Is It a Big Problem or a Little Problem? When to Worry, When Not to Worry, and What to Do

Amy Egan, Amy Freedman, Judi Greenberg, and Sharon Anderson are members of a developmental team consisting of a speech pathologist, occupational therapists, and a special educator/behavior specialists. Based at Ivymount's Center for Outreach in Education (CORE) in Rockville, Maryland, this developmental team consults with schools, childcare centers, teachers and parents in the Washington, DC metro area about children who are experiencing difficulty at school and/or at home. They have served as speakers and facilitators of parent groups and have presented numerous workshops to parents and professionals.

Excerpt 
It’s a nagging feeling. It’s a worry that keeps pushing its way into your brain at night as you lay exhausted in bed, simply wanting sleep. It’s a concern that your thoughts keep turning to during the chitchat of neighborhood moms at your weekly playgroup. It’s something that you hem and haw about bringing up with your pediatrician. You find yourself asking, again and again: Is this a big problem or a little problem? In other words, Should you worry, or should you not?
Problem behaviors come in all shapes and sizes, and at all ages and stages of development. Some are bigger than others, but all cause parents and professionals (and children) some degree of angst and stress. As members of a team of child developmental specialists, and as mothers and a grandmother, we are very familiar with these issues, and have worked with thousands of parents and professionals to help them sort out the challenges faced by young children. Our team is based in Rockville, Maryland, at the Ivymount School’s Center for Outreach and Education (CORE). Our mission is to help teachers and families identify needs and implement strategies for helping young children be more successful at home and at school. The team consists of two occupational therapists, a speech and language therapist, and a behavioral specialist. We provide individualized support, resources, and strategies to help families, teachers, and, most important, children who face big and little problems. This book will do the same for you.
Differences in children’s learning styles, temperaments, and personalities are a given, but when should those differences raise a red flag? What strategies might parents try on their own before getting anyone else involved in the problem-solving process? How much frustration or anxiety should a parent (or child) endure before calling in a specialist? When should a parent seek a professional opinion? And what can a frazzled parent do in the meantime, while waiting for that professional evaluation?
Let’s begin with a list that sums up the most common complaints we hear from parents (and professionals) about young children. These behaviors may represent a “little” problem, easily manageable with a few specific strategies, or they may be the tip of the iceberg of a bigger problem.
10 Common Concerns of Parents About Their Children  1. He doesn’t listen. 2. She’s stubborn and always needs to have things go her way. 3. He’s constantly on the go, in perpetual motion. 4. She has so many tantrums! She’s so emotional! 5. He has a really hard time with changes in routine. 6. Sometimes she gets so wound up! 7. He’s so clumsy and always getting hurt. 8. She can be so mean and aggressive toward other kids. 9. He’s really shy and withdrawn.10. She’s such a picky eater.
These ten statements could describe almost every child, on one day or another, at some point during their early years. However, when one or more of these complaints become the norm for a child, a red flag goes up. If these glitches are pervasive and affect a child’s ability to be happy, relate to others, and go about his daily life, there may be a real problem. Only further investigation will tell us whether it is a “big” problem or a “little” problem.
Most children have little problems. This book is full of strategies to help parents and other caregivers manage the little problems of early childhood. When we use these strategies to adjust the environment, modify behaviors, and give a child time to mature a bit more, little problems can resolve themselves without outside intervention. For the purposes of this book, “little” problems are those that are manageable without outside intervention. “Big” problems, on the other hand, may require the support of professionals. If our strategies and suggestions do not solve the problem, if the problem seems to be bigger than parents and teachers alone can fix, we’ll point you in the right direction for further evaluation and support. Big problems will often seem much more manageable once the proper professionals are involved. A little intervention can go a long way toward keeping a big problem not-so-big!
“There’s nothing out there that describes my child’s issues,” complained an exhausted mother recently. It is a complaint we hear frequently in our work with families of young children as well as from their teachers and child-care providers. Nice neat labels don’t always describe the children we work with. They are regular children in regular schools, preschools, and child-care centers who, for a variety of reasons, are having difficulty being successful at school and/or home. Most teachers don’t know what to do with these kids: they have tried everything in their bag of tricks and come up empty handed, or have come up with a plan that only works part of the time. Some of these children are even on the verge of being kicked out of preschool or child care because of their behavior.
These children may be enigmatic—happy and affectionate one minute, aggressive or stubborn as nails the next; cooperative and eager to please in one setting, but aloof or bossy in another. They appear in virtually every classroom in the country. Aggressive, aimless, class clown, impulsive, rigid, controlling, explosive, anxious, and disorganized are a few of the terms used by parents and teachers to describe such individuals.
These children don’t necessarily have ADD or ADHD but may have language processing problems, or sensory processing differences. They may have difficulty understanding or remembering multistep directions. They may be extremely touch-sensitive and lash out impulsively when others come uninvited, albeit innocently, into their personal space. They may have trouble getting their body to do what their brain is directing, such as with motor-planning problems that interfere with all sorts of activities in a typical child’s day. Children with any of these conditions experience constant frustration and/or assaults on their sense of self-worth. Not surprisingly, frustration and low self-esteem often leads to behavior problems.
Hitting, biting, yelling, or a thirty-minute tantrum over a Popsicle color certainly gets parents’ attention, and they need to know what to do. Having a speech and language evaluation followed by speech and language therapy may address the underlying issues of auditory comprehension, but in the meantime parents need a “Band-Aid”—practical ideas and strategies to help them get through the days, or ideas to give the teacher that might prevent another biting incident this week.
Dealing with the immediate behavior problem is only half of the solution. The underlying cause (if there is one) needs to be identified and treated as well, so that it no longer triggers the problem behavior. This book addresses both of these needs. It takes a long-term and short-term approach to helping children become more successful in their interactions with others and in their classroom and home environment.
The chapters of part 2 delve into specific areas of development, what different or delayed development might look like, underlying causes of behaviors, strategies to support children, and explanations of why these strategies work. Sometimes, however, parents do not know what the underlying problem is—or if one exists—but where a child has trouble is obvious. Certain scenarios, be they birthday parties, playdates with certain friends, or trips to the store, are sure to end in tears or tantrums. For this reason, the chapters of part 3 are organized into typical parts of a child’s life. Unique factors present in different environments trigger behavior problems or stress in a child. By understanding the potential stressors in different parts of a child’s life, we can better prepare him for the challenge and support him throughout the experience with situation-specific strategies. Finally, the appendices provide nitty-gritty reference tools to aid in using the strategies described throughout the book.
One goal of this book is to empower parents: to remind them of their strength and influence in their young child’s development. Using the resources and strategies in this book, parents can help a child experience more success and less frustration as he goes through his day, before ever stepping foot into a clinician’s office.  Copyright © 2007 by Sharon Anderson, Amy Wusterbarth Egan, Amy Freedman, and Judi Greenberg. All rights reserved.