Tricks that treat problem children

Identifying children with behavioural problems at an early age is difficult. But new research has found they have traits in common, such as a liking for stories with nasty surprises

Shout "Trick or treat!" at a young child, and the youngster who expects a trick is more likely to have an attention disorder. It's a strange prediction, but one that emerges naturally from new research.

Shout "Trick or treat!" at a young child, and the youngster who expects a trick is more likely to have an attention disorder. It's a strange prediction, but one that emerges naturally from new research.

Dr Claire Hughes and Professor Judy Dunn, from the Institute of Psychiatry, London, wanted to determine if there were any means of predicting whether very young children would have behavioural problems later on. Almost 10 per cent of children worldwide may have ADDH - attention-deficit disorder with hyperactivity. These children are not usually diagnosed until they are six, and as Hughes says, "What we see in clinics is the tip of the iceberg".

The children she and Dunn studied were "hard-to-manage" - restless, inattentive and easily distracted - but their parents were not aware that they might grow up to be problem adults. They made comments such as "He's a real boy", or "He's just like his father" - indeed, parents often like playful and impish three-year-olds. Hughes, however, describes them as difficult, and felt that the three-year-olds' problems were at least as severe as older children who had already been diagnosed with ADDH. "Some of those kids - I thought: 'You're scary now; I don't want to meet you when you're eight!'."

Hughes and Dunn discovered that the biggest difference between normal pre-schoolers and the hard-to-manage ones was their poor "executive function". The children were not terribly good at goal-directed behaviour and strategic planning. That might sound like it needs a business plan, but the kind of tasks the researchers used were rather simpler. The children had to copy a set of actions, such as the researcher's hand movements; or, in a task called the "Tower of London", an adult would balance three balls on three pegs, then move the balls between the pegs in a set sequence. The children had to copy the sequence exactly to show that they knew what the adult was trying to achieve and could follow a series of logical steps to attain the goal.

The children were also tested to see whether they could understand other people's emotions, and if they had a "theory of mind" - the ability to understand another person's thoughts. A typical story to test the children's understanding of someone else's thoughts and emotions involved Mickey, a mischievous mouse, and Pingu the penguin, who likes a cola drink. When Pingu isn't watching, Mickey pours all Pingu's cola out of the can, and replaces it with milk, which Pingu hates. When Pingu turns his attention to the can and drinks from it, how will he feel and why?

In this story, Pingu has a "false belief" about his drink - he thinks there is cola, not milk, in the can and he is going to be pretty unhappy when he tastes it. What the researchers discovered was that the hard-to-manage children were less able to predict another person's emotions or what their thoughts might be, but were better at understanding the story if there was a nasty surprise involved. Pingu was one "person" whose emotions were a little more transparent to the children.

Again, these children were also better at predicting what a person's emotions might be - if Mum went away, or sister broke a toy - when the emotion was a negative one. Previous findings by psychologists showed that young boys with behavioural problems thought their parents and peers felt hostility towards them and were thus more likely to be hostile in return. It is as if these children don't have a straightforward theory of mind. Rather, they have a "theory of nasty minds".

"What we were finding was this same response," says Hughes, "but in a much younger age group."

The children can solve theory-of-mind tasks, but in an anti-social rather than a pro-social way. There also appeared to be a gender difference. More boys than girls were hard to manage, although not by much - 40 per cent of the children the researchers tested were female. However, in further studies, Hughes showed that when girls are good at theory-of-mind tests, they tend to get on well and have warm relationships with their mothers, while boys who are good at considering what others might be thinking tend to be trouble.

This finding is also reflected in studies by Dr Jon Sutton, from the Caledonian University, Glasgow, and Dr John Swettenham, from University College London, whose work indicated that bullies, far from being dim, are actually very good at theory-of-mind tasks. It is precisely because they can understand another person's perspective that they are able to manipulate them emotionally and mentally.

The children Hughes and Dunn tested were from inner-city nurseries, so there could be an environmental effect. Children in happy and affluent families learn that when adults promise surprises, there will be a nice surprise. Potentially, the inner-city children the researchers were testing had experienced exactly the opposite. Hughes says, "It is possible that the 'bias' in hard-to-manage pre-schoolers' understanding of intentions actually provides an accurate reflection of their environment... they're used to people pulling fast ones." But although the data can't distinguish between environmental and genetic factors, she suspects that these children inherently believe that other people are hostile, and do not have behaviour problems, because they are surrounded by adults who give them nasty surprises.

That this barrage of tests - on executive functioning, theory of mind and emotional understanding - can help predict behavioural problems later in life is clear. The children are now six years old. Half of the hard-to-manage ones would be diagnosed in clinics as having ADDH, and a quarter are already being treated.

The key is intervention, as early as possible. Children can be taught to stop and think before they act, and to break down a task into its consecutive steps. Having the "right" friends can also help. Initially, the researchers had thought that difficult children would be ostracised, but instead they discovered that the hard-to-manage kids were going round in little gangs, copying the worst aspects of each other's behaviour. Hughes thinks that difficult children should be encouraged to have friends who are less anti-social.

Friendship is perhaps the ray of light at the end of the tunnel. Further studies have proved that children as young as three can form long-term friendships. By following and filming these children between the ages of three and five, Hughes showed that they played pretend games with one another and, as a result, used more words to express emotions and mental states. Perhaps as a consequence of this the friends were better able to solve theory-of-mind tasks - in a social rather than an anti-social way.

"Parents often think that buying children computer games that teach them things is a good idea," says Hughes. "But social, unstructured, pretend play is better."

If she has one message to offer to parents and teachers, it is the simple one - "Let them play!"