and reliability, determining the severity of
disorder, and classifying the problems in an easy way [9].


Studies have shown that child rearing quality have much effects in child’s normal development. Also, some factors such as family conflicts and marriage failure, lack of warm relationships with parents, insecure attachment, severe rules and parental psychiatric illness increase the risk of formation of emotional and behavioral problems in children. In addition, Conduct problems increase drug abuse. Conduct problems, drug abuse and anti-social and delinquent behaviors are associated with how children are being reared [10].
Children’s parents who have emotional problems chal-
lenges are not sure of their parent’s roles, and are esti-
mated the child’s rearing so stressful and have conflicts to
one’s spouse relationships.Therefore, the efforts for im- proving children’s mental health needs to address child’s rearing and child-mother relationship quality [11].
Webster – Stratton’s child rearing program, which is
implemented in 10 sessions step by step, in which differ-
ent ways of punishment, encouragement, ordering, child
behavior management are taught in the form of special ways including role playing, has been detected by useful
intervention ways for normal children’s parents and of
children with psychiatric problems [12].
On the other hand, self-esteem and parent’s sufficiency
feeling are studied in children’s behavior management in
some research, and improving self-esteem in increasing mother-child interaction quality has been reported. A high level of self-esteem in a mother is a supportive factor against child’s behavioral problems, which this itself leads to increasing self-esteem, improving social and edu- cational performance, and reducing depression and stress. In contrast, low level of self-esteem, leads to using difficult and annoying methods in child rearing, which this itself leads to the continuation of child’s behavioral problems [13].
Sanders and Wooley (2005), have been studied the re-
lationship between three levels of self-esteem and its ef-
fects on child rearing performance in the two categories named the mothers who referred to clinic and those who
did not referred to it, and considered the first group of mothers as low-level self-esteem ones, and reported the self-esteem as the strong indicator for child-rearing ways [13].
Behavioral family interventions (BFI) are based on so- cial learning model and having experimental support, and is made use in an extensive public. Evidence de- rived from controlled trials has shown BFI of the eva- luated methods in social-psychological interventions. But, only a small population of parents took part in this type of child rearing ways[13].
Sanders and Wooley (2005) have devised multi-faced
child rearing program, which are based on some evi-
dence, for educating parents and supporting them [14].

IJSER © 2011

International Journal of Scientific & Engineering Research Volume 2, Issue 8, August-2011 3

ISSN 2229-5518

This program is developed based upon social learning model and the risk factors related to its social formation, and its aim is to consider the risk factor associated to emotional behavioral problems formation in children. The purpose of this program, named Triple-p, is to increase parent’s adequacy in an extensive level throughout socie- ty. This program has five levels due to existing different levels in functions failure and various needs of the par- ent-child [15]. Evaluating the effects of this educational type as a group caused the impressive reduction of child- ren’s behavioral problems [16]. The necessity of imple- menting such kind of program is felt in our country, and this method is applied for 100 parents for informing them, which indicates the effectiveness in these individu- als [17].
In controlled studies, there are much evidence in favor
of the effectiveness of behavioral family intervention
based on social learning principles for preventing and
treating a wide range of emotional and behavioral prob-
lems in children. Studies done in the last twenty years
have shown that behavioral family intervention is effec- tive in reducing conduct behaviors and other behavioral
problems in children [17-20].
There are many studies concerning the effect of vari-
ous aspects of Triple-p program. This program is imple-
mented by Sanders (2003), and Sanders and Taggart
(2003) in social level. In another study, Sanders et al
(2005) employed an eight session intervention program
with adolescent’s parents, which caused increasing pro-
ductive rearing skills, reducing conflict between parent
and child, increasing parent’s self-esteem, reducing par-
ent’s depression, anxiety, and stress [21]-[22]. This me-
thod is capable of being adapted with cultural criteria within different countries [23]. This program has been
applied for parents of children in certain age groups.
Deam, C., Myors, K., & Evans. E. (2003) taught 74
nurses, social workers, teachers and employees of social
welfares for this program. These individuals should per-
form Trile-P group program at least in two groups of par- ents. 560 cases of parents who had children aged in 2-10
years old are involved in experiment, and almost half of these patients reported that at least one child has beha- vioral problem. The study mentioned reported reducing
children’s behavioral problems, improving parenting scale, reducing in scale scores of the problems associated with improving parenting scale, reducing in scale scores of the problems associated with parent’s problems and improving depression, anxiety and stress [24]. Cann. W., Rogers, H., & Matthews,J.(2003) showed that the group program named Triple-p improves the children’s beha- vior, children rearing ways, the sense of adequacy and reduces depression, anxiety, stress and parents disagree- ment [25]. Ralph, A., & sanders, M.R (2003) showed that group program named Triple-p improves the children’s behavior, children rearing ways, the sense of adequacy and reduces depression, anxiety and psychological stress [26]. Cann, W.,Rogers , H .,& Worely , G .(2003) studied
the provision of these services by telephone in 73 families, and showed that consulting has a positive effect on over- all family and children performance and improved the children’s behavior, child rearing ways, adequacy and capabilities of parents and their compliance, and reduced depression, anxiety and psychological stress [27]. In another study the effects of this intervention on the par- ents of 83 ADHD children were evaluated and improved child behavior, improved sense of adequacy and capabili- ty of the parents, reducing negative child rearing me- thods, conflicts between parents, reduce depression, an- xiety and stress and high satisfaction was reported from the program [28].


