Why does he act this way?

I have been baby-sitting a 9-year-old boy since he was 4.  Recently he has begun to have these very sudden fits which include him telling anyone around that he hates us, we've ruined his life and he wants us out of it, and that if he doesn't get his way that he would rather be dead.  We don't know what to do anymore with him, because we try talking to him, we've tried spanking him, we've tried taking away privilages (i.e  gameboy, tv, nintendo).  Nothing seems to get through to him.  These fits come so suddenly that we have no way of predicting them.  I think that they somehow have something to do with his father, because he travels out of town a lot for business and isn't home as much as he needs to be.  I also think that it has something to do with the fact that whenever his parents fight, they always seem to do so in front of the children.  This hurts all the kids badly; I can see it in their eyes when they come to me looking for help.  I have tried to tell the parents if they're going to fight, at least they could do so behind closed doors, but that doesn't seem to help.  We really have come to a wits end about what to do with the little boy.  Do you think that there could be some metal problem triggering these episodes?  We have tried to send him to a therapist, but his father disagrees with whatever is said.  What do we do now?

[Kevin Kennedy, Ph.D.]

Dear Jill,

There may not be a lot you can do. It's up to the boy's parents to seek help, and it sounds like the help should be for themselves because of the instability their problems are having on the family. There is every indication, particularly in light of the acute onset of this behavior, that the behavior is a reaction to family-related stress. Children do not display such reactions spontaneously - they are responses to unsettledness in their environments.

The boy's behavior does need to be managed in a systematic way, regardless of what is prompting it. Clearly defined expectations are crucial, as is a plan for what will happen if the expectations are met or not met.

From a disciplinary standpoint, a time out plan should be part of the equation. But equally important is positive reinforcemnt for adhering to the expected behaviors.

[DENISE]

This could also be an indication of a learning disability. Does this child have any trouble remembering rules, or playing with friends? How is his school work? Does he ever complain when he has to do homework, or in general? Children give us a lot of subtle clues if we only listen.

I hate to mention this, but it needs to be done. When my cousin was around 13, he started to have erractic behavior such as this. He would all of a sudden stand up in class and say, "F*** you" to the teacher. This is just one example. Everyone thought he must be taking drugs or who knew what. It turned out that he had a brain tumor. They didn't realize it until he collapsed one day and couldn't be awakened. For him it was too late.

I might also suggest that he be checked for seizure activity or tourettes syndrome.