Q.1) I have a 14 years old son. He is intelligent and very affectionate towards us. We were amazed by the way he learnt a great deal in his childhood. However, in the past one year, things have changed drastically. He does not listen to either one of us unless we threaten him with punishment. As a child, he was very active but now, he has lost the drive to learn anything new. He doesn't do anything on his own unless we / teachers force him or accompany him. Please tell me what can we do to improve his behavior?

Ans. Behavioural problems can occur in children of all ages. Some children have serious behavioural problems. The signs of this to look out for are:

If the child continues to behave badly for several months or longer, is repeatedly being disobedient, cheeky and aggressive.

If the child ‘s behaviour has changed such as a fall in marks, physical complaints of headaches, stomach aches for which no cause is found, irritability, oppositional behaviour etc.

A child is more likely to develop an oppositional defiant disorder if they:

Have a difficult temperament;

Have learning or reading difficulties - these make it difficult for them to understand and take part in lessons. It is then easy for them to get bored, feel stupid and misbehave;

Are depressed;
Have been bullied or abused;
Are `hyperactive' - this causes difficulties with self-control, paying attention and following rules.

Parents themselves can sometimes unknowingly make things worse by giving too little attention to good behaviour, always being too quick to criticise, or by being too flexible about the rules and not supervising their children adequately.

Children need to learn that rules are important and that `no' means `no'. It can be tempting for parents to give in `for a quiet life'. The trouble is that this teaches the child to push the limits until they get what they want.

It helps if discipline is fair and consistent ( that means if you say switch off the TV- make sure it is done- maybe give a 5 minute warning in advance), and it is crucial for both parents to agree on how to handle their child. One parent should avoid siding with the child- even if one parent does not agree with the other, avoid disagreeing in front of the child. Later on, discuss how both parents could have dealt with the child and reach a compromise which both parents agree upon and follow. If parents disagree about rules, their children may get mixed up because they don't know whose rules they should be obeying.

All young people need praise and rewards when they improve their behaviour. Remember to praise even the small, everyday things, and let them know that you love and appreciate them.

Be calm
This can be difficult in the heat of the moment, but it does help. Be calm and clear with your commands, for example `please switch off the TV' or `it's bedtime'. Discuss with the child and fix a time for lunch, homework time, dinner, TV , and bedtime. Adhere to this. Give a 5 minute warning in advance. Praise and reward when he follows any of these.

Be clear with your child
For example `please put your toys away' tells children exactly what you expect them to do. DO not just say- “ Be Good”. Keep it short and simple.

Be realistic
It's no good promising a wonderful reward or dreadful punishment if you are not going to see it through. It is much better to offer small rewards rather than punishments.

For example `when you have tidied your room, you can have an ice cream'. Don't expect miracles. If your child has only partly tidied their room, praise them for having started.

The importance of your relationship
When times are difficult, it is easy to forget that you can actually have nice times together. Everybody can end up feeling angry and upset. So you need to plan to have good times together. For example, you could play a game, read or go out for a run with them for 10 minutes every day.

It is worth asking the school about whether they are also worried about your child's behaviour. It is helpful if parents and teachers can work together.
You can seek advice from the school psychologist.

If serious problems continue for more than 3 months, it is worth asking your general practitioner/Psychiatrist for advice.

Q.2) I am 24 years old and in love with a girl, who is a very good friend of mine. We met two years back and have been good friends since then. Recently, I expressed my feelings to her, but after the proposal our relationship is not the same. We continue to be friends, and meet regularly, but things have changed. This is affecting my professional and personal life. Now, I do not feel like going to any social place. I am even ignoring my friends and family members. How do I deal with this situation?

Ans. Sometimes, things do not work out as we would like them to. Because you have expressed your feelings to her, she has become conscious of them and probably you are more tense as well in front of her now. If you feel you can continue to be with her as a friend without getting too upset, then continue to meet her. You will need to be light hearted, tell her you

Said what you felt to her but it is okay if she does not want a boyfriend –girlfriend relationship with you. However, if you are finding it difficult then be clear- tell her that she means a lot to you but you find it difficult to be just friends with her and it may be better to stop meeting. If she does not reciprocate your feelings, there is no point in inflincting pain on yourself by continuing tio meet her. Stop meeting her and slowly you will get on with your life. Take each day one step at a time. Continue to meet your other friends, go out, walk, join a gym. Life is a myriad of things. Sometimes we cannot have it all though.

Q.3) I am a 26 years old girl. I have completed my MBBS but could not secure admission to the post-graduate (PG) course. This failure, I feel has led me into a depressed state of mind. I have become increasingly intolerant towards one & all. I cannot concentrate on my studies and don’t like to talk to people. Please advise.

Ans. When you keep a goal in mind, try to keep Alternatives in mind too. If this does not workl, I can always do that. There are lots of options these days. Do not isolate yourself- talk to friends, family, go out, you must exercise. Make a written plan- write down 2 month, 6 month and 2 year goals. Then start working towards them. Remember to talk to yourself-

Look in the mirror and smile- erase those frowns- tell yourself like you would to someone else- Hey- it’s ok,. It’s not the end of the world. Its been disappointing but life has it’s ups and downs. It may take me a little longer but Ill get there.

If you feel you have been persistently sad, your sleep and appetite is affected, if you have thoughts of dying, do not ignore them- talk to your doctor and get a mild antidepressant like Escitalopram or Fluoxetine which are mild and non addicting and help. It is your health- just as you should not ignore a fever or a pain similarly , you should not ignore sadness which is interfering with your daily activities.

Q.4) I am a 48 year old working woman, married to a man of the same age for the past 23 years. We have two daughters who are 20 and 15 years old. My husband is an increasingly short tempered person. He used to get into quarrels and fights while traveling and otherwise, right from early years of marriage. But for the past ten years he is shouting at home for petty things. He verbally abuses me and my daughters and such a scenario continues for two or more days. Is this a form of psychiatric disorder and is it possible to cure this through medication? If yes, please suggest me how to convince him to go for treatment. I am unable to discuss this with any of my friends and relatives and feel bottled up whenever there is a fight.

Ans. Yes, sometimes a change in behaviour may indicate a Depressive episode or Bipolar disorder. Also stress at work and personality factors may be responsible too. Often it may be a lack of communication or wrong communication which aggravates matters. When he is in a calm frame of mind- talk to him- Use “I” statements- ie. “I feel upset when you shouted at the child over homework yesterday. “ Empathise with him. Appreciate what he does do- “I know you have had a long day. Thanks for remembering to get the groceries as I had asked. That’s thoughtful of you.”

“I know you love the children. They look forward to going out with us. Should we go out and have a dosa?”

“Tell him you are concerned about his health because he has been looking tired lately.” Tell him you care for him and he should get regular medical check ups. Maybe go get a check up done yourself too. Get his BP, routine tests done. If he smokes or drinks, ask the doctor to advise him not to. Ask the doctor to advise him to exercise too.

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