Behavioral disorders prevalence among children who are deprived of family is more than those who left orphans due to the effects and factors of natural disasters, or are living in hostelry environments due to parental separa- tion, economic poverty, addiction, or lack of parent’s ap- propriate and correct functioning. Crisante (2003) taught kindergarten staff of long-term care centers, and these individuals consulted 39 subjects aged preschool children ( mean age: three years) based on the three programs named Triple-p level. Based on the findings of this study, the parent’s experiences were more desirable for them, had more confidence and were more agreeable in apply- ing rules [24].
Considering the content expressed in this article, and ba- sic attention to the prevention of mental disorders in children and early diagnosis and treatment of these dis- orders, it is recommended for families and the public to be trained and be aware in identifying and preventing these disorders to positively treat the psychological health of the people, especially children, by the help of psychol- ogists, psychiatrists, expert consultants and occupational therapists.


[1] Setodih H. Social pathology. 12 th ed. Tehran : Avay Noor ; 2004.P.18-23 [2] Shamlo S. Psychological pathology. 8 th ed. Tehran: Roshd;

2004. P. 132-55

[3] Nelson , J . R., Babyak , A., Gonzalez , J., & Benner , G . J . (2003)

. An investigation of the types of problem behaviors exhibited by K – 12 students with emotional or behavioral disorders in public school settings . A vailable on : http : // goliath . ecnext . com / coms2 /

[4] Quay , H.C., & Peterson , D. R . (1987) . Manual for the Revised

Behavior Problem Chechlist . Miami : Ouay & Peterson

[5] Achenbach , T . M ., & Edelbrock (1977) . The classification of child psychopatrhology : A review and analysis of empirical ef- forts . Psychological Bulletin , 85, 1275 – 1301

[6] Kendall , P.C. , (2000) Childhood disorders . UK : Psychology

Press Ltd Zavar

IJSER © 2011

International Journal of Scientific & Engineering Research Volume 2, Issue 8, August-2011 4

ISSN 2229-5518

[7] Sanders , M.R ., Gooley , S ., Nickolson , J. (2000) . Early interven- tion in conduct disorder for children

[8] Sanders , M.R., Markie – Dadds , C., Tully , L.A., & Bor , W .

