Ask An Expert / Behavior and Conduct Disorders

My 4-year-old with a behavior disorder attends therapy but she can’t compose sentences or express feelings. Am I doing enough for her?

There are some different treatments to consider

Mandi Silverman, PsyD, MBA
Mandi Silverman, PsyD, MBA

Clinical Psychologist, ADHD and Behavior Disorders Center

Child Mind Institute

My daughter is 4 years old. She was diagnosed with a behavioral disorder but not autism. She is currently on Risperdal (1ml/day). She attends speech and psychomotor therapy. Her eye contact has improved a little, but she still can't compose her own sentences. She can tell me what she wants but cannot express feelings. I don't know if what I'm doing is enough. I would like to know what you think. Thank you.

I want to commend you for being so invested in your daughter’s mental health. It sounds like you are working very hard to make sure she is getting comprehensive care. Additionally, you are asking an important question that many parents find themselves asking: Am I doing enough for my child?

It is very common for children with behavior disorders to struggle with skills such as making eye contact and planning and organizing their speech. Likewise, it is not uncommon for children with language delays to have difficulty expressing their emotions with words. Although we take it for granted as adults, expressing one’s emotions with words requires higher order processing, such as recognizing one’s own emotions and saying abstract things such as “I’m upset” or “I’m angry because you won’t listen to me.” This is one of the reasons why some young children resort to expressing themselves with aggression and oppositional behavior rather than their words.

There are a couple kinds of treatment that I think will be helpful for you and your family. Research suggests that parent training is the best treatment for young children with behavior disorders. Given that your daughter is 4 years old, she and your family might be a great fit for Parent-Child Interaction Therapy (PCIT), which is a kind of parent training. PCIT teaches parents specific skills, such as paying positive attention, ignoring negative behaviors, using effective prompts, and implementing an effective discipline strategy using time-outs. The most unique aspect of PCIT is that there is a live coaching component, meaning the therapist is teaching the parent skills while the parent is actually interacting with the child.

Your daughter might also benefit from some basic affective education training (known more simply as education on emotions) to increase her “feelings vocabulary.” I would recommend seeking treatment with a psychologist who specializes in cognitive behavior therapy (CBT) with children. While we know CBT is not as effective with younger children, it could still help teach your daughter emotional awareness and expand her feelings vocabulary. It would be great if the psychologist could collaborate with your daughter’s speech therapist to reinforce skills in that treatment as well. It is important to note, however, that the central component of your daughter’s treatment should be the parent training mentioned above.

If, after implementing these interventions, you find that your daughter’s concerning behaviors and language delays persist, you may want to seek a second opinion regarding your daughter’s diagnosis. A more specialized and comprehensive assessment could yield more thoughtful and individualized treatment recommendations.