FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

ENTIRE FAMILY NEEDS COUNSELING TO DEAL WITH "MOODY" SON

Question: I'm concerned that my 9-year-old son may hurt himself or someone else. Though he is an honor-role student, he is in the principal's office two or three times each week because of his uncontrolled anger. He has started hitting me and hitting, kicking and threatening to kill my husband, who is also his stepfather. I don't know what has brought on this change in him. What can I do to help him and to help our family?

Answer: All children go through stages of being defiant and testing limits. What you describe, however, is significantly more that the occasional "test of will" that all children challenge parents with. (As a fellow parent, I must say I've been through enough of these myself!) Fortunately, children rarely attempt or commit murder, but just mentioning this makes the hairs on the back of my neck stand up. It is a serious call for help. 

I can't tell you exactly what is going on with your son's behavior without more information. What I can tell is that he is either suffering from an underlying psychiatric disorder such as depression, or he is emotionally overwhelmed by his perception of the events in his life. Recent changes in friends, sports, school or family are where I'd look for clues about his illness. Obviously, you need the help of a professional to identify the nature of his problem and then determine a proper treatment for it. Your pediatrician or family physician is a good place to start, but I would be surprised if assistance from a child psychiatrist isn't going to be part of the treatment team. 

I wouldn't be surprised if his change in behavior turns out to be the result of depression. I make this educated guess because 30 percent of us have depression some time during our lives. Depression can have symptoms of anger, lack of interest in usual activities, change in appetite (increased or decreased), change in school performance and a change in sleep pattern. Some individuals with depression have a variant known as "bipolar" disorder. Those with this condition have periods when they have symptoms like those I've just described, but these periods alternate with times when they exhibit increased energy, difficulty staying on task and impaired judgment. This bipolar depression is also sometimes called manic depression. Your son could be suffering from this, too. 

Actually, there are a number of conditions that could cause your son to have the set of behaviors you described. He needs professional help as soon as possible, but so does the entire family. His behaviors cause you and your husband to react in a fashion that has not helped resolve the problem. I'm sure that this is also true of his siblings and probably true of his biologic father if he sees him with any regularity. All of you need to learn more effective ways of helping your son deal with the stresses in his life. That is easy to understand but very hard to do. Counseling with the entire family is the best way to get everyone "reading from the same page of the playbook." 

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.