Should My Granddaughter Be Hospitalized for Tantrums?

Reader’s Question

I have an 11-year-old granddaughter who is very bright and talented but has always been fairly “hyper” and prone to temper tantrums. Her mom (my daughter) is divorced from the child’s father, is remarried and has had two more children. Because of her temper tantrums (which seemed to happen more often at home), she was enrolled in a community child guidance program. However, she has exhibited aggressive tendencies there as well. Her mom was happy to have her out of the house because she was getting stressed and because caring for the babies was preventing her from getting sleep. My other daughter and myself have been housing, feeding and transporting this child to school. The State is now intervening because my granddaughter’s mother hit the child and then reported herself. My granddaughter has never had a definitive diagnosis and has been put on a couple of types of meds which didn’t appear to help.

Because she is so young, probably clinically depressed, has been tried on medications, and probably has too many people intervening, I’m wondering if it wouldn’t be best for her to be hospitalized. I’m scared for her future. She is fine with me, but I’m 60 years old, have a full time job and don’t know if I’d be able to permanently house her.

I’m scared for her. Any ideas?

Our Clinical Psychologist’s Reply

There are numerous possible underlying causes for overly aggressive behavior in children. Aggressive behaviors can include hitting, kicking, spitting, biting, shoving, throwing objects, destroying property, or displaying tantrums. The most common causes include:

• limited communication and problem-solving skills (i.e., the child hasn’t learned other, more mature ways to resolve conflicts and get needs met),
• excessive stress and frustration (i.e., the child is using aggression as a channel to vent emotional pain),
• emotional conflicts (e.g., the child feels unloved, abandoned, or is struggling with self-esteem issues),
• over-exposure to violence (i.e., the child is repeating patterns he/she has witnessed or learned),
• temperament (i.e., some children have low tolerance thresholds and are more easily unnerved and prone to anger),
• psychiatric illness (e.g., bipolar disorder, depression, ADHD),
• and even certain medical conditions.

Aggressive behavior in children is sometimes perpetuated or compounded by certain factors in their environments. Behavior tends to be repeated when it has been reinforced. Sometimes, adults inadvertently “reward” temperamental behavior by directing desired positive attention only when the child is acting-up, or by caving in to unrealistic demands. Children also tend to repeat aggressive patterns when they continue to encounter the “stimuli” or situations that provoke the outbursts. What the child witnesses and learns from elders with respect to how to solve problems and get needs met is also important, as is the discipline style of the primary caregivers.

Hospitalizing children for severe disruptive behavior problems is a delicate matter. Generally speaking, children aren’t admitted to inpatient psychiatric treatment programs unless they pose a significant and imminent danger to themselves or others. That said, there are times when hospitalization is the only reasonable way to provide the structure necessary to bring behavior under control; correctly assess and treat any psychiatric, emotional, medical, or other underlying causes; and direct necessary attention to the family and other environmental dynamics contributing to the problem.

Of course it’s impossible to make an accurate judgment of your situation remotely, but there are certainly some red flags for family dysfunction. Your daughter may have become “stressed out” but her stressors are largely the consequences of her own choices (e.g., to enter a relationship with this child’s father, have a child by him, and to enter a new relationship and have two new babies). So, stress or not, she is still the mother of this child and there is a strong likelihood that the child is acting-out the drama of a dysfunctional family dynamic. It is noble for you to be concerned as the grandmother, but you do not bear direct responsibility for this child’s welfare. Naturally, you don’t want your granddaughter to be in an abusive situation, either. But whether it’s through hospitalization or through more interaction with the child guidance program, treatment is not likely to be effective unless the entire family dysfunction is addressed. Working with a professional or team of professionals specializing in comprehensive assessment and treatment of such problems would also seem in this child’s best interest. It’s often a combination of the appropriate therapies — e.g., child guidance counseling, dysfunctional family dynamics counseling, medication, coping skills training, etc. — that makes the difference in turning a troubled child’s life around.