(2000). The Triple p – positive parenting program: A compari- son of enhanced, standard and self – directive behavioral fami- ly intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology , 68 (2) , 624-640

[9] Harris , J., Tyre , C., & Wilkinson , C. (1993) . Using the Child

Behavior Checklist in ordinary primary schools. British Journal

of Educational Psychology , 63 . 245 – 260

[10] Sanders , M.R.,Ralph , A., Thompson , R .,Sofronoff, K.,& Gardiver, P.(2005) . Every family : A public health approach to promoting children’s willbeing, Brief report. Brinsbane, Australia: University of Qweensland

[11] Sanders, M.R.(2002) Parenting interventions and the prevention

of serious mental health problems in children. MJA,177,7,87-92 [12] Patterson, J.,Mockford,C., & Stewart – brown , S.(2005) . Parent’s

perceptions of the value of the Webster – Stratton parenting pro- gramme: a Qualitative study of a general practice based initiative . Child , Care, Health & Development, 31 , 53 -64

[13] Sanders,M.R.,& Wooly , M.L.(2005) . The relationship between ma- ternal self – efficacy and parenting practices: Implications for parent training . Child, Care , Health & Development, 31,65-73

[14] Morawska , A .,& Sanders, M.R.(2006) . Self – administered behavior- al family intervention for parents of toddlers: Effectiveness and dis- semination . Behavior Research andTherapy, 44,1839 -1848

[15] Turner,K.M.T.,Dadds, C.M.,& Sanders . M.R.(2002) . Facilitator’s

manual for group . Milton Australia : Triple p International

[16] Turner KMT , Sanders MR. Help when it’s needed first : A controlled evaluation of brief , preventive behavioral family intervention in a primary care setting . Behavior Terapy. 2005; 37(2) : 131- 42

[17] Tehranidoost, Mahdi; Alaghbandrad, Javad; Dashti. Behnoosh, Za- hra. Shahrivar (1383). ―Evaluating the effectiveness of constructive training programs in reducing behavioral problems in children‖. Pa- per presented at the International Congress of Psychiatry of children and adolescents

[18] Arnold , D.S., O’Leary , S .G . Wolff , L . S .,& Acker , M.M. (1993) .

The parenting Scale : A measure of dysfunctional parenting in discip- line situations . Psychological Assessment , 5,137 -144

[19] Dadds, M.R.,& powel , M.B.(1991) . The relationship of interparental conflict and global marital adjustment to aggression ,anxiety and immaturity non clinic children .Journal of child psychology , 19.553-


[20] Lovibond , S.H., & Lovibond,P.F.(1995). Manual of the Depression

.Anxiety and stress scales (2nd .ed) . Sydny: psychology Foundation


[21] Sanders, M.R. (2003) The translation of an evidenced-based paren- tiong program into regular clinical services. Australian e – Jurnal of the Advancement of Mental Haelth . 2,3

[22] Mc Taggart , P .,& Sanders , M.R. (2003) . The transition to school procect: Results from the classroom . Australian e – Journal of the Advancement of Mental Health,2,3

[23] Crisante , L.,&Ng, S. (2003) . Implementation and process issues in using Group Triple P with Chinese parents: preliminary findings. Australian e – Jurnal of the Advancement of Mental Haelth . 2,3

[24] Deam ,C.,Myors,K., & Evans . E . (2003) . community – wide imple- mentation of a parenting program : the South East Sydney Positive Parenting Project .Australian e – Journal of the Advancement of Men- tal Health,2,3

[25] Cann. W.,Rogers ,H.,& Matthews,J.(2003). Family intervention service program evaluation : A brief report on initial outcomes for families. Australian e-journal of the Advancement of Mental Health,2,3

[26] Ralph , A.,& sanders , M.R (2003) . preliminary evaluation of the

Group Teen Triple p Program for parents of teenagers making the

transition to high school . Australian e – Jurnal of the Advancement of Mental Haelth . 2,3

[27] Cann, W.,Rogers , H .,& Worely , G .(2003) . Report on a program evaluation of a telephone assisted parenting support service for fami- lies living isolated rural areas. Australian e-Journal of the Advance- ment of Mental Health,2,3

[28] Rogers , H .,Cann,W.,Cameron , D.,& Littlefield , L . (2003) . Evalua- tion of the family Intervention System for children presenting with characteristics associated with Attention Deficit Hyperactivity Dis- order. Australian e – Jurnal of the Advancement of Mental Haelth. 2,3

IJSER © 2011