The ''difficult'' child is a behavioural term, which expresses the attitude of adults towards the child's adjustment difficulties to his/her environment on the one hand and the manner in which the child expresses his/her distress on the other. Since frequently what is presented is a symptom, this behaviour encompasses a range of professional diagnoses. We discussed in this chapter the most prevalent diagnoses that come to expression in this way. In order to facilitate understanding, we divided these disorders, but it is important to mention that not only does comorbidity exist among them, but more than half the children suffering from one of them is suffering from an additional psychiatric disorder.

Behaviour disorder is the most prevalent presenting symptom in children referred to outpatient clinics. Prompt diagnosis in these cases is especially crucial due to its preventative aspect. With the tools at our disposal today, we can prevent the development of the disorder in adolescence or adulthood. In other cases we can help the child arrive at a satisfactory integration into his/her immediate environment in order to develop with the maximum utilization of the creative and intellectual potential at his or her disposal. It is necessary to begin this diagnosis as early as infancy, so as to warn the environment regarding the existence of a disorder and help the family arrive at a new equilibrium. This will allow the child to find his or her place in the family dynamic and later in the social environment.

An understanding of the "difficult" child is based on the bio-psychosocial model at all its levels. At the aetiological level, it affords a broad understanding of the syndrome's development, starting from the genetic and up to the environmental-cultural level. At the clinical level, it allows deployment of the clinic. This begins with understanding neurotransmitter levels and the way brain waves function and ends with the impact on the environment of the child's behaviour and his or her interactions with it that reflect on all aspects of life. At the therapeutic level, this model demands combined treatment, which touches a totality of symptomatic characteristics and affords parallel and decisive attention to the child's various difficulties.

We suggest a model based on the integration and interaction between all the various characteristics, both external and internal, of the child's world, in addition to the time-perception component, which is significant in understanding the development rate of this syndrome as well as its recession and situational circumstances. In other words, we suggest a model in which a dynamic syndrome is presented, which is likely to worsen or improve at different times and in different circumstances according to the child's situation. This dynamic model of increased severity or improvement emphasizes both the importance of early preventive therapy, which advances improvement of the syndrome, and its situational nature as reflected in its social and cultural aspects.

The "difficult" child in one situation will be an easy and convenient child in another. Understanding this dynamic imparts to the syndrome the dimension of a trait, as well as emphasizing and strengthening the importance of a total therapeutic approach.

An internal difficulty in the child's normative development can be expressed in deviant behaviour. This behaviour, a temporary external reaction, must be examined in order to help the child, but will not necessarily lead to his or her diagnosis, i.e. to the existence of psychopathology. In conclusion, we suggest here an approach which views the ''difficult'' child as a child who suffers from biological, emotional or social disharmony. This child, under specific and individual stress factors, including temperament, internal and external demands, and interaction with the environment will develop the ''difficult child syndrome''. The syndrome is onion-like, hence it needs a careful and patient evaluation in order to be fully understood.